Ground Truths: Podcasts

Roxanne Khamsi: We Are All Genetic Mosaics

Eric Topol — Sat, 25 Apr 2026 18:38:44 GMT

“You are a slightly different genetic version of yourself today from yesterday, and will be different yet again tomorrow.”—Roxanne Khamsi

“Each neuron really is a beautiful and unique snowflake”—Ed Yong

Roxanne Khamsi is one of the leading life science journalists, a contributing writer at The Atlantic, recognized with multiple awards for notable publications. Her new book is entitled BEYOND INHERITANCE. It tells the story about us all being genetic mosaics, chock full of somatic (acquired) mutations, and the implications of those mutations for our health. The myth of a single genome, carbon copy, master blueprint, but instead a dynamic, shifting mosaic in constant internal evolution.

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And here’s the back cover. I was delighted to endorse this book, and reread it to prepare for our podcast. It’s extraordinary and mind-bending.

Here are the topics we covered:

—The Math. 330 billion cells of our ~37 trillion turnover each day, which yields trillions of mutations per day.

—Cellular competition. Winners and losers of an “endoevolution,” Darwinian selection inside us whereby healthy or super-fit mutated cells can crowd out the unfit ones.

This was theorized in 1881 in a book THE STRUGGLE OF PARTS, by Wilhelm Roux

which led to Friedrich Nietzsche’s famous quote “Uniformity is pure delirium.”

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—Single-cell sequencing. How this field catapulted forward owing to the ability to zoom in on genomic mutations at the cellular level.

—Cancer chemotherapy overkill. The routine scorched earth, carpet bombing approach can promote resistance and deleterious mutations, leading to an adaptive strategy of leaving some cancer cells behind, as has been shown to be effective in prostate cancer for improving survival.

—The immune system somatic hypermutation. B cells have the theoretical capacity to produce 1 quintillion unique antibodies (a million trillion). If this weren’t possible, we could die from a common cold. In the Covid pandemic, even before the Omicron variant appeared, Covid booster shots induced hundreds of unique antibodies with neutralization capacity against Omicron. The anticipatory “Red Queen” effect.

—Autocorrection of mutations. They can revert, cure a rare genetic disease from within. It can be considered “Natural Gene Therapy.” Example below of a skin condition Epidermolysis Bullosa with revertant mutations (→ normal skin appearance)

—Different role of acquired mutations through the lifespan. Examples: At embryonic stage, Lines of Blaschko (Image below). In mid-life endometriosis, and in older adults Loss of the Y chromosome (LOY) and Clonal Hematopoiesis of Indeterminate Potential (CHIP). Note these 2 somatic mutation clone conditions are associated with risk of diseases; CHIP-cardiovascular and cancer; LOY-heart failure and Alzheimer’s. I’ve written about CHIP extensively here and here.

—Phenocopy. How a somatic mutation can look the same as a germ-line, inherited mutation, with respect to a disease, and how that is determined.

—Environmental effects inducing somatic mutations: UV light, air pollution, plastics

—and 3 new papers in the past week!

Somatic mutations in the microglia cells of the brain, same as cancer mutations, drive inflammation and are enriched in the Alzheimer’s brain
2.. The potential of “promolytic drugs” to be used to prevent cancer in people who exhibit precancerous somatic mutations
3. How somatic mutations can be the basis of autoimmune diseases

We also spoke about the role of somatic mutations in aging and super aging

A related excerpt at The Atlantic

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Many thanks to those who have contributed—they have greatly helped fund our summer internship programs for the past two years. We just accepted 51 interns for the 2026 summer, a new record, from thousands of high school, college, and med school student applicants. Our fully loaded cost to do this program is ~$300,000 per year. We’re deeply appreciative for your support of Ground Truths that has enabled this program to prosper and expand.

One more thing:

SUPER AGERS was featured on the CBS Morning Show this week in a segment with Dr. Jonathan LaPook, Chief Medical Correspondent, on the meaning and measurement of biological aging.

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Sebastian Mallaby: The Infinity Machine

Eric Topol — Sun, 19 Apr 2026 14:07:17 GMT

This is one of my favorite books over recent years. Sebastian Mallaby is the Paul A. Cocker Senior Fellow for International Economics at the Council of Foreign Relations and author of 6 bestselling books.

THE INFINITY MACHINE tells the story of AI’s progress over the past 15 years largely, but not exclusively, from Demis Hassabis as the protagonist and leader of DeepMind’, with its 2010 mission statement to achieve superintelligence by 2030. It’s a rich, informative, page turner.

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What We Discussed:

—What is an Infinity Machine?

—Influence of Claude Shannon’s Information Theory and Douglas Hofstadter’s Pulitzer Prize winning book Gödel, Escher, Bach

—Origin of DeepMind in 2010. Prescient. Charter, business plan, included use of agents. How Demis Hassabis was made for the mission!

—Contrasts with Sam Altman and the other AI leaders, the Oligopoly (cover of The Economist this week). For example, Nature papers vs white papers on company websites.

—In March 2016, the same day when DeepMind’s AlphaGo beat Lee Sedol, Hassabis says it’s time to do protein folding (later known as AlphaFold).

—Symbolic AI (historic, deductive, rule-based) vs Deep Learning (Toronto tribe) and Reinforcement Learning (Alberta tribe).

—The Big Miss: DeepMind’s lack of early recognition of the importance of transformer models (leading to ChatGPT), creating a big opening for OpenAI. And why was this missed? The Comeback Story. Is this happening again with coding (not in the book)?

—The AI Arms Race and Hyperscaling

—How the complex relationship between Google and DeepMind evolved

—The Double Cross

—With the dangers anticipated (parallels to Oppenheimer, Manhattan Project, and the atomic bomb), how to promote AI safety?

—Is the major build up of data centers justified?

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And, if you’re interested on extending healthspan, two recent podcasts/TV segments on SUPER AGERS

On With Kara Swisher

On PBS

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Trisha Pasricha: How to Get to Poophoria, Making Your Bowel Movements a Joy!

Eric Topol — Fri, 10 Apr 2026 15:53:25 GMT

Dr. Trisha Pasricha is a gastroenterologist, Assistant Professor at Harvard Medical School, and the Ask a Doctor columnist for The Washington Post. Her new book gets deep into the stigmatized, taboo, rarely discussed topics of our bowel movements and farts, no less the science that backs that up, with lucid explainers for the mechanisms (such as the gut-brain axis). Her research is on the gut origin of Parkinson’s disease.

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Here’s a quote from Trisha early in the book:

“I’m not a wellness guru. I’m a scientist.”

Another quote from a Vanderbilt professor:

“An effortless, socially appropriately timed bowel movement is the second greatest bodily pleasure known to man.”

The proportion of people with bowel issues is remarkable, a brief summary:

Some of the topics covered in our lively, fun and highly informative conversation:

—The 3 P’s Propulsion, Pliability, Pelvic Floor

—Ten Myths

—99% of farts have no odor; the 1% that do are from hydrogen sulfide, Pepto-Bismol substantially reduces the latter (and an incredible experiment of people with rectal tubes and judges smelling their gas)

—What is the normal frequency of pooping?

