How to be a "Super Ager" (it's not your genes)

From peptides and protein, to sleep hygiene and vaccines, what actually helps you age well? Physician Eric Topol breaks down the science — and the myths — of longevity and anti-aging. TED Radio Hour+ listeners now get access to bonus episodes, with more ideas from TED speakers and deeper conversations with Manoush. By signing up for Plus, you directly support our work and public media, so all your episodes (like this one!) come to you without sponsor breaks. Learn more atplus.npr.org/ted http://plus.npr.org/ted. See pcm.adswizz.com https://pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences. NPR Privacy Policy https://www.npr.org/about-npr/179878450/privacy-policy

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Speaker 00

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• 0:16Manoush Zomorodi?

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• 0:47Manoush Zomorodi?

  Ideas worth spreading. From TED and NPR. I'm Manoush Zomorodi. On the show today, a guide to being a superager, living long and well. It's a strange moment for growing old. We live in an era when some seem to be suggesting that aging.

• 1:11Speaker 02

  I'm that crazy guy trying to not die.

• 1:13Manoush Zomorodi?

  Is optional.

• 1:14Speaker 03

  He spends $2 million a year attempting to reverse.

• 1:17Speaker 02

  I think we're entering into a new era where death may no longer be inevitable.

• 1:21Manoush Zomorodi?

  Silicon Valley elite, celebrities and influencers alike race against the clock to limit signs of aging. We are essentially hacking human biology.

• 1:30Speaker 04

  I've had three facelifts.

• 1:31Manoush Zomorodi?

  Everywhere the light touches is Botox. People collect more data about their bodies than ever.

• 1:38Speaker 04

  Having a Fitbit has truly changed my life.

• 1:41Manoush Zomorodi?

  And AI is bringing breakthroughs for conditions once thought to be untreatable.

• 1:46Speaker 05

  AI will help cure diseases. Yes. AI will help cure cancer. Yes. And. It's already in.

• 1:51Manoush Zomorodi?

  But we're also in an age of insurance inequity and uneven distribution of these medical miracles, not to mention billion-dollar industries built on selling you alleged cures to growing and looking older. So it's hard to know what hot trend or medical breakthrough is worth spending your time and money on, and what is, well, bunk?

• 2:17Speaker 06

  It drives me nuts. It's things that we have validation with all kinds of great studies and the highest level peer-reviewed literature to take years before it gets to implementation.

• 2:29Manoush Zomorodi?

  This is Dr. Eric Topol.

• 2:32Speaker 06

  I am a cardiologist, author of Superagers, and I'm a professor and executive vice president at Scripps Research.

• 2:41Manoush Zomorodi?

  Eric is an expert on the best ways to expand not just our lifespan, or how long we actually live, but our health span.

• 2:51Speaker 06

  A lot of this longevity fixation is related to lifespan rather than health span, healthy aging.

• 2:58Manoush Zomorodi?

  Uh huh.

• 2:59Speaker 06

  The average American health span is 64. That's when major diseases creep in, and lifespan is 79 on average. So you've got a big gap of about 15 years.

• 3:12Manoush Zomorodi?

  Oh, wow.

• 3:13Speaker 06

  Where your health span has ended and your lifespan continues.

• 3:16Manoush Zomorodi?

  In some ways, Eric's career has been driven by his own personal obsession with the idea that through science and medicine, we can change our aging destiny.

• 3:27Speaker 06

  I grew up with so many of my family members dying at very young ages, my grandparents and aunts and uncles. I spent a lot of time when I was a kid going to funerals. And, you know, my parents also died at young ages. So I feel, well, I'm condemned, you know, I'm gonna, I'm gonna be signing out any time here. So part of it was just understanding our fate, if you will. Part of it is also to shed some light on a field that's had lots of confusion. And this equivalence of health span with lifespan, which is so different that, you know, we need to really compartmentalize these and understand that what drives them are altogether different.

• 4:08Manoush Zomorodi?

  Long before he made a breakthrough discovery in the science of healthy aging, we'll get to that in a minute, he was a curious college student, sure that people's genes held the answer to how long they would live.

• 4:21Speaker 06

  I always was fascinated by genetics and I basically set up a major in genetics and wrote a thesis in 1975 called "Prospects for Gene Therapy in Man", long before we could sequence genes, of course. That was about 40 years early, I think. But it was more like understanding what makes us tick. And I was working as a respiratory technician, night shift. And I saw, while I was in the intensive care unit, changing the equipment. It was like Lazarus. These patients, I was thinking the next day they wouldn't be there. And then all of a sudden, they would come back to life on their way to full recovery.

• 5:02Speaker 06

  That prompted me to change my plan of going on to be someday a genetics professor of sorts to, oh, maybe I should just be a doctor and change into medicine.

• 5:14Manoush Zomorodi?

  So it's interesting, then, that some of your most recent research is actually saying, genes, we thought you were super important when it comes to aging. Actually, not so much.

