8/17/2026

This is the fourth piece in my series about Eric Topol's book, Super Agers: An Evidence-Based Approach to Longevity.

There is so much to talk about in this book. In this chapter, Topol takes a close look at some of the most basic components of our diet: sweeteners, salt, carbohydrates, protein, and fat.

What I find particularly interesting is that he doesn't simply label one nutrient “good” and another “bad.” Again and again, he emphasizes that the amount matters, but so does the type and quality of what we consume.

Sweeteners

The evidence linking sugar-sweetened beverages to poor health outcomes is particularly consistent. Topol cites studies associating high consumption with higher all-cause mortality, cardiovascular mortality, cancer mortality, increased atrial fibrillation, and dental disease.

One reason is obvious: sugary drinks can deliver a large amount of rapidly absorbed sugar without making us feel particularly full.

Topol is much more cautious about artificial and non-nutritive sweeteners. The evidence is mixed. Some studies have found little compelling evidence of harm, while others suggest that certain sweeteners may affect glucose regulation or alter the gut microbiome.

His overall conclusion is that artificial sweeteners appear less concerning than large amounts of sugar, but they should not automatically be regarded as completely harmless.

For ordinary people, the practical advice is simple:

Best choices: water, unsweetened tea, unsweetened coffee, and whole fruit.

Occasionally having a sweetened drink is one thing, but don't make it a regular part of your life.

Perhaps the deeper lesson is to gradually train ourselves to need less sweetness altogether.

Salt

Topol's discussion of salt is more nuanced than simply saying, “The less, the better.”

1. Too much sodium is a problem.

The relationship between high sodium intake and hypertension is well established, although the size of the effect varies considerably from person to person.

2. Don't blindly pursue “the lower, the better.”

Different health organizations recommend somewhat different sodium limits, and the evidence doesn't support the idea that reducing sodium indefinitely will produce proportionally greater benefits.

Topol notes that moderate sodium intake is not necessarily a problem, while very high intake is much more clearly associated with cardiovascular risk.

3. Sodium may affect more than blood pressure.

Topol also discusses evidence that excessive sodium may impair blood flow to the brain through dysfunction of the blood-vessel lining, potentially affecting cognitive health.

4. Moderation is more realistic than a miserable diet.

His practical suggestions include:

• Don't routinely add salt to food.

• Pay attention to sodium on food labels.

• If you have hypertension, be particularly careful about sodium.

• If you don't have kidney disease, consider a potassium-chloride salt substitute.

• Don't turn healthy eating into an intolerable, flavorless diet.

In other words, the goal is sensible reduction, not eliminating salt from your life.

Carbohydrates

Topol introduces the term “carbotoxicity” to describe the potential harms associated with excessive carbohydrate consumption.

His message is both very low carbohydrate intake—less than about 40% of total calories—and very high intake—more than about 70%—have been associated with increased all-cause mortality.

The more important question is:

What kind of carbohydrates are you eating?

Good carbohydrates

Topol gives priority to:

• non-starchy vegetables

• legumes

• fruits

• whole grains

• resistant starch

• other high-fiber, minimally processed foods

He cites a large body of research involving 185 prospective studies and 58 randomized trials showing that consuming roughly 25–30 grams of dietary fiber per day was associated with substantially lower risks of cardiovascular disease, type 2 diabetes, colorectal cancer, and all-cause mortality.

Poor-quality carbohydrates

These include:

• added sugars

• refined grains

• rapidly digested starches

• highly processed potato products

• foods with a high glycemic load

These foods can cause rapid rises in blood glucose and insulin and are associated with weight gain and poorer cardiovascular outcomes.

So once again, the message:

“Eat better carbs.”

Protein

The standard protein RDA of 0.8 grams per kilogram of body weight per day may not adequately reflect the needs of seniors. Much of the evidence behind that recommendation came from relatively short-term studies involving younger adults.

Because sarcopenia—the age-related loss of muscle mass and strength—is one of the major threats to healthspan.

Topol argues that older adults probably need more protein than the basic RDA, although the optimal amount remains uncertain. He considers increasing intake to around 1.2 g/kg/day reasonable.

But he also warns against assuming that more protein is always better.