—the Bristol Scale of poop appearance and what it means

—Transit time

—The uselessness and danger of bowel cleanses

—Fibermaxxing

—5 minutes max on the toilet and positions to help propulsion

—Psyllium and laxatives

—The art of wiping and bidets

—Fecal incontinence

—Not to miss urges and the TRPV1 and PIEZO2 receptors

—Impact of coffee, alcohol, NSAIDs (Ibuprofen, aspirin, naproxen, etc), and hydration

—What are the different definitions of constipation?

—What gives poop its color?

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On the Future of Species

Eric Topol — Sun, 29 Mar 2026 13:59:31 GMT

Adrian is a molecular biologist and co-founder and CEO of Genyro, a synthetic biology company. He has published 2 previous books on life science (Life Without Genes and An Intelligent Person’s Guide to Genetics). In this conversation we discussed his new book, cover below and the title of this post.

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ABI. As Adrian puts it, a monumental shift, a second genesis, the “artivolution,” ability to use a molecular Gutenberg press, it’s post-Darwinian.

I made an infographic about the book and our conversation with NotebookLM

The expansion of genome sequences beyond “Fred’s library” (referring to Fred Sanger, father of genome sequencing, little green box)

We talked about the jump from DNA reading to editing and now writing genomes, with the potential of the latter for both good and harm. I disagreed with Adrian about the bright prospects for curing diseases, but there are many possibilities for positive impact, such as intervening vs the climate crisis and sustainability.

We also discussed the large language of life models (LLLMs) and by coincidence my colleagues and I just published a review of these in this Nature Biotechnology (←free access is hyperlinked).

“It should be possible to meet most of humanity’s needs through biologically inspired designs—to solve many global problems, revolutionize health care, extend human lifespan, and create other organisms to order.”—Adrian Woolfson

If you are into life science, I think you’ll find Adrian’s book thoughtful and provocative, even if you don’t agree with some of his optimism like a disease-free organism.

The topic connects with digital biology, a theme that is approached in many editions of Ground Truths, such as this one with Patrick Hsu

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A Master Class on Sleep

Eric Topol — Fri, 06 Mar 2026 14:50:59 GMT

Yo-El Ju is the Barbara Burton and Reuben Morris Professor of Neurology at Washington University, St. Louis. She got her AB from Harvard and MD from Columbia and actively practices sleep medicine and is a prolific researcher, one of the top sleep scientists in the country.

Here are some of the topics we discussed and a few related hyperlinked citations:

—Importance of Deep Sleep (and her paper on what happens when deep sleep is purposely disrupted, how it is modulated, effect of alcohol

—The Orexin Antagonist drugs that promote sleep (and a study that shows they can reduce p-tau217 and other neuroinflammation markers

—Link of sleep regularity with less all-cause, cardiovascular, and cancer related mortality

Figure 3.9 from SUPER AGERS (SRI-sleep regularity index)

More things we discussed:

—A sleep foundation model that predicts 130 diseases

—Impact of menopause on sleep

—Getting to sleep vs staying asleep

—Role of naps

—Impact of interruptions of sleep

—Sleep apnea and new interventions

—Vagal nerve stimulation and sleep

—Cerebrospinal fluid wave that occurs during attention lapse after poor sleep

—cognitive behavioral therapy for improved sleep

—Wearables, sleep scores, and effect on sleep

—Any supplements that help sleep?

—The rare genetically endowed short sleepers

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I also want to thank the National Academies of Science, Medicine and Engineering for their recent recognition.

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Robert Wachter & Eric Topol - Discuss a Giant Leap Book

Eric Topol — Wed, 04 Feb 2026 21:44:45 GMT

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Vagus Nerve Stimulation and the Immune System

Eric Topol — Sun, 01 Feb 2026 17:17:36 GMT

The vagus nerve, also known as the Great Nerve, connects the brain to all parts of the body, like an internet (Figure below). Every week we’re learning more about its importance for health and disease. Until recent years the brain and immune system were thought to be in separate “firewalled” compartments. But that turned out to be far from the truth.

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Dr. Kevin Tracey, who directs the Feinstein Institute at Northwell Health, has been studying the vagus nerve for more than 3 decades. In the early 1990’s he made the seminal observation that stimulating the vagus reduces the inflammatory cytokine known as tumor necrosis factor (TNF), what he described at the time as a “holy shit” moment. In 2025 he published the book THE GREAT NERVE with many rich patient anecdotes and the history for how this field developed.

I wrote about the brain-immune axis previously on Ground Truths, spotlighting the vagus nerve’s role. That included much more on depth of the pathways if you are interested.

We discussed the recent FDA July approval for refractory rheumatoid arthritis (RA)(unresponsive to medications or intolerance to medical therapy) based on a sham-controlled randomized trial published in December 2025 in Nature Medicine. It is striking that the benefits were derived from 1 minute of vagal stimulation per day. That stimulation is barely perceived (tingling, many not at all) by device recipients. The surgery takes one hour to implant the tiny stimulator device along side the vagus nerve in the neck.

But this is much bigger than a treatment for RA. It is now being tested for lupus, Crohn’s disease, and other autoimmune conditions. That’s beyond the role vagus nerve stimulation (VNS) has played for epilepsy and depression, independent of VNS’s anti-inflammatory impact (Tracey named it “the inflammatory reflex”).

We also discussed handheld VNS devices, potential use for Long Covid and POTS, cold plunges, heart rate variability, stress, and other topics related to the vagus nerve and parasympathetic nervous system (the brakes, “rest and digest” as opposed to the sympathetic nervous system (the gas, “fight or flight”).

Most people are not aware of this device approved treatment for an autoimmune disease. Our treatments are so drug-centric but they are immunosuppressive, have important side-effects, and are expensive. It’s good to see a non-drug approach get compelling data as an alternative. Moreover, as I recently wrote about, there’s a shift ongoing from treatment to cures vs autoimmune diseases that will be adding to the mix.

Here are some very recent papers about the vagus nerve to give you a sense about how its prominence is getting appreciated more all the time

Gut-brain-vagus axis for reward circuit and addiction, 30 Jan 2026, Science Advances

Randomized trial of VNS for depression , Int J of Neuropsychopharm 2026

The vagus nerve role in heart function after a heart attack, Cell, February 2026

Vagus receptors and hemorrhage, blood volume, Nature, 28 Jan 2026

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A Look Into the Blue Zones

Eric Topol — Sun, 18 Jan 2026 16:39:58 GMT

Back in 2005 Dan Buettner patented Blue Zones. He’s written 9 books, of which 5 were NY Times bestsellers, and has another one in the works. His 2023 Netflix documentary series “Live to 100: Secrets of the Blue Zones” won Emmy awards and was widely viewed. Many of the main points that Dan has emphasized over the years—healthy diet (he highlighted whole grains, beans, nuts, greens, and “peasant food” here), physical activity, social engagement, and sense of purpose—are backed up by randomized trials and/or large, prospective studies, as I reviewed in Super Agers.

In this interview, I asked Dan about the critique he’s faced, predominantly from Saul Newman, a biologist in the UK, about accuracy of the data for extreme longevity in the blue zones. In December 2025, two of his collaborators published in The Gerontologist a rebuttal response (open-access) entitled “The validity of Blue Zones demography: a response to critiques” on the rigorous demographic work they’ve done.

