Super Agers is a detailed guide to a revolution transforming human longevity. This is a breakthrough moment in the history of human health care. The person making that bold claim is one of the most respected medical researchers in the world, Eric Topol.

Dr. Topol’s unprecedented, evidenced-based guide is about how you and your family and friends can benefit from new treatments coming available at a faster rate than ever. From his unique position as a leader overseeing millions in research funding, Dr. Topol also explains the fundamental reasons—from semaglutides to AI—that we can be confident these breakthroughs will continue. Ninety-five percent of Americans over sixty have at least one chronic disease and almost as many have two. That is the essential problem this revolution is solving. He explains the power of the new approaches to the worst chronic killers—diabetes/obesity, heart disease, cancer, and neurodegeneration—and how treatments can begin long before middle age, and even long after. In thirty years, we will have five times as many people at least one hundred years old and they will be healthier than ever because of the breakthroughs Dr. Topol describes.

Super Agers Book Review

Although the official description of this book mentions “guide” twice, it turns to be more of a guide through the science of longevity, bordering on a reference book, rather than a guide to attaining personal longevity. You could find the information to do that, but it is buried deep in the detail. For example, after a quick introduction to lifestyle impacts there are only a couple of pages about supplements – probably because there isn’t enough evidence about most supplements, so they don’t make it into the book.

Having said that, there’s still plenty of interesting content in Super Agers. Topol provides a comprehensive chapter on GLP-1 agonists (which he views positively) including a brief history of weightloss drugs. But as with most of the topics covered, it then gets a bit too detailed for me, with a long list of drugs and conditions involved – unlikely to be helpful at a personal level, but then maybe that’s because biology is complicated and people should be getting personal advise from a clinician, not a book.

The longevity science is interwoven with some intriguing history of medicine (I found the section on covid vaccine history particularly fascinating) and his personal experiences, though as mentioned above, often going into too much detail for popular science readers. For me, I found the key points were often covered in a chapter’s introductory paragraphs and then I could skim read the more technical information after that.

In summary, if you’re after a how to live a healthy life book then there a better options, but if you really want to understand the science behind the headlines then this could be for you.

Here are 100 key points from Super Agers:

