How to Catch Alzheimer’s Before It Starts, with Dr. Eric Topol - Transcript

Dr. Mark Hyman
When you start talking about preventing Alzheimer's and picking it up early, how early can you start to see the p tau changes?

Dr. Eric Topol
P tau two seventeen is the very first one that goes up and it starts twenty years before mild cognitive impairment. Twenty years.

Dr. Mark Hyman
Doctor Eric Topol is a world renowned physician

Dr. Eric Topol
Using data, tech, and deep insight

Dr. Mark Hyman
to transform how we detect and prevent diseases Like Alzheimer's before they even start.

Dr. Eric Topol
There's so much data to show that that social isolation is a risk factor for neurodegenerative and cardiovascular and even cancer.

Dr. Mark Hyman
Strength training is a powerful drug, and sleep is a powerful drug. They're better than most of the drugs we have, actually. Before we jump into today's episode, I wanna share a few ways you can go deeper on your health journey. While I wish I could work with everyone one on one, there just isn't enough time in the day. So I built several tools to help you take control of your health.

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Welcome back to the podcast, doctor Topols. Good to have you again.

Dr. Eric Topol
Thanks, Mark. Good to be with you.

Dr. Mark Hyman
The last time, you know, we talked a lot about AI and health and medicine and, gotten some pretty cool topics. Since then, you've written a book called SuperAgers, which I think is a great a great title. When you start talking about preventing Alzheimer's and picking it up early, how early can you start to see the p tau changes, for example, or the proteomic clock change in someone? Is it is it five years before they get symptoms? Is it ten, twenty years?

Dr. Eric Topol
Yeah. I'm so glad you asked about that. P tau two seventeen is the very first one that goes up, and it starts twenty years before mild cognitive impairment. Twenty years. I mean, it's incredible.

Dr. Mark Hyman
That's dementia, isn't Yeah.

Dr. Eric Topol
Yeah. Mean, you got another few years from when you go from MCI to actual Alzheimer's.

Dr. Mark Hyman
Yeah. It reminds me of this patient I had who had APOE four, and that's the high risk Alzheimer's gene. Doesn't mean they're going to get it, but it really dramatically She improves the was a patient of mine at Canyon Ranch like twenty five years ago, and she was in her nineties. She was a dentist, she was still working, and she had been a health nut her whole life. Here she was in her nineties, completely cognitively intact.

Not sure I'd want her to be my dentist at 95, but still she was she was all there, and I was Wow. It was one of those memorable patients that, you know, teach you a lesson about what's possible. And I was like, Wait. Just because you have a genetic risk doesn't mean you're gonna get the disease. Like, everybody in my mother's side of the family, on her dad's side, all had severe heart disease in their fifties, heart attacks, you know, bypasses and so forth.

You know, I thought, oh boy, I'm gonna be in trouble. But it turns out that, you know, they might have a predisposition, but they're not You kinda started, I think, and you can correct me if I'm wrong, down this road by doing this study of elderly people who you end up calling welderly, which were people that lived a long time. And you dove into a lot of things, genetics, lifestyle and I would love you to sort of unpack some of the myths that got busted there because I think everybody thinks that, you know, there's a longevity gene or if you just, you know, had a good hand dealt to with your genetic cards that you're going to live a long time. And if you don't, you're kind of stuck with whatever you got. You know, Oh, my father got heart disease, my mother had diabetes, and my grandma got Alzheimer's.

I'm just kind of destined to be getting some disease in the future. But you kinda found some surprising things when you did this study. Can you can you unpack that study a little bit, what you found, and what was surprising about it?

Dr. Eric Topol
So it was called the Welderly study, and it took seven years to find fourteen hundred people who were average age, near 90 and up to a 100 and two who had never had had a chronic illness, age related or otherwise. So it was, you know, very unique cohort that has not yet ever been replicated in terms of that type of demographic. And we did whole genome sequencing in all of them. And surprisingly, we thought we'd find, as you said, all these genetic underpinnings, and we found almost nothing. This is also consistent with so many of these people had relatives like the patient I present in the book, Lee Russell, who is 98, and her parents died in their fifties and sixties, her brothers the same.

And so it isn't a genetic story. For many people, like myself with a terrible family history, it's quite liberating. But of course, some of it's genetics. But for the most part, it's much less than we thought. It was a big surprise to us.

It was a disappointment because we thought we were gonna find all these important things. And it's really in contrast to the elderly, which is, as you know,

Dr. Mark Hyman
the Oh, typical the elderly. I like that. I like that. The elderly. The elderly are

Dr. Eric Topol
the people 60. They have all these chronic age related diseases. The contrast is striking, and the genetic story is much less important than I think we had forecasted. And also, of course, if you talk to these people, they really did take care of themselves. They really had good lifestyles.

I think we learned a lot from them.

Dr. Mark Hyman
Can you talk a little bit about that? Because that's part of what your work is really focused on is a polygenic risk, which means what are the patterns of genes that put you at risk but don't necessarily make you predestined?

Dr. Eric Topol
Yeah. That's really important that you're bringing up because there are several studies I review in the book of polygenic risk, and how that's neutralized by lifestyle factors. That's another way to support what we found on the welderly. Whatever genetic load there is or burden, that there's ways to titrate that, by taking care of ourselves. But there's another point that's really interesting.

Some of the people in that welderly group did not take care of themselves. I remember one fellow 99 years old who was still still smoking two packs a day.

Dr. Mark Hyman
Wow.

Dr. Eric Topol
Nothing, of course, is a 100%, but there's a lot to titration of risk with, you know, really good lifestyle behaviors. But there's another factor here, whether it's random or whether I do think, as I get into it later in the book, our immune system is so critical. And that is giving us that resilience to withstand the threat of age related diseases. And I think we're only scratching the surface right now because clinically, we don't have a way to to get the metrics of our immune system. We're just starting to do it now, and we need to really get something that would be part of our assessment, whether it's annual checkup or whatever, particularly as we get older.

As you well know, we have this problem with immunosenescence or immune system starting to really let our guard down as we get older, and it's highly variable. Some people, it's entirely intact all the way through their nineties, and other people, it's already starting to lose some of its integrity in their fifties and sixties.

Dr. Mark Hyman
Yeah, so a lot of what people think of as the normal age related diseases, heart disease, cancer, diabetes, dementia, these are all inflammatory diseases. And there's a term for this called inflammaging.

Dr. Eric Topol
Yes.

Dr. Mark Hyman
And that we tend to get more inflamed as we get older. So on one hand, our immune system works less well to fight against infections, but on other hand, it's overactive and causing inflammation. And I think, you know, one of the things you talk about in the book is your epigenetic clocks, biological clocks, how do we look at organ clocks and overall clocks. And I was thinking about the other day, it occurred to me that when we measure a lot of the biological clocks, we do it through a blood test. Yeah.

And the cells we're looking at, because there's no cells except for white blood cells, because red cells have no nucleus and no DNA. So white blood cells are the things we're actually measuring these clocks on. So are we actually indirectly measuring our immune age?

Dr. Eric Topol
Yeah. So this is really important that the epigenetic methylation clock, that is a body wide assessment of biological age, but it doesn't, as you say, it doesn't get to the crux of the matter. And so that's why it's so exciting on these protein or proteomic scores where you take up to 11,000 plasma proteins, and you get eight organ clocks, including the immune system. So brain, heart, liver, kidney. This is really great because now this can be done very inexpensively.

We're doing it in our research these days, and the costs for us have come down from what was it, 800 or $900 to less than a $100. Wow. And and the biobank, UK Biobank, is doing it for $50 for in 500,000 people. They've already done it in 50 some thousand. And so when you have those protein clocks, you know, with AI separates out what's tagged to each organ, that's getting at your point, Mark, because it's no longer relying on just some white cells.

It's actually getting to the crux of the proteins that are associated with each organ. So it's our first cut of a way to inexpensively get a readout on the aging of each organ and also our immune system. And I think that's a breakthrough, and it's gonna be part of our routine assessment patients going forward. And it's critical. To me, the science of aging has brought these things forward, not just these ideas of reversing aging with, you know, things fancy things like partial epigenetic reprogramming or cellulitics or, you know, telomeres lengthening and all kind of stem cells, but rather the metrics that have come in these recent years, like organ clocks and other things we'll talk about.

That's what's so exciting, given us this real opportunity to prevent age related diseases like we've never done before.

Dr. Mark Hyman
Yeah, I just wanna unpack that because it's so important. I'm sure most people get it. So normally when we look at biological age, quote biological age and the way it's been measured in the past, it's been by looking at your genes and the epigenome, which is basically the control mechanism over your genes that determines which genes get turned on or off or expressed. And we're looking at patterns in that epigenome that give us a sense of your biological age. And that's kind of an expensive, somewhat nonspecific way to check.

But you're talking about this new technology using the tens of thousands of proteins in our blood that can be measured very easily and cheaply that show patterns that can give you clues about the specific rate of aging of different organs in your body. Is that right?

Dr. Eric Topol
Yeah. And that's the key because it's not just you know, with polygenic risk score or genome sequencing or things like, you know, APOE four that you mentioned, that just said that just told us yes or no. That just told us you may be at risk for this type of cancer or Alzheimer's, whatever. Now we're getting at the point of not just what organ, but when. So the three major age related diseases take more than twenty years.

Cancer for almost all cancers, cardiovascular, and certainly Alzheimer's, neurodegenerative, they take more than twenty years. And we've never really been able to get on top of that with all this runway that we have to work with. It's incredible. And so

Dr. Mark Hyman
Yeah. You're right.

Dr. Eric Topol
You know, now we have a way to be ahead of it, And that these metrics, these ways of seeing what in what person, what organ if if one is aging too fast, out of pace with that person, and also what is the trajectory or arc of that. So this is, I think, an opportunity that we've never had before, and it's a it's a really big advance.

