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Outlive: The Science and Art of Longevity
Goodreads Choice Award
Nominee for Best Nonfiction (2023)#1 NEW YORK TIMES BESTSELLER • A groundbreaking manifesto on living better and longer that challenges the conventional medical thinking on aging and reveals a new approach to preventing chronic disease and extending long-term health, from a visionary physician and leading longevity expert
“One of the most important books you’ll ever read.”—Steven D. Levitt, New York Times bestselling author of Freakonomics
Wouldn’t you like to live longer? And better? In this operating manual for longevity, Dr. Peter Attia draws on the latest science to deliver innovative nutritional interventions, techniques for optimizing exercise and sleep, and tools for addressing emotional and mental health.
For all its successes, mainstream medicine has failed to make much progress against the diseases of aging that kill most people: heart disease, cancer, Alzheimer’s disease, and type 2 diabetes. Too often, it intervenes with treatments too late to help, prolonging lifespan at the expense of healthspan, or quality of life. Dr. Attia believes we must replace this outdated framework with a personalized, proactive strategy for longevity, one where we take action now, rather than waiting.
This is not “biohacking,” it’s science: a well-founded strategic and tactical approach to extending lifespan while also improving our physical, cognitive, and emotional health. Dr. Attia’s aim is less to tell you what to do and more to help you learn how to think about long-term health, in order to create the best plan for you as an individual. In Outlive, readers will discover:
• Why the cholesterol test at your annual physical doesn’t tell you enough about your actual risk of dying from a heart attack.
• That you may already suffer from an extremely common yet underdiagnosed liver condition that could be a precursor to the chronic diseases of aging.
• Why exercise is the most potent pro-longevity “drug”—and how to begin training for the “Centenarian Decathlon.”
• Why you should forget about diets, and focus instead on nutritional biochemistry, using technology and data to personalize your eating pattern.
• Why striving for physical health and longevity, but ignoring emotional health, could be the ultimate curse of all.
Aging and longevity are far more malleable than we think; our fate is not set in stone. With the right roadmap, you can plot a different path for your life, one that lets you outlive your genes to make each decade better than the one before.
“One of the most important books you’ll ever read.”—Steven D. Levitt, New York Times bestselling author of Freakonomics
Wouldn’t you like to live longer? And better? In this operating manual for longevity, Dr. Peter Attia draws on the latest science to deliver innovative nutritional interventions, techniques for optimizing exercise and sleep, and tools for addressing emotional and mental health.
For all its successes, mainstream medicine has failed to make much progress against the diseases of aging that kill most people: heart disease, cancer, Alzheimer’s disease, and type 2 diabetes. Too often, it intervenes with treatments too late to help, prolonging lifespan at the expense of healthspan, or quality of life. Dr. Attia believes we must replace this outdated framework with a personalized, proactive strategy for longevity, one where we take action now, rather than waiting.
This is not “biohacking,” it’s science: a well-founded strategic and tactical approach to extending lifespan while also improving our physical, cognitive, and emotional health. Dr. Attia’s aim is less to tell you what to do and more to help you learn how to think about long-term health, in order to create the best plan for you as an individual. In Outlive, readers will discover:
• Why the cholesterol test at your annual physical doesn’t tell you enough about your actual risk of dying from a heart attack.
• That you may already suffer from an extremely common yet underdiagnosed liver condition that could be a precursor to the chronic diseases of aging.
• Why exercise is the most potent pro-longevity “drug”—and how to begin training for the “Centenarian Decathlon.”
• Why you should forget about diets, and focus instead on nutritional biochemistry, using technology and data to personalize your eating pattern.
• Why striving for physical health and longevity, but ignoring emotional health, could be the ultimate curse of all.
Aging and longevity are far more malleable than we think; our fate is not set in stone. With the right roadmap, you can plot a different path for your life, one that lets you outlive your genes to make each decade better than the one before.
496 pages, Hardcover
First published March 28, 2023
About the author
Peter Attia
4 books804 followersPeter Attia (born 19 March 1973) is a Canadian-American physician known for his medical practice that focuses on the science of longevity. He is also the first person to make the round-trip swim from Maui and Lanai. He is the author of the book Outlive: The Science & Art of Longevity (with Bill Gifford).
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Displaying 1 - 30 of 4,245 reviews
August 26, 2023
1. There are no footnotes in the body of the text. The reader has to guess there will be a note, turn to the back of the book and search the note section by page number and then by the sentence to see if there is one. Weird, especially considering how Attia tries to emphasis his reliance on science and numbers.
2. The actual important/useable information could have been distilled down to a 20-30 page pamphlet with footnotes to relevant studies. The rest is anecdotes, analogies and Attia’s personal opinions.
3. The book is not formatted in a way where the usable info is easy to spot and go back to for later reference. It sucks having to wade through 400 pages of fluff material.
4. The final section on emotional health is about Attia’s struggle to overcome being an asshole that segues in to a mention of DBT as a way to make this section fit in to the book.
Yet, if Attia had just written a book on this topic alone and the research and data behind the treatment and success rates, it would be an excellent book.
