How To Live Longer and Better: The Secret to Super Ageing with Dr Eric Topol #626

23:53Dr Eric Topol:So I don't think that it's intriguing that some people, if they get down to a low-carb diet, it's very healthy for them. Some people, a high keto, ketogenic diet can be helpful. So there is no one diet that's right for all people. And in fact, that's really the cornerstone of medicine is we have all these population guidelines, but we don't take in consideration that each of us are unique and may not apply to what we come up with for all people. The all people thing just doesn't exist.

24:29Dr. Rangan Chatterjee:Exactly, the research tells us what the average is and none of us is average, right? We're all unique. And I've had some patients who seem to, A, on the subjects of red meat, there's a difference, I think, between unprocessed red meat and processed red meat. And then I found some patients seem to do really well with some red meat in their diet, whereas others don't seem to as well. And I wonder, as AI gets more involved with medicine, and as we understand our own personal genome more and more, I wonder if we'll get to a point in the near future where we can be trying out different diets, and then you can basically look at the biomarkers, the important biomarkers, and go, is this working, right?

25:19Dr. Rangan Chatterjee:Because ultimately, there are certain biomarkers that we know we would like in a certain range. We would like the HbA1c, our average blood sugar. We know roughly where we want it. I think there's some research showing that even an HbA1c above 5.2 will start to increase your all-cause mortality, even though you're not diagnosed with pre-diabetes until 5.7 in the US and 6.0 here in the UK. So it's kind of interesting to me that we could get to a point where saying, look, the population shows us the Mediterranean diet is great. That's a great starting point. And now, you try out a few things, and let's keep checking your biomarkers and see on which diets are you thriving the best and your biomarkers are in the best range.

26:11Dr. Rangan Chatterjee:That seems like a reasonable approach going forward to me. Yes, I agree.

26:16Dr Eric Topol:And in fact, in the book, I talked about how, for example, just a glucose sensor for a month could help people find certain foods that cause big spikes of their glucose or prolonged spikes. Whether that should be recommended isn't clear. But if what we've learned is that if you are having big and long spikes of glucose to certain foods, that does increase your risk if you are pre-diabetic, as you mentioned, Rangan, that is your somewhat elevated hemoglobin A1C or fasting glucose, every year a few percent of those people move on to type 2 diabetes, and we don't want that to happen. So for people with prediabetes, we can do some of that today to find out the particular food, the types of foods that get them into a, if you will, a very high glucose and prolonged zone, which we want to avoid.

27:18Dr Eric Topol:But that's just the first stab at this. As you say, we need to know more. There's a lot of, it's complicated. That is, you know, it's not just glucose. It's lipids. It's your gut microbiome. It's the order of when you eat. It's the, there's so many factors, how much you exercise. And there's interactions with what you eat and your sleep quality and your stress. You know, so this is, of course, that's a perfect example of where multimodal AI that looks at all these layers of data can give a person guidance. You know, it's meaningful. We're not there yet. But that's what we need to practice is to understand all these different layers of data, how they interact.

28:04Dr. Rangan Chatterjee:What are some of the things you learned about yourself when you popped on one of these CGMs, these continuous glucose monitors?

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30:01Dr. Rangan Chatterjee:What are some of the things you learned about yourself when you popped on one of these CGMs, these continuous glucose monitors?

30:09Dr Eric Topol:Yeah, I was sobering because, you know, some of my guilty pleasures would be like tortilla chips. And oh, my gosh, you know, I had a big spike with that. So I got to cut down on that. You know, I've got grandkids who love pizza, as you can imagine. And trying to have a slice of pizza, oh, no. You know, that's a real problem. So I learned certain foods that, you know, they're really,

30:37Dr Eric Topol:I don't really wanna look at the spikes, you know, better not to have a glucose sensor on. But I, you know, I think for me, you know, other people I know can eat the same foods and they're totally flat. They don't have any, you know, jump in their glutes.

30:52Dr. Rangan Chatterjee:So it is a very individual response. It's interesting because I think you finding out that tortilla chips and a slice of pizza massively elevates your blood sugar. In many ways, that's the, although blood glucose, you know, is not everything. It's clearly an important metric when we're looking at short-term and long-term health. In many ways, you could say that is a beautiful demonstration of personalization, because you have found, for you, Eric, you have discovered that if you eat tortilla chips and or a slice of pizza, your sugar shoots up. So with that information now, you're empowered to go, well, what am I going to do with that?

31:35Dr. Rangan Chatterjee:Maybe now instead of having it, and I don't mean you're doing this, but if someone was having that three to four times a week, they might go, you know what? Maybe I'll just have it once a fortnight now rather than regularly. It's very empowering, I think, when you on an individual level can see the difference something makes. let's think about protein through the same lens which is perhaps these general recommendations whilst useful wouldn't it be great if we had some sort of metric like I don't know we could measure our muscle mass and and look at it where it should be at that age relative to the population and let's say you're eating under the protein recommendations but you've hit that muscle mass target, then maybe we could say, yeah, for me, this amount of protein is working.

32:28Dr. Rangan Chatterjee:Do you know what I mean? I kind of feel more and more, a lot of the generic advice we give, it kind of confuses people because then they see experts fighting over, you know, well, one expert says, go high protein, then it says, goes low protein. And people go, well, what the hell do I do with that? Whereas in some ways, if we had an end metric, we could go, well, it kind of depends. So why don't you try that for a bit? We'll measure your, do you know what I mean? That feels where we should be going with medicine.

32:58Dr Eric Topol:I'm totally aligned with you here. I think what you're bringing up is quite insightful. So the two factors that are going to change our muscle mass are, as you say, protein intake is one factor. And the other, of course, is resistance training, strength training. and the problem is people want to have like a they don't want to necessarily do the work the the the resistance training or just lots of physical activity it's much easier to take a bar or powder you know but the real benefit here is in in the physical activity uh in general and going back to your earlier point you know how do we measure this how do you gauge it and you know You don't have to have, you know, when I learned how important resistance training was, because I didn't emphasize that.

33:52Dr Eric Topol:I always thought it was aerobic exercise was the big thing. You know, I got a DEXA scan. I looked at my muscle mass. That was really helpful for me to say, hey, I got to do much better than that. And I went, you know, on a resistance training kick. I didn't change. Most people get enough protein in their diet. That's not really the issue. but I think what we're learning here is that it is an individual story and what it takes is not from a bar or a hyper protein intake diet but rather you're gonna get a big kick from increasing strength resistance training which unfortunately still most people are not into that.

