Longevity is easiest to misunderstand when it is treated as a race against time. This conversation with Doctor Mike points toward a steadier frame: healthspan is built by the signals we repeat, the stress we recover from, and the evidence we are willing to respect.
Full transcript with timestamped links back to the original YouTube conversation.
I think that uh anybody who's selling supplements who calls themsself a longevity, you know, scientist or expert has lost their credibility because there's no supplements that have been shown to reverse aging, slow aging is a totally unregulated jungaloid space. And he's unfortunately he's he's one of the people that that are doing this now. Longevity clinics are selling $ 2, 000 lifesaving full body MRIs. Tik Tok influencers hawk glucose monitors to people without diabetes and best-selling authors are pushing supplements to prolong life, all with zero real evidence. To unpack what the data actually shows, I'm joined on this episode by Dr. Eric Toppel, worldrenowned cardiologist, researcher, and founder of the Scripps Research Translational Institute. He's the author of the new book Super Agers, which takes an evidence-based look at the science behind living longer. It's not bells and whistles. This is the real science that will help you age gracefully. In this episode, we'll discuss aging, the huers capitalizing on your fear of aging, as well as what innovations we can expect to see from AI within our lifetimes. Without further ado, please welcome Dr. Eric Toppel to the Checkup Podcast. Dr. Toppel, I've been following your work for a long time across social media. one of the few doctors on social media that I think is doing an amazing job following the evidence, telling the truth when it comes to complexities in health care related to AI longevity, truly the science behind the research that's going on. How did you get interested in talking about AI, healthc care, specifically on the web where that's not a natural place for a doctor to find themselves? Right. Well, thanks. It's great to be with you, Mike. So I think the story is kind of a a long history of interested in well first it was people's genetics and then it was digital and then AI and so they've been kind of sequential ways that we can deal
kind of sequential ways that we can deal with the data of people to promote uh health and so that it goes back to that and I'm really into ingesting lots of reading materials on a daily basis and so trying for social media was really sharing that uh and so that's why I got kind of stuck in the COVID uh years because you know I couldn't find you know really great reliable sources and so I said well I'm not an infectious disease guy but I can deal with data and evidence and so that was also the impetus to to go back to the healthy aging story which we had put a big effort in um some years ago with the largest and I think singular cohort of healthy aers average almost 90, 400 of them where we did whole genome sequencing. So we've had a long-standing interest in healthy aging because most of the medical world as you well know is disease centric and so we've always trying to look at the other side of this and surprisingly that study which we it was almost a decade of work it showed very little. the genetics of healthy aging is kind of a small piece. Uh and so that is liberating for people like me who have a terrible family history. When you got onto social media to talk about the research, was that primarily during COVID the first time that you were on social media? No, I got back in in um 2009. Okay. Then Twitter. Um, I was very reluctant to do it because it seemed like it was about what people were eating for dinner or lunch and whatever. But a friend of mine convinced me that, you know, you have a lot of stuff that's worth sharing. And then so progressively I would do more of the stuff that I would read on a daily basis. So that's what led to um, you know, now 16 years and you know into Blue Sky and LinkedIn and the others. But the main one that I really concentrate on these days is in Substack because it's a long form and I can
because it's a long form and I can really get into the evidence of things and try to point out what's exciting or what's disillusioning or whatever. But yeah, I mean I I what I found is communicating like that, if we all did that, we would be able to get this whole field, the medical community, the the life science community, it would be much easier to have uh the the real evidence out there. But unfortunately, we're outmanned um so much by an organized finance front of a lot of myths and even disinformation. Yeah. I remember in 2017 uh I just finished up my family medicine residency at the time and I was writing for the new perspectives blog for the AFP and I wrote that the absence or the lack of evidence-based physicians online is going to create a gray zone for which misinformation can flourish and just 3 days later we had this explosion of misinformation at a very critical time. So, I love the fact that you're encouraging other doctors to do the same because I feel like what happens on social media is misinformation will always be shared. It's people say it in common tongue when they're hanging out with one another in locker rooms. But if there's a doctor present in that locker room, if there's a medical expert who can share the other side of that equation, usually with evidence behind it, that will convince people to not fall victim to the misinformation. But there's not a lot of us on social media. Absolutely. you know, you're I you discovered this at a young age and you really have a a great presence, but we're talking about way less than 1% of physicians and scientists that, you know, take the time to do this because it isn't the way they kind of grew up and their careers um moved. It was that was uh not the kind of thing they had their head down to do, whether it's seeing patients or whether it was doing their experiments or whatever. And so this is really we have to change. We
this is really we have to change. We have to change the whole biomedical landscape because if we don't uh and it's going to take some time to counter this, we're going to be subject to this lack of trust and this kind of alt facts world that we're in right now. Yeah. I remember back in even my training days, it was labeled unprofessional if you were on social media or perhaps doing television medicine. Did you ever have any hurdles like that? Yeah, that's a really important point. That's how much the conservative medical establishment is. They didn't get it. They they the large um entities, the societies, I often call them trade guilds. They were against physicians. Don't do this. And of course the institutions were very worry about this because you weren't representing the institution but your name was associated. And so still today there's that tension uh because the ability to express oneself and the ability that somehow that is connected with the profession or uh your society that you're a member of or your institution. It's a problem still today. Yeah. I rarely see so eye to eye with another guest about the importance of social media and healthcare. Like I get the notion of where the unprofessionalism grew from because if you look at medical media 20 years ago and what the major players were on television, it was people promising snake oil, miracle cures, fat loss remedies that were not evidence-based. And as a result, they thought if you were going into those fields, ultimately that's the only path forward. But I think with your work, you've certainly proven that there's a way uh to get the audience engaged from an evidence-based standpoint. You don't have to approach it with miracle promises or negativity. There's a way to tell the truth and there's an appetite for it. Is that true? Yeah, absolutely. And this is I think of there's one area that this is you you just nailed it. It's this whole longevity and aging because there is so
longevity and aging because there is so much out there with these longevity clinics and companies and supplements and true snake oil lack of evidence. Uh it's rampant uh the biohacking world that we are in now. That's what was an impetus that I really need to delve into this uh because we need to get straight. What is the science where it can take us versus what is the dominant stuff that's out there right now? Yeah, I see and I'm curious what your feelings are on a opinion I've held for probably the last 10 years. I have this firm belief that health care is bad on two fronts. One on the tail end of those so low socioeconomic status. People can't get good healthare because they don't have insurance. They're underinsured, can't pay for their medications. But also on the flip side, for the VIPs of the world who think they can buy good health care, they can buy shortcuts, they can demand antibiotics when they have a viral infection, they can demand propal to go to sleep and end up having a terrible instance like with Michael Jackson. Do you see that happening in the world as well? And was that part of your impetus for talking about aging? you know, uh I in my previous book I actually pointed exactly what you're talking about because most people just think about oh it's the lower socioeconomic uh group that has problems with access and care but there's the other side of it where it's too much medicine. So for example going out and getting total body MRIs with no substant sub nothing substantiating it right and of course as I go out in the book um a colleague here in New York Drew Koular a New York uh New Yorker journalist as well as a physician he did this and now he's got this whole prostate issue he's dealing with and it's he's a young guy and this is the problem when you get a test of thousands of dollars that doesn't have any evidence It's heavily promoted. So what happens in the affluent that want
what happens in the affluent that want to get more tests and they're somehow getting convinced from entities that this is good to promote their health, they wind up getting these rabbit hole incidental and they could get biopsies because something was their lung or their liver. They can get pneumothorax or you know bleed into their liver. I mean this is the problem. We have over medicine just as much as we have under. Uh and so when we look at the bad outcomes in this country, almost all of it's a sign to the fact of access and um it's it's not just that we have unfortunately a a predatory type problem in the affluent and it isn't just executive physicals uh where you can pay thousands of dollars to have every test known to mankind. We have other channels to get uh a similar type of battery of tests that aren't needed. Yeah, I actually had the CEO of Peruvo, Andrew Lacy, sitting right across from me a couple months ago. Wow. And I was very strict and honest about the fact that there is no evidence uh for benefit. And he said, "Well, not yet. And I don't want to wait 20 years to see the data." And I'm like, "Well, what if the data shows that there's harm?" Yeah. Because I believe one of your tweets recently, you wrote that you believe that there is more harm to getting one of these preventive whole body MRI scans. Is that true? That's right. I think until we know more, we should assume that. I do think if you a total body MRI in select circumstances might be worthwhile. Like for example, you found um tumor DNA in a blood at the microscopic level and now you want to see is there any you know m macroscopic is there something to correlate or or in some cases you need to find out where is this coming from but to or hereditary syndrome. Yeah. I mean if you have I mean 2A or something if you have a um predisposition gene that is un unequivocal you know so-called pathogenic gene for cancer um
so-called pathogenic gene for cancer um that might be something to consider but even then if you have to rely on the total body MRI to find it we're talking about billions of cells that are creating a mass that's pretty late you want to find it you want to prevent it and if you want to prevent it um we're going to eventually be doing a blood test more widely in people who are at high risk. That's one of the strategies that we will eventually prevent cancer by knowing who is at risk and then getting all over it because once if you find it on a an MRI uh that's already pretty advanced and and the this is the real problem is the people that are saying my life was saved because I got a total body MRI and they found this mass. Well, for every one of those we have now there's been hundreds of thousands of people who've had this test. Um um actually I think maybe even million plus and there are people who have been harmed and there's no reporting of that data. Uh there's just celebrities like the Kardashians and others. It's like you watched our clips from the interview. You know this is crazy. And to say oh we're going to have the data in 20 years. Well, how much harm can be done? And also it's very expensive. Yeah. Uh so I don't accept that and I want hard evidence and some of the doctors that are uh so-called longevity experts, authors, um they are promoting this. There are companies that are they call themselves longevity companies. They say part of your being a member is you get a discounted total body MRI. This is terrible. How do you feel about uh those longevity experts uh promoting these standup MRI uh full body MRIs when in the past perhaps you've praised some of those individuals? I know like Peter Aia was someone whose work you've admired. What's your take on him discussing topics like the MRI rapomy etc. Yeah. So I challenged him. I have a
etc. Yeah. So I challenged him. I have a much smaller podcast uh ground truth uh where I write newsletters or interview and I had uh done a review of his book uh where I said there were a lot of good things but there also were a lot of bad things and one of them was the total body MRI there was rapamy there was an overdose for protein that was advocated and many other things so I invited him and of course it's hard to get to Peter uh through his his people. Finally, he agreed to do it because he knew I had some questions for him and he is, you know, very strong about his views uh and how, you know, it's good to have take rapamy. When I challenge him that this is an amunosuppressant, it's very potent. It's different for every person. And also, you know, there's this rapamy leaderboard where all these people are taking different doses once a day, once a week. Nobody knows the dose and there are no data in people that it's either safe or that it promotes um healthy aging or slows aging or anything. So he of course is kind of like what you got from the Pernovo CEO. I don't want to wait 10 years. I have a I kind of have a a hunch and I want to practice medicine you know based on my best I don't I'm not I don't buy it. You know, I admire Peter for some like his sections in his book on metabolic syndrome uh are excellent, but then there's so many things where he just jumps ahead uh which I would challenge. He recommends that people take a gram of protein a day to eat. That's a huge amount per body per pound of body weight. Per body weight, I'm sorry, per pound of body weight per day. So a a person that weighs, you know, 160, which is lightweight, would be 160 grams of protein a day. No, but the half of that is kind of where we're at for older adults where it's shown to help maybe even some muscle mass, but you know, we go to be careful of kidney disease, etc.
