Cardiologist reveals how to be a super-ager

A renowned cardiologist has created a blueprint for achieving maximum longevity at optimal health. He explains how.

One of Eric Topol’s patients is a 98-year-old woman who has never suffered a serious illness. The renowned cardiologist encountered Mrs LR when he treated her for swelling in her legs. He was struck that while her parents and siblings had died between the ages of 43 and 75, she had remained free of chronic disease.

Mrs LR drove herself to the medical centre. She has a passion for painting and puzzles, an extended social network and an optimistic outlook. She “exemplifies healthy ageing”, Topol says, and he classifies her as one of the “wellderly”. In contrast, most people are the “illderly”; only about a quarter of people aged 65 to 74 in the UK have no diagnosed long-term health condition.

When it comes to longevity, good health is often attributed to one’s genetics.

But what Topol finds particularly fascinating, he tells me when we speak over video call, is that “genes are not as important as we thought”.

A professor at Scripps Research in San Diego, California, Topol, 70, has published a series of bestsellers on the future of medicine as well as more than 1,300 journal articles. For one research project he looked at 1,400 people who were aged 80-plus, had never been sick and had never had one of the big three chronic illnesses: cancer, heart disease and neurodegenerative disease. He found there was little in their DNA that accounted for their healthy ageing, but they were considerably thinner than their peers, exercised more, were better educated than the general population, and were upbeat and sociable.

This is how you join the 'wellderly'

One thing Topol says can’t be emphasised enough is that cancer and the major age-related diseases of the heart and brain can incubate for 20 years at least before revealing themselves clinically. Those years offer a great opportunity to work on preventing such illnesses.

With that in mind, he has written a new book, Super Agers, in which he lays out how to achieve one’s maximum health span – the number of years lived in optimal health – and shift from the illderly path to the wellderly.

“You’re going to gain healthy ageing years by adopting these very important lifestyle changes,” Topol says. And the earlier you do so, “the more years of healthy ageing you gain”.

1. Adopt an anti-ageing diet

Topol is an advocate of the Mediterranean diet, which is high in vegetables, fruit and fibre. He hasn’t eaten red meat for years. “It’s pro-inflammatory, so if you’re going to have it, don’t make it a frequent thing,” he says.

He recommends using the app Open Food Facts to scan packets to identify ultra-processed foods (UPFs), which he says he is “religious” about avoiding.

The Mediterranean diet will help you age better.

One day UPFs will be regarded in a similar way to cigarettes, he believes. “A lot of these are pro-inflammatory and they’ve been linked with all three major age-related diseases.”

There is little evidence that intermittent fasting improves anti-ageing, and until there is more, his advice is to eat an early dinner and avoid consuming any more calories until breakfast.

He drinks a cup or two of coffee in the morning. “I don’t drink it because it’s going to improve healthy ageing, but that’s a bonus.” Observational studies have shown that there is an association between drinking coffee and lower risk of various cancers, cardiovascular disease, Parkinson’s and type 2 diabetes, although this could be linked to other factors.

2. You don’t need to be teetotal

“I’ll have a glass or two of wine on weekend nights. That’s about it for me,” Topol says. The data is clear that anything more than moderate drinking (seven drinks a week for men; four to five for women) is not good for us.

Going completely sober isn't necessary.

However, social engagement is important for healthy ageing and that often involves a drink. Topol’s best summary of the studies of light alcohol intake (a couple of drinks a week) is that it is not a problem, but the risk quickly increases.

3. Ditch the supplements

His patients often provide long lists of the supplements they’re taking. “I just shake my head. They’re wasting a lot of money.”

4. It’s never too late to start exercising

Topol cites the case of Richard Morgan, a 93-year-old Irishman who had never exercised regularly before he reached his seventies, when he started using a rowing machine in his shed and then went on to win indoor rowing competitions.

Even walking briskly for just over an hour a day is associated with living for four and a half years longer than those who don’t exercise. Though it is important, if walking is your main exercise, that your heart rate is increased for a sustained period of 30 minutes or longer and you are not simply counting steps accrued during the day.

For years Topol emphasised to his patients the importance of aerobic exercise, but he has become convinced that preserving core strength is also vital. “In the past year-plus I’ve been very diligent about incorporating balance and strength training,” he says. Topol strength trains four times a week using resistance bands and exercises such as planks and lunges, as well as balance training and completing a similar number of sessions of aerobic exercise, such as walking, cycling and swimming.

