Reading Super Agers (2)

At the end of my last post, I said I'd report back once I'd finished the sections on health check-ups and supplements.

This is the second set of notes.

Last time we established one thing: longevity is mostly not a genetic lottery — genes explain only 25–30%, while lifestyle and environment account for 70–75%.

Which raises the question: what kind of lifestyle actually extends healthy lifespan?

In this part of the book, Topol re-examines three things one by one: eating, moving, and screening.

Some of the conclusions are very different from what we assume.

Here goes — enjoy:

1. There is no universal perfect diet

Let's start with eating.

Van Tulleken's experiment proved the harm of an unhealthy diet. So, flipping it around, if you eat by a "healthy menu," will you live longer?

Topol cites a paper in the top journal Cell. Scientists at Israel's Weizmann Institute of Science recruited 800 ordinary people without diabetes and fitted each of them with a continuous glucose monitor, recording their blood sugar fluctuations around the clock as they went about their daily lives.

They logged every one of the more than 52,000 meals these 800 people ate. They drew blood, measured waists and hips, and even collected stool samples to sequence the genes of every microbe in each person's gut.

Then came the conclusion.

When these 800 people ate exactly the same food — the same slice of whole-wheat bread, the same banana —

their blood sugar responses were worlds apart.

For some, that "healthy" slice of whole-wheat bread sent their blood sugar soaring;

others ate ice cream, supposedly off-limits, and their glucose curve stayed perfectly calm.

If it isn't the food itself that determines the blood sugar response, then what is?

The scientists put more than a hundred variables into an algorithmic model, and the factor that came out on top, with absolute dominance, was —

the gut microbiome. The trillions of invisible bacteria in your belly.

Topol's metaphor is a lovely one: the gut isn't a simple digestive funnel; it's more like a complex trading market. The food you eat is just raw material. How much nutrition and how much sugar ultimately reach your bloodstream depends on the "traders" inside you — the makeup, metabolism and responses of your gut flora at that moment.

This is the emerging field of "personalised nutrition":

there is no universal perfect diet, only the perfect match for you.

2. Not even genes can give a standard answer

As soon as this conclusion came out, people objected: what if it's genetics? What if I was just born with a better metabolism?

It really isn't.

In 2020, King's College London led a cohort study called PREDICT 1, with more than a thousand people — and crucially, a large number of them were identical twins.

Identical twins are the perfect control group for studying genetic influence: bodies cast from the same mould, exactly the same hardware. If genes truly determined how we respond to food, then when twins ate the same plate of pasta, their glucose curves should overlap perfectly.

The result: even with 100% identical DNA, the two people's blood sugar trajectories were still wildly different.

Beyond the gut microbiome, PREDICT 1 found another key factor — how you eat.

The time of the meal, the order in which you eat things, the state you're in before and after.

Vegetables first, then meat, then rice last; versus a bowl of rice on an empty stomach first, then everything else —

you think it's more or less the same, but to your metabolic system, these are two completely different scripts.

Meal timing and order, layered on top of your one-of-a-kind microbiome, have an overwhelming effect on metabolism.

We are always searching for a universal formula, a plan that works for all of humanity.

But the body — or life itself — is precisely the thing that most refuses to be standardised.

Topol's advice is practical: under the guidance of a health professional, wear a continuous glucose monitor and test how each food, and each way of eating it, affects you.

The answer isn't in a recipe book; it's in you.

3. When it comes to exercise, we may all have it wrong

After eating, moving.

When we think of exercise, we think of jogging, swimming, cardio — and that's always the standard script doctors give their patients.

And strength training? Many people think that's something young people do in the gym while taking selfies in the mirror.

Topol admits he thought so too at first, until a set of numbers changed his mind:

Human muscle mass and strength begin to decline at around age fifty. Between sixty and ninety, men quietly lose about 33% of their muscle mass, and women about 26%.

What does muscle loss mean?

It means stooping and hunching; it means back pain and arthritis come knocking; it means that even stepping down a single stair, you might lose your balance and fall and break something.

After seeing these numbers, this towering figure in cardiology, in his seventies, dutifully started doing resistance and strength training four to five times a week, twenty to thirty minutes each time.

In his own words:

"If I'm destined to get old, I'd rather be a strong old man."

4. Strength training doesn't need a gym

When many people hear "resistance training," they picture intimidating barbells.

It really isn't that. It doesn't even require spending a penny on a gym membership.

All you need is to learn to work with gravity using your own body:

push-ups, pull-ups, sit-ups, squats, lunges;

or a resistance band that costs a few dozen yuan, a pair of small dumbbells at home.

As long as it works the muscles in your arms, chest, abs, legs, glutes and back, that's enough.

There are two numbers in the book worth copying down:

First, the wall sit. Back against the wall, thighs parallel to the floor, three times a week, eight minutes each time — its effect on lowering blood pressure is comparable to aerobic exercise, even high-intensity interval training. Eight minutes is probably the cheapest blood-pressure medicine in the world, and it has no side effects.

Second, sixty minutes of resistance training a week in total — about the time it takes to binge a few episodes of a short drama — lowers all-cause mortality by about 25%.

Clinically, that's a very big number.

5. Started at seventy, a champion at ninety-three

You might be thinking: at my age, is it too late to start?

There's a man in the book called Richard Morgan.

For the first seventy years of his life, he had almost nothing to do with "exercise." In his seventies, for the first time in his life, he sat down at a rowing machine in an old shed in his backyard.

