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Super Agers: An Evidence-Based Approach to Longevity
Brought to you by Penguin.
The New York Times Bestseller
In this breakthrough moment in the history of human health care, Super Agers is an evidenced-based guide to the revolution transforming human longevity. From his unique position as a leader overseeing millions in research funding, Dr Topol explains how you can benefit from new the treatments becoming available at a faster rate than ever, and the fundamental reasons — from semaglutides to AI — that we can be confident these breakthroughs will continue.
More than a quarter of the adult population lives with two or more chronic diseases, with that figure increasing to over half in individuals aged 65 and older. Dr Topol explains the power of the new approaches to the worst chronic killers — diabetes/obesity, heart disease, cancer, and neurodegeneration—and how treatments can begin long before middle age, and even long after. In thirty years, we will have five times as many people at least one hundred years old and they will be healthier than ever because of the breakthroughs Super Agers describes.
These remarkable discoveries are deeply inspiring about our human potential. We can now realistically see how we can make considerable headway for preventing age-related diseases and may one day be able to slow the body-wide aging process itself.
'An extraordinary book that offers a reality check as well as a blueprint for the future.'
Siddhartha Mukherjee, author of The Emperor of All Maladies
'A highly readable and engaging tour de force, Eric Topol takes on a field full of overblown or premature claims, using his personal expertise as a physician to wade through the mass of conflicting evidence to separate fact from hype and pseudoscience, and show us a path to healthy aging.'
Venki Ramakrishnan, Nobel Laureate and author of Why We Die
'Imagine a world where diseases once thought incurable are treated, where we are healthier for longer. This future is getting close thanks to a radical convergence of AI and bioscience. In this gripping, vitally important and meticulously researched account, Eric Topol reveals the extraordinary breakthroughs that are transforming medicine—and our lives.'
Mustafa Suleyman, author of The Coming Wave
Eric Topol 2025 (P) Penguin Audio 2025
The New York Times Bestseller
In this breakthrough moment in the history of human health care, Super Agers is an evidenced-based guide to the revolution transforming human longevity. From his unique position as a leader overseeing millions in research funding, Dr Topol explains how you can benefit from new the treatments becoming available at a faster rate than ever, and the fundamental reasons — from semaglutides to AI — that we can be confident these breakthroughs will continue.
More than a quarter of the adult population lives with two or more chronic diseases, with that figure increasing to over half in individuals aged 65 and older. Dr Topol explains the power of the new approaches to the worst chronic killers — diabetes/obesity, heart disease, cancer, and neurodegeneration—and how treatments can begin long before middle age, and even long after. In thirty years, we will have five times as many people at least one hundred years old and they will be healthier than ever because of the breakthroughs Super Agers describes.
These remarkable discoveries are deeply inspiring about our human potential. We can now realistically see how we can make considerable headway for preventing age-related diseases and may one day be able to slow the body-wide aging process itself.
'An extraordinary book that offers a reality check as well as a blueprint for the future.'
Siddhartha Mukherjee, author of The Emperor of All Maladies
'A highly readable and engaging tour de force, Eric Topol takes on a field full of overblown or premature claims, using his personal expertise as a physician to wade through the mass of conflicting evidence to separate fact from hype and pseudoscience, and show us a path to healthy aging.'
Venki Ramakrishnan, Nobel Laureate and author of Why We Die
'Imagine a world where diseases once thought incurable are treated, where we are healthier for longer. This future is getting close thanks to a radical convergence of AI and bioscience. In this gripping, vitally important and meticulously researched account, Eric Topol reveals the extraordinary breakthroughs that are transforming medicine—and our lives.'
Mustafa Suleyman, author of The Coming Wave
Eric Topol 2025 (P) Penguin Audio 2025
Audible Audio
Published July 31, 2025
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May 3, 2025
How science is looking into what helps us live longer
In Super Agers cardiologist Eric Topol explores improving not just lifespan but health span. He defines and discusses in depth five critical dimensions : lifestyle, cells, omics (the study of the full complement of biological molecules in an organism), artificial intelligence, and drugs/vaccines. The book description is likely to make potential readers think this is a book of advice on how technologies can help us live longer, and I feel this will set up the wrong expectations. This is definitely a science book, a fairly sophisticated one, with a lot of information on where science stands now and where researchers are trying to go, not a book for a general audience of people looking for ways to improve their aging.
To help you decide if you are in the target audience, here is a typical passage:
Like sugar, there is a dedicated gut-brain reward circuit for fat intake conveyed through the vagus nerve. Separately, the fat circuit encourages more caloric intake, but it is synergistic with the sugar reward circuit for promoting dopamine release and overeating. Single-cell studies identified that the vagal neurons involved in the circuit, when silenced, abolished fat intake preference.
I would guess a large proportion of readers would respond with a “wow” to this passage. For some it will be “Wow, fascinating”, but for many more, I think it would be, “Wow, what the heck does that mean?” If you are among the latter, this is not a book for you.
For those who do find scientific explanations like the one above interesting, there is a lot to like and to learn in this book. In addition to the more important discussions, I learned about things like “crapsules”, pills that people can take to get a fecal microbial transplant!
I especially enjoyed the discussion of AI use in the research, such as the AI’s ability to screen a person’s history and make connections and assess risks better than a human is likely to do faced with large amounts of data and how AI can be superior to humans in screening mammograms.
Science fans will find a lot to enjoy and to learn in this book; readers less inclined towards detailed scientific exploration will probably be disappointed.
I received an advance review copy of this book from Edelweiss and Simon and Schuster.
In Super Agers cardiologist Eric Topol explores improving not just lifespan but health span. He defines and discusses in depth five critical dimensions : lifestyle, cells, omics (the study of the full complement of biological molecules in an organism), artificial intelligence, and drugs/vaccines. The book description is likely to make potential readers think this is a book of advice on how technologies can help us live longer, and I feel this will set up the wrong expectations. This is definitely a science book, a fairly sophisticated one, with a lot of information on where science stands now and where researchers are trying to go, not a book for a general audience of people looking for ways to improve their aging.
To help you decide if you are in the target audience, here is a typical passage:
Like sugar, there is a dedicated gut-brain reward circuit for fat intake conveyed through the vagus nerve. Separately, the fat circuit encourages more caloric intake, but it is synergistic with the sugar reward circuit for promoting dopamine release and overeating. Single-cell studies identified that the vagal neurons involved in the circuit, when silenced, abolished fat intake preference.
I would guess a large proportion of readers would respond with a “wow” to this passage. For some it will be “Wow, fascinating”, but for many more, I think it would be, “Wow, what the heck does that mean?” If you are among the latter, this is not a book for you.
For those who do find scientific explanations like the one above interesting, there is a lot to like and to learn in this book. In addition to the more important discussions, I learned about things like “crapsules”, pills that people can take to get a fecal microbial transplant!
I especially enjoyed the discussion of AI use in the research, such as the AI’s ability to screen a person’s history and make connections and assess risks better than a human is likely to do faced with large amounts of data and how AI can be superior to humans in screening mammograms.