34:33Dr. Rangan Chatterjee:Yeah, we've covered ultra processed food, we've covered protein in that paragraph that I read out before under diet, you also mentioned time-restricted eating. Yes. What's your current read of the literature on time-restricted eating and do you practice it yourself?

34:53Dr Eric Topol:Yeah, so there are a lot of randomized studies now and there's lots of different schedules as you know, in the five-two and this one and that one. And the data are very consistent to show that time-restricted eating helps to keep weight under check. It's a good way if someone wants to lose weight. But what isn't clear is that what I practice is eat a dinner, hopefully on the early side, and don't eat anything till the next morning for breakfast. That's a time-restricted eating because, as we know, lots of people eat in the evening and snacks and whatnot. So it all depends. but if you wanna have a practical time-restricted eating where you're giving your body a break from metabolizing food intake, just that works.

35:46Dr Eric Topol:And it's not having to go a day or two days a week without any, you know, with fasting. So I'm an advocate for going from evening meal on the early side to the following morning with nothing to eat in between.

36:01Dr. Rangan Chatterjee:So maybe, you know, to make it really clear for people, something like an 8 a.m. breakfast, dinner finished by 6 p.m.? I mean, I know it depends on your... Or 7 even.

36:14Dr Eric Topol:For me, it's usually 7. It's like a 12-hour thing.

36:18Dr. Rangan Chatterjee:12 hours where you're eating within, and then you have 12 hours where no food passes your lips.

36:24Dr Eric Topol:Exactly. I think that's the most practical and beneficial way if you want to come up with an ideal timing of food. Yeah. Yeah.

36:33Dr. Rangan Chatterjee:It's kind of interesting, isn't it? 50 years ago, that's probably what most humans on the planet were doing anyway, right? We now have to give it a name, like time-restricted eating or fasting, but it was probably just normal living until relatively recently. And then I have found that for some patients, they can experiment with increasing it, So actually, they can go to a 10-hour eating window, like an eight till six. Have you seen much difference in the data? And a lot of the data hasn't really passed out a difference between men and women. But are you familiar from your research of any difference in results when it comes to time-resurated eating for men compared to women?

37:15Dr Eric Topol:I haven't seen anything that's particularly helpful in that to differentiate by sex.

37:25Dr. Rangan Chatterjee:Okay, so we're talking about lifestyle plus at the moment. We've just sort of, I mean, there's plenty more in the book, right? But we've sort of covered three core areas of food. You know, ultra processed foods, protein intake, and time-restricted eating. Let's move on to exercise. And in that paragraph, you say exercise means more than aerobic fitness. it includes good posture that's something we don't often hear about resistance weight training and something which maintains your sense of balance so i think people have heard of aerobic training on this podcast many people have heard over the years the importance of strength training but you also bring in good posture and things that improve your balance

38:12Dr Eric Topol:i found that really interesting yeah and of course they're they're uh interconnected of course so um As we get older, our proprioception is compromised, and so we're much more prone to fall. And our posture often deteriorates. And so having a good upright posture is important for every part of our body, whether it's our lungs for expansion, whether it's our bones, our muscles, and also, of course, balance. So attention to that. balanced training what's really interesting it as as we get older our balance can really be that because we don't have that perception the proprioception of our body parts and our brain but training is easy to get that back and keep it at a level that's much younger and so as you know because of falls so many terrible things happen you know not just hip fractures but you know just important musculoskeletal injuries.

39:19Dr Eric Topol:So this is a part of a workout. It's really important to spend a couple few minutes to keep up the balance training and all the time to focus and think about posture. And when you have better strength training, promote better posture as does balance training. So it's all interdependent.

39:42Dr. Rangan Chatterjee:Yeah, Eric, a few days ago, I had Courtney Conley in my studio. she's many things but one of the things she specializes is in foot health and she was showing and presented to me research showing that your big toe strength is one of the most critical factors when it comes to your fall risk because of course we just look at general macro balance but she goes when you really look down to it one of the key factors is your big toe strength so it's really all these things you can go into a lot of detail and one of the other things she told me is she said in your foot rongan, there are four kinds of receptors that give you proprioceptive input.

40:22Dr. Rangan Chatterjee:But I think she said after the age of 50, you need way more pressure being put through them to activate them, i.e. like you mentioned in your book, you mentioned how the brain changes structurally as we age, which I found absolutely fascinating. But the way our nerve fibers in our feet change as we age. And it does seem to me that 40 or 50 seems to be the point in life where the sort of habits that we maybe got away with before we stop getting away with. And I knew balance was important. You're talking about it. But I really got that from Courtney as well, that this is something that really needs to be trained, probably from your 40s if you want that exceptional balance in your 80s.

41:12Dr Eric Topol:I couldn't agree with you more about that. And I think she is very much right about calling on the strength of our lower extremities and feet. And that's why part of that balance is also strengthening our calves and getting attention to the lowest part of our lower extremities, for sure.

41:37Dr. Rangan Chatterjee:When we think about exercise, and there's these multiple components, how do you think about exercise through the lens of the big three? I mean, what's the impact of exercise on cancer? What's the impact of it on heart disease? What's the impact of it on neurodegeneration?

41:55Dr Eric Topol:Yeah, if there is one thing that has the biggest impact of lifestyle factors, this would be it. Because it's across the board and it has been shown to slow biological aging, the body-wide aging with these so-called epigenetic clocks. and it has a protective effect as we conceive it through the immune system. That is, it's anti-inflammatory. So it has, the more, while you're exercising, it's like a trial run for an immune system. You'll have a little inflammation of muscles from doing that and then you're basically training your body to deal with the most intact, high-integrity immune system. So its effect is profound, and it's really vital across all three of these age-related diseases.

42:54Dr Eric Topol:If you're going to just pick one thing to concentrate on, this would be it.

42:59Dr. Rangan Chatterjee:Yeah. It's hard to not get away from that when you look at the research. I mean, look, everything's important. Food's important. Sleep's important. Stress management's important. All these things are important. But I mean, really, the research on exercise is frankly overwhelming. And we need to challenge the societal narrative that as you get older, you take it easy. In many ways, you get away with taking it easy in your 20s and 30s. I'm not recommending that, but you kind of get away with it. But as each age passes for me, I'm paying more attention to daily movements. And walking, frankly, is, yes, I understand aerobics and resistance training, but I try and make sure I walk, I don't always manage it, but for at least 60 minutes a day, sometimes in one go, sometimes two 30-minute walks, sometimes three 20 -minute walks.