• 5:28Speaker 06

  Yeah, that was a real shocker. So many years ago, we started a unique project of finding people who were at least 80 years old, who'd never been sick and on no medications. This is a rarefied group. But the whole idea was, there'd been so little work on the genetics of health span. There'd been a fair amount to look at some genetics of people who were centenarians with extreme lifespan. But that's different from people who'd never had an age-related disease.

• 6:00Manoush Zomorodi?

  Eric and his team called this group of super aging, healthy anomalies over the age of 80, the Welterly.

• 6:08Speaker 06

  It took seven years to find 1,400 participants. And then, once we had them all together, we did whole genome sequencing to look for what was the genomic underpinnings, to see if they were different than the people who are, we call the elderly.

• 6:26Manoush Zomorodi?

  That's elderly, the people, most of us, who typically have at least one major age-related illness by age 65. Eric and the Scripps Research Team looked for the longevity secrets in the DNA of Welterly super agers. And what they found changed everything they thought they knew about how humans age.

• 6:48Speaker 06

  The stunning result was, while there were some small differences, otherwise, there was not much to be able to say this was a genetic story at all. So this was either due to luck, which seems far-fetched to say all these people were so lucky, or something else. And I think the something else is what we've learned so much about in the last couple of years especially, that the immune system of people, when it's intact, really helps to withstand these major age-related diseases. So although that has some connect with our genetics and our DNA, it's also highly influenced by our lifestyle choices

• 7:32Speaker 06

  and our environment and so many other factors.

• 7:36Manoush Zomorodi?

  So we want those last few decades of our lives not to be infirm or lonely or in pain. We want to feel vibrant and part of the world and enjoy ourselves. So you have said that the real opportunity now isn't just helping people live longer, but preventing those big diseases that make aging hard really awful. So the big three, you say, are Alzheimer's, heart disease, and cancer.

• 8:05Speaker 06

  Exactly. So a Welterly or super ager, we would define it now. Is somebody who's reached 80 and older and has never had a significant cardiovascular disease, a cancer, or neurodegenerative disease. So they basically are intact of the big three age-related diseases. And that's not common, but that's what we should be achieving at a much higher frequency.

• 8:30Manoush Zomorodi?

  Eric says there are five domains that help predict risk and prevent age-related diseases. The first he calls Lifestyle Plus.

• 8:40Speaker 06

  So the lifestyle one, we've learned a lot more about, like, for example, sleep regularity being so important and deep sleep when our brain washes out all of its metabolites that are really pro-inflammatory, toxic to our brain. That's why deep sleep is so important. And exercise, not just aerobic, but also strength resistance training and balance training. We've learned also how social engagement is so critical, being out in nature, and, you know, many, many different lifestyle factors, which we didn't realize how important they are.

• 9:15Manoush Zomorodi?

  The next area to focus on in prevention is what Eric calls Olmics.

• 9:20Speaker 06

  Now, Olmics refers to the biologic layers. We're talking about genes, DNA, our so-called polygenic risk score, because these diseases we've been talking about are not from one gene, but from hundreds of different genes that can interact. But also our proteins, there's big breakthroughs in proteins. Now we have these organ clocks where we can tell the pace of each organ in our body from our brain, our immune system, artery, heart, liver, and on and on. And then there's these biomarkers. We have this big, big breakthrough for Alzheimer's to be able to predict even 20 or more years in advance, so-called P tau 217. So.

• 10:04Speaker 06

  Omics are proteins and genes and the microbiome of our gut and the side chains of our DNA called methylation. Those are omics.

• 10:14Manoush Zomorodi?

  Then there's our cellular health.

• 10:16Speaker 06

  This is a big area because we're going to be using cell therapy for lots of things like autoimmune disease. We've seen cures potentially for people with refractory lupus and multiple sclerosis and many autoimmune diseases, which was unfathomable until recent times, using cell therapy, not just take cells out of the body, but working with lymphocytes that are in the body.

• 10:42Manoush Zomorodi?

  Next, to be a super-ager, Eric says we need vaccines and drugs to help treat aging's biggest culprit: inflammation.

• 10:52Speaker 06

  Vaccines and drugs that basically keep our immune system healthy and are potent anti-inflammatories. We've seen a remarkable class of drugs, the Ozempic GLP-1 drugs that have that property.

• 11:06Manoush Zomorodi?

  Finally, to tie all that bio data together, you guessed it, artificial intelligence.

• 11:13Speaker 06

  We couldn't pull all these data together in any individual without multimodal AI. It's billions and billions of data points for each person. We couldn't think of being able to prevent these diseases without the help of the tools of AI for the analytics. So those are the five domains. They're all going to be part of our ability to predict a person's risk and prevent their age-related disease in the future.

• 11:43Manoush Zomorodi?

  So can you explain how inflammation relates to that? Because I think a lot of us have been hearing that word. Women's magazines for years, eat a low inflammatory diet, blueberries and almonds, and we think, okay, yes, I will do that. But what exactly is inflammation?