Science fans will find a lot to enjoy and to learn in this book; readers less inclined towards detailed scientific exploration will probably be disappointed.
I received an advance review copy of this book from Edelweiss and Simon and Schuster.
April 30, 2025
Eric Topol, one of the most prominent physician-scientists in the world and the founder and director of the Scripps Research Translational Institute, has authored his fourth non-fiction book for lay readers, Super Agers. Super Agers examines current trends in longevity research, specifically focusing on approaches that can extend the healthy periods of people's lives, healthspan, rather than a narrow focus on just extending life itself, lifespan.
Topol introduces a five dimensional approach to medically approaching healthy aging: Lifestyle+ (diet, exercise, sleep, environmental exposures), Cells (especially cells of the immune system), Omics (the molecular information of the whole organism), artificial intelligence (AI), and drugs/vaccines (aka therapeutics). These dimensions are interrelated and interdepending, and Topol has seemingly ranked them according to how he views their importance, Alternatively, these dimensions could be described as prevention, diagnosis and prognosis, and treatment. Despite the early attention to these dimensions, Topol's overall focus throughout is only modestly organized by them. After two early chapters that myopically undersell the importance of genetics and oversell the impact of lifestyle choices and environmental exposures (neither of which are independent of genetic influences), the book adopts a somewhat ad hoc structure, feeding readers a series of loosely connected literature reviews made more understandable to non-experts. This meat of this concerns the four major chronic killers: metabolic disease, cardiovascular disease, cancer, and neurodegeneration. Only the final two chapter directly address themselves to tackling aging in a proactive way, providing little in the way of actionable insights and highlighting few exciting innovation on the longevity front.
The anticlimactic nature of Super Agers isn't surprising. Medical science has very little to offer in the way of significant advances in aging at this time. Lifestyle choices are the most accessible levers available to pull for everyday people, but the ability for people to pull those levers concerns forces that are largely out of their control, specifically genetic predispositions and their social niches and resources. This unfortunate constraint is hardly acknowledge by Topol. Even when lifestyle factors are maximized most of these gains will be marginal at best. This doesn't mean they're not worthwhile to some, but many people will simply not care enough to be overly invested in building healthy habits and this is a sensible tradeoff. Ultimately, it is mostly about avoiding the penalty of really damaging behavioral patterns or the dysfunctional physiological states they can induce and seeking proper medical care at the right moments.
There were a number of important bright spots in the book. Topol heartily embraces polygenic risk scores to guide care as well as a number of other emerging precision approaches. He also celebrates the advances observed in the GLP-1 agonist class of drugs. These were great albeit obvious inclusion in my view. The book would have also benefitted from a more urgent tone concerning the need for more rigorous research. I was a bit concerned how eagerly Topol championed findings from observational work or loosely controlled, underpowered clinical studies.
All in all, this is solid work covering some of the latest medical research on conditions that shorten lifespans and provides some insights into the future ways that medical science may tackle aging so as to extend healthspans.
*Disclosure: Received this book as an ARC from NetGalley
Topol introduces a five dimensional approach to medically approaching healthy aging: Lifestyle+ (diet, exercise, sleep, environmental exposures), Cells (especially cells of the immune system), Omics (the molecular information of the whole organism), artificial intelligence (AI), and drugs/vaccines (aka therapeutics). These dimensions are interrelated and interdepending, and Topol has seemingly ranked them according to how he views their importance, Alternatively, these dimensions could be described as prevention, diagnosis and prognosis, and treatment. Despite the early attention to these dimensions, Topol's overall focus throughout is only modestly organized by them. After two early chapters that myopically undersell the importance of genetics and oversell the impact of lifestyle choices and environmental exposures (neither of which are independent of genetic influences), the book adopts a somewhat ad hoc structure, feeding readers a series of loosely connected literature reviews made more understandable to non-experts. This meat of this concerns the four major chronic killers: metabolic disease, cardiovascular disease, cancer, and neurodegeneration. Only the final two chapter directly address themselves to tackling aging in a proactive way, providing little in the way of actionable insights and highlighting few exciting innovation on the longevity front.
The anticlimactic nature of Super Agers isn't surprising. Medical science has very little to offer in the way of significant advances in aging at this time. Lifestyle choices are the most accessible levers available to pull for everyday people, but the ability for people to pull those levers concerns forces that are largely out of their control, specifically genetic predispositions and their social niches and resources. This unfortunate constraint is hardly acknowledge by Topol. Even when lifestyle factors are maximized most of these gains will be marginal at best. This doesn't mean they're not worthwhile to some, but many people will simply not care enough to be overly invested in building healthy habits and this is a sensible tradeoff. Ultimately, it is mostly about avoiding the penalty of really damaging behavioral patterns or the dysfunctional physiological states they can induce and seeking proper medical care at the right moments.
There were a number of important bright spots in the book. Topol heartily embraces polygenic risk scores to guide care as well as a number of other emerging precision approaches. He also celebrates the advances observed in the GLP-1 agonist class of drugs. These were great albeit obvious inclusion in my view. The book would have also benefitted from a more urgent tone concerning the need for more rigorous research. I was a bit concerned how eagerly Topol championed findings from observational work or loosely controlled, underpowered clinical studies.
All in all, this is solid work covering some of the latest medical research on conditions that shorten lifespans and provides some insights into the future ways that medical science may tackle aging so as to extend healthspans.
*Disclosure: Received this book as an ARC from NetGalley
May 31, 2025
Thorough And Evidence Based Analysis
Super Agers was much better than expected. Eric has written extensively about patient empowerment, personalized medicine, and the advent of wearable devices and tracking and artificial intelligence enhancing medical diagnostics and treatment. I thought this might be a bit of a lightweight topic for him, but he has taken it on quite seriously.
He has also taken on a few of the people who are aggressively promoting a good number of changes to achieve longevity. Some of these individuals do sell services and products that they say will enhance longevity and health. But sometimes the experiment and go down some awkward and nonproductive roads. An example would be one of the most prominent physicians advocating, many changes, including lifestyle, changes for Jeopardy and increasing health span advocated three day water only fast for a long time. He also did keto for a considerable period of time, but has given up on that also. Eric appears not to be a fan of non-Plant based keto however, I personally have found that to be quite successful in altering my A1c fasting glucose and essentially reversing values that were consistent with diabetes type two. Often this diet was told to be bad for your lipid profile and not sustainable, but I have sustained it and maintain a low A1c value of 5.2 for last six years.
But Eric seems to be quite right on many of the other topics that he’s covered and I recommend this for a scientifically literate individual as he doesn’t spend a lot of time going over the basics. And 20% of the book is relegated to footnotes for the right reader. This is definitely a five star book for others. It may only be a three star book.
For me, one of the highlights of Twitter, is to be able to read Eric’s thoughts on different aspects of medicine every day.