go to be careful of kidney disease, etc. Yes. And then of course now we know that very high levels of of protein intake will promote aththeroscerosis, promotes inflammation, particularly if it's animal protein. And then you know there's there's several other things that he kind of goes off the track where there's no data. There's just no evidence. It's his beliefs. Now he's titled to his beliefs and apparently you know he has a pretty big following but now he has a company that he's promoting longevity and he's selling supplements. And I basically think he wasn't doing that at the time of the book. I think that uh anybody who's selling supplements who calls himself a longevity uh you know scientist or expert I has lost their credibility because there's no supplements that have been shown to reverse aging, slow aging, promote healthy aging even though there's lots of claims. This is a totally unregulated jungaloid space. and he's unfortunately he's he's one of the people that are doing this now. Yeah. I see this pattern evolve quite often where you have someone who's very interested in pursuing the future of healthcare and they jump hurdle over many of the important steps that you need in order to validate research to understand if it works on a broad scale between interperson variability uh between safety with other medications and all those things are bypassed in the name of trying to get further. But as we've seen historically with health care, not even just with the last 20 years, but a hundred years, there were things that expert opinion drove us into the direction that was very dangerous. Oh yeah. And that goes for something as wild as bloodletting or very extreme instances. No, totally. And I think you have to put the body of evidence together. What do we know? What don't we know? and you know what do we need to research to you know to find if there's compelling evidence and if you take that hard stance I think you're on on terapirma uh and we just need to do more
terapirma uh and we just need to do more of that but unfortunately if you go across the longevity landscape today it's there's not enough of what we're talking about here and hopefully um there's a way to get on track again yeah I think the way we get on track is by having these conversations and shining a light on the negative ways to speak about longevity. I also had a guest on the podcast, Brian Johnson. Oh my gosh. Who is famously doing some very extreme things uh testing on himself whether or not uh it's going to help him live longer. And I warned my audience to not start trying that for themselves. Also, not creating anxiety for themselves thinking that if they don't have that, they're missing out on some miracle cure all product because it doesn't exist. these things are not just unproven but proven to be harmful in a lot of instances. What's your take on the entire Brian Johnson spectacle? Yeah, I mean he is the extreme version um don't die and uh that's of course absurd. Um but the things he's done like having plasma feresis from his young son and uh having a penile sensor for monitoring his erections during the night. I mean these are just you know the list goes on and on. Uh there's nothing to substantiate any of his hundreds of supplements and his exact number of calories per day with his whole staff and it's absurd. Uh and so uh yeah th this is the the worst example. Zero evidence. He's got a big fan club. Um you know and it's really unfortunate because he's he's really the purveyor of misinformation uh regarding uh slowing the aging process. We have nothing that has been shown at least through objective measures to slow the aging process with only a singular exception that Steve Horvath's clock the methylation epigenetic clock where exercise and and
epigenetic clock where exercise and and actually we wrote together a piece in the Lancet about it but it was his original work. Exercise so far is all we have and that's not I don't even know if that's part of his his regimen. No, it definitely is. I mean the things that he does say right is you know staying out of the sun to decrease skin cancer risk, exercise, okay, sleeping uh correct number of hours per night but then it you know even sleeping the correct number hours per night is taken to an extreme where he deems having only a perfect sleep score. But I'm like that's not living in reality. Your body can withstand one night's less of poor sleep because you have a life, a child, a job, etc. Oh yeah. No, I think the deep sleep story and that's where science comes in and I can't comment. I I'm not familiar enough uh from his the details of his stuff, but we we've learned that every night during deep sleep is when we clear these toxic chemicals from our brain, right? And these glimpmphatics that are basically a channel. And what's interesting is as we get older, of course, our deep sleep is reduced. And so we have to try to counter that. And what was really uh amazing is these medicines like ambient not only you may feel like you're getting more sleep, but you're actually getting these toxins are going backwards instead of out of your brain. It's it's amazing really the how they truly backfire. So deep sleep is really worthwhile and in fact tracking that can be helpful. I it certainly helped me and sleep regularity. But as you say, Mike, it isn't like I now try to be pretty tight about when I go to sleep each night, but you know, do I want to go out on a weekend or do stuff? You have to have a life, too. But also, there's a misconception about total sleep because people think, oh, you got to have eight hours. And as I reviewed the all the data in in um super aers, seven hours is actually where it falls out. But that's just, you know, you're
out. But that's just, you know, you're asleep in bed 7 hours. much more importantly is what is the quality of the sleep particularly that slowwave deep sleep and people who are not great sleepers might benefit from at least for a little while tracking that and getting it to and as as we get older unlike you uh it becomes more important because it is import a key determinant of risk for Alzheimer's disease. Yeah, that's why a lot of my patients who struggle with sleep I I'm quick to order a home sleep study to check for sleep apnea. It's it's one of the major causes especially in our uh overweight population of uh a way of disturbing sleep without even realizing it. So oh absolutely that's step number one is their sleep apnnea. And after you get that rolled out because it is common uh then of course you know start looking at ways and it's amazing all the interactions with exercise what you eat regularity when you go to bed all these different factor you have to learn yourself what it takes to to be a better sleeper and that the importance of that I think we've really and the mechanism we've really now become and that's part of the science of aging. It's a it's about our age uh our brain aging uh which we now can get through an organ clock which is amazing. We didn't have that a couple years ago. So there's all these metrics from the science of aging, all these mechanisms that have really blossomed our knowledge base. So you don't have to hack it or reverse it. You can actually use the metrics to figure out um ways to prevent age related diseases. That's the the real premise of the book. Yeah. For me, hyper optimization has become a disease. Exercise is good. Yes. Not playing sports because you fear an injury and you think that will ruin your athletic score, problem. Sleeping 7 to nine hours a night is good. Trying to from an OCD
night is good. Trying to from an OCD perspective keep the same 7 to N hours rigidly ruining relationships, not good. And I feel like with the biohacking community, they believe more is better. Yeah. But in health care, perfect is the enemy of good and what's best is actually the balance. Yeah. And the balance has been missing. No. And it goes to exercise, too, because these extremists, I mean, we were talking about Peter at the time when he wrote the book, he exercised four hours a day. Who has time to exercise four hours a day? He told me during all his wealthy clientele. Yeah. He told me during the podcast I did with him, he brought it down to two hours a day. Okay. But also as I review the data for extreme exercise is uncertain. That is there's a level of intensity where you get to then maybe it actually is not good for you. And the sleep you know people think eight or nine hours actually the data if you look at from the population level it's everybody's different. Seven hours is kind of the it's not nine. In fact, that's where you start to see associations with lack of uh good outcomes. So, a lot of things in extreme I agree with you. Uh moderation in everything is a good thing. Yeah. I think that's smart. Uh so, maybe grandma was right with that age-old advice. There's a lot to that. Um tell me more about this biological clock because I know Brian Johnson has frequently said his uh penis is 27 years old, his brain is 40 years old. Uh, I actually just used a a scale that a company sent me and it told me my biological metabolic age was 26 or something even though I'm 34, 35. Um, is this a validated way of measuring age? And is it easier to just look at your cholesterol, get a blood pressure cuff, and check those numbers, figuring out risk through that way as opposed to calculating a biological age. Yeah. So I don't think that uh these getting these
don't think that uh these getting these age uh metrics. So there's bodywide aging and the main one that's been validated extensively is through the DNA methylation. It can be done through saliva. Ideally you don't want to get it through a company because they have interest to make you younger and that you will send all your friends to get these tests and whatnot. But yeah, it's very accurate for your epigenetic age, which many will equate with a biologic age. But there's a lot of other tests that are being sold as u giving you your biologic age that don't have a good validation. Um so that's one test. But the organ clocks, the organ clocks uh are not out commercially yet. They were initially discovered at Stanford by Tony with Corey and colleagues. Now they've been validated by multiple groups and multiple large cohorts and so they're going to be out there eventually and that's eight organs and your immune system and they will be very valuable when they're available from a reputable you know laboratory because they will tell us in a person at risk. So, let's say your concern is Alzheimer's. What about your brain clock? Is it outpacing your chronologic actual age? And how does it stack up against your other organs? So, yeah, we're not ready. I don't know what clock, you know, Brian Johnson's gotten because the ones that are now validated in that I mentioned are not available. Uh, unless he had some special um access, I doubt it. And then of course there's other things like there's the plasma protein um it's called PTA tow for prophylated P tow 217 which 20 years in advance of Alzheimer's tells you whether you're at elevated risk and it adds to other things like the genetic apoE4 alil or your family history. So getting back to your question, yes you should have your LDL cholesterol and your blood pressure
cholesterol and your blood pressure those are standard things but we will have and that's so exciting about preventing so primary prevention of the big three age related diseases has been a fantasy for millennia but we now are approaching a time when we have the ability to get these data in the right people at the right time in their lives and with multimmodal AI I say this is the one you're going to be um concerned about and we're going to prevent this or at the very least we're going to put it off for many many years. And that I think is is our exciting unique opportunity right now. Yeah. How does this work on a practical actionable sense? So for example, for my patients over the age of 40, I calculate an ASCVD risk score, a 10-year score of them having a stroke or heart attack. Um, and then from there I can decide whether or not they're a good candidate for a statin or other modalities. So I remember vividly an episode of a TV program that I actually went to the premiere of with Chris Hemsworth and Peter where they told Chris Hemsworth that he had an elevated risk for Alzheimer's and it drastically changed his worldview. I don't know if that's a good test and I don't know if I would recommend that test for my patients because outside of making healthy lifestyle changes which I've been preaching to them before getting the results of that test. What changes finding out that you're high risk for a condition like that? Well, I think for the right person it can be a world of difference because in general we know about lifestyle factors and I I call it lifestyle plus because it's not just diet. lots of details there. Um, sleep, exercise, but it's all these other layers of data. Uh, you know, it's includes things like social isolation and, uh, nature, being out in nature and environmental exposures. I mean, there's a long list and we can get into some of the details if you like, but the point