• 11:59Speaker 06

  Yeah, so when our immune system, which is all of our cells and proteins that fight off not just infections, but keep us from getting cancer and heart disease and neurodegenerative diseases, our immune system starts to lose its integrity as we get older. And it's a process of immunosenescence. And then interdependent with that is inflammaging. Okay, so it's inflammation with aging. And so when the immune system is dysregulated, when it's just getting off the rails. It starts to go haywire and makes a lot of these proteins that are basically untoward inflammation, whether it's in the brain or throughout the body,

• 12:44Speaker 06

  in the walls of arteries. And this is what causes so much trouble. So some inflammation is good and important for healing. But inflammaging is really accelerating and making these age-related diseases take hold.

• 13:02Manoush Zomorodi?

  When we come back, Dr. Eric Topol explains why AI has changed the way he thinks about preventive care and how our modern medical advances could give us all a shot at being super agers. You're listening to the TED Radio Hour from NPR. I'm Manoush Zamirodi. We'll be right back.

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• 14:58Manoush Zomorodi?

  It's the TED Radio Hour from NPR. I'm Manoush Zomorodi. Today on the show, how to become a superager. When Dr. Eric Topol studied the DNA of healthy people over 80 years old, so-called "superagers," he expected to see something in their genes that was protecting them from major age-related diseases. Instead, he found that genes had a pretty minimal effect. It was lifestyle choices and preventive measures that extended their health span. Because, of course, a long life is great, but not if you're miserable and suffering.

• 15:37Speaker 06

  We can accept that we're going to age, okay? So maybe there'll be reversal of aging someday, but that's a little more far-fetched. But we don't have to accept that we are going to have these age-related big three diseases: heart disease and cancer or neurodegenerative diseases. And so that's where the opportunity lies, that there's so much going on right now that with 20 years' advance warning of these conditions in individuals, determining that risk, predicting it, we should be able to get ahead of it and make a big dent in these big three age-related diseases.

• 16:17Manoush Zomorodi?

  So does that mean that essentially, as you age, keeping your immune system in good shape is the whole game?

• 16:25Speaker 06

  That's a real big part of it. What we eat is a part of that story, how we exercise, how we sleep, how we have social engagement, a long list of lifestyle-plus factors. But also, we've only learned in recent times that there are other ways to keep that immune system intact. And one of the big surprises was, for example, the shingles vaccine. We didn't know. And now with four huge natural experiments in four different countries around the world, in Wales, in Canada, Australia, and the US, we've learned that the shingles vaccine reduces Alzheimer's and dementia by at least 20 to 25%.

• 17:08Manoush Zomorodi?

  Oh, wow.

• 17:09Speaker 06

  And it isn't because it's working against the virus herpes zoster so much as it's keeping the immune system intact. Because people that get the vaccine are older people. In the US, it's age 50. In other countries, it's even older. But that's just one new trick we've learned. And now, you know, that's a segue to many other tactics we'll use in the future to keep people's immune system intact.

• 17:38Manoush Zomorodi?

  So I recently got my first shingles shot, and it certainly was not touted to me as preventive medicine for anything other than getting shingles, which I'm told is very painful and just awful. Why is this not more public knowledge? That there is more information out there about the added benefits of vaccines and other preventive medicines?

• 18:03Speaker 06

  This is so startling. If this was a drug to reduce Alzheimer's disease, it would be a blockbuster. Everyone would know about it because the pharma companies would be all over it. But because it's a vaccine and we live in an anti-vax movement, and this wasn't expected, this was a surprise. It's not just been replicated, but now four different, what we call, natural experiments, which are better than even randomized trials in many respects. So I don't think the word is out there. I've been trying to help get it out, but there hasn't been enough work to disseminate these very important findings. And it isn't just going to be this vaccine. We're going to have lots of other ways to improve the immune system.

• 18:48Speaker 06

  So for example, very recently, we learned about the importance of the thymus gland. And the thymus gland, which is...

• 18:55Manoush Zomorodi?

  I don't even remember what that is.

• 18:57Speaker 06

  Yeah, right. The medical world has forgotten its existence.

• 19:01Manoush Zomorodi?

  As well.

• 19:02Speaker 06

  Yeah, because your thymus gland is pretty big and functional when you're a child. But as you become a teenager and to adulthood, it was thought that it becomes just fatty tissue and a-functional.

• 19:14Manoush Zomorodi?

  Wait, where is it and what does it do?

• 19:16Speaker 06

  Well, it's under the sternum and the chest bone. But what we've learned, I mean, this was amazing. So researchers at Harvard, Hugo Ertz and his colleagues, they used AI to define the thymus, quantify its health in adults, you know, average age in their late 50s and 25,000 plus people who were followed many, many years from a chest CT scan. They could quantify the thymus health. And the people who had good thymus health, that it wasn't just fatty tissue and wasn't a functional. They had incredibly improved survival, the lack of cancer, they had lack of cardiovascular disease.

• 19:58Speaker 06

  They had all the benefits that we saw of super agers, right? So this is another remarkable discovery that reinforces how our immune system, which of course connects with inflammation, how that is so fundamental to healthy aging. This, to me, is a landmark series of reports. It also showed through a separate paper that if you're going to get cancer treatment, if you have a healthy thymus as an adult, your chance of recovery or lack of remission is much, much higher. And here again, we thought the thymus gland was doing nothing in adults and it's doing a lot in some people.