Super Agers was much better than expected. Eric has written extensively about patient empowerment, personalized medicine, and the advent of wearable devices and tracking and artificial intelligence enhancing medical diagnostics and treatment. I thought this might be a bit of a lightweight topic for him, but he has taken it on quite seriously.
He has also taken on a few of the people who are aggressively promoting a good number of changes to achieve longevity. Some of these individuals do sell services and products that they say will enhance longevity and health. But sometimes the experiment and go down some awkward and nonproductive roads. An example would be one of the most prominent physicians advocating, many changes, including lifestyle, changes for Jeopardy and increasing health span advocated three day water only fast for a long time. He also did keto for a considerable period of time, but has given up on that also. Eric appears not to be a fan of non-Plant based keto however, I personally have found that to be quite successful in altering my A1c fasting glucose and essentially reversing values that were consistent with diabetes type two. Often this diet was told to be bad for your lipid profile and not sustainable, but I have sustained it and maintain a low A1c value of 5.2 for last six years.
But Eric seems to be quite right on many of the other topics that he’s covered and I recommend this for a scientifically literate individual as he doesn’t spend a lot of time going over the basics. And 20% of the book is relegated to footnotes for the right reader. This is definitely a five star book for others. It may only be a three star book.
For me, one of the highlights of Twitter, is to be able to read Eric’s thoughts on different aspects of medicine every day.
July 13, 2025
DNF - I did something I consider to be a cardinal sin while reading books, halfway through I ditched it and ChatGPTd the remaining half with a 3 page summary request and a few deep dives. The book contains a rambling bunch of stats and charts and studies that might suit clinicians or scientists , but unfortunately he’s targeted the book towards the common reader.
Virtually zero actionable suggestions for practical implementation, the few that were there were common sense and taken from “How Not to Die” (a much more informative read). Skip skip skip.
Virtually zero actionable suggestions for practical implementation, the few that were there were common sense and taken from “How Not to Die” (a much more informative read). Skip skip skip.
May 20, 2025
DNF@ 35% I absolutely loved his previous book about AI in medicine, but after going through more than a third of this one, I was sadly not impressed. Up until this point, it was simply a run down of studies and their findings. I'd like to see his recommendations clearly laid out with studies supporting each one so there is more of a practical structure instead of having a section on MI, a section on diabetes, etc etc. It was very disconnected because of this structural organization choice.
Possibly he gets into his recommendations later? Disappointing. Maybe I'll give it another try in the future.
Possibly he gets into his recommendations later? Disappointing. Maybe I'll give it another try in the future.
August 3, 2025
Dr. Eric Topol a prominent physician-scientist, cardiologist, prolific writer, and founder and current director of the Scripps Research Translational Institute. As a fellow physician and big picture thinker who shares Dr. Topol's passion for connecting trends before they hit the mainstream, I've very much enjoyed Dr. Topol's prior books, especially 2019's Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again. That said, the challenge with this genre is built into the premise: futurist medical books tend to age about as gracefully as unrefrigerated dairy. Once the predictions either pan out or don’t (like Dr. Topol's now-regrettable sunny-eyed take on disgraced biotech company Theranos -- though to be fair, many smart people were hoodwinked), their shelf life gets… compressed.
Dr. Topol's latest book, 2025's Super Agers, is no exception. Clocking in at 464 pages (or 15 hours in audiobook format), it’s a densely packed, occasionally repetitive, and highly technical look at the science of aging—squarely aimed at a healthcare-literate audience. Topol dives into the difference between lifespan (how long we live) and healthspan (how long we live healthily without significant quality of life impairments), and as someone in his early 70s himself, there’s a certain urgency to the discussion. He synthesizes a lot of peer-reviewed literature in discussing how we age—and how we might do so better. For the most part, the analysis is measured and grounded (thankfully the extreme antics of the likes of Bryan Johnson and the Biomedical Research & Longevity Society, formerly the Life Extension Foundation, aren't lauded). But at times, especially when he ventures into genomics (the field I work in) and polygenic risk scores, the optimism feels a bit premature. I’d call myself cautiously curious; Topol is quite bullish.
Overall, this is an engaging if hefty read, best suited to healthcare professionals or science-minded readers who plan to tackle the content soon, before the inevitable obsolescence kicks in. If you’re new to Dr. Topol’s work, I’d actually recommend starting with some of his earlier titles, which are tighter, more accessible, and still at least somewhat relevant.
Further reading:
Methuselah's Zoo: What Nature Can Teach Us about Living Longer, Healthier Lives by Seven Austad
Being Mortal: Medicine and What Matters in the End by Atul Gawande, MD
How Medicine Works and When It Doesn't: Learning Who to Trust to Get and Stay Healthy by F. Perry Wilson, MD
My statistics:
Book 239 for 2025
Book 2165 cumulatively
Dr. Topol's latest book, 2025's Super Agers, is no exception. Clocking in at 464 pages (or 15 hours in audiobook format), it’s a densely packed, occasionally repetitive, and highly technical look at the science of aging—squarely aimed at a healthcare-literate audience. Topol dives into the difference between lifespan (how long we live) and healthspan (how long we live healthily without significant quality of life impairments), and as someone in his early 70s himself, there’s a certain urgency to the discussion. He synthesizes a lot of peer-reviewed literature in discussing how we age—and how we might do so better. For the most part, the analysis is measured and grounded (thankfully the extreme antics of the likes of Bryan Johnson and the Biomedical Research & Longevity Society, formerly the Life Extension Foundation, aren't lauded). But at times, especially when he ventures into genomics (the field I work in) and polygenic risk scores, the optimism feels a bit premature. I’d call myself cautiously curious; Topol is quite bullish.
Overall, this is an engaging if hefty read, best suited to healthcare professionals or science-minded readers who plan to tackle the content soon, before the inevitable obsolescence kicks in. If you’re new to Dr. Topol’s work, I’d actually recommend starting with some of his earlier titles, which are tighter, more accessible, and still at least somewhat relevant.
Further reading:
Methuselah's Zoo: What Nature Can Teach Us about Living Longer, Healthier Lives by Seven Austad
Being Mortal: Medicine and What Matters in the End by Atul Gawande, MD
How Medicine Works and When It Doesn't: Learning Who to Trust to Get and Stay Healthy by F. Perry Wilson, MD
My statistics:
Book 239 for 2025
Book 2165 cumulatively
April 6, 2025
I’m a sucker for wanting to live a long and healthy life. So, this book is admittedly right up my alley! Dr. Topol summarizes and synthesizes the latest medical research on conditions that influence human health and longevity. The content is presented in a clear, actionable format, with compelling arguments that inspired me to make several life changes. I find myself quoting and referencing relevant passages almost daily.
Who is this book for?
1 The layperson seeking to live their healthiest life.
2 The advocate or caregiver searching for additional guidance.
3 The medical professional or researcher looking to stay informed about the latest data.
Your approach to the book may differ depending on your background. While it contains dense sections of supporting data—a minimum standard in scientific works—these can be skipped by lay readers and caregivers, whereas technical readers will appreciate diving deeper into the weeds.
