The Excerpt
SPECIAL | Dr. Eric Topol shares a new vision for living longer and better
Thu, 08 May 2025
What if the second half of life could be just as healthy, active, and fulfilling as the first? Drawing on the latest science, world-renowned cardiologist and researcher Dr. Eric Topol challenges outdated ideas about aging and reveals how factors like exercise, sleep, social connection and cutting-edge AI tools can help us extend not just our lifespan—but our healthspan. Dr. Topol joins The Excerpt to share insights from his new book "Super Agers: An Evidence-Based Approach to Longevity."Episode Transcript available hereSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.
Chapter 1: What is the new vision for aging presented by Dr. Topol?
Hello, and welcome to The Excerpt. I'm Dana Taylor. Today is Thursday, May 8, 2025, and this is a special episode of The Excerpt. In an era where aging is often framed as something to resist or reverse, Dr. Eric Topol offers a far more empowering vision. What if the second half of our lives could be just as vibrant and healthy as the first? In his latest book, Super Agers,
An evidence-based approach to longevity, the renowned cardiologist, researcher, and author lays out a bold, data-driven roadmap to extending not just how long we live, but how well we live. In addition to years of research, Dr. Topol has also been recognized by Time as one of the 100 most influential people leading change in the medical community. Dr. Topol, thank you for joining me.
Great to be with you, Dana.
Chapter 2: What is the difference between healthspan and lifespan?
In the book, you discuss the concept of healthspan versus lifespan. What's the difference and which one should people focus on to improve longevity?
Well, we don't really want to live to 110. and be demented or have all sorts of other chronic diseases. But on the other hand, if we could live well into our 90s and have no chronic diseases, the big three, age-related ones, cancer, cardiovascular, and neurodegenerative, that would be the goal. So I think most everyone would agree that healthspan overrides lifespan or longevity.
You argue that genes play a surprisingly limited role in healthy aging despite decades of genomic research. What was the most surprising thing you learned from your study?
Chapter 3: How do genes influence healthy aging?
So some years ago, we did a study we called the Welderly, and we enrolled 1,400 people, average age of almost 87, who had never had a chronic illness. an age-related disease. And we thought the whole genome sequencing was going to demystify everything. But as it turned out, we found very little. And so really the emphasis that has been put on our genes for healthy aging is misplaced.
It's a small component, but there are many other factors, especially what I call lifestyle plus factors that appear to play the dominant role.
Well, you mentioned the profound impact of physical, regular physical activity on health span. Can you elaborate on the types of exercises that are most beneficial?
Chapter 4: What types of exercises are best for longevity?
Well, as a cardiologist, I would always advocate aerobic exercise. Yeah, like, you know, certainly walking and bicycling, treadmill, swimming, that sort of thing. But what has been really extraordinary in recent years is the data that supports
strength or resistance training, as well as balance training, things like posture, but especially getting stronger as we get older because our muscle mass is decreasing. And to counter that, to prevent frailty, to promote healthy aging, resistance training, which is advocated at least three times a week, is something that's really quite important.
In an age of vosempic and personalized medicine, how do you see the balance between behavioral changes and pharmaceutical solutions in promoting public health?
Chapter 5: How do behavioral changes compare to pharmaceutical solutions for public health?
It's a great question, Dana, because the GLP-1 drugs like Ozempic caught us by surprise because, as I wrote in the book, for 20 years they were around for diabetes, but the people taking these medications with diabetes didn't have much weight loss, so we were misled.
And now we're seeing not just the marked effects on weight loss, but also on many other conditions, even some not related to weight loss at all. But the overriding thing is the lifestyle factors, the exercise, the types of nutrition and diet, and that does include our body weight, and also, of course, sleep.
But then the lifestyle factors extend to things like social isolation, time in nature, exposure to environmental toxins like small particulate air pollution, microplastics, forever chemicals, and the list goes on. But we have an admixture where lifestyle factors are the most important.
But now we have a drug class that came out of nowhere in recent years that is probably the most momentous drug class due to its reduction of inflammation. And of course, it's now being tested in Alzheimer's in people who are not even overweight.
As you mentioned, sleep is super important in maintaining health. Can you explain the role of the glymphatic system in sleep and its impact on brain health?