43:52Dr. Rangan Chatterjee:Because even on just walking alone, the research shows a massive reduction in risk of many different types of cancer.

44:01Dr Eric Topol:I'm so glad you mentioned that because there was a really big study from last week that compared all the different types of aerobic activity, walking and swimming, jogging, running, and on and on. Walking stood out as a major, major protective, well beyond what people think. And I think a brisk walk is a great thing. In fact, if you're into other very vigorous physical activity, it shouldn't be at the exclusion of walking. Walking is really important. And it brings in all those things we were just talking about, like posture and balance. And there's something about walking that is more than you would think with respect to its contribution to healthy aging.

44:48Yeah.

44:50Dr. Rangan Chatterjee:Going back to your Welderly project, you noticed that genes weren't really telling the story. Back in 2008, back then, we did think, didn't we, across society, that it's all going to be genetics. Once we sequence the genome, we're going to know what's going on. And so obviously, back then, you guys thought, we've got these couple of thousand people, we're going to find the genes that promote healthy aging. And then you find, oh, we can't see any similarities. it's all to do or mostly to do with their lifestyle. One of the things you also identified, and I found it interesting that you mentioned the research nurse who was Sarah, your daughter, who was helping you with the trial, which must have been lovely to work on something like that with your daughter.

45:35Dr. Rangan Chatterjee:But you put in the book that she noticed that everyone in that group were remarkably upbeat.

45:44Dr Eric Topol:Yeah.

45:45Dr. Rangan Chatterjee:And I found that really, really interesting. We can look at the hard health things, diets, exercise, sleep, all those things. But this is almost the softer side of medicine. What is their personality? What is their approach to life? And I think it's amazing that your daughter actually noticed that. They were all upbeat.

46:07Dr Eric Topol:Yeah, I'm glad you picked up on that. I was struck by it because she would visit them in their home and take their blood for the sequencing and, you know, have a discussion, conversation with them. And that's what she noted was the theme across all. The most common thread was that their disposition, you know, they were, they are upbeat, happy people. Now, one of the things, of course, is are they upbeat because they're so healthy or did that help contribute to them? And of course, it's not something that you have a switch where you can turn on people to be more optimistic folks. But there's something about that quality that is correlated, at least, with healthy aging.

46:53Dr. Rangan Chatterjee:The word correlation is really interesting there, isn't it? Because, you know, you're a researcher, you're always trying to look at the data and accurately report the data. I know in the Blue Zone documentary on Netflix, one of the themes that came up, I think, was that a lot of these people who've lived past 100, who are well, they don't have chronic disease, have this upbeat personality. They look on the bright side of things. It also reminds me, Eric, of a conversation I had with a lady called Bronnie Ware a few years ago. She wrote the book, The Five Regrets of the Dying. I'm not sure if you're familiar with it or not.

47:29Dr. Rangan Chatterjee:But she was a palliative care nurse for eight years. And she basically noticed that on people's deathbeds, they all said the same kind of things. You know what they They regretted working so much. They regretted not spending enough time with their friends and et cetera, et cetera. And I asked her, I said, I said, Bonnie, did everyone you cared for at the end of their life have regrets? She said, no. I said, what was some of the things you noticed in the people who did not have regrets? And one of the things, you know, several things, but one of those things was hope.

48:04Dr Eric Topol:Yeah.

48:05Dr. Rangan Chatterjee:Right. So I find it fascinating that I can look at your worldly projects. some of the stuff we get from the blue zones, some of the things that brawny wear noticed with people at the end of their life, I think we have enough correlational data, at least to say, look, I think your personality, your outlook to life, I think it does make a difference. I think we can say that.

48:29Dr Eric Topol:I wholeheartedly agree with that. No question to me.

48:33Dr. Rangan Chatterjee:In Lifestyle Plus, because I think, if I think about what we've spoken about so far, I do want to come to sleep shortly, But one of the things that you talk a lot about are the environmental toxins. And I think it's a really interesting thing to put under the umbrella of Lifestyle Plus, because it's something that I think a lot of people are not paying attention to. So they're trying to eat better. They're trying to get their, I don't know, 10 ,000 steps a day in or whatever they might be trying to do. They're trying to prioritize their sleep. but I routinely see people around me ignore the plastic issue, the environmental toxin issue.

49:14Dr. Rangan Chatterjee:So could you sort of give us an overview? Where are we with the research? How concerned are you? And then what are some of the things we can think about doing to reduce our toxin exposure?

49:28Dr Eric Topol:Yeah, and this is a real problem because we're not doing it nearly enough and things just keep getting worse. So air pollution is the one most proven to be pro-inflammatory in the body and increase the risk of all these diseases. And of course, also type 2 diabetes. So this is a singular thing that we obviously need to work on with the climate crisis. Now, with respect to the plastics, there's still some controversy about how dangerous these, that we ingest and that are in our air and throughout our environment, just so pervasive. But the most compelling study to me was the one from Italy where the microplastics found in people's arteries, their carotid arteries, when they had time to surgery, about 60 % had that.

50:21Dr Eric Topol:And those are the people that over the years following, not only did they have vicious inflammation as a response to the plastic in their artery microplastic, but then they had a almost fivefold risk subsequently of heart attacks and strokes. So that study to me cinched it that all these people that are denialists about the plastic crisis, they are off because maybe it doesn't cause dementia, although we know it accumulates in the brain, these microplastics, nanoplastics, but it does incite locally inflammation as we've seen in the artery, and it accumulates in every part of the body, including our reproductive system, which may account for lesser fertility.

51:04Dr Eric Topol:So I'm worried about the plastics that we, and on a personal level, we can do certain things, but we also need big, you know, worldwide and governmental policy changes. And then the Forever Chemicals is the same thing. We've tolerated these companies that have this in, you know, so much of our physical environment. And we're not doing anything about that. Now, all these things could change if we had policies to reduce their burden and we're not doing it.

