Dhru Purohit Show - How To Catch Heart Disease, Alzheimer’s and Cancer Early: Tests You Need To Know About, Genetic Risk Factors, and Key Lifestyle Habits that Make a Difference with Dr. Eric Topol

Episode Date: September 17, 2025

This episode is brought to you by One Skin and Momentous. Cardiovascular disease remains the leading cause of death worldwide. But today, we no longer have to wait for symptoms to understand our risk. Advances in technology now make it possible to get a clear snapshot of individual risk, not only for heart disease, but also for cancer and neurodegenerative conditions, empowering us to take proactive steps to lower risk and support long-term health. Our guest today breaks down what’s truly worth investing in and what we can skip. Today on The Dhru Purohit Show, Dhru sits down with Dr. Eric Topol, a cardiologist and Professor of Molecular Medicine at the Scripps Research Institute. Dr. Topol shares insights on the importance of preventive health, with a focus on cardiovascular disease, cancer, and neurodegenerative conditions. He explains the role of polygenic risk scores in assessing individual risk, explores the strengths and limitations of various testing methods, and highlights how lifestyle choices shape disease prevention. Dhru and Dr. Topol also discuss emerging technologies in health monitoring, the influence of environmental factors like air pollution, and what the future may hold for aging and health management. Dr. Eric Topol is Executive Vice President and Professor of Molecular Medicine at Scripps Research and founder of the Scripps Research Translational Institute. A practicing cardiologist and one of the ten most-cited researchers in medicine, he is renowned for his wor in AI, genomics, and digital clinical trials. Named to the Time 100 Health list in 2024, he also writes the Ground Truths newsletter and is the author of The Creative Destruction of Medicine, The Patient Will See You Now, Deep Medicine, and Super Agers. In this episode, Dhru and Dr. Topol dive into:  Cardiovascular disease causes, risks, and prevention (1:07) Polygenic risk genetic links to disease and understanding your risk (7:56) Heart health with Dr. Topol’s key recommendations (13:21) Cancer testing types of tests and how to approach results (27:47) Medical guidance mistrust, confusion, incidental findings, and the importance of evidence-based practitioners (34:20) Alzheimer’s detection, blood work, testing, and the role of AI (43:13) Environmental risks, air pollution, and sleep irregularity, and why these factors must be addressed (53:20) Parkinson’s disease: the fastest-growing neurodegenerative condition (57:01) Prevention and lowering your risk of developing major diseases (59:52) Gut health and the gut-hormone connection (1:02:05) Aging and immunity: links between age-related diseases and the immune system (1:06:19) Measuring biological age (1:08:14) Final thoughts and takeaways (1:16:27) Also mentioned in this episode: Super Agers: An Evidence-Based Approach to Longevity Polygenic Risk Scores: Ready for Prime Time? What a Polygenic Risk Score Can and Can’t Tell You Allelica Polygenic Risk Test Dhru’s APOE Chat GPT Results  For more on Dr. Topol, follow him on X/Twitter, The Scripps’ socials: X/Twitter, Facebook, Instagram, YouTube, TikTok, Threads, LinkedIn, Bluesky, or visit their Website. This episode is brought to you by One Skin and Momentous. Right now, One Skin is offering my community 15% off; just go to oneskin.co and use the coupon code DHRU to save 15% and give your skin the scientifically proven, gentle care it deserves. Optimize your energy and mental clarity with the Momentous Three: Protein, Omega-3s, and Creatine made by and used by the best. Head to livemomentous.com and use code DHRU for 35% off your first subscription. Sign up for Dhru’s Try This Newsletter Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Eric Topal, welcome to the podcast. You know, I've heard you say, and you're writing your book, that the top diseases that are out there, I'm going to name some of them, these are the diseases that cut off our lifespan. These are the diseases that they don't start overnight, contrary to what some people think. And they take years to develop and cook and grow inside of the body. And so if we could dedicate some of our resources to catching these diseases early, and of course there's the whole prevention side, which we're going to get into as well, that can make a significant difference in how we age. So I'd love to jump right in and provide some value to our audience, if that's okay with you.

I'd love to start off with the number one killer out there for men and women, cardiovascular disease. So when you talk about understanding our risk, catching the growth of these diseases early, what does that look like for the person who's listening today? Great to be with you, Drew. I think we are an exciting time, which is, you know, I wrote the book about the fact that we've never done prevention very well. but now we can. And the reason for that is we can determine who really is at risk. And it's not always so simple, you know, that, oh, we have a family history of heart disease

or you have these multiple well-known risk factors. We can go deeper to find out, for example, with a polygenic risk score, or look at things like apolypropotin B, lipoprotin A, you know, various factors, inflammation in the blood, the heart aging clock, the pace of aging of the heart, or the arteries. So we have these new ways to find out who's at risk, and then we can get all over it. That is, as you really aptly pointed out, most people don't realize that cardiovascular disease, just like cancer and neurodegenerative disease, takes 20 years, 20 years or more, as it basically is incubating within us before we get clinical signs and symptoms. So that it gives an ample opportunity.

And for cardiovascular disease, you know, there's so much we can do to prevent this atherosclerosis process from ever getting into the point where it is blocking the blood supply to vital organs, particularly the heart or the brain. And also, of course, the idea that one would have a heart attack or a stroke. So the events that are associated with clotting on top of the atherosclerosis hardening of the artery process. Let's dive into that a little bit deeper. So if somebody was 40 years old, man or woman today, and they came to you and they said, hey, I want to know how my heart is aging. What is the best snapshot besides auditing my lifestyle, which we can include inside of that as well? what's the best snapshot to see am i aging in a way that's healthy or do i have what you call accelerated

aging where i could end up being in a position of getting a heart attack you know way earlier in life than i quote unquote needed to get a heart attack right well first thing just to emphasize which a lot of people still don't know is that the number one cause of death in women women is heart disease um unfortunately still there's a perception within women and in the general public that it's cancer. It's not true. It's still heart disease. And interestingly, heart disease is increasing. All right.

So now, what do we do to find out of somebody's at risk? Well, as you mentioned, there are things like this artery or heart aging clocks that is to tell us the pace of aging. They're not available yet. They've been published on and they soon will be available. perhaps before the end of the year or early next year. And that's an exciting advance because we never had a way to do that before. But what we can do today is get a polygenic risk score, which is, you know, very inexpensive.

And it says, you know, what level of risk of heart disease, you know, from zero to 100, with 100 being the highest risk? That's a really good start to tell if somebody has a risk that is not perceived, just not known, from the general factors that we commonly associate like smoking and diabetes, obesity, sedentary lifestyle, and high LDL cholesterol. This adds a lot more to that. Could you explain the test? Because our audience may not be familiar with it.

You know, where would they end up getting it, right? Is it something you pay for out of pocket? And then when somebody's looking at a report, what kind of information is it actually providing you that's providing all this deeper level of insight? And I want to add to this is that you've been both in your book as well on Twitter, which I love your Twitter. I love your substack. You know, you're writing on there. You've been critical of some aspects of longevity, some aspects of testing that don't have as much science or backing around them that are wasting people's money and potentially leading them in the wrong direction.