Last, but most importantly: Can you trust Dr. Topol? My research shows that he is a highly experienced, respected, and ethical medical professional.
Thanks to Eric Topol, Simon & Schuster and NetGalley for the Advance Reader Copy (ARC)!
Who is this book for?
1 The layperson seeking to live their healthiest life.
2 The advocate or caregiver searching for additional guidance.
3 The medical professional or researcher looking to stay informed about the latest data.
Your approach to the book may differ depending on your background. While it contains dense sections of supporting data—a minimum standard in scientific works—these can be skipped by lay readers and caregivers, whereas technical readers will appreciate diving deeper into the weeds.
Last, but most importantly: Can you trust Dr. Topol? My research shows that he is a highly experienced, respected, and ethical medical professional.
Thanks to Eric Topol, Simon & Schuster and NetGalley for the Advance Reader Copy (ARC)!
February 25, 2025
The author of this book is a physician and, although marketed to the general public, this book would be more useful to those in the medical community. He discusses a number of ways to increase lifespan including lifestyle, supplements and drugs. There are numerous research studies summarized with a good number of charts included. The book is organized into chapters that discuss various aspects of the study of aging including genetics, lifestyle, cardiovascular disease, cancer, neurodegeneration and others. One concluding statement was hopeful: "We are going to see major progress in prevention of age-related diseases and preserving organ-specific health". As a nutritionist and one who believes in the powers of diet, exercise and other lifestyle habits, I agree with one of Topol's conclusions. "We need to maintain our healthy aging, predominately by focusing on lifestyle plus means, so that we can get to the next phase of digital biology deliverables".
If you are interested in a book that gives a rather comprehensive summary of the current research this book would be for you. I received a complementary copy of this book from the publisher via NetGalley.
If you are interested in a book that gives a rather comprehensive summary of the current research this book would be for you. I received a complementary copy of this book from the publisher via NetGalley.
June 5, 2025
I’m giving this 4⭐️ and not 3 because I believe the fault lies with me. I didn’t know what I was getting in to and that is on me for just jumping in with not much knowledge.
It was dry, technical, and dense. A lot of the ideas and medical breakthroughs were very interesting, but it wasn’t information that I could take and implement in my own life. I do worry it’s being mis-marketed - it is not a “how-to” guide. It is a summary of various medical studies and research about how medicine will be used in the near future for things like obesity, cancer, and Alzheimer’s. It did not have any new tips someone could use to age better right now.
It was dry, technical, and dense. A lot of the ideas and medical breakthroughs were very interesting, but it wasn’t information that I could take and implement in my own life. I do worry it’s being mis-marketed - it is not a “how-to” guide. It is a summary of various medical studies and research about how medicine will be used in the near future for things like obesity, cancer, and Alzheimer’s. It did not have any new tips someone could use to age better right now.
June 2, 2025
The most well-researched and thoroughly evidence-based work about longevity I’ve read. Incredibly data dense, but super approachable and accessible, even for a dumdum like me.
I learned a lot of simple, common sense lifestyle shifts I’m actively making to try to increase my own healthspan, as well as good questions to ask and tests to request when speaking with medical providers.
I hope not only to live long, but also to live well - if that’s also a goal you share, I really cannot recommend this book enough. I listened to the audiobook and it felt like having a long conversation with a physician who really cared about me.
I learned a lot of simple, common sense lifestyle shifts I’m actively making to try to increase my own healthspan, as well as good questions to ask and tests to request when speaking with medical providers.
I hope not only to live long, but also to live well - if that’s also a goal you share, I really cannot recommend this book enough. I listened to the audiobook and it felt like having a long conversation with a physician who really cared about me.
September 3, 2025
Appreciate the data driven approach. Some points, including the title, seemed gimmicky but the focus on prevention and healthy lifestyle was more motivating than I expected. The discussion on access and affordability and social determinants of health was also really interesting.
September 4, 2025
Makes me hopeful on a few things.
May 26, 2025
There were things I already knew about, other things I don’t care to know about, and other things that I found highly annoying, e.g. avoid highly processed foods but embrace taking many medications that have not been subject to long-term studies (I’m looking at you GLP-1’s). References to diagnostic tests that could be done to prevent the onset of disease, but who is getting tested for things they show no symptoms of? I’m not, and I receive some of the best healthcare ever offered in the history of mankind. So yeah, go get yourself tested for something you might one day have and freak yourself out while you do whatever you can to prevent its onset. Sheesh. No thanks. Exercise, eat nourishing and nutritious meals, and go enjoy life.
August 4, 2025
Basandosi sulle intuizioni del Dott. Eric Topol, rinomato cardiologo e scienziato, e sui concetti esplorati nel suo nuovo libro "Super Agers" e nella sua newsletter "Ground Truths", ecco dieci consigli essenziali per promuovere un invecchiamento sano e migliorare la qualità della vita, attingendo alla vasta collezione di fonti a disposizione. Il Dott. Topol e la sua analisi approfondita delle evidenze scientifiche suggeriscono che l'attenzione a questi aspetti del "lifestyle+" può avere un impatto profondo sulla nostra salute.
Ecco i dieci consigli fondamentali:
1. Limitare drasticamente gli alimenti ultra-processati (UPF). Eric Topol li definisce "alieni, prodotti industrialmente, sostanze innaturali" che non sono nemmeno vero cibo. Questi alimenti sono legati a un rischio significativamente maggiore di malattie cardiovascolari e metaboliche, diabete di tipo 2, ipertensione, obesità e deterioramento cognitivo. È fondamentale leggere le etichette ed evitare prodotti con additivi, zuccheri aggiunti o falsi e con troppi ingredienti.
2. Adottare un modello alimentare mediterraneo. Questo approccio alimentare è ampiamente supportato da studi che ne dimostrano i benefici per la riduzione della mortalità per tutte le cause, le malattie cardiovascolari, il cancro e le malattie neurodegenerative. Si concentra su frutta e verdura, legumi, cereali integrali, noci e semi, grassi sani come l'olio d'oliva e gli avocado, e pesce grasso ricco di omega-3.
3. Praticare esercizio fisico regolare e diversificato. Come evidenziato da Eric Topol e dal Professor Euan Ashley, l'esercizio può essere considerato "il singolo intervento medico più potente mai conosciuto". Ha un impatto favorevole su tutti i sistemi d'organo, compresi il sistema cardiovascolare, il cervello, i muscoli e il sistema immunitario. È consigliabile combinare attività aerobica e allenamento di forza/resistenza, oltre a lavorare sulla flessibilità e l'equilibrio. Anche un'attività frammentata e di breve durata è utile per iniziare.
4. Dare priorità a circa sette ore di sonno di qualità. Il sonno è uno stato biologico non negoziabile, essenziale per la salute. Durante il sonno, in particolare nella fase non-REM (sonno profondo), il sistema glinfatico del cervello elimina i prodotti di scarto metabolico, comprese le proteine tossiche come il beta-amiloide, precursore della malattia di Alzheimer. La deprivazione del sonno o un sonno di scarsa qualità sono associati a un aumento del rischio di demenza. Mantenere una regolarità negli orari di sonno-veglia, evitare pasti tardivi, alcol prima di coricarsi e la luce blu dei dispositivi elettronici sono pratiche cruciali.