Very high protein intake—particularly above about 1.5 g/kg/day—has been associated in some research with potentially unfavorable effects, including changes in the gut microbiome and production of pro-inflammatory metabolites. He also discusses concerns about leucine-rich animal proteins and pathways related to atherosclerosis and cellular waste disposal.

However, this is an area where Topol acknowledges significant uncertainty.

We don't yet have the kind of long-term, large-scale randomized trials that could definitively tell us exactly how much protein older adults should consume to maximize healthspan and prevent sarcopenia.

There's another interesting limitation: food labels don't tell us how much of each essential amino acid a food contains. So consumers can't easily compare foods based on amino acids such as leucine, lysine, or methionine.

The practical message I take from this section is:

Older adults should pay attention to getting enough protein to preserve muscle, but don't assume that an extremely high-protein diet is automatically healthier.

Fat

Fat is another example of why nutrition isn't as simple as “avoid fat.”

Topol explains that fat activates a gut-brain reward pathway involving the vagus nerve. This pathway can work together with the brain's sugar-reward pathway to increase dopamine signaling and encourage overeating.

That helps explain why combinations of fat + sugar can be so difficult to resist.

These foods combine multiple powerful reward signals while packing a lot of calories into a relatively small amount of food:

• ice cream

• pastries

• donuts

• cookies

• chocolate

• many packaged desserts

Fat quality matters

Topol also emphasizes that the type of fat matters.

Replacing saturated fats with mono- and polyunsaturated fats, particularly plant-based unsaturated fats, has been associated with more favorable cardiovascular and metabolic outcomes.

This is another reason not to think simply in terms of “high-fat” versus “low-fat.”

A handful of nuts, olive oil, or avocado is very different from a highly processed food loaded with saturated fat.

What about the ketogenic diet?

Topol is skeptical of the popular ketogenic diet, which is extremely high in fat and very low in carbohydrates.

He cites research associating ketogenic diets with potential problems including:

• higher cholesterol

• cardiovascular risk

• “keto flu”

• brain fog

• fatty liver

He also discusses a randomized NIH study comparing a ketogenic diet with a plant-based, low-fat diet. Interestingly, participants on the ketogenic diet consumed about 700 more calories per day during the two-week study, and the low-fat group lost more weight.

That finding challenges the idea that simply lowering carbohydrates and insulin will necessarily reduce hunger and food intake.

So what is the big picture?

I think Topol's message can be summarized in one sentence:

On carbohydrates, protein, or fat; pay attention to their quality, their source, and the amount you consume.

All three macronutrients are necessary. They can also contribute to health problems when consumed in inappropriate forms or excessive amounts.

In summary:

Carbohydrates: choose fiber-rich, minimally processed sources.

Protein: get enough to preserve muscle as you age, but don't assume extremely high intake is better.

Fat: favor unsaturated fats and pay attention to the powerful combination of fat and sugar in highly palatable foods.

Sugar: particularly avoid making sugary beverages a regular habit.

Salt: reduce excessive intake without turning healthy eating into an unsustainable low-sodium diet.

8/16/2026

This is the third piece in my series about Eric Topol's book, Super Agers: An Evidence-Based Approach to Longevity.

Ultra-Processed Foods (UPFs)

One topic in the book that caught my attention is ultra-processed foods, or UPFs.

In simple terms, these are industrially formulated food products made from processed ingredients and additives rather than primarily from whole foods. They often contain combinations of added sugars, refined fats, sodium, artificial flavors and colors, emulsifiers, and other additives. Many are designed to be inexpensive, convenient, shelf-stable, and extremely palatable.

Common examples include:

• sodas and energy drinks

• packaged chips, cookies, and candy

• mass-produced packaged breads and buns

• frozen ready-to-heat meals, such as pizza and TV dinners

• reconstituted meat products, such as hot dogs, fish sticks, and chicken nuggets

• sweetened breakfast cereals

In Chinese, people might loosely put some of these foods under terms such as 零食、预制食品 or 垃圾食品, although these terms are not exact equivalents of “ultra-processed foods.”

What does the research show?