Dr. Mark Hyman
Yeah. I mean, you you you are a cardiologist, so you you were taught in, you know, plumbing one zero one, basically, and waiting till things happen. And, yes, you could give a statin, but that's a very, you know, kind of, I would say, weak tool. I mean, it it's a tool, but it you know, the benefit's marginal. Like, it's it's not like a panacea or a magic pill.

Dr. Eric Topol
Yeah, it works well, you know, when someone's already had a heart attack, secondary inflammation. But we're not making big inroads. There's still plenty of people having heart attacks and bypass surgery and stents and everything else. So we have to do better. And as you know, cardiovascular is the most preventable of these three diseases, eighty, ninety percent.

Former colleagues from Cleveland Clinic came out with this ninety percent, others eighty percent. But then cancer and neurodegenerative are forty, fifty percent preventable through lifestyle. So Yeah. We know some things even without these new metrics and new capabilities to be able to prevent these disease. We're just not doing

Dr. Mark Hyman
And did you find out in that study of the the elderly? What what were those things that you found? What was surprising? What what did you sort of see that you were surprised at or unexpected?

Dr. Eric Topol
Well, I've been it was interesting, the disposition of these people, very almost all of them, remarkably upbeat people. You did not see people that were complaining or misanthropes or anything like that. You know, they had a relatively sunny disposition like Lee Roussall and the other fellow who I present in the book, two patients of mine, they were kind of prototypic. So that's one thing, you know, it's hard to there's not hard science on personality and being optimistic. Of course, they're very grateful for how well they've healthily aged, but it's more than that.

They've been that way throughout their lives. They're physically active. They're not sitting around. I remember when I was getting back in touch with my 98 year old, she's so busy with her art gallery, the oil painting. It was hard to get her an appointment to go visit her.

So these people, they stay busy, they stay active. They're not socially isolated. They don't live in a cave, you know? They're relatively thin. You don't see much obesity in people who are well into their nineties who have staved off any major age related disease.

So they have a profile that's pretty typical among this group, and they're they're not common. I mean, really, it took seven years to find this cohort. So Yeah. Yeah. You know, we're talking about well less than one percent of people in that age group.

Dr. Mark Hyman
Yeah. Mean, less common in America. I I was in Sardinia and Korea, and you see more of those people who are, you know, bit and thin and healthy and happy. I mean, yeah, it's true. I think optimists live longer even if they're wrong.

Dr. Eric Topol
I think I to that. You know, the mental health I I Yeah.

Dr. Mark Hyman
I call myself a pathological optimist. I don't know why, but I always seem to see a you know, it's like the the life of Brian. You'll look on the bright side of life. You know? It's kind of a funny thing, a Monty Python skip.

But I think that mindset plays a big role, and I think we underestimate the role of our beliefs and our mindset and our view of the world and our level of gratitude, our level of service or engagement or connection to other people. They seem like squishy things, but I think they are really consequential.

Dr. Eric Topol
Yeah. No. I have a whole chapter on mental health because of its primacy here and the interactions with physical health and how stress, anxiety, depression, you know, is a key to these age related diseases, how we how we deal with that. And as you touched on earlier, this whole inflammation story is a common thread of the big three age related diseases. And, you know, we know that stress can induce that, anxiety.

So any way that we can keep that inflammation low, and of course, that's going to be very much a factor of what we eat and our exercise and sleep health and all that. So there's so many things. It could be environmental toxins, burden that have that effect on inflammation, but we never should underestimate, our mental health for that factor.

Dr. Mark Hyman
I was reading a lot about sociogenomics years ago and this whole idea that how our social relationships connections affect our gene expression. And I remember seeing these studies where they looked at people who were in relationship, if they had a conflictual relationship, were turning on inflammatory genes and gene expression. If they had loving heart heart center connections, they would have anti inflammatory genes turned on, you know? And and I think that's kind of worth noting that it's it's, may not be a hard science, I think it's although that was pretty good science, I was really just this idea that that we should not neglect our relationships. And often, I think what happens in people's lives is they work hard, they have their career, their family, they go and go go and they they neglect their social relationships and their networks.

And they end up like retiring or stopping. And they have like, where are their friends? And who who are the people they can call up? And the amount of loneliness and disconnection is is a big factor.

Dr. Eric Topol
No question. And you know, that was a graph that a lot of people have highlighted in the book about how as we age, we tend to become reclusive. And there's so much data to show that that social isolation, is is a risk factor for neurodegenerative and cardiovascular and even cancer. So we we wanna avoid that. And I think highlighting that, the that social interaction.

I mean, we are really a social animal. We have to use that ability to help us stay in the mix. And so this is something I was impressed with that research. I would have been one to discount it. But when I went through it all, it really was cogent.

Dr. Mark Hyman
You talked about, you know, the polygenic risk score and that it increases your risk, but it doesn't necessarily guarantee you're gonna get a problem. There's a lot we know about how to modify that risk. I I mean, I'm wondering, you know, the smoker you mentioned earlier who smoked two packs a day, you know, just as there's, like, the APOE double four, which is the high risk Alzheimer's and heart disease gene, the the double two, I've heard some people refer to as the jackpot gene. It's like you can smoke and drink and eat whatever you want, and you you kinda won the genetic lottery, and you don't have to worry as much. Is it was there anything to that?

Were there any The double Parts of that?

Dr. Eric Topol
Yeah. Well, if you wanna pick APOE two homozygous, that's pretty good. But it doesn't give you the ability to withstand age related diseases. It gives you longevity. So that's the difference here that we're talking about, health span versus lifespan.

And so APOE two double is the one you wanna get. And of course

Dr. Mark Hyman
I got one copy. I got one copy.

Dr. Eric Topol
Oh, good for you. And in fact, when I go through genome editing, there's a whole chapter in the book where people are editing Apo turning ApoE four to ApoE two right now. I mean

Dr. Mark Hyman
Oh, wow.

Dr. Eric Topol
Yeah. I mean, it's wild. And in animals and, you know, the idea is to do this in people. That may happen someday. Who knows?

But right now, APOE2, no question that it does, unlike APOE4, it has a better associated lifespan, but it doesn't give you that age related protection from these three diseases, really.

Dr. Mark Hyman
What also I think was important in your book is you do talk about the difference between this health span, lifespan distinction. You know, we spend the last 20% of our lives in poor health. Doesn't mean you do what you want, you're engaged, and you feel good. Right? And what's the point of living a long life if you feel like crap for the last 20% of your life?

Dr. Eric Topol
Right.

Dr. Mark Hyman
Or you're taking a pile of pills. How did they kind of kind of make that almost the same in this well-being group? How is their lifespan, health span the same?

Dr. Eric Topol
There's a couple of things here. We've got to do something about this elderly that you're framing because that's what we have now. That's that's basically the the story in most people, and they as they get in through the sixties and seventies, they have at least one of these three, if not more, age related major diseases. That is compromising their health span, and it may indeed their lifespan as well. But living with one of these major diseases, whether it's mild cognitive deficit, moving on to Alzheimer's, or one of these cancers that you're trying to be a survivor and fighting it, or certainly all the cardiovascular disease issues that crop up heart failure and arrhythmias and everything else.

This isn't easy. This is not the life you want. What I think is so extraordinary is we're at a time where we have the means of squashing these, preventing these diseases like we never had. So why accept this the way we've been all these years with this highest density of age related disease people when we have the the stack, the full stack? Now it isn't just polygenic risk score or sequencing, which we could get.

It's also become very inexpensive, but it's all these other layers of data that we've been talking about. The point about that is, let's say the polygenic risk score is wrong or off a bit. You've got all these other checkpoints of layers, and then you have multimodal AI to bring it all together. And so that's what gives us that pinpoint precision, both with respect to time, you know, when this is gonna be cropping up way in advance, and that's when we get all of these people to work with them to prevent the disease. And, of course, that could be the lifestyle plus factors, or it could be drugs and other means and even more high-tech ways to go into surveillance.

So we have a path to do this for the big three diseases. We just gotta get moving on it.

Dr. Mark Hyman
I wanna unpack that because there's a lot there you said. I I I wanna just just ask you a question, though, before we dive into the big three, is heart disease, cancer, and dementia. You left out diabetes. Yeah. I'm wondering why you left that out.

Yeah. Because it's sort of the cause of all three of those things.

Dr. Eric Topol
Well, that's right. Diabetes by itself, you know, we can handle that. But the problem with diabetes is it leads to the other three. The other three are the big ones we have to work with. And diabetes isn't necessarily age related.

There's some of that, but it's not nearly like the other three. And it doesn't have the twenty year lead time to work with. So there's a lot of reasons why.

Dr. Mark Hyman
Yeah.

Dr. Eric Topol
Although diabetes is considered a killer, certainly can compromise health span. It's mainly working through the other three. You know, people are not dying of diabetes, but they're dying of the heart related kidney, you know, other sequelae, certainly more dementia and and more cancer too. That's why I don't lump it in there. But I think the prototype is Alzheimer's.

You saw I wrote in the book and then also a subject. There's this breakthrough test, the p tau two seventeen.

Dr. Mark Hyman
Yeah.

Dr. Eric Topol
And if you are ApoE four, I mean, you're a carrier, that's twenty twenty five percent of us are carriers, or you have a family history of Alzheimer's or both, you probably wanna get a p tau two seventeen because it's as good as cerebral spinal fluid. It's as good as a PET tau scan, you know, which is a lot of radiation and hard to get.

Dr. Mark Hyman
CT And scan of the brain, but it's, yeah, expensive and radiation and hard to get.

Dr. Eric Topol
Yeah. And here you got a blood test, which is not that expensive. It's available in this country for the past two years. And, you know, Mark, most people never heard of it. I think it's part of your function tests that you do.

Dr. Mark Hyman
It is. It is. Yeah. I added that.

