6 days ago
Why Self-Care Has Become The Most Important Form Of Healthcare – And What You Can Do To Improve It
Extending healthspan—the period of life spent free from major diseases—is far more about lifestyle choices than genetics.
In his recently published (and very good) book Super Agers: An Evidence-Based Approach to Longevity, Dr. Eric Topol emphasizes that extending healthspan—the period of life spent free from major diseases—is far more about lifestyle choices than genetics. His recommendations, grounded in decades of research on individuals who thrive into their 80s and beyond, focus on practical, evidence-based strategies.
In addition to the health-related benefits of proper self-care, there are growing financial benefits. As healthcare related to chronic conditions (including heart disease, diabetes, obesity, cancer, and neurogenerative diseases such as Alzheimer's) becomes increasingly expensive, and as more of the costs of healthcare are being passed onto insured consumers in the form of increased deductibles, co-payments, and coverage limitations, and as more individuals are uninsured, avoidance of expensive healthcare conditions and procedures has become essential to financial security.
It's NOT All in Your Genes
For much of my generally healthy life, I have been hearing that 'you can't beat your genes.' I have always been skeptical of this notion, not due to any hard evidence to the contrary, but because of an instinctive sense based on observation that it must be an oversimplification, and because of a stubborn refusal to accept such a fatalistic approach in my own life and those of friends and family members. Fortunately, there is growing evidence to suggest that my instinct has been correct, including one study highlighted in Dr. Topol's book.
Two decades ago, a California research team he led sequenced the genomes of 1,400 adults aged 80 or older without any major illness. The researchers expected to find genetic differences between this cohort (which they called the 'Wellderly') and the majority of older adults who have at least two chronic conditions (which they called the 'Illderly').
However, the Wellderly study found almost no difference between the biological makeup of the two groups. What they did find was that Wellderly members were more physically active, more social, and typically better educated than the general public. That genes don't necessarily determine healthy aging is 'liberating,' and suggests that 'we can all do better' to delay disease, says Topol.
In his book, Dr. Topol cites many examples of Super Agers whose parents died in their 50s from chronic conditions. Yet, these people are going strong in their 80s and 90s, and he believes that lifestyle has a much greater impact on health and longevity than genetics. While genetics may set the 'upper limit' for human lifespan—generally 90–100 years—he believes that lifestyle choices largely determine how close individuals come to reaching that potential without significant limitations.
Dr. Topol and a growing number of other experts estimate that 80–90% of heart disease, 40–50% of cancers, and nearly half of Alzheimer's cases are delayable or preventable through lifestyle factors such as exercise, diet, sleep, and social connection. Genetics may account for only 10–20% of overall health outcomes and lifespan, with lifestyle accounting for the remaining 80–90%.
Evidence-Based Self-Care
If you accept this premise, the next question is, 'What kind of self-care will extend my healthspan that is supported by evidence-based research?' There is no shortage of unsupported recommendations. One of the reasons I admire Dr. Topol's approach is that he sticks to what is supported by research and cites the research being cited. As background, he is a cardiologist, founder of the Scripps Research Translational Institute, and a molecular scientist who has published 1,300 articles and multiple books.
Following is a summary of what Dr. Topol has to say about what he calls 'Lifestyle+.' However, I highly recommend that you read the chapter in his book on this subject, as it contains many actionable insights that are beyond the scope of this article, including summaries of the evidence supporting some healthspan-promoting practices and casting doubt on the efficacy of others.
1. Exercise as the Cornerstone
2. Mediterranean Diet
3. Sleep Quality and Duration
4. Social Connection and Cognitive Engagement
5. Avoiding Unproven Longevity Hacks
Measuring Your Risk
Dr. Topol recommends a personalized and dynamic approach to health risk evaluation, including but also moving beyond traditional population-based screening and annual tests. His logic is based on the fact that many potentially debilitating diseases develop over decades, and that understanding one's vulnerability to one or more of them well in advance can facilitate interventions to prevent or delay the onset of symptoms. His key recommendations include:
1. Longitudinal Tracking of Lab Tests
2. Emerging Blood-Based Screening
3. Genomic and Polygenic Risk Scores
4. Brain Health and Alzheimer's Disease
5. AI and Digital Tools
6. Avoiding Unnecessary Full-Body Scans
7. Reservations about Aging Clocks
Recommended for a Reason
I rarely endorse a single work as I am with Super Agers, but as it has become increasingly clear that we must take more responsibility for our own health care—for both healthy aging and financial security—it has become equally difficult to find trusted sources of information about how best to do this among the torrent of possibilities that are not evidence-based (e.g., more than 60,000 diet books are sold on Amazon).
With that said, the combination of rapid advances in life science and information technology, including polygenic risk scoring, genome sequencing, imaging, and multimodal AI, is accelerating the pace of change and identifying new opportunities to increase healthspan that would have been unthinkable just a few years ago.
So, there is no healthspan 'handbook' available today that will be completely relevant tomorrow. Our ongoing challenge will be to sort through the many possible breakthroughs to identify the few that are truly supported by evidence. There are 326 research citations in Dr. Topol's nearly 100-page bibliography in Super Agers, which is the kind of scientific rigor we need to guide us today and hope to have at our fingertips tomorrow.
