What is a “super-ager”? Cardiologist Eric Topol breaks down the science of living longer, healthier lives.
Cardiologist Eric Topol discusses his article, “What Super Agers Can Teach Us About Longevity and Health Span,” and his book, “Super Agers: An Evidence-Based Approach to Longevity.”
- Exceptional health in older adults isn’t primarily genetic but linked to lifestyle.
- Health span, not just lifespan, is the key to a long and healthy life.
- Prioritize exercise (including strength training), quality sleep, and an anti-inflammatory diet.
- Be wary of unproven supplements and expensive diagnostic tests.
- Preventing disease through lifestyle is the most evidence-based approach.
What exactly separates “lifespan” from “health span”? Lifespan refers to the total number of years a person lives, regardless of their health status. Health span, on the other hand, represents the years lived in optimal health, free from significant age-related diseases like cardiovascular conditions, neurodegenerative disorders, and cancer.
Cardiologist and author Eric Topol dives into this crucial distinction, drawing from his extensive research and his new book, “Super Agers: An Evidence-Based Approach to Longevity.” He highlights the surprising findings from his “Wellderly” study, which analyzed the genomes of over a thousand adults aged 80 and above who remained remarkably healthy. The study revealed that their good health wasn’t mainly due to protective genes. Instead, it was strongly associated with lifestyle choices such as maintaining a leaner physique, engaging in regular exercise, and nurturing robust social connections.
This contrasts sharply with the approximately 60% of U.S. adults who experience at least one chronic disease. Topol argues that our societal goal should shift from merely living longer to living longer in good health. He clarifies that there are two main pathways to achieving this: slowing the aging process itself or, more practically, delaying the onset of chronic illnesses. Topol makes a compelling case that focusing on prevention and delaying disease is the most scientifically supported strategy for maximizing our health span.
The Genetic Myth of Super-Aging
Topol’s journey to understanding longevity took a significant turn with the “Wellderly” study. This ambitious seven-year project aimed to identify and sequence the genomes of 1,400 individuals who had never suffered from chronic diseases and were not on any medications. The findings were eye-opening. When compared to the general elderly population (where 95% have a chronic disease by age 65), there were no substantial genomic differences detected between the Wellderly and their less healthy peers.
“This is not a genomic story,” Topol explained. He shared the example of one of his patients, Lee Rual, who, at 98, had siblings and parents who died in their fifties and sixties. This pattern was common among the Wellderly – often outliving healthier relatives. Topol believes this points to the immune system’s critical role. A resilient and intact immune system as we age appears to be essential for maintaining health span, suggesting it’s more about how our bodies function than just the genetic blueprint.
This finding surprised him. “The dogma maybe, is that our health span would be indexed to our DNA,” he admitted. However, the research also strongly supports the impact of lifestyle, showing that adopting healthy habits by age 50 can add seven to ten years of healthy aging. The earlier and more consistently these habits are maintained, the greater the extension in health span.
Rethinking Lifestyle: Exercise, Sleep, and Diet
The insights from the Wellderly study have influenced Topol’s approach to patient care. He now emphasizes the importance of both aerobic and strength training. Previously, he’d steered patients away from resistance training, favoring cardio. Now, he advocates for incorporating exercises that build muscle mass, especially for those over 60, and highlights the value of balance training.
Sleep hygiene is another area of focus. Topol probes patients about their sleep patterns, inquiring about daytime sleepiness and nighttime disruptions. He stresses the importance of regular sleep schedules for managing anxiety, stress, and depression, all of which impact physical health. The regularity, more than just the duration, is key.
Regarding diet, Topol debunks the current “protein craze,” calling the advice to consume massive amounts of protein “bro science.” He stresses that while protein needs might slightly increase with age, excessive intake, particularly of animal protein, can promote inflammation and atherosclerosis. He champions a Mediterranean or Mediterranean-like diet, rich in vegetables, fruits, and plant-based proteins, which studies show is associated with better health span. He singles out ultra-processed foods as particularly detrimental, constituting a significant portion of the American diet and actively promoting inflammation.
Navigating Longevity Advice: Beware of Hype
Topol warns against the proliferation of pseudoscience and marketing in the longevity space. He notes that some influencers promote expensive interventions like plasmapheresis and hyperbaric chambers without robust evidence. He also cautions against the unregulated supplement industry, citing examples like AG1, where company-funded studies lack independent validation and real-world health outcome data.
“If you are selling or hawking supplements or if you have companies that are promoting longevity, then this is a real conflict regarding trying to be objective,” he stated. Consumers should be skeptical of physician influencers who profit from the products they endorse.
Similarly, Topol expresses concern about the push for total-body MRIs. He argues that there’s no data to support their widespread use for screening healthy individuals, often leading to incidental findings that cause anxiety and unnecessary procedures. Instead, he advocates for targeted screening based on individual risk factors, including genetic predispositions and emerging AI-driven predictive tools. For example, AI can now identify women at high risk for breast cancer from normal mammograms or predict Parkinson’s or Alzheimer’s disease years in advance from retinal scans. These advancements offer a more precise approach to early detection and prevention.
The Future of Healthy Aging
Topol remains optimistic about the future of medicine, particularly in preventing major age-related diseases. By integrating data from genes, proteins, and medical imaging, we can identify individuals at high risk and implement targeted surveillance and prevention strategies. This proactive approach, combined with advancements in areas like GLP-1 drugs and anti-inflammatory therapies, promises a new era of personalized health.
“We do have a tremendous amount of control over healthy aging,” Topol emphasized. Focusing on lifestyle factors—diet, exercise, sleep, and social engagement—bolsters our immune system and combats inflammaging. He reminds us that these beneficial practices don’t need to be expensive. “When it starts to cost a lot of money, that should be a red flag.”
The ultimate goal, he concludes, is to shift from a population where most older adults have chronic diseases to one where a significant portion are “super-agers”—individuals who reach 85 and beyond free from major age-related illnesses. It’s an ambitious, yet achievable, vision for the future of health.