Yeah, so the glymphatics, not lymphatics, are the drainage system for our brain, which gets activated during deep sleep, the slow wave type of sleep. And that deep sleep is so essential. Unfortunately, as we get older, it gets decreased in amount of time. It tends to come in the earlier phases of sleep. Interestingly, not, you think deep that it would be late in the night, but it's not the case.
And we want to maximize that because that's the best way we get our brains refreshed and get rid of the stuff that's in our brain through the glymphatic system, which is relatively recent discovery that there's this elaborate system for basically pumping out these things toxins from our brain that accumulate each day.
So sleep health is far more important to prevent these age-related diseases than we'd ever really recognized before.
You emphasize the role of AI in building personalized health forecasts. What do you think is the greatest opportunity and the greatest risk of integrating AI into preventative medicine?
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Chapter 6: What role does sleep play in brain health?
put a person under surveillance for that concern, that disease, and get all over it and prevent it. Something we've never been able to do in the history of medicine.
I want to dig into environmental toxins because it's a significant concern in super agers. What are some common environmental exposures that people should be aware of and how can they minimize their risk?
So this is something that's basically chasing our tails. We have all these new capabilities for promoting healthy aging and healthy longevity. But on the other hand, we're seeing increased exposure to air pollution, which is difficult to counter except for having air filtration in your home and being attentive to air quality.
Then the next, of course, is the problem with microplastics that are getting to every part of our body and especially our heart arteries and our brain and implicated in conditions like heart attacks, strokes, and higher risk of dementia. So how do we get rid of plastics? That's hard. We can certainly reduce the intake of things that are in plastics.
Don't microwave things that are in plastic containers. Don't use plastic any way we can avoid it. And that, of course, also applies to forever chemicals that are pervasive in so many things where we unfortunately, Dana, don't have
the national priority like they do in some parts of Europe and other parts of the world to reduce the toll of these major environmental risks that are unfortunately mitigating the progress that we're making. So we can do some things at the individual and family level, but we also need things to occur at the national level.
You explore the potential of personalized nutrition using AI in the book. How can AI revolutionize our approach to diet and nutrition for better outcomes?
So we don't know yet whether that will take hold, but it's a really intriguing prospect. And the point is we each metabolize the food that we eat, the things that we drink totally differently. So if you and I had the exact same food, the amount, the exact same timing, one of us would have potentially a glucose spike and the other one would have no increase in glucose at all.
And the same would be with other things like lipids. So the point being is that if we can understand what is the uniqueness of each of us, And we can do that starting now with sensors and other ways, like our gut microbiome, which turns out to be very important.
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Chapter 7: How can AI enhance personalized health forecasts?
Given your emphasis on evidence-based approaches to aging, how do you assess the credibility of the Blue Zones concept? And what lesson should we take away from this controversy when identifying models for healthy aging?
Yeah, I'm so glad you asked about that because now we have to consider the blue zones as a real myth. The more it's been looked into very carefully, the absence of evidence for the healthy aging longevity in these zones of the world has never been confirmed.
poor records and inability to confirm the data about these people that were thought to be these special, exceptional, healthy agers is a real problem. There's no question that we, as I present in the book, 98-year-old people who are completely healthy, never had an age-related chronic disease, But there doesn't appear to be any zone in the world that is special.
There may be a cluster of people here and there, like in Okinawa or Italy, as was presented in Blue Zones. But it's been hyped up, unfortunately, to the nth degree, and it just lacks the substantial evidence to support it.
Looking ahead, Super Agers discusses future possibilities for altering the aging process. What are some of the most exciting technological advancements on the horizon that could change how we age?
What excites me and what I think is very different is from this science of aging, That is, we have all these clocks now we didn't have before. And so the near term, one of those things we just talked about may click eventually, but none of them are there yet. And it may take years before any are shown to be safe and effective.
But on the other hand, we can now predict a person's arc of age-related diseases now, unlike ever before, and it's just going to keep getting better. And that's why I think the science of aging brings us today to a lot of exciting potential.
Because if we can suppress the three age-related big diseases, the big killers, that's accomplishing a huge amount that doesn't necessitate one of these elegant approaches to reverse aging. Instead of reversing aging, it's preventing the age-related diseases.
Dr. Eric Topol's new book, Super Agers, is on bookshelves now. Eric, thank you for joining me on the excerpt.
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