51:35Dr. Rangan Chatterjee:This is where I think government and these sort of bodies really need to step in because the problem with the whole plastic or the environmental toxin exposure conversation is that I think to many people, it just feels, oh my God, what am I going to do with this? That's another thing in my already busy and stressful life that I need to now think about. And what we don't really think about is the fact that 20, 30 years ago, we just didn't have all this in our lives. And I think about it on a number of levels. I think about our children, right? So let's look at this through the lens of allergies, right?

52:13Dr. Rangan Chatterjee:We know that food intolerances and allergies have gone up dramatically over the past few decades. And there's many potential reasons for that. But it does seem that the gut microbiome is a major player here. And so it's, you know, I've had a conversation with a few experts on this podcast over the years. But one of the things we've discussed is, well, could it be that your generation, Eric, and the generation older to me, actually, when they were growing up, they didn't have all these ultra processed foods. They didn't have the overuse of antibiotics. Their microbiomes were healthy and robust at a very formative age.

52:55Dr. Rangan Chatterjee:So perhaps that population just don't have all these food allergies and intolerances. Whereas, and I'm not saying I know this to be true for sure, but could it be that the younger kids who grew up in the 80s and the 90s, when ultra processed foods were getting ramped up and antibiotics were probably being overused quite a lot by many medical professionals. So our microbiomes were kind of negatively affected at that age. Could that have primed us to be more susceptible to intolerances and allergies later? Now, if that's the case, we can then apply that mode of thinking to plastics. There's a generation of kids now who are growing up in plastic everything.

53:40Dr. Rangan Chatterjee:Plastic bottles for their water, go to the Starbucks or the coffee shop after school and get a trendy takeaway drink to walk around with with your friends. But that's hot liquids going into these plastic cups, which is the worst thing in terms of releasing those plastics. So I worry about what this might be doing to this generation. And speaking to your point about the denialists, it's like, well, hold on a minute. Maybe we don't have the evidence to say concretely that this is a problem, but I think we have enough evidence to adopt the precautionary principle and go, well, wait a minute, let's just err on the safe side.

54:18Dr. Rangan Chatterjee:I don't think any of us would think it's a good idea to have plastic in our body and our reproductive system. Or one study, Eric, I saw, it had plastic in the amniotic fluid, which I thought, this is crazy. I mean, what's your take?

54:33Dr Eric Topol:Well, I think the worst reflection of where we're headed is to see all this cancer cropping up in young people, where you see colon cancer, breast cancer. These are people in their 30s and even 20s and other forms of cancer. We've never seen this before. These are new spikes that have happened in recent years. And, you know, whether that's any one of these environmental toxins that we're not doing anything about, all of this together is worrisome. You know, we shouldn't see people new trends and spikes in cancer because that is something that should be alarming, right? So, no, I'm very concerned about this.

55:24Dr Eric Topol:And here's the other thing about it is as you see patients that do everything right, they are taking really good care of themselves. They check the box on every possible lifestyle factor. But then they get a dreaded age-related disease. Why? Well, is it because of their environmental exposures and some combination with their genetic susceptibility? So this is a concern that all the progress we can make, and we'll talk about some of the tech-facilitated progress, We're chasing our tails if we don't get onto this environmental forms of burden that are not... At this point, we're doing nothing except making them worse.

56:15Dr. Rangan Chatterjee:Under this sort of umbrella of environmental toxins, you mentioned three things. Air pollution, microplastics, and forever chemicals. One of the sad things about air pollution, of course, is that it's out with your control, and it probably affects people of lower socioeconomic status more because they're probably the ones who are living in the more congested urban environments where there is more pollution around. Of course, not all the time, but as a general rule, which is very, very sad. Yes, we need governments to change policies. On an individual level, if you could afford it, Do you think there's a case for indoor air filters?

57:00Dr Eric Topol:Yes. I mean, our indoor air, we don't have enough attention paid to that, whether our places of work and our home. So that's something that could improve. And your point about the inequities, they go across the board. There are more exposures, more ultra-processed food. So, yeah, and again, what efforts we have to extend healthspan need to be considered globally for all people. not just for wealthy people. And so this also requires specific attention.

57:33Dr. Rangan Chatterjee:Okay, that's air pollution. Number two you mentioned was microplastics. So you mentioned the potential problems. I also had Professor Dale Bredesen on the show a few months ago from the Buck Institute of Aging, and he is very concerned about microplastics. And again, to be fair to Dale, he said, I don't think we've got, you know, causative proof yet of plastics and Alzheimer's, but there's enough there to worry him. And there's enough there for him to immediately cut out as much plastic from his life as he can, basically. Which I find, you know, when you've got some of the top researchers saying, look, I've seen enough to go, we might not have definitive proof yet, but I'm going to reduce it as much as I can.

58:16Dr. Rangan Chatterjee:Oh, yeah. What would your advice be to someone listening to this go, okay, well, there's only so much I can do, but what are some things that I can do that will reduce my microplastic exposure?

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1:00:29Dr Eric Topol:Yeah, and I think we should be working on that individually. That's wild, yeah. And you mentioned about plastics, water bottles, heat and plastic, like microwave and hot drinks and, you know, the utensils that we use. I mean, there's so much plastic everywhere that we can reduce that to some degree. There are filters you can add to your water. there's many things you can do. It's limited to some degree, but our storage and our reliance on plastic is just way out of control. And at least part of it is under our control.

1:01:13Dr. Rangan Chatterjee:One of the things that really helped me change my plastic exposure, and I think this speaks to the point we mentioned before about CGMs and what you discovered about tortilla chips and pizza for you. What I discovered when I started experimenting with CGMs a few years ago, and it was eye-opening. And what I learned has had a profound impact on me. And I think with some people, these things are game-changing in terms of the insight they give people. But what are we now? We're in January 2026. I think in November 2024, I was in LA doing some interviews for my last book, and I got a test done in LA.

1:02:00Dr. Rangan Chatterjee:You can get anything tested in LA, right? But one of the tests came back saying that levels of BPA in my blood were in the red range. Oh, yeah. And that did something, because it wasn't as if I wasn't familiar with the problem with plastics. And I think this speaks to something really important, Eric, about human behavior, which I would love to get your take on. I knew a lot of the science about plastics, but it took me to get a blood test, see my levels in the red to go, oh my God, right, enough's enough. And since then, I don't think I've had a single hot drink in a takeaway cup. I don't think I have.