5. There is no information in the book that can’t easily be found online for free.
6. The book feels like it was written initially as a stream of thought and someone else was tasked to edit it in to some kind of organized format.
7. Attia’s reliance on extreme monitoring of his patients bloodwork, glucose, etc feels like a grift. If you run enough tests on people you will eventually find some result outside the range of “normal”. That doesn’t mean anything is wrong. His assumption that if lowering a value to x is good, then x/2 must be better could actually be quite wrong.
8. Attia mentions centenarians but never seems to address the fact that these people lived to these ages without the kind of extreme monitoring or regimens he proposes.
This issue is probably the one that is my deal breaker with all longevity experts. My grandparents lived to 90, 102, 100 and 96. Some smoked, some drank, none ran, none lifted weights and none went to therapy. One was even in the Bikini Islands within the strike zone for the Castle Project explosions. I have to believe a huge part of their longevity is due to genes. Which ones? Who knows. So what parts of their environment was the other factors that lead to their longevity?
Instead of focusing on making people guinea pigs of what ones hopes are longevity regimens, perhaps a better focus would be on super seniors and researching what about them genetically, their diets or their habits is setting them apart from the average.
2. The actual important/useable information could have been distilled down to a 20-30 page pamphlet with footnotes to relevant studies. The rest is anecdotes, analogies and Attia’s personal opinions.
3. The book is not formatted in a way where the usable info is easy to spot and go back to for later reference. It sucks having to wade through 400 pages of fluff material.
4. The final section on emotional health is about Attia’s struggle to overcome being an asshole that segues in to a mention of DBT as a way to make this section fit in to the book.
Yet, if Attia had just written a book on this topic alone and the research and data behind the treatment and success rates, it would be an excellent book.
5. There is no information in the book that can’t easily be found online for free.
6. The book feels like it was written initially as a stream of thought and someone else was tasked to edit it in to some kind of organized format.
7. Attia’s reliance on extreme monitoring of his patients bloodwork, glucose, etc feels like a grift. If you run enough tests on people you will eventually find some result outside the range of “normal”. That doesn’t mean anything is wrong. His assumption that if lowering a value to x is good, then x/2 must be better could actually be quite wrong.
8. Attia mentions centenarians but never seems to address the fact that these people lived to these ages without the kind of extreme monitoring or regimens he proposes.
This issue is probably the one that is my deal breaker with all longevity experts. My grandparents lived to 90, 102, 100 and 96. Some smoked, some drank, none ran, none lifted weights and none went to therapy. One was even in the Bikini Islands within the strike zone for the Castle Project explosions. I have to believe a huge part of their longevity is due to genes. Which ones? Who knows. So what parts of their environment was the other factors that lead to their longevity?
Instead of focusing on making people guinea pigs of what ones hopes are longevity regimens, perhaps a better focus would be on super seniors and researching what about them genetically, their diets or their habits is setting them apart from the average.
April 16, 2023
This book has sections that contain invaluable information. But as a book it's 5x too long.
I saw this line in the acknowledgments section:
"my then publisher said my draft was too technical and lacked any sense of me as a person and my own journey to understanding the importance of longevity."
I wish publishers would stop this approach. Non-fiction books don't need a hero's journey. Often readers simply want the information. Adding a narrative just dilutes and prolongs the book.
I saw this line in the acknowledgments section:
"my then publisher said my draft was too technical and lacked any sense of me as a person and my own journey to understanding the importance of longevity."
I wish publishers would stop this approach. Non-fiction books don't need a hero's journey. Often readers simply want the information. Adding a narrative just dilutes and prolongs the book.
June 26, 2023
Yes, honestly, everyone wants to know more about longevity.
We want to live longer and live better.
Medicine 3.0 consists of 5 broad domains.
1. Exercise
2. Nutrition
3. Sleep
4. Emotional health
5. Exogenous Modules (Drugs, hormones, or supplements)
Our goal is to live longer without the disease.
I am interested to improve my VO2 Max too.
The author suggested training our "Core" to improve our stability especially for older people to avoid falling.
An ideal book to discover more new tactics and ideas to improve our quality of life.
We want to live longer and live better.
Medicine 3.0 consists of 5 broad domains.
1. Exercise
2. Nutrition
3. Sleep
4. Emotional health
5. Exogenous Modules (Drugs, hormones, or supplements)
Our goal is to live longer without the disease.
I am interested to improve my VO2 Max too.
The author suggested training our "Core" to improve our stability especially for older people to avoid falling.
An ideal book to discover more new tactics and ideas to improve our quality of life.
June 30, 2023
This book was written by men, for men.
Let me explain...
And this will be long, because I felt like this book had so much potential.
1. The author should have started the book with his mental health story. Literally, the last chapter he starts to talk about the fixed mindset versus the growth mindset (without using those terms exactly), but that should be topic #1. You literally cannot proceed, if you have a fixed mindset.
2. This author could benefit from reading the book Invisible Women. He references many studies and statistics, but it is well known that women are very underrepresented in those statistics. He talks about, what he calls, "Healthcare 2.0 vs. Healthcare 3.0". Healthcare 3.0 is supposed to take the patient, as an individual, into consideration. We cannot apply statistics to women, if those statistics do not involve women. Another topic that is harmful for women, is dieting. He suggests calorie cutting and fasting, although he does say it's not for everyone. I think he just doesn't understand how harmful those topics are, especially to young women who have probably been using calorie counting apps since they first learned how to download an app.