• 20:38Manoush Zomorodi?

  So now I'm thinking, of course, tell me how to protect my thymus, something that did not occur to me to ask until this very moment.

• 20:45Speaker 06

  Great question. There's lots of things being considered about how we could keep our thymus healthy. But the things we talked about that work on our immune system in general, exercise, a diet that's anti-inflammatory, good sleep, health. These things probably do help keep our thymus in a healthy state. But we need to do more than that. So there are various new studies in recent times that certain growth factors, one's called FGF21. And there's this incredible Mexican salamander that has the ability to keep their thymus and regenerate even after you surgically remove it. We're learning about the pathways from that organism.

• 21:30Speaker 06

  But we don't know enough about thymus health now that there's been this really remarkable discovery about its importance as we get older.

• 21:42Manoush Zomorodi?

  Well, I'm going to take this opportunity, Dr. Topol, to ask you about technology and mammograms. So every woman is told they should start getting mammograms. I believe it's after the age of 40. And recently I went and they said, do you want to spend an extra $40 to get an AI screen? And I was like, OK, sure. I don't really know what that is. They said it will find things more carefully. Here's the $40. Did I make the right decision?

• 22:11Speaker 06

  Well, I'd say yes and no. Firstly, I don't believe they should charge patients to get the AI read. But that read does give a higher detection rate, about 30% more breast cancers are picked up from the AI as compared to the radiologist. So that part's good information. But what really unnerves me is there are other two types of AI tools that should be incorporated as well, again, without charging patients. And that is the AI of the normal mammogram to detect the risk in the next three to five years. And then also the AI of the breast artery calcification,

• 22:54Speaker 06

  because that quantifies the risk of heart disease in that person. So we are not using AI as we should. We shouldn't be charging patients. And we're only using the first of the three different types of AI to get the superhuman interpretation of the mammogram.

• 23:12Manoush Zomorodi?

  Hmm. I mean, my experience just makes me think, wow, AI is arriving in healthcare as an upsell before most of us even understand what it's capable of, what it does. So set the scene for us. What is the current moment that we are in when it comes to technology and healthcare? And where are we going?

• 23:31Speaker 06

  Right, well, the medical imaging is the most advanced part of medical AI, because it's been incubating and progressing for several years now. And so now, for most medical images, whether it's an X-ray, a mammogram, CAT scan, PET scans, whatever type of scan, and also things like the retina, the cardiogram, pathology slides, we now have very strong evidence that AI can interpret the image better than expert physicians, which is a big step forward for AI. So it enhances the accuracy. It doesn't mean that it shouldn't be reviewed by physicians,

• 24:14Speaker 06

  but it sees things that we can't see, superhuman eyes, if you will. And so the problem is, Manoush, we haven't leveraged that at all. And the only thing that, you know, barely we're getting at are things like just a piece of the mammogram and not having that appropriately embedded as part of the procedure rather than putting a burden on patients for cost. And we're not doing it for most of the things that we know it has remarkable capabilities for accuracy. So this is the area that has come along the most. But of course, it's been worked on for several years.

• 24:55Manoush Zomorodi?

  Dr. Eric Topol explains AI's potential from the TED State.

• 25:01Speaker 06

  The thing that we don't talk much about are diagnostic medical errors. And according to the National Academy of Medicine, almost all of us will experience at least one in our lifetime. We know from a recent Johns Hopkins study that these errors have led to 800,000 Americans dead or seriously disabled each year. So this is a big problem. The question is, can AI help us? This is a picture of the retina. This was the first major hint, training 100,000 images with supervised learning. Could the machine see things that people couldn't see?

• 25:44Speaker 06

  And so the question was to the retinal experts, is this from a man or a woman? And the chance of getting it accurate was 50%.

• 25:55Speaker 06

  But the AI got it right 97%. The ability for computer vision to pick up things that human eyes can't see is quite remarkable. Here's the retina, picking up the control of diabetes and blood pressure, kidney disease, liver and gallbladder disease, the heart calcium score, which you would normally get through a scan of the heart, Alzheimer's disease before any clinical symptoms have been manifest, predicting heart attacks and strokes, hyperlipidemia, seven years before any symptoms of Parkinson's disease to pick that up.

• 26:38Speaker 06

  In the future, we'll be taking pictures of our retina as checkups. This is the gateway to almost every system in the body. Now, as a cardiologist, I love to read cardiograms. I've been doing it for over 30 years. But I couldn't see these things.

• 26:57Manoush Zomorodi?

  In your talk that you gave, this was in 2023, you explained the potential of retinal scans. This is a photograph of the back of your eye that apparently tells AI not just about your eye health, but your risk of all kinds of things. Is that happening now? How is a picture of your eye showing us whether we might be at risk for kidney disease or Parkinson's or a heart attack even?