1:02:45Dr. Rangan Chatterjee:I've only drunk out of a plastic water bottle, I think, when I'm desperate. So on, let's say, a transatlantic flight, when literally after seven hours, I'm like, I need to drink something. But that test... And this podcast has empowered me to change my behavior. What's your take on that? Because we can talk about this stuff. But I reckon a lot of people will go, yeah, and crack on with their lies. How are we going to get people to actually go, no, it is worth reducing the plastic exposure in your life?

1:03:16Dr Eric Topol:Well, what you just touched on is actually, in my view, one of the most important things we have for prevention. and that is when you give out the guidelines, recommendations for all people, it never really sinks in. But when you give a person their data, and that's the data that they're a very high risk for this cancer, they're very high risk for Alzheimer's, and then you say these are the things you can do, the chance of you getting someone to change their behavior and their whole arc of health subsequently is so much greater. And that's exemplified by your experience with BPA and plastics. Wouldn't it be great if a lot more people could access that information about themselves?

1:04:04Dr Eric Topol:Because that's the thing that gets people to make changes.

1:04:09Dr. Rangan Chatterjee:But we don't have enough of that. I want to come back to Forever Chemicals in just a minute, that third category. But I think what you just said there, I think for me and for you by the sounds of it is so critically important and it goes back to what we said earlier about prevention Eric this idea that in modern medicine for all its amazing you know breakthroughs of which there have been many one of the things I think we can sort of honestly say when it comes to chronic disease is that we get involved quite late in the disease process. Whereas you say, of course, you've already said it, these big three illnesses, cancer, heart disease, and neurodegeneration, which includes things like Alzheimer's and Parkinson's, they're going on for at least 20 years before you get there.

1:05:02Dr. Rangan Chatterjee:So in your view, with all the research you've done, what does ideal prevention look like today? Forget about the logistics. If you could design a preventive health service today, what would be some of the key fundamentals you would want to bring into it? Right.

1:05:23Dr Eric Topol:So in February, we're starting a prevention of Alzheimer's trial. And that I think is indicative of that we're at least trying to prove the concepts of the new prevention era. And so what we're talking about now is you have a person's, all their medical records and not just the medical records and their lifestyle plus factors, okay? But now you have at least the key genetic information, like these so-called polygenic risk scores, or even their whole genome sequence. Could you just say, for people who've never heard that term,

1:06:05Dr. Rangan Chatterjee:could you just explain what a polygenic risk score is? Right.

1:06:08Dr Eric Topol:So that means that you're getting the, of at least a million or more letters in the genome that are linked to common diseases, like the cancers and Alzheimer's and heart disease. you're getting a readout of what your risk is from zero to 100. And that's really important. It's very low cost, but we should all have that. It's a guide of risk, whereby when you have that information, it doesn't tell you when. It doesn't say you're going to have Alzheimer's at age 60 or 90. We're going to get to that in a moment that we have now when. But it gives you at least a sense of something to be on the lookout for and your physician, of course, as well.

1:06:57Dr Eric Topol:So polygenic risk score, genome sequencing, which now can be done at very low cost, a couple hundred dollars. That data is going to be, and in fact, the UK is the world leader in that. The next is the proteins. So now we can get up to 11 ,000 proteins from the blood, from a tiny sample. and we get a readout of each organ clock. So we're talking about the pace of aging of your brain, your immune system, your heart, your liver, every organ in your body, we can get the pace of aging, not just your body-wide aging, which we can get through a so-called methylation clock. Then we have these biomarkers.

1:07:42Dr Eric Topol:So for Alzheimer's, we have this incredible breakthrough marker, P-tau-217, which is related to the tau protein in the brain. So these are ways to be 20 years ahead of your health arc. It's like a health GPS, if you will.

1:08:00Dr. Rangan Chatterjee:Sorry, you said P-tau-217.

1:08:02Dr Eric Topol:Can you just explain to people what that is, Eric? Yeah. So I think people now have heard a lot about amyloid and tau, these misfolded proteins that accumulate in our brain, incite lots of inflammation in our brain, It turns out that one of these on the tau protein at the residue 217, it has lots of numbers. That one can be picked up in the blood. It's been available for a couple of years as a blood test. A lot of physicians don't even know about it, no less patients. And that helps to cinch that in the years ahead, if you're 50 years old and you have a high risk for Alzheimer's from your family history or APOE4 allele or your polygenic risk score, if your P-tau is high, that really puts you in this high-risk category.

1:08:53Dr Eric Topol:And that's who we're focused on for our prevention of Alzheimer's trial. But if it's low, it's very reassuring, right? So it's a big, big advance in Alzheimer's disease, perhaps the biggest advance in many decades.

1:09:11Dr. Rangan Chatterjee:Do you think everyone should be getting a P-tau 217 to assess their risk of Alzheimer's?

1:09:18Dr Eric Topol:Only if they have other features of increased risk. So if they have APOE4, one in four of us have that as a carrier. And some people, of course, have two copies. So if they have that, if they have a family history of Alzheimer's, if they have a high polygenic risk score, yeah. If you have any of those or all of those, getting a P-Tau-217 would help because then you'll know.

1:09:47Dr. Rangan Chatterjee:Can you bring it down? If you know it's up, can you do things? Because that's the key, isn't it? You can bring it down.

1:09:53Dr Eric Topol:Exactly. So it's not just a marker. It's modifiable. It's like LDL cholesterol for the heart. It's the same thing. Exercise, we know, brings P-Tau-217 down considerably. weight loss, better diet. So lifestyle factors are doing a big thing to help us to deal with a marker now that is not just framing risk, but also reducing prevention or delaying at the very least.

1:10:25Dr. Rangan Chatterjee:And that, of course, just highlights the importance of testing, right? Because if you were just sailing on with your life, you had no symptoms at all, which is common, you know, even though these things develop for 20 years, you may have no symptoms, right? Or you may not notice any symptoms. If you, you know, if you have an APOE4 allele, if your mother had Alzheimer's, and then you see your PTAL 217 is up, that might be the trigger to go, okay, I just can't keep sailing on and living as I'm living. I, this is great. I've identified it. Let me sort out my lifestyle now. Let me make some changes.

1:11:09Dr. Rangan Chatterjee:That's the exciting thing. I think in your book, you mentioned with these polygenic risk scores, I think you mentioned a Norwegian trial where, do you remember that one? Perhaps you could just explain what, because I think it motivated people to change, right?