5. Moderare il consumo di sale, bevande zuccherate e alcol. Le bevande altamente zuccherate sono costantemente associate a un aumento della mortalità. Sebbene un consumo moderato di sale sia accettabile (1-2 cucchiaini al giorno), livelli superiori a 5 grammi al giorno aumentano il rischio cardiovascolare. Il Dott. Topol sottolinea che "sia il consumo moderato che quello pesante [di alcol] non fanno bene" e che le bevande alcoliche sono classificate come cancerogene.
6. Minimizzare l'esposizione a tossine ambientali. La definizione di "lifestyle+" del Dott. Topol include l'attenzione alle condizioni ambientali. Questo significa essere consapevoli dell'inquinamento atmosferico e, in particolare, delle microplastiche e delle "sostanze chimiche per sempre" (PFAS). Le microplastiche, ubiquitarie nel nostro ambiente, sono state trovate in vari tessuti umani, incluso il cervello, e sono associate a gravi rischi per la salute. Per limitare l'esposizione, Topol consiglia di evitare contenitori di plastica per alimenti, fast food e cibi ad alto contenuto di grassi, preferendo bottiglie in vetro o acciaio e utensili da cucina in legno o acciaio.
7 Scegliere carboidrati di alta qualità e grassi sani. Il tipo di macronutriente è fondamentale. Privilegiate i carboidrati non trasformati come amido resistente, fibre alimentari, verdure non amidacee, legumi, frutta e cereali integrali. Per quanto riguarda i grassi, preferite i grassi insaturi mono- o polinsaturi di origine vegetale, poiché il passaggio dai grassi saturi e trans è associato a una sostanziale riduzione del rischio di malattie cardiovascolari e diabete di tipo 2.
8. Essere scettici nei confronti della maggior parte degli integratori alimentari. Il Dott. Topol consiglia di prenderli "con un pizzico di sale", poiché ci sono "poche o nessuna prova concreta del beneficio di assumere vitamine o integratori", specialmente per coloro che seguono già una dieta sana. Alcuni, come il calcio con la vitamina D o la niacina, sono stati addirittura associati a potenziali rischi.
9. Coltivare forti connessioni sociali. La solitudine e l'isolamento sociale sono riconosciuti come gravi problemi di salute pubblica, associati a un aumento significativo della mortalità per tutte le cause, cardiovascolare e legata al cancro. Coltivare relazioni e l'impegno nella comunità è una componente vitale di uno stile di vita sano.
10. Considerare gli approcci alla nutrizione personalizzata, come la "dieta AI", con consapevolezza**. L'idea di una dieta universale "taglia unica" è considerata "ingenua" a causa dell'unicità biologica di ogni individuo. Il Dott. Topol sottolinea come l'intelligenza artificiale e la proteomica ad alto rendimento stiano avanzando la nostra comprensione della nutrizione personalizzata, basata su genoma, metabolismo e microbioma intestinale. Sebbene sia ancora nelle fasi iniziali, strumenti come i sensori di glucosio continuo possono aiutare a comprendere le risposte individuali al cibo, all'esercizio e al sonno.
Questi consigli, tratti dal lavoro del Dott. Topol, sottolineano l'importanza di un approccio olistico alla salute e all'invecchiamento, che va oltre le cure mediche tradizionali e abbraccia l'empowerment individuale attraverso scelte di vita informate.
Ecco i dieci consigli fondamentali:
1. Limitare drasticamente gli alimenti ultra-processati (UPF). Eric Topol li definisce "alieni, prodotti industrialmente, sostanze innaturali" che non sono nemmeno vero cibo. Questi alimenti sono legati a un rischio significativamente maggiore di malattie cardiovascolari e metaboliche, diabete di tipo 2, ipertensione, obesità e deterioramento cognitivo. È fondamentale leggere le etichette ed evitare prodotti con additivi, zuccheri aggiunti o falsi e con troppi ingredienti.
2. Adottare un modello alimentare mediterraneo. Questo approccio alimentare è ampiamente supportato da studi che ne dimostrano i benefici per la riduzione della mortalità per tutte le cause, le malattie cardiovascolari, il cancro e le malattie neurodegenerative. Si concentra su frutta e verdura, legumi, cereali integrali, noci e semi, grassi sani come l'olio d'oliva e gli avocado, e pesce grasso ricco di omega-3.
3. Praticare esercizio fisico regolare e diversificato. Come evidenziato da Eric Topol e dal Professor Euan Ashley, l'esercizio può essere considerato "il singolo intervento medico più potente mai conosciuto". Ha un impatto favorevole su tutti i sistemi d'organo, compresi il sistema cardiovascolare, il cervello, i muscoli e il sistema immunitario. È consigliabile combinare attività aerobica e allenamento di forza/resistenza, oltre a lavorare sulla flessibilità e l'equilibrio. Anche un'attività frammentata e di breve durata è utile per iniziare.
4. Dare priorità a circa sette ore di sonno di qualità. Il sonno è uno stato biologico non negoziabile, essenziale per la salute. Durante il sonno, in particolare nella fase non-REM (sonno profondo), il sistema glinfatico del cervello elimina i prodotti di scarto metabolico, comprese le proteine tossiche come il beta-amiloide, precursore della malattia di Alzheimer. La deprivazione del sonno o un sonno di scarsa qualità sono associati a un aumento del rischio di demenza. Mantenere una regolarità negli orari di sonno-veglia, evitare pasti tardivi, alcol prima di coricarsi e la luce blu dei dispositivi elettronici sono pratiche cruciali.
5. Moderare il consumo di sale, bevande zuccherate e alcol. Le bevande altamente zuccherate sono costantemente associate a un aumento della mortalità. Sebbene un consumo moderato di sale sia accettabile (1-2 cucchiaini al giorno), livelli superiori a 5 grammi al giorno aumentano il rischio cardiovascolare. Il Dott. Topol sottolinea che "sia il consumo moderato che quello pesante [di alcol] non fanno bene" e che le bevande alcoliche sono classificate come cancerogene.
6. Minimizzare l'esposizione a tossine ambientali. La definizione di "lifestyle+" del Dott. Topol include l'attenzione alle condizioni ambientali. Questo significa essere consapevoli dell'inquinamento atmosferico e, in particolare, delle microplastiche e delle "sostanze chimiche per sempre" (PFAS). Le microplastiche, ubiquitarie nel nostro ambiente, sono state trovate in vari tessuti umani, incluso il cervello, e sono associate a gravi rischi per la salute. Per limitare l'esposizione, Topol consiglia di evitare contenitori di plastica per alimenti, fast food e cibi ad alto contenuto di grassi, preferendo bottiglie in vetro o acciaio e utensili da cucina in legno o acciaio.