After that, he rowed an average of forty minutes a day, paired with a high-protein diet and strength training twice a week without fail — dumbbells, lunges, curls.

At ninety-three, he won four world championships in indoor rowing.

The total distance he has rowed over the years is the equivalent of ten times around the Earth.

Morgan's granddaughter happened to be a researcher in the physiology lab at the University of Limerick in Ireland. The scientists invited the old man into the lab and gave him a thorough full-body examination:

of the mass on his body, 80% was muscle and 15% fat;

his maximal oxygen uptake was on par with a young person's;

his peak heart rate during exercise was 153 beats per minute — equivalent to a healthy fifty-year-old.

A man who only started exercising at seventy had rowed his body back forty years.

It's never too late to start.

6. The truth about check-ups: screening is stuck in the 1960s

Now for check-ups — the question left over from last time.

Regular check-ups, early detection, early treatment — surely that can't be wrong?

Topol's verdict is blunt: our current cancer screening strategy is "still stuck in the 1960s."

For a long time, for the five major cancers — breast, colorectal, lung, cervical and prostate — the medical establishment's only screening criterion has been age: for example, start colonoscopies or mammograms at 50.

This crude strategy has three consequences:

First, it's extremely ineffective. In the United States, mass screening detects only 14% of cancers, yet costs more than US$40 billion a year.

Second, false positives and overtreatment. Take mammograms for breast cancer: over a ten-year screening cycle, about half of women will get a "false positive" — even though 88% of them will never develop breast cancer in their lifetime. Worse, one in seven women aged 50 to 74 has been "overdiagnosed": tiny lesions that would never have threatened their lives are found and treated, putting healthy people through surgery and chemotherapy they didn't need.

Third, it misses young people. In recent years, the incidence of colon cancer and other malignancies among people in their twenties and thirties has surged, and one-size-fits-all screening built on a 50-year threshold doesn't reach them at all — by the time they're diagnosed, it's often already late-stage.

So what do we do?

Topol says future screening must abandon "age determinism" and turn to technologies such as AI and genetic assessment to pinpoint each person's disease risk.

A study of a Finnish genetic database covering 450,000 people showed that, using polygenic risk scores, those in the top 1% of risk should begin colorectal cancer screening at 49, while the lowest-risk 20% could safely wait until 67.

There's nothing wrong with check-ups themselves.

What's wrong is measuring everyone with the same ruler.

7. Further out: reprogramming cells, and AI that can hear ageing

At the end of this part, Topol looks further ahead.

The first is cellular reprogramming. Shinya Yamanaka, winner of the 2012 Nobel Prize in Physiology or Medicine, discovered that activating four specific transcription factors can turn adult cells back to a younger state, erasing the marks of ageing that the years leave behind. The technique has already been validated in primates — after precise cellular editing in crab-eating macaques, the biological age of some tissues fell by 5 to 7 years.

But Topol also offers a warning: the technology is far from mature, and the slightest misstep in reprogramming cells could trigger cancer. How to find the precise balance point between "turning back the clock" and "cells running out of control" remains the core unsolved problem in the field.

The second is AI. Topol says there is a decades-long "silent window" between us and disease — heart disease, cancer and Alzheimer's often take more than 20 years of slow accumulation before they strike. All that time, the body is quietly sending out signals; we just haven't had tools sensitive enough to catch them.

AI is the first technology truly capable of hearing those signals.

For example, a trained AI model can analyse the features of a person's voice — not what they say, but how they say it: whether their speech has slowed, whether the rhythm of their pauses is unusual, whether subtle slips have crept into their word choice.

These changes are imperceptible to the naked eye.

But AI can raise a warning six years before the symptoms of Alzheimer's actually appear.

The body has always been talking; we just couldn't hear it before.

Still, Topol doesn't land on these new technologies.

He says that rather than pinning our hopes on technology that isn't mature yet, we'd do better to look to ourselves — and improve our healthy lifespan in lower-barrier ways. He calls this "Lifestyle+."

So what's the "+"?

Popular health advice has always been about diet, exercise and sleep. Topol says that isn't enough — social factors have to be added.

Be social, not lonely.

A long-term health tracking study of 2.2 million people showed that loneliness raises the risk of premature death from all causes by 32%, cardiovascular death by 34%, and cancer death by 24%.

And "social isolation" — a lack of social contact — raises the risk of premature death almost as much as smoking, obesity and physical inactivity, and increases the risk of dementia by 50%.

These numbers line up, quietly, with what the Wellderly project found in my last post:

those 1,400 super-healthy older people were almost all optimistic and sociable — bridge, dancing, volunteering, still needed by life in their nineties.

So it wasn't that they were lively because they were healthy.

Quite possibly, they were healthy because they were lively.

Final Thoughts

These notes boil down to four lines:

Eat: there is no universal perfect diet. The answer isn't in a recipe; it's in your microbiome, how you eat, and how your body responds;
Move: beyond cardio, take strength seriously. Sixty minutes of resistance training a week lowers all-cause mortality by about 25% — and starting at seventy is not too late;
Screen: more check-ups aren't necessarily better. One-size-fits-all screening by age is outdated; the future belongs to precise screening tailored to individual risk;
Connect: the harm of loneliness is on par with smoking. Good friends rival the very best longevity drug.

Having written all this, I realise that what this book really wants to say may come down to one sentence:

Longevity isn't a secret waiting to be discovered; it's a daily practice.

As for the truth about supplements, that's further on in the book.

I'll report back once I've finished it.

To be continued.