Why Self-Care Has Become The Most Important Form Of Healthcare – And What You Can Do To Improve It

In his recently published (and very good) book Super Agers: An Evidence-Based Approach to Longevity, Dr. Eric Topol emphasizes that extending healthspan—the period of life spent free from major diseases—is far more about lifestyle choices than genetics. His recommendations, grounded in decades of research on individuals who thrive into their 80s and beyond, focus on practical, evidence-based strategies.

In addition to the health-related benefits of proper self-care, there are growing financial benefits. As healthcare related to chronic conditions (including heart disease, diabetes, obesity, cancer, and neurogenerative diseases such as Alzheimer’s) becomes increasingly expensive, and as more of the costs of healthcare are being passed onto insured consumers in the form of increased deductibles, co-payments, and coverage limitations, and as more individuals are uninsured, avoidance of expensive healthcare conditions and procedures has become essential to financial security.

It’s NOT All in Your Genes

For much of my generally healthy life, I have been hearing that “you can’t beat your genes.” I have always been skeptical of this notion, not due to any hard evidence to the contrary, but because of an instinctive sense based on observation that it must be an oversimplification, and because of a stubborn refusal to accept such a fatalistic approach in my own life and those of friends and family members. Fortunately, there is growing evidence to suggest that my instinct has been correct, including one study highlighted in Dr. Topol’s book.

Two decades ago, a California research team he led sequenced the genomes of 1,400 adults aged 80 or older without any major illness. The researchers expected to find genetic differences between this cohort (which they called the “Wellderly”) and the majority of older adults who have at least two chronic conditions (which they called the “Illderly”).

However, the Wellderly study found almost no difference between the biological makeup of the two groups. What they did find was that Wellderly members were more physically active, more social, and typically better educated than the general public. That genes don’t necessarily determine healthy aging is “liberating,” and suggests that “we can all do better” to delay disease, says Topol.

In his book, Dr. Topol cites many examples of “Super Agers” whose parents died in their 50s from chronic conditions. Yet, these people are going strong in their 80s and 90s, and he believes that lifestyle has a much greater impact on health and longevity than genetics. While genetics may set the “upper limit” for human lifespan—generally 90–100 years—he believes that lifestyle choices largely determine how close individuals come to reaching that potential without significant limitations.

Dr. Topol and a growing number of other experts estimate that 80–90% of heart disease, 40–50% of cancers, and nearly half of Alzheimer’s cases are delayable or preventable through lifestyle factors such as exercise, diet, sleep, and social connection. Genetics may account for only 10–20% of overall health outcomes and lifespan, with lifestyle accounting for the remaining 80–90%.

Evidence-Based Self-Care

If you accept this premise, the next question is, “What kind of self-care will extend my healthspan that is supported by evidence-based research?” There is no shortage of unsupported recommendations. One of the reasons I admire Dr. Topol’s approach is that he sticks to what is supported by research and cites the research being cited. As background, he is a cardiologist, founder of the Scripps Research Translational Institute, and a molecular scientist who has published 1,300 articles and had multiple books referenced.

Following is a summary of what Dr. Topol has to say about what he calls “Lifestyle+.” However, I highly recommend that you read the chapter in his book on this subject, as it contains many actionable insights that are beyond the scope of this article, including summaries of the evidence supporting some healthspan-promoting practices and casting doubt on the efficacy of others.

1. Exercise as the Cornerstone

  • Dr. Topol identifies regular physical activity as “the single most important medical intervention we know”. Overwhelming amounts of research conclusively indicates that exercise not only reduces the risk of heart disease, cancer, and neurodegenerative disorders, but also strengthens the immune system and preserves cognitive function.
  • He cites a systematic review of 196 studies covering more than 30 million participants that linked exercise to a 31% reduction of all-cause mortality, with a “dose response” of more activity conferring more benefit.
  • He advocates for a combination of:
    • Aerobic exercise (such as running, brisk walking, and cycling)
    • Strength training (including resistance and grip strength exercises)
    • Balance training (e.g., standing on one foot)
  • In addition to the above benefits, these activities help counteract age-related muscle and bone loss, improve balance and mobility, and enhance mental clarity.
  • Dr. Topol also cites evidence that it’s never too late to start exercising and that a little goes a long way. Significant health benefits are associated with just 150 minutes per week of moderate physical activity (e.g., dedicated brisk walking) plus muscle-strengthening activity at least twice a week for 20-30 minutes each.
  • More and more vigorous exercise provides even more health benefits, although it is possible that the benefits plateau at very high activity and intensity levels.

2. Mediterranean Diet

  • Dr. Topol recommends the Mediterranean diet, which is rich in whole foods, colorful fruits and vegetables, legumes such as lentils and garbanzo beans, whole grains, nuts and seeds, healthy fats such as olive oil and avocadoes, and fatty fish such as salmon and tuna, with limited consumption of dairy products (preferably yogurt and hard cheese).
  • This diet is associated with a dose-related lower risk of cardiovascular, cancer, and neurodegenerative disease, as well as all-cause mortality.
  • He warns against the consumption of ultra-processed foods (which he likens to smoking in terms of its negative health effects) and cautions against more than light consumption of alcohol. In both cases, he notes that the negative health effects are dose-related, with higher levels of consumption translating to greater health risks. [Notably, he doesn’t devote a specific section to the dangers of smoking, though he does mention them, presumably because he believes they have been well established at this point.]
  • He also expresses skepticism about the keto diet, suggesting that heavy consumption of protein from animal sources may lead to weight loss but result in poor health outcomes (except where this diet is indicated for specific medical conditions).
  • He also warns against excess sugar (especially in sugary beverages), excess salt consumption (particularly for people with hypertension), and heavy consumption of processed (especially) and unprocessed red meat.
  • He reports that the evidence supporting the benefits of intermittent fasting and restricted caloric diets is mixed, though they may prove to have beneficial effects on inflammation and immune response.