We're going to go into that for a second. But help us understand why this is not that that you're criticizing. Well, a polygenic risk score can across all the cancers, the common cancers, heart disease, and Alzheimer's disease, that can be obtained from a saliva sample that's processed with a so-called 1M million snips that are these gene letter variants in our genome, the ones that these variants that are tracking with the various diseases of interest. And so, as it turns out, when you are looking at this gene chip data, which is much cheaper, you know, it really can be done for $20, $30. Some of the companies charge 10 times as much, but it's not an expensive test. You know, in the book I list at least 10 companies that are doing this and there's more to come. Mass General Brigham in Boston is doing it on their patients as part of their care of patients,

and they've reported on that. So it should be the norm. Drew, this is something that, where it sits in the research domain and doesn't get to the clinical routine practice, it's really unfortunate. Now, that gives us the person a readout of how high a score for heart disease. If it's really high, let's say, you know, 90 or above, that says, oh, there's something going on here that requires further assessment. And that's the best first inexpensive way. way beyond the factors that we've already known for decades from the Framingham heart study, that's the best way of establishing true risk of heart disease. It doesn't tell us about the pace

of aging of the arteries or the heart. We're going to get that in the near term, which is exciting. That's another big advance. Also very inexpensive tests. They're done through plasma protein, so it requires a blood test. But that'll be available soon as well. So just coming back to this polygenic risk score, you're giving a saliva sample. It's quite inexpensive, as you mentioned. There's different companies that are out there. Maybe we'll list some of them in the show notes. But largely you're getting a genetic output showing certain genes or gene snips.

I'm not sure what the right language is that if you have those, that those are through the literature that's out there have been connected to a higher risk of cardiovascular. disease. Am I with you so far? Absolutely. So let me give a little more explanation. So we are obviously the product of our mother and father. And these polygenic means these common diseases, they're not just one gene that cause them. There's hundreds, hundreds of gene letter variants that are linked to these diseases, right? So what happens is when you get your own genome, which is a admixture of your mother and fathers, you may get a very unusual combination of these letters, these variants, that doesn't show up in your mother or father's family history. Like, for example, I have a really bad family history, but I don't

have any heart disease, okay, in my family history. But when I get my apologetic grade school for heart disease, it's like 95, extremely high. And that's just because of the way that these variants came together in me that weren't necessarily showing up in either parent, if that is clear. So that's a several hundred of these variants predict heart disease extremely well, the risk of heart disease. And that's what it's 20 years of work have gotten to this point in millions and millions of people with all different ancestries. So this is such an invaluable type of data source, and it's amazing it isn't being used. And within that, you're also emphasizing that there might be limitations. Like you're not going to know from a genetic test how much plaque buildup you have,

both calcified plaque and also soft plaque that's there. But at least you'll understand your risk. And if you understand your risk, that would lead to potentially a patient taking more seriously the idea of preventative care. That's the idea that you, that you, that you, uh, people understand. Except there's one other dimension to this. So let's say you are at high risk for heart disease, but you don't know from that data, whether it's at age 98 or 58, okay?

And that's why the clock data of the artery and the heart is another helpful dimension, because then it starts to frame, you know, how, how fast is your artery aging, your heart aging. So that's why this imminent, rich information will add to the risk because otherwise you're not sure when that's going to show up in your life. So I'm sure you've heard the phrase, you know, genetics load the gun and lifestyle pulls the trigger, right? What are your thoughts and commentary on that phrase? Yeah, I agree. I'm with you. The point here is that if you tell everybody this is what you, this is what you, you know, you're going to say,

you should do, diet, exercise, sleep, and whatnot, you don't get a lot of uptake. You know, it's general recommendations for the public. When you, I think, alluded to, when you are now talking to a person who is at high risk for a condition, the chances of them getting onto the important lifestyle improvement becomes much higher. It's not 100%, but it's much higher than just non-specific generalized recommendations to all people. Let's continue down that pathway of generalized recommendations, right? I believe your background is in cardiology, right? So you were fully the right person to talk about this on top of all the research and, you know,

people citing you hundreds, thousands of times, you know, your work over the years. Let's take a common recommendation that happens. People turn, especially males. they turn 40. And whether through a cardiologist or their general practitioner, somebody might recommend a CT scan, right? Yeah. Yeah. How do you feel about those recommendations when it comes to heart health?

We all know the rules for aging well. Get good sleep, eat enough protein, manage stress and exercise, have some community. But there's one step that most people forget. Your skin. It's your body's largest organ and one of the clearest indications of health as you age. That's why I love OneSkin and what they're up to. Their products make it easier than ever to keep your skin healthier for longer. And it's not just the surface.

One skin works at the cellular level. Their products are powered by their patented OS01 peptide, scientifically proven to target the root cause of wrinkles, thinning, or sagging, and even age-related hair loss. One skin believes that the purpose of skin care is not just to improve how you look, but to optimize your skin's biology at the cellular level so it's more resilient to the aging process. So whether your goal is to protect your skin,

support hair growth, or simply age with more vitality, One Skin has you covered. One Skin is the world's first skin longevity company. By focusing on the cellular aspects of aging, One Skin keeps your skin looking and acting younger for longer. So for limited time, you can try One Skin with 15% off using the code Drew.

That's D-H-R-U at OneSkin.co. That's 15% off at OneSkin, O-N-E-Skin. S-K-K-I-N-1Skin.co, that's dot CO with the code D-H-R-U. After you purchase, they'll ask you where you heard about them. Please, please, please support the show and tell them we sent you. Yeah, I'm not into the CT scan alone just for calcium because I think what it does is that unless you have a zero or extremely low level, it induces tremendous anxiety and it leads to unnecessary procedures.

This is what I've seen in my practice. and, you know, that extends now for decades, and certainly for the last decade, the overuse of calcium scan has been extraordinary, and I've had too many patients that have been incapacitated, who shouldn't have been, just because they had a high calcium score. And we know that calcium is actually an adaptive process to atherosclerosis.

The person is trying to get that calcium build up to prevent the plaque. in the artery from cracking or developing a blood clot, right? So I'm not a big fan of it. I do think CT angiograms can be extremely helpful if someone has symptoms are very high risk, because then you get a map of the arteries. No, you're no longer trying to look at specs of calcium. You're getting the real map of whether there's blockages and how severe the blockages are and, you know, everything else. And in fact, as I highlighted in the book, even if you don't have a narrow, we can now do AI in the wall of the artery, the so-called epicardial fat, and say how inflamed the arteries are,

which is really another big advance because you have very inflamed arteries, they're more likely to cause trouble, even if you don't already have a narrowing. So just to put it, I think that there are some cardiologists that order an internist that order these calcium scans all the time. I'm not enthusiastic because the experience I've had in so many, you know, I would say hundreds of patients who have been misled and it's really had a disabling, at least a mental health effect on them for no good reason. So on the con side, there's the mental health impact, and this could go with all sorts of testing. And we'll parse through, you know, what testing is worth it, what's not worth it. And that's my hope.

I want to go through cardiovascular disease. I want to talk about cancer. I want to talk about some of the other diseases that you mentioned inside of the book, like neurodegenerative diseases. And we want to also chat about the metabolic diseases as well. But on the con side for something like a CT scan, you're primarily worried about people seeing it and then immediately feeling like I'm doomed and then not taking any action?

Well, they might take action, but they're living every day of their life thinking, and, you know, some of them become cardiac cripples. You know, they just think that they get their destiny is to have, you know, bear it bad heart disease. The other part of this, Drew, is that doctors react to these high calcium scores and they do angiograms, even though the patients don't have symptom. And I've even seen people have bypass surgery with no symptoms that was led to by a calcium scan.