We also discussed the marketing and business operations of Blue Zones LLC, the company he sold to Adventist Health in 2020. His son, Danny, is the EVP of the company and likely successor to Dan’s work in the future. As Dan said, “He’s my genetic upgrade.”

I hope you find this conversation informative. An AI-generated transcript is available in the tab at top right above.

Some biomedical updates from the past week:

A vaccine to prevent colon cancer in carriers of mutations of Lynch Syndrome looks good for strong immune response and safety, ready for Phase 3 clinical trials
A review of the data of Tylenol during pregnancy reaffirms its safety and lack of increased risk for autism, ADHD, and intellectual disability.
Our perspective/review on how AI and large language models can reduce global health inequities
Another big jump vs refractory autoimmune diseases, this time for hemolytic anemia, using engineered T cells. See my recent review of this topic, from treatment to cures.
A pair of new large prospective cohort studies that reinforce the importance of even small increases in physical activity, along with sleep and diet, for reduction all-cause mortality and improvement in healthspan.

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Thanks to Ground Truths subscribers (nearly 200,000) from every US state and 210 countries. Your subscription to these free essays and podcasts makes my work in putting them together worthwhile. Please join!

If you found this interesting PLEASE share it!

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Paid subscriptions are voluntary and all proceeds from them go to support Scripps Research. They do allow for posting comments and questions, which I do my best to respond to. Please don’t hesitate to post comments and give me feedback. Let me know topics that you would like to see covered.

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How Our Brain Drains Its Waste Products

Eric Topol — Sun, 21 Dec 2025 16:45:13 GMT

Jonathan Kipnis is a neuroscientist, the Alan A. and Edith L. Wolff Distinguished Professor of Pathology and Immunology at Washington University, St. Louis, who discovered meningeal lymphatics and has been a prolific researcher in brain drainage and the continuous immune system surveillance of the brain.

I made this infographic with the help of Notebook LM to summarize many of the concepts we discussed. (Notebook LM is free and worth trying)

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We went over his new review with 24 co-author leading experts in the recent issue of Neuron

A Clever Cover

The drainage system anatomy on influx and efflux (blue arrows)

The 3 ways the flow of glymphatics are modulated. I mentioned the recent studies that show atrial fibrillation, via reduced cardiac pulsation, has an effect on reducing glymphatic flow.

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We also discussed his recent review on the immune surveillance system in Cell:

A schematic of key channels for the “faucet” and “drain”

and how the system changes from healthy to central nervous system autoimmune diseases (such as multiple sclerosis) and aging with different immune bar codes.

The outsized role of astrocytes in the brain, a subject of recent Nature feature, was also mentioned.

Our understanding of the brain’s immune system has been completely revamped. Kipnis’s recent review in Nature Immunology highlights the critical role of the outer layers —the skull, dura and meninges—as an immune reservoir that is ready to detect and react abnormalities in the brain with a continuous “intelligence report.”

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Notably, Kipnis touched on lymphatic-venous anastomosis (LVA) surgery (Figure below) for Alzheimer’s disease which is popular in China, available at 30 centers in multiple cities, and the subject of multiple randomized trials as a treatment for Alzheimer’s. Trials of LVA surgery are also getting started in the United States for treatment of Alzheimer’s and Parkinson’s diseases.

Here is a Figure to show the surgical anastomoses (connections) from the deep cervical lymphatics to external jugular and internal jugular veins

This podcast was packed with insights relevant to health, spanning sleep quality, sleep medications, autoimmune diseases, and Alzheimer’s disease. I hope you find it as informative and engaging as I did.

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This is my 4-year anniversary of writing Ground Truths. Post number 250! That’s an average of more than 1 per week, nearly 5 per month. Hard for me to believe.

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The Story of Francis Crick, a new masterpiece biography by Matthew Cobb

Eric Topol — Sun, 07 Dec 2025 18:41:35 GMT

A recording from my enthralling conversation with Prof Matthew Cobb about the life and science contributions of Francis Crick, regarded as one of the most influential biologists of all times, along with Darwin and Mendel. As you’ll see, there’s so much more to Crick’s story than cracking DNA’s double helix structure in a matter of weeks with James Watson. Matthew Cobb, Emeritus Professor of the University of Manchester, has written several award-winning books on life science, but I think this is his most important one to date, deeply researched and a thrilling account of Crick’s life, clearing up, as best as one can, many questions, and presenting some surprises.

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The transcript is available (A.I. generated) by clicking at the top right.

A few things we discussed

—Crick’s reaction to James Watson’s book

Crick contrasted his own approach to science writing with Watson’s memoir: “The difference between my lecture and your book is that my lecture had a lot more intellectual content and nothing like so much gossip. (...) Your book on the other hand, is mainly gossip and I think it a pity in this way that there is so much of it that it obscures some of the important conclusions which can be drawn of what we did at the time”.

—The Peyote Poem, by Michael McClure (part 1) that had a big influence on Crick

—Crick’s 1994 neuroscience book “The Astonishing Hypothesis”

“You, your joys and your sorrows, your memories and your ambitions, your sense of personal identity and free Weill, are in fact no more than the behavior of a vast assembly of nerve cells and their associated molecules.”—Crick

The book has been reviewed at Science, Nature, The Economist and many other journals. Here is a gift link to The Economist It has deservedly been named a best book of 2025 by The Guardian, The Economist, and many other media.

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Upcoming, this Wednesday 9AM PT, live podcast

I will be interviewing founder of the Blue Zones

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Thanks to US News for recently being named one of the 25 best leaders in the United States

https://www.usnews.com/news/leaders/articles/best-leaders-2025-eric-topol

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Jennifer Gunter & Eric Topol: Discuss Women’s Health and Recent Changes by FDA for MHT

Eric Topol — Fri, 28 Nov 2025 17:36:00 GMT

A couple of weeks ago, the FDA Commissioner published a WSJ oped “The FDA Liberates Women’s Hormone Replacement Therapy” (←gift link) and, with other FDA colleagues, a JAMA essay entitled “Updated Labeling for Menopausal Hormone Therapy” (open-access). That change, and the data cited, led to a series of articles in the days that followed, such as at STAT News “FDA reverses decades-old warning on hormone therapy products for menopause. Agency says the treatments o!fer heart, brain, and bone health benefits” and at the Washington Post “The FDA finally corrects its error on menopause hormone therapy. Women have been needlessly scared away from effective treatments.” If you read through these links, you’ll be confused. Does MHT have proven cognitive benefits? What about a study from 1991 that showed ~50% reduction of fatal heart events with MHT? Or the 35% decreased risk of Alzheimer’s disease? Or the breast cancer increased risk attributed to medroxyprogesterone acetate?

I turned to my go-to gynecologist truth teller, Dr. Jen Gunter, to get her review of the evidence. This is a complex topic, with old data from the 2002 Women’s Heath Initiative (WHI), new reports since, population level analysis, changes in preparations of MHT including local delivery, and much more.

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Here is our conversation which isn’t just about MHT but includes “Big Wellness” marketing direct to middle aged women, the new FDA approved drug for hot flashes, the $14 million cut of the NIH’s Office of Women’s Health , marked increase in philanthropic support of women’s health research, the Surgeon General nominee, ovarian failure, and a lightning round on proven benefits of MHT.