3. He suggests way too many medications. In fact, he starts suggesting medications before we even get to the chapters on food. If anything, food recommendations should be listed prior to medications. I'm specifically referring to the section where he talks about using drugs to lower ApoB levels. A quick Google search told me; fatty fish, legumes and plant protein, olive oil, and minimally processed fiber-rich sources of carbs could help lower ApoB levels. All of those foods are also listed in The Mediterranean Diet, which is the most highly recommended diet for a reason.
4. I work in Oncology, so for the chapter on Cancer, I would have talked about beauty and household products. Many of the foods we eat have carcinogens, but also our beauty products, our clothes, our household products. We are basically in a giant fishbowl of carcinogens. I use apps like Yuka, Bobby Approved, and Healthy Living to scan products before I buy them.
5. He talks about how exercise can help with our breathing and then mentions meditation at the very end of the book when he is talking about mental health. Meditation can also be a good way to manage our breathing. A lot of these topics go hand and hand, so the way this book is structured is a little all over the place.
6.Protein is important, but not at the cost of fiber and other nutrients. This is one of the reasons I could tell this book was written by a man. Men push protein so hard, because they care more about muscle than women do. Colon cancer is on the rise in young people, because we are being told to eat more protein and less carbs. The lack of fiber in our diets is the main cause, but protein can be very filling. If you're eating it in excess, you might not be hungry enough to eat your fiber rich foods. As my nutrition professor would say "everything in moderation".
7. Also, he never mentions Blue Zones, not once. Which I find extremely odd, seeing this is a book about longevity. Episode 4 of the show Down to Earth, talks about the blue zone of Sardinia. They actually found that the people there had a high carb, low protein diet. They also walked a lot more than the average American, and they made all of their "carbs" from real ingredients, from scratch. The issue with carbs in America, is much more a testament to the American food industry, but I digress.
8. Unfortunately for this author, and for many men in general, he grew up with toxic masculity which negatively impacted his mental health. I think he has come a long way, from what he has said in his chapter on mental health, but I could tell he is still learning. There is a lot of unconscious bias spread throughout this entire book and it only became more obvious in his chapters on exercise and nutrition. He basically tells us, the entire first half of the book that his "Healthcare 3.0" is not a one-size fits all solution. That he tailors it to fit his patients unique needs. Yet, the chapters on fitness and food are very specific instructions. He even says, if you find yourself disagreeing with what he says to "stop overthinking nutrition so much, hit pause on the audio-bo0k, go outside and get some exercise" (I was listening to the audiobook so I'm not sure what the physical book says).
In conclusion, I do think there are a lot of important topics covered in this book and if you are a really unhealth person, you could find this book beneficial. If you are already a healthy person, this book was probably nothing new for you. I really liked the first half of this book, I felt he started to lose me once he got to exercise and nutrition. I also think he could have benefitted from a more feminine POV.
Let me explain...
And this will be long, because I felt like this book had so much potential.
1. The author should have started the book with his mental health story. Literally, the last chapter he starts to talk about the fixed mindset versus the growth mindset (without using those terms exactly), but that should be topic #1. You literally cannot proceed, if you have a fixed mindset.
2. This author could benefit from reading the book Invisible Women. He references many studies and statistics, but it is well known that women are very underrepresented in those statistics. He talks about, what he calls, "Healthcare 2.0 vs. Healthcare 3.0". Healthcare 3.0 is supposed to take the patient, as an individual, into consideration. We cannot apply statistics to women, if those statistics do not involve women. Another topic that is harmful for women, is dieting. He suggests calorie cutting and fasting, although he does say it's not for everyone. I think he just doesn't understand how harmful those topics are, especially to young women who have probably been using calorie counting apps since they first learned how to download an app.
3. He suggests way too many medications. In fact, he starts suggesting medications before we even get to the chapters on food. If anything, food recommendations should be listed prior to medications. I'm specifically referring to the section where he talks about using drugs to lower ApoB levels. A quick Google search told me; fatty fish, legumes and plant protein, olive oil, and minimally processed fiber-rich sources of carbs could help lower ApoB levels. All of those foods are also listed in The Mediterranean Diet, which is the most highly recommended diet for a reason.
4. I work in Oncology, so for the chapter on Cancer, I would have talked about beauty and household products. Many of the foods we eat have carcinogens, but also our beauty products, our clothes, our household products. We are basically in a giant fishbowl of carcinogens. I use apps like Yuka, Bobby Approved, and Healthy Living to scan products before I buy them.
5. He talks about how exercise can help with our breathing and then mentions meditation at the very end of the book when he is talking about mental health. Meditation can also be a good way to manage our breathing. A lot of these topics go hand and hand, so the way this book is structured is a little all over the place.