So I'm, there's never been a randomized trial of these calcium, CT scans to show that they benefit people. All there are these correlations with that, you know, the higher the calcium score, the more likely they have going to have heart disease. But that's different than do calcium scans actually help people? And we don't have any data to support that. I think on an individual level,

when I hear from a lot of my podcast audience, when I think about myself, everybody has, especially as they get into their forward, 50s and beyond, everybody has that story with heart disease, a cardiovascular disease being the number one killer of men and women. Everybody has that story of somebody who was non-symptomatic, went to the gym on Monday morning, and dropped dead on the treadmill and maybe fell and hit their head or something else that ended up happening for it. And so you hear some of these stories, which again are stories that people have in their community.

And they're worried that, oh my gosh, could that be me one day? And I'd like to know ahead of time if there was something that could be, you know, done about that. And, and, you know, you mentioned these tests, the polygenic risk scores that are there. They're looking at genetics. They're not looking at soft plaque. They're not looking at hard plaque. There's these coming tests that will hopefully be here soon, the ones that you, the ones that you mentioned. but a lot of those individuals are saying,

okay, I would want to know at least how much further I've progressed because do I have to get a lot more aggressive in how I'm treating things? And I'm just trying in my own life weigh the pros and cons of those components. So you've mentioned about CT scans. I personally at the age of 40 with heart disease risk in my family, I decided after looking at a lot of different evidence, working with a cardiologist who I trusted, I went and got an advanced CCTA scan.

It was one of these branded tests that were there. I paid for it. I have no affiliation with the company that was out there. It's called a clearly scan. I wanted to see how much hard plaque do I have? How much soft plaque do I have? Because I eat a particular diet and lifestyle and I work out. And I'm not waiting for that test to tell me that, hey, I don't have to do anything.

It was more just seeing, am I aging at a healthy level? Or am I acceleratedly aging when it comes to my heart? especially with me being South Asian and being at the highest risk profile. So do you have any thoughts or commentary about that? No, just to be clear, the CCTA is the angiogram with actually die as given, okay, because you can't get that characterization of the plaque, the built-up arthrosis, whether it's soft or hard, on a calcium scan. So I do think that's a good test, although the one you've had isn't as good as the one

at the Oxford University is now pending at FDA, which actually gets the inflammation level. And I wrote about that in the book, and there's been several papers with, you know, extended follow-up, 15, 20 years of that with angiogram. So that is even more impressive than the clearly test that you had. But still, what you had is better than a plain calcium scan. The problem is, you know, it's expensive. There's some radiation. Yeah, I think mine was about like $2,000 plus you have to have a doctor.

I try to come up with things that are inexpensive that are, you know, giving us, if you'd had symptoms, okay, or let's say you had, somehow you had a stress test that it was very positive, then I think that what you had would be good. But it may be too much to go for such an expensive test like that, that, you know, for example, you would, it probably was a good result. You probably didn't have anything to worry about. But you would also know about that from a very inexpensive polygenic risk score if that was very low or even, you know, intermediate. That would be very reassuring for you. So, you know, it's fine that you did that. You know, not everybody has a couple thousand dollars isn't covered by an assurance, right? Sure.

And so I try to come up with things that will work for everybody because, you know, there's enough of longevity people out there that are selling supplements. and selling total body MRIs and drugs that are not, you know, getting any, have any evidence. I don't want to do that. I'm trying to stick with the evidence. And I don't have a problem. Somebody, you know, has enough money. They can want to get some extra tests. But, you know, sometimes it backfires.

Sometimes the test winds up with finding things that are not clinically relevant. It leads to more procedures. And, you know, it can be a trouble. It can be a problem. Well, that's what I appreciate about your book, Super Agers, which is you're here to bring a different sort of idea around aging and help people understand what's worth doubling down on. And as you mentioned, what things can potentially take you a rise so that people could have a version of informed consent on their longevity journey, right? They can understand what's worth it. What's going to damage the pocketbook, but is a gamble, right?

and what is completely going to potentially going to be taking you off track that doesn't have research or maybe even has some emerging research showing that it could actually lead to opposite results. And we're going to be talking about that, especially when it comes to some aspects of cancer. So already available right now, these polygenic risk scores, and there's some companies that are out there that do them. And it's generally, it's an inexpensive test. They might be bundled with other things. So people have to kind of do their own research that's out there. And then hopefully soon, you're saying maybe like a year or two will be this more advanced test that will measure the actual aging of the arteries.

What was the name of that again? So it's a proteomic protein test, hundreds of proteins that come out of partitioning with AI that track with each organ of the body, brain, immune system as a system, artery, heart, liver, kidney, pancreas, lung. So you get these organ clocks, which I think is one of the biggest advances that we've had in medicine in a long time. And that is then giving a much more temporal dimension of risk, right? So it confirms the risk, but it also says, well, how far along are you? You know, how fast accelerated aging of your arteries or your heart, whatever, in this case, is taking place. there are this work was first pioneered by Stanford University and they've set up a couple of different companies tealomics and viro bioscience they're about to get these launch commercially it will not be

two years it'll be months from now and we're going to be using them in some of our research studies so they can get to scale inexpensive tests that help get us these really important proteins that reflect aging of various parts of our body relevant to our current discussion is about the arteries and the heart. And with these tests, because I'm not as familiar with them, of course, is there the level of scrutiny on the research end that's there that you'd be looking for to feel excited about? Oh, yeah. No, I don't get excited unless it gets independently replicated, meaning by other groups multiple times, you know, with large cohorts, you know, extended follow-up, like I said, you know, 10, 15-year follow-up. And so that's when I start to say, huh, there's something here,

you know, there's like a eureka moment that we have made a big advance in medicine. So that's why I'm keen on organ clocks. And, you know, I think that's, unfortunately, and I can't emphasize is enough. In the research world, we make big advances, but the lag that it takes to get into the clinical world of doctors not only knowing about it, but changing their practice, it takes much too long. It shouldn't be this way. So if you ask physicians now about organ clocks, most of them don't know about it, and when they are available soon, they won't know about it. And it's the same thing as polygenic risk scores. What doctors are recommending those? Very few. It's just unfortunate that we have such a body of evidence that gets ignored now and it continues to be ignored. And we just have to go beyond that.

Well, one area that that is extremely common that you write about in the book is the area of cancer. Many people actually don't know that there's a lot of things that they could do or there's a few things that stand up to your level of scrutiny to detect and pay attention to how. we are headed down the path of eventually ultimately getting cancer or, you know, keeping our risk lower. So first, let's talk about some of the testing. What are some of the best and then also we'll get to some of the worst type of testing that you think is out there. I think that there's some overlap with these polygenic risk scores. There's also some connection to cancer, but there's also some additional testing that you think is relatively a good offering bang for buck bang for buck wise can you talk about that let's be real between work a family and everything else it's easy to fall short on the nutrients our body truly needs even with a healthy diet most of us

are still missing out on key essentials like protein creatine and omega-3s that's why i lean on the momentous three a simple profound powerful trio that helps me feel strong focused and energized. What I love about the Momentus 3 is the quality. Their creatine uses Creerpeer. The purest, most bioavailable form of creatine monohydrate available today. It's an essential nutrient for both men and women when it comes to peak, cognitive, and physical performance. Their protein is made from grass-fed way protein isolate, clean, powerful, and free from gum, fillers and artificial flavors. And their omega-3s support brain health, heart function. And omega-3s are known for reducing inflammation, especially for those of us who aren't getting enough

fatty fish in our diets. Momentus products are NSF and informed sport certified, trusted by top health experts, and built to meet the highest of standards. If you're looking for a little daily support to help you stay on track with your energy, strength, and long-term goals, Momentus has your back. These aren't trendy supplements. They're foundational tools for thriving now and aging well. If you're interested in the Momentus 3, head over to live momentus.com and use the code D-H-R-U, Drew, that's me, for 35% off your first subscription. The code again is D-H-R-U-Drew, that's me, at Live-L-I-V-E-M-MENTUS, M-O-M-O-M-E-N-T-O-U-S dot com for 35% off your first subscription today.

