What can I do now to live longer and healthier?
26:42 Share

Hey there, I'm Kathleen Goldtar and I have a confession to make. I am a true crime fanatic. I devour books and films and most of all, true crime podcasts. But sometimes I just want to know more. I want to go deeper.

And that's where my podcast, Crime Story, comes in. Every week, I go behind the scenes with the creators of the best in true crime. I chat with the host of Scamanda, Teacher's Pet, Bone Valley, the list goes on. For the insider scoop, find Crime Story in your podcast app. This is a CBC Podcast.

Hi, I'm Dr. Brian Goldman. Welcome to The Dose. This week, we have a very special guest on The Dose and on our sister program, White Coat Blackheart. Dr. Eric Topol is a cardiologist and director of the Scripps Research Translational Institute, where he is on a mission to revolutionize human health. His new book, Super Agers, is a detailed guide on how to make it to age 100 and beyond and

And to that end, he's assembled cutting edge research and tech, but he's also giving us lessons from people who don't age quite the same as you and I.

On this special episode of The Dose, we're asking, what can I do now to live longer and healthier? Hi, Eric. Welcome to The Dose. Thanks, Brian. Great to be with you again. Great to be with you too. And I'm just going to ask you, what's one healthy habit that you surprised yourself by adopting? Well, for me, I guess the big one was sleep. I was a pretty poor sleeper, and now I've revamped my whole plan with a regularity and

very attention to, you know, what I eat, when and exercise, et cetera. So I've been able to get my deep sleep up quite a bit just through all those different maneuvers.

Oh, I knew you were the guy I needed to talk to. I have a lifelong history of insomnia, early morning awakening, which I have discussed ad nauseum on The Dose and on White Coat Black Arts. You are the guy I want to talk to. So before we begin, can you give us a hi, my name is, tell us what you do and where you do it. I'm Dr. Eric Topol. I'm a cardiologist and I'm a researcher at

at Skiff Research in La Jolla, California. In your book, you talk about a 95-year-old woman who, as far as you can tell, has hardly been sick, maybe never been sick. What's going on inside her body that we can learn from? Well, actually, she's 98. Her name is Lee Roussel, and she's very proud to be identified as she should be. She has not been sick throughout her whole life.

And her relatives, her mother, her father, her brothers, all died 30 to 40 years age younger than her. And she's very representative of a big study that we did that took seven years to enroll

so-called Welderly, as we called it, study of people who were over age 85, average age was almost 90. And we did whole genome sequences on them to determine how they could be so healthy with no chronic diseases, no medications, you know, at this ripe older age. And what was very much critical common thread with Lee, Roushall, is that most of them had relatives who died much younger

And so that went along with the genome sequences, which we didn't find much relative to various controls. We called the elderly, the typical people who get these illnesses like cancer, cardiovascular, and neurodegenerative diseases in their 60-plus age group. So we concluded from that study, and it was reinforced by the patient I present in the book, that being a person of extreme health span,

you know, here approaching 100, never having an age-related disease, that is not very much gene determined. That is DNA determined. And it is something that is likely a function of having a remarkably intact immune system throughout one's life. Of course, there's always the luck factor thrown in there, but it's hard to imagine all of this could just be luck.

In what you were just saying, you mentioned, you referred to something called healthspan. So what's the difference between lifespan and healthspan? Well, healthspan is what we're after, which is to have a very high quality life without cancer, without neurodegenerative disease, without cardiovascular disease. Those are the big three. Of course, you'd like to add in any other disease that could be serious or debilitating, but the big three covers most of it. And getting that age 85 and beyond is what you might consider debilitating.

the goal of super agers or welderly. And that's what I think is very much different than longevity or lifespan, which is, you know, just eke out more years, no matter what kind of health status you have. I don't think we're interested in that, or at least I'm not interested in that. And

And I can tell you that as an emergency physician, that's what I see. The people who come back to the ER again and again are eking out the last few years of their lives, suffering from the kinds of chronic diseases that you're trying to help people avoid. I want to ask you, how much of our health and longevity is in our DNA and how much is up to us and our personal habits, do you think? It's liberating for those of us like me who have a terrible family history because most of this is

in our lifestyle and I would put it in the heading of inflammation in the immune system. It kind of fits into this model whereby all the lifestyle things that are good for us, like a diet that is anti-inflammatory rather than pro-inflammation, you know, good sleep health, good exercise, all these things reduce inflammation and basically give us a better immune system functionality.