7 Scegliere carboidrati di alta qualità e grassi sani. Il tipo di macronutriente è fondamentale. Privilegiate i carboidrati non trasformati come amido resistente, fibre alimentari, verdure non amidacee, legumi, frutta e cereali integrali. Per quanto riguarda i grassi, preferite i grassi insaturi mono- o polinsaturi di origine vegetale, poiché il passaggio dai grassi saturi e trans è associato a una sostanziale riduzione del rischio di malattie cardiovascolari e diabete di tipo 2.
8. Essere scettici nei confronti della maggior parte degli integratori alimentari. Il Dott. Topol consiglia di prenderli "con un pizzico di sale", poiché ci sono "poche o nessuna prova concreta del beneficio di assumere vitamine o integratori", specialmente per coloro che seguono già una dieta sana. Alcuni, come il calcio con la vitamina D o la niacina, sono stati addirittura associati a potenziali rischi.
9. Coltivare forti connessioni sociali. La solitudine e l'isolamento sociale sono riconosciuti come gravi problemi di salute pubblica, associati a un aumento significativo della mortalità per tutte le cause, cardiovascolare e legata al cancro. Coltivare relazioni e l'impegno nella comunità è una componente vitale di uno stile di vita sano.
10. Considerare gli approcci alla nutrizione personalizzata, come la "dieta AI", con consapevolezza**. L'idea di una dieta universale "taglia unica" è considerata "ingenua" a causa dell'unicità biologica di ogni individuo. Il Dott. Topol sottolinea come l'intelligenza artificiale e la proteomica ad alto rendimento stiano avanzando la nostra comprensione della nutrizione personalizzata, basata su genoma, metabolismo e microbioma intestinale. Sebbene sia ancora nelle fasi iniziali, strumenti come i sensori di glucosio continuo possono aiutare a comprendere le risposte individuali al cibo, all'esercizio e al sonno.
Questi consigli, tratti dal lavoro del Dott. Topol, sottolineano l'importanza di un approccio olistico alla salute e all'invecchiamento, che va oltre le cure mediche tradizionali e abbraccia l'empowerment individuale attraverso scelte di vita informate.
June 19, 2025
This was a cool textbook masquerading as a gen market book. HEAVY on the evidence-based in the title.
Going to go ahead and say that this is not very accessible to anyone not at least tangentially connected to the medical/biological research field. If you're looking for a gen pop exploration of longevity, "Outlive", although probably already outdated, is probably more what you're looking for.
Going to go ahead and say that this is not very accessible to anyone not at least tangentially connected to the medical/biological research field. If you're looking for a gen pop exploration of longevity, "Outlive", although probably already outdated, is probably more what you're looking for.
July 9, 2025
There is very little discussion of how the super agers become super agers. There isn’t enough here about what we can adjust in our lifestyle to become super agers. There is a lot of writing about all the potential medical treatments that may benefit us in the future. A better read is Michael Gregeor’s “How Not to Die”
January 12, 2026
The author offers an engaging and optimistic synthesis of cutting-edge biomedical science, but its central weakness lies in its techno-centric bias and uneven treatment of feasibility. While Topol compellingly translates advances in genomics, AI, and precision medicine into an accessible narrative, the book tends to overstate the near-term scalability and equity of these innovations, underplaying structural constraints such as cost, healthcare system fragmentation, and global disparities in access. Moreover, the emphasis on individualized, data-driven longevity solutions occasionally crowds out deeper discussion of social, behavioral, and environmental determinants of healthy aging—factors that remain empirically more impactful for most populations. The book, however, is a visionary roadmap for what could be possible, but less convincing as a balanced guide to what is broadly achievable in real-world aging societies today.
July 7, 2025
Very optimistic and detailed look at aging and health. Lots of mention of the benefits of AI for drug discovery and extending human health. Lots of biochemical details were above my head.
Favorite quote on some of the crazy health trends the rich are pursuing: "When they were young they wanted to be rich. now that they are rich, they want to be young."
Favorite quote on some of the crazy health trends the rich are pursuing: "When they were young they wanted to be rich. now that they are rich, they want to be young."
July 11, 2025
I was disappointed in this book, maybe because it was not what I had anticipated. It would be perfect for a medical school student wanting to know possible future pharmaceuticals and procedures for mitigating or eliminating the effects of diseases and conditions that impact our health span. A lot of focus on genetic editing, stem cell research and drugs. The author seemed to especially have a proclivity for glp1 agonist drugs.
December 28, 2025
Very very dense and goes into a lot of technical detail. If you're going to read it, read it now. It will be out of date relatively soon as the science is moving quickly.
Recommendations, however are much the same as we've heard for years: exercise, sleep, and eat a diet with a lot of vegetables and little processed junk.
Recommendations, however are much the same as we've heard for years: exercise, sleep, and eat a diet with a lot of vegetables and little processed junk.
June 1, 2025
This is a very intense read. It is super scientific and really gets into the details. I think that he highlights the issue about health inequity, who will be able to afford these $2 million treatments? Also, we’re not changing all of the things that are causing these problems like a bad diet, pollution and micro plastics. I’ll stick with broccoli and going for a walk in nature!
June 16, 2025
If you like scientific, evidence-based medicine & information, you will love this book.
If you’re looking for the ‘rules’ to become a super-ager, you won’t find it here & will ultimately hate this book.
You decide. 🫶
If you’re looking for the ‘rules’ to become a super-ager, you won’t find it here & will ultimately hate this book.
You decide. 🫶
August 30, 2025
A lot of interesting info. Actually too much and too detailed, but still good stuff.
November 24, 2025
No notes.
October 18, 2025
A very uplifting book reporting on scientific achievements that are helping people live longer healthier lives. He gives a lot of credit to AI for aiding in the progress. He also holds out hope that the GLP1 drugs will be found to be helpful in the treatment of more chronic diseases in addition to Diabetes.
July 30, 2025
As non-interestingly written as possible - blah
August 8, 2025
The “lifestyle+” and concluding chapters were gold. Most of the rest was really too technical for the lay reader.
August 29, 2025
Really 2.5…and not for non science folks. GLP-1, gut microbiome, AI…rinse and repeat.
May 1, 2025
Discover how revolutionary new treatments are transforming the fight against chronic diseases and extending healthy lifespans. This informative, evidence-based guide explores breakthroughs in diabetes, heart disease, cancer, and neurodegeneration, offering hope for a healthier future for you and your loved ones. The book is easy to understand and founded on the latest medical discoveries.
Thanks, NetGalley, for the ARC I received. This is my honest and voluntary review.
Thanks, NetGalley, for the ARC I received. This is my honest and voluntary review.
October 25, 2025
I acknowledge up-front that it’s easier to criticise than it is to produce a literary work. And there is a huge amount of, fairly detailed, biochemistry in this book. Yes, Topol tries to make it accessible to a general reader, and the diagrams certainly help a lot. But, I’ve got a reasonable background in chemistry and biochemistry, and I found it a slog. And, I skipped over many sections..... rather than trying to understand/remember exactly how “Abatacept binds to its CD80 and CD 86 receptors to block T Cell activation” .