Yeah, so again, the polygenic risk scores, that one saliva sample that you can get all these risk scores from, tells us about all the common cancers, breast, colon, prostate, lung, you know, all the common cancers that are out there. So from a genetic standpoint. Yeah. Yeah, from common variants, right? So these are in 5% of the population or more, and there are hundreds of variants that track with each of these cancers.

And so you get the same kind of readout. You know, are you very high risk or low risk, whatever. Now, in addition to that, in our genome sequence, this is a whole genome with six billion letters, which amazingly now you can get that done, a whole genome sequence for a couple hundred dollars, a tenth of what it costs to get that CT angiogram that you had. And that tells us about rare variants that you may not know about, that would be like, for example, braca for breast cancer, but also that carries a risk for other cancers like prostate cancer.

you know, Lynch syndrome, which is a risk for colon cancer. So that gives us another dimension of cancer susceptibility genes, all right? Now, beyond those, of course, if a person has these mutations, these variants, family history, other risk factors, then we can do more. We can do a multi-cancer early detection test, a blood test that picks up if there's microscopic tumor DNA, in our plasma from a blood sample. So there's all sorts of things we can do to get ahead of cancer because, again, it takes 20 years to manifest a cancer that's building within us, and we wind up making the diagnosis very late. And these screening studies we do, Drew, like mammography and colonoscopy and others, they're not very good at picking up cancers until they're pretty far along,

and they don't catch most cancers actually at all. So for the woman who's listening today, and also, of course, men are impacted by cancer as well, too. But let's take, for instance, breast cancer, which is on the minds of a lot of my audience being, let's say, 75% female in that prime age where a lot of people are sort of talking about this conversation, you know, 40 to 65 plus. What would your recommendation be? And obviously this is not medical advice, but what would the recommendation be for a consideration? And we'll go through a few cohorts of people. somebody who knows people in their friend group, maybe not directly their family, who are struggling for breast cancer, they're stating as different statistics that some cancers are on the rise.

And they're getting these general recommendations from their practitioners of, hey, you should get your annual mammogram after maybe a certain age or a mammogram every so many years based on the age that they're at. should they be still moving forward with those recommendations, or is it worthwhile exploring a different path like one of these blood tests that you mentioned that can pick up some of these cancer proteins? Yeah, it's a good and important question, like most of your questions, actually. Here we have a lot of problems with mammography because as it's been shown, if you take women who are 50 years old and they have their mammogram every two years for a decade, they have over that period of time, 60% will have a false positive readout, which causes, again, not just a lot of anxiety, but it can cause, you know, the woman is brought back, has more scans, sometimes biopsies, might even lead to unnecessary surgery, right?

So we got a real problem with false positives and also false negatives. Now, what we've learned, and this is from the largest trial, in the history of medical AI in Sweden with over 80,000 women, half of them had mammography read by radiologists, half of them had the radiologist plus AI. That picked up 25% more breast cancer, missed by the radiologists. And these are not trivial breast cancers. These are significant ones. So the point being is that every woman who has a mammogram in this country should have a AI for no extra charge because that way you're not going to have a false negative, right? And so that's unfortunate. Again, we have the data from this remarkable study published,

actually published two different articles in the Lancet. And we have it incorporated in daily practice in the U.S., right? So that's a problem. And in fact, one of the big radiology companies around the country, I think it's called Radnet, is charging. women extra, like $35 if they want to get the AI read out. That's crazy. It should just be part of the mammogram, right? Now, who should get these extra tests like a polygenic risk score, genome sequence? If there's a family history of breast cancer or even other clustering of cancer, it's probably good to get those tests because even though a gene mutation might be connected with one type of cancer like Braca for breast cancer, Bracca 1 or 2. It also can be connected with

other forms of cancer. So in people who have this family history of clustering of cancer, it's good to get the genetics done, right? And again, it's quite inexpensive. And that would temper how frequent a mammogram should be done, when it should be initiated, like, for example, should it be age 40, age 45? We're even seeing breast cancer crop up. in women in their 30s now. Overall, there's been a big spike of cancer, not just breast cancer, colon cancer, and others, in young people, which is really disconcerting.

So our approach to cancer shouldn't just be on the basis of age. It should just be on other factors, which aren't taken into account. Right now, every woman, age 45, is supposed to get a mammogram every couple of years, if not more frequently. And that's just not backed up by good data. I think that one of the challenges that happens, just zooming out and looking at this whole space,

not being the subject matter expertise like you are, right? I'm not the subject matter expertise. I find that a lot of people who listen to my podcast, listen to other people's podcast, because health care feels so confusing, and essentially if they read your book, which I highly recommend, there's a lot of advocacy of them stepping into sort of a little bit more

the CEO role of their health. They may not be the doctor, but they got to be a little bit of the CEO. But then there's not always clear answers for them. And they're relying on health care practitioners. I see it as sort of action, reaction when it comes to things like people seeking out whole body MRIs, which I know you've been critical about. We'll talk about that in a second, is that they feel like they hear mixed things. And they feel like even in a case where somebody is super evidence-based like yourself, they're saying that medicine isn't often being practiced in the way that is based on the latest

research and science. So those individuals can be very vulnerable to the different competing forces that are out there that are saying, hey, listen, a whole body MRI may not be perfect, but in some cases, you're obviously not being exposed to radiation. Yes, there might be incidental findings. There might be some false positives or false negatives that might be there. but hey, that problem is there with also, you know, x-rays as well too. But at least we can catch maybe some cancers a little bit earlier that wouldn't have been picked up in a mammogram.

That's at least what a lot of people have hurt, like what they've been left with on my podcast when they're trying to seek out the best way to go about stuff. Are you sympathetic at all to sort of that why we're in a little bit of this mess that you outline inside of the book? Yeah, well, you're bringing up some important points for me to respond to. you know, I do think that we do have a problem in the medical community of not keeping up with the data and evidence. And so that's on the medical community. That's on us overall. Yes. We also have a mistrust problem, which is leading to these, you know, influencers and social media and, you know, lack of it, and filling in the holes and recommending total body MRI. Like, for example, what are the data to support total body MRI that Kim Kardashian had one and saved her life or whoever the celebrity is, there are no data published,

okay, to show that getting a total body MRI saved a life, not one, just anecdotes of this one or that one. The point being is that if you are picking up cancer on MRI, and if indeed it's cancer, I think you kind of minimize the incidental findings, which I've seen people nearly die from liver biopsy bleed for something that wasn't a cancer or a collapsed lung, pneumothorax, for a lung biopsy that wasn't a cancer. So there's lots of incidental findings that get chased down. In the book, I talk about Drew Kulhar, who is a New Yorker writer, but also a physician at Cornell, who his whole mind has been, real estate and his brain has been taken over by this prostate mass that's not been characterized despite any young like you.