Here’s a brief clip on her views of the women’s health “wellness” predators

We also discussed the reasons for Dr. Gunter’s planned move next year back to Canada after practicing gynecology for 3 decades in the United States.

I referred to a recent GT I wrote about the WHI and the potential favorable impact of MHT on the immune system, as suggested by new data on organ clocks. That finding, which has been replicated, may be linked to healthy aging, extending healthspan.

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Many thanks to those who have contributed—they have greatly helped fund our summer internship programs for the past two years. It enabled us to accept and support 47 summer interns in 2025! We aim to accept even more of the several thousand who will apply for summer 2026.Thank you , , , , , and over 1,000 others for tuning into my live video with ! Join me for my next live video in the app.

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Dr. Susan Monarez—Former CDC Director, First Live Interview

Eric Topol — Sat, 08 Nov 2025 15:58:31 GMT

Dr. Susan Monarez was the first CDC Director to be confirmed by the Senate and served from July 31, 2025 – August 27, 2025. Because she refused to give approval to new vaccine recommendations without ever seeing them or their evidence and firing scientists without cause, she was fired. In my view, she’s a hero for standing up for science and speaking truth to power.

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In her first live interview since leaving the CDC, we review her background. That includes growing up in rural Wisconsin and getting her college and PhD education at UW-Madison, the latter in microbiology and immunology. She then went on to 18 years of government service with an extensive portfolio of jobs and management at BARDA, the White House, ARPA-H, and others, before becoming Acting Director of the CDC in early 2025.

We discussed the horrific CDC shooting on August 8th, days after she started. Then we reviewed a conversation that we had on August 19th in which she laid out her exciting vision for the future of CDC, emphasizing the goal of prevention (BTW, CDC stands for Centers for Disease Control and Prevention) and asked me to help as an advisor. At the time, she was well aware, with growing tension, that her tenure at CDC might be limited.

I asked about her perspective for the jobs of 4,300 people at CDC who have been terminated, which account for more than 1/3rd of the workforce, no less the gutting of the budget.

Then we got into what she learned from this ordeal and her plans for the future, which includes a very ambitious initiative: 90/90/2035. As you’ll see from our conversation, Dr. Monarez is exceptionally resilient and an optimist. She’s got lots to do in the years ahead to carry out her mission of promoting human health!

Dr. Monarez just started a Substack The Road Best Traveled so you can follow her there. It was a real privilege for me to do this interview with her. In deep admiration of her willingness to not only take on the job of CDC Director in tough circumstances, her professionalism during testimony at the Senate committee hearing, her impressive yet unrealized vision for transforming the CDC, and refusing to cave to immense pressure from the HHS Secretary to move ahead with his agenda.

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Seth Berkley & Eric Topol - Discuss Fair Doses Book

Eric Topol — Wed, 05 Nov 2025 18:27:13 GMT

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Tom Frieden & Eric Topol - Discuss the Formula for Better Health Book

Eric Topol — Wed, 01 Oct 2025 20:52:34 GMT

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Shana Kelley: Biosensors to Track Proteins and Inflammation in Our Blood in Real Time

Eric Topol — Sun, 14 Sep 2025 16:43:08 GMT

Prof is the Neena Schwartz Professor of Chemistry and Biomedical Engineering at Northwestern University and President of the CZI Chicago Biohub, which brings together life scientists at Northwestern, University of Chicago, and U. Illinois Urbana Champaign. Her lab’s website provides recent publications in the 3 major areas of biomolecular sensors, rare and single cell analysis, and intracellular molecular delivery.

You are undoubtedly familiar with wearable biosensors on the wrist and rings, and continuous glucose monitoring (CGM), all of which can transmit physiologic data in real time to your smartphone. What is different about Prof Kelley’s work is the ingenious way of continuously tracking any proteins in our blood via a sensor that could function just like CGM in the future (hair thin sensor applied just below the skin and data relayed to your smartphone). A proof-of-concept paper in Science showed how exquisitely sensitive such a sensor worked to track inflammation markers [interleukin-6 (IL-6) and tumor necrosis factor (TNF)] in the diabetic rat model. As seen. below, just the injection of insulin evoked inflammation, and introduction of lipopolysaccharide (LPS) did so markedly.

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This capability opens up the potential for monitoring body-wide inflammation in real time, but also extends to many other conditions such as autoimmune diseases, heart failure (e.g. continuous brain natriuetic peptide monitoring), and neurodegenerative diseases (with specific markers of neuroinflammation). This innovation represents a new dimension in individualized (precision) medicine.

In our conversation, Shana takes us through the discovery of these unique bimolecular sensors that have no reagents, and use electricity to shake off the protein from DNA strands. And she maps out the path to clinical trials and commercialization in the next couple of years.

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All content on Ground Truths—its newsletters, analyses, and podcasts, are free, open-access.

Paid subscriptions are voluntary and all proceeds from them go to support Scripps Research. They do allow for posting comments and questions, which I do my best to respond to. Please don't hesitate to post comments and give me feedback. Let me know topics that you would like to see covered.

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Many thanks to those who have contributed—they have greatly helped fund our summer internship programs for the past two years. It enabled us to accept and support 47 summer interns in 2025!

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Charlotte Blease: Is A.I. Going to Remedy Medicine’s Problems?

Eric Topol — Fri, 12 Sep 2025 03:00:26 GMT

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Whether A.I. will transform the practice of medicine in a positive way remains controversial. Health researcher Prof Charlotte Blease, on faculty at Uppsala University in Sweden and researcher at Harvard University, has written a new book —Dr. Bot—that critically assesses the unmet needs in healthcare and whether A.I. can fulfill them. She provides an optimistic viewpoint (see the subtitle), and our conversation probes whether that is justified. She has a substack, too, here

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Thanks for listening to Ground Truths. Through analytic essays and podcasts, I try to cover the important issues and discoveries in life science and medicine. If you have suggestions for topics I should get into, please pass them along.

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Peter Hotez & Eric Topol - Discuss “Science Under Siege” book

Eric Topol — Mon, 08 Sep 2025 22:00:17 GMT

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and I discuss his new book, co-authored with Michael Mann, SCIENCE UNDER SEIGE, on the anti-science superstorm culminating from the climate crisis, the Covid pandemic, and a vast interconnected network that has waged a direct assault on scientific truth.

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During our conversation we trace history of priors in civilization, such as Lysenko and Stalinism in the last century. And acknowledge the future role of A.I. for promoting infinite disinformation.

Beyond human suffering and direct health outcome consequences (such as Red Covid), the toll this is taking on the career of young scientists, universities, public health agencies, and loss of public trust are reviewed. The interdependent role of the media and the wellness industry is touched on.

The book and our conversation puts forth a call to arms, potential solutions, including the need to move away from invisible scientists and political activism.

Thanks for listening to Ground Truths podcasts and reading the analytic posts.

In case you missed any, these are a few recent and related ones:

Podcasts with Michael Osterholm and Sanjay Gupta on their new books—The Big One and It Doesn’t Have to Hurt, respectively.

Next up is and her new book Dr. Bot on where we are headed with medical A.I.

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Sanjay Gupta & Eric Topol - Discuss “It Doesn’t Have to Hurt” book

Eric Topol — Fri, 05 Sep 2025 17:52:40 GMT

Thank you , , , , , and many others for tuning into my live video with Dr. Sanjay Gupta. Join me for my next live video in the app.