And that's, of course, things that we can build on with medications and other ways to keep that critical immune system with full integrity throughout one's life. That gives us a whole new look for being able to prevent these diseases permanently.

in the years ahead. We're going to get into that, particularly diet, in just a moment, but indulge me for a second. I've been reading a lot lately about a structure inside every cell in the body. It's called the mitochondria. For laypeople, please explain what is it and what does it have to do with healthspan? Well, it's the fuel supply of our cells, and there's ways to affect mitochondrial dysfunction. That's one of the many things that changes as we age.

But it's, as I was alluding to, it's affected by the process of inflammation, which I think is really the critical underpinning. Because all processes within cells can be taken off track, damaged, including the mitochondria, when you have this inflammation.

inflammation gone wild in our body tissues, organs, or in our brain. So yeah, mitochondria is part of the story. They are very important, what we call organelle, or an organ within the cell, like the nucleus and other subcellular, if you will, organs. So what you're trying to do through the development of healthy habits is to reduce inflammation.

And inflammation seems to be the underpinning of a lot of chronic diseases, including heart disease, neurodegenerative diseases, cancer. Have I got it right? Absolutely. And it's tied into the immune system, whereas the things that trigger the inflammatory response are the cells in our immune system that secrete these proteins called chemokines and cytokines that

And so there's this tightly intertwined connect between the immune system and the process of inflammation. Okay, time to get really practical. How much is healthspan determined by diet? I guess I can give you one example. It's a lot more than most people appreciate. There were 105,000 people

followed for 30 years, only 9% of this large cohort reached age 70 with healthy aging. So we're not even talking about age 85, but age 70, they also looked at age 75, only 9%. And what did they eat? They ate a plant-based, largely Mediterranean-type diet.

with low amounts of red meat. And of course, as we learned, avoiding ultra-processed food to the extent possible. So we know, adjusting for everything, that the diet helped this hundred-some thousand people. That's how they got to healthy aging status, because they looked at every other possible variable. And while it's impossible to completely control for that,

It's a very impressive study to reinforce the randomized trials that the best diet we know of is a largely plant-based Mediterranean diet. Obviously, seafood is good, but animal protein, particularly from red meat and ultra-processed foods, are bad.

When you say they're bad, does that mean you should avoid them altogether or can you eat them in moderation? Yeah. Moderation is okay. I guess what you define moderation. If people think eating red meat, you know, five times a week is moderation, no. But if it's, you know, once or twice a month, you know, that shouldn't be a problem. But

Also, too much protein is kind of a protein craze right now in the US. I don't know if it's also there in Canada. It is. Okay. Well, it's crazy because if you have too much protein, you actually promote inflammation. As been shown in experimental models, you can really rev up atherosclerosis. So you don't want to do that. And so protein of

one gram per kilogram, which is 2.2 pounds, as you know, that's okay. But one gram per pound, as some people have been advocating,

is off the charts for promoting inflammation. So it's okay to increase your protein intake to some degree, but as you get past, let's say, 1.4 grams per kilogram, that's when you start seeing this pro-inflammatory response, which you don't want to get. What are flavonoids and what do they have to do with health? Well, flavonoids are interesting. There's a lot of foods and beverages like beer and so many things that people do like, but

that contain a rich amount of flavonoids, and they are good things to have in your diet. They typically are in that same overlap with a lot of the foods in the Mediterranean diet. But yeah, flavonoids are good. The more of those, the more you see the pattern of healthy aging. So that's a good thing. And interestingly, of all things, coffee.