6.Protein is important, but not at the cost of fiber and other nutrients. This is one of the reasons I could tell this book was written by a man. Men push protein so hard, because they care more about muscle than women do. Colon cancer is on the rise in young people, because we are being told to eat more protein and less carbs. The lack of fiber in our diets is the main cause, but protein can be very filling. If you're eating it in excess, you might not be hungry enough to eat your fiber rich foods. As my nutrition professor would say "everything in moderation".
7. Also, he never mentions Blue Zones, not once. Which I find extremely odd, seeing this is a book about longevity. Episode 4 of the show Down to Earth, talks about the blue zone of Sardinia. They actually found that the people there had a high carb, low protein diet. They also walked a lot more than the average American, and they made all of their "carbs" from real ingredients, from scratch. The issue with carbs in America, is much more a testament to the American food industry, but I digress.
8. Unfortunately for this author, and for many men in general, he grew up with toxic masculity which negatively impacted his mental health. I think he has come a long way, from what he has said in his chapter on mental health, but I could tell he is still learning. There is a lot of unconscious bias spread throughout this entire book and it only became more obvious in his chapters on exercise and nutrition. He basically tells us, the entire first half of the book that his "Healthcare 3.0" is not a one-size fits all solution. That he tailors it to fit his patients unique needs. Yet, the chapters on fitness and food are very specific instructions. He even says, if you find yourself disagreeing with what he says to "stop overthinking nutrition so much, hit pause on the audio-bo0k, go outside and get some exercise" (I was listening to the audiobook so I'm not sure what the physical book says).
In conclusion, I do think there are a lot of important topics covered in this book and if you are a really unhealth person, you could find this book beneficial. If you are already a healthy person, this book was probably nothing new for you. I really liked the first half of this book, I felt he started to lose me once he got to exercise and nutrition. I also think he could have benefitted from a more feminine POV.
December 17, 2023
I recently had the opportunity to listen to the audiobook version of "Outlive: The Science and Art of Longevity," and it was an enlightening and thought-provoking experience. The link to the audiobook can be found here
Outlive: The Science and Art of Longevity
, allowing you to explore the fascinating world of longevity and healthy living.
"Outlive" delves into the science behind longevity, providing valuable insights into the factors that contribute to a longer and healthier life. The narrator's engaging voice and clear delivery made it easy to absorb the wealth of information presented in the book.
This audiobook not only delves into the scientific aspects of longevity but also explores the art of living well. It offers practical tips, actionable advice, and inspiring anecdotes that empower listeners to make positive changes in their own lives.
What sets "Outlive" apart is its comprehensive approach. It covers a wide range of topics, including nutrition, exercise, sleep, stress management, and mental well-being, providing a holistic perspective on longevity. The author's expertise and passion for the subject shine through, making it an engaging and informative listen. I found myself inspired and motivated to adopt healthier habits after listening to "Outlive." It offers a roadmap for making meaningful lifestyle changes that can have a profound impact on our well-being and longevity.
Whether you're already on a journey toward a healthier lifestyle or looking to start one, "Outlive: The Science and Art of Longevity" is a valuable resource. I highly recommend immersing yourself in this audiobook to gain a deeper understanding of how you can enhance your overall quality of life.
"Outlive" delves into the science behind longevity, providing valuable insights into the factors that contribute to a longer and healthier life. The narrator's engaging voice and clear delivery made it easy to absorb the wealth of information presented in the book.
This audiobook not only delves into the scientific aspects of longevity but also explores the art of living well. It offers practical tips, actionable advice, and inspiring anecdotes that empower listeners to make positive changes in their own lives.
What sets "Outlive" apart is its comprehensive approach. It covers a wide range of topics, including nutrition, exercise, sleep, stress management, and mental well-being, providing a holistic perspective on longevity. The author's expertise and passion for the subject shine through, making it an engaging and informative listen. I found myself inspired and motivated to adopt healthier habits after listening to "Outlive." It offers a roadmap for making meaningful lifestyle changes that can have a profound impact on our well-being and longevity.
Whether you're already on a journey toward a healthier lifestyle or looking to start one, "Outlive: The Science and Art of Longevity" is a valuable resource. I highly recommend immersing yourself in this audiobook to gain a deeper understanding of how you can enhance your overall quality of life.
February 16, 2024
This is one of the most important books I have read and it will be in my Top Five books for 2024. Peter Attia is a doctor who became frustrated with the typical approach to illness and medicine. His focus is on proactivity rather than reacting to a diagnosis. He is also extremely interested in changing the narrative and the reality about aging by increasing longevity.....his goal is to help people live longer and live better. He strongly believes there needs to be a paradigm shift in medicine to prevent diseases.
Attia's goal is to change the Marginal Decade in our golden years to be a Bonus Decade. His objective is to delay death and get the most out of our extra years. We should be healthier in our later years and when death arrives, it should be a steep but brief descent rather than dragged out.
His main areas of focus are: exercise, nutrition, sleep, and emotional/mental health. These focus areas aren't new, but what is unique about Attia's approach is his conversational writing style coupled with significant research and data.