the details if you like, but the point is most people don't go after all these things unless they have specificity about them. Then you can see and I don't know the story about this fellow but then you can say huh I am doing everything I can to prevent this condition that I never want to get that I'm at high risk for. So but the point is it's not just that. So firstly now used to be you could only until recently you could only say you're at risk for Alzheimer's but guess what we can't tell you when it could be when you're age 100 or it could be when you're 60. We can't tell you when. Now we can tell you when that that's very helpful and now just like LDL you can change your lifestyle get even more into it and you can see your PTA 217 come down and that's like an LDL cholesterol where you should expect and we have to again validate all this that you would slow the progression because you get that marker 20 years or more before any mild cognitive impairment of Alzheimer's. So we have a we have multiple biomarkers which this one is the best and and we also for example the ompic drugs the glip one drugs they're in trials now in thin people to prevent Alzheimer's if one of those hits which it's certainly possible given all the other data we've seen right then you have a drug a disease modifying drug for Alzheimer's and by the way uh they have potent anti-inflammatory effects in the brain. So they they really are a good candidate and there are many other drugs in the pipeline. So if I was this fellow and I was concerned about my family history of Alzheimer's and I had let's say an APOE4 alil which is a carrier 25 or so percent of us have that. Um I didn't have a good lifestyle. I might want to know I might want to get a PTA 217. A lot of people don't know
a PTA 217. A lot of people don't know about that yet. It's in the book and I wrote a Substack about it recently. It's a breakthrough test and that would then set me into a plan to prevent the disease and be up on the new treatments added to what we have today because mostly what we have today is lifestyle but most people are not adopting those changes. Yeah. You know those lifestyle changes are so valuable for not just the brain. So like making ev every one of those adaptations of exercise, diet, sleep, uh social removing social isolation, creating a healthy mental health space. Um they're valuable not just for Alzheimer's risk, but for so many other risks. Yes. And me being a family medicine doctor, I find myself in a unusual space to talk about this because most people who are in this space speak from a longevity standpoint or from a research standpoint. And from those standpoints, all that research is very exciting to me. When I'm trying to make the patient in front of me as healthy as possible, I'm not just thinking about a disease. I'm not thinking about a organ. I'm thinking about them as a whole. Yes. So holistically. And if I'm thinking about them holistically, I want them institute those changes irrespective of their p uh pau level. Right. Yes. So that's why I don't know how much it changes my guidance versus why I like the ASCVD risk is because that might change my guidance about medication. Whereas I would never recommend a healthy low-risk person to take a statin, but if they're at high risk, now I can implement something that would have negative repercussions from someone healthy, but positive repercussions for someone who has uh potentially high risk for having one of these instances. Yeah. But it goes deeper than that in in a respect because for as a cardiologist um we have seen all the trends of the lower LDL potentially the better and we have all these new things like these injectable PCSK9 monocone antibodies and antisense
PCSK9 monocone antibodies and antisense and so we could really go get the LDL down to you know 20 or 10 instead of that getting less than 70 for example. But again, if you knew the person is at very high risk, which we can do now for cardio, so it's taking it to a different level. I don't I wouldn't recommend getting LDL down as some authors do and people do to the lowest possible level, but if I knew somebody was at high risk and want to achieve primary prevention, that's a prototypic example. Um, but you know, I think this whole idea is that you're right. I spend a lot of time with patients and I suspect you do because you want to get granular with them. What are they eating? What is their exercise? What time of day? What and you basically need to work with them to how is it going to work in their life? Like what time a day do you have to exercise? And how can we change some of these things that you're eating and get rid of the ultrarocessed food and you know and so this takes time and most physicians don't have that time, right? And so this is a real problem. This is our medical system because the people don't know what they don't have that patient doctor relationship with the gift of time to be able to really get to the nitty-gritty of how each person can pull out all the stops. So you're right. If we could do that, it doesn't happen. Meanwhile, what we do know is a person is much more likely to get serious if they have specificity about a condition. So you know they may know all these things but when it comes to them and they are you know motivated that's when you see like for example uh the the randomized study was presented um by the neurology association last month in San Diego where I live. They took a group that had all had PTA elevated. So they all had higher risk of Alzheimer's. And
all had higher risk of Alzheimer's. And they randomly assigned to pull out all the stops for lifestyle. And these people had their PTA and the other markers go drop down 50 75%. And they felt much better because they were doing things in their lifestying of a trial. So we we tend to think if we can talk to uh to patients and really um try to get them to uh adopt all the things that we know. It's great, but it just doesn't happen for you as a motivational tool. It could be valuable. It could be I think it's motivational, but it's also it just doesn't happen in the typical patient doctor experience today. I mean, so where are they going to get this information? And I'm talking about all the details of it and all the evidence for it because some people say, you know, I just recently had a patient uh come in and um towards the end of the visit um the wife was there and she said, "Uh, Dr. Toppel, is it okay if he continues his moderate drinking?" I said, "Well, you know what? What is that?" And she says, "Well, he has two tequilas and six beers every night." And I I thought you was joking with me, Mike. I really No, of course. Yeah, that sounds you know my fellow was with me and I mean he was also you know bugeyed and so no that's not moderate drinking you know but people have a lot of misconceptions out there but if I hadn't asked I could have if I'm in a rush like a lot of doctors say moderate drinking that's fine. Yeah. Okay. So you have to get into the depth of these and people just don't know you know moderate to them and what is um you know they don't even know what actually is ultrarocessed food right and so this requires an education for many people and like you said motivation most people frankly are not motivated until they
frankly are not motivated until they know that there's a goal don't get this disease and this will help you not get this and we're going to get other things to help, not just lifestyle. Sure. Uh, are there any things on the horizon in terms of preventive treatments besides the GLP-1 medications that are in trial for someone who does have an elevated risk for a neurodeenerative condition that once they find out, it's not just they're making lifestyle changes, but there is some kind of medication or a different approach. Yeah, there's several drugs that are now being assessed for primary prevention of Alzheimer unlike the drugs we have today which are not very good. They carry high risk. They're in people who already have Alzheimer's and we've already seen you can get amaloid out of the brain but it doesn't get people's Well, that whole hypothesis is kind of shaky as well. Yeah. No, this is to prevent not just the accumulation of these proteins that are misfolded but also to prevent the inflammation in the brain. And so there are all what's amazing is there's this whole revolution of these uh gut peptides like um the uh story with um the glip one and uh glucagon and now there's triple receptors and there's all these other uh um gut hormones that because there's a gut brain axis there's um they're now in going into trials and of course pill form not just injectables and so we're going to see many different drugs beyond the the current um ompic and um zeppbound for this potential. So it is exciting because the problem we have today is we're trying to come up with cures but prevention is a lot better. It's a lot relatively easier and that's where you get the really not just the best for the patients but the be the bang for the buck of investment in the research and um in the the years of high quality life lost because of having one
quality life lost because of having one of these um age related diseases. Yeah. I um I oftentimes want more prevention, but I'm also realizing that if you don't have good validated data behind that, it's easy to go in the wrong direction. Uh in my career, a good example of that is aspirin for primary prevention and how we've walked that back because of what we learned in uh newer research. So I'm I'm hoping that we can do this in a way where we're not putting the cart before the horse and we're taking a patient centric approach and not rushing the research in order to put out good data as opposed to rushing and putting out something that perhaps might not be helpful in the long term. Yeah. I mean I think as you well know you always have to reassess the evidence as it comes in. This is where a lot of people got lost trust during the pandemic because we were learning things. Uh and it's always that case. I mean we're there it's a dynamic thing and search for the truth is not so simple. It's not a static thing. It's so yeah I mean we have to reassess the aspirin story as you point out is really important because there are tens of millions of people taking aspirin. I just had a resident uh present a case and said patients taking aspirin for presurgical clearance. I said why? And they said I don't know. And I'm like well this is where we investigate and we step in. So yeah and we we get stuck in these things because and even you know our colleagues in in medicine they might not keep up with the literature to take to tell a person age 70 plus that that bleeding is more of a risk than the benefit of preventing. Yeah. I actually uh Dr. Paul Offford who's been a multi-guest on this channel had a great term for it medical inertia. Yes. Where we just continue on with the old medicine without actually seeing what's new. But again, we got to balance it without not jumping too far ahead. Um, I'm curious as someone who's looking into tech and health care quite often. What's your take on the continuous
What's your take on the continuous glucose monitors because I have a lot of questions posed to me by patients who don't have uh either type 1 diabetes or type two diabetes who are interested in it. I've seen influencers uh most popularly the glucose goddess. I don't know if you've heard of her. Yes, I have. She's in the book. Okay. She recommends everyone gets a glucometer in order to check uh the velocity or the rise of uh spikes. And for me, from my understanding, I have no idea what to do with that data because when I look at someone's hemoglobin A1C, I know what to do. I look at someone's fasting blood sugar, I know what to do. When I look at their 2-hour postprandial, I know what to do. But when I look at a elevation postmeal, I don't know what to make with that data. Is there something that I'm missing here or are people again putting carb before the horse? Well, there's a lot there to unpack. Uh Mike, so we've recently uh did a big study uh where we got all the layers of data including the the glucose monitor, but the gut microbiome, the genome, everything they ate and drank and their sleep, physical activity, because you need all these things to understand what is spike from. Some people they have no spikes. They can eat anything. And then others can get spikes 200 plus that are long in duration. And when you see a spike like that, that would say hm there may be um a risk a higher risk of of eventually developing type 2 diabetes. But I don't think these uh getting healthy people getting continuous glucose has much role except for you know a couple weeks or you maybe now that it's consumer available. Yeah. Just health curiosity. Yeah. Curiosity. We don't know that the spikes uh except for perhaps increased risk of diabetes. We have a paper coming out in nature medicine about that very soon. But does it have any risk increase for cancer, for Alzheimer's, uh for
cancer, for Alzheimer's, uh for cardiovascular disease? We have no clue about that. Those the studies need to be done. But one thing that's really of course fascinating the work from Erin Seagull in Israel and his colleagues they did that brought in this whole field is that if you and I ate the exact same thing the exact same amount the exact same time one of us might have a no spike and the other one could be you know the 240. So we each are unique and the same work was done with um lipids by Tim Spectre in King's College in the UK. So it isn't just our metabolism is very unique and someday we could get a diet that emphasizes the things that avoid unnecessary um metabolites or high glucoses, but right now we're not there. We have a big investment by the NIH to go after that right now. Um and it's, you know, it's it's going to take years to sort it out, but the AI diet, that sort of thing. Yeah. But, um, right now, this is more uh, you know, future than anything. Yeah. It's if people learn about certain foods, certain people that are they they have really big spikes. And those who have no spikes, it's say, "Oh, I'm, you know, I'm I'm in a very um nice place right now." But like you pointed out earlier, as we get older, you know, it may not be the same. So it's it's not just a one-off thing or the microbiome can change and then it might not be the same. There you go. So we have to learn whether um having this every five minute glucose measurement, it takes us beyond the standard measurements that you were alluding to and it's it's an unknown now. Yeah. I think about impacts like much like how you said the whole body MRI can have negative impacts. I remember getting some genetic tests done and it said that I have low risk for developing type 2 diabetes and I said, "Oh, well, should that mean I go out and eat a ton of refined sugar?" Like what is the actionable? Again, I'm family medicine.