1:11:22Dr Eric Topol:Yeah, it's exactly what you said with the BPA. So it was actually in Finland where they gave their polygenic risk score for heart disease to thousands of people. and then they followed them to see whether it changed their behavior. It was remarkable. When they had their data for high risk of heart disease, they stopped smoking, they lost weight, they increased activity. That study really cements the idea that when people have their data, they make durable, important changes under their control. Yeah.

1:11:59Dr. Rangan Chatterjee:One of the interesting things in your book, which I think is going to be counterintuitive for many people, is your approach to screening for things like cancer. So perhaps you could talk, you know, breast cancer, of course, is very common these days. And you sort of, and I've heard you say this in interviews as well, that only 12 % of women are ever going to get breast cancer. So why should we be screening the other, you know, 88 %? So to some people, that's going to be quite controversial, because the prevailing view, I think, in society, Eric, is that, you know, well, I want to make sure that I don't miss it.

1:12:39Dr. Rangan Chatterjee:So could you kind of talk us through your approach to screening, maybe use breast cancer as an example, and why you think we need to be targeted and look at our individual risk?

1:12:51Dr Eric Topol:Yeah, I know. The way we screen for breast cancer today is dumb and wasteful. Now, why do I say that? Well, if you take a woman age 50, and you take 10 ,000 of them, this has been shown. I mean, this is data that is in JAMA. If you screen them for 10 years, there'll be a 60%. That is 6 ,000 of the 10 ,000 women age 50 over 10 years will have false positives. and that induces lots of anxiety and biopsies and all sorts of recalls. So that's one thing. Second thing is we are using age. That is a dumbed-down approach. We've already talked about how some young people can get breast cancer, young women, but also we have risk-based screening.

1:13:43Dr Eric Topol:In fact, there's just a study comparing risk versus age. Risk was superior. Why aren't we acknowledging that age is a dumb way to partition with how we screen? We can do polygenic risk scores. We can do genome sequencing. But we are, as you said, we're screening all women, at least that's the advice, on a frequent basis to engender false positives. And here's the other thing that is just crazy. Most cancers, breast cancer, are not detected through screening. Not, like over 80 some percent. So this screening isn't working. The women are showing up with breast cancer rather than being picked up from their mammogram.

1:14:32Dr Eric Topol:So we can do so much better and everything is on detection. Why not prevention? Why aren't we preventing breast cancer in high risk women? We can do that now. We're not using all our knowledge in genomics And here's another thing, the clocks that I mentioned, the immune system clock, that's part of the output. You can't really likely get a metastatic cancer if your immune system is intact. Why aren't we checking the immune system clock? That is, if you don't have a youthful immune system and you have a genetic predisposition for cancer, that's a recipe for risk. So we are not using our knowledge base in a smart way, in a prudent way, to just not put all women.

1:15:23Dr Eric Topol:It's like treating people as cattle. Okay? We should be much smarter than that. We're not the same. And this is the individualized medicine approach that, of course, that I've tried to work on for decades.

1:15:37Dr. Rangan Chatterjee:On a population level, in let's say a publicly funded healthcare system like the National Health Service, of course utilizing your resources appropriately with the right levels of risk and reward is very important but that works for a population but on an individual level Eric what if there's a woman listening to this right now and they say well Dr Topol I'm hearing you but I don't have any family history of breast cancer I've got no genetic risk factors for breast cancer but I still want a mammogram because I don't want to miss early cancer. If someone was saying that to you, what would you say to them?

1:16:20Dr Eric Topol:Well, you know, that's an individual choice. That's fine. But what I would say is if you had your genetic information and you had a polygenic risk score, so people that say they have no genetic risk, Well, as it turns out, when we talk about this polygenic risk order, just to go back to that for a moment, we are the blend of our parents. And even if neither of them have a cancer risk variant that's important, we are the hybrid. And it's this combination of letters of the genome that gives us, that's why it's called polygenic risk. So that's why we should know our polygenic risk besides mutations like BRCA1, BRCA2, and many others that are informative for risk.

1:17:10So what I'm saying is we have the goods here to tell who is really at risk and who isn't.

1:17:17Dr Eric Topol:And so, for example, if you knew you were at very low risk, maybe you'd still have a mammogram, but maybe every five or 10 years rather than every one or two years. We are not using all this great knowledge base. That's what I'm trying to get at.

1:17:30Dr. Rangan Chatterjee:Yeah.

1:17:31Dr Eric Topol:So I guess we're, I don't know if we're at that point

1:17:34Dr. Rangan Chatterjee:or we'll get to that point very soon where if we get your polygenic risk score, I'm guessing we might get to the point where we can pretty confidently say you're at risk of several things, but breast cancer ain't one of them, right? Right. And so therefore, if you are really not at risk of breast cancer, using the best available scientific evidence, there's another key point there, isn't there, which everything has a cost. Nothing is neutral. I don't mean a financial cost. There's even an emotional cost. Going to the screening, waiting for your results, it's very anxiety inducing. If they're not sure and you then need to go and have that biopsy, you introduce a risk of complication.

1:18:19Dr. Rangan Chatterjee:So it's not as if screening has no potential downside, right? Which is why, of course, prostate cancer screening is so controversial, because some people want PSAs all the time and others like, well, wait a minute, there's loads of false positives. You're going to have loads of guys having invasive biopsies, which are potentially unnecessary unless we do it in the correct way. And I'm not convinced the general population understands the nuances of screening. I think there's very much been this idea that all screening is good. The more we can screen, the better. But I'm with you. I don't think that's necessarily the case.

1:18:56Dr. Rangan Chatterjee:Here's a question I have for you, Eric, as we think about this. We were talking before about environmental toxins. We haven't got to forever chemicals yet. I'll remember to come back to that. We've got air pollution and microplastics. Something I've been thinking about for a number of years is, as the world evolves, as it always does, certain people are going to be able to thrive in a toxic modern world better than others. And perhaps some of that will come down to genetics. Maybe some people are better detoxifiers than others, right? So if that is the case, we can apply what you just said about breast cancer in a similar way to like the toxins, right?

1:19:42Dr. Rangan Chatterjee:Let's say you get a genetic risk score and you're like, I'm really bad at detoxifying these chemicals. I don't know, maybe you're someone who would benefit from doing sauna five times a week, right? Because I don't know, I'm just hypothesizing. Whereas if you're someone who naturally detoxifies stuff, so maybe you're going to clear plastics quite well. Is there any research on that? Or what's your take on that, Eric?