A few things that stood out for me:
* Type 2 diabetes can lead to heart disease, cancer, and Alzheimer's
* Focus on nutritional biochemistry rather than diets
* Exercise is the most potent longevity drug
* Regular exercisers live one decade longer than sedentary seniors
* Be a generalist, not a specialist, with the type of exercise/training
* Train like it is for the Centenarian Decathalon; train to be a kickass 100 year old
* Be the captain of your ship regarding your health, exercise, nutrition, and habits
* Be an athlete of life
* People who live to be 100 develop diseases much later in life, if at all. If they get cancer, they get it three decades later than the average person.
* Metabolic Syndrome metrics are the most important: blood pressure, triglycerides, low HDL cholesterol, waistline size, and fasting glucose
* Monitor critical biomarkers (uric acid, homocysteine, inflammation, ALT liver enzymes, ratio of triglycerides to HDL cholesterol, VLDL, insulin levels)
* Sleep deprivation increases insulin resistance by up to a third
* Research has shown that chronic poor sleep is a powerful potential cause of Alzheimer's
* Alcohol turns from friend to foe while sleeping. Initially acts as a sedative but then metabolizes into chemicals that impair the ability to sleep
So.....What is the plan for the rest of your life?
Attia's goal is to change the Marginal Decade in our golden years to be a Bonus Decade. His objective is to delay death and get the most out of our extra years. We should be healthier in our later years and when death arrives, it should be a steep but brief descent rather than dragged out.
His main areas of focus are: exercise, nutrition, sleep, and emotional/mental health. These focus areas aren't new, but what is unique about Attia's approach is his conversational writing style coupled with significant research and data.
A few things that stood out for me:
* Type 2 diabetes can lead to heart disease, cancer, and Alzheimer's
* Focus on nutritional biochemistry rather than diets
* Exercise is the most potent longevity drug
* Regular exercisers live one decade longer than sedentary seniors
* Be a generalist, not a specialist, with the type of exercise/training
* Train like it is for the Centenarian Decathalon; train to be a kickass 100 year old
* Be the captain of your ship regarding your health, exercise, nutrition, and habits
* Be an athlete of life
* People who live to be 100 develop diseases much later in life, if at all. If they get cancer, they get it three decades later than the average person.
* Metabolic Syndrome metrics are the most important: blood pressure, triglycerides, low HDL cholesterol, waistline size, and fasting glucose
* Monitor critical biomarkers (uric acid, homocysteine, inflammation, ALT liver enzymes, ratio of triglycerides to HDL cholesterol, VLDL, insulin levels)
* Sleep deprivation increases insulin resistance by up to a third
* Research has shown that chronic poor sleep is a powerful potential cause of Alzheimer's
* Alcohol turns from friend to foe while sleeping. Initially acts as a sedative but then metabolizes into chemicals that impair the ability to sleep
So.....What is the plan for the rest of your life?
July 8, 2023
Best book I've read on this topic. Really changes your thinking on all sorts of health topics. I've followed Peter Attia's podcast for a while, but this is an excellent summary of all his best knowledge on health. He gave me a new goal and word - healthspan! Forget living a long time, the goal is to have a healthy body for as long as possible.
But the biggest takeaway from the book is exercise is the biggest lever on healthspan. I would have thought diet and exercise were close, but no, exercise is orders of magnitude the biggest lever. And this applies to reducing risk from all the "4 horseman" as he calls them (cancer, metabolic syndrome, alzheimers and brain degenerative diseases, and cardiovascular disease).
"Study after study has found that regular exercisers live as much as a decade longer than sedentary people. Not only do habitual runners and cyclists tend to live longer, but they stay in better health, with less morbidity from causes related to metabolic dysfunction."
One benefit of exercise is that it boosts your metabolism, which basically makes your body run healthier and be better at repairing itself. Interestingly, on the subject of taking supplements, Dr Attia was mostly negative on that with one exception, that he had a whole chapter about: rapamycin. I want to learn more about this drug.
"By cleansing our cells of damaged proteins and other cellular junk, autophagy allows cells to run more cleanly and efficiently and helps make them more resistant to stress. But as we get older, autophagy declines. Impaired autophagy is thought to be an important driver of numerous aging-related phenotypes and ailments, such as neurodegeneration and osteoarthritis. Thus, I find it fascinating that this very important cellular mechanism can be triggered by certain kinds of interventions, such as a temporary reduction in nutrients (as when we are exercising or fasting)—and the drug rapamycin."
Strength is also super important, as muscle mass and bone density decay significantly after age 50, and it's very hard if not impossible to gain back later. Dr Attia recommends that whatever age you are (20s to 80s) it's best to build strength. His goal for his patients is to be in the top 5th percentile of strength for their age. Strength is another top predictor of healthspan - in a way it even defines it as if you are strong you can still hike/bike/surf/etc, and if you can't do the things you love you will lose your zest for life.
"One of the prime hallmarks of aging is that our physical capacity erodes. Our cardiorespiratory fitness declines for various reasons that begin with lower cardiac output, primarily due to reduced maximum heart rate. We lose strength and muscle mass with each passing decade, our bones grow fragile and our joints stiffen, and our balance falters, a fact that many men and women discover the hard way, by falling off a ladder or while stepping off a curb."