Dr. Eric Topol
Yeah. I I don't know all the tests that you do in that, but that one is a good one. So then you know you have if you have I don't recommend everybody getting this. But if you have APOE four and you have family history, now you know with the p tau test, and you can get a brain clock. Okay?

You can even get a methylation clock. You got these layers of data now. Right? And you also know about your lifestyle and what's good and what's not so good about it. Now you find, oh, p tau two seventeen's elevated substantially, let's say.

Well, this is like an LDL cholesterol. Right? Because if you exercise and you go into a healthy lifestyle, you can bring it down. And we've seen a randomized study presented here in San Diego at the Academy of Neurology annual meeting where they had these the people who are had p tau two seventeen elevated. They they were randomly assigned to intervention with lifestyle, and it came way down, you know, p two seventeen, p tau one eighty one, all these markers, 75 up to 75% reduction.

That should reduce the chances of ever developing Alzheimer's, particularly if it started early. And then, of course, if a person started late, it should put it off, should defer it. So this is exciting, and I'm just amazed that most people don't don't know about this test. No. I agree.

Dr. Mark Hyman
I wanna I wanna just double down on that because what you're saying is so revolutionary. You know, up till now, basically, you had a family history of Alzheimer's. You had to cross your fingers and, you know, wait around and hope to not get it. And there wasn't anything we offered from medicine that was going to prevent it or even treat it once you got it. So it was kind of a scary thing.

And nobody wanted to know their ApoE status because it's like, well why should I know? Because what am I going do about it?

Dr. Eric Topol
Yeah.

Dr. Mark Hyman
And I think, you know, what we've learned is that now with early biomarker testing, and like you said, these develop twenty, thirty, forty years before you ever forget something, right, you forget your keys or you start having memory loss, You can start to see these early clues in your blood, and you layer on top of that proteomics, layer on top of that AI to uninterpret it all. And all of a sudden, you have a window into where you might be headed that you could do something about. Yeah. Yeah. I think trials like the finger trial and the pointer trial are these large clinical trials that show while all the drugs we have for Alzheimer's have failed, lifestyle interventions can slow, prevent, slow, and even reverse sometimes the changes that we see.

And I think Richard Eisen's work is very exciting about pTau two seventy because it's like you can actually start to see how we can actually even reverse it once you start to have it, which is a

Dr. Eric Topol
pretty crazy idea. That's what's the difference where we were a few years ago to where we are now is that we know that these markers are so accurate, and we can use them to see if we're making progress. Okay? So you have the let's say the brain Orden clock and the p tau two seventeen and someone who clearly has high risk of Alzheimer's, and you go six months with this new lifestyle. Right?

And you see, oh, wow. The brain pace of aging is slowing down, and the p tau two seventeen has come down 50%. You say, this is working. And if you want, you can do imaging, of course. But this is extraordinary because now we have the GLP one drugs like Ozempic, Mounjaro, that are being tested in big Alzheimer's trial in thin people.

These are not obese or overweight.

Dr. Mark Hyman
Yeah.

Dr. Eric Topol
These are thin people. Yeah. And because they have such potency of reducing brain inflammation. So we're not talking about the drugs that are being used for Alzheimer's, which don't work very well and are very risky and can cause hemorrhage in the brain. These are drugs that have been out there, you know, twenty some years.

You know, have a whole chapter in the book is how we blew it. We thought they were only good for diabetes, you know, and it took

Dr. Mark Hyman
this Right. Right.

Dr. Eric Topol
This scientist in Denmark, Lotte Knudsen, who kept pushing, we have to try it. We have to try it in obesity. And they kept saying to her, well, Latte, it's not gonna work because the diabetics only lose three or four pounds. Well, now we see we can get people to lose forty, fifty, sixty, eighty pounds. These drugs are so potent.

And the reason it was blown was because the diabetics don't lose that weight, and we don't know why still today, which is such a mystery. Right? But what if it works in Alzheimer's? Because it's working in so many other ways in terms of addiction, in terms of, you know, all these other cardiovascular, many conditions that we did not expect. So even if it doesn't work, there's other drugs, many other drugs that get well into the brain that knock down brain inflammation like GLP one.

And so we're gonna have drugs for people who are at high risk for Alzheimer's to add to the lifestyle factors. But, of course, you wanna press on the lifestyle stuff first before you ever really start with drug.

Dr. Mark Hyman
So so you're you're someone who's listening, you go get this test, You're, you know, you're in your forties, shows up as something that's a little bit elevated. What do you do?

Dr. Eric Topol
Yeah. Well, first, don't get the test unless you have the risk factors. Right? I mean, you don't really wanna get this without ApoE four status or at least Alzheimer's in your family. Right?

Because Right. Or a polygenic risk score even that says you're high risk for Alzheimer's, something like that. Because if you get tests that are not you don't have a high test pre probability, as you know, you're gonna get potentially false positives. And the American Alzheimer's Association, which I think has some problems, they're labeling people with p tau two seventeen as stage one Alzheimer's if it's elevated. That's not good because it could be wrong.

Any test could be wrong, especially if it's done on the wrong people. So as long as I'm admonishing that get the test only if you have increased risk, and if it's elevated, then you're gonna go on a campaign to bring it down. And no, since you're saying this person's young, in their forties or fifties, they got lots of time to really get on it. And, you know, within a few years, we're gonna have a lot more additional ways to bring that down. But just I mean, the lifestyle story, it's hard to get people to to adopt all these healthy behaviors, particularly get it isn't just a behavior.

How do you get a lot more deep sleep, for example, a lot more sleep regularity, which has big impact? That's not even a behavior. That's just something that people, they have to learn how to how to improve. The fact when you get into this aggressive prevention mode, it's more likely that people are gonna take it seriously if they have this marker aligned with their risk.

Dr. Mark Hyman
So in terms of the the lifestyle, that's that's sort of a generic term, but let's kinda break it down. Diet, exercise, sleep, stress, relationships, I mean, toxins. You call it lifestyle plus. Yeah. You know, what are the biggest levers to pull?

Dr. Eric Topol
Well, we start with diet. You know, I think you've been on this, but the ultra processed foods are just horrendous. Right? They are Yeah. The vectors of inflammation in our body, and they are propagating.

They are in I think we're talking about cause and effect of these three age related diseases. And The US has the highest consumption in the world, 70% plus. And, of course, a lot of people are 80% or more. And in the book, you know, I review

Dr. Mark Hyman
Yeah. That's average. That's average. Yeah. Yeah.

Dr. Eric Topol
Children, high, very high. I I review in the book my friend Chris Stuntelligan, wrote the book Ultra Processed People. And, you know, he he went on, like, a thirty day, and he's a really great physician scientist in The UK. And, well, he told the whole story. He had a brain scan beforehand.

He had all these infla inflammation markers beforehand. And in thirty days, kinda like supersize me, he tried to go as high as he could on ultra processed food. By the time the thirty days was up, his brain was all inflamed. He every biomarker had gone through the ceiling of abnormality for inflammation. I mean, it's just thirty days of this bad diet.

He gained 20 pounds. Mhmm. You know, this is this is a something we have to work on. It it's just we've done nothing in this country to bring it down. Other countries are taking it more seriously.

The second thing about the diet, what you think is vital, is the protein craze. We have people out there that are advocating ridiculous amounts of protein, and I review that in the book that there's danger for that, not only for the kidneys, but also we've seen studies after study that show too high a protein diet, particularly animal protein, can induce promote atherosclerosis. That's the last thing we want. Right? It's pro inflammatory.

So that's why, although it's probably wise, if we keep up a decent amount of protein, maybe amp it up a bit as we get older, you know, maybe 1.2, 1.4, one or so per kilogram, not per pound, and that's what some people are advocating. And that's just wrong. It's it's it's dangerous. There's no data to support it. You know, I talk to people who are on this protein craze, and I try to get them onto the data and the evidence, which is, you know, really a danger sign if they go too high on a daily and it's not gonna increase their muscle mass when you go past good studies, 1.5, 1.6 per kilogram.

So that's those are couple of the main things. I don't know what you think about that, but couple of main things about the diet that we we need to get out there.

Dr. Mark Hyman
And the sugar the sugar in the starch too is just a component of the ultra processed food. But I think that's part of the driver of what's causing a lot of the problem. And it is you know, they're calling Alzheimer's type three diabetes, right, diabetes of the brain. I think that's that's a big factor for people, the amount of sugar and starch. And it's it's obviously hidden in the ultra processed food.

Yeah. I think the protein thing is interesting. Mean, I think what were you gonna say? Something about the sugar thing?

Dr. Eric Topol
I think I agree with you. I I reviewed the sugar story, salt, caffeine, alcohol. We went through every one of these things. Everything you eat, fats and plant based diets and red meat. And I went through the whole thing, and you're familiar with this recent study of one hundred and five thousand people followed thirty years, and only nine percent of them, only nine percent, got to the elderly state past age seven.

And the nine percent, what did they eat? They mainly plant based foods, Mediterranean diet, some but small amounts of red meat, the kinds of things you would you would anticipate where the data evidence is back backing it up. So, yeah, the diet is really important, and we keep seeing study after study reinforcing that.

Dr. Mark Hyman
I think one of the things that's really important, Ajay, though, is is being functional. Frailty is the killer. I mean, hip fracture is a bigger risk for death than getting a diagnosis of cancer. That muscle mass is a big deal. Yeah.