actionable? Again, I'm family medicine. I'm always actionable actionable from these tests. And if the action is not guiding me, I'm telling my p my uh residents to not order those tests, right? So, for example, I had a elderly patient who was having uh lower GI bleeding and my resident was about to order a colonoscopy and I said, "Well, did you ask the patient if they would want surgery if they find something?" And they're like, "No." They went, Patient said, "I don't want surgery under any circumstances. My life is already in a bad position. My quality of life is below where I want to be. I wouldn't do any surgery." We don't need to do a colonoscopy anymore. There you go. So, I think we need to get back to that age of understanding why we're getting tests. We we do too many damn tests. It's just ridiculous. And I'm not saying for research we shouldn't do them. Yeah. Like all this research, we need to get to the point where we can individualize someone's diet, to their genetics, to their uh CGM results, but we're just not there. No. And then the people that are weaponizing it usually for some kind of profit motive. I mean, I remember even seeing a documentary where they fed collegiate athletes different varieties of animal-based protein meals and they saw that there was some fat content in the blood after the meal. And I'm like, well, that's supposed to happen, right. And you're painting it out as if they're somehow unhealthy. Yeah. So, it's easy to twist the science when you're taking truth wrapped in a lie and exposing it to the major audiences. So, I see that happening a lot. I'm actually curious, what was the reference to Glucose Goddess in your book? Oh, well, I mentioned that there are influencers like her. I mean, Peter was really keen on them, too. Um, you know, I've been involved in this space for almost 15 years that I was on the board of Dexcom. So, I could see their value in people who had type 1 diabetes and in certain people with type two diabetes that hard to control. um that take us beyond you
to control. um that take us beyond you know a measure that's reflecting a month or months of but I you know I really have circumspect about where we need to get the data for consumers before we have the glucose goddess and others that are saying you should do this and after they do this they then sell a supplement to decrease your spike. Oh yeah, you know, exactly. You know, this is the problem we have right now. This is a a predatory world without data and you know people any given person with large um social media present. I think hers is Tik Tok or something they reach these and then they basically it's replaced in too many circles. You know where is the evidence and this this person told me I'm going to go do this. It's just it's anecdotal. Yeah. And it's it's even often baseless. It's it's really for though for the people that spend their lives actually trying to do the research. It's it's dispiriting because it just basically negates the the hard effort it takes to get the data. Yeah. Doing quality research is hard. It's demoralizing because oftentimes you're proving yourself wrong more than you're proving yourself right. In fact, when you're setting out to do good research, you're trying to prove that you're wrong. the null hypothesis and most people aren't familiar with that. And I think the reason why I went into social media and talking about healthcare is because I saw researchers who were amazing at doing that year in and year out. We're good at doing this social media world. And I said, well, I'm not a great researcher. I can't do bench work. I'm not that's not where my talents lie. So, let me take their work and then bring it to the general public. whereas other people who are not good at researching just make up their own research and start pushing it out for these predatory marketing purposes. So, you know, it's funny you mentioned that because some years ago in the journal Science, one of the very top journals, there was a thing called the Kardashian index. Okay. And what they did was they
index. Okay. And what they did was they took the number of citations you had in papers and then your presence on then Twitter and they saw that, you know, drastic imbalance. Yeah. And it was really funny. So, it's it's so true what you're bringing up. Um, and that's why, as we talked about earlier, it's really important for everybody in the research community to have a voice and to stand up for their work and for what is what we know as of truth and facts because without that, look what's happened. There's this kind of collapse mode. So, I I am with you. Um I don't I mean being on social media uh is on any given day can be very challenging but it's like everything else in medicine there's a net benefit right and so I I think it's really important to stay with it and to encourage I try to get all our young faculty and trainees to get on it and I have variable success because you know they they say they don't feel like they have enough to contribute or they will just be um followers watchers, but they don't want to actually be people to post things and they've seen how how, you know, people get uh assaulted, attacked. They don't want to be part of that. I understand it's you have to have be callous and you have to be committed that you want to share what you think is is worthwhile, helpful information. Yeah, that's going to be tough for everyone to do. I think that's why you're seeing those variable levels of success. But I think even for those individuals who have tried it and realize it's not for them, that could be okay. but then support your colleagues who are doing that work because I look at um a post from the CDC and it has 10 likes on it. I'm like, where are the doctors supporting that post? Exactly. So, you don't have to be out there shaping and creating content on your own. You could be supporting someone else's content who's doing that work. And ultimately, what the algorithms feed back to us is what we like, what we support. And if the general public only supports the extremist content, the
supports the extremist content, the algorithm will just be a mirror of that. Absolutely. No, we have less than 1% of physicians who are actively engaged in one of the major platforms. And on the other hand, you know what percent of people we have that have no uh matter back who who have done their own research and what we are so outnumbered and this is a real problem. So I don't know that we can ever get everyone but even if we get 10% that would be a huge win. Yeah. Um the second part of why I think it's beneficial to have more medical professionals who are evidence-based online is for public good in the essence of public health has become political and in order to impact public health you have to have a presence. For example, I often times when I go to medical conferences, I'll tell a story as an example. I was on an airplane once across uh Atlantic and a young gentleman went into aniflactic shock. I asked for his EpiPen. He didn't have one. I asked uh the flight attendant for their kit. There wasn't one there, but I did see epinephrine for the cardiac ACLS kit. And I said, "Okay, let's do some rough calculations." We maggyvered it and we gave it to him. Saved his life. It was a great story. Yeah. If I did that and didn't have social media, no one would have heard about it. I then told the story on YouTube, it got 10 million views. Senator Chuck Schumer calls me. We're able to do a press conference advocating for airlines to get epinephrine pens on board in order to uh curb these potential anaphylactic attacks from becoming much worse than they could be. And as a result, we got a net win from that. So public advocacy through social media is also very valuable. And I think it's never been more valuable than in the day and age where we find ourselves with RFK Jr. in the helm of HHS. What's your take on that? Yeah, it's it's more than troubling. you know, we have um the misinformation at the highest level um
misinformation at the highest level um unimaginable because the people that are now um at HHS and these agencies in leadership are um ones that many have been um taken a contrarian view of the evidence and they're now seeking to eradicate or suppress the people who are been the mainstream of doing the work and the research and um this at gutting the resources there are some common threads I mean we do want to see work that's being done to Annie up to uh ultrarocessed foods um air pollution u microplastic nanoplastics big issue for pro-inflammatory impact and uh with organ damage like the heart and brain Forever Chemical. So maybe RFK Jr. could help us because in past administrations we've seen no serious attempt. Now that's the good part. The bad part is if you keep taking away the people at these agencies, the funding of merit grants that have gone through um peer review and got a meritorious scoring and you're now saying, "Well, we're not funding that anymore."uh and you're taking down billions of funding from the crown jewel of biomedical research in the world which is now 47 billion which is actually trivial compared to you know our national expenditures and the investment is of course extraordinary. You start taking that apart and now we're talk hearing about 40% reduction of that beyond what we've already seen. We're talking about gutting and not just at this remarkably opportune time of what we can do to promote healthy aging, but we're going to just slow that down. We're giving that opportunity away. Uh whether it's other countries, whether it's just put aside for a long time
it's just put aside for a long time because that's that's the priority. Make America healthy again. If that really was what we're after, we'd be doing these things to prevent the age related diseases of cancer, cardiovascular, and neurodeenerative. That would be our center stage. But it isn't. What our center right now is let's just keep taking away, let's get rid of all the leadership. Let's put in place some people who have not been supportive of what would be considered ground truths in biomedical work. So we have a really difficult uh mission right now and eventually I am optimistic we will be fine but we will lose momentum. we will lose years. Um, and that's really sad because you know it's it's kind of like during COVID in that first year we had no vaccine and what if you could just make it to the point where you could have a vaccine and you were in that advanced age and high-risisk group imunosuppressed whatever it and we're kind of like that. Time is a very important aspect of this and we're going to lose this time to get the mission accomplished of preventing the big three diseases that compromise our health span. So the way I see it is this is all going to happen. We have the blueprints of how to do this. Take advantage of you know what we already know and what we will know. But by taking apart our health uh research system and public health agencies and taking away all the research funding for independent work that was reviewed by Congress and appropriated by Congress but is then getting negated by being doed or executive orders which at least in my view would be considered illegal. Uh it certainly isn't the way it's designed. So we we have a a rough patch but I don't lose my kind of optimistic sense that we will prevail ultimately just that time factor is it
ultimately just that time factor is it going to take one three years and then how much do you actually lose you know for that unit time is it more than a year because you got to reboot stuff that's the uncertainty that I have you think about all those people that will end up suffering unnecessarily and it's it's sad and I appreciate you trying to call balls and strikes in this scenario where you know what RFK is recommending about chronic disease is good and what he's saying about vaccines is bad. I used to be that way too, especially before he came in uh to HHS as acting secretary. But now I've lost that. I become a bit more pessimistic and a bit more alarmist than I usually am because the whole notion of make America healthy again of the idea that we need to focus on chronic health more so than infectious disease. All these premises that he talked about getting chemicals out of uh our children's foods and out of our water systems, all of that seemed to be just talking points. Well, they has recruited, you know, the mag maha moms. I'm a huge part of our country now. The moms that believe that their kids got autism from vaccines and all these things that you just mentioned. So, he's getting to a lot of people. The problem is he makes stuff up. Exactly. He says, "Okay, uh, take vitamin A and cod liver oil for measles." And then these poor kids wind up in the hospital with vitamin A, you know, fulminant liver problems. I mean, so the hospitalizations that have been for the Texas measles outbreak is not just for measles. It's because of what he's done. Yeah. And not promoting the vaccines. And when he does, then he gets this the Maha movement to go against him. And then he backs off and he just vacasillates from making stuff up to please his his base, if you will, of people that he made. He created this along with Andrew Wakefield who propagated fabricated data that ultimately was, you know, had to be um uh retracted retracted from the Lancet.