To improve strength, Dr Attia does and recommends consistent weight training, with a lot of focus on stability, as the most important thing is to be strong in a way that avoids injury as we do other things. He also does things like rucking, which sounds interesting and I may have to get into - the thesis here is our ancestors did a lot of carrying of heavy things, and it's really good for us therefore, but we don't do it as much anymore. Goal: be able to carry half your body weight in each hand for 1 minute.
In my half-ironman training in the past few years I've done a lot of zone 2 bike rides, and I continue to do them. But I didn't realize they were actually really good for you outside of building base cycling form. Dr Attia does multiple zone 2 workouts per week. I love this, because it gives me permission to just go a long slow bike ride and know that is improving my fitness across the board. And of course, I use those to listen to audio books and podcasts - win/win!
"As fundamental as zone 2 training is for professional cyclists, however, San Millán believes that it’s even more important for nonathletes, for two reasons. First, it builds a base of endurance for anything else you do in life, whether that is riding your bike in a one-hundred-mile century ride or playing with your kids or grandkids. The other reason is that he believes it plays a crucial role in preventing chronic disease by improving the health and efficiency of your mitochondria"
The biggest correlated predictor of longevity number that we have is VO2 max. Dr Attia says his goal is to get to the top 2 percentile of VO2 max for his age. I love this, and this is my new goal in life. My Garmin watch says I'm 90th percentile, so I have more to climb!
"It turns out that peak aerobic cardiorespiratory fitness, measured in terms of VO2 max, is perhaps the single most powerful marker for longevity."
Good tip: "Where HIIT intervals are very short, typically measured in seconds, VO2 max intervals are a bit longer, ranging from three to eight minutes—and a notch less intense."
And: "The tried-and-true formula for these intervals is to go four minutes at the maximum pace you can sustain for this amount of time—not an all-out sprint, but still a very hard effort. Then ride or jog four minutes easy, which should be enough time for your heart rate to come back down to below about one hundred beats per minute. Repeat this four to six times and cool down."
Alcohol is one of my weaknesses as I love a nice bottle of wine with a nice dinner. And I've listened to podcasts on the topic and read a book about it: Drink. My French teacher (and most French in general) swear that a small amount of wine is good for you, but the science is clear - alcohol is a net negative even in small amounts. But small amounts is much better for you than large amounts, and so if you are going to drink, Dr Attia recommends:
"I strongly urge my patients to limit alcohol to fewer than seven servings per week, and ideally no more than two on any given day, and I manage to do a pretty good job adhering to this rule myself."
Dr Attia highly recommends trying a GCM, which I haven't done yet but am very interested in.
One thing I didn't know is you can't overeat protein - if you do so your body just excretes it. However if you overeat carbs or fats your body has to store those, and this is the major cause of weight gain. His chapter on how to measure your blood results and eat healthier was nothing new but a good overview.
"Putting all these changes into practice typically means eating more olive oil and avocados and nuts, cutting back on (but not necessarily eliminating) things like butter and lard, and reducing the omega-6-rich corn, soybean, and sunflower oils—while also looking for ways to increase high-omega-3 marine PUFAs from sources such as salmon and anchovies."
I have been a fan of occasionally doing 8/16 fasting as a tool for losing weight or if I just had a big late dinner the night before. But as a regular tool, despite the popularity of fasting in the last few years, Dr Attia is not a big fan, as it causes too much muscular decay. I still think its a useful occasional tool, but not a regular habit to adopt.
"As a result of this and other research, I have become convinced that frequent, prolonged fasting may be neither necessary nor wise for most patients. The cost, in terms of lost lean mass (muscle) and reduced activity levels, simply does not justify whatever benefits it may bring. My rule of thumb for any eating pattern, in fact, is that you must eat enough to maintain lean mass (muscle) and long-term activity patterns."
Dr Attia's last chapter was on mental health, where he was quite vulnerable and shared his own issues with abuse and depression, which led to a lot of anger. I think a lot of successful people are driven by trying to prove something in this way. Was a really good reminder that we all are probably not spending enough time paying attention to our mental health - it's as important as exercising, eating well, and sleeping well. So those are the big 4!
Overall, great overview and one I may be re-reading parts of it. I was already applying a lot of this, some of it I was aware of but not applying so great reminder. And I learned some new things too.
But mostly and overall, it's a strong case for living healthy now. If we are healthy now, we can find all kinds of things in the future to look forward to doing.
"“I think people get old when they stop thinking about the future,” Ric told me. “If you want to find someone’s true age, listen to them. If they talk about the past and they talk about all the things that happened that they did, they’ve gotten old. If they think about their dreams, their aspirations, what they’re still looking forward to—they’re young.” Here’s to staying young, even as we grow older."
But the biggest takeaway from the book is exercise is the biggest lever on healthspan. I would have thought diet and exercise were close, but no, exercise is orders of magnitude the biggest lever. And this applies to reducing risk from all the "4 horseman" as he calls them (cancer, metabolic syndrome, alzheimers and brain degenerative diseases, and cardiovascular disease).
"Study after study has found that regular exercisers live as much as a decade longer than sedentary people. Not only do habitual runners and cyclists tend to live longer, but they stay in better health, with less morbidity from causes related to metabolic dysfunction."