And the question is, that's the problem as you get older because when you lose it and it's hard to build it and there's something called anabolic resistance, meaning when you're older, it takes a lot more work and a lot more protein to do the same thing you did when you had these trophic or growth hormone like things when you were younger, anabolic hormones that were floating around your blood. And and the protege group, which is a group of protein scientists led by Don Lehman and others, and I've had him on the podcast. He talks about even higher amounts being needed, like, you know, one up to, you know, one and a half to two grams per kilo. And and this was like a I'm not a protein expert, but it was interesting to read their their data showing that that it's it was this this overcome this resistance and they need to maintain muscle mass, that their data was was like the kind of global think tank on, I don't know, protein experts

Dr. Eric Topol
Well, together that

Dr. Mark Hyman
came up with

Dr. Eric Topol
I reviewed all that data and I would just say, you know, if you're gonna go past 1.5, one per kilogram, you're starting to get to a fuzzy zone. But but, Mark, you can increase your muscle mass not by just, you know, having adequate protein, by, you know, doing

Dr. Mark Hyman
Strength training.

Dr. Eric Topol
Strength training. And I I gotten to do that heavy over the last year because after all the research, you know, I always advocated aerobic exercise as a cardiologist. You know? Cardiologist. Right.

Right. And I these people, patients would come in and they were really cut and buffed, I'd say, well, what are you doing losing Well, all these now I'm doing that, not maybe as trying to be any like the Terminator, but I've been on a big kick on resistance and strength training, balance, posture, you know. Also, I've never been this strong in my life. And I don't I don't need crazy amounts of protein. The point being is

Dr. Mark Hyman
Yeah.

Dr. Eric Topol
It's part of the exercise. It isn't like you just change your diet and you build up muscle. Right? It's the exercise that's so essential. And by the way, the data for resistance training, as I review in the book with various graphs, it's extraordinary for preventing age related big three.

So we should be doing that. I learned from that. I didn't realize how impressive that body of data was.

Dr. Mark Hyman
Yeah. You you and me both. When I was 59, I'm like, yeah. I better start strength training. And it's changed my life.

And my body, I pictured it when I'm 40, and I was a runner. I was into yoga. I wasn't overweight. But like my body looked like I was like a skinny little rail compared to now. I'm not like, you know, the Terminator or the Rock, but I'm I'm like, you know, at 65 beefier than I've ever been in my whole life.

Yeah.

Dr. Eric Topol
Yeah. I was like, wow. This is For me, it's the same Reason that's possible. I think this is a really important step. And then the other biggie is, of course, the deep sleep story and regularity.

I mentioned it earlier. We need to get as we get older and going along, as you said, with the inflammaging is that we don't get enough sleep as we get older, particularly the slow wave deep sleep, and we've gotta get that up. When I started looking at data, I was horrified because I'm not a very good, I had not been a good sleeper. And I started tracking it with a ring and a smartwatch, and I'm saying, wow, I'm getting less than fifteen minutes of deep sleep at night, you know, and terrible overall scores in my sleep because of that. And so I started finding out what is causing all this problem.

Right? And because I had very, you know, irregular times of going to sleep, you know, erratic. And what I ate, what I drank, when I exercised, you know, when I ate, all these factors were playing such a big role. Now I've been able to get it's rare that I wouldn't get over forty five minutes a night, even up to an hour or so. It's been a big difference.

So I know that But what did you do?

Dr. Mark Hyman
Oh, I What were the things that made a difference?

Dr. Eric Topol
Yeah. So the all these things, cumulatively, by tracking, learning, like, for example, not exercising too late in the day, not eating too late in the day, you know, in the evening. Interestingly, alcohol affects many people with respect to deep sleep, but that one didn't seem to have too much of an effect on me. Avoiding drinking too much of fluids and then avoiding having to get up interrupted sleep made a big difference. During the night because I always be hydrating in the evenings.

No. Hydrate all day long, but don't hydrate in the evening. So lots of things that I did, but the timing and also certain foods, it was basically, I wasn't aware of it, but, you know, the indigestion was interrupting sleep somehow. Yeah. So certain foods and also, I think there's these interactions, you know, stress and things that we all deal with.

I learned about a better coping mechanisms to get sleep. And I I'd like still like to amp it up more because that data that I review in superages, it's very impressive, the the link between the deep sleep, which is when we get rid of the toxic waste of metabolites in our brain, that's the time. And by the way, I know we both see patients that take Ambien and other sleep medicine. And what's interesting is that they backfire. Not only do they not get rid of the waste, but they actually increase, Ambien especially been noted, to increase the waste that stay in the brain.

So you the person may feel like they're getting more sleep, but they're not. And of course, along the way, I didn't have it, but certainly one of the concerns I had with that low amount of deep sleep was, did I have sleep apnea? Was that the issue? And that fortunately wasn't the case, but as you know, that's a common problem that doesn't get diagnosed.

Dr. Mark Hyman
So it sounds like writing the book helped you live longer because you're acting all these things. I don't know Like you hadn't known before. Time will tell. But those are powerful drugs.

Dr. Eric Topol
Time will tell.

Dr. Mark Hyman
I mean, strength training is a powerful drug, and sleep is a powerful drug. Yes. They're better than most of the drugs we have, actually.

Dr. Eric Topol
It did. It helped me. But, of course, I wasn't gonna once I reviewed all the evidence, and I was I felt compelling, That led me to change my ways, and I'm hoping that's gonna help a lot of other people too. But I don't know if it's gonna make my make me into the elderly. I with my family history, it's always in my mind, despite our elderly trial that our study that, you know, I may not get into yet.

So far, I fit I don't have any age related chronic disease, and I hope I can go another, you know, ten, twenty years. We'll see.

Dr. Mark Hyman
Well, I think you're few years older than me, and if you've escaped those diseases by now, you probably kinda dodged the bullet.

Dr. Eric Topol
I hope so. I I mean but the main thing is I wanted to get the hard evidence out there. I wanted to get so people know that there is a huge body of evidence that is not Brian Johnson, don't die, or other new longevity clinics that charge $250,000 that do hyperbaric chambers, plasmapheresis, all these putative antiaging supplements, none of which have any data, you know, all this kind of reckless use of things. I wanted to just put it out there that, hey. This is what we know, and it can make a world of difference.

And a lot of this stuff is not very expensive either. You know? And so that was the real purpose of doing a book. And I just as a I as a outgrowth, it helped me too. Yeah.

I think

Dr. Mark Hyman
the things that work the best cost the least. Yeah.

Dr. Eric Topol
Yeah.

Dr. Mark Hyman
Eating well doesn't have to be very expensive. No. Exercising is basically free. You know, getting sleep and optimizing your sleep is basically free. Yeah.

Building relationships, connections, pretty much free. You know? And, yes, there may be things around the margin where we're gonna learn in the future that maybe plasmapheresis helps or maybe, you know, stem cells might help or maybe, some of these, know, things that are under investigation now like rapamycin may help. Yeah. But but right now, the the the their edge their edges, not the the core of what people should be doing.

Yeah. I calls it majoring in the minors and minoring in the majors, you know, and I think that's a very good way to think about it. I'm with you. Live a crappy lifestyle and take those drugs and things and actually think you're gonna do much.

Dr. Eric Topol
No. And all these things that people are, you know, trying to advance, the rapamycin story, they're they have a danger too. We can't measure the immune system, you know, routinely. So why are we taking an immunosuppressant drug, which in some people could be a big deal? Anyway and if you look at this leaderboard of all the the longevity researchers or influencers Yeah.

Doses. You know? It's like, it's one Right. A week, different dose once a day. Nobody knows, but it's never been shown to have any benefit in people.

It's all in rodents.

Dr. Mark Hyman
Yeah. There was one trial I saw that was on elderly, and they found that if it was given intermittently, it actually improved their response to vaccines and actually helped their immune system function better, whereas continuous dosing didn't. And I I think there's mTOR one and mTOR two which have different roles in immunity. And so, I mean I mean, that story is still getting unpacked, but I I find it interesting. But but, again, it's like it's like if you don't do the basics right, that still doesn't matter.

Dr. Eric Topol
Right. We don't know of any studies, you know, that are real. Those are these small studies that in a limited number of people, they're not major endpoint. But, you know, one thing that's interesting, Mark, is, you know, Steve Horovath who had came up with the Horovath clock we were talking about, that epigenetic. The only two things so far that have decreased biologic aging from that clock are exercise and then more recently, the GLP one drugs.

I mean, that's kinda interesting. That's body wide, biologic aging. Well, we haven't seen any studies that that's been accomplished through, you know, these other things like rapamycin. So I welcome I mean, if rapamycin works or metformin or whatever, I'm I I want these things to succeed, but I don't want people to jump to that unless we have the evidence because all of these carry some risk. I mean, metformin carries less risk than than rapamycin because it doesn't cause immunosuppression, but it it isn't something that we know is gonna promote healthy aging.

Dr. Mark Hyman
But it does it does inhibit mitochondrial complex one, which worries me because

Dr. Eric Topol
Yeah.

Dr. Mark Hyman
With progressive resistance training compared to placebo with and without metformin, if you did a strength training with metformin, you didn't get the same response to building muscle. Really got like, I was like, Oh, boy. Yeah. That's not a good thing. I think that So, yeah, there may be like

Dr. Eric Topol
You're making a good point. You really are.

Dr. Mark Hyman
This is really exciting. So, basically, Alzheimer's and dementia, the the take home is there's there's biomarkers now that we can detect early, both genetic risks combined with blood tests that give us an early indication that we should get on it. And then Right. The getting on it part, there's a lot of things we can do, lifestyle plus all the things we talked about. And there and there there's more for sure that we could unpack.

So I wanna kinda get the other ones. Heart disease. And this is your area of specialty.

Dr. Eric Topol
Yes. I I wanna go to heart disease, but I just wanna mention one thing. You know, it's kind of chasing our tails, but the environment in terms of air pollution, in terms of microplastics, nanoplastics, and also, of course, forever chemicals. These things are you know, all three are inflammation inducers that are increasing our toll of age related diseases, the the big three, and diabetes too for that matter. So, you know, we're not doing enough about these, and and I think this is something that you've been, working on for quite some time.