Coffee is really tied to very good outcomes, more survival, less cardiovascular, less neurodegenerative disease, less cancer, up to four cups a day. So these are some things that we're not anticipating when you go deep into all the literature that we have right now. Up to four cups a day and any particular type of coffee? Well, most of the studies have been with regular caffeinated coffee. So we don't know as much about

decaf or tea or other hot drinks. So most of the data, the body of evidence is sitting with caffeinated type coffee. There's been a sea change in recommendations regarding alcohol. So what can you tell us about alcohol consumption and chronic diseases and health span? Yeah, well, let's go back to that moderate category because not long ago, I had a patient come in and finishing up the visit, his wife said,

is it okay if my husband continues his moderate drinking? And I said, well, what is moderate? She says, well, he has two tequilas and six beers each night. And I said, what? Even I know that's not moderate. Yeah. Well, I mean, I thought she was joking, but they actually thought that was moderate. And so, you know, what we have here is a real problem because every report that comes out has different conclusions.

We've had three big reports from the U.S. this past year, one from the Surgeon General and one from the National Academies and another one from the Health and Human Services. And they all have different conclusions. The National Academy of Medicine says, well, moderate drinking, less than seven drinks per week, etc.

It's okay. It actually has some benefit. And the only risk when you start getting up much more than that is breast cancer. And then the other two reports are that any amount of alcohol has a higher risk with dose escalation, more risk for certain types of cancer. So basically, if you want to

put all this data together. We don't know what moderate is and what the threshold is. And this is a problem, Brian. Whenever you're trying to come up with some kind of magical recommendation for all people, we're all different. We all metabolize alcohol differently.

And we all have different risks for cancer. So if you're at high risk for certain types of cancer, that would be some reason to really cut your alcohol intake to low. So this is an unsettled area. However, certain countries like Ireland has put this warning on all alcohol beverages. I understand that's being contemplated in other countries like in Canada. So there's a concern about the cancer risk.

It is a carcinogen in animal models, so it does have that capacity at high doses and with binges. But generally, low levels of alcohol intake, I don't see as a problem.

Of course, everyone has to evaluate that. Some people, it really cuts down their deep sleep. And other people, it's something that's great to enhance social engagements, which is something we want to see. So it should be individualized to a fair extent. So I can't pin you down to a definition of moderate because I know in some, you mentioned less than seven drinks. I've certainly seen recommendations of less than three drinks per week.

Yeah, I mean, I think in women, it's supposed to be less. So seven in men, this is, you know, less than five, four in women. That's generally agreed upon that the level should be lower. The problem, Brian, is the data are all over and the national economies did the best job of really dissecting every study and, you know, redoing all the analyses.

And it didn't look nearly as concerning. So I think seven would be the upper limit in men and probably five, four or five in women. But yeah, if you cut it to a couple of glasses of wine a week, then I don't think there's anything to worry about, frankly. But this is trying to come up with a recommendation for all people, which is tricky.

Hey, I'm Reshma Sajjani, founder of Girls Who Code and Moms First. I consider myself a pretty successful adult woman. So why is it that in midlife, as I'm about to turn 50, I feel so stuck? Join me as I try to find the answer on my so-called midlife from Lemonada Media. I talk to experts and extraordinary guests about divorce, exercise, menopause, sex, drugs, and more to understand what we're going through and how to make the most of it. Listen wherever you get your podcasts.

All right, let's turn to exercise. I grew up in the generation that was told that aerobic exercise is the one thing I should do, and I've been doing it for more than half a century. What am I missing? Oh, I'm with you. As a cardiologist, that was all I would recommend. What we missed is that in recent years, the data for the importance of resistance, strength training has really become exceptionally strong.

And so that should be part of everyone's routine. And it's not hard to get that in and balance training too, as we get older, because you can get, you know, much more sturdy balance and much better strength and avoid the muscle mass loss that occurs with aging. So, you know, this is a really important difference in the recommendations that have been around for decades, which is

We know how vital keeping up one's strength is as we get older. And it's better to start that earlier than when you're 80 and keep your strength and fitness to a very high level. So don't give up on aerobic exercise. That's still recommended five days a week, 30 minutes. It could be a brisk walk. It could be lots of different things to get your heart rate up for

half hour or longer, but add in at least two sessions or three of some type of resistance training. And I think that's easy. It can be done with things like sit-ups and push-ups and bands and lunges and planks and all sorts of things that don't require any real expense, but actually will make people much stronger.