uh retracted retracted from the Lancet. And that was the most destructive study in the history of vaccines because of it was all made up. And so we have fabrication, you know, all over the place. And I I do uh agree with you that this is unacceptable, but I don't know a way it's going to get rained in because these are these people are de facto in control now and they are propagating all sorts of things to do a study now that is what do the vaccines cause autism? That is probably one of the most carefully studied things we've done in the history of medicine. and to do a $ 500 million study uh uh effort to come up with a universal flu vaccine using technology that are decades old when we have such great studies from multiple academic labs that show here's the path to a universal flu universal COVID vaccine so we don't have to go through varants and boosters and but it's just going backwards. We just keep going backwards and with myths and conspiracy theorists and it's really sad, Mike. Yeah. The the amount of misinformation shared is is wild because it's happening on major outlets and I don't know how it's being allowed to happen. He'll say the MMR vaccine has immunity waning at 4. 5%. Which is just completely wrong. Lancet uh published the results and it's 4% not 4. 5. uh he'll say China has uh the diabetes population of their children by 50%. 50% and it just fully 50% of the population of China has diabetes. That's according to RFK that you just make stuff. Rotoirus vaccine has killed more people than it's saved. Just made up statistics. And then like forgetting the uh infectious front, you would think at least he would focus on the food aspect. And his focus on the food aspect has been to remove uh one oil and replace it with beef tallow. Oh
oil and replace it with beef tallow. Oh yeah. No, the beef tallow is completely sitting at a fast food burger joint celebrating that there's beef in there, right? Like it plays like an SNL parody. It does. And somehow people are not realizing that that's happening. In fact, I did a debate against 20 vaccine hesitant / antivax individuals where I was surrounded by them and they each had five minutes to sit and talk with me and we did it for three hours. Wow. And one of the individuals said to me something I won't forget. He said, "Now that Well, it was right before RFK actually was uh confirmed."and he said, "Now, if RFK is to be confirmed as HHS secretary, will he then be the expert and you're the one sharing misinformation?" And I said, "Whoa, the take on that, no." And my answer was, and I'm curious what you think of that answer, science doesn't happen by an individual expert. It happens by consensus. and the consensus groups that have been putting in this work. The WH gave for the vaccine alliance, these groups have been doing it for decades, they're the ones who are leading the consensus driven statements, not RFK Jr. or one person, whoever is the head of HHS. Yeah, I couldn't agree with you more. That's how we get to the ground truths of in this case vaccines and how no public health um strategy has been more effective uh for saving lives children and adults alike in history. And so to try to take that down uh is just egregious. And so as you say, not just the WHO, not just Gabby. I mean, we're just talking the problem is if you go back during the pandemic because the WH wouldn't say this virus is airborne and they had the lockdowns or light lockdowns, whatever you want to call them. They had the schools and it's all this ammo for these these all these agencies. They don't know what they're talking about. And so the loss of trust
talking about. And so the loss of trust people were not presenting the data in a straight way or saying we don't know say we don't know if the the whole uh you know six-foot rule and all you know all this stuff that so we are at a nater of trust because of some of this stuff it it fed into the you know and I'm hoping that we'll gradually it won't happen right away gradually turn this around and get get the trust est reestablish lished. Yeah. The hypocrisy I want to highlight for the audience is WHO and CDC had missteps. I talked about them quite often on this channel. I actually interviewed Dr. Fouchy a couple times on the channel and spoke about some of the errors to him. Um, we call those errors. We call them mistakes of judgment. We call them mistakes of communication, mistakes of science, whatever they were in each individual situation. But hey, how come RFK Jr. doesn't own up to his mistakes? Oh, no. Where are these mistakes of making up data, making up statements that uh HIV doesn't cause AIDS? How how in the world can we have someone at the helm of a health agency just take that notion with no evidence? I remember also in this vaccine debate there was a pediatric oncology nurse who was vaccine hesitant and she said to me why do you think that RFK can't be at the helm when he you agree with some of the things that he's talking about like trying to remove forever chemicals or these things out of our system and I said well what is they actually edit this part out so this is kind of a fun fact for the audience as well I said uh and she said why don't you allow him to be HHS secretary. I don't even agree with everything my husband does and I've chosen to spend my life with him. I said, great example. Tell me what's the most important factor that leads you to be confident to stay with your husband for the rest of your life. She says it's his faith. His faith in religion, his faith in our family. Got it. For me, the equivalent of that
Got it. For me, the equivalent of that for who I want as HHS secretary is scientific rigor. Right? And if your husband broke his faith, would you want to be with your husband? She said, "No."said,' Well, if the HHS secretary breaks scientific rigor over and over again, I don't want them as head of HHS, even if they have an occasionally good idea. So, I thought that was a response. That's perfect. I mean, there's no room for, you know, arrogance, hubris, not willing to fess up that, you know, you were wrong that you got the wrong read at that time and you know, unfortunately, this is how it works. you know Francis Collins who's was a phenomenal NIH director uh he wrote a book uh after the pandemic um the path to wisdom and he his book is full of telling his mistakes and that's who you kind of admire is you know he he really um realizes how his communication could have been better and he learned from people like you did sitting and talking with the people that were uh had different beliefs and that coming together and that realization that is the humility we we always have to have that and we're not seeing that right now as you aptly point out and it's all the way to the top you know it's not just at HHS it's almost like don't ever fess up to a mistake you know don't we it this is you know it could be tariffs it could be you name it there's never isn't it something there's never a mistake because it's become a PR strategy if you're just very confident Eventually there'll be something else. Oh yeah. And not only that, but you keep saying the same thing they made up enough times. You you even believe it, right? Exactly. And then everybody believes it. It's amazing. Yeah. It's really a bad situation in that regard. How does the cuts to NIH, probably less so USID, but how do the cuts to these major research agencies impact our knowledge of aging and longevity?
longevity? Oh, I think it will be potentially immeasurable. Um, it's an attack in multiple fronts. Um, I mean, there's a National Institute of Aging, uh, which has been the NIH across the board. We've seen, you know, we're we're threatened with not just a 40% cut of all NIH, but also the so-called indirects, which is mostly paying for the space and the utilities and the things that are needed to do the research, not just uh you know uh tallying up the the um the financial aspects, which is the administrative side. So that's still in suspension. the we were talking about 15% versus what is going at normally universities 60%. We have the universities that are under siege and so higher um education. So all of this impacts highquality research that goes through the peerreview process which has been that itself has been slowed. Uh grants I mean there's now uh so many grants that have been cancelled. I just had to lay off 15 of our people in the recent weeks. People I've worked with for you know more than a decade. uh and we are definitely doing and we spent seven years to develop the elderly cohort of 1400 people that some of these research health initiative the decades the diabetes prevention project decades they're all taken down and every one of these like for example a lot of things got wrong from the women's health initiative and all of a sudden you know female hormones were condemned right they would cause cancer and blood clots now we're learning from the science of aging. One of our objectives should be to prevent o early ovarian failure because that advantage that women has have uh premenopausal is remarkable protecting from all these age - related diseases whether it's the um
diseases whether it's the um rejuvenating the thymus gland or prevention of the ovarian failure which is of course um is going to happen in all women eventually. So we are learning in fact from the um the work that in the organ clocks that uh taking hormones is actually good for the immune system and the brain. Now that's counter to the old work that was done in the women's health initiative and so much more needs to be done if we can prevent Alzheimer's in women which is more common in men even age adjusted and it was tied to that we could be thinking about in women who are high risk should they be considering taking the right doses and kinds of hormone that's the kind of thing we should be doing right now and I I want to highlight to the audience research we should be doing not you should be taking yes because there are people who have created these hormone clinics where they're just slinging hormones left and right. Oh, I couldn't agree with you more. It's a big unknown, but this provocative data that we should be on it and again not cutting research for it. No. And not making premature selling predatory stuff without the evidence which is just rampant out there. So yeah, I that's just an example of the the science of aging has brought us so much new information that we didn't have. We wouldn't have known what I just said if it wasn't for the discovery of organ clocks and the ability to say when you're going to get this illness and here's what we're going to do. So we put that push that off for you know a decade or forever. Um so I think this is a field which is exciting. I mean, it's never had a more propitious uh opportunity as right now. And at least in this country, we're not I mean, I doubt that HHS secretary is even aware of this stuff. If he really if he was interested and this make America healthy again, which you know, I'm not sure was ever really healthy. Uh but if we might
ever really healthy. Uh but if we might get healthy, this would be the work that we would get behind rather than just cutting everything. Yeah. I just had uh PhD Kevin Clatt from UC Berkeley talking about how these cuts are impacting metabolic kitchens where research is being done on ultrarocessed food. The things that he's talking about, there is no plan to actually find out this research that he claims to find. Like the idea that he's going to create an autism study that he will find an answer. I remember before September. Well, no, before he got put into the position he is now, he actually said that he'd get it in two months. Oh, yeah. Then he pushed it to September. Now it's 2026. Yeah. By all under pressure. But you know what you're saying is a great example. So Kevin Hall, who I look to as one of our top nutrition scientists based at NIH, he resigned in conflict with um uh Kennedy uh because they wanted him to twist his report. Now this is another big problem, Mike. So he had a paper coming out about the ultrarocessed food. He's been a leader, a pioneer in this work, showing us the the problems. and the NIH in the new regime wouldn't allow him to communicate with the public. The New York Times uh communicated him directly, but he wasn't. And he they send the questions, but he had to have them alter them. They were altered and they they had to be what what uh RFK Jr. wanted on the ultrarocessed food, which wasn't what the study showed. So, they took his work and they manipulated and they ascribed it to him. They not only altered his answers, but they never said, "Well, we changed, you know, uh, Kevin's an Hall's answers." And this is beyond the beyond. You know, one thing is to have misinformation, but then to take a respected researcher who had who resigned or whatever you want to call retired because of this. This is