We gotta get serious about this because any advances that we're gonna make, we're gonna talk about cardiovascular in a moment here, we gotta these are the things that were are are taking a big toll on us because, for example, the plastic story, let's just talk about that for a second in the heart. The big study from Italy, multiple centers, where they took the carotid artery plaque at the time of surgery, and they looked to see if there was plastics, microplastics, nanoplastics in the artery plaque. And they found it in over sixty percent of people. And that artery under the microscope was in grossly inflamed right around where the plastics were. During follow-up

Dr. Mark Hyman
Was it a dose response? Yeah. Like, in other words, the more plastic

Dr. Eric Topol
The more plastics, the more vicious inflammation. And what was even worse is the people who had the plastics followed versus those who didn't have plastics in their in their plaque had a four to five fold increase of heart attacks, strokes, and death compared to those without the plastic that was basically establishing residence in their arteries. And so as we talk about cardiovascular now, preventing heart disease, you know, we gotta factor in that particular thing because the plastics are everywhere. They're they're not degradable, and they were just, you know, more and more of them. We gotta do something about it.

But for the heart, this is

Dr. Mark Hyman
where Wait. I wanna just I wanna double that. Before you get to the heart, I wanna just double click on this because, you know, what you're saying and people go, yeah. I talk to them about it. To have a traditional physician who's got the credentials that you have saying that toxins are something we should pay attention to is near heresy when it comes to traditional medicine.

It's something I've been talking about for decades because I've seen it. Yeah. And when you look for it, you see it. Even when you look at it's been there. It's just it's just been ignored because doctors don't know what to do about it.

Because they go, okay. Well, you do for exposure by doing this and that and other thing. But this is something that I think is gonna be an important thing to be investigated. How do we measure our toxic load? How do we start to help the body detoxify by supporting its both internal detoxification systems like the liver and the kidneys and the colon and the skin and sweat, all the things?

How do we actually help the body detoxify? And what are novel methods of detoxification that we might wanna think about when it comes to these compounds? Because they're everywhere and we're all polluted.

Dr. Eric Topol
Well, yeah.

Dr. Mark Hyman
Think you're right. They do play a huge role in all these diseases of aging.

Dr. Eric Topol
You're right. I mean, the dirty air and the dirty water, what the things we drink. So the plastics, of course, are pervasive. And we can do some things at an individual family level, you know, in terms of not having things stored in plastics. Like, the worst case scenario is you take something, food that you have in plastic, and you put it in a microwave.

It's like

Dr. Mark Hyman
Oh, that's terrible.

Dr. Eric Topol
Microplastics you're gonna eat at you know, to fourth power. Right? So there are some things we can do, and, you know, just to everything we can to avoid the use of plastics. But, you know, this is this is something we're not addressing, and that's where the data are so incredibly strong. And air pollution.

What are we doing about air quality? Because the air quality, these fine particulate matter, 2.5 and smaller, they are the real incriminated. They're the culprits for inflammation, big time increasing inflammation. And, you know, you for example, we have now young people, and we're gonna get to cancer. I don't mean to divert it from cardiovascular.

That's my true love. But the young people with cancer, why are people in their twenties and thirties presenting with colon cancer, breast cancer, and other cancers like we've never seen before? Who you know, what is the could it be the ultra processed food that they eat high amounts? Could it be these environmental toxins? Could it be, you know, the cumulative of all these things?

But something has got to give there because we're not, you know, we're not protecting our young people, and we're seeing much more, a real spike in in cancer. These are age related diseases we're actually seeing in young people, which is just horrible.

Dr. Mark Hyman
You know, this literature around toxins has been around and even in heart disease. I remember reading a paper. I think it was the American Journal of Cardiology years ago where they looked at, anybody who had lead levels over two, which is considered normal because level in the reference range is one to 10, but there's there's the normal level of lead is zero in the human body, so not like it required mineral, that their risk of having a heart attack was higher or as high as those who had elevated cholesterol and an increased risk of strokes. And it was it was a big risk factor. And it was thirty nine percent of the population that had a lead level over two because we live in a world where there's coal burning and and and lead levels in the soil and stuff from from historical exposure.

So you're right. I mean, this toxin story is a big rabbit hole but and and I've written a lot about that and I talk a lot about it. But I think there's a lot of ways can reduce their risks and reduce their exposures and not be crazy. But there's there's ways to mitigate it and to help your body eliminate the toxins. I I agree.

So let's talk about the the heart Heart, because people say, well, story's that been told. You know, we've got statins. We've got this piece of SK nine inhibitors. We're all good. Like, what's the big deal?

What should we worry about? It's just all about LDL cholesterol. What's new? Yeah. What what should we be looking at?

What should we be thinking about? And and and why why are we still seeing so many people with heart disease?

Dr. Eric Topol
Yeah. It's still the number one killer around the world, not just here. And it's still the number one killer in women who, you know, they think that it's breast cancer. No. No.

It's this is it. This is exciting because we do know the things that we've been reviewing for risk factors, but we have a way to now establish the risk. Are they really high risk without before they ever have heart disease, twenty years plus? And the way we do that is we can get a simple lipid panel, add the LP, APOB, so a little more than what is the standard lipid panel. The LP will be part of a lipid panel in the next year or two.

But, anyway, when we get that lipid panel, which is, again, very inexpensive, and we can also get a polygenic risk score, very inexpensive, we can also get a heart clock. Right? And we can get inflammation markers. Anyway, now you have the full stack with your records and, you know, and and you have somebody who is well before they've ever manifest heart disease. And you say, oh, wow.

This person is really high risk for heart disease. What do we do? Well, you get their LDL down, you know, not just to below 70. We go down to 20 or, you know, less than 30. Right?

We have so many ways to do that now. We have these injectables that are against this PCSK nine. We've got new drugs, five new LP little a drugs that are gonna be out within the next year or so that are really potent.

Dr. Mark Hyman
And we've had none of them. None till now. Yeah.

Dr. Eric Topol
We never had one. We always tell, oh, too bad your LP is over a 100. You know, nothing we can do. We're gonna be able to change that, and that's gonna have a big impact. We can get all the inflammation, get all over it, right, in terms of bringing the inflammation down.

We've already seen how GLP one drugs do that before any weight loss, so that should work well in people who aren't even obese. And we've seen how that can prevent heart, preserve ejection fraction heart failure, which is half of all heart failure, right? GLP-1s prevent that. For heart disease, we're seeing some really breakthroughs for the treatment, particularly the new target of LDL that we have five different drug classes, statins you've mentioned. But the the PCSK nine, we have three different ways to do that now.

We got other new drugs that are coming. Just recently, the CETP inhibitor worked really well

Dr. Mark Hyman
on

Dr. Eric Topol
top of so we got yeah. We can stamp out inflammation. The other thing is we have a metric we never had before, which is AI. And by the way, that also goes with Alzheimer's. You can do a retina AI exam.

So you have a picture of the retina, and you do AI on it, and it tells you when you're gonna have Alzheimer's, if you're gonna have Alzheimer's, five to seven years in advance. The retina also tells if you're going to have heart disease or a stroke in advance. It will even tell if you're going to, you know, your calcium score of your heart arteries through your retina. Remarkable. We should be that should be widely available.

It isn't yet, but it will be. We'll be doing smartphone retina checks someday. Right? But here's where we get a real kick on a a jump on this because if you are concerned about high risk and somebody is, let's say, 40, 50, they have significant risk factors, you can do a CT angio, which is now becoming very inexpensive, and you can look at inflammation in the artery. I go through this in the book.

Inflammation's in the artery without a narrowing. Okay? So the the basically, it does AI of the fat around the artery, and it and this is something that was developed in The UK and is now getting ready for FDA approval. This is a big jump because we always were

Dr. Mark Hyman
So this isn't the CLEARLY scan. This is something else?

Dr. Eric Topol
No. No. The CLEARLY and the other ones in The US don't do this. But this is a Oxford University of Oxford spinout. I think it's called Karista.

They're gonna have that available soon. And I went through the data in the book. I mean, they've had multiple papers, but it's striking. If you have inflammation without a narrowing, it's you know, you you could have fifteen fold risk of a heart attack. So that's when you use that as a metric, just like we were talking about the p tau two seventeen for Alzheimer's.

Dr. Mark Hyman
Yeah. Yeah.

Dr. Eric Topol
We've got all these new things for cardiovascular. We are gonna get a a grip on this, I mean, that was you know, ideally start early, but, you know, the lifestyle factors work really well. This is the most preventable known of the three big age related diseases through lifestyle.

Dr. Mark Hyman
Because even without a lot of the drugs, like, lifestyle plays a big role. Like, you know, I've seen data up to ninety percent by healthy diet, exercise, stress mitigation, sleep. Right?

Dr. Eric Topol
Yeah. I mean

Dr. Mark Hyman
Is that is that

Dr. Eric Topol
In the book, I found all these studies that I was really struck by that are recent that showed that if we practice the the lifestyle factors that we've been reviewing with the details, that we just we discussed, that gets us seven to ten years of healthy aging without one of these age related diseases. I mean, who wouldn't watch seven to ten years of healthy aging just from the stuff we've been discussing without any, you know, magic potion or pill? So that's I think people don't know about that. I didn't know about that. It's really impressive.

Dr. Mark Hyman
That's powerful. So so but you're saying that some of the advances in cardiology are more pharmacological that you're thinking are coming, like the drugs that lower this genetically determined lipoprotein called LP, which I've been checking for thirty years. APO B, which I've been I checking for thirty read some article the other day that was like, there's this great new test that can be more predictive and be risk of heart attack than any other test. It's just discovered. I'm like, what is that?

I'm like, look. Click through the article. It's like APOB. I'm like, oh

Dr. Eric Topol
god. Yeah.