1:20:07Dr Eric Topol:I think it's an interesting hypothesis and it needs to be tested, yeah.

1:20:11Dr. Rangan Chatterjee:Yeah. Well, let's come back to the third one of those environmental toxins, forever chemicals. What are they? And I saw a clip, I think, online of you. I think you were talking to Mel Robbins, and she was showing you all kinds of things from her house, including hairspray, right? And I think she couldn't pronounce anything that was in the hairspray, and I think you were quite concerned. So talk to us about forever chemicals. Talk to us about things like hairspray and what's in these things and then what we should be doing about this, basically.

1:20:47Dr Eric Topol:Yeah, no, this is a pervasive problem. Perfluorocarbons and, you know, there's thousands of these forever chemicals that are non-degradable, that are in our environment, our furniture, our tires, our, you know, carpet. and we could have all these things, we could have all these things without those chemicals if we told these companies that they're prohibited, right? But we just tolerate it. And everyone knows about what happened with the cigarettes and cancer and heart disease and how the company suppressed all the data and refuted it for years. And then finally, here it is. Well, that's what we have with the Forever Chemicals.

1:21:36Dr Eric Topol:There's a company, 3M here in the US, which is the number one offender. They've known about the dangers of these, but they just kept using all these chemicals in their products. And of course, there are a lot in personal hygiene and cosmetic products. I mean, it's all over the place. But they are then polluted in our water and our air. and it just adds to this burden of pro-inflammatory, noxious for our health, and we do nothing about it. Why aren't we saying to these companies, no, you take those out and you can put in other organic degradable chemicals that achieve the same thing. But there's no teeth in our regulation of toxic perfluorocarbons and other related PFAS.

1:22:32Dr. Rangan Chatterjee:Non-stick pans, you know, one of the kind of, in inverted commas, great modern inventions to improve cooking. Unfortunately, that's come with a dark side, hasn't it, right? Absolutely. The ease of cooking, you know, you make your envelope on it, it's way easier, easier to clean. But it's forever chemicals, isn't it, that end up in your bloodstream?

1:22:56Dr Eric Topol:Yes, yes, yes, absolutely.

1:22:58Dr. Rangan Chatterjee:The public doesn't even know about it. That's the other problem. The problem I have with all this stuff is that I want to empower people and share it. I don't want to stress people out. Right. Because I know people are living these busy, stressful lives. But if I'm going to be honest, if we're going to be both honest as healthcare professionals, we kind of have to tell people, you know, if they can't do anything about it or don't want to, that's up to them. But I think we have a responsibility to say, guys, you know, we've got rid of all our Teflon pans. a few years ago. Once I saw it, I'm like, look, we just can't be having this.

1:23:34Dr. Rangan Chatterjee:We're going to be exposed to this when we eat out. There's nothing I could do about that in a restaurant. So my sort of philosophy is control the environments that I can control. I can control what's in my house. Yet, is it more of a pain sometimes to wash up? Yeah. But at least I'm not putting forever chemicals in my body. We've tried to replace all ours and gone back to cast iron, basically. right same here yeah there's so much in your book that I want to talk about but I've got an eye on time I wonder if I might just pivot here Eric to some of my Instagram community have put in some questions that they wanted to and so I don't normally do this but maybe I'll try a sort of I wouldn't quite say quick fire but you know I could go into depth in all of these but let's try and get through a few of them if possible.

1:24:31Dr. Rangan Chatterjee:Someone's asked, can stress and sadness cause heart complications?

1:24:38Dr Eric Topol:Yes. There's the acute severe form, it's called Takotsubo syndrome, that you can actually have the heart really sick from a profound stress. But there's also the chronic stress, which can be seen to promote atherosclerosis and heart disease. So yeah, the answer is yes. And that's why we want to try to reduce the stress, improve things like do that, like exercise.

1:25:09Dr. Rangan Chatterjee:Really important. Okay. Second question that came in, what is the most impactful thing a healthy person can do to drive the biggest change in their health?

1:25:22Dr Eric Topol:We touched on it, Rang, and it was exercise. Amp it up with the right kind of balance of activities.

1:25:29Dr. Rangan Chatterjee:Okay, next question. When is it too late for me to think about changing my lifestyle? That's from, I think, one of the audience members who might have been in their 60s. So yeah, when is it too late?

1:25:42Dr Eric Topol:Never too late and never too early, right? So the studies show at age 50, as you at the beginning of our conversation highlighted, you can get at least seven years of healthy aging by doing this at age 50. If you're at 60, you're still going to get years of healthy aging added. But if you start even younger, it's even better. So it's never too late, never too early.

1:26:09Dr. Rangan Chatterjee:Other than traditional blood tests, what tests may doctors be missing when it comes to heart health?

1:26:18Dr Eric Topol:Yeah, so that is going to be important because LP little a, lipoprotein A, is going to be, there's five different drugs that are going to be available soon. And that's a risk factor we never had a treatment for. So that one is going to be become, it should be part of the standard test. Other than that, we don't have good inflammation blood tests, but I do think the artery and heart clock, the pace of aging of the artery and heart, that will become standard in the years ahead.

1:26:47Dr. Rangan Chatterjee:Yeah, super interesting. Next question. Is lack of community and connection a factor in heart health?

1:26:55Dr Eric Topol:Yes, and across all three age-related diseases. You don't want to be isolated. You want to be engaged with other people. We need that. We need that for our health. What do you think the mechanism is there? It's a great question. I don't think we know that. Lots of theories, but the data are much more, I think, conclusive than I would ever have forecasted. When you review it all, it's really solid.

1:27:25Dr. Rangan Chatterjee:Yeah, it really is. I agree. What is the link between blood pressure and heart health?

1:27:32Dr Eric Topol:It's a big link. that is when you stress the artery wall or the heart by having too much excessive blood pressure you're allowing injury to take place throughout the arteries in the body and certainly in the muscle of the heart to be thick and hard to relax and fill so yeah you want to get their blood pressure under control because it does have a big toll on your whole vascular system going back to

1:28:00Dr. Rangan Chatterjee:something we said before in the conversation about personalization, Eric. One of the things I've thought about for a while is, and this is why I like these, you know, the more tests that we can find, the more biomarkers we can find, which give us what we actually want, the more I think it helps us personalize things. So blood pressure, right? Let's say you're going for 120 over 80, right? Well, I'm six or seven, so I'm a bit more, you know, I wouldn't quite say I'm like a giraffe compared to a human, but I'm a tall guy, right? So is there a case that the blood pressure that would be optimal for me might be different from the average?