3. Sleep Quality and Duration

  • He stresses the importance of deep, restorative sleep, highlighting new insights into the brain’s glymphatic system, which clears waste products during sleep. He also notes that this kind of sleep becomes more difficult with age.
  • Good sleep supports cognitive health and may reduce the risk of neurodegenerative diseases.
  • He notes that consistent sleep routines, regular exercise, adequate meal separation from bedtime, a cool and dark sleeping space, and the avoidance of blue light from electronic devices before bedtime facilitate improved sleep quality.
  • He cites evidence that seven to eight hours is the ideal daily amount, with negative effects both below and above that level.

4. Social Connection and Cognitive Engagement

5. Avoiding Unproven Longevity Hacks

  • Dr. Topol cautions against unproven interventions such as supplement regimens, full-body scans, and experimental drugs that lack solid evidence in humans.

Measuring Your Risk

Dr. Topol recommends a personalized and dynamic approach to health risk evaluation, including but also moving beyond traditional population-based screening and annual tests. His logic is based on the fact that many potentially debilitating diseases develop over decades, and that understanding one’s vulnerability to one or more of them well in advance can facilitate interventions to prevent or delay the onset of symptoms. His key recommendations include:

1. Longitudinal Tracking of Lab Tests

  • He emphasizes the importance of monitoring trends in your lab results over time rather than relying solely on single, cross-sectional values compared to population averages. Subtle changes within your personal baseline can reveal early signs of disease, sometimes before values fall outside the “normal” range.
  • These are the key standard blood tests he recommends:
    • Lipid Panel
      • Measures total cholesterol, LDL, HDL, and triglycerides.
      • Assesses cardiovascular risk and guides lifestyle or medication interventions.
    • Blood Glucose
      • Includes fasting blood glucose and HbA1c (glycated hemoglobin).
      • Screens for diabetes and prediabetes and monitors metabolic health.
    • Hormone Levels
      • Commonly includes thyroid function tests (TSH, T4, T3), testosterone (for men), and estrogen (for women).
      • Evaluates endocrine health and can reveal age-related hormonal changes.
  • He also specifically highlights the value of Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), Lipoprotein(a) (particularly for those at high risk for cardiovascular disease), and tracking markers such as platelet count and red cell distribution width (RDW), which can indicate underlying health issues if they change over time.
  • He does not universally recommend Vitamin D testing, but says that it should be considered on an individual basis where deficiency is suspected or risk factors exist.

2. Emerging Blood-Based Screening

  • He highlights the potential of multi-cancer early detection (MCED) blood tests (“liquid biopsies”) that look for cancer signals in the blood. While not yet standard practice, these are advancing rapidly and may soon become part of individualized risk assessment.

3. Genomic and Polygenic Risk Scores

  • For cancer, cardiovascular, and other diseases, he sees promise in polygenic risk scores (PRS) and genetic testing for known pathogenic variants. These can help tailor screening strategies to your individual risk profile, potentially reducing unnecessary testing for those at low risk and focusing attention on those at higher risk.

4. Brain Health and Alzheimer’s Disease

  • p-Tau217 Blood Test: Detects early biomarkers of Alzheimer’s disease, particularly useful for those with genetic risk factors (e.g., APOE4 carriers).
  • APOE4 Genetic Testing: Identifies genetic predisposition to Alzheimer’s, though he emphasizes the value of polygenic risk scores (see above) and biomarker testing for a fuller risk assessment.

5. AI and Digital Tools

6. Avoiding Unnecessary Full-Body Scans

  • He warns against routine use of total body MRI or similar scans in healthy people, as these often lead to false positives and unnecessary, sometimes risky, follow-up procedures.

7. Reservations about Aging Clocks

  • He does not currently recommend commercial “aging clocks” or biological age tests due to concerns about cost and accuracy.

Always Look for the Evidence

I rarely endorse a single work as I am with Super Agers, but as it has become increasingly clear that we must take more responsibility for our own health care—for both healthy aging and financial security—it has become equally difficult to find trusted sources of information about how best to do this among the torrent of possibilities that are not evidence-based (e.g., more than 60,000 diet books are sold on Amazon).

With that said, the combination of rapid advances in life science and information technology, including polygenic risk scoring, genome sequencing, imaging, and multimodal AI, is accelerating the pace of change and identifying new opportunities to increase healthspan that would have been unthinkable just a few years ago.

So, there is no healthspan “handbook” available today that will be completely relevant tomorrow. Our ongoing challenge will be to sort through the many possible breakthroughs to identify the few that are truly supported by evidence. There are 326 research citations in Dr. Topol’s nearly 100-page bibliography in Super Agers, which is the kind of scientific rigor we need to guide us today and hope to have at our fingertips tomorrow.

Originally posted on Forbes.com