I'm William Brangham and this is "Horizons."

Some new secret to living a long life seems to be popping up almost every day.

If you drink that coffee before noon, you get those benefits.

Living near green spaces could add more years to your life.

Brangham: But what are the most effective ways to really become a super ager?

And how can you make sure those extra years are healthy ones?

Coming up next.

♪ Narrator: Support for "Horizons" has been provided by Steve and Marilyn Kerman and the Gordon and Betty Moore Foundation.

Additional support is provided by Friends of the News Hour.

♪ This program was made possible by contributions to your PBS station from viewers like you.

Thank you.

From the David M. Rubenstein Studio at WETA in Washington, here is William Brangham.

Welcome to "Horizons."

For thousands of years, we humans have tried to avoid growing old.

We don't age, we upgrade.

Brangham: Tens of billions of dollars are spent every year on potions and procedures to make us look younger, feel younger and think younger.

It is a hugely profitable, but ultimately fruitless hunt for the so-called fountain of youth.

In fact, more than half of us suffer from at least one chronic illness and that percentage jumps as we age.

Over 7 million of us have Alzheimer's disease.

But science has started to zero in on a few intriguing things.

There are some proven techniques we can do to hold off at least a few aspects of aging and disease.

And there are some of us, they're called super agers, who do this seemingly effortlessly.

They're people who, according to many of the ways we measure aging, are far younger than their calendar years would indicate and they don't suffer from the same ailments.

We're going to meet a few of them at the end of this program, but first, we turn to two people who have spent many years studying and trying to understand the process of aging.

Dr.

Eric Topol is a cardiologist and founder of the Scripps Research Translational Institute.

He's also the author of "Super Agers, "an evidence-based approach to longevity."

And Dr.

Sandra Weintraub is a clinical neuropsychologist and professor at Northwestern University's Feinberg School of Medicine, where she researches cognitive brain aging.

Doctors, welcome to both of you.

Thank you so much for being on "Horizons."

Eric Topol, to you first.

Will you just take a stab at defining super agers for us?

Who are they, how do you describe them?

Sure, William.

There's many definitions of what might be considered a super ager, but for us, it's at least age 85 without the age-related diseases, neurodegenerative, cancer, and cardiovascular.

So that's what we have used as our criteria.

And do they don't get a special uniform, like the S on their chest, like Superman, to be a super ager?

Well, it's something we should aspire to.

I don't know if the uniforms would help be an incentive, but certainly being free of the major age-related diseases ought to be something we can achieve in the years ahead.

And Dr.

Sandra Weintraub, what would you add to that definition?

What's a super ager?

Yeah, so we actually coined the term in the late 1990s when we came from the direction of studying age-related memory loss and Alzheimer's disease, but we noticed that there were people who just didn't fit that pattern, who didn't lose their memory.

And so we defined super agers as 80 years old, and on a special memory test where you have to learn 15 words, 20 minutes later, you can remember at least nine of them, which is similar to what somebody 20 to 30 years younger can do.

So we had a very specific memory-dependent description of super aging.

Dr.

Topol, when you ask people about, oh, why so-and-so seemed to age more than others, they always say, "Oh, it's just her genetics."

But we know genetics are really not the sole story here.

Are there some overarching themes or principles that emerge when you study people who are so-called super agers?

That's right, William.

When we did whole genome sequencing of 1400 people that qualified as super agers, we didn't find very much in their sequence, their genomics, DNA, to account for this remarkable health span.

So for us, the hunt went on, and it appears that everything comes together to support that the immune system is fundamental in keeping us healthy and helping to prevent these age-related diseases.

So in fact, now that we have these organ clocks, the immune system clock and the brain clock together appear to be most dominant for helping keeping us protected against the major diseases.

And Dr.

Weintraub, does that dovetail with the research that you've been doing?

Yes, the research that we've been doing has also been looking at factors like social connections.

And one of the things that characterizes our group of super agers is their affinity for social interaction.

They value social relationships, very important to them.

And so we definitely don't have genetic answers yet, but we are also looking for those.

Dr.

Topol, as both of you know, there is this enormous industry out there trying to sell people on ideas and products and philosophies about how to be a super ager.

And I know part of your book, you have argued, is trying to push back on some of that.