Topol cites a randomized controlled trial in which participants who followed an ultra-processed-food diet gained weight, while those who ate an unprocessed diet lost weight, despite the diets being matched in the amount of calories, sugar, fat, fiber, and other nutrients that were offered.

He also cites research associating higher UPF consumption with a range of health problems, including fatty liver disease, some cancers, sleep disorders, inflammatory bowel disease, depression, and dementia.

One statistic particularly caught my attention:

A 62% increase in all-cause mortality was associated with consuming more than four servings of UPF per day.

Topol says this finding was supported by a comprehensive review of 45 studies involving approximately 75,000 women and 40,000 men followed for up to 30 years.

But perhaps the most fascinating part of the chapter is a personal experiment conducted by Topol's friend, Chris van Tulleken, a British physician-scientist and author of Ultra-Processed People.

One month on an 80% UPF diet

Van Tulleken conducted an experiment on himself. He increased the proportion of ultra-processed foods in his diet from about 20% to 80% for one month, while undergoing extensive assessments before and after the experiment, including blood tests and brain imaging.

The result was shocking: 

He gained 15 pounds in one month.

He also reported major changes in brain connectivity involving regions associated with habitual behavior, reward, and appetite.

His hunger-related hormonal responses changed dramatically as well. According to Topol, one of his appetite-related measures showed a fivefold increase, while his C-reactive protein, a marker associated with systemic inflammation, doubled.

But there was another fascinating twist.

Chris and his identical twin brother, Xand, had both undergone whole-genome sequencing, and their genetic profiles included many variants associated with a predisposition to obesity.

So one might expect the two brothers to respond similarly to the same diet. They didn't.

When Xand conducted the same ultra-processed-food experiment, he gained 44 pounds—nearly three times as much as Chris.

According to Topol, this was the largest weight difference observed in the extensive twin study in the United Kingdom.

Once again, it's not all in the genes

This brings me back to one of the most interesting themes in Super Agers.

Genes matter. But they don't determine everything.

The two brothers had essentially the same genetic background, yet their responses to the same diet were dramatically different.

And this is also consistent with what Topol found in the Wellderly research we discussed in my first piece: exceptional healthy aging cannot be explained simply by having the right genes.

There are clearly complex interactions among genes, diet, environment, behavior, metabolism, and many other factors.

So what should we do?

Topol's practical advice is straightforward:

Read the labels.

When choosing packaged foods, look at the ingredient list. When there is a choice, favor products with fewer ingredients and fewer unnecessary additives, and be particularly cautious about products loaded with added sugars and highly refined ingredients.

He suggests using the Open Food Facts app when you're uncertain about a product. It provides nutritional and ingredient information for millions of food products, Open Food Facts

I find this particularly useful because the most practical lesson isn't necessarily:

“Never eat processed food.”

It's: Know what you're eating.

Will UPFs eventually be treated like cigarettes?

Topol makes a provocative prediction:

Ultra-processed foods may eventually come to be regarded much like cigarettes.

The evidence concerning UPFs is compelling enough to take seriously, but it is not identical to the decades of evidence establishing the enormous harms of tobacco.

My takeaways

1. Eat more food that looks like food. Eat less food that looks like a chemistry experiment.

2. "Fiber is the polar opposite of ultra-processed foods—it slows digestion, lessens glucose spikes, and helps reduce cholesterol."

Finally, eat less of the foods that were designed NOT with your health as their primary purpose.

8/15/2026

I'm going to continue yesterday's sharing from Eric Topol's book, Super Agers: An Evidence-Based Approach to Longevity.

Topol coins two interesting terms in the book. He calls the small group of exceptionally healthy older people the “Wellderly”—healthy-aging outliers—and contrasts them with the much larger group he calls the “Illderly,” people whose later years are increasingly affected by chronic disease.

Here are some numbers that put the situation into perspective:

1. In the United States, 60% of adults aged 18 and older have at least one chronic disease.

2. 40% have two or more chronic diseases.

3. Among people aged 65 and older, 80% have two or more chronic diseases, 23% have three or more, and about 7% have five or more.

As Topol puts it:

“If you or someone you know has a chronic condition, it is probably one of the big four: diabetes, heart disease, cancer, or some kind of neurodegeneration. Beyond these, chronic lung and kidney disease are high on the list.”