Dr. Mark Hyman
But I mean

Dr. Eric Topol
You only you only need to get it once, and then you can tell if if you need to check it further. But you're getting at a a key point here is it isn't just that we have better you know, more armamentarium of drugs, but we didn't know how to get the risk down. You know, we didn't know how to say this person's really high risk for atherosclerosis because we didn't really have we didn't use the polygenic risk score. We didn't have as we do now, we're gonna have a heart clock. We we so there's a big debate out there, as you probably know.

How low should we go on LDL? Should we pull out all the stops? Well, you look at all the data, the lower you go, the more protection, but you don't wanna necessarily give people, you know, ezetimibe and statin and a injectable and all these things unless they really are at high risk. Then you go for broke, and you also get the LPA, and you get the inflammation down. We have ways that we can do that, and we're gonna keep having better ways.

So this is a striking it's a combination of who's at risk, the partitioning of risk, and having a better ways to work on that risk.

Dr. Mark Hyman
Just to play devil's advocate because this conversation comes up all the time. You're a cardiologist, so your favorite organ is the heart. And so your idea is get the LDL as low as you can. Not in every aspect it.

Dr. Eric Topol
In people who are at high risk.

Dr. Mark Hyman
In people who are at high risk. Okay. So if you're really high risk. But what about the effects, for example, on the brain and cognitive function? Because the, you know, cholesterol is a big part of your brain and sex hormones, is what your your testosterone is made from is cholesterol.

So how do you kind of navigate that? And what's the truth, and what do we know?

Dr. Eric Topol
Yeah. Mean, the statins are probably the most studied drug class in history, really. Some of the data that comes out of these big meta analyses which say, oh, people don't get any leg cramps. That's not true. You and I know that's not true.

People do get severe leg cramps where they can't even sleep at night, you know, and and all sorts of other, you know, leg, and muscle related symptoms. Now with respect to cognitive and sexual dysfunction, the data really don't show a hit there at all. And in fact, you know, I think that we have some data to suggest the chances of having dementia, in people, and Alzheimer's, as you know, accounts for seventy percent of dementia, that if you if you don't have the LDL lowered to, let's say, less than a 100, less than 70, you're gonna be at higher risk for dementia. So if anything, the data support statins. And, you know, the data for sexual dysfunction, it's again, some of that's vascular.

And if it's vascular, we're talking about atherosclerotic, and that, again, is gonna be ameliorated with and, of course, we don't have to just rely on statins. A lot of people do have side effects from statins no matter what the group at Oxford keeps saying that everyone can take a statin, it's just, you know, it's mental if they can't. When I wrote an op ed in the New York Times like a decade ago, and I called out the diabetes from statins, Okay? Because if you take a very potent statin, you have a higher risk of developing type two diabetes. Right?

Dr. Mark Hyman
Yeah.

Dr. Eric Topol
Oh, did I get slammed by my cardiology colleagues for that? I said, well, wait a minute. That's the data, folks. I'm sorry. And over the years, we've seen many more reports about, you know, the potent statins, high doses where you get a higher risk.

Yeah. And you know what? Most physicians are not keeping up with this. They're not watching their patients to see if their glucose, glycohemoglobin, you know, a one c or fasting glucose. And this is bothersome to me because that is a side effect of statins, potent statins.

So, again, this is important because if we're gonna lower LDL and pull out all the stops and, you know, high doses of rosuvastatin, Crestor, or atorvastatin, Lipitor, that could also raise the risk of that person developing type two diabetes. We don't wanna do that. And we have cardiologists at my college, they are really sold on statins, and they basically ignore this diabetes issue. And did I ever take grief? No.

Dr. Mark Hyman
I agree with you, and I think there's a concern I have around its effect on mitochondrial function Some of the data I've seen that even in people without muscle pain, even without elevated muscle enzymes, that there's mitochondrial damage on muscle biopsies. And for me, mitochondria are so key to healthy aging in the brain, in everything from Parkinson's to heart disease, diabetes. Diabetics have poor poorly functioning mitochondria that may be part of why it causes it. And so I I'm wondering, you know, some of these other drugs that are coming down pike, even though some of them are expensive, may be a better solution.

Dr. Eric Topol
Well, people that have clear cut adverse effects, you know, the the PCSK nine injectable drugs are a winner, because they're potent. And they have not been associated with diabetes, which is really interesting. They have not been associated with cognitive or other side effects. So most insurers cover that now. We, you know, went through years where it was because they were so expensive, the cost has come down.

So as long as people have the right indication where they have significant side effects or they need to have their LDL substantially lowered, it's usually not a financial stress for most people.

Dr. Mark Hyman
So heart disease still is lifestyle, but then there's a cocktail of other drugs in very high risk patients that you can detect early to figure out. And and what about lipoprotein fractionation, which is a lab test that we include as part of function health as well as APO B and LPA, something I've been testing for thirty years. But do you think that's as important? Because to me, the particle number and particle size story is important and it's a of a clue that there's insulin resistance, which is one of the biggest drivers of heart disease and all the other age related diseases.

Dr. Eric Topol
Yeah. I mean, I think it's mild, potentially mild incremental information. I just don't see that it has nearly the impact of just zeroing in on LDL and LP. I do recommend that everybody get an ApoB at least once, and then you can figure out whether that needs to be further assessed. These other things, you know, it's an additional expense.

I just haven't seen the the value. But, you know, I have colleagues that are lipidologists that test every known particle in the mankind. Right? I just haven't. I haven't really seen the benefit because it doesn't change usually.

To me, I gotta know the person's risk, and then I'm gonna go after inflammation. I'm gonna work on their lifestyle, and if necessary, you know, get their LDL down as low as possible. So the the other things just don't have a for me, added value. But I do know there are people that are, you know, wild and crazy on every particle, small, large, dense, you know, you name it out there.

Dr. Mark Hyman
Yeah. Yeah. So I hear you on that. I think it's, you know, sometimes more information isn't always better, but, you know, then what is the most important information? I think you've covered that in your book.

And I think, you know, we're going down the kind of the horsemen of the apocalypse, you know, the the the heart disease, the cancer, the the dementia. I think diabetes is sort of all in there related. But you're talking about how there's kind of a newer with the advances in our diagnostics, whether it's imaging or retinal scans or new ways we can measure dementia biomarkers we never had before cancer, we'll get into in a sec, that these diseases can become more optional. Like, they're not inevitable.

Dr. Eric Topol
They don't.

Dr. Mark Hyman
Have more agency than we ever had before given what we know now. And when you layer up what we're learning with AI and using multimodal treatments, we will be able to actually make a big dent if people really understood how to navigate this. And the sad part is that, you know, you spend your time thinking about what's coming. Most physicians are just trying to deal with the onslaught of what is and don't have the the bandwidth to actually apply this stuff until it kinda is way often decades later. And so I I I really appreciate your sort of paying attention to, you know, what's happening and keeping your nose to to the scent of where things are emerging because otherwise people just don't know.

And doctors, like you said, don't know. And and the average person doesn't know, but this is such a hopeful message. I I wanna kinda finish on on cancer because I think this is one of those things that, you know, the c word, you know, nobody wants to get that diagnosis. It's very scary. Most cancers are picked up late stage Yes.

When this five year survival rates are very low in the five to twenty percent, if that. And picking things up early and understanding your risk can can lead to cures essentially. Like and I think with what I'd like to hear is your sort of perspective on this with new, liquid biopsy testing, with with new new technologies of imaging, with new, you know, maybe other proteomics that are coming. What what is what is out there that's emerging? Because, you know, my sister died of cancer at 57.

My dad died of cancer. He was otherwise really healthy. He'd been a smoker when he was younger but quit and ended up getting lung cancer. Like, they could potentially even still be around if they hadn't died of cancer. And I don't want to get cancer.

Dr. Eric Topol
I'm you. Yeah, my mother died of cancer in her fifties, and most of my relatives on my father's side had colon cancer. You know, I've had a lot of cancer in the family for sure. And I agree, no one wants to go through this. And I do believe we have a path to prevent cancer, and certainly it's spread, right?

If you can find it microscopically, which we don't right now very well, long before it's ever shown on a scan. And once it's on a scan, if it's really cancer, you're talking about billions of cells, right? You want to find it if it does exist microscopically. So why is this such an exciting area? Again, we can find through the full stack who's at risk and for which cancer.

And so we have a way, you know, whether it's polygenic risk or genome sequence, we can do, for example, you know, just looking at the clocks, which is another way to get a window into a risk of cancer. If a person has a significant risk and, you know, family history is part of that. Right? Then they also confirm through these other I mean, a simple polygenic risk will tell us a lot. This is now a different story completely, Mark, than the way we screen for cancer today, which is as dumb as it could possibly be.

Age 50, you show up women mammogram. Right? Alright. Only twelve percent of women in their lifetime will ever have breast cancer. Eighty eight percent will never develop breast cancer, but they're all supposed to get mammography on a frequent periodic basis starting age 40, 45.

This is, you know, crazy. We don't do anything to partition risk. The same for prostate cancer, colon cancer, you name the cancer, this is what we do. We treat every human the same. We waste all this money on mass screening.

Right? Now what I'm suggesting is let's partition people's risk. If they're high risk, then they should have screening. But that screening is different. It's basically establishing the risk, and then if we see a person, you know, as a significant risk, you can then do a plasma tumor DNA assessment.

Right? That right now is pretty expensive. It's $809,100 dollars. The one that's used the most is gallery of of, GRAIL, and almost 400,000 people have had that test. But guess what, Mark?

The people who've had the test is because they're age 50. I mean, that's the a plus. That's not the reason they should get the test. It should be because they have risk of cancer. Anyway, the yield for that test is very low, and most of it is already late stage.

Two out of thousand, you might pick up an early cancer. So you gotta use the test right in the right people. This is something I can't emphasize. Then that test and all the other liquid biopsies have a much better chance to be helpful. So we have that, but, also, this is where our immune system kicks in because we don't have that immune metric system metric except for immune clock.