One thing, I did find slightly disconcerting was his proclivity for citing studies that were either non randomised or very small samples, or, in general, studies that, in my opinion, would not count as “evidenced based”. I think his enthusiasm for “what lies ahead” outpaced the requirement for real “evidence based” research.
Sometimes he is a bit misleading, for example, (p185) he speaks of a single injection impacting a gene and achieving a reduction in LDL Cholesterol in monkey, then leads straight into the observation “that if it works and is safe ..that people with a high risk of coronary and heart disease...a disease that kills about 700,000 Americans a year would be potential candidates”. To me, this link seems a bit of a stretch and potential over-claiming..almost in the “gee-whiz” category. Surely, not everybody with high LDL cholesterol needs this sort of therapy and surely there are other causes of coronary and heart disease.
I rather got the impression that what we have here is the Topol’s own review of literature in his field. Are we reading his summary cards of all the scientific articles he’s been reading? And how much of this is from his weekly newsletter? It’s almost like he’s trying to summarise all the on-going research in his field and make some guesses about where it is going. And, to some extent, that is exactly what I was looking for. The down-side is the huge number of diseases that he tries to cover...for example, type 1 diabetes, lupus, rheumatoid arthritis, multiple sclerosis....and often it’s a bit superficial with a throw-away line about some line of research being “promising”. One thing I DID like was that he connects with the original scientific papers so one can read the original research. (Frequently, I found it less exuberant in its claims than Topol).
I found this paragraph of considerable interest and concern: “According to the World Health Organization, the average American celebrates just one healthy birthday after the age of sixty-five.....For Americans aged sixty years and above, 95 percent have at least one chronic disease, such as heart disease or diabetes, and 79 percent have at least two chronic conditions” Wow!
Topol himself sums up his thoughts in the following words:
“Overriding the aging process poses profound challenges. It’s hard to prove in people....Many of the potential ways we must alter the pace of aging carry a serious risk of cancer....One of the other obstacles that holds back a drug or intervention to promote lifespan is that aging is not considered a disease by regulatory agencies.....We have little data to support that slowing the aging process leads to a “compression of morbidity,” the concept initially proposed by James Fries in the early 1980s.....Fries proposed that over time we are moving toward an “ideal survivorship curve,” meaning that we extend healthy aging and there’s minimal time for chronic illness (fig. 13.1, left panel), as if a person suddenly falls off the cliff or dies with intact health in their sleep.
While it would be ideal for people who made it healthy, well into their eighties or nineties not to have to suffer dementia, cancer, cardiovascular disease, or frailty for many years, it’s hard to find any support for this concept.....There’s no evidence yet for safely and effectively slowing the aging process in human beings.....Notwithstanding these difficulties, I do believe we will ultimately see body-wide modulation of aging.....Most age-related diseases have a long warm-up period of at least one to two decades before symptoms manifest.
AI appears to be capable of reliably predicting tipping points before they happen in complex systems....This precision medical forecasting allows for intensive lifestyle + factors to be put in place for the individual.
Potent anti-inflammatory drug or partial epigenetic programming could be used to target an organ but might wind up slowing the aging process throughout the body.....The exponential growth we have seen with generative AI will be paralleled by the same in digital biology.
There’s a pervasive belief that we’re either immunocompetent or immunocompromised. That’s wrong!....By conducting an “immunome,” we will be able to predict a person’s response to infections, vulnerability to cancer or its spread, and propensity for developing cardiovascular and neurodegenerative diseases.
What if we could periodically grade an individual’s immune system?....A company called Infinity Bio19 amazingly, can take a small amount of blood and determine a person’s exposure to over five hundred viruses via their antibodies. In the same assay, the new technology can detect hundreds of autoimmune antibodies.....It is currently only available for research projects.....For a preview, my results for this test are presented in figure 13.4.
If we could get an immunome on a periodic basis, it could help to pinpoint our arc to immunosenescence and guide our decisions about potential interventions.
Until now, our medical approach has been reactive, with secondary prevention at best. A patient has a heart attack; we put them on statins and aspirin to prevent another event. For a diabetic, we treat blood sugar and lower the hemoglobin A1c.
There are two factors that remain the most formidable obstacles. One is our profound health inequity. [in the USA]. .....If expanding health span turns out to be only for the rich and privileged, then it can be considered an abject failure.....Our lack of a universal health system in the United States, the singular outlier of rich countries in the world, puts us at an unnecessary disadvantage for promoting health span expansion at the population level.
The second great obstacle is about chasing our own tails. How can we simultaneously be hyper-innovative for extending health span but ignore all the things that are shortening it?
Air pollution, micro and nanoplastics, the toxic PFAS forever chemicals, intake of ultra-processed foods....And anti-science is a threat that can only be addressed through a restoration of trust in biomedical expertise”.
My main take-away from the book is the significance of exercise. Here is what Topol himself says: Nothing surpasses regular exercise for promotion of healthy aging! Exercise can be viewed as the single most effective medical intervention that we know. Regular exercise leads to favourable adaptations of the cardiovascular system, brain, pancreas, skeletal muscle, gastrointestinal tract (enhanced production of short-chain fatty acids, SCFA), liver, adipose tissue, gut microbiome, and peripheral blood vessels.....Further, exercise protects against atherosclerosis and improves cardiovascular function.
A randomized trial showed inflammation biomarkers were suppressed more with exercise than with a GLP-1 drug.......Compared with no exercise, briskly walking 450 minutes178 per week was associated with living 4.5 years longer.....That evidence comes from a cohort of more than 650,000 individuals followed for over a decade.....A systematic review of 196 studies with more than thirty million participants reported the link to a 31 percent reduction of all-cause mortality, with a “dose response” of more activity, more benefit.
The much ballyhooed 10,000-step goal was supported by a UK Biobank study of over 72,000 participants, which found the lowest mortality risk was seen for 9,000 to 10,500 steps per day....A significant dose-response curve of benefit—the more exercise, the less cancer—was seen across seven cancer types (colon, breast, kidney, liver, myeloma, non-Hodgkin lymphoma, and endometrial).....The relationship between physical exercise and cognition has been intensively studied,.....A review of the randomized trials suggests that the favourable impact of exercise is consistent but small”. [Which seems to be rather a damp squib after all the earlier build-up but at least it’s consistent and positive].
What’s my overall take on the book? Generally a bit overwhelmed by the coverage and the detail and the number of variables involved. It’s clearly not a simple field of endeavour. And I’ve given up trying to summarise it here. Generally, he writes well and makes things understandable. A bit of repetition in places...maybe unavoidable. And the worrying tendency to cite non-randomised, one off (let alone double-blind) studies. Am I going to live longer as a result. No. I don’t think so. And, I suspect that we have already seen the greatest advance in the field with the reduction in cigarette smoking. It will be hard to match that. And I suspect that effect impacts all the statistics on longevity too. Happy to give it five stars.