So it can lead to lots of incidental findings, right? The problem is it doesn't prevent. If you do pick up cancer on a total body MRI, it's already at a big state of billions, billions of cells. You haven't prevented the cancer. It's a mass now, right? So if you want to prevent the cancer, you need to get it either just identify someone's high risk and put them under surveillance, or identify it at a microscopic level where you can then rev up the immune system and do other things to squash it before it shows up on an MRI. I don't consider finding an actual cancer on a total body MRI is a prevention because it's already big enough to see on an MRI. That, you know, if it's real. Of course, a lot of these are not real cancer. There's so many that are chased down

rabbit holes that aren't. So we have no data. And the main company pushing these total body MRIs, not just the influencers, Pernovo, they said they're going to do a trial over the years ahead. They have no trial. There's no publication that proves that this is benefiting people. So we have a problem here is a lot of people are going out and they're paying, you know, a couple thousand thousand dollars for these total body MRIs, not covered by insurance and not substantiated by evidence. So that's why I'm against them. On the other hand, if you're microscopic blood test, the blood test that says you have some tumor DNA present, well, that's an AI can be used to say which organ is likely responsible, whether it's a colon, the breast or pancreas, whatever,

then you could get a total body MRI. That's a different matter, okay, to hopefully not see any mass because then it's already, you know, somewhat advanced. So I hope you understand what I'm trying to say is I'm not against total body MRI when it's necessary. I just don't think it's our best way to prevent cancer. And it leads to potentially overriding incidental findings that can be very problematic for patients. on the cancer side, is the blood tests that you're talking about?

I know there's a few that are out there. Is it Grails? Is that the main one that you would say? Grail has been used, I think, in 400,000 or more people now. The problem I have with it is being used for age 50 and older. And so if you just take somebody age 50, he doesn't have any risk factors for cancer, no family history. You're going to get a low yield of picking up cancer at an early state.

But it has done that, picked up early. microscopic cancer, not seen by MRI. That's good. But in order for us to do that grail or these, there's 10 other ones, many are coming on to be commercially available. They don't have as much of a track record yet. But these tests, they should be used in people at high risk, not just indiscriminately. Right. So what we have now is indiscriminate use of MRIs of these tests, you know, have everything. That's not a good way to go ahead. You want to establish a person's risk.

You're familiar with Bayes theorem, right? Yes, yes. Yeah, the test is only as good as the pre-test probability, right? And so if you have a low pre-test probability, then the test stinks. All right, that's what we're talking about, is using tests like Grail or hold a body MRI when there's no high risk. We should be coupling high risk with any tests that we do. We can establish a person's risk.

Your feeling is the current environment is not really set up to do that on a level that benefits most people who are listening. So you're also understanding that people are navigating this on their own. And within that, you're trying to bring them back to the things, knowing that most people are listening are trying to, in a way, be their own doctor. Even though they're not a doctor, they're trying to figure out and put these pieces of the puzzle together in between 15, minute appointments, no conversation about really prevention with the doctor, you're saying, okay, I understand all that. I understand it's complicated. Within that, here's the things that I want you to consider, right? Yeah. Yeah. And also, of enough people do this, it's like a grassroots, you know, campaign to get medicine on track. You know, if enough people were informed,

you know, which is why I wrote superagers, right, if they are informed, they can drive this. Okay. And even if their physician isn't familiar, they can become familiar. And a lot of this can be done without a physician, too. So we need a campaign to get medicine on track. We're not there based on the evidence that has been generated by, you know, now many, many years of really high-quality research that sits in another orbit, not the clinical care orbit. Yeah.

Let's switch over to some of these neurodegenerative diseases like Alzheimer's. In your book, you talk about some pretty exciting blood work that's available now that could be part of idea of catching some of these early so that we can be more aggressive and maybe even double down with lifestyle factors that people sometimes don't double down on until they find out that they have a higher risk, as you talked about earlier. So do you want to talk about the blood test in particular that you mentioned for Alzheimer's disease? Yeah. So, Drew, this is a real breakthrough. and it's culminated over the recent years, I've never seen anything in neuroscience as important as this, because up until now,

we haven't had a way to prevent Alzheimer's disease. Most people would say that's the top of their dreaded list, that they would not want to ever have that disease. And basically, it was kind of a fatalistic issue. If you're at high risk that, you know, if you live long enough, you're going to develop first cognitive impairment and then Alzheimer's.

This test called P-Tau-217, it's a blood biomarker for the site 217 on the tau-misfolded protein that accumulates in our brain. It's as good as a PET scan, which is a lot of radiation and only available at certain places, a PET scan for amyloid or tau. And it is picking up the risk of Alzheimer's up to 20 some years before a problem. person develops mild cognitive impairment. But beyond all those important features, it's modifiable. If you exercise, if you improve your lifestyle factors, you can bring it down, along with these other parallel markers like P-Tal 181 and G-FAP and neurofilament and many others. But P-Tau-217 is the best one we've seen. It's extraordinary. It, you know, you You'd have to otherwise go to do a lumbar puncture,

which nobody would want to have to get cerebral spinal fluid. We can now do this in a blood sample. So it's really extraordinary. It's been available in the U.S. for the last two years. And this is something that if you're at high risk for Alzheimer's, because you have APOE4 genotype, family history of Alzheimer's, high polygenic risk score for Alzheimer's, you could benefit by getting this.

and then getting onto a really great lifestyle program to bring it down and either defer or preempt your risk. If, let's say somebody like myself, my grandfather had Alzheimer's disease at the very end. And at that point in time, he was already dealing with and battling a cancer. He had like a cancer that started in his mouth and kind of moved forward. So I don't know the exact type of cancer that he had. But if I wanted to go get this test, this blood test for looking at my likelihood of Alzheimer's disease, and I have done my 23 ME data, and I've uploaded it to a lot like a lot of people are doing to, you know, some AI program that they might have, either OpenAI chat GPT or GROC or something else. And there are some other people that are out there that have these genetic reports that you can upload to in companies. and I did see that I have one of the alleles, I guess it's the, is the, April E4.

April E4, right? I don't have the double allele, but I have one of the alleles. 20% of people have APOE4 carriers. So now let's say, okay, I have some family history. I have the gene. Genes don't immediately mean that you're going to get it. There's just an increased likelihood that's there. I'm doing a lot of the things that I've read and heard about from individuals,

about protecting my brain as I age, staying away from. from ultra-processed foods, staying metabolically healthy, working out, et cetera, et cetera. But let's say I wanted to get this blood test done. What's my best option? Am I going to try to convince my primary care provider to order it for me? Do I try to go to one of these direct lab companies or direct-to-consumer companies and see if they offer it?

What would you recommend? Yeah, so first, since you already have uploaded your 23M-E data and you've got to your APOE4, you can also get your polygenic risk scores from that data, too. So just go to chat, GBT, and say, hey, could you give me my polygenic risk score? And I believe you had a Twitter thread, sorry, an X thread about this a few weeks ago, and you linked to a study. I actually uploaded that study, which was talking about polygenic risk scores in the form of Alzheimer's disease.