call retired because of this. This is just uh I mean profoundly uh unacceptable. And it was called out tangently. We can't have this what whoever is left to do the work. We can't have them muzzled and we can't have their work being manipulated uh to support uh other hypotheses that are unproven. Yeah. And this is an administration that supposedly values scientific freedom. Oh. There's a lot of things as you know that you know kind of dressed up which is not really the truth. Uh, and right now it seems like the predominant mission is to gut the monies that are supporting research and public health agencies. And I don't know, Mike, maybe you know, where is all this money going? It's a great question. I I don't know the answer to that, but I know that the NIH, the HHS, they need to do a better job at retaining researchers, retaining dollars for research. Just understanding how much money it takes to perform a a twoe controlled metabolic study is incredible in order to do it correctly, not just to get the result that you want, because it's easy to get the result that you want if you're uh willing to cheat the science and not are actually after the truth. So, very problematic. I'm curious, how long until our medical establishment starts asking RFK to resign? It's a really important question. Um the problem with that is um if you're a medical researcher and you sound off then if you have any funding left, it's likely to be eviscerated and you will be a target. I mean the problem right now is we are in a culture of fear. So that adds to it. Uh you know I give Kevin credit because he stood up and told the story and and moved on. But we you know we have few examples of that. Most people have moved on quietly and uh you know many are looking for jobs and it's going to be
looking for jobs and it's going to be hard to find a job in an academic center now because they're all in shrink mode. So uh the problem of retribution, the problem of organizing a movement uh and of course it's not just HHS, it's part of an administration which has lots of common threads uh which is basically we went into a reckless I couldn't believe more that we could be smarter about our our uh funding that is if you're going to spend 47 billion maybe you could get more out of that 47 billion. Sure, let's promote more young people who many too many older folks are getting all this funding and bu brilliant ideas, hyper innovation and but that's not what we had here. No, we had a reckless indiscriminate we're going to cut thousands 10, 000 people before RFK Jr. even was elected the administration he was saying pack your bags you know on on Twitter X pack 10, 000 of you are leaving or some crazy stuff. So that's the agenda and um in order to take that on I mean it's not just at HHS it's it's much more uh challenging and those who stand up and really are um viferous about it are likely to be facing uh retaliation. Yeah. I I actually have friends in positions of uh seuite execs from major organizations and they've seen my videos talking about their RFK Jr. situation and they say that they want to be vocal, but their organization is not letting them because a lot of the grants they get are federally funded and they're concerned about losing those grants. Much like how you say, the fear of retribution is all across the board. Yeah. Even in private institutions. No, it's it's really um it will it go on for years, I don't know. Uh but um you know, if it keeps up the velocity what we've been seeing in the first few months, um it it's really a serious problem. And eventually, you know, uh
problem. And eventually, you know, uh because of it, we're already seeing kids with, you know, hospitalized with vitamin A liver toxicity. Who knows what else? And we haven't even controlled the measles countrywide outbreak and what's next. Um no less that. So, um, we're not in a good position right now. And, um, this is, you know, Senator Cassidy, who was a deciding vote, who trusted him, saying, "I believe in vaccines." Well, he was worried about the same retribution about getting funding against his campaign. Yeah. I mean, this is what we have now. Um, politics trumping science. Yeah. Pun intended. Yeah. What's interesting is uh the RFK administration probably gets one thing wrong the most and it's not HIV. It's not vaccines. It's they talk about this chronic health epidemic that we're experiencing. That is true. We're more obese than we've ever been. We have higher rates of diabetes, heart disease, etc. But they believe that is due to some sort of foreign entity as opposed to just overeing poor quality foods. and they think they can somehow stop that without a plan. It's very hard to change someone's behavior. It's very hard to change uh private organizations marketing behavior. In New York, we tried uh limiting the size of uh big sodas and that got crushed. Michelle Obama tried to do the same on a major scale. Crushed. And yet they're talking about as if it's easy to change human behavior without ever actually succeeding in changing human behavior. I think that's where they get things wrong the most. Especially when it comes to the chronic health front. Yeah. No, I agree. We have the worst consumption, highest consumption of ultrarocessed foods in the world here in the US. Yep. It has been tied to cancer, neurodeenerative and cardiovascular diseases, type 2 diabetes, every bad
diseases, type 2 diabetes, every bad outcome, right? the proportionate to the consumption and kids is even higher than 70%. Now what does it take to do something? It needs a plan. It also needs to take on the department of agriculture and big food which is basically a few companies that control our whole food intake. Uh and RFK Jr. is an environmental lawyer. Yeah. If you're going to go after something, do that. you know, and I I talked to Rob Kaiff who's a very close friend who was a commissioner twice uh in the past and recent outgoing and he says taking on USDA and big food is just really really difficult because they're powerful forces. But you know if if we want to see this would be an opportunity have a plan where you know we're going to have much better uh warning education um getting instead of you know kakamimi food dye uh additive thing we get serious about it because there is an opportunity here that could some good could be made but we haven't seen any of that there is no plan alley it's all been very um uh unknown about some of the things that this maha movement has gotten behi behind him. Um where where are the deliberate steps that going to make a difference because that's one that could really be useful. I mean there are countries that have really gotten serious about this problem. We're not one of them. And by the way, as you know, regarding the US, because we have such ridiculous uh mismatch of our expenditures for our healthy aging, for survival, for maternal um mortality, um for infant mortal, you know, wherever you look, we do so poorly. And there's an opportunity. It's hard to make it worse, but you got to have a plan. And
worse, but you got to have a plan. And it's got to be logical. You can make it worse if you just cut all the funding. Yeah. You said, "How can you possibly make this worse?" But we are the outlier country of all of the rich countries in the world. And and we're not getting we're going worse, not anywhere better. So you you know, here you have an opportunity unidirectional. You can only make it better, but you got to do something that is smart. Yeah. It it reminds me of an analogy how we just said if you're in the low socioeconomic space you get worse health outcomes. High economic space you could also get worse outcomes. America is that personified in some way. So it is where we get both. Yeah. Exactly. You really do. And people don't understand about that being hurt at the high end. Well, we're the perfect example. We're spending tons of money not getting good outcomes. So I think that's a good example of it. And I also want the listeners and viewers to realize that this isn't it's political in the sense that it's public health focused, but it's apolitical in that it's not about Dems or Republicans or moderates because uh RFK Jr. was a Democrat not too long ago. Yes. Uh he's now part of a Republican administration. Um in 2020 when uh I was reaching out to Trump's first term administration, they sent Dr. Fouchy to this podcast. So we worked with them then. Then when Biden came into office, we worked with their administration to get the surgeon general and Dr. Fouchy on. So we work with every political party. It's just about telling the scientific truth and trying to do the best that you can with the limited information that we do have. So this is not a political attack in that sense. Strictly public health focused. I think that's great and that you've had these conversations with folks and it's without regard to the politics. Well, we also have to remember that uh the COVID vaccine which for the triumph that it was is largely creating a lot of divisiveness and distrust in the general public. Yes. Especially on the conservative side of things. And
the conservative side of things. And again, the antivaccine movement kind of started on the liberal California granola side of things and now it's progressed into the conservative. So again, showing the apolitical nature, but Donald Trump called it his vaccine. Yeah. And now the conservatives hate the vaccine. So it's very interesting how the sides flip back and forth depending on uh whatever is at stake in in a given time. Absolutely. Um I wanted to talk about and shift the conversation a bit to AI. Yeah. In your book in 2019 deep medicine you said how AI would revolutionize the doctor patient relationship. It's 2025. My relationship with my patients has not been revolutionized. We have chat GPT responses creating hallucinations in discharge instructions and I'm getting really poor quality notes when I try and use the AI scribes for my patient encounters. Have Have I been premature in thinking that this was happening now or is this a failure on AI's part? Uh well, it's there's a lot here. It isn't just, you know, the AI scribe of a conversation. I don't know where you you may be using DAX. Uh, no, a different one. Okay. Some health systems, um, like Emory and many others, they're using and you know, every doctor says they're two to three hours a day they're saving from having to work on a keyboard. That's great. That's a beginning. Um but that's just one part of this because that note of the conversation that synthetic note not only is the record note which is better than the notes that are typically made but it can be used to do all the downstream things like uh connecting the followup appointments um prescriptions uh tests and anything that needs to be done. nudging the patient subsequently for things that
patient subsequently for things that were discussed, getting of course the audio record and the links to the patient so they're not confused. Um it can also do deal with the pre-authorizations which is a nightmare for lots of physicians. So that note digitizing that encounter has lots of potential and it has been seen um you know at least with some of these uh and that's exciting but that's just one part. The big thing, Mike, is that we have well on the patient doctor relationship. We need to get the gift of time. As we talked about earlier, if you only have seven minutes with a patient or 12 minutes for a new patient, this is not time where you're going to get talk about lifestyle where you listen to a patient's deep concerns where you interrupt them in 8 seconds. You know, this is not the way you want a relationship. AI has potential to get us there. That is by making the appointments we have less time uh out of keyboard keyboard liberation more eye to eye contact and more trust and presence you know doing the exam that you really show that you know the laying of hands which is fundamental and also this engagement with the patient um you know at at any time ideally so they have this they know you have their back right that isn't going to happen overnight but we have an opportunity to towards that. Now beyond the patient doctor relationship which has to go back long before you were born like about twice your age. It was a precious intimate relationship patient doctor. It was you know it was almost the relationship in medicine. Of course that's changed drastically now eroded and it has to come back. But we also have other problems that AI is helping us with like errors. We make serious diagnostic errors at the tune of 12 million a year in this country and the John's Hopkins study showed 800, 000 people a year are either disabled or dead from these diagnostic errors. AI has tremendous
diagnostic errors. AI has tremendous opportunity there not only from the scans which it can see things that humans will never see. Let's go back to that the athoscotic score you were using which has been the standard for decades. The chest X-ray was shown to be better with AI than that score for predicting future cardiovascular events. But for looking for calcified plaque at everything things that we can't see. Okay. Yeah. I mean calcified plaque and mediainal fat pads and I mean things that we don't even the we can't see the pixels that the AI is analyzing. It's extraordinary. And we now can look at the retina. This is part of the AI prevention and say in the next 5 years even though you have no symptoms you're going to have the beginnings of Alzheimer's or kidney disease or how are you controlling your diabetes your blood pressure um whether you're going to have a heart attack or a stroke and 10 other things from the retina or the cardiogram we can say you know anemia your what is your hemoglobe these are things humans can't see can't possibly I mean I've been reading cardiograms for decades. I can't tell you the age and sex, the ejection fraction and all these other things whether you're going to develop atrial fibrillation, which is another reason why you should lose weight because this is not a good thing. So, we have AI to to as a totally different method for reducing errors and seeing things that we can't see. Digital eyes, machine eyes, whatever you want to call them. Yep. And there's lots of other facets of AI, but to me the most exciting one is the super aer story, which is you take all your layers of data and and you're very young, but let's say you were 50 and you want to know are you at risk for one of these three age - related diseases that's going to really change your health span? And we then get the right layers of data.