One thing, I did find slightly disconcerting was his proclivity for citing studies that were either non randomised or very small samples, or, in general, studies that, in my opinion, would not count as “evidenced based”. I think his enthusiasm for “what lies ahead” outpaced the requirement for real “evidence based” research.
Sometimes he is a bit misleading, for example, (p185) he speaks of a single injection impacting a gene and achieving a reduction in LDL Cholesterol in monkey, then leads straight into the observation “that if it works and is safe ..that people with a high risk of coronary and heart disease...a disease that kills about 700,000 Americans a year would be potential candidates”. To me, this link seems a bit of a stretch and potential over-claiming..almost in the “gee-whiz” category. Surely, not everybody with high LDL cholesterol needs this sort of therapy and surely there are other causes of coronary and heart disease.
I rather got the impression that what we have here is the Topol’s own review of literature in his field. Are we reading his summary cards of all the scientific articles he’s been reading? And how much of this is from his weekly newsletter? It’s almost like he’s trying to summarise all the on-going research in his field and make some guesses about where it is going. And, to some extent, that is exactly what I was looking for. The down-side is the huge number of diseases that he tries to cover...for example, type 1 diabetes, lupus, rheumatoid arthritis, multiple sclerosis....and often it’s a bit superficial with a throw-away line about some line of research being “promising”. One thing I DID like was that he connects with the original scientific papers so one can read the original research. (Frequently, I found it less exuberant in its claims than Topol).
I found this paragraph of considerable interest and concern: “According to the World Health Organization, the average American celebrates just one healthy birthday after the age of sixty-five.....For Americans aged sixty years and above, 95 percent have at least one chronic disease, such as heart disease or diabetes, and 79 percent have at least two chronic conditions” Wow!
Topol himself sums up his thoughts in the following words:
“Overriding the aging process poses profound challenges. It’s hard to prove in people....Many of the potential ways we must alter the pace of aging carry a serious risk of cancer....One of the other obstacles that holds back a drug or intervention to promote lifespan is that aging is not considered a disease by regulatory agencies.....We have little data to support that slowing the aging process leads to a “compression of morbidity,” the concept initially proposed by James Fries in the early 1980s.....Fries proposed that over time we are moving toward an “ideal survivorship curve,” meaning that we extend healthy aging and there’s minimal time for chronic illness (fig. 13.1, left panel), as if a person suddenly falls off the cliff or dies with intact health in their sleep.
While it would be ideal for people who made it healthy, well into their eighties or nineties not to have to suffer dementia, cancer, cardiovascular disease, or frailty for many years, it’s hard to find any support for this concept.....There’s no evidence yet for safely and effectively slowing the aging process in human beings.....Notwithstanding these difficulties, I do believe we will ultimately see body-wide modulation of aging.....Most age-related diseases have a long warm-up period of at least one to two decades before symptoms manifest.
AI appears to be capable of reliably predicting tipping points before they happen in complex systems....This precision medical forecasting allows for intensive lifestyle + factors to be put in place for the individual.
Potent anti-inflammatory drug or partial epigenetic programming could be used to target an organ but might wind up slowing the aging process throughout the body.....The exponential growth we have seen with generative AI will be paralleled by the same in digital biology.
There’s a pervasive belief that we’re either immunocompetent or immunocompromised. That’s wrong!....By conducting an “immunome,” we will be able to predict a person’s response to infections, vulnerability to cancer or its spread, and propensity for developing cardiovascular and neurodegenerative diseases.
What if we could periodically grade an individual’s immune system?....A company called Infinity Bio19 amazingly, can take a small amount of blood and determine a person’s exposure to over five hundred viruses via their antibodies. In the same assay, the new technology can detect hundreds of autoimmune antibodies.....It is currently only available for research projects.....For a preview, my results for this test are presented in figure 13.4.
If we could get an immunome on a periodic basis, it could help to pinpoint our arc to immunosenescence and guide our decisions about potential interventions.
Until now, our medical approach has been reactive, with secondary prevention at best. A patient has a heart attack; we put them on statins and aspirin to prevent another event. For a diabetic, we treat blood sugar and lower the hemoglobin A1c.
There are two factors that remain the most formidable obstacles. One is our profound health inequity. [in the USA]. .....If expanding health span turns out to be only for the rich and privileged, then it can be considered an abject failure.....Our lack of a universal health system in the United States, the singular outlier of rich countries in the world, puts us at an unnecessary disadvantage for promoting health span expansion at the population level.
The second great obstacle is about chasing our own tails. How can we simultaneously be hyper-innovative for extending health span but ignore all the things that are shortening it?
Air pollution, micro and nanoplastics, the toxic PFAS forever chemicals, intake of ultra-processed foods....And anti-science is a threat that can only be addressed through a restoration of trust in biomedical expertise”.
My main take-away from the book is the significance of exercise. Here is what Topol himself says: Nothing surpasses regular exercise for promotion of healthy aging! Exercise can be viewed as the single most effective medical intervention that we know. Regular exercise leads to favourable adaptations of the cardiovascular system, brain, pancreas, skeletal muscle, gastrointestinal tract (enhanced production of short-chain fatty acids, SCFA), liver, adipose tissue, gut microbiome, and peripheral blood vessels.....Further, exercise protects against atherosclerosis and improves cardiovascular function.
A randomized trial showed inflammation biomarkers were suppressed more with exercise than with a GLP-1 drug.......Compared with no exercise, briskly walking 450 minutes178 per week was associated with living 4.5 years longer.....That evidence comes from a cohort of more than 650,000 individuals followed for over a decade.....A systematic review of 196 studies with more than thirty million participants reported the link to a 31 percent reduction of all-cause mortality, with a “dose response” of more activity, more benefit.
The much ballyhooed 10,000-step goal was supported by a UK Biobank study of over 72,000 participants, which found the lowest mortality risk was seen for 9,000 to 10,500 steps per day....A significant dose-response curve of benefit—the more exercise, the less cancer—was seen across seven cancer types (colon, breast, kidney, liver, myeloma, non-Hodgkin lymphoma, and endometrial).....The relationship between physical exercise and cognition has been intensively studied,.....A review of the randomized trials suggests that the favourable impact of exercise is consistent but small”. [Which seems to be rather a damp squib after all the earlier build-up but at least it’s consistent and positive].
What’s my overall take on the book? Generally a bit overwhelmed by the coverage and the detail and the number of variables involved. It’s clearly not a simple field of endeavour. And I’ve given up trying to summarise it here. Generally, he writes well and makes things understandable. A bit of repetition in places...maybe unavoidable. And the worrying tendency to cite non-randomised, one off (let alone double-blind) studies. Am I going to live longer as a result. No. I don’t think so. And, I suspect that we have already seen the greatest advance in the field with the reduction in cigarette smoking. It will be hard to match that. And I suspect that effect impacts all the statistics on longevity too. Happy to give it five stars.
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