But if we did you know, if our immune system was amped up, we wouldn't have cancer spread. We wouldn't see metastasized.

Dr. Mark Hyman
It was surveilling. Yeah.

Dr. Eric Topol
You know, what we know is this. Some people this is really fascinating. Some people will have a positive test for tumor DNA, and they reassessed in a few months, and it goes away. What do you think happened? Was it a false positive, or did that person's immune system kick in?

I think what we're learning is it's the immune system. And what we have to get is this is the missing piece right now, the immuno. If we can get this and find people who are at risk for cancer and just make sure throughout their lifetime that their immune system has got good integrity and it can fight off, the threat of a cancer of a of a foreign protein that would be on the antigen on the surface of a of cancer cell. So I am really gung ho because if you look at the treatment of cancer, we're now seeing things we've never seen. Personalized neoantigen vaccines to cure pancreatic cancer, to cure renal cell carcinoma, intractable that is, people that fail everything else.

The other thing, just to mention, here again is AI. We are seeing AI used for the electronic health record using the unstructured notes and the regular notes and set points. That is the lab values. But even when they're in their normal range, AI analyzes, woah. It's even in the normal range.

And we look at it and say, there's no asterisk, so it's okay. Well, no. The AI says, uh-uh. This is flagging a risk of pancreatic cancer. This is flagging a risk of ovarian cancer.

The hardest diagnose of cancer we're seeing that can be brought much earlier through AI of all of a person's data. We saw it from the study that was done in Denmark in the VA for pancreatic cancer. We're gonna see Sloan Kettering has But

Dr. Mark Hyman
what were they looking at? Because they weren't they weren't looking at tumor markers, were they? Were looking at just regular blood tests?

Dr. Eric Topol
Yeah. So they looked at a person's nonspecific symptoms like abdominal symptoms for pancreatic cancer. And they saw they saw ranges of liver function tests in the normal range, but trending in the wrong direction. Right?

Dr. Mark Hyman
So Yeah.

Dr. Eric Topol
The AI picked up the higher risk of people that we might not we we might discount these are nonspecific symptoms. These tests are lab tests. They look normal, but they're not normal when you are looking at this in serial assessment. So I'm also lots of different ways that AI is helping to, us to gauge a person's risk and help us to pick up these occult difficult to diagnose cancer.

Dr. Mark Hyman
I mean, it is so important what you're saying that there was a paper in Nature Medicine recently on personalized lab data and and the idea was that exactly what you're saying Yeah. That even though it's quote normal

Dr. Eric Topol
Right.

Dr. Mark Hyman
It may not be normal for you because if you were like 20 and it goes up to 35 which is still in the normal range, that might not be good.

Dr. Eric Topol
That's right.

Dr. Mark Hyman
And we need to start getting a baseline of what our data is and tracking it over time and having AI help us learn from it because you know as a doctor, you see thousands of patients that come in and they have their lab panel every year. You can't keep in your mind what their liver function tests were last year or five years ago or ten years ago and how that differs and how that what's the variation from their normal or baseline test. You can't you can't do that as a human being. Right? And I mean I I have certain patients who are OCD and they bring in spread sheets with years and years of their data and you can graph it all.

I'm like, wow. That's like, I never saw that before. But without that, you really don't know what's going on.

Dr. Eric Topol
And you're that that's the paper I was talking about on set points. Exactly. What you're Yeah. And we just don't look at that because if it's normal, we don't look at, you know, the last few years how things are just, you know, inching up. And that's what that's the way AI can help us, and it is helping.

We've already seen proof of it. So for a variety of conditions, but especially these three age related disease and especially cancer, because we are not doing well with cancer. You you said it. We're only diagnosing cancer when it's way too late, and that's gotta change because when it picked up first picking up that the person has risk and picking up when it's microscopic well before you ever catch it on a scan. That's why, you know, I'm not I'm not keen on these, you know, total body MRIs because they're being used to pick up already a cancer that's got a mass.

Right? And, of course, a lot of times, it's not even cancer. It's benign, and people go through unnecessary biopsies. But I do think if a person's high risk, and certainly if they have a positive liquid biopsy, you know, tumor DNA, then it's a very reasonable thing to pursue. We're gonna do much better.

And all these years of trying to treat cancer and cure it, You know, what do people have to go through to get there when you could prevent it? And, you know, I think this is where we have a a brilliant future. It may take a while to get it implemented, but it it's ready to go in many respects.

Dr. Mark Hyman
Just to go a layer deeper. So just talk about polygenic risk for cancer. And we've heard about the BRCA gene or, you know, familial polyp disease

Dr. Eric Topol
Right.

Dr. Mark Hyman
Increased risk of cancer disease. Those are unusual, although they're they're things you can measure and track if you have a family history. You're talking about a different set of genetic biomarkers that are being discovered that help us segment people in terms of their risk Right. Related to different cancers.

Dr. Eric Topol
Yeah. So you're bringing up the rare mutations. But I I for example, they can all be had in a sequence, costs a couple $100, a full whole genome sequence. And BRCA two, we as men, you know, we're a lot of a lot of us carrying a BRCA gene. And just because we don't have breast cancer, that means we have a higher risk of prostate cancer ourselves and other forms of cancer.

So these are pathogenic genes, and I go through that BRCA2 story in some depth because of the Icelandic data where it made a difference of up to seven years of of healthy aging, mainly because of cancer. Now so you get these rare so called pathogenic genes that have a high risk of cancer, But you also can get a whole bunch of susceptibility genes. So they're not as high deterministic, you know, very like we were talking about APOE four, two two copies, but they are increasing the risk. So what you have are three different types of gene markers. One is the rare variants like BRCA two, BRCA, BRCA two, and and as you said, Lynch syndrome and these other familial polyposis.

The next is the common variant. The common variants, which is what you pick up in a these are, like, say, 200, 300 gene variants that would give you the high risk for breast cancer. They're not BRCA. These are just common variants that you gotta admixture from your mother and father. Right?

And then the third group are these other susceptibility genes that can be gleaned from a a genome sequence. When you have all that data, which is, again, not expensive and processed properly, then you know if what type of cancer you're at risk for, if you're at risk for a cancer. It doesn't tell you when. It just says yes, no. Right?

That's the the when is when we have to, you know, get early get on this early and not not treat everybody who's 50 and older as if they were Yeah. You know, a cattle that we're all the same. We have to be much smarter about this.

Dr. Mark Hyman
Like, and this is what we call precision medicine or personalized medicine where it's very And then we're we're finally entering the year. I think AI is gonna help us get smarter about that. The other thing, you know, you sort of mentioned was sort of liquid biopsies. And and you kind of touched on this a little bit, but proteomic kind of testing. The liquid biopsy, from what you're I hear you saying, you don't think it's a good screening tool because it picks the things late.

But if everybody got it, it would pick up things earlier. Right? If it was sort of cost was down and scale was up for blood tests every year with your checkup, you could potentially be picking up stuff much more frequently and much earlier. Right?

Dr. Eric Topol
Well, potentially. But you see, it's not be it's just being done for on the age criteria. And the yield of picking up an early cancer is two per thousand people, which is really, really low. Right? That doesn't make it a

Dr. Mark Hyman
Unless you're one of those two. Yeah. I mean

Dr. Eric Topol
and, also, you know, if you had the test and it's negative, that doesn't put you in, you know, in a safe

Dr. Mark Hyman
group.

Dr. Eric Topol
Yeah. It's only if it's positive where it's really helpful. I do think these tests are gonna get better. There's lots of ways. You know, this is a a very minimal amount of tumor DNA in the plasma, and there's ways to jack that up to make the test better.

And as you got to, it's gotta be cheaper. But, yeah, again, this whole base or theorem of don't do tests that are not in people who are at healthy, of no risk. But when you do it in people like, the the two per thousand I cited is in healthy people aged 50. But if it was done in people who were you know, clearly had increased risk, that yield of picking up

Dr. Mark Hyman
Then it's a better test.

Dr. Eric Topol
Yo. Yeah.

Dr. Mark Hyman
Better test.

Dr. Eric Topol
And, also, when you're paying $900, that's, you know, substantial. If we get that test down to $100 or something like that, and it's it's more sensitive, more accurate in the right people, it's gonna become very commonly used. So you're you're heading down the right path with that point.

Dr. Mark Hyman
Yeah. And then the other thing I've been hearing about is proteomic tests where common protein some of the common proteins we look at for cancer, like CA one twenty five or CA 99 for colon cancer, like, they're combining that with multiple other proteins, and they're able to kind of using AI to predict that, know, you'll be able to pick up these cancers much earlier with these proteomic signatures that they have in the blood, which are really inexpensive to do.

Dr. Eric Topol
Right. So that's a Johns Hopkins Bert Vogelstein effort. And that's right. As you said, they combine some key proteins that have been established as markers with some gene variants and made a relatively inexpensive test, and that's one that certainly has a potential as well. We're going to be able to do so much better with the screening using the blood, because once it shows up in the blood in a microscopic, that's when we get all over it because this is, I think, new era of early diagnosis.

It's essential. And we just you know, again, you get it on a mammogram, it's already got a problem. You know? And Yeah. We're not even using AI in this country for mammograms routinely, and we should.

That's the best AI case that exists today. Hundred thousand plus women in Sweden, the AI picked up twenty five percent more cancers compared to radiologists alone. Wow. You know, significant cancer. And and no increase in false positives.

Why aren't we using that? So we're not doing a good job here for cancer screening or partitioning risk, no less preventing it.

Dr. Mark Hyman
I mean, mentioned imaging a little bit, but my understanding is that with new AI advanced sort of interpretations of that with these more high resolution scans, you can pick up cancers down to two millimeters, which is pretty small, like, makes it a sign of a ballpoint pen. Yeah. And and at that point, they're not likely to have spread or metastasized. Then Right. You know, you can see changes over time if you do serial imaging.