• 27:22Speaker 06

  Yes, what a great question because, again, we should be doing this. The retina is probably the richest image there is from our body. Because it's a gateway to firstly, not just the brain, but to every part of our body. Surprisingly, you know, things like the kidney, the liver, even things we never would have forecasted, but especially, you know, telling us about risk for Alzheimer's and Parkinson's and many other conditions, heart disease, risk of stroke.

• 27:54Manoush Zomorodi?

  Wow.

• 27:55Speaker 06

  So it turns out that's one area, not in the United States, but in Hong Kong and in Asia, where they have started companies to provide that data from a retina picture.

• 28:09Speaker 06

  So it isn't available here. Again, we're behind, but we're seeing now the output. So there's companies that are giving you your retina picture that you get from your eye doctor and telling you your risk of heart disease based on that. And also one that's giving risk of Alzheimer's disease. So it isn't here yet, but eventually it should be the norm. This is what we call opportunistic imaging, where there's so much in that image that we're leaving on the table.

• 28:41Manoush Zomorodi?

  Hmm.

• 28:42Speaker 06

  And AI can give us so much more, and it's just software. It's not any extra cost. So eventually we'll get there. You know, a kid that eventually will take selfies of our own retina and have an AI algorithm give us an output of like every part of our body, every condition that we might be at risk for, if you want to get that information. But we're not there yet because right now we still rely on the kind of high quality retina images that you get from an eye doctor.

• 29:14Manoush Zomorodi?

  Do you have hope that there can be this transition from playing whack-a-mole with disease in terms of how we treat people and becoming more of a preventative, a more sort of resilient older population?

• 29:30Speaker 06

  Yes, this is where I have the most excitement for the future of medicine and in particular, the use of AI. I think in the years ahead, we will regard AI's most important contribution as facilitating prevention. Prevention especially of these three age-related diseases that we've been talking about because they are eighty, eighty-five percent of the difference between health span and lifespan. So we are at a time when 20 years ahead or more, we can tell a person, let's say they're age 50, not only are they at high risk for one of these diseases, but we can also tell

• 30:13Speaker 06

  them for the first time when, not just if. Then we can do all these things so that we changed what would be their natural history. And I am confident eventually we're going to have ways to prevent these big three age-related diseases. And that's why, you know, we're starting very soon, the first prevention of Alzheimer's trial. In 1,200 people with very high risk of Alzheimer's because of their APOE4 genetics, their protein markers, PTOW 217, their family history, their polygenic risk. And we're going to test, for the first time in this large-scale study, the lifestyle factors.

• 30:53Speaker 06

  The exercise, the sleep, the diet, and the stress in a coached group, intensive coaching, versus a group that just gets some educational material. And then after that, we'll start looking at different drug candidates on top of lifestyle, assuming that we show and validate that that makes a difference in these markers, like the brain aging clock and the PTOW 217, which are really reliable ways to project the arc of a person's Alzheimer's risk. So, we're in a new day.

• 31:27Manoush Zomorodi?

  What will the coached people get? I'm curious.

• 31:30Speaker 06

  Oh, yeah, yeah. So they get 24/7 virtual and human coaching. Basically, for all lifestyle factors, they're going to get continuous aggressive coaching with human backup for questions and encouragement. And we're able to dissect how much of the benefit, assuming there is, is related to exercise. How much of it's due to sleep? And on and on. These all be quantified.

• 31:55Manoush Zomorodi?

  And for each individual.

• 31:56Speaker 06

  Exactly.

• 31:56Manoush Zomorodi?

  So, like, I might be a person who doesn't need quite as much sleep, but I definitely need to move regularly because of my genetic profile and because of my habits, or something like that.

• 32:09Speaker 06

  Right. And, you know, one thing that's really important that I think you've touched on, when we tell the whole world, "This is what you should be doing," it doesn't really get a lot of uptake and respect. But when we talk to an individual and we define precisely what their risk is and when it might show up, the chance of them making some changes in their lifestyle, which we know has impact, is much, much greater. Everything has to work at the individual level. Population-level messages just don't have that kind of impact.

• 32:43Manoush Zomorodi?

  In a minute, Dr. Eric Topol on how America's healthcare system can make it tough to age well and the health trends he thinks are total nonsense.

• 32:53Speaker 06

  You've got the same people who wouldn't take a vaccine, which has randomized trials, tens of thousands of people with overwhelming benefit to risk ratio. And there's the same people that would inject an experimental peptide in their blood.

• 33:09Manoush Zomorodi?

  I'm Manoush Zamirodi, and you're listening to the TED Radio Hour from NPR. Protein maxers and peptide curious? Stay with us.

• 33:30Speaker 00

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• 34:37Manoush Zomorodi?

  Before we get back to the show, have you checked out the NPR app recently? From live radio and digital stories to videos and podcasts, the NPR app has everything you love about NPR in one place. It's the TED Radio Hour from NPR. I'm Manoush Zamirodi. On the show today, we're talking to Dr. Eric Topol about what it takes to be a superager in an era of make America healthy again, healthfluencers, and billion-dollar anti-aging industries.