we then get the right layers of data. AI, multimodal AI analyzes it and says, "Guess what? You're not at risk." Or, "Guess what? it's just this condition that you're at risk for and when and this is what we're going to do. So, we couldn't do this without AI. It's large language models, large reasoning models and that's what makes this time so unique is we we'd have all this data dressed up to go nowhere. Yeah. But with the AI, it makes it possible to be individual level data to help you to coach you to use the your images to AI analyze them. Uh it's extraordinary, but it hasn't gotten into the the medical practice. It will. Yeah, I I can say what do you think the timeline for that is? Well, you know, a couple of the people um who got the Nobel Prize in medicine like Demis and Jeffrey Hinton for their work in AI, they're they've endorsed the book and they see this proposal imminent. Now Dennis was on 60 minutes just a couple weeks ago and he said within a decade or so I've learned through my mistakes three books where I try to predict the future of medicine creative destruction democratization you know digitization and then AI when it's going to take hold it's always longer than you think medicine is a kind of sclerotic oify medical inertia but sometimes for the good of medicine yeah yeah because it's easy to flip-flop too you don't want to jump You want to see compelling evidence and we don't have that for many things that we're talking about. That's why a plea to get that when you have the the parts that look like the some of the parts which look extraordinary. So let's get that. But it takes longer than you think. Uh and I think that we will get there in your practice of medicine in a couple of decades. You won't even talk about AI because it'll be completely embedded omnipresent everywhere. You'll
embedded omnipresent everywhere. You'll be you will see many less patients in person. You know what did it take to get tele medicine in high gear which I had written about 14 years ago took a pandemic right hopefully we don't need a pandemic to get these things moving or some other you know major catastrophe but it takes longer but it will happen it's inevitable because we as humans we as physicians we're humans we can't deal with all this data we're talking about billions of data points for any person things that we will never see and we have to say we need help lean on machines right and that's why in your I I would hope to see it but I won't see it in my practice of medicine but you will and it's just a matter of time unfortunately you know it could be a couple of decades could be a little longer but um it's a path that there is no other way to deal with the data to get back if you know a better way to get back the patient doctor relationship let me know I mean you know so Well, uh I mean changing uh incentive structure for primary care and those things I think will make an impact as well because right now primary care is not as celebrated as well as it should be in terms of creating a foundation for one's health. A lot of young folks especially in the urban areas are relying for urgent care centers to provide their primary care and there's no way you're getting a doctor relationship. No, not not at all. But you know then the affluent can have concierge medicine and then you get lots of time with your doctor and you have their cell phone number and text them and allact is that the is that what we want is that the medicine we want for people here so this is a real problem um and that's why we need to decompress we need to give patients more charge that's another reason why AI is kicking in diagnosing all these common skin lesions urinary tract infections arrhythmias um you know ear infections in children Those will all be done by AI. Yeah.
Those will all be done by AI. Yeah. Okay. So, the common reasons to go see a family physician, primary care physician, a lot of those that are not life-threatening, they're going to be done. Here's the AI. I I have it, you know, validated by the physician for the prescription only. I don't have to go with the visit. You're going to see a lot more of those things in the next, you know, that's actually moving pretty quickly. giving patients a virtual health coach if they want it or if they want it to help them prevent the disease of interest of concern. These are things that are happening um now that will take a while to you know get get uh proven but I I'm convinced with what I have seen so far they will and so the it the physic the physician community doesn't like the idea of patients having more charge. I mean, you as a young physician, you're willing to accept that. But older docs like me generally, uh, now I'm I'm in control. Yeah. Control freak. I don't want them coming in with their sensor data and, you know, all this stuff they got from chat GPT5, whatever stuff. I I want to be the one calling the shots. That has to change, right? You know, I'm giving the commencement address later this week at Mount Sinai Medical School and you know, talking about this is that we are in a flux. We're not going to be picking doctors for as brainiacs with their best GPA score, uh, you know, averages and their MCAT scores. We need people, yeah, you know, that really are empathetic and compassionate. And I think that I think is going to be an important part of the next generation along with the AI along with the patients having more charge. Yeah. I'm curious how the general public will land in terms of getting information from AI and I'll give you one specific example that I find um funny and sad at the same time. Elon Musk, head of Doge um or not head of Doge, I can't even keep track anymore. Um is
anymore. Um is endorsing RFK Jr. to some degree, his notions of asking questions, his medical theories, etc., especially on his platform X. I asked Grock, which is the AI of X. Yeah. What percentage of health claims that RFK Jr. makes are factually inaccurate? And it said greater than 50%. Why isn't someone who's an industry leader like Elon Musk asking his own AI system about the factual accuracy of the person deciding the nation's healthcare? Yeah, it's amazing. I I Gro is actually pretty good and it's and I it's much greater than 50% of Cord. But you're absolutely right. Why? So if people like if he's not listening to that on such a huge stage, right, is he going to listen to it about his cholesterol score? Uh it seems pretty unlikely, doesn't it? Yeah. So that's why I don't know how will AI interface with the general public when it comes to the virtual health coach stuff. Well, I'm expecting that when that emerges and is proven that it helps people and changes their natural history of these age related diseases that it won't be in the current climate. Okay, got it. Okay, because it can't be. I mean, you know, we're we we basically are upended everything, right? But we we'll get there. I mean I I I'm very optimistic that eventually the things the promise that we see today the ability to prevent the big three age - related diseases will be actualized and um it won't be at a time when we're at peak misinformation. Uh but it it will get back. I mean too many times in history there's been instability. Maybe not as bad as this. Uh where you know it got get back. Uh we will get there. Uh I I just hope it's sooner than later. Yeah. To leave people with some actionable points if they want to be super aers. What can they do? Well, they should know all the details of lifestyle. Uh that means you know in
lifestyle. Uh that means you know in terms of we don't just say exercise we're talking about not just aerobic but core strength training balance posture you know all the different things that are components of of fitness and it doesn't mean you have to be extreme as we discussed that's you know my colleague from Stanford you and Ashley said one minute of exercise like five minutes of gain of healthy aging okay and there's something to that the data support that uh in large respect Now um knowing about the sleep story and tracking it if you are suspect and as you say getting a sleep apnnea is is it real because it's more common than a lot of people realize it can be easily treated prevented. So that sleep thing and getting you know the details the regularity the diet thing is couldn't be more important. There's too many people that are um not just the ultrarocessed foods, but are this protein craze we're in now, eating lots of red meat, which is pro-inflammatory, and knowing what foods are generally um anti-inflammatory or not pro uh but and then all the other things that we discussed. So, everybody could do that, but I just know that that familiarity with the details isn't enough. And I think if you have a family history of one of these three conditions, let's say it's my area cardiovascular, so you had someone with a heart attack and your family parents or something like bypass surgery, something major, and you have uh your LDL cholesterol checked and you could even have inflammation proteins like CRP checked, whatever. Um, then the question is how aggressive you want to get. Not just with the lifestyle factors, but do I just go with statins? Maybe I don't tolerate statins. A lot of people have that problem, particularly as they get older. Um, do I try to go as low? You know, these are questions that are
know, these are questions that are really important. And remember when we learned that the determinants are not just your genetics but largely non-genetics that gives hope to people that I have so many patients that come in to me say my father had a heart attack at 50 I I feel like I'm going to have a heart attack at 50 but we can change that because it's not just the genes uh here and we have tools that we didn't have before. We're going to have uh pills and treatments to lower LP little a which we never had. We always would say all these years, h you got a really high LP little A, too bad. There's nothing we can do. We're going to have there's five drugs that are about to, you know, get across the goal line. So our armamentarium has never been better. Our ability to block inflammation. So it's just a matter of how aggressive and having those layers of data together. Like for example um you can get now a CT of the heart arteries and you can see by AI how much inflammation you have even without a blockage. Mhm. And that's the kind of thing as we get using that more inexpensive very low radiation people at high risk could find out before they developed a plaque that was significant to to use that as a a metric. So that's just heart disease. Each of them have that type of edge. And that's why I think it's so exciting. We we never had this kind of rich um things to work with to prevent the diseases even though we dreamt about it forever. Yeah, it's very exciting. And I'm glad that you're pointing out that there's a duality here, not a false dichotomy. It's not just lifestyle or medication. It's lifestyle for everyone. And for who benefits, high risk, who needs it? added layer, medication is definitely an option. And all of these breakthroughs that we have from a technological standpoint will help us better risk stratify who is high risk, who would benefit from earlier intervention so that we don't have to treat heart
that we don't have to treat heart attacks. We can prevent those heart attacks. And I think that's very valuable. Yeah. And I think it's important Mike just to emphasize there's one big hole in the story and that is we don't have an immunome that is if we want to assess an immune system of a patient today what do we have it's 2025 and we have CBC that's CBC the ratio of the white blood cell neutrfils to lymphosy that is a cockami way to address I mean we know so much about antibodies and B and T cell function NK cells, all these other components, dendritic cells, and we don't assess any of it in the clinic, any of it. And look, we just went Well, is that because it's so ever changing and responsive to the environment that it would be hard to No, it's part of it, but you can do the perturbations to simulate that in the lab. So, you can see you you can give um you know, all sorts of ways to see how does your T - cell respond to this or that and B cells and and auto antibodies. So I in the book I I have in the last chapter kind of the beginning of the immuno where I had a John's Hopkins spinout test that every auto antibbody every virus that I've ever been exposed to in my life and surprises some surprises there I never had CMV exposure where most adults have had that and there's links to all these different like FD bar yeah I've heard yeah with multiple scerosis if you have the right genetic predisposition so we're going to get there and it's not that hard And there are many beginning to see the shots on goal. That's the thing be the big three age related diseases are very much dependent on a intact immune system not too heavy uh strong and not unguarded. We could probably not get metastatic cancer if our immune system really kicked in. Right. And we have ways to the beauty of the current um date today is that we can uh riostat
