In the quest to extend human healthspan, few voices are as influential as Eric Topol, a physician leader and professor of Translational Medicine whose work sits at the intersection of genomics, big data, and artificial intelligence. In his recent book, Super Agers: An Evidence-Based Approach to Longevity, and through his newsletter Ground Truths, Topol outlines a comprehensive framework for not just living longer, but staying healthy deep into old age. He moves beyond traditional advice to introduce the concept of "Lifestyle+," which integrates diet, exercise, and sleep with the often-overlooked impacts of environmental toxins and social connectivity.
The "Lifestyle+" Framework
Topol argues that while biomedical technologies are transforming medicine, many healthy years can be added through "low-tech" lifestyle adjustments. His expanded "Lifestyle+" definition includes factors such as exposure to microplastics, "forever chemicals," and the detrimental effects of social isolation. He notes that a favourable lifestyle—consisting of regular exercise, a high-quality diet, and not smoking—can add approximately eight to ten years of life free from major chronic diseases like cancer and type 2 diabetes.
Exercise: The "Miracle" Intervention
Drawing on conversations with experts like Stanford’s Euan Ashley, Topol describes exercise as perhaps the most potent medical intervention known to humankind. The data suggests a remarkable return on investment: one minute of exercise can "buy" five minutes of extra life, while high-intensity sessions may offer as much as seven or eight minutes.
Topol emphasises that a balanced routine must include more than just aerobic activity. To combat sarcopenia—the age-related loss of muscle mass—individuals should incorporate at least sixty minutes of resistance training per week, which is associated with a 25 per cent reduction in all-cause mortality. Furthermore, balance exercises, such as the one-leg stand test, are critical; an inability to stand on one leg for ten seconds is associated with a doubling of mortality risk.
Diet and the Danger of Ultra-Processed Foods
A poor diet is currently linked to 22 per cent of all deaths globally, more than tobacco or any other medical condition. Topol is particularly critical of "ultra-processed foods" (UPFs), which he describes as "alien," industrially produced substances that disrupt gut-brain signalling. Consumption of UPFs is linked to a 66 per cent increased risk of cardiovascular death and a 16 per cent increased risk of cognitive impairment in older adults.
Conversely, Topol champions the Mediterranean diet, which is backed by robust randomised trials showing it can reduce the risk of heart attack, stroke, and neurodegenerative diseases. He also highlights the vital role of dietary fibre, which acts as the "polar opposite" of UPFs by slowing digestion and reducing glucose spikes. Interestingly, high-fibre diets may even lead to "pooping calories" by reducing gut absorption.
Sleep: The Brain’s "Dishwasher"
Topol identifies sleep as a "non-negotiable biological state" as essential as food or water. During non-REM sleep, the brain’s glymphatic system—a plumbing network discovered only recently—activates to clear out metabolic waste products like beta-amyloid. Topol compares this to "turning on the dishwasher" before bed to wake up with a "clean brain". Even one night of sleep deprivation can lead to a significant accumulation of toxic proteins associated with Alzheimer’s disease.
Environmental Toxins and New Frontiers
A striking addition to the longevity conversation is Topol’s focus on environmental hazards. He cites deeply concerning evidence regarding microplastics, which have been found in human arteries and are linked to a fourfold higher risk of heart attack or stroke. Recent studies even show microplastics accumulating in the brain, with levels 7 to 30 times higher than in the liver or kidneys, particularly in individuals with dementia.
Looking forward, Topol discusses the emergence of "organ clocks". By measuring thousands of plasma proteins, researchers can now identify "extreme agers" whose specific organs (like the heart or brain) are aging faster than their chronological age. This technology promises a quiet revolution in personalised medicine, allowing individuals to identify and mitigate specific risks long before they manifest as disease.
Ultimately, Super Agers serves as a reminder that while we cannot change our genes, we have significant control over the biological drivers of aging through the "Lifestyle+" choices we make every day.
Book Link: Super Agers: An Evidence-Based Approach to Longevity
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