Seems to me that's a that's a kind of a useful tool.

Dr. Eric Topol
Might be. It may

Dr. Mark Hyman
pick up things that are more sensitive than the gallery, which is not as sensitive.

Dr. Eric Topol
Yeah. It might be. I think what we've seen in these unequivocal you know, a huge trial is that AI of a regular mammogram, not like you're talking about, not ultra high resolution, it can really make a difference. And so that, I think, is, you know, we should be implementing that and we're not. And it's just a, you know, a missed opportunity.

There's a big study that showed that if you have AI analysis of a regular mammogram, you can predict cancer from that in that woman five years ahead if they're gonna develop cancer. So the AI of scans continues to see things that we humans can't see. And the fact that you can look at a mammogram with an AI not only make the diagnosis of cancer more, you know, better than radiologists alone, but also see some patterns that indicate the person's much higher likelihood of cancer in the next five years. So it's just like what we're talking for about with the ability to predict the other age related diseases.

Dr. Mark Hyman
Yeah. So the and the fourth thing you said was really around finding ways to enhance our own body's immune function. Yeah. Like, natural killer cell function. I know Patrick Sun Shang is working a lot on this, and I don't know I am not deep enough into it to know whether there's a lot there to it, but it seems like an interesting theory that if we can see a decrease in our own tumor surveillance with lower natural killer cells, which is part of our immune system, the white blood cells that kill cancer infections, that we could amplify that effect, that could be a powerful therapy.

Dr. Eric Topol
Yeah. So this there's a whole chapter on the immune system. And after the brain, this is the most complex system there is. There's so many different cells and interferons and antibodies. But the the big thing here is we have ability to control our immune system like never before, up or down, like a rheostat.

Right? And with that capability, that gives the confidence that we can amp it up for people at high risk for cancer or at the earliest possible diagnosis. So we're no longer gonna give these, you know, toxic drugs, but we're gonna just get their immune system in high gear. And, also, of course, what we've never seen before, Mark, is by taking people with autoimmune diseases like lupus, systemic sclerosis, even multiple sclerosis, by giving them, T cell, engineered T cells, CAR T, directed towards depleting their B cells that when the B cells come back, they forgot that the person has an autoimmune disease. They have a control alt delete.

I mean, this is incredible. Right? That they no longer and for now, seven years of follow-up, they're cured of an autoimmune disease. We had never seen anything like that before. And, of course, you know, we're seeing, you know, more and more reports of this ability to cure, really vicious autoimmune diseases that can killers and no less really severe morbidity.

So that is another besides the cancer immunotherapy Yeah.

Dr. Mark Hyman
That's huge.

Dr. Eric Topol
Oh, I mean, the fact that the more you give immunotherapy, higher gear, the more chance you are going to be able to treat successfully a person with an intractable cancer. So between all these things we're learning about the immune system, no less the missing metric, the ability to test a person's immune system at any point during, let's say, their annual checkup or whenever. Once we get that, then that's the missing link right now. Then then we're off

Dr. Mark Hyman
to That's the protein clocks. That's the immune age protein clock.

Dr. Eric Topol
Yeah. Yeah. We have an immune clock, but we want more than that because that as you got too early on in our conversation, that's a piece of it. But we want to know about the T cell story, the B cells, the NK, all these different cells. We wanna know about I do present in the book a kinda first tier immunome that I had of a Johns Hopkins startup called Infinity Bio, where I had all my autoantibodies, every virus I've ever been exposed to in my life.

Interestingly, you know, I never had been exposed to CMV, and all sorts of things that are gonna helpful. And and this could be done inexpensively. It will be common. It's all part of this immunome that we don't have right now that we need.

Dr. Mark Hyman
To loop back on the cancer thing, but before I go with that, you mentioned T cells and measles. People probably don't know about it. B cells are the ones that create antibodies, autoimmune diseases are where you make antibodies against your own body's tissues. So that's why it's so important. And T cells are more of an ancient part of your immune system.

They're more general and and and are we call cell mediated, which is different than antibody mediated. And those will basically turn off the B cells so that you don't make antibodies. That's kinda cool. I didn't know about that.

Dr. Eric Topol
Yeah. You know, these these Tregs that are the key T cells that you could, you know, get to tone down, your whole immune system. And then, you know, and then killing these these cells that have the the foreign the alien antigen, the cytotoxic c d a t cells. I mean, so we the immune system we have is rich. The problem is as we get older, you know, it lets down, and and some people more than others.

And we have to be on top of that. That's the one thing that if you had to go back and say, the elderly, how did they get there? Maybe some of them, it was just, you know, random sarcastic luck. But for the most part, these people are you know, they got a great immune system that just carry them through, and we want everybody to have a great immune system someday.

Dr. Mark Hyman
And I think we're gonna learn more about how to do that. Just to kinda go back to the cancer story, I I just wanna finish summarizing it because as I think about all these new technologies, whether it's, you know, collections of genes that put you at higher risk that aren't a cancer gene, but that, you know, collectively increase your risk combining with the liquid biopsies to get more and more accurate at less less of a cost combined with protein signatures of different cancers that can be picked up, you know, way before you'll see anything in any other test combined with better resolution AI imaging done serial over time. It seems to me that, you know, you can't prevent us from getting cancer because we live in a toxic world and there's shit that happens. But we could make dying of cancer a historical footnote.

Dr. Eric Topol
Oh, yeah. Yeah. I mean

Dr. Mark Hyman
Is that fair to say?

Dr. Eric Topol
Yeah. I mean, prevent what we have to do, and I go through this in the cancer chapter in the book, we have to prevent metastasis because people don't die of the cancer per se. They die of the spread of that cancer. And if we can just get rid of metastasis, which we can, there's a way to do this now, then that's gonna be our big dent in the cancer story. And, you know, obviously, we wanna even catch it when it's before it gets to microscopic.

And we put people under surveillance who once we determine they're at high risk. But I think what is so exciting here is just prevent it ever getting legs. Don't if it doesn't spread, we got a winner strategy here.

Dr. Mark Hyman
You and I can geek out on this all day long. I think we didn't get to a lot of things I didn't wanna talk about, but we covered, I think, some of the most important things, which is the advances in medicine are happening so rapidly that we're learning about ways to detect early, very early, far early than we used to, and to be proactive with what we learn about through lifestyle and other novel therapies that we can make these three horsemen of the apocalypse kind of not so scary anymore, heart disease, cancer, and dementia.

Dr. Eric Topol
Yeah. I mean, that's the nuts of it. I think what's so exciting and, you know, why I'm so optimistic is for millennia, we talk about preventing these diseases, and we never did. And now we can do it. We we can do it.

It wouldn't happen if we didn't have the science of aging metrics we've been discussing, these new ways to track a person, you know, really accurately and temporally. And it wouldn't happen without the multimodal AI to assemble, integrate all the data at the individual level. So it's these two things coming together that's made this possible. It's a unique, you know, really momentous time, and that's why, you know, I'm so optimistic that we can make a difference. This will be the chance in the in medicine to finally fulfill that fantasy of primary prevention.

Dr. Mark Hyman
And really, at at at the end the day, comes down to creating large datasets on each individual. So learning about all your biomarkers and data from genetics to proteins to lab testing to be able to, understand the the the root causes and the risks and then using AI and and big data analytics to actually make sense at all through the lens of our new understandings of human biology and and like systems biology. And to me that's to me so exciting because we've been sort of just playing reactive medicine for so Oh, long yeah. And it's This is a time when we can move towards more proactive medicine. And I think doctors would be happy about that if they can figure out if we can figure out a way to make them do their job in a more sort of streamlined, easy way that makes this accessible to them and to their patients, it's gonna be a game changer.

Dr. Eric Topol
Yeah. I mean, you know, we're we're even banking on cures, and that's much harder than prevention. Yeah. And, you know

Dr. Mark Hyman
A pound of pound of of cure. A pound

Dr. Eric Topol
If we get serious about it, we can really do something.

Dr. Mark Hyman
Well, it's exciting. I need I think everybody needs to check out your book, Super Agers. It's quite it's quite a story. It's a little more sort of technical than maybe most people would like, but there's chatty bitty. You can look up stuff you don't understand.

And and I think that this this book is, is a potential way to change our thinking in medicine. I I really enjoyed it, and I and I'm really grateful for you being so curious. You're like a curious George. And I think thank you for your curiosity. Thank you for all the work you've done in medicine for so many years, and, hope we get to chat again soon and and, get you back on the podcast and we talk about some things we could talk about.

Dr. Eric Topol
I would just would add. I tried to get it as simple as I could for everyone to understand. And there are some parts that get a little dense. I I apologize early in the book for that, but I think there's a lot of things in there that hopefully everyone can understand. And I did do the reading so that people they don't have to, you know, read it.

They can just do the the audio and hear the passion and all that. And finally, there's 70 some graphs in there. So a lot of times people can graph grasp the graphs. And so, hopefully, your point is a good one because, you know, there's a lot of 1,800 citations, so there's a lot there. Hopefully, the people will will get something out of it.

Dr. Mark Hyman
I know I'm gonna see you well over 100 years old.

Dr. Eric Topol
I know. I hope you're right. And vice versa.

Dr. Mark Hyman
If you get to a 100, invite me to your birthday.

Dr. Eric Topol
I just wanna get to whenever age and and and say as long as I can to meet that kind of worldly criteria of plus 80 and no age related major diseases that we've been discussing.

Dr. Mark Hyman
I think that's a take home. Don't end up being elderly. You can be elderly by just following this advice.

Dr. Eric Topol
We're gonna get there. A lot more elderly in the future. That's what's in store.

Dr. Mark Hyman
Thank you. Alright. Well, thanks so much, Eric.

Dr. Eric Topol
Thank you.

Dr. Mark Hyman
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