1:28:44Dr. Rangan Chatterjee:And if so, it may not be. I'd love your take on this as an experienced cardiologist. And if so, wouldn't it be better to have some sort of real-time marker of vascular endothelial function so i could go well let's say it was sitting at 130 over 90 which it's not thankfully but if it was and if that marker was okay i might be able to say well yeah but maybe for me it's okay you see where i'm getting at getting to yeah no i think the blood pressure has to be

1:29:14Dr Eric Topol:individualized as well because your example is a good one um you know an atypical body height but also for example in older folks you don't want to be too aggressive you can get them to faint and pass out. So everything has to be guided for that personal. We don't have markers that you mentioned. We should, ideally, to help us guide what is optimal blood pressure for any particular person.

1:29:44Dr. Rangan Chatterjee:And the last question that came in, this was an anonymous question, which I guess the reason it will become evident why when I ask the question, but someone came in saying, should I be concerned if I've started to get erectile dysfunction in my 50s?

1:30:03Dr Eric Topol:No, not necessarily because we're seeing that even in much younger men as well, in their 30s and even younger. So the question is, is that indicative of vascular dysfunction? You were just getting at that with your blood pressure question. So at least it should be looked at, is there high blood pressure? Are there other explanations for that? It could just be, of course, not indexed to the vascular tree, but it should be at least considered.

1:30:35Dr. Rangan Chatterjee:Yeah, okay. Errol, listen, it's been so fascinating talking to you. There's just so much we haven't spoken about that is in this very, very thorough book. As we start to close down this conversation, is there something important or something that you're really passionate about that we haven't mentioned yet in this conversation that you'd like to bring up? Yeah, thanks for giving me the chance for that.

1:31:01Dr Eric Topol:What I really want the person listening, watching this to get at is I have tremendous optimism that we're gonna prevent age-related diseases. So as you know, there's lots of work being done to try to reverse aging. You know, a lot of big biotechs are really going after this. And that might be great someday if we had a pill or a treatment that reversed aging. But what I'm suggesting is let's accept that we're aging, right? It's a biologic process. But let's not accept that we can't make a huge dent in age-related to big three diseases. So I, again, through the data that we are now seeing, the ability to track the immune system, we never had that before, the ability to look at each person's organ over time time to see, to detect one that is starting to act up early.

1:31:55Dr Eric Topol:And the fact that we have 20 years or more to work with to anticipate a person's risk. And the fact that in recent weeks, even, there have been new AI models that have shown you can, for 20 years ahead, you can predict a person's health arc, not just if they would get a condition, but when. So a 50-year-old would present and say, you know what? If we don't do anything, when you're 67, you're going to have mild cognitive impairment. Let's do all these things so we take that and move it to age 90. So I just want to leave you with AI, multimodal AI, and all these new layers of data. We're going to go into an era of prevention that I am really excited about.

1:32:44Dr Eric Topol:Treatment is not the end all. It's prevention. And we can do this. We couldn't do it before. We didn't have the layers of data. We didn't have the AI to process it, but we do now. And that's what I think is going to be the big change going forward. Yeah.

1:32:59Dr. Rangan Chatterjee:I mean, that message of hope and empowerment that came through just then is also what comes through when I read Super Ages. And I think it's a very inspiring note to leave people on. You have covered this, Eric, but just very finally, for that person who's listened to us and is feeling a bit down on themselves and is like, you know what, I've neglected my health my entire life. I thought the reason I had type 2 diabetes is because both of my parents had type 2 diabetes. I don't want to get Alzheimer's like my mom, but I fear it's too late. To that person, what would you say?

1:33:41Dr Eric Topol:Yeah, no longer is there room for this defeatist attitude. We can change the natural history of these conditions. and part of it is our efforts, these lifestyle factors. And there's a whole new pipeline of new medications on top of lifestyle. And if we start ever to get our health policy alive for the environmental toxins and we hit on all cylinders, all these things are going to make a difference. So we shouldn't have this sense that we are stuck with our parents' conditions that's the wrong way to think about things. No longer is that the way to be thinking about one's future health. Dr.

1:34:34Dr. Rangan Chatterjee:Topol, it's been a pleasure talking to you. Thank you for all the research you've done over the years. Thank you for writing such an empowering book. And thank you for leaving people with hope.

1:34:44Dr Eric Topol:Well, thank you, Rang. I'm really a delight to talk with you. And it's been fun.

1:34:53Dr. Rangan Chatterjee:Really hope you enjoyed that conversation. Do think about one thing that you can take away and apply into your own life. And also have a think about one thing from this conversation that you can teach to somebody else. Remember when you teach someone, it not only helps them, it also helps you learn and retain the information. Now before you go, just wanted to let you know about Friday Five. It's my free weekly email containing five simple ideas to improve your health and happiness. In that email, I share exclusive insights that I do not share anywhere else, including health advice, how to manage your time better, interesting articles or videos that I've been consuming, and quotes that have caused me to stop and reflect.

1:35:39Dr. Rangan Chatterjee:And I have to say, in a world of endless emails, it really is delightful that many of you tell me it is one of the only weekly emails that you actively look forward to receiving. So if that sounds like something you would like to receive each and every Friday, you can sign up for free at drchatterjee.com forward slash Friday Five. Now, if you are new to my podcast, you may be interested to know that I have written five books that have been bestsellers all over the world, covering all kinds of different topics, happiness, food, stress, sleep, behavior change, movement, weight loss, and so much more.

1:36:16Dr. Rangan Chatterjee:So please do take a moment to check them out. They are all available as paperbacks, ebooks, and as audiobooks, which I am narrating. If you enjoyed today's episode, it is always appreciated if you can take a moment to share the podcast with your friends and family, or leave a review on Apple Podcasts. Thank you so much for listening. Have a wonderful week. And please note that if you want to listen to this show without any adverts at all, that option is now available for a small monthly fee on Apple and on Android. All you have to do is click the link in the episode notes in your podcast app. And always remember, you are the architect of your own health.

1:36:59Dr. Rangan Chatterjee:Making lifestyle change is always worth it because when you feel better you live more