This, he says, is what his book is ultimately about: how we can maximize our healthspan and stay on the Wellderly path rather than moving toward the Illderly path.

Why the immune system?

When Topol turns to age-related diseases, I was somewhat surprised that he began with the immune system.

But his explanation is fascinating.

He writes:

“The recognition of the immune system as a common mechanistic underpinning for chronic diseases, whether it be related to why they occur or to the untoward sequelae that they induce, is a historic turning point.”

In other words, the immune system plays a central role in many of the diseases associated with aging.

Heart disease, cancer, and neurodegenerative diseases often take decades to develop. That means there may be a very long window during which we can potentially intervene before they become clinically apparent.

Take atherosclerosis, which can eventually lead to heart attacks and strokes. It remains the world's leading cause of death and disability. A major component of the process is inflammation in the walls of blood vessels—and inflammation is generated by the immune system.

Cancer provides another example. Cancer doesn't usually become deadly simply because a tumor exists; the danger often comes when cancer cells spread to other parts of the body. Our immune system plays an important role in recognizing and controlling abnormal cells.

The Brain is another example. Increasing evidence points to the role of chronic inflammation and immune-system activity in neurodegenerative diseases such as Alzheimer's and Parkinson's disease.

And when the immune system mistakenly attacks our own tissues, we get autoimmune diseases—for example, attacking the nervous system in multiple sclerosis or the joints in rheumatoid arthritis.

Topol therefore makes a much broader argument:

Dysfunction of the immune response is one of the principal drivers of accelerated aging.

This is where things get particularly interesting.

The answer isn't simply to “boost” the immune system. An immune system that is too weak can leave us vulnerable to infection and disease, but an immune system that is excessively or chronically activated can also damage our own tissues.

Topol compares it to a Goldilocks problem:

Too little isn't good. Too much is bad. We need to get it just right.

And perhaps the most important part is that the right balance may be different for different people and different tissues.

Only relatively recently have scientists begun developing tools to precisely modulate immune and inflammatory responses. According to Topol, this is an area where the science is advancing rapidly.

Which brings me to the question I'm most interested in:

If healthy aging depends partly on keeping our immune response “just right,” how do we actually do that?

That may be where the story gets really interesting.

8/14/2026

I recently borrowed an e-book from our library, Super Agers: An Evidence-Based Approach to Longevity by Eric Topol, a New York Times bestseller.

The book draws on a wide range of research on aging and healthspan. One study described in Chapter 2, “It’s in Your Genes?”, caught my attention.

It was the Wellderly research project, which began in 2008 at Scripps Research.

The researchers wanted to understand why some people remain remarkably healthy well into old age. Topol describes the study participants this way:

“People who were at least 80 years old and had never been sick or had a chronic illness.”

It took the researchers almost six years to identify about 1,400 people who met this unusually strict definition of healthy aging and agreed to participate. The participants provided blood samples so that researchers could sequence and analyze their entire genomes—roughly three billion letters of DNA.

The researchers had an obvious hypothesis: perhaps these exceptionally healthy older people possessed special genes that protected them from the diseases associated with aging.

They were wrong.

Topol writes:

“Despite the arduous and expensive task of sequencing and interpreting whole genomes several years ago, there wasn't much in their DNA to illuminate the basis for healthy aging.”

Their genetic risk markers for Alzheimer's disease and heart disease were only marginally better than those of the general population.

What stood out instead were their lifestyles and characteristics.

The Wellderly participants had an average age of about 84. Compared with the general population of older Americans, they were almost 30 pounds lighter, exercised more, and had more education.

They were also remarkably socially active and optimistic.

The research nurse who interviewed them found them to be unusually upbeat. Many belonged to bridge clubs, participated in dancing, maintained active circles of friends, or volunteered in their communities. Some participants were still so active well into their nineties that it was difficult to find a convenient time to schedule an appointment with them.

And there was an amusing contradiction: some were still smoking cigarettes—in some cases, as many as two packs a day.

In other words, these people weren't following some perfect longevity formula.

After years of studying them, the researchers had failed to find a simple genetic explanation for their exceptional healthspan. But that failure itself was revealing.