What do you make of this industry most broadly?

Is it a useful thing to have the nation focused on this?

Well, yes and no.

On the one hand, we have some really interesting biotech companies that are actually trying to reverse or slow aging.

And there's a lot of possible ways that could be achieved, but so far that only has been shown to have proof in mice and rats.

And on the other hand, we have the pseudoscience, the predators that are selling all sorts of things like anti-aging supplements, peptides, and even all these longevity clinics, which have no basis.

So we have this mixture of some good science that's really advanced the field and understanding the biology of aging and possibly ways in the future that we might be able to intervene.

And on the other, we have just such a jungle of vulnerable people because they actually don't know that these things have no evidence or basis.

Dr.

Weintraub, I see you nodding your head there.

What do you make of this jungle, as Dr.

Topol describes it?

Yes, I fully agree with that.

I think that another thing I would like to add is that there's no one formula.

There's no one answer.

And it's not going to work for everybody because the one thing we've learned by studying various trajectories of aging is that as people get older, they are much more different from one another than a group of younger people.

So in your 20s, more people cluster around what's considered to be the mean of a cognitive test score.

But when you're in your 80s, that mean represents a huge dispersion around the mean.

So I think that I agree that there's absolutely no proof for many of these things.

I'm not sure why people are willing to take them when they won't take things like medication or antidepressants, but I don't think there's going to be one answer.

I think we're all looking for it, but I don't think there will be.

I mean, as you both know, there's also an enormous battery of tests that are put towards people to say, test for this, test for that.

There are routine scans and tests that we do all the time at different age brackets in this country.

What are the tests that are actually helpful and meaningful, Dr.

Topol, to help people understand, "Okay, really, what are my risks "as far as developing an age-related issue?"

Yeah, well, William, there's not like one test for all people, but what we need to do is find out what that individual has particular high risk for.

So for example, let's say a person has a family history of Alzheimer's disease and has an APOE4 allele, one or two copies, may even have a so-called polygenic risk score, which we should all have for our common conditions of these age-related diseases.

That person might really benefit from getting a p-tau217, which is really a breakthrough in the whole field of neuroscience to predict the risk of Alzheimer's and even give us a sense of timing of when cognitive impairment could be manifest.

So each of these major diseases, whether it's heart disease, a neurodegenerative or cancer, there are particular strategies and lab tests that will help us.

And one of the biggest things that's come in recent weeks, actually, is the realization that our thymus gland that we thought, as we became adults, just involuted and became fatty tissue, but it turns out that we can get from a CT scan, low resolution, very inexpensive, very little radiation, we can get the thymic health score, and that is a critical determinant of how good our immune system is.

And as I mentioned earlier, that's going to turn out to be very important for our overall protection against age-related diseases.

Dr.

Weintraub, do you think that there are studies that we do now that are not that helpful?

I mean, again, I think of a battery of tests that happen where people are, at age 45, you get a colonoscopy now.

Are there other tests that we do broadly?

Again, these are not inexpensive.

We are still as wealthy as a nation we are.

There's limited resources.

Are there tests that we are doing too much of?

Yeah, I can only speak to the tests that we're not doing enough of.

And because I'm a neuropsychologist, one of the tests that we really don't do enough of is measuring people's brain health early on.

We don't, when I see patients in my clinic, I don't know what they were like when they were 20 or 30 or 40.

And yet I know they have a 40-year history of all their blood pressures and their liver function tests and so on.

So I think that having a brain measure that actually measures your cognitive ability at a younger point in life, that would be a great baseline so that you could track changes over time because everybody then has their own baseline.

Right, Dr.

Topol, it's a difficult thing to do to get young people to say, "Hey, "just in case you might develop age-related dementia, "maybe you ought to get a baseline right now."

I mean, on some level, we're pushing past the stigma about these diseases and the idea that young people think, "I'm never going to get old, "I'm never going to lose my mind."

Well, this is really important that you're bringing up because each of these major age-related diseases take 20 or more years to incubate in our bodies.

So getting a hand on things early, be age 40 or 50, that's going to really anticipate potential risk and enable prevention.

So we're going to be moving towards that for sure.