And I uploaded the study to chat GBT. I uploaded my raw data, and it walked me through a score-based system. Yeah, there you go. Of that, of that information. So, okay, so you're okay with the average consumer who's listening to the average podcast listener doing that, understanding that AI has limitations and, you know, always kind of keep that in mind, but generally he's going to be giving pretty good data. Yeah, I mean, I haven't seen the output from the various AI choices, whether it's

GROC or chat GPT or the others. But it's a starting point, you know, it's basically free if you get a hold of your 23 immune data. It can also be done with your ancestry DNA data if you can upload that. So yeah, I mean, it's worth doing that, you know, to get a handle on it. I can't vouch for if it's as good as done by up-to-date variants, you know, that are up to the moment literature, but it might be a really good start. Now, as far as getting the P-Tal-217, you can get that through a physician's order, get it through Lab Corps Quest. Fuji has a new one that was just FDA approved several weeks ago.

So there's lots of ways to get it. I don't know if you can get it direct to consumer. Probably can, but I'm not aware of that route. It's what last I saw was $190 to get this through the main big labs around the country. So it's not expensive. It's not cheap, but it's not that expensive. And I wouldn't recommend it for anybody, but someone like you, who has APOE4, family history, you've already got two of the three big risk factors.

The polygenic risk score would be the other one if that showed that you're a high risk and you have all three of the risk factors, right? And the good thing is you're young, right? So let's say your P-Tal-217 comes out really low. I mean, you're basically good, you're good for the next couple of decades probably, you know. You can check it every now and then in the next few years, but that's anticipatory of a long, period of time ahead. So I think it'd be worthwhile in your situation, yes. It might be worthwhile. I'll link to it in the show notes, but I'll just share my screen

with you here for a moment if you can get a chance to see. This is when I previously had put all my information in. So I put it all into chat, GPT, including my genetic data from 23 and me, and I asked, I answered a bunch of lifestyle questions. So it gave me a breakdown of like, based on that paper that you had linked to. Again, this isn't medical advice. This was just me, you know, trying to navigate some of this stuff. So I have this APO E3, E4. It added a plus three for my risk factor. Yeah, yeah.

My polygenetic snips, it added a plus nine. Several risk variants, including homozygous B, I, N1, and a bunch of other stuff. Yep. So my subtotal genetic risk score was 12. So that's considered slightly elevated, right? That's big. And you know what's great? is in your lifetime, you're going to be able to prevent Alzheimer's very likely,

which is so you're so lucky, right? You're getting an early start. You've identified that you are at high risk. And there's so many ways that we're going to prevent Alzheimer's in the future. Lifestyle, that you're on it already. We can talk about that more. But you are the prototype of the future because you now know you're at high risk for Alzheimer's in your lifetime.

You don't know when, you know, age 70 or age 90. But you are at high risk for late onset Alzheimer's disease. Yeah. Right. But the great thing is that we even talk about now. And I do believe in the future of technology. I'm a techno optimist. I'm so excited about AI and all the things that will bring to medicine and healthcare and democratizing that.

And there's many things that we could do right now. So I answered a bunch of the questions that were in there for if you have a negative risk factor, you know, you get an added score. if you have positive risk factors that takes away. So again, I'll link to this a snapshot. But if you look at it, based on the fact of me answering a bunch of different things, I had a minus seven taken away. So I had a plus 12 because my genetics, but because my lifestyle factors are dialed in, I had a minus seven.

So there's things that we can do now today. Yeah, yeah. Right? That make a huge difference. And this is what you're talking about inside of your book. And I'll just share this since I have you here. My genetic total was 12 plus. my lifestyle was minus seven.

So my total risk score was plus five. So walking away from this, my interpretation was continue to pay attention to this, stay true to your lifestyle. Some things that other people may not be worried about as much, like moderate level of alcohol. I've just chosen not to have alcohol personally, right? I know the data can be a little bit mixed on moderate to light levels of alcohol. But these are things that make me feel good about the lifestyle.

decisions that I'm choosing to help me continue to keep my risk score lower as I continue to age. Good for you. I give you a lot of credit. You're, you know, you're working in a futuristic path here. And I love it. I don't know what the lifestyle factors that were probed by chat GPT, but did it ask about your sleep data? It asked about, yeah, it went through sleep quality, right?

it went through alcohol, smoking, are you eating an anti-inflammatory diet, physical activity? Yeah, yeah. But it also asked, which is where I think that it's important that we have podcasts, as much as influencers and individuals get criticism, the challenge that we had for a long time, and much of that criticism is warranted is the data has been there for years. It's just it doesn't get talked about. And you got to figure out who you want to listen to and pay attention to. For example, one of the areas that it asked about is air pollution.

There's been so much data for years that if you live in a highly polluted area, that you are more likely to increase your risk of getting certain diseases. All the ones we're talking about. All the ones we're talking about. Neurodegenerving cancer. Yeah. And type 2 diabetes add to that too. Yeah.

Even having family that's in medicine, many doctors being Indian, you know, I have so many doctors in my family. I never had one of them ever talk about. this. I never had my primary care provider talk about this. It was always learning from things like podcast. Again, there's the good and there's the bad or seeing people that I look up to like Peter Atia, Dr. Rhonda Patrick, other individuals who would say this data has been around there. It just doesn't get attention. And then one step further being that, okay, if we know that air pollution is a problem, we also know based on EPA studies that indoor air is often up to 300 times more polluted because of

off gassing, you know, cooking is a big contributor to indoor air being polluted. So that's where I personally chose, okay, great, I'm just going to get a low cost, good quality, hepa air quality, hepa filter just to make sure. Now, is there randomized controlled trials about this? No. But do we know enough about air pollution being an issue for people and being connected to these diseases that I'm going to take a little bit more of a precautionary approach in my life because I have an increased risk of something like an Alzheimer's disease.

Yeah, so let me be clear. I'm not calling for randomized trials of everything in medicine or health, okay? I concur with your position that the data for indoor air pollution is important. Not everybody thinks about it as just outdoor. And you can. The point here is if you use a hepa filter, it can't do any harm, all right? it's not like a total body MRI or a calcium scan. It can do harm. So I'm looking at risk benefit and you know what if there's no risk of something but only potential benefit, that's different for

criteria for requiring a randomized trial to weigh the balance of harm and risk, okay, or benefit. So let's make sure that we are on sync on that one. I think what you're doing is great. The other sleep measure besides quality, like deep sleep is sleep regularity turns out to be really important. And I don't know if you are one that, you know, younger people tend to have all sorts of different times when they retire for bed. I don't know where you are, but that's one that turns out to be important across the board, just like air pollution and so many others, because we have this circadian rhythm that we often don't respect. And that one surprisingly has a significant correlation. So not just,

quality, but also regularity. Yeah, regular being going to sleep relatively within an hour of the same time, ideally the same time that's there waking up about the same time. That's a good indicator of sleep quality, but also it's a good lifestyle habit to support your circadian rhythm. Yeah, yeah, exactly. Yeah, that's fantastic. Okay, anything else that you want to mention about neurodegenerative diseases, one thing,

some things that have been a little bit sort of viral in the, last month, you know, one of the fastest growing, I think, if not the fastest growing neurodegenerative disease is Parkinson's disease, right? And there is a group of researchers that are making a strong argument. It's emerging data that's there that Parkinson's disease is largely a man-made disease based on environmental toxins. And we need more and more research around it, but there was this viral study that came out that there's associative, again, you know, not not a causative, but that people that lived next to golf courses. Did you see this data?