As Topol puts it:

“While our multiyear study failed to demystify the role of our DNA in attaining the most long-lived health span, it opened our minds to other factors.”

Topol estimates that genetics accounts for roughly 25–30% of lifespan outcomes, with lifestyle and environmental factors accounting for much of the rest.

The important distinction here is between lifespan and healthspan.

Lifespan is simply how long you live.

Healthspan is how many of those years you live in good health, without significant disease or disability.

And that distinction is important.

The Wellderly study challenge the idea that exceptional aging is simply a matter of winning the genetic lottery.

The most striking lesson for me is this: favorable genes may give you an advantage, but your genes don't necessarily determine how well you age. There are a lot more within our control than we thought.

And that is encouraging.

To be continued...

8/13/2026

Today I heard the news about the Beijing–Ulaanbaatar C919 flight on August 12, 2026. It is being described as a genuine milestone for China's homegrown passenger aircraft.

The C919 entered domestic commercial service in 2023. Since then, it has expanded its operations within China and has also flown to Hong Kong. But August 12 marks another important threshold: the C919 is beginning scheduled international passenger service, with Air China operating a daily round trip between Beijing and Ulaanbaatar.

This is an important step in China's attempt to break into a market that has long been dominated by the Boeing–Airbus duopoly.

But we should keep things in perspective. The C919 flying to Mongolia does not mean that China has become a global competitor on equal footing with Boeing and Airbus. The Ulaanbaatar route is relatively short, and the aircraft is being operated by China's own national carrier. There are still enormous challenges ahead, including international certification, production at scale, global maintenance and support, and winning the confidence of airlines and passengers around the world.

In other words, this is a milestone, but it is not the finish line.

And that makes me think of what Mao Zedong said on March 5, 1949, shortly before the establishment of the People's Republic of China:

“夺取全国胜利，这只是万里长征走完了第一步。” (Duóqǔ quánguó shènglì, zhè zhǐshì Wànlǐ Chángzhēng zǒu wán le dì yī bù)

“Winning nationwide victory is only the first step in the Long March.”

At that time, China was often described as 一穷二白 (yī qióng èr bái)—economically poor and industrially and technologically underdeveloped.

The numbers help put that starting point into perspective.

In 1949:

• China's population was about 542 million.

• Average life expectancy was only about 35 years.

• Per-capita annual national income was about 69 yuan.

• Per-capita annual electricity consumption was only 7.9 kWh.

• Per-capita steel production was about 0.29 kg.

• Per-capita crude-oil consumption was only 0.2 kg.

China was overwhelmingly an agricultural economy. One economic-history source estimates that agriculture accounted for 68.4% of national income in 1949, while industry accounted for only 12.6%.

The phrase 一穷二白 described a country facing an enormous gap in industrialization, infrastructure, technology, capital, and living standards compared with the advanced industrialized countries of the time.

Then came a long journey.

1949 — 一穷二白
China began its postwar reconstruction from an extremely poor and underdeveloped industrial base.

1978 — Reform and Opening
China began a dramatic transformation of its economy, opening itself to foreign technology, capital, trade, and markets.

2023 — C919 enters commercial service
China begins operating its own domestically developed large passenger aircraft.

2026 — C919 begins scheduled international service
The aircraft crosses another important threshold, beginning to operate an international passenger route.

And this brings me to a phrase that has nothing to do with China, but somehow seems strangely appropriate here.

In 1968, the cigarette company Virginia Slims launched a famous advertising slogan aimed at women:

“You've come a long way, baby.”

This phrase has entered the English language as a way of describing how far someone—or something—has traveled from where it began.

Looking at China from 1949 to 2026, it's highly appropriate to say,  “You've come a long way, baby.” 

But there is another phrase that is just as important:

“这只是万里长征走完了第一步。”
This is only the first step in the Long March.

The two ideas actually belong together.

Recognize how far you have come. Appreciate the milestone. But don't mistake a milestone for the destination.

That is true of a country. And it is true of a person.

No matter how far the C919 has come, and no matter how remarkable the transformation from 一穷二白 to a Chinese-built large passenger aircraft may be, there is still a long road ahead.

You've come a long way, baby. But keep walking.

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