• 35:17Speaker 02

  So I take around 30 pills for breakfast and around 20 pills for lunch. I first started doing the cold plunge, I was freezing. But now, my body feels so good. Yeah, so my son gave me a liter of plasma. I gave my dad a liter of plasma.

• 35:31Manoush Zomorodi?

  We are in this sort of strange cultural moment where longevity has become sort of a status symbol, right? Like, can you spend money on supplements and do cold plunges? And people are biohacking and getting the plasma infusions of young relatives. People have clearly gotten the message of prevention, but where is the line between real longevity science and the pseudoscience? Because I think for some people, it all sounds highly scientific, or maybe there's not quite the proof, but what does it hurt?

• 36:07Speaker 06

  Right. Well, you know, we have a moment where the medical community's word and judgment is being challenged every day. And the idea that there's these influencers who, they have the secrets, they know, right? They have big impact. So, like, example, cold plunge, right? This is remarkable. I mean, I'm a cardiologist, and I would consider a cold plunge a stress test, much more than a treadmill. Because if you get in a cold plunge, you are getting a big jump in blood pressure, you're constricting all your blood vessels, your heart rate is jacked up, and if- If you're gonna have a heart attack, you could find out in the midst of a cold plunge or soon thereafter.

• 36:52Speaker 06

  I would never suggest people who might have risk for heart disease to have that. And there's no real data to show benefit.

• 36:59Manoush Zomorodi?

  But it makes you feel alive, Eric.

• 37:01Speaker 06

  Yeah, yeah, you know, it's gonna give you more brown fat. I mean, help me. I mean, this is just too much. So every one of these things, the peptide craze, the protein craze, all these things are unsubstantiated and potentially dangerous.

• 37:16Manoush Zomorodi?

  That's the question I have. Peptides and protein?

• 37:19Speaker 07

  If you're aging faster than you want, you want the Glow Stack. So it's a stack of peptides which enhance cellular turnover.

• 37:27Manoush Zomorodi?

  My Instagram feed is gonna be filled with them that I just said those two words out loud.

• 37:30Speaker 04

  Protein popcorn, protein cookies, protein Pop-Tarts, like candy.

• 37:34Manoush Zomorodi?

  What is the deal? Well, protein builds muscle, I suppose, but peptides has become, I don't even know what they truly are. Can you talk us through both of those?

• 37:42Speaker 06

  Yeah, so the protein thing, just to take that quickly, there are advocates like Peter Attia to take much higher than recommended protein daily consumption. For example, one gram per pound, which is about three times what the recommended allowance is. And you could make a case that maybe you should increase from what the recommended allowance is. But that level of protein, people don't know that we can't store any protein in our body. So it just goes right out. Second, if you're taking all this extra protein, it doesn't come without other calories. You know, we have an obesity and overweight epidemic. And why would you want to take unnecessary extra calories? Next, there's the cost

• 38:27Speaker 06

  of all these protein powders and bars and all that. And then finally, the thing that most people aren't aware, that extra protein, especially if it's coming from animal sources, that is a problem. Red meat, for example, that is pro-inflammatory. We don't want that. So this is dangerous and also unsubstantiated. There are no data to support this protein craze.

• 38:52Manoush Zomorodi?

  Is this just the latest version of the keto diet?

• 38:54Speaker 06

  Yeah, I mean, the keto diets, that has some utility in certain rare examples, like to manage epilepsy, potentially certain cancer treatments. But overall, the keto diet faded because it has risks that were not adequately taken into account. Protein, I think, is gonna slide down eventually when people get it. Peptides. Now peptides.

• 39:19Speaker 02

  One five seven. It just makes you feel fricking good. Like you wake up, no pain, no aches.

• 39:24Speaker 06

  This thing teaches your body to just burn more calories. Theoretically, you could change nothing about your diet or your exercise and still lose weight. You know, this is really interesting, Manoush, because I reviewed all the data, which there basically are no data for the peptides.

• 39:39Manoush Zomorodi?

  Interesting.

• 39:39Speaker 06

  This is just, you know, a couple of amino acids strung together. And there are many of them that are in wide scale use, like BPC one fifty seven. You know, I made up one called BS two oh two five. That's really what they are, right? They have no data. They mostly come from China. You don't even know what you're getting. When they've sent them to independent labs, sometimes they're not even the peptide that they say they are. Sometimes, basically, there's nothing there, or sometimes they're contaminated. They aren't necessarily sterile. People are injecting these into their bloodstream. So these have no track record, except in some animal studies.

• 40:21Speaker 06

  There are no good human studies that show placebo controlled. These are very expensive, usually two hundred and fifty to three hundred dollars. Often they're taken in stacks or multiple.

• 40:33Manoush Zomorodi?

  Yeah. What's your stack, Eric? Isn't that what people say?

• 40:35Speaker 06

  Yeah, what's your stack? It's incredible. This is just completely out of control. We even have the HHS secretary, RFK Junior, who is a big advocate of these peptides and is trying to take them off from being banned from compounding facilities throughout the country.