Yeah, I know. Rudy Dorsey, the neurologist, who I know very well is one of the authors. Yeah, so the pesticide story, you know, I'm- explained it for those that are not familiar in our audience? Yeah, so the more one was exposed to pesticides by proxisting. proximity to golf courses, which you use these, the more incidents over time was seen of Parkinson's. So the link, as you say, not causal, but an association. And that wasn't the first time it's been reported, of course. And Ray has a book out on this. He's really concerned about the

environmental risk that are attributing to our increased prevalence of Parkinson's. Right. So I wouldn't be surprised because, like you said, air pollution, ultra-process foods, microplastics, nanoplastics, forever chemicals. These are all burdens that increase body and brain inflammation, right? And pesticides, you can add that to the list as well. So I don't know that it's the fundamental root cause of Parkinson's, but it's very likely a contributing factor, right? And like you said earlier about the genes and the, you know, additional hits in people who are predisposed to Parkinson's, this certainly could be an added factor especially. Yeah. Well, let's wrap up on the other big disease category that you talk about,

which are these metabolic diseases, like type 2 diabetes, for example, right? These ones are a little bit easier to catch early. Would you say that is a fair statement? Yes, because we can use things like glycohemoglobin A1C, fasting glucose, you know, triglycerides, blood pressure. They're very easy to diagnose metabolic syndrome or pre-diabetes so you can prevent their progression to actual type 2 diabetes, which we certainly want to prevent. Anything that you think that would be relevant are important for people when talking about this last category that they were chatting about, these metabolic diseases. So, they're largely lifestyle driven. That's an important thing.

and if there was the single most important thing that you could do on a regular basis to reduce your risk of developing them, would you say that that would be regular exercise? Well, that's up there, definitely. There's a genetic component, too, because there are probably 90 million people with pre-diabetes in the United States, and about a third of those are thin people. So it's not just that they, you know, got obese. So it does occur, and that's definitely a genetic contribution that's making its, you know, the manifestation of that and the fact that they may not have the best lifestyle factors as well, right? But some people, they do everything right, exercise, and they still have a high hemoglobin A1C, signs of insulin resistance or even metabolic syndrome.

So, okay, what can we do about this? Well, for one, as you said, picking it up in a physical or visit, those tests are easy to get, obviously checking one's blood pressure and getting things like fasting glucose, glyco, glyco-hemoglobin A1C, these are important to know about because some people are harboring these pre-diabetes or type 2 diabetes risk factors, which, as you know, that's not an old person's disease. That can show up very young in life, you know, in their 30s and 40s, and getting ahead of that and preventing the progression. We just published a study in Nature Medicine, July 31st, a big study. We use continuous glucose sensors to help pick up people at risk. And those people

that have very high spikes after eating, or even not even with food, but just high spikes and high duration of those spikes, they were more likely to be associated with progression to diabetes. All right? So they're more serious. That's another way we can get a handle on this. The one thing we didn't talk about for this as well as for Alzheimer's is the gut hormone story. Please. Yeah.

This is the biggest thing. thing in medicine that I've seen in a long time, that people think, oh, Zempe or Zepbound, you know, we're there. No, that's just the beginning, right? You know, as I wrote a chapter in the book, it took 20 years to finally figure out that we ought to try weight loss as an indication, obesity. But now, as you know, very well, we're seeing benefits across all sorts of things for kidney, liver, heart disease, migraine, headaches. I mean, polycystic ovary syndrome and infertility, and the list gets longer all the time.

Next month, there are two trials for Alzheimer's coming out. For people who already have mild Alzheimer's, not for prevention. And I wasn't optimistic they were going to be positive, but it sounds like they may well be. Even if they're not, the point here, Drew, is that we have so many more of these gut hormone memetics coming.

I mean, there's more than 10 of them. not just the two that we have in common use today. And they're going to have combinations. They're going to be in pill form, not injectables. They're going to become inexpensive. And they're going to be used increasingly frequently to prevent this pre-diabetes or metabolic syndrome progression, not just in people with diabetes. And they may well be used to prevent Alzheimer's, which would be extraordinary.

And I wouldn't be surprised in your lifetime, because you're an increased risk for Alzheimer's, you'll be taking some kind of gut hormone pill. It may not be like the ones we have today, but it may be a combination of one of the ones we have today in your future. We'll see how it plays out. So just to connect the dots for our audience, you're talking about the sort of explosion of people using maybe different GLP type drug. Yeah, the GLP drugs are basically, it's working on the same hormone that we have naturally at that receptor, glugogon-like receptor, GLP-1. And And then there's, you know, the GIP, which is DIP, gastrointestinal peptide, and there's glucagon, and these are all gut hormones. And gut hormones talk to our immune system, and they talk to our brain.

And they knock down inflammation in our brain and body. And they're turning out to be more useful than we had ever imagined. As you know, we're already seeing people who are alcoholics, gambling addicts, nicotine addicts, drug addicts. nail-biting addiction, all these people seem to be benefiting as well. So it's having effects that are far more pronounced than we ever envision. And we're in the starting zone here. There's many more of these coming, and they're in clinical trials. So if you think things are big now, follow this space.

It's just going to get more exciting over time. From my standpoint, help me understand if this is a correct way to think about it, right? painting the picture for our audience who's, you know, hearing this conversation, our modern lifestyle, which has come with a lot of incredible benefits and technology and life-saving drugs, et cetera, improved, you know, outcomes at birth, less women dying in birth, more babies saved, so many great things. But our modern lifestyle, primarily when we look at sort of the big food component of it, is so addictive that it's just been incredibly difficult for people to eat in a way that would

naturally be producing these hormones on their own. So it's not that these drugs are adding something new. They're more the taking out that sort of addictive piece and causing the overeating of certain foods that are driving a lot of these diseases in the first place. And if those foods are not there and the overconsumption of calories are not there, you end up getting your body's natural healing effects that would be preventing these diseases. Is that a wrong, is that an incomplete or incorrect way to think about things? I don't know. The reason I say that is because the age-related diseases, the three that we spoke about, cardiovascular, cancer, or neurodegenerative, they are really an outgrowth of an immune system that's dysfunctional,

dysregulated, and the attendant inflammation that goes with that. And so, in general, as we age, this is nothing to do with eating too many calories. As we age, our immune system starts to go immunosinessence, and we lose some of that protection and that tight regulation. and we also have inflammation, right? So what I'm talking about is for age-related diseases, the big three that we discussed here today, that we need something more to counter the process in some people.

All right? So if you're 70 and you have lots of signs of immunosinessence, your immune system isn't working well, that may have nothing to do with your lifestyle. It may just be the process of aging in you. we have a way now forward on top of lifestyle to modulate that. And that's why I think we're going to see a big jump in the number of super ages in the future, the welderly, as we call it,

because we have a way to modulate the age-related diseases, which we've never done before. We have never prevented Alzheimer's. We have never really prevented cancers in people at high risk. And our work in preventing heart disease is not something exemplary by any meat. We can change that. That's what's so momentous about this time right now. As we wind down here today, I'd love to get your thoughts on a couple more things for our audience that you talk about in the book.

So one of the areas that I want you to talk about is this explosion of different ways to measure our biological age. We've already talked about some of the ones that you're super. super excited about. Can you talk about the buyer beware side of biological clocks that are out there? Yeah. So the one that's marketed a lot is the methylation clock. These are the epigenetic markers, side chains of our DNA, also can be done with saliva. And there are a lot of direct-to-consumer companies that are marketing these for very high prices.

and it's actually a very inexpensive test, right? So you shouldn't be spending a lot of money to get these. I do think they're going to have value when they're standardized and high quality, like we see in academic labs that are doing research. But a lot of these companies I don't trust, right, because I don't know how well they're actually doing the asses. And I do know they're charging, you know, hundreds of dollars for a simple test of methylation markers.