One benefit of exercise is that it boosts your metabolism, which basically makes your body run healthier and be better at repairing itself. Interestingly, on the subject of taking supplements, Dr Attia was mostly negative on that with one exception, that he had a whole chapter about: rapamycin. I want to learn more about this drug.
"By cleansing our cells of damaged proteins and other cellular junk, autophagy allows cells to run more cleanly and efficiently and helps make them more resistant to stress. But as we get older, autophagy declines. Impaired autophagy is thought to be an important driver of numerous aging-related phenotypes and ailments, such as neurodegeneration and osteoarthritis. Thus, I find it fascinating that this very important cellular mechanism can be triggered by certain kinds of interventions, such as a temporary reduction in nutrients (as when we are exercising or fasting)—and the drug rapamycin."
Strength is also super important, as muscle mass and bone density decay significantly after age 50, and it's very hard if not impossible to gain back later. Dr Attia recommends that whatever age you are (20s to 80s) it's best to build strength. His goal for his patients is to be in the top 5th percentile of strength for their age. Strength is another top predictor of healthspan - in a way it even defines it as if you are strong you can still hike/bike/surf/etc, and if you can't do the things you love you will lose your zest for life.
"One of the prime hallmarks of aging is that our physical capacity erodes. Our cardiorespiratory fitness declines for various reasons that begin with lower cardiac output, primarily due to reduced maximum heart rate. We lose strength and muscle mass with each passing decade, our bones grow fragile and our joints stiffen, and our balance falters, a fact that many men and women discover the hard way, by falling off a ladder or while stepping off a curb."
To improve strength, Dr Attia does and recommends consistent weight training, with a lot of focus on stability, as the most important thing is to be strong in a way that avoids injury as we do other things. He also does things like rucking, which sounds interesting and I may have to get into - the thesis here is our ancestors did a lot of carrying of heavy things, and it's really good for us therefore, but we don't do it as much anymore. Goal: be able to carry half your body weight in each hand for 1 minute.
In my half-ironman training in the past few years I've done a lot of zone 2 bike rides, and I continue to do them. But I didn't realize they were actually really good for you outside of building base cycling form. Dr Attia does multiple zone 2 workouts per week. I love this, because it gives me permission to just go a long slow bike ride and know that is improving my fitness across the board. And of course, I use those to listen to audio books and podcasts - win/win!
"As fundamental as zone 2 training is for professional cyclists, however, San Millán believes that it’s even more important for nonathletes, for two reasons. First, it builds a base of endurance for anything else you do in life, whether that is riding your bike in a one-hundred-mile century ride or playing with your kids or grandkids. The other reason is that he believes it plays a crucial role in preventing chronic disease by improving the health and efficiency of your mitochondria"
The biggest correlated predictor of longevity number that we have is VO2 max. Dr Attia says his goal is to get to the top 2 percentile of VO2 max for his age. I love this, and this is my new goal in life. My Garmin watch says I'm 90th percentile, so I have more to climb!
"It turns out that peak aerobic cardiorespiratory fitness, measured in terms of VO2 max, is perhaps the single most powerful marker for longevity."
Good tip: "Where HIIT intervals are very short, typically measured in seconds, VO2 max intervals are a bit longer, ranging from three to eight minutes—and a notch less intense."
And: "The tried-and-true formula for these intervals is to go four minutes at the maximum pace you can sustain for this amount of time—not an all-out sprint, but still a very hard effort. Then ride or jog four minutes easy, which should be enough time for your heart rate to come back down to below about one hundred beats per minute. Repeat this four to six times and cool down."
Alcohol is one of my weaknesses as I love a nice bottle of wine with a nice dinner. And I've listened to podcasts on the topic and read a book about it: Drink. My French teacher (and most French in general) swear that a small amount of wine is good for you, but the science is clear - alcohol is a net negative even in small amounts. But small amounts is much better for you than large amounts, and so if you are going to drink, Dr Attia recommends:
"I strongly urge my patients to limit alcohol to fewer than seven servings per week, and ideally no more than two on any given day, and I manage to do a pretty good job adhering to this rule myself."
Dr Attia highly recommends trying a GCM, which I haven't done yet but am very interested in.
One thing I didn't know is you can't overeat protein - if you do so your body just excretes it. However if you overeat carbs or fats your body has to store those, and this is the major cause of weight gain. His chapter on how to measure your blood results and eat healthier was nothing new but a good overview.
"Putting all these changes into practice typically means eating more olive oil and avocados and nuts, cutting back on (but not necessarily eliminating) things like butter and lard, and reducing the omega-6-rich corn, soybean, and sunflower oils—while also looking for ways to increase high-omega-3 marine PUFAs from sources such as salmon and anchovies."
I have been a fan of occasionally doing 8/16 fasting as a tool for losing weight or if I just had a big late dinner the night before. But as a regular tool, despite the popularity of fasting in the last few years, Dr Attia is not a big fan, as it causes too much muscular decay. I still think its a useful occasional tool, but not a regular habit to adopt.