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A Brief Summary of Our Conservation

We discussed the new understanding and approach to chronic pain, which affects nearly 1 in 4 adults. Dr. Gupta gets personal telling the story of his wife, Rebecca, who has an autoimmune disease and at one point he had to carry her up stairs. He also tells the story of his mother who had a back injury and didn’t want to live because of the pain. How his family members got relief is illuminating.

Our whole understanding and approach to pain has changed, with the acronym change from RICE to MEAT.

A newly approved drug Suzetrigine (Journavx) exploits the sodium channel gene mutation initially discovered via a family of fire walkers. It’s the first new pain medicine approved for more than 2 decades. Many other new non-opioid treatments are reviewed, no less lifestyle changes (anti-inflammatory diet and sleep), and acupuncture.

Sanjay’s research over the past few years has led to a video special on CNN with the same title as the book, set to air 9 PM EST Sunday.

If you know someone suffering chronic pain, please share the post.

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Mike Osterholm & Eric Topol - Discuss “The Big One” book

Eric Topol — Wed, 03 Sep 2025 20:58:47 GMT

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Bruce Lanphear: Chronic Lead Exposure, a Risk Factor for Heart Disease

Eric Topol — Sun, 17 Aug 2025 14:47:44 GMT

This is a hybrid heart disease risk factor post of a podcast with Prof Bruce Lanphear on lead and a piece I was asked to write for the Washington Post on risk factors for heart disease.

First, the podcast. You may have thought the problem with lead exposure was circumscribed to children, but it’s a much bigger issue than that. I’ll concentrate on the exposure risk to adults in this interview, including the lead-estrogen hypothesis. Bruce has been working on the subject of lead exposure for more than 30 years.

Let me emphasize that the problem is not going away, as highlighted in a recent New England Journal of Medicine piece on lead contamination in Milwaukee schools, “The Latest Episode in an Ongoing Toxic Pandemic.”

Transcript with links to the audio and citations

Eric Topol (00:05):

Well, hello. This is Eric Topol with Ground Truths, and I'm very delighted to welcome Professor Bruce Lanphear from Simon Fraser University in British Columbia for a very interesting topic, and that's about lead exposure. We tend to think about lead poisoning with the Flint, Michigan, but there's a lot more to this story. So welcome, Bruce.

Bruce Lanphear (00:32):

Thank you, Eric. It's great to be here.

Eric Topol (00:33):

Yeah. So you had a New England Journal of Medicine (NEJM) Review in October last year, which was probably a wake up to me, and I'm sure to many others. We'll link to that, where you reviewed the whole topic, the title is called Lead Poisoning. But of course it's not just about a big dose, but rather chronic exposure. So maybe you could give us a bit of an overview of that review that you wrote for NEJM.

Bruce Lanphear (01:05):

Yeah, so we really focused on the things where we feel like there's a definitive link. Things like lead and diminished IQ in children, lead and coronary heart disease, lead and chronic renal disease. As you mentioned, we've typically thought of lead as sort of the overt lead poisoning where somebody becomes acutely ill. But over the past century what we've learned is that lead is one of those toxic chemicals where it's the chronic wear and tear on our bodies that catches up and it's at the root of many of these chronic diseases that are causing problems today.

Eric Topol (01:43):

Yeah, it's pretty striking. The one that grabbed me and kind of almost fell out of my chair was that in 2019 when I guess the most recent data there is 5.5 million cardiovascular deaths ascribed to relatively low levels, or I guess there is no safe level of lead exposure, that's really striking. That's a lot of people dying from something that cardiology and medical community is not really aware of. And there's a figure 3 [BELOW] that we will also show in the transcript, where you show the level where you start to see a takeoff. It starts very low and by 50 μg/liter, you're seeing a twofold risk and there's no threshold, it keeps going up. How many of us do you think are exposed to that type of level as adults, Bruce?

Bruce Lanphear (02:39):

Well, as adults, if we go back in time, all of us. If you go back to the 1970s when lead was still in gasoline, the median blood lead level of Americans was about 13 to 15 µg/dL. So we've all been exposed historically to those levels, and part of the reason we've begun to see a striking decline in coronary heart disease, which peaked in 1968. And by 1978, there was a 20% decline, 190,000 more people were alive than expected. So even in that first decade, there was this striking decline in coronary heart disease. And so, in addition to the prospective studies that have found this link between an increase in lead exposure and death from cardiovascular disease and more specifically coronary heart disease. We can look back in time and see how the decline in leaded gasoline led to a decline in heart disease and hypertension.

Eric Topol (03:41):

Yeah, but it looks like it's still a problem. And you have a phenomenal graph that's encouraging, where you see this 95% reduction in the lead exposure from the 1970s. And as you said, the factors that can be ascribed to like getting rid of lead from gasoline and others. But what is troubling is that we still have a lot of people that this could be a problem. Now, one of the things that was fascinating is that you get into that herbal supplements could be a risk factor. That we don't do screening, of course, should we do screening? And there's certain people that particularly that you consider at high risk that should get screened. So I wasn't aware, I mean the one type of supplements that you zoomed in on, how do you say it? Ayurvedic?

Supplements With Lead

Bruce Lanphear (04:39):

Oh yeah. So this is Ayurvedic medicine and in fact, I just was on a Zoom call three weeks ago with a husband and wife who live in India. The young woman had taken Ayurvedic medicine and because of that, her blood lead levels increased to 70 µg/dL, and several months later she was pregnant, and she was trying to figure out what to do with this. Ayurvedic medicine is not well regulated. And so, that's one of the most important sources when we think about India, for example. And I think you pointed out a really important thing is number one, we don't know that there's any safe level even though blood lead levels in the United States and Europe, for example, have come down by over 95%. The levels that we're exposed to and especially the levels in our bones are 10 to 100 times higher than our pre-industrial ancestors.

Bruce Lanphear (05:36):

So we haven't yet reached those levels that our ancestors were exposed to. Are there effects at even lower and lower levels? Everything would suggest, we should assume that there is, but we don't know down below, let's say one microgram per deciliter or that's the equivalent of 10 parts per billion of lead and blood. What we also know though is when leaded gasoline was restricted in the United States and Canada and elsewhere, the companies turned to the industrializing countries and started to market it there. And so, we saw first the epidemic of coronary heart disease in the United States, Canada, Europe. Then that's come down over the past 50 years. At the same time, it was rising in low to middle income countries. So today over 95% of the burden of disease from lead including heart disease is found in industrializing countries.

Eric Topol (06:34):

Right. Now, it's pretty striking, of course. Is it true that airlines fuel is still with lead today?

Bruce Lanphear (06:45):

Well, not commercial airlines. It's going to be a small single piston aircraft. So for example, when we did a study down around the Santa Clara County Airport, Reid-Hillview, and we can see that the children who live within a half mile of the airport had blood lead levels about 10% higher than children that live further away. And the children who live downwind, 25% higher still. Now, nobody's mapped out the health effects, but one of the things that's particularly troubling about emissions from small aircraft is that the particle size of lead is extraordinarily small, and we know how nanoparticles because they have larger surface area can be more problematic. They also can probably go straight up into the brain or across the pulmonary tissues, and so those small particles we should be particularly worried about. But it's been such a long journey to try to figure out how to get that out of aircraft. It's a problem. The EPA recognized it. They said it's an endangerment, but the industry is still pushing back.