And going back to your earlier question, if you're at risk for heart disease, people want to know when they're young, in fact, there's new guidelines about their LDL cholesterol and their lipoprotein A, and especially if people are at increased risk, we need to get all over that as young an age as possible.

So prevention is going to be, just as Dr.

Weintraub said, starting out early.

Dr.

Weintraub, if someone were to take a cognitive test as you're describing early in life, and let's say there was some signal that they might have a propensity for this, is there prevention for dementia or Alzheimer's in any meaningful way?

Well, I think that Dr.

Topol's book is really a great summary of everything that you can possibly do to control risk.

It's all a matter of controlling risk.

And there are risks coming from everywhere, from sleep, from your mood, from your diet, from exercise.

And so being aware of those risks and specifically what those risks are for you personally.

For example, I'm not a big exerciser.

I'm going to try, but... You're not supposed to admit that on national television.

I admit it, but I did play tennis for many, many years.

So I figured maybe I got it early on when that kind of risk input was valuable.

But seriously, the risk control is the most important thing.

That doesn't mean that, if you control all of that, you're not going to get dementia, but it means that, if you don't control it, you're probably much more likely to get it.

And so you do the best you can with your lifestyle.

Topol: Yeah, and we're actually starting, William, a prevention of Alzheimer's trial in the next week where we're taking 1200 people with the highest risk of Alzheimer's and randomly assigning half to intensive lifestyle coaching, 24-7.

Exercise, sleep health, diet, everything, social connections.

And then the other half, just to get some educational materials.

And we're going to find out how that lowers p-tau217, affects the brain, pace of aging clock.

And we're going to get some information, very granular about this whole lifestyle improvement before we start to look at potential candidate drugs that might also help us prevent Alzheimer's.

I mean, both of you, as you're talking here, seem to be laying out some basic principles, prescriptions, non-pharmaceutical prescriptions for how to get as close to being a super ager if you can, even if you don't get the Superman uniform later in life.

Dr.

Weintraub, what else would you add to this?

What is it, if someone comes to you and says, "Look, I'm trying to do this, "I'm trying to live the best possible life I can."

And again, you hide the fact that you're not an exercise yourself from them.

What is it you, what do you counsel people to do?

What should we all be doing?

Well, I have a list, okay?

And it's the typical list of diet, exercise, depression, sleep, and kind of go through things and say, well, what are you doing and where can you potentially improve what you're currently doing to decrease your risk further?

So I don't have any specific suggestions, but for example, a lot of people say to me, "Well, should I do crossword puzzles?"

I say, "Do you do crossword puzzles?

"You like to do them?"

"No, I never did them."

Well, if you don't like them and you've never done them, that's not going to be the answer for you.

So it's going to be something that maybe you're interested in painting and you really haven't done much of it, but that might be of more interest to you.

It's more important to get engaged.

The other factor, as I mentioned earlier, is social connections, very important.

It's, as people get older, certainly their social network shrinks tremendously, family members, friends, and it's really important to try to maintain as much as possible those social connections.

Brangham: Dr.

Topol, what else would you add to that list?

People coming to you saying, "Help me out, you study this, what should I be doing?"

Yeah, I mean, I think each of the big three, the exercise and sleep and diet have a lot of specifics to get into, but beyond that and beyond social engagement, things like being out in nature, the data for that are actually quite striking.

The whole idea of having purpose and hobby.

One thing we've learned among the super-agers is a remarkable sunny disposition, this optimism, which you don't know, William, whether it's because they're super ager or that it helped them become one.

Brangham: Right, it's chicken and the egg there.

It's very rare to meet one of these folks who are not an optimistic, upbeat person.

So I think we've learned about the common threads across these folks, and I think we're just going to do the things that we know, like all these lifestyle things we've discussed, I call them lifestyle plus, because it's not just the three conventional ones, they really have an impact, all of them, on the health of our immune system, interestingly, and preventing this so-called immunosenescence that occurs with aging and inflammaging.

So we understand the biology so much better, and we're going to keep learning about things.

It could be listening to more music or various things in our environment that could make a difference to promote that health of our immune system.

Dr.

Weintraub, I can't help but thinking that some of the things you're describing, I get it, to eat better and to sleep better and to have connections with friends, some of these things are difficult, though, and are somewhat dependent on your wealth, to buy better foods, to have the time to be in a place where you can go outside into nature, to be able to travel, to choose your hobbies that make you happy are very difficult to do if you're caring for elderly parents or working two jobs or just struggling to make ends meet.