• 40:52Speaker 07

  So like supplements are not regulated by FDA. Peptides are not supposed to be regulated. The Biden administration improperly moved them to category three without any evidence. The only justification they have is if there's a safety concern and there was no science that indicated a safety concern. So it was improper. We have now remediated.

• 41:12Speaker 06

  That by moving them back. So this is a mess. People should know there are dangers. You don't have the ability to send them to independent labs before you inject. When you get them, they say on the bottles or the syringes, for research use.

• 41:29Manoush Zomorodi?

  Oh, wow, wow, wow.

• 41:30Speaker 06

  Yeah.

• 41:31Manoush Zomorodi?

  I, I, I have a lot of empathy for people who think, why not give it a try? Like, there's no sort of cohesion when it comes to medical guidance, certainly in the United States. We have the government changing the food pyramid. There's real distrust, and for good reason. Some of the Maha community, some things that they're suggesting are very dangerous. Other things like better nutrition, I think you'd agree with, right?

• 41:59Speaker 06

  Yeah, I know. It's really troubling because we used to have this notion that all the things that are recommended for population health should have evidence to back them up. And now we are willing to see things supported with zero evidence, and worse than that, potential real harm. And so it's very troubling, and it goes along the continuum of the anti-science, anti-vax. And what's so paradoxical here is you've got the same people who wouldn't take a vaccine, which has, you know, randomized trials, tens of thousands of people with overwhelming benefit to risk ratio. And there's the same people that would inject an experimental

• 42:44Speaker 06

  peptide in their blood. So none of it makes sense, really.

• 42:50Manoush Zomorodi?

  So what do you suggest to people? Because there is this feeling that, you know, I can do everything right. I can get the right amount of sleep. I can eat good food. I can get exercise, but I'm still breathing in microplastics or drinking forever chemicals. How do you empower individuals to feel that they can protect their health, especially the fact that, you know, a lot of these things require health insurance?

• 43:17Speaker 06

  Right.

• 43:17Manoush Zomorodi?

  We have a broken system.

• 43:19Speaker 06

  Yeah, we have a big problem here because we don't have the kind of universal healthcare that every other high-income country does have. So that our fragmented setup is very poorly positioned to integrate these new things. And not only we have the barriers that have been entrenched for many decades, but we also have now the people that are running the public health agencies that are going against evidence. So it's a troubling time. Still, everyone has agency to, as you say, do their best with their lifestyle factors. In terms of air quality, particularly indoors, there's things you can do.

• 44:00Speaker 06

  There's reducing the plastic burden intake, keeping an eye on the things that are in your home regarding forever chemicals. It's not enough, Manoush, but yeah, it's difficult. And this is not a good time, but hopefully it's just a transient one, and that will get back on track eventually.

• 44:20Manoush Zomorodi?

  So if I go to see my doctor, what should I ask them? Because I feel like it hasn't really changed all that much in the last 20 years. What do you think people should be asking for?

• 44:31Speaker 06

  Well, you're already ahead of the curve on the Shingrix vaccine, right?

• 44:35Manoush Zomorodi?

  Oh, good, yes.

• 44:36Speaker 06

  And that tells me you're over 50.

• 44:38Manoush Zomorodi?

  Yes.

• 44:39Speaker 06

  That's the good age to really get ahead of what you could be seeing when you're 70-plus, because that's how long these diseases take to incubate.

• 44:47Manoush Zomorodi?

  Mm-hmm.

• 44:48Speaker 06

  And of course, they start even before age 50. So the question is about heart disease. From that mammogram, why didn't you get the breast artery calcification defined to see if you're at high risk?

• 45:00Manoush Zomorodi?

  I didn't know about it.

• 45:02Speaker 06

  Why hasn't your doctor given you a polygenic risk score for heart disease and all the common cancers and Alzheimer's disease?

• 45:10Manoush Zomorodi?

  Can I ask for that now?

• 45:11Speaker 06

  Yeah, and why don't you have an APOE four to know if you're at risk for Alzheimer's? It used to be, Manoush, that you wouldn't want to know because nothing you could do. That couldn't be further from the truth now because we know lifestyle has a big impact on at least deferring my years, the onset of mild cognitive impairment, no less Alzheimer's. So this idea of the Cassandra, you know, I don't want to know, we're past that stuff.

• 45:37Manoush Zomorodi?

  So even if it doesn't run in my family, do you think it's worth asking for those tests?

• 45:41Speaker 06

  Well, yeah, the polygenic risk score, that set, basically, it looks at every common disease, all the different cancers, atrial fibrillation, heart disease, and I think you know, women, their biggest killer is heart disease, and a lot of them don't know it. And when you think about your parents, just because it doesn't run in your mother or your father's lineage, the point is you're getting this combination of genes. You could have a very different type of risk when you have this combination of genomic variants. So that's why polygenic risk scores are independently useful in determining the risk of a person not discernible from their family history.

• 46:24Manoush Zomorodi?

  Have you run the numbers on yourself, like, given everything you know, what sort of habits are you integrating into your life? What sort of medications, if I may ask? How are you trying to live as long and well as possible?