um date today is that we can uh riostat up and down the immune system, right? We could give like shingles vaccines. Today is the fourth study to show shingles vaccine lowers the risk of dementia and Alzheimer's disease. Well, who would have guessed that? Well, it's revving up our immune system. So, it's a twofer. Y a lot of people aren't getting them because of the antivaccine movement. And they works well against shingles, too. To the 90 plus% by the way. Yeah. 95 some percent. And uh you know 20 25% reduction of of dementia, Alzheimer's and that's nothing to snicker at. So we're we're learning how to rev up and down the immune system to take control. That's the other part of this. We got to really uh get that down so that when we see patients in clinic we can say you know our immune system you know it's great or that's I I am shocked that this day we an age we are not there yet but I I think it's not far uh around the corner. Yeah, I think it's it's changing and uh I think the notion of hygiene hypothesis means something different to my generation because hygiene hypothesis used to be that you don't challenge your immune system with non-pathological microbes. So therefore, your immune system perhaps overreacts. But I think about that in terms of exercise. Yeah. If you're hygienic, you're not exercising. And when you're not exercising, you're not creating inflammation. you're not challenging your immune system because inflammation during exercise is modulated by your immune system. So I feel like the immune system plays such a wider role than just a typical protection from bacteria or viruses or fungi in so many variables whether it's exercise, cancer risk, uh bone health, etc. Oh, you you nailed it. I mean exercise across the board it is how you keep your immune system intact, especially as we age. As we get older, we have this imunosiness problem and some people not I mean the super aers one of my patients present in the book
one of my patients present in the book I'm sure her immune system is incredible but many of us uh it really dips and we need to you know get it back up and it's a little bit of a Goldilock story. You don't want to get so selfattacking. Yeah. Boosting the immune system but you also don't want to get it where you have your guard down and then that's when you get uh in trouble um with the opportunistic thing. Yes. So this this area if we can it's it's going to demand more research. That is the piece and of course after the brain the immune system is the most complex system in our body. And so again you can't deal with all that data if you don't have AI. That's true. Uh I want to end on one point that I experience a lot of frustration within my practice and being a cardiologist you probably have a very strong stance on this. Young people 30 years old will come to my office and say their Apple Watch dinged that they had 5 seconds of aphib. I know what to do with aphhib and someone who's symptomatic, who has risk factors based on their little calculation scores that we do. What are we supposed to tell the general public with all these trackers that are at play where we don't have definitive data on what to do yet? Yeah, that's a great one. So this uh smartwatchbased diagnosis of atriofib was the first consumer AI uh deep learning ever uh authorized by the FDA. Um so what you bring up is a quandery because if they're symptomatic it's easy. Yes. Um but then you have to get um ideally the PDF of that from the person's watch um where you actually look is this really atrial fib right and 5 seconds that's very transient right but if it's sustained then you want to say okay are there structural reasons where if that person's in atrial fib let's say they have a valve abnormality let's say their left atrium is really enlarged are they more likely to develop a blood clot that would you go to their brain uh where
would you go to their brain uh where they would need blood thinners because really the story is if it's transient a but if it's sustained and if it's in a person who has risk for stroke right then it's a whole different matter see you have to sort out which it is often times that will require an echo cardiogram I do those you know in the clinic with a smartphone focus yeah yeah I mean who needs to send somebody for a formal echo cardiogram unless it's something you know pretty severe but not enough doctors are using smartphone um echoes or ultrasounds, but they should it's it's the modern stethoscope, right? And it's much more uh revealing. Yeah. So, that would be the thing to do is, you know, get that smartphone ultrasound echo and or get a formal echo and then sort it out, but only if it was sustained five beats. Eh, but you know, if it's gone on for many minutes, um even, you know, this could be the person doesn't experience it. Uh but uh it could be a matter that's worth uh at least looking into. It's not something to be largely ignored if it's sustained. Right. Yeah. I've had companies come to me asking to do a sponsorship on the YouTube channel and they have a new product that is sensing atrial fibrillation in the general population and they said this is a great breakthrough. But every piece of literature that I've looked at to see if screening the general population for atrial fibrillation was valuable, it was found either insufficient or perhaps not valuable. What's your take on screening the general population for aphib? Well, I wouldn't screen the general population, but I think um if you were to go there have been some more recent studies to say if you take people at higher risk uh over let's say 60 uh obesity which is a significant risk for atrial fibrillation uh heavy alcohol diabetes. Well, we have the Chad score Chad's mask too. If those people you want to look just like you were saying that's not screening anymore. I feel like that's already targeted. Yeah, there's ways that you can put, you know, two fingers on a credit card type thing and get the answer pretty quick if they're in it
answer pretty quick if they're in it that moment, right? Uh that's a type of screen that's been used like countrywide in Australia and you get like 1% of people that don't even know it and they're in chronic atrial fibrillation. Um so it is worth knowing if it's sustained. Um but there we don't really have a good approach yet to do that. Uh I I check again in every patient I see in clinic I do u a six lead cardiogram from two fingers on the left leg. I mean it's just get so much information and sometimes I find people just at that moment they didn't know it a natural fib and then we kind of sort things out but it's not something that once you find out about it that you want to uh turn your back on. The question is how deep do you want to find it? Yeah. Um, and finding it in young people is very unlikely to mean something. Finding in people of, you know, beyond a certain age where it could, and most people don't realize that weight loss is a great way, I mean, who would have guessed, right? Limiting alcohol intake. There's a lot of valuable the belly reservoir of inflammation is mediating the heart's propensity for this aryia. That was a wakeup call. And of course then you know where does the eclipse one drugs to try to reduce uh that I've put several patients on those drugs um because they weren't able to lose weight otherwise and their atrial fibrillation was something that we didn't want to have to go do an ablation but we could actually get rid of it just from lifestyle remission from those individuals. Wow. Absolutely. Yeah. I haven't seen data on that. That's cool. But yeah, I I couldn't take the uh uh sponsorship because I couldn't put out the message that a 30-year - old will need to screen themselves for API. So I I didn't want to because that's the question when they want me to market it. They don't want me to say, "Hey, this is only for this specific subgroup." Then I'm eating into their sales. So I'm telling I would be telling the audience everyone should be taking this. And I I don't think that's Well, I I admire you for that. There's not
I admire you for that. There's not enough of that. But look, Apple when they put this thing out. Yeah. Everyone, whatever age who has an Apple Watch could do this. That's bad. They did. They basically did it. Yeah. Exactly. And that's a problem. And so I have a lot of worried. Well, yeah. Because of that, you got these people with false alarms or maybe they had the five beats and this is creating a lot of unnecessary visits because they didn't say unless you have risk. They wanted everyone to use this app. And how well because if it saves one life, that's a great press story. Yeah. And they've used that they use that one person many times. Yeah. Exactly. Yeah. So, well, I guess uh that's what the future holds for us. Uh balance, being honest, transparent, and uh learning from our mistakes moving forward. Yeah, I I couldn't agree more. It's really been a joy to discuss all this with you because it's refreshing actually. Yeah, it's very exciting. Thank you for your time, Dr. Toppel. The the next time you're excited to talk about a subject in this space, we're happy to have you on once again. Oh, thanks. I'll look forward to that chance. Where would uh where would you like the audience to follow along your journey? Well, uh the I'm really happy about the super aers book if they're interested in trying to promote healthy aging. I'm on X and Blue Sky, but the main thing I do is the Substack ground truth and so every week I try to put out a newsletter and sometimes also podcasts um to um what's hot, what's exciting um and this is where I got into recently Pete Tao 217 these longevity companies that don't have really the the foundation for their claims. But sometimes, you know, it's like the mechanism of deep sleep and of how it's great for brain health. So, I try to cover things that most people aren't they're not covered in the mainstream media, high quality media, and they're really interesting. Um, often on a science level and hopefully at a level that people understand. I always could do better than that. That is to get it to the use no language that
is to get it to the use no language that someone would question. Well, that's what AI is great for. Yeah. But I try to share and again going back to our earlier discussion I if we all did that we all would get smarter quicker. Um and I'll I'll keep doing it because I just think sharing useful information um to people. I wish I I started when I was you know 50 when I was involved with the whole vio thing. I wish I'd started when I was 30 or whenever you did because you're the impact you'll have in other young people will be much more profound. Yeah. I remember even reading your work on cat cardiac kath labs over stenting people and it kind of reminds me that it feels like uh longevity clinics are now the modern-day kath labs. Yeah. They're gouging people. I had the gouging gauging and whatever gorging stance. We have that that analogy is is quite appropo. Cool. Well, thank you so much for your time, Dr. Toppel. Appreciate. Thank you. Call me Eric. One of the worst offenders in this scenario is Gary Brea. Click here for my video debunking all his claims on how he says to live longer. And as always, stay happy and healthy.
Transcript auto-generated by YouTube. Verbatim — duplicates intentionally preserved.
Dr. Eric Topol and Doctor Mike spend much of this conversation separating useful medical progress from the performance of optimization. Full-body scans, biological clocks, continuous glucose monitors, supplements, and wearables can all produce data. Data only helps when it changes care in a meaningful way.
More measurement is not automatically more health.
Predatory health content often borrows the language of science without accepting the discipline of science. It offers certainty before the evidence is ready.
A calmer approach asks better questions: Who was studied? What outcome changed? How large was the effect? What are the harms?
The conversation moves from Alzheimer’s risk and ultra-processed food to vaccines, public health, and AI. Longevity is not only an individual project. It is shaped by clinical trust, food environments, policy, and access to care.
Personal rituals matter. So does the world those rituals sit inside.
The most useful longevity guidance is rarely glamorous: eat mostly whole foods, move often, sleep, maintain connection, avoid smoking, understand your risks, and work with clinicians when decisions carry medical weight.
That is the work. Quiet, repeated, and measurable where measurement helps.
Good medicine does not make people more anxious. It helps them see clearly.
Before buying a test or tracker, ask what decision it will improve.
Be cautious with creators who offer certainty, fear, or treatment claims without strong human evidence.
Use medical care as a partnership, especially around screening, medication, and disease risk.