Eric Topol (07:55):

Yeah, I mean, it's interesting that we still have these problems, and I am going to in a minute ask you what we can do to just eradicate lead as much as possible, but we're not there yet. But one study that seemed to be hard to believe that you cited in the review. A year after a ban leaded fuel in NASCAR races, mortality from coronary heart disease declined significantly in communities near racetracks. Can you talk about that one because it's a little bit like the one you just mentioned with the airports?

Bruce Lanphear (08:30):

Yeah. Now that study particularly, this was by Alex Hollingsworth, was particularly looking at people over 65. And we're working on a follow-up study that will look at people below 65, but it was quite striking. When NASCAR took lead out of their fuel, he compared the rates of coronary heart disease of people that live nearby compared to a control group populations that live further away. And he did see a pretty striking reduction. One of the things we also want to look at in our follow-up is how quickly does that risk begin to taper off? That's going to be really important in terms of trying to develop a strategy around preventing lead poisoning. How quickly do we expect to see it fall? I think it's probably going to be within 12 to 24 months that we'll see benefits.

Eric Topol (09:20):

That's interesting because as you show in a really nice graphic in adults, which are the people who would be listening to this podcast. Of course, they ought to be concerned too about children and all and reproductive health. But the point about the skeleton, 95% of the lead is there and the main organs, which we haven't mentioned the kidney and the kidney injury that occurs no less the cardiovascular, the blood pressure elevation. So these are really, and you mentioned not necessarily highlighted in that graphic, but potential cognitive hit as well. You also wrote about how people who have symptoms of abdominal pain, memory impairment, and high blood pressure that's unexplained, maybe they should get a blood level screening. I assume those are easy to get, right?

Bruce Lanphear (10:17):

Oh yeah, absolutely. You can get those in any hospital, any clinic across the country. We're still struggling with having those available where it's most needed in the industrializing countries, but certainly available here. Now, we don't expect that for most people who have those symptoms, lead poisoning is going to be the cause, right. It'd still be unusual unless you work in an industry, for example, smelting batteries to recycle them. We don't expect it to be real common, and we're not even sure, Eric, whether we should be doing widespread screening. If I looked at this as a population scientist, the real focus should be on identifying the sources. We mostly know where those are here and radically moving it down. Getting rid of the lead service lines, which was such a big part of what President Biden was doing, and it was perfect. For every dollar invested to reduce lead exposure from those lead service lines. Ronnie Levin at Harvard said there'd be a 35-fold return in cost, benefits really, and this has always been true, that reducing lead exposure throughout the past 40 years has always been shown to be amazingly cost beneficial. The problem is operating within a free market health system, even though there's tremendous social benefits, that benefit isn't going to be monetized or privatized. And so, who's going to make those decisions? We hope our government is, but that doesn't always play out.

Eric Topol (11:52):

Well. What's interesting is, as opposed to the problems we have today that are prominent such as the microplastic, nanoplastics, the air pollution, the forever chemicals, that just keep getting worse, I mean, they are just cumulative. This one, there was tremendous improvement, but it’s still not enough. And I guess you're zooming in on the lead lines. That'd be the most important thing to work on today. Another thing that has come up, there's been trials, as you may I'm sure, because all over this field of chelation, there's a trial that was run by the NIH, supported by NH that looked at chelation to prevent coronary disease. Is there any evidence that people who have a problem with lead would benefit from chelation therapy?

Bruce Lanphear (12:44):

Well, there's two major studies that have been done, and Tony Lamas was in charge of both of them. The first one Trial to Assess Chelation Therapy (TACT) study, it was a randomized controlled trial, not intended specifically to focus on lead, but rather it was to look at sort of this alternative therapy. They found significant benefits about an 18% reduction in subsequent cardiac events. That led to a second study that was just published last year, and it was focused on people who had diabetes. They saw some benefit, but it wasn't significant. So whether that's because there wasn't enough variability and exposure, it's not entirely clear, but we've seen this with lead in IQ deficits in kids where we can show that we can reduce blood lead levels. But ultimately what tends to happen is once you've taken lead out of the blood, some of it's released again from the bone, but you still have all that lead in the bone that's there. You get some of it out, but you're not going to get the bulk of it out.

The Lead-Estrogen Hypothesis

Eric Topol (13:47):

Right. It's a reservoir that's hard to reckon with. Yeah. Now another thing, you have a Substack that is called Plagues, Pollution & Poverty, and you wrote a really provocative piece in that earlier and April called How Estrogen Keeps Lead - and Heart Attacks - in Check, and basically you got into the lead estrogen hypothesis.

Eric Topol (14:10):

Can you enlighten us about that?

Bruce Lanphear (14:12):

Yeah. A lot of the seminal work in this area was done by Ellen Silbergeld, who's a brilliant and somewhat peculiar toxicologist and Ellen for years, I focused on childhood lead exposure, and for years Ellen would tell me, almost demolish me for not studying adults. And because she had found back in 1988 that as women go into menopause, their blood lead levels spike increased by about 30%, and that's where most of our lead is stored is in our bone. And so, as I was thinking about this, it all became clear because blood lead levels in boys and girls is about the same. It's comparable up until menarche, and then girls young women's blood leads fall by about 20%. And they stay 20% lower throughout the reproductive years until menopause. And especially during those first few years around menopause, perimenopause, you see fairly striking increases in the weakening of the bone and blood lead levels.

Bruce Lanphear (15:19):

So that might very well help to explain why estrogen is protected, because what happens is throughout the reproductive life, women are losing a little bit of lead every month. And estrogen is at its lowest during that time, and that's going to be when blood lead is at its highest because estrogen pushes lead into the bone. Not only that, women lose lead into the developing fetus when they're pregnant. So what Ellen found is that there was less of a spike around menopause for the women that had three or four pregnancies because they had offloaded that into their babies. So all of this, if you put it together, and this is of course in a very short note of it, you can see that lead increases dyslipidemia, it leads to tears in the endothelium of the arterial wall, it's going to increase thrombosis. All of these things that we think of as the classic atherosclerosis. Well, what estrogen does is the opposite of those. It decreases dyslipidemia, it repairs the arterial endothelial wall. So how much of it is that estrogen is protective, and how much is it that it's moving lead out of the system, making it less biologically available?

Eric Topol (16:46):

Yeah, I know. It's really interesting. Quite provocative. Should be followed up on, for sure. Just getting to you, you're a physician and epidemiologist, MD MPH, and you have spent your career on this sort of thing, right? I mean, is your middle name lead or what do you work on all the time?

Bruce Lanphear (17:09):

Yeah, I've been doing this for about 30 years, and one of my mentors, Herb Needleman spent 40 years of his career on it. And in some ways, Eric, it seems to me particularly in these very difficult entrenched problems like lead, we don't have any pharmaceutical company reaching out to us to promote what we do. We've got industry trying to squash what we do.

