What do you need to eat to become a super ager?

If anyone would know, it’s Eric Topol, a cardiologist and author of the best-selling book “Super Agers: An Evidence-Based Approach to Longevity.” Topol has spent years studying what it takes to become a super ager — someone who lives into their 80s or beyond without the debilitating chronic conditions (heart disease, cancer and neurodegenerative diseases) that strike so many adults.

Instead, what separated them from their less-healthy peers were their lifestyle habits.

That means that becoming a super ager isn’t simply a matter of inheriting the right genes: It’s a matter of creating the right habits. Those habits, Topol said, are exercising regularly, eating a healthy diet, getting around seven hours of nightly sleep, and developing strong social bonds with family and friends.

To increase your odds of becoming a super ager, Topol recommends following a largely Mediterranean diet — which means eating foods such as fresh fruits, vegetables, nuts, seeds, olive oil, seafood and poultry. He also encourages people to avoid ultra-processed foods, which tend to contain added sugars, salt, artificial sweeteners, emulsifiers and other additives that have been linked to poor health.

Topol, who is 71, previously shared with us how he exercises for a long and healthy life. But we wanted to know how he also manages to eat a healthy diet while leading a busy life as a researcher and clinician. So we caught up with him to find out what he eats in a typical day, which foods he strictly avoids and why, and what advice he gives to his patients who struggle with their diets.

This interview has been edited for length and clarity.

What’s your general approach to nutrition?

I’m trying to stick as much as I can to an anti-inflammatory diet. I follow a Mediterranean-like diet because I believe it’s the best approach. That means lots of vegetables, fruit, legumes, plants, salmon and other fish. I also haven’t had any red meat in probably 45 years now. I wrote in my book about how well validated the Mediterranean diet is. It’s the only diet that’s had backing from randomized trials and big, carefully done observational studies. I’ve been on this diet for quite a long time.

You mentioned that you don’t eat red meat. Can you tell us why?

My wife got me started on that 45 years ago. She’s a health nut, too. When she told me she wasn’t eating red meat, I was happy to give it up. I have a family history of colon cancer. And already back then there was data showing a link between red meat and cancer.

What do you eat for breakfast?

I usually get up around 5 a.m., and I eat around 6 a.m. or so. I’ll do some reading first, and then I’ll get a big cup of black coffee. My breakfast is very much routine. I look forward to it every day, unless I’m traveling. It’s nonfat Greek yogurt. I have a good portion of that with blueberries or strawberries, sometimes both. And then I put some low-sugar granola on top. I use a brand called Early Bird granola. Since I wake up hungry, I’m always looking forward to it.

What do you eat for lunch?

It depends on whether I’m working from home or at the office or in clinic. But it’s generally around noon or 1 p.m., and I’ll basically eat a bunch of different nuts — walnuts, almonds, peanuts, I love them all. I make my own mix of nuts. I’ll get these big bags of almonds, walnuts and peanuts. I’ll take a handful of each and mix them up. And that’ll be lunch. They’re really good and inexpensive. It’s really more of a glorified snack. But that, for me, is something I’ll always look forward to. It gets me through the middle of the day.

Sometimes I have lunch for social purposes, and if I do, then I’ll typically get a salad. I may also throw in a few crackers or mini pretzels that I buy at Trader Joe’s.

Why do you eat so many nuts?

I think nuts are really healthy, and they’re a good source of protein and other nutrients. That’s always been my downfall, loving them too much. I had a couple bouts of kidney stones almost a decade ago, and someone told me I shouldn’t eat nuts because they contain a lot of oxalates, which can promote kidney stones if you’re predisposed and you don’t keep well hydrated. But nuts are probably my favorite food. And I love blueberries, strawberries and dried figs, too, which also have a lot of oxalates. I’m like an oxalate magnet. It seems like my natural-food affinities are things that I shouldn’t be eating with my history of kidney stones.

But I’ve come up with a way to circumvent that. I’ve learned that I can still eat these foods as long as I’m very rigorous about hydration. I know that if I just have flat water, I won’t drink that much. But if I have fizzy water, I’ll drink a lot of water throughout the morning and afternoon. So, I always have fizzy water with me. I wouldn’t mess with nuts if I didn’t drink a lot of fluids because I wouldn’t want to have kidney stones again. It’s the worst pain I’ve ever had in my life.

Kidney stones are pretty common by the way, particularly as you get older.

What do you eat for dinner?