• 46:39Speaker 06

  Yeah, that's a very important question because you practice what you preach, right?

• 46:44Manoush Zomorodi?

  Yeah.

• 46:44Speaker 06

  So doing all the research for super agers changed my position. I always was an advocate for aerobics, and I had not done hardly any resistance training or balance training. And now I'm onto that several times a week. So that was a big change. The second big change for me was I had very chaotic sleep habits of staying up very late. And now that's a big thing. I've taken my deep sleep from various things, particularly regularity, up from a terrible number. It's in the right direction. I wish it was even better. In addition to all that, because my polygenic risk Risk score tells me I'm at high risk for heart disease, even though it never was in either parent.

• 47:27Speaker 06

  I was taking a statin, but then I developed terrible muscle cramps. So I want to keep my LDL very low. And so I'd done that with the injectable drug Repatha that I take. And the polygenic risk score should be routine. I don't know why the medical community doesn't adopt it universally. But that helps to at least know about the risk. And of course, there are other ways, as I mentioned, that we will know. And it's especially in women, postmenopausal women. We've got to know that person is got heart disease risk because there's so much we can do about that.

• 48:06Manoush Zomorodi?

  Yeah, I feel like for women over 50, there's suddenly this new attention being paid on perimenopause, menopause, whether or not hormones are a good thing. There's certainly a lot of money being made on that. I read everything that's out there and I still don't know what to do. I feel like this abundance of information can make people a little crazy.

• 48:28Speaker 06

  Right, right. Yeah, I think if you stick to the evidence and not just opinions, you know, there's evidence-based and then there's eminence-based. Stick to the former, you'll be okay. But you're only going to get that from the highest level of peer-reviewed journals and people who are committed to presenting the evidence in a forthright way.

• 48:53Manoush Zomorodi?

  I mean, this is what happens when information goes everywhere. Part of us wants to just be told what to do. We want there to be easy to understand rules, guidelines that we can follow without having to overthink it. Some of us get a little weird if we have too many data points. But I think what you're saying is we are heading into an era of personalized medicine that is extraordinary and we need to do a better job to embrace it.

• 49:21Speaker 06

  Absolutely, particularly this field of longevity and healthy aging. It's a bit like the dis- and misinformation that we saw throughout the COVID pandemic. We gotta get this right because there's so much opportunity here to promote healthy aging that a lot of people are not really aware of. And if we do get on track with this and people do get the right word, it can make a world of difference in their healthy aged lives. Just lifestyle alone has been shown, if you start age 50 and you attend to all the things that we know, you can get seven to 10 years more of healthy aging. And people don't even know that.

• 50:01Speaker 06

  So there's so much we can get out there that's really high quality information that should help people.

• 50:07Manoush Zomorodi?

  Right, and I think that was my biggest takeaway from your book, that it's really never too late to start changing your aging destiny. We actually here at NPR partnered with Columbia University Medical School to do a clinical trial on the health benefits of incorporating short movement breaks into our days. We had 20,000 people sign up. I actually ended up writing a book about it that's coming out soon. And what we found was that older people actually had different challenges in terms of changing their lifestyle. You know, they're not stuck at a desk all day anymore. They're actually more active during the day. But these long periods of the evenings from say 5:00 PM to 11:00 PM, they would sit.

• 50:51Manoush Zomorodi?

  But when they took these movement breaks, it not only helped them sleep better, improved their mood, and you know, it improved their glucose levels. Overall, they just felt healthier and it felt like a small thing they could do. You know, little changes can make a big difference.

• 51:08Speaker 06

  Absolutely. You can be stronger than ever in your life when you're in your 70s and 80s. You can have the highest level of fitness and all sorts of other great things can come. I mean, you might have been a bad sleeper and of course, as we age, our sleep liability increases. But you can counter that with so many different things in your daily life. So you're absolutely right. This is critical. People, just because they're older, shouldn't be thinking it's too late. In fact, there's great opportunities to promote healthy aging at all ages.

• 51:41Manoush Zomorodi?

  That was Dr. Eric Topol. He's the author of Superagers: An Evidence-Based Approach to Longevity. You can hear his full talk at ted.com. And what a great reminder that technology is changing treatments fast, but don't believe everything you hear about quick medical fixes. Thank you so much for listening to our episode about being a superager. This episode was produced by Phoebe Lett. It was edited by Sanaa Meshkhanpour and me. Our production staff at NPR also includes James Delahoussaye, Katie Monteleone, Fiona Giran, Matthew Cloutier, Hersha Nahada, and Rachel Faulkner White. Our executive producer is Irene Noguchi.

• 52:24Manoush Zomorodi?

  Our audio engineer was Jimmy Keely. Our theme music was written by Ramtin Arablouei. Our partners at TED are Chris Anderson, Helen Walters, Roxane Hylash, and Daniela Bello Rezo. I'm Manoush Zamirodi, and you've been listening to the TED Radio Hour from NPR.

• 52:48Speaker 00

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