Bruce Lanphear (17:35):

It really does take a career to really make a dent in this stuff. And in a way, you can look at my trajectory and it is really following up on what Herb Needleman did and what Clare Patterson did, and that was finding the effects at lower and lower levels. Because what we do with lead and most other toxic chemicals, the ones that don't cause cancer, is we assume that there's a safe level or threshold until we prove otherwise. And yet when you look at the evidence, whether it's about asbestos and mesothelioma, air pollution and cardiovascular mortality, lead and cardiovascular mortality, benzene and leukemia, none of those exhibit a threshold. In some cases, the risks are steepest proportionately at the lowest measurable levels, and that really raises some tremendous challenges, right? Because how are we going to bring air pollution or lead down to zero? But at the same time, it also provides these tremendous opportunities because we know that they're causing disease. We know what the sources are. If we could only bring about the political will to address them, we could prevent a lot of death, disease, and disability. I mean, about 20% of deaths around the world every year are from air pollution, lead, and other toxic chemicals, and yet the amount of money we invest in them is just paltry compared to what we invest in other things. Which is not to pit one against the other, but it's to say we haven't invested enough in these.

Eric Topol (19:14):

No, absolutely. I think your point, just to make sure that it's clear, is that even at low levels, this is of course where most of the population exposure would be, and that's why that's so incriminating. Now, one of the things I just want to end up with is that we know that these are tiny, tiny particles of lead, and then the question is how they can synergize and find particulate matter of air pollution in the nanoplastic, microplastic story and binding to forever chemicals, PFAS. How do you process all that? Because it's not just a single hit here, it's also the fact that there's ability to have binding to the other environmental toxins that are not going away.

Bruce Lanphear (20:10):

That's right. And in a way, when we talk about lead playing this tremendous role in the rise and decline of coronary heart disease, we can't entirely separate it out, for example, from air pollution or cigarette smoke for that matter, nor plastic. So for example, with air pollution, if we look at air pollution over the past century, up until the 1980s, even into the 1990s, it was leaded, right? So you couldn't separate them. If you look at cigarette smoke, cigarette tobacco in the 1940s and 1950s was grown in fields where they used lead arsenic as an insecticide. So smokers even today have blood lead levels that are 20% higher than non-smokers, and people who are not smokers but exposed to secondhand smoke have blood lead levels 20% higher than non-smokers who aren't exposed to secondhand smoke. So in a way, we should try to tease apart these differences, but it's going to be really challenging. In a way we can almost think about them as a spectrum of exposures. Now with plastics, you can really think of plastics as a form of pollution because it's not just one thing. There's all these additives, whether it's the PFAS chemicals or lead, which is used as a stabilizer. And so, all of them really are kind of integrated into each other, which again, maybe there's some opportunity there if we really were ready to tackle.

Eric Topol (21:40):

And interestingly, just yesterday, it was announced by the current administration that they're stopping all the prior efforts on the forever chemicals that were initiated in the water supply. And I mean, if there's one takeaway from our discussion, it's that we have to get all over this and we're not paying enough attention to our environmental exposures. You've really highlighted spotlighted the lead story. And obviously there are others that are, instead of getting somewhat better, they're actually going in the opposite direction. And they're all tied together that’s what is so striking here, and they all do many bad things to our bodies. So I don't know how, I'm obviously really interested in promoting healthy aging, and unless we get on this, we're chasing our tails, right?

Bruce Lanphear (22:31):

Well, I think that's right, Eric. And I was reading the tips that you'd written about in preparation for your book release, and you focused understandably on what each of us can do, how we can modify our own lifestyles. We almost need six tips about what our government should do in order to make it harder for us to become sick, or to encourage those healthy behaviors that you talked about. That's a big part of it as well. One of the things we're celebrating the hundredth anniversary. This is not really something to celebrate, but we are. The hundredth anniversary of the addition of tetraethyl lead to gasoline. And one of the key things about that addition, there was this debate because when it was being manufactured, 80% of the workers at a plant in New Jersey suffered from severe lead poisoning, and five died, and it was enough that New York City, Philadelphia and New Jersey banned tetraethyl lead.

Bruce Lanphear (23:31):

Then there was this convening by the US Surgeon General to determine whether it was safe to add tetraethyl lead to gasoline. One scientist, Yandell Henderson said, absolutely not. You're going to create a scourge worse than tuberculosis with slow lead poisoning and hardening of your arteries. Robert Kehoe, who represented the industry said, we know lead is toxic, but until you've shown that it's toxic when added to gasoline, you have no right to prohibit us from using it. So that is now known as the Kehoe rule, and it's relevant not only for lead, but for PFAS, for air pollution, for all these other things, because what it set as a precedent, until you've shown that these chemicals or pollution is toxic when used in commerce, you have no right to prohibit industry from using it. And that's the fix we're in.

Eric Topol (24:27):

Well, it sounds too much like the tobacco story and so many other things that were missed opportunities to promote public health. Now, is Canada doing any better than us on this stuff?

Bruce Lanphear (24:40):

In some ways, but not in others. And one of the interesting thing is we don't have standards, we have guidelines. And amazingly, the cities generally try to conform to those guidance levels. With water lead, we're down to five parts per billion. The US is sticking around with ten parts per billion, but it's not even really very, it's not enforced very well. So we are doing better in some ways, not so good in other ways. The European Union, generally speaking, is doing much better than North America.

Eric Topol (25:15):

Yeah, well, it doesn't look very encouraging at the moment, but hopefully someday we'll get there. Bruce, this has been a really fascinating discussion. I think we all should be thankful to you for dedicating your career to a topic that a lot of us are not up on, and you hopefully are getting us all into a state of awareness. And congratulations on that review, which was masterful and keep up the great work. Thank you.

Bruce Lanphear (25:42):

Thank you, Eric. I appreciate it.

________________________________________________

My Recommendations for Preventing Heart Disease

(Markedly Truncated from Text and Graphics Provided in SUPER AGERS)

Recently the Washington Post asked me for a listicle of 10 ways to prevent heart disease. I generally avoid making such lists but many people have de-subscribed to this newspaper, never subscribed, or missed the post, so here it is with links to citations:

Guest column by Eric Topol, MD

The buildup of cholesterol and other substances in the wall of our arteries, known as atherosclerosis, is common. It can lead to severe plaques that narrow the artery and limit blood flow, or to a crack in the artery wall that can trigger blood clot formation, resulting in a heart attack.

While we’ve seen some major advances in treating heart disease, it remains the leading killer in the United States, even though about 80 percent of cases are considered preventable. There are evidence-based steps you can take to stave it off. As a cardiologist, here’s what I recommend to my patients.

1. Do both aerobic and resistance exercise

This is considered the single most effective medical intervention to protect against atherosclerosis and promote healthy aging. Physical activity lowers inflammation in the body. Evidence has shown that both aerobic and strength training forms of exercise are important. But only 1 in 4 Americans meet the two activity guidelines from the American Heart Association: aerobic exercise of 150 minutes per week of at least moderate physical activity, such as walking, bicycling on level ground, dancing or gardening, and strength training for at least two sessions per week, which typically translates to 60 minutes weekly.

The protective benefit of exercise is seen with even relatively low levels of activity, such as around 2,500 steps per day (via sustained physical activity, not starting and stopping), and generally increases proportionately with more activity. It used to be thought that people who exercise only on the weekend — known as “weekend warriors” — put themselves in danger, but recent data shows the benefits of exercise can be derived from weekend-only workouts, too.