How do we make this prescription not something solely for the wealthy?

Yeah, there are so many health inequities, and we're all very much more attuned to those now than we used to be.

There are lots of public programs available.

I wish there were more, but there are lots of senior centers.

We encourage people in the communities around our medical center to get involved in these activities, to go to places where they can have a hot lunch every day.

And so, there are resources out there, but they require a lot of research and a lot of active searching for them.

And Dr.

Topol, just in the last minute or so we have left, the same question to you.

How do we make this so that this is more available to all of us?

And again, I understand that this is, some of these are societal problems and that's not your job here to address, but what would you counsel in that regard?

What we've been learning is it takes deliberate efforts to try to reduce these inequities.

So coming up with programs, the people who will benefit the most are the ones, of course, not getting access to these, whether it's the testing or the strategies, the improvement of lifestyle.

But we've already seen programs, particularly in the UK and other parts of the world, where that intent efforts were made.

So none of the things that we're discussing are of extreme cost in terms of things like lifestyle changes.

And also some of the testing can be done very inexpensively.

So it just takes the will because the economic burden can be markedly reduced in the people that are at the highest risk.

So hopefully we'll start to see that deliberate effort.

All right, Dr.

Eric Topol, Dr.

Sandra Weintraub, thank you both so much for spending the time talking with us.

Such a fascinating conversation.

Thank you so much for being here.

Topol: Thank you.

Weintraub: Thank you.

Before we go, we've been talking about how to best live a long and healthy life.

So we wanted to hear from some of these super agers themselves.

Here are a few of the research participants from Northwestern Universities and the University of Chicago's Super Ager Research Program.

I'm Sheila Nicholas and I'm 85.

My real name is Lawrence Seiger.

I go by Larry.

I'm 93 and a half years old.

My full name is Julian Schachner, but everybody calls me Jay.

So I go by Jay.

I'm 94.

I'll be 95 in June.

My name is Lajuana Weathers and I'm 89, almost 90 in two months.

I'm Marvin Mackinen and I'm 86 years old.

Super means like Superman, Superwoman, keep going, keep going, keep going.

And that's the way I am.

My kids say, "Mom, you need to sit down."

No, as long as I can continue to do it, I'm going to do it.

They keep telling me that my mind is 20, 30 years younger than my body.

I don't know why or how, but I'm enjoying it tremendously.

My wife and I actually, years before we turned 80, were also volunteers.

When we turned 80, they asked us to become Super Duper.

I think I'm just one of those that just is in the right place at the right time and in the right environment to be a part of this.

I'm a little uncomfortable, frankly, being called a super ager because I don't see anything special about myself.

But I guess I'm very fortunate.

My second wife is a wonderful cook and we eat properly.

She makes me laugh.

And there was an insurance commercial that said people who laugh live on the average seven years longer than those that don't.

It was unusual too, that a married couple, we're both... Super Agers.

And we come from diverse backgrounds.

You want to live long, you have to take care of this temple that you live in, all the areas of it.

Not just what you eat, what you think, what you say, how you present yourself.

Are you loving?

Are you kind?

All of those good things that make people come toward you rather than see you and run away.

I think walking is a wonderful activity.

I try to walk about two to three miles every day.

It doesn't always work out that way.

But, and sometimes you just don't feel like doing it.

But it's important to continue.

My wife died about a month ago and we have both donated our brains to Northwestern University to be in a research program.

That was an exciting, to do something for future generations, you know, youngsters like you and your grandchildren who may not have to be concerned about this in the future.

Think positive, stay active, eat healthy, enjoy your life in a positive way.

Enormous thanks to all of those participants for talking with us.

That is it for this episode of "Horizons."

You can find us on YouTube and wherever you get your podcasts.

We'll see you next week.

Narrator: Support for "Horizons" has been provided by Steve and Marilyn Kerman and the Gordon and Betty Moore Foundation.

Additional support is provided by Friends of the News Hour.

♪ This program was made possible by contributions to your PBS station from viewers like you.

Thank you.

♪ You're watching PBS.