"As a result of this and other research, I have become convinced that frequent, prolonged fasting may be neither necessary nor wise for most patients. The cost, in terms of lost lean mass (muscle) and reduced activity levels, simply does not justify whatever benefits it may bring. My rule of thumb for any eating pattern, in fact, is that you must eat enough to maintain lean mass (muscle) and long-term activity patterns."
Dr Attia's last chapter was on mental health, where he was quite vulnerable and shared his own issues with abuse and depression, which led to a lot of anger. I think a lot of successful people are driven by trying to prove something in this way. Was a really good reminder that we all are probably not spending enough time paying attention to our mental health - it's as important as exercising, eating well, and sleeping well. So those are the big 4!
Overall, great overview and one I may be re-reading parts of it. I was already applying a lot of this, some of it I was aware of but not applying so great reminder. And I learned some new things too.
But mostly and overall, it's a strong case for living healthy now. If we are healthy now, we can find all kinds of things in the future to look forward to doing.
"“I think people get old when they stop thinking about the future,” Ric told me. “If you want to find someone’s true age, listen to them. If they talk about the past and they talk about all the things that happened that they did, they’ve gotten old. If they think about their dreams, their aspirations, what they’re still looking forward to—they’re young.” Here’s to staying young, even as we grow older."
May 15, 2023
When I first heard Peter Attia’s discussion around aging and the Centenarian Decathalon in 2018, a huge paradigm shift occurred in my thinking.
As a practicing Physician Assistant in Brain & Spine health, I have soaked up Attia’s podcasts and show-notes (i.e. graduate level lecture notes) for the last 4+ years. His thinking, particularly regarding frameworks and scaffolding around health, has benefited most of my patient interactions (at least the ones who want to make changes to lifestyle).
This book does not disappoint. As some reviewers have noted, there is not much that’s new, especially for an up-to-date practitioner or health consumer.
But this is the first succinct “collection” of Attia’s framework.
This is the closest he’s come to giving you the blueprint.
The openness and vulnerability is spot-on. The small chapter on emotional health struck a personal cord as well as, considering the personality types and thinking patterns are relatively similar among healthcare and medical thinkers.
It may be the most powerful chapter for healthcare providers (particularly men) to read. A great extension of Terrence Real’s “I Don’t Want to Talk About It”.
The reader will easily find a myriad of changes to their habits and thinking, which if implemented, will lead to avoidance of early morbidity and mortality.
Wonderful addition to place at the top of the longevity/healthspan bookshelf.
Well done.
As a practicing Physician Assistant in Brain & Spine health, I have soaked up Attia’s podcasts and show-notes (i.e. graduate level lecture notes) for the last 4+ years. His thinking, particularly regarding frameworks and scaffolding around health, has benefited most of my patient interactions (at least the ones who want to make changes to lifestyle).
This book does not disappoint. As some reviewers have noted, there is not much that’s new, especially for an up-to-date practitioner or health consumer.
But this is the first succinct “collection” of Attia’s framework.
This is the closest he’s come to giving you the blueprint.
The openness and vulnerability is spot-on. The small chapter on emotional health struck a personal cord as well as, considering the personality types and thinking patterns are relatively similar among healthcare and medical thinkers.
It may be the most powerful chapter for healthcare providers (particularly men) to read. A great extension of Terrence Real’s “I Don’t Want to Talk About It”.
The reader will easily find a myriad of changes to their habits and thinking, which if implemented, will lead to avoidance of early morbidity and mortality.
Wonderful addition to place at the top of the longevity/healthspan bookshelf.
Well done.
April 2, 2023
I've been looking forward to reading this for months. What a disappointment.
Don't buy it unless you have absolutely zero idea what "longevity" is and you've also been banned from using sharp pencils.
I'd suggest you read "Fantastic Voyage" instead, below. Even though it's much much older it's still superior in my opinion and you'll learn more.
https://www.goodreads.com/book/show/8...
And if you're still fascinated in the subject then just use Google to learn the latest to keep up-to-date.
(40% of the book is taken up with contents, so it's a shorter read than you'd expect)
Don't buy it unless you have absolutely zero idea what "longevity" is and you've also been banned from using sharp pencils.
I'd suggest you read "Fantastic Voyage" instead, below. Even though it's much much older it's still superior in my opinion and you'll learn more.
https://www.goodreads.com/book/show/8...
And if you're still fascinated in the subject then just use Google to learn the latest to keep up-to-date.
(40% of the book is taken up with contents, so it's a shorter read than you'd expect)
March 27, 2024
Fascinating and challenging, but also sobering. Here’s how he concludes (I shared this in last Sunday’s sermon):
“I had long subscribed to a kind of Silicon Valley approach to longevity and health, believing [it] possible to hack our biology, and hack it, and hack it, until we become these perfect little humanoids who live to be 120 years old. I used to be all about that, constantly tinkering or experimenting with new fasting protocols or sleep gadgets to maximize my own longevity. Everything in my life needed to be optimized. And longevity was basically an engineering problem. Or so I thought.
My obsession with longevity was really about my fear of dying. . . . I was running away from dying as fast as I could. Yet at the same time, ironically, I was also avoiding actually living. . . . The saddest part is that I wasted so much time being so detached, so miserable, and so misguided. So much time pursuing an empty goal. . . .
I had been