Want to live to a healthy old age? Here’s what a top doctor does based on hard science

Exercise is the most important thing a person can to do extend their health span, longevity researcher Dr. Eric Topol says. DjelicS/E+/Getty Images via CNN Newsource

Who among us wouldn’t want to live a good life well into our 90s, especially if we could do it disease-free while still being as witty and spry as Betty White, as eloquent as Toni Morrison or as civically engaged as Jimmy Carter?

But you’d need good genes to live that long, right?

Not necessarily, according to Dr. Eric Topol, founding director of the Scripps Research Translational Institute in La Jolla, California, and former chairman of cardiovascular medicine at the Cleveland Clinic.

For almost 20 years, Topol has been studying a group of 1,400 Super Agers, or people who reached the age of 80 and beyond without developing one of three common, chronic, age-related conditions (cancer, heart disease and neurodegenerative disease), as part of the Wellderly study.

To his surprise, when his team conducted whole-genome sequencing on all the Wellderly study participants, the researchers found nothing genetic, across the board, that conferred an age and health advantage.

Topol’s new book, “Super Agers: An Evidence-Based Approach to Longevity,” explores the other factors at play and the science that backs them up. He examines lifestyle factors such as diet, exercise and sleep. He also looks at new technologies including the following :

• polygenic risk scores that sift through a person’s DNA to quantify disease risk;
• the new science of “omics” (for example, proteomics to analyze the complete set of proteins expressed by a body) that can be used to produce organ clocks measuring how fast our individual organs are aging; and
• artificial intelligence to synthesize all available health data points.

All these technologies show promise in helping more people, if not reach Super Ager status, then achieve a longer health span by either delaying the onset of disease or aggressively treating conditions to prevent progression and complications.

Topol, who will soon turn 71, practices what he preaches.

“I hope to be (a Super Ager),” he told CNN Chief Medical Correspondent Dr. Sanjay Gupta, recently, on his podcast Chasing Life. “If I can get another 10 or 15 years without an age-related disease, that’d be great. And I’ve really doubled down on the things that I can do to help get there.”

Exactly which steps has the doctor-scientist who studies Super Agers taken to increase his odds of reaching their ranks?

“I made extensive changes from the research, once we learned that it isn’t in your genes … to achieve healthy aging, free of cancer, free of cardiovascular disease and free of neurodegenerative disease,” Topol said.

Lessons taken to heart: exercise, sleep and diet

One of the biggest changes Topol said he made was to his exercise routine. “I used to only do aerobic exercise, and as a cardiologist, that was my thing,” he said. “Now I do balance training and strength training (as well). It’s an extensive difference. … And so, I’m more strong and fit than I’ve ever been.”

In fact, exercise is so important that Topol ranks it as No. 1 on the list for anyone who wants to get started on the path of a longer life.

“It’s free. And if you’re not doing anything, if you’re a sedentary, then start with walks, brisk walks if you can, and keep increasing it,” he said. “Challenge yourself (with) hills and pace … if you are working up a sweat, that’s a really good sign.” (Check with your doctor before starting any new exercise routine.)

To get your upper body in shape, he recommends resistance bands, and to improve balance, he said to practice standing on one foot, then the other. “These are all free or cost minimum,” he said, noting that with a few inexpensive items you can do your workout at home (like he does), no gym membership required. “So work on that and then other things will start to fall in place. … If you exercise more, you’ll sleep better, too.”

Which brings us to the next major change Topol made.

“I realized how important (sleep) is because of ‘glymphatics.’ That was a new insight in the book: about deep sleep and getting these waste products out of your brain,” he said, referring to the recently discovered glymphatic system, which helps flush out waste products in the brain and central nervous system, much like the lymphatic system does for the rest of the body.

“I was a poor sleeper,” he confessed, so he worked “extensively” on improving the different factors that could impact it. “Things like … what do I eat? And when do I eat? Also hydrating, mostly early in the day … to have less interrupted sleep.” He added that for him fasting is “detrimental” to his sleep, as are both exercising or eating a big meal too late in the evening.

And, do not give short shrift to sleep regularity, Topol advised. “I used to go to sleep all over the place (in terms of time), and now I’m very regimented, except for maybe one night a week,” he said, noting that this tweak was “phenomenally effective” in levelling up his sleep game.