Okay, I've been saving this until now. As I said, I've been a lifelong insomniac and apparently you had a certain battle with insomnia too and you've adopted health habits that have improved your sleep. So Dish, what are those? Well, I haven't been a good sleeper for as long as I can remember. I can fall asleep in seconds, but wake up at early morning hours and hard to get back to sleep and I'm kind of wired and all that.

And I said, I got to get this right. You know, interrupted sleep, basically. So I went on a campaign of tracking sleep, which is not hard now with smart watches or rings. I haven't used it, but there's even mattress sensors that do that. And basically going after deep sleep because we've learned that the lymphatics in the brain, these channels,

They are critical for basically getting rid of all our waste products from our brain each day, these toxic metabolites that if we don't get rid of them, they promote inflammation of the brain and they're a risk factor for Alzheimer's and dementia and other age-related diseases.

Of course, when I started measuring it, my deep sleep was terrible. Could be average less than 15 minutes, oftentimes single digit, and it's just horrible. So I just started doing everything I could to bring it up. Start a regular pattern. That's really important. The sleep regularity index is critical for all these age-related major diseases. Not exercising too late in the day, not eating too late.

Finding out what foods would cause an upset stomach that would interfere. Hydration during the early day, early afternoon, not in the evening. So there's no reason to have to void during the night. Basically, I've been able to get, amp that up, you know, a remarkable amount. I'm never happy. I'm still trying to increase it to beyond 40, 45 minutes average from what it was.

hopefully, eventually get it up to an hour or more. But we lose this deep sleep during the aging process. So it's really critical that we go after it if you're not a good sleeper and you're having issues. This is usually the slow wave that's occurring that is usually early in the night. Even though it sounds like deep sleep, you'd think it would be late in the night. But no, it's usually in those first couple of hours that you get the most

amount of this slow-wave sleep. So tracking it for people who are having a problem with sleep might be something worth considering. My sister and my mother both had dementia, both died with dementia. What can I do to prevent it? As you know, 70% to 80% of dementia is Alzheimer's. And now there's a blood test you can tell if you're at risk for Alzheimer's, which is specific to Alzheimer's.

So there's a test called P-tau-217. It's a fancy term for a test for binding site on the tau protein, a misfolded protein. It picks up Alzheimer's risk two decades before there's mild cognitive impairment. And it's available. It's been available for almost two years now. And a new one from a Japanese company was also formally FDA approved.

The others have been, you know, at companies that are available like LabCorp and Quest. So in your case with a family history, have you had an APOE allele test? I have not had an APOE allele test. And of course, APOE4 is the risk factor. You know, I would get that too. And you can also get a polygenic risk score for Alzheimer's. And soon you'll be able to get a brain organ clock to see if your brain aging is different than

if it's accelerated and different from the other organs in your body. So you'll have many layers of data to be able to confirm if you're at risk. And that's the first step. Specifically for Alzheimer's, that's what's good about this test. It doesn't show up for other types of dementia. So there's a way to get at this without even a scan. So we're at a point now where the whole field has been revamped for diagnosis of risk,

and blood-based diagnosis of Alzheimer's without needing to go through a high radiation expensive PET scan. You know, having positive tests doesn't mean that you're going to get dementia on a certain date. You can stave it off, can't you? I think a lot of people don't realize this. These markers like PTAL 217 and PTAL 181 and others, they're exceptionally responsive to lifestyle factors like exercise.

and weight loss if need be, and more optimal diets and sleep. This is not a fed complete. That is, you can take control with lifestyle factors. And beyond that, we're going to have many different drugs that'll help. Right now, the GLP-1 drugs like Ozempic and Munger or Terzepatide, they are being tested in Alzheimer's in people who are not overweight or obese and will have results of those large trials early next year.