• Doctors can’t promise to reverse or halt aging itself, but we can promise the second half of our lives can be much healthier than our forebears’.
• All five dimensions interact with one another: lifestyle+, cells, omics, artificial intelligence, drugs/vaccines.
• Our multiyear study failed to demystify the role of our DNA in attaining the most long-lived health span.
• In the United States, 60 percent of adults have at least one chronic disease, and 40 percent have two or more.
• Preventing or markedly delaying age-related diseases, thereby extending health span, is what this book is (nearly all) about.
• All inflammation is generated by our immune system.
• Dysfunctionality in our immune response is a principal driver of accelerated aging.
• Surely expanding the human health span is as worthwhile as halting the growth of one killer virus?
• Many more healthy years can be added to our lives without fancy, expensive technology.
• A poor diet is linked to 22 percent of all deaths.
• The evidence remains thin for what constitutes the best healthy diet, no less the presumption that it should be the same for all people.
• Overeating of ultra-processed food likely involves the disruption of gut-brain signals that unprocessed food conveys to the brain.
• A 62 percent increase in all-cause mortality is linked to more than four servings per day of UPF.
• Overall, the data for artificial sweeteners is unfavorable, although it is not nearly as worrisome as high sugar consumption.
• The evidence suggests that for older adults, 51 higher protein intake is needed, but the optimal amount is unknown.
• Perhaps the best summary from the mixed data is that light alcohol intake is not a problem, but the risks quickly increase.
• Taurine deficiency has been associated with diabetes, hypertension, liver disease, abdominal obesity, and inflammation.
• More than half of our gut microbiome flora rhythmically fluctuates throughout the day-night cycle.
• Studies highlighted the gut microbiome as a dominant contributor for our unique response to food.
• Globally, the proportion of adults with inadequate physical activity has been pegged at 27.5 percent.
• There’s no age limit that precludes getting in shape to counter age effects.
• The loss of one hour of sleep from daylight savings time in Germany and the United States was associated with a significant rise in heart attacks in both countries for four days.
• Sleep apnea is associated with a twofold or greater risk of cardiovascular and metabolic diseases.
• No safe threshold has been identified for chronic effect of PM2.5 on cardiovascular health.
• In response to exposure to microplastics, cancer cells spread at an accelerated rate.
• The marked rise of various cancers in younger adults in recent years may be attributable to environmental factors.
• Systematically reviewed, which included over 2.2 million people, demonstrated an association between loneliness and a 32 percent increased all-cause mortality.
• Socioeconomic status determines one’s likelihood of good health as much as cigarette smoking.
• When we eat sugar, insulin levels go much higher than if sugar is injected into our bloodstream.
• Even though the GLP-1 family of drugs is having such pronounced effect on weight loss now, we don’t fully understand why.
• The inflammation that is associated with white adipose tissue occurs throughout the body.
• Nearly one in ten have nearly double the genetic risk of type 2 diabetes.
• Only 7 percent of Americans fulfill the definition of being metabolically healthy.
• 80 to 90 percent of heart disease can be prevented by attention to the lifestyle + factors.
• People with autoimmune diseases have a considerably higher risk of developing heart disease.
• Gut microbiome analysis of fourteen hundred participants revealed specific bacteria species that metabolize cholesterol and lower its blood level.
• About 20 percent of people who have a normal LDL cholesterol will have a high apoB, denoting risk of cardiovascular disease.
• Mutations accumulate in our cells at a rate of fifteen to fifty per cell each year.
• Approximately 25 percent of cancers are preceded by chronic inflammation at the site of the tumor origin.
• Metastasis is what kills more than 90 percent of those who die from cancer.
• Cancer detection is not equivalent to favorably altering outcomes.
• Our current cancer immunotherapy approaches are helping but are all too often insufficient to achieve durable success.
• The gut microbiome constituents have a substantial influence on the success of cancer immunotherapy.
• In over nineteen thousand participants in a randomized trial of low-dose aspirin (100 mg) or placebo with five-year follow-up, there was a significant excess of all-cause deaths.
• In neurodegenerative diseases, the brain’s immune cell system plays a major role.
• Gene therapy directed at removing APOE4 is already being tested in Alzheimer's patients.
• After seven hours, more sleep is associated with more risk of Alzheimer's.
• There are no validated disease-modifying treatments that stop or delay Parkinson's progression.
• We’re making major headway for identifying specific factors from the young in experimental models, which may ultimately lead to clinical trials in older people to preserve cognitive function.
• Our current approaches to curing rare diseases will play an increasing role in managing common diseases.
• The vast majority of rare diseases, more than 80 percent, have a genetic basis.
• Eventually it will be possible for the gene-edited brain to self-edit unfavorable alleles like APOE4.
• RNA editing has several advantages because it doesn’t change proteins, the effect is short-lived.
• The term gene tuning has been applied because, like adjusting dial settings on a soundboard, epigenome marks can be modified to harmonize the expression of multiple genes at once, not just turn them on or off.
• Engineering the gut microbiome has enormous potential for modulating our immune response and inflammation throughout the body.
• There are nearly one hundred disease-causing mtDNA mutations that are maternally inherited, affecting about one in five thousand individuals.
• My team at Scripps Research and those at several other academic centers have offered whole genome sequencing as a way to unravel the diagnosis when the patient has a serious and chronic unknown condition.
• About eighty different autoimmune diseases affect more than 10 percent of the population.
• Obesity is a known risk factor for several autoimmune diseases.
• It is likely that most autoimmune conditions arise from two factors: genetic susceptibility, and a second hit, such as a viral infection.
• The gut-associated lymphoid tissue (GALT) is considered the largest immune organ in the body.
• Given the central disease-causing role109 of CD4 + T cells specific for gluten, multiple companies are in clinical trials with modified gluten proteins as antigen-specific therapy.
• We’ll someday be able to rejuvenate our immune cells to prevent immunosenescence and inflammaging.
• There is intensive effort by several companies pursuing a far better universal flu vaccine in ongoing clinical trials.
• The HIV virus’s genome mutates at the highest rate known to science.
• Establishing Epstein-Barr as the most common cause of MS prompted initiatives to develop a vaccine.
• Estimates for annual deaths from microbial resistance exceed five million.
• The potential for bacteriophages to aid the fight against drug-resistant bacteria is promising.
• Social challenge to our political culture may prove to be our greatest challenge in continuing to add to life expectancy.
• A key mechanism that has been raised for the benefit of time in nature, and promotion of well-being, is activation of the olfactory pathway.
• I’ve begun prescribing nature walks and visits to my patients.
• After a good night’s sleep, exercise performance is enhanced, glucose regulation is improved, and mood is uplifted.
• The proportion of one-person households around the world has markedly increased.
• Social isolation is associated with a significant risk of premature death of similar magnitude to that of smoking.
• Human touch appears to be consistently therapeutic.
• The results from 145 randomized trials of mobile phone apps for mental health with nearly forty-eight thousand participants did not provide any strong evidence of benefit.
• A longer lifespan gives more chance for all the diseases of biological aging to manifest.
• Telomerase verse transcriptase activator compound is encouraging because it promoted telomere synthesis, blunted tissue aging hallmarks, and reduced brain inflammation.
• Garbage removal is one of the cells’ most vital and elaborate functions.
• Many compounds activate autophagy.
• Muscle tissue sends out six hundred molecular signals.
• More extensive and durable chronic inflammation has been linked to promoting cancer as well as neurodegenerative, cardiovascular, and metabolic diseases.
• The DunedinPACE clock was derived from DNA methylation and nineteen biomarkers in blood for determining pace of aging.
• For lifespan, genetics appeared to contribute about 20 percent, and a favorable lifestyle had an independent pronounced effect.
• Intermittent fasting practices discussed in chapter 3 have not provided support for antiaging impact but have shown improvement in the immune response.
• A high-fat or ketogenic diet, particularly on a long-term basis, has been linked to accelerated aging in mice and humans, reflected by increased cellular senescence.
• While there are no dietary supplements that have been shown to promote health span, there is one good candidate— taurine.
• Exercise is the only well-validated intervention to reset biological age in humans.
• The prize many of us have in mind is actually reversing any functional declines.
• Proprietary plasma factors are being tested in clinical trials for Parkinson’s disease with cognitive impairment and mild to moderate Alzheimer’s disease.
• There are many ongoing early phase (1/2) clinical trials and programs testing senolytics.
• When an old mouse receives a transplanted ovary from a young mouse, her lifespan is expanded.
• An exhaustive review of all the literature on rapamycin showed lack of evidence of an effect for many age-related issues.
• “Silent” is a better way to think of the role of the sirtuin family in modulating much less reversing the aging process.
• Reversing fibrosis, the untoward organ scarring that can develop with aging, is being pursued in clinical trials.
• We should assume that expanding health span or slowing aging simply defers morbidity rather than compresses it.
• We’re on the path to making biology programmable.
• Until now, our medical approach has been reactive, with secondary prevention at best.
• If expanding health span turns out to be only for the rich and privileged, then it can be considered an abject failure.
• We will inevitably see suppression of age-related diseases that for many is unimaginable right now.