What they're telling us is epigenetic, age. If you think of it as how is our body rusting out and these methylation markers are kind of like the rust. The problem is that it's not the same as biologic age. That's just the dimension of our methylation. Now it does give you, let's say for you, it could say, Drew, your methylation age is 35 years, but you're 40 something, right? That's great. And most of these companies, give a report that's favorable. So I don't know what that means. But the point is, if you have an advanced methylation age, right, where it's a gap that's going in the wrong direction, that might be a cue that something's going on and you might want to see an organ age. So you see

what I'm saying is it doesn't give you any specificity. Currently, it's being charged too much commercially. We need to get better, inexpensive ones that we can rely on that are standardized. But eventually it's a very low-cost kind of body-wide assay. It could be useful. Right now, I don't recommend getting it. It's not really biological age. It's epigenetic methylation age. On the topic of aging, I'm going to repeat something I heard you say in another interview and you tell me if I got it right. There is this idea that your body, people's bodies could be aging at different levels, right? Some people have accelerated aging. Some people are better at how they're aging and they could become a superager, as you write about inside your book. So that is a valid

idea. But the only thing clinically research-wise that we know, for sure, without a fact, that can slow down your biological clock, right? So I'm 43. But if I want my biology to be 35, 37, whatever it might be, the only thing that is proven right now is exercise. Is that correct? Yeah. So the only, this Horvath clock, the epigenic clock that I was talking about. The only intervention so far that's definitively improved that, and this is Steve Horvath and I wrote about this in The Lancet, and he's published independently on that, is exercise. No other lifestyle factors that we know. Now, some of them have been tested. Recently, there's some interest that omega-3 intake, whether it be through foods or even supplement,

might achieve that, hasn't been replicated yet. And somaglutide, Ozympic, just published recently, again, not independently replicated and was done in a very special group of people with HIV, lipohypertrophy, but look good. But so far, the only thing that's been definitively shown to improve epigenetic methylation age is exercise. Have you, over the years, changed or reemphasized? your recommendations as you become more familiar with the data of how much exercise people actually need to achieve some of the benefits. Have you changed your mind over the years of how

much you tell people as a doctor, as a cardiologist, to double down on the exercise? What is your recommendation now? And has that changed over the years? Well, it has to be, you know, adjust to the person. You know, first thing I do when I'm going over with a person and, of course, even in my own life is, you know, what? When are they going to exercise? How? You know, what are the, are we talking about, you know, brisk walking? Or are we talking about other aerobic forms of exercise, bicycling, treadmill, elliptical, whatever? So talking about getting five sessions a week, ideally. Hey, but even if we can get less than that, at least 30 minutes a session, that's been backed up for years. I've been doing

that for decades, right? That has strong support. The new thing, of course, is that resistance training added to that, a couple of sessions a week is also, you know, perhaps equally as important. And as a cardiologist, I didn't have enough respect for that date until I reviewed it. And I've changed my practice, personally, no less advocating to patients, that a couple of sessions of strength training, and I would also add in their balance training, which is really important as we get older, those are equally important. So they have to somehow get integrated. And do you have to go crazy, you know, extreme? As we saw on a recent paper, 7,000 steps was a plateau per day of seeing some of the real benefits of exercise.

So it doesn't have to be going crazy extreme, but there is some unknown about that plateau of benefit from vigorous to, you know, very vigorous activity. We don't really know it's one of the things I got into in the book, which is, is there a limit too much? you know, like triathlons and Ironman and stuff like that. But for most of the case, the more exercise, the better. And even if it's not vigorous, even if it's moderate, it's still really good. And, you know, it's never too late to get into a good solid exercise program. And for me, you know, I started, you know, in my 60s to get into strength training. I was never into that.

And now I'm really, it's made a big difference. And I really appreciate the data that supports it. That's huge. Have you also seen an improvement in some of the things that you've been measuring that might be related to that besides noticing that you're getting stronger? Are you a participant in any of these tests that you've mentioned or your regular metabolic labs like your fasting insulin or other things? Have you seen those things improve? Well, those were normal for me, you know, as far as I don't have any signs of metabolic syndrome or pre-diabetes. But, you know, I certainly. stronger, yes, just feeling more fit and, you know, just, it's helped in a lot of ways. But I don't know that I can come up with a parameter. I haven't done an epigenetic clock. My p-tow 217 is pending right now, so I'll let you know when I get that bad. But I didn't have one before, so I don't know. but, you know, so I'm waiting to get my organ clock data, too.

But I think one of the things to emphasize what's so exciting here is a lot of the things we've talked about today are new. We never had these tools, these metrics before. And that's what's going to help us in this path to prevention. And, you know, whether it's people like you who are young or even as we get older, you know, I think most people do want to be superagers and live, 85 plus with no cancer, no neurodegenerative disease at all, no mild cognitive impairment, and no heart disease.

That should be our goal. I believe it's attainable, and it will become increasingly possible in the times ahead. So that's where I think this kind of all fits in. It's fantastic. Well, Dr. Eric Tobol, this has been fantastic. The book is incredible, and I believe especially for an audience like mine, where I definitely would put myself more in the exploratory aspect of longevity. I'm curious and I know I'm not the typical person.

I see it as a little bit of a hobby, so I'm willing to do certain tests or learn. But I always want to have voices that are out there like yours to help bring balance so that everybody understands an informed consent approach to what they're thinking about with their health. We need all of these conversations to be happening. And I think that your voice and your book is an important one at this time where we might be going too far off in one direction without doubling down on enough of the basics. So I really appreciate you coming on and sharing your approach to helping us all hopefully step into this space of becoming a superager. Oh, thanks so much. I appreciate the chance to have this fun conversation with you.

Absolutely. The link is in the show notes. will be putting that out there to everybody. And the book has gotten fantastic reviews for many people, including individuals like Nassim Taleb, who gave it a great review on X Twitter a little while ago. So I thought that was fun to read. Thank you for your incredible contributions to this space.

And just like you, I'm excited about the future. And thanks for helping our audience become excited about everything that's available to them now, as well as what's to come in the future, too. Terrific. Thank you. Hi everyone, Drew here. Two quick things. Number one, thank you so much for listening to this podcast. If you haven't already, subscribe, just hit the subscribe button on your favorite podcast app. And by the way, if you love this episode, it would mean the world to me. And it's the number

one thing that you can do to support this podcast is share it with a friend, share with a friend who would benefit from listening. Number two, before I go, I just had to tell you about something that I've been working on that I'm super excited about. It's my weekly newsletter. And it's called try this. Every Friday, yes, every Friday, 52 weeks a year, I send down an easy-to-digest protocol of simple steps that you or anyone you love can follow to optimize your own health. We cover everything from nutrition to mindset to metabolic health, sleep, community, longevity, and so much more. If you want to get on this email list, which is, by the way, free and get my weekly step-by-step protocols for whole-body health and optimization, click the link in the show notes that's

called Try This or just go to Drew Perot.com. That's D-H-R-U-P-U-R-O-H-I-T dot com and click on the tab that says try this.