Start exercising now – it will help!

And he tries to get outside regularly; a UK Biobank study found that long-term exposure to greenery where we live was associated with reduced anxiety.

5. Deep sleep matters

About seven hours of sleep is the optimal amount. Surprisingly, sleeping beyond seven hours may be associated with signs of cognitive and mental health decline, Topol says. There also appears to be a relationship between sleeping for more than eight hours and heightened all-cause morbidity – though Topol stresses that this is at a population level, and that some people perform better with eight or six hours’ sleep.

Among the benefits of deep sleep, or non-rapid eye movement sleep, is that it helps to clear the brain of metabolic waste that may increase the risk of Alzheimer’s.

Using a sleep tracker, Topol discovered that he was getting as little as 15 minutes a night of deep sleep. Some experts suggest we need one to two hours, but it depends on our age, Topol says. He increased his deep sleep to an hour a night by adopting a stricter bedtime routine, stopping exercising and eating late in the evenings, and hydrating earlier in the day so he didn’t wake to urinate. He is sceptical of sleep medications, some of which could make toxins in the brain more concentrated.

6. The tests that could help you live longer

Genome sequencing is underused, according to Topol, who says it is vital for identifying disease-causing genetic mutations in those with unknown illnesses (last week David Cameron called for all infants admitted to pediatric care to be tested for unusual genetic conditions). In some cases, a test to reveal disease-causing genes – particularly those associated with cancer – may cost only a few hundred pounds.

Polygenic-risk tests for specific diseases are also available for common cancers, heart disease and Alzheimer’s. They can be sought at private clinics and online and test a sample of saliva or blood.

There are tests that can look at heart disease or dementia risk.

Organ clocks, which measure proteins in the blood, can reveal which individual organs are ageing faster than the rest of the body. Studies have been carried out with UK Biobank participants, and Topol expects commercial tests will be available in the near future – and will eventually form a routine part of health assessments.

7. But don’t say yes to every test

Topol is scornful of companies offering full MRI scans. “That’s completely off the rails,” he says. “The chance for harm is greater than the potential benefit.”

Scans can also lead to unnecessary interventions. He has seen patients almost bleed to death from a liver biopsy or who suffered a collapsed lung “from a biopsy of an innocent nodule”.

He is dismissive of Bryan Johnson, the Silicon Valley biohacker who is spending $2 million a year trying to reverse the ageing process, and of private clinics offering blood transfusions from young people at dollars 8,000 a litre. “Ridiculous! We have longevity clinics that charge $250,000 a year. It’s reckless and predatory.”

Microbiome tests are popular, but Topol cautions that there isn’t a reliable commercial test yet.

8. Beware of anti-ageing drugs

He worries that not enough is being done to tackle serious threats to our lifespans, including environmental pollution, microplastics and “forever chemicals”.

The jury is still out on some scientific advances, including much-hyped anti-ageing drugs.

“Some are very effective in mice and rats, but rodents are not people,” he says. “There’s some very strong science that’s being pursued but there’s no guarantee we’re going to get there.”

However, he is excited about where science is taking us. A company called Infinity Bio has developed a blood test that can determine a person’s exposure to more than 500 viruses. This may become commercially available in a year or two.

9. Ozempic could prevent diseases in old age

Topol’s greatest enthusiasm is reserved for GLP-1 drugs such as Ozempic, which he says may play a role in “the next frontier for medicine”.

“These gut hormones that talk to the brain and talk to the immune system are going to be one of the most important groups of medicine going forward to help prevent the big three diseases – cancer, cardiovascular, neurodegenerative – and we have trials for Alzheimer’s ongoing.”

He is not overly concerned about the side-effects. “Gastrointestinal side-effects usually dissipate in the first few weeks. The side-effect of muscle mass loss in people who are obese can be countered by resistance training.”

Weight loss drugs could help in the future, despite serious side effects.

But he does have one reservation: he is not a fan of people having to take drugs for the rest of their lives. “It would be nice if we had a weaning strategy, and the companies don’t appear to have any interest in that.”

This article originally appeared on The Times.

Originally published as Cardiologist reveals how to be a super-ager