2. Follow an anti-inflammatory diet

A predominantly plant-based diet — high in fiber and rich in vegetables, fruits and whole grains, as seen with the Mediterranean diet — has considerable evidence from large-scale observational and randomized trials for reducing body-wide inflammation and improving cardiovascular outcomes.

Foods rich in omega-3 fatty acids, such as salmon, also form part of a diet that suppresses inflammation. On the other hand, red meat and ultra-processed foods are pro-inflammatory, and you should limit your consumption. High protein intake of more than 1.4 grams per kilogram of body weight per day — around 95 grams for someone who is 150 pounds — has also been linked to promoting inflammation and to atherosclerosis in experimental models. That is particularly related to animal-based proteins and the role of leucine, an essential amino acid that is obtained only by diet.

3. Maintain a healthy weight

Being overweight or obese indicates an excess of white adipose tissue. This kind of tissue can increase the risk of heart disease because it stores fat cells, known as adipocytes, which release substances that contribute to inflammation.

In studies, we’ve seen that glucagon-like peptide (GLP-1) drugs can reduce inflammation with weight loss, and a significant reduction of heart attacks and strokes among high-risk patients treated for obesity. Lean body weight also helps protect against atrial fibrillation, the most common heart rhythm abnormality.

4. Know and avoid metabolic syndrome and prediabetes

Tied into obesity, in part, is the problem of insulin resistance and metabolic syndrome. Two out of three people with obesity have this syndrome, which is defined as having three out of five features: high fasting blood glucose, high fasting triglycerides, high blood pressure, low high-density lipoprotein (HDL) and central adiposity (waist circumference of more than 40 inches in men, 35 inches in women).

Metabolic syndrome is also present in a high proportion of people without obesity, about 50 million Americans. Prediabetes often overlaps with it. Prediabetes is defined as a hemoglobin A1c (a measure of how much glucose is stuck to your red blood cells) between 5.7 and 6.4 percent, or a fasting glucose between 100 and 125 milligrams per deciliter.

Both metabolic syndrome and prediabetes carry an increased risk of heart disease and can be prevented — and countered — by weight loss, exercise and an optimal diet.

As the glucagon-like peptide drug family moves to pills and less expense in the future, these medications may prove helpful for reducing risk in people with metabolic syndrome and prediabetes. For those with Type 2 diabetes, the goal is optimizing glucose management and maximal attention to lifestyle factors.

5. Keep your blood pressure in a healthy range

Hypertension is an important risk factor for heart disease and is exceptionally common as we age. The optimal blood pressure is 120/80 mm Hg or lower. But with aging, there is often an elevation of systolic blood pressure to about 130 mm Hg, related to stiffening of arteries. While common, it is still considered elevated.

Ideally, everyone should monitor their blood pressure with a home device to make sure they haven’t developed hypertension. A mild abnormality of blood pressure will typically improve with lifestyle changes, but more substantial elevations will probably require medications.

6. Find out your genetic risk

We now have the means of determining your genetic risk of coronary artery disease with what is known as a polygenic risk score, derived from a gene chip. The term polygenic refers to hundreds of DNA variants in the genome that are linked to risk of heart disease. This is very different from a family history, because we’re a product of both our mother’s and father’s genomes, and the way the DNA variants come together in each of us can vary considerably for combinations of variants.

That means you could have high or low risk for heart disease that is different from your familial pattern. People with a high polygenic risk score benefit the most from medications to lower cholesterol, such as statins. A polygenic risk score can be obtained from a number of commercial companies, though it isn’t typically covered by insurance.

I don’t recommend getting a calcium score of your coronary arteries via a computed tomography (CT) scan. This test is overused and often induces overwhelming anxiety in patients with a high calcium score but without symptoms or bona fide risk. If you have symptoms suggestive of coronary artery disease, such as chest discomfort with exercise, then a CT angiogram may be helpful to map the coronary arteries. It is much more informative than a calcium score.

7. Check your blood lipids

The main lipid abnormality that requires attention is low-density cholesterol (LDL), which is often high and for people with increased risk of heart disease should certainly be addressed. While lifestyle improvements can help, significant elevation typically requires medications such as a statin; ezetimibe; bempedoic acid; or injectables such as evolocumab (Repatha), alirocumab (Praluent) or inclisiran (Leqvio). The higher the risk, the more aggressive LDL lowering may be considered.

It should be noted that the use of potent statins, such as rosuvastatin or atorvastatin, especially at high doses, is linked to inducing glucose intolerance and risk of Type 2 diabetes. While this is not a common side effect, it requires attention since it is often missed from lack of awareness.

A low high-density lipoprotein (HDL) cholesterol often responds to weight loss and exercise. We used to think that high HDL was indicative of “good cholesterol,” but more recent evidence suggests that is not the case and it may reflect increased risk when very high.

To get a comprehensive assessment of risk via your blood lipids, it’s important to get the apolipoprotein B (apoB) test at least once because about 20 percent of people have normal LDL and a high apoB.

Like low HDL, high fasting triglycerides may indicate insulin resistance as part of the metabolic syndrome and will often respond to lifestyle factors.

The lipoprotein known as Lp(a) should also be assessed at least once because it indicates risk when elevated. The good news is scientists are on the cusp of finally having medications to lower it, with five different drugs in late-stage clinical trials.

8. Reduce exposure to environmental pollutants

In recent years, we’ve learned a lot about the substantial pro-inflammatory effects of air pollution, microplastics and forever chemicals, all of which have been linked to a higher risk of heart disease. In one study, microplastics or nanoplastics in the artery wall were found in about 60 percent of more than 300 people. Researchers found a vicious inflammatory response around the plastics, and a four- to fivefold risk of heart attacks or strokes during three years of follow-up.

While we need policy changes to address these toxic substances in the environment, risk can be reduced by paying attention to air and water quality using filtration or purification devices, less use of plastic water bottles and plastic storage, and, in general, being much more aware and wary of our pervasive use of plastics.

9. Don’t smoke

This point, it should be well known that cigarette smoking is a potent risk factor for coronary artery disease and should be completely avoided.

10. Get Good Sleep

Although we tend to connect sleep health with brain and cognitive function, there’s evidence that sleep regularity and quality are associated with less risk of heart disease. Regularity means adhering to a routine schedule as much as possible, and its benefit may be due to our body’s preference for maintaining its circadian rhythm. Sleep quality — meaning with fewer interruptions — and maximal deep sleep can be tracked with smartwatches, fitness bands, rings or mattress sensors.

Sleep apnea, when breathing stops and starts during sleep, is fairly common and often unsuspected. So if you’re having trouble sleeping or you snore loudly, talk to your doctor about ruling out the condition. Testing for sleep apnea can involve checking for good oxygen saturation throughout one’s sleep. That can be done through a sleep study or at home using rings or smartwatches that include oxygen saturation in their sensors and body movement algorithms that pick up disturbed breathing.

Eric Topol, MD, is a cardiologist, professor and executive vice president of Scripps Research in San Diego. He is the author of “Super Agers: An Evidence-Based Approach to Longevity” and the author of Ground Truths on Substack.

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Thanks to many of you Ground Truths subscribers who helped put SUPER AGERS on the NYT bestseller list for 4 weeks.

Here are 2 recent, informative, and fun conversations I had on the topic

Michael Shermer, The Skeptic

Russ Roberts, EconTalk

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