As for diet, Topol (who hasn’t touched red meat in 40 years but does eat fish) said he wasn’t surprised the evidence showed that a plant-based diet with enough lean protein “prevailed as the best.”

“What was interesting, though, is how toxic (and) pro inflammatory ultraprocessed foods were,” he said, adding that he does everything he can to minimize UPF — which he jokingly calls UFOs, or alien food . “It’s hard to get it to zero, but I’ve (made a) conscious effort.”

Topol said he also increased his protein intake “some,” due to his age and because he started strength training, “but I don’t go to toxic levels that are advocated by others, that have no evidence (and) that are pro-inflammatory.”

He said he keeps protein to about 90 grams a day for his 180-pound (82-kilogram) frame, by adding nuts, legumes (including beans) and more fish, even canned tuna in water, to his diet.

“I generally eat a salad every night,” he said. “Now I’m a little more conscious about having something with it. … But (it’s) not the protein craze that’s being advocated by some of the extremists.”

Supplements, alcohol and stress

What about supplements and vitamins? “I don’t rule out that they could help (if) you have a specific deficiency — if for some reason your vitamin D is very low, or your vitamin B12,” Topol said.

But “for healthy people who are not symptomatic (and) who take good care of themselves,” he said, “there’s no data to show that these provide any benefit” much less an antiaging one.

“I think they’re a waste of money, and some of these supplements have potentially adverse effects,” he said. “It’s just infuriating because they’re not regulated, so (marketers) can say anything, and people believe it and buy it.”

When it comes to consuming alcohol, Topol said he keeps his drinking “light,” to fewer than seven drinks per week, after which the risks start adding up quickly. He said it doesn’t seem to affect his own sleep, but it might impact that of others, so he recommends watching out for that.

Another top-of-the-list item: mental health and stress management. Topol mainly turns to exercise to help navigate both of these elements, but he said being out in nature is another often-overlooked route.

“The nature prescription is part of the book. There really is something to this,” he noted, adding that he takes advantage of San Diego’s climate and location to do plenty of hiking and walking. “It’s good for mental health, it’s good for stress and anxiety, just to be out in our environment.”

It’s never too late to start any or all of these lifestyle adjustments, Topol said.

“These diseases take 20 years at least (to develop). So, you get even more (bang) if you start in your 40s and 50s or 60s … but if you start when you’re 70 (or) 80, you’re still going to derive years of healthy aging, maybe not quite as many, but still,” he said.

And because these common, chronic, age-related conditions — cancer, heart disease and neurodegenerative diseases — do take so long to fully manifest, Topol said we have time to intervene to change their trajectory.

Medical technologies gaining traction

But to fully leverage that latency period before the symptoms of a disease appear, it’s important to be aware of personal risk, so people and their doctors (and society more broadly) can focus prevention and early detection efforts on the right people at the right time.

“Knowing one’s risk — that’s the next part, which is: we’re going to prevent these three diseases in the future. We can now, and we’re going to even get better at that,” Topol said.

Topol said he learned from his polygenic risk scores that he’s at high risk for coronary artery disease, despite not having a family history. So, he has focused on getting his LDL cholesterol down. “I’ve gotten it low, and perhaps I got more aggressive about that. I’ve checked my other lipids, like Lp(a) (lipoprotein[a]), so I feel like I’ve done everything I can to go into high prevent-mode for that.”

Topol said wants to get his immunome (all the genes and proteins of his immune system) mapped, to measure how well his immune system is functioning. It’s a measurement he believes will one day soon be commonplace for everyone. He already has data on “every virus I’ve ever been exposed to and every autoantibody that I have.”

He also plans on having his organ clocks measured, because different organs (such as the heart and brain) age at different rates, putting people at higher risk for certain diseases. “I think it’s going to be very helpful, because then I’ll know (how) my heart organ clock correlates with my risk of heart disease.

“So those are some of the things I’ve done and/or I want to do,” he said.

“It’s an extraordinary time in medicine, because we have a path to prevention,” Topol said, “because of the way the science of aging (is developing), with these metrics like organ clocks and protein biomarkers and our genetics — all these layers of data — we are going to be able to prevent these diseases. And that’s exciting. We’ve never done that before.”