I love big salads. I’ll combine lettuce and arugula, and throw in a bunch of shredded carrots, tomatoes and avocado. A few times a week, I’ll take some frozen salmon or frozen fish that I got from Trader Joe’s, and I’ll bake it and then cut it up, and put it on top of the salad. I like balsamic vinegar and olive oil. I mix that up and put it on the salad. That’s my dinner. It only takes five or 10 minutes. Sometimes, I’ll throw in some crumbled blue cheese or Gorgonzola cheese to give it a little extra zip. In the right season, I’ll get some ears of corn, heat them up, and then cut some corn and throw that on the salad, too.

If you saw it, you’d say, “Eric, that’s a pretty big salad!” My family always teases me about it. But I love it. If I don’t have it for a couple days, I get withdrawal from my salad.

Do you eat that every night?

Pretty much. It’s a very healthy and filling dinner. It’s something I’ve enjoyed for quite a long time. It’s a ritual of sorts.

On weekends, I might get together with friends and go to a restaurant, and have something different. Or if I have to go to a work dinner at a restaurant, then I’ll eat whatever they’re serving. It’s never as healthy, but there’s always something good that I can find. Usually, it’s going to be a seafood dish. That’s what I’ll look for. Last night, for example, I was at a restaurant for a big meeting, and I had sea bass.

Are you sure you’re eating enough calories?

Yes, I’ve actually added it up. My breakfast is about 400 calories. The nuts that I eat for lunch are a similar number of calories. Then the big salad that I usually have for dinner is probably another 700 or 800 calories.

Do you eat dessert?

I try not to eat after dinner. In the past, when I wore a glucose monitor, I realized that I didn’t need those extra challenges to my pancreas. But if I’m feeling some hunger soon after dinner, and it’s before 7 p.m., then I might have dried fruit. Or I might even have some more nuts. There are these really thin Trader Joe’s lemon cookies that don’t have many calories. I might have a few of those, too. But I like to fast from about 7 p.m. to 6 a.m. That’s close to a 12-hour fast.

Are there any foods that are guilty pleasures for you?

Yes, I like really good tortilla chips. I’m a sucker for those. Tortilla chips are really high in calories, salt and fat. My wife likes to buy them, and I tell her not to keep them in the house because it really tests my willpower.

I like ice cream, too. But what I’ve learned about ice cream is the stuff that you typically buy is full of ultra-processed junk. You have to get ice cream that doesn’t have all the extra additives.

What nutrition advice do you give to your patients?

Every patient I see, I have them tell me what they had for breakfast, lunch, between meals and for dinner. Then I get a feel for their diet, and I can start suggesting changes or modifications. There’s a lot of people that don’t really know what a healthy diet is. They need help.

In my clinic, a lot of people come in who are overweight, and I try to talk to them about what we can do to get their weight under control without necessarily going on a GLP-1 drug. These are things that are important to discuss.

What are some things that come up a lot?

A lot of people are drinking smoothies without realizing what’s in them and how much sugar they have. There could easily be 1,000 calories in a smoothie, and people aren’t aware.

Some other things that are common: Most people when I ask them what they’re eating, they tell me they eat a fair amount of red meat. I tell them that’s okay but maybe eat less of it. A lot of people are eating and snacking late in the evening after dinner and even between meals. So, it isn’t even just what they’re eating but when they’re eating that can be a problem.

I also frequently have to counsel patients about their alcohol intake. The one that always gets me is this one patient that I had: I had talked to him about his diet, and as we were finishing up, his wife asked if it was okay for her husband to continue to drink in moderation. I said, “Okay, well what is that?” And she said he has six beers and two tequilas every night. I thought they were joking. I started laughing, and they both looked at me and said, “What?”

I think the wife thought there was something peculiar about it. But her husband, the patient, thought it was perfectly normal.

What advice do you have for our readers?

Don’t fall into the protein craze of eating ridiculous, excessive amounts of protein that are just going to be excreted or urinated out. And if you’re getting that protein from bad sources like red meat or ultra-processed foods, then you’re also potentially increasing inflammation.

You should strive for a diet that doesn’t promote inflammation. If you’re reading labels, and there’s a bunch of ingredients on the label, that’s a bad sign. If you’re buying things in bags and boxes, that’s typically a danger sign itself, unless it’s a pure ingredient, like a bag of nuts. You’ll see a lot of packaged foods that have 14 ingredients and nothing you would recognize. Stay away from those. They’re inflammatory. Not all ultra-processed foods are bad. But it’s hard to keep track of which ones are inducing inflammation and which ones are not. So it’s probably best to just stay away from them.

Do you have a question about healthy eating? Email EatingLab@washpost.com, and we may answer your question in a future column.