We're at a point now where we're going to have potent anti-inflammatory drugs that work in the brain and the body that should kick in to help the lifestyle factors, which are also fundamental. So it's kind of a combination of that we have these new layers of data from the science of aging, these clocks and protein markers. We have the influence of lifestyle, which we can track

with these same markers. And then we're going to have a lot of other things in the tool chest for medications to add on because the gut hormone story is exploding in terms of the gut-brain axis, the ability for the gut hormones like glucagon-like peptide, GLP-1, and others to talk to the brain

and talk to the immune system. You have filled me with optimism and challenged me to change some of my habits. Reading your book, though, I could try and adopt 50 suggestions all at once, but I have a feeling that that sets me up to fail. So how do you suggest people listening to this conversation take that first step and go from there? Well, the very first one is to get your physical activity amped up.

And that includes, of course, aerobic, but also strength resistance training. And certainly if you're older, balance training is important too. So that would be the number one priority. And that could be, it doesn't have to be extreme, even, you know, starting with brisk walking, but if you can do bicycling or elliptical or treadmill, that's terrific. Uh,

But that's aerobic plus strength training. It would be, if one thing you're going to do, that's going to be the biggest bang for the buck. They're all intertwined though, Brian. Well, Dr. Eric Topol, this has been a great conversation and so good that I suspect that our podcast subscribers are going to want to listen to it several times to get every nugget, every gem, or maybe read a transcript.

I want to thank you for coming on The Dose to talk about your book, Super Agers, and all the great information inside it and how to live longer and the difference between lifespan and healthspan. So thank you so much for speaking with us. Thank you, Brian. I'm certainly hoping for a lot more Super Agers in the years ahead.

Dr. Eric Topol is a cardiologist and director of the Scripps Research Translational Institute and the author of Super Agers: An Evidence-Based Approach to Longevity. Here's a dose of smart advice: Living long and living well means avoiding or postponing cancer, heart disease, and brain diseases like dementia and Parkinson's. What these diseases have in common is that they unleash inflammation inside the brain, the heart, the blood vessels, and other vital organs.

you can tame that inflammation by adopting some healthy habits. Beginning with exercise. Walk, run, swim, or cycle. To get the benefit, do 150 minutes a week of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobics per week. Add strength or resistance training two or three sessions a week. It doesn't have to be free weights. Planks, lunges, or resistance bands will do.

From age 30 on, we lose 3-5% of muscle mass per decade of life. The more you keep it, the hardier you will age. Add balance exercises like standing on one foot while brushing your teeth. Next is diet. The Mediterranean diet is the best at keeping you healthy by reducing inflammation. It helps prevent heart disease. And while it can't reverse Alzheimer's disease, it can slow and to some extent even reverse some of the cognitive effects of dementia.

Make sure you add flavonoids to your diet. They're found in berries, red cabbage, onions, kale, parsley, green tea, red wine, dark chocolate, citrus fruits, and soybeans. There is no health benefit to drinking alcohol, so keep it to less than three to five drinks per week. Try to get as much deep sleep as you can. That's when your brain gets rid of toxic chemicals that contribute to dementia. To track your sleep cycles, buy a smartwatch or download a sleep tracker app.

Make sure you're up to date on your vaccines. For people over the age of 50, there's evidence that the shingles vaccine can help prevent dementia. And studies are underway to see if GLP-1 inhibitors like Ozempic, Wegovi and Munjaro can help prevent or delay the onset of Alzheimer's and other diseases. There's lots of good science that's giving us answers. Do not fall for sales pitches or commercial products that promise more than they can possibly deliver.

Extending your health span is not about buying some dubious miracle cure. It's what you can accomplish yourself by paying attention to the basics. If you have topics you'd like discussed or questions answered, write to us at thedoseatcbc.ca. This edition of The Dose was produced by Samir Chhabra, Jennifer Warren, and me, our senior producer is Colleen Ross. The Dose wants you to be better prepared about your health. If you're looking for medical advice, see your health care provider. I'm Dr. Brian Goldman. Until your next dose.

For more CBC Podcasts, go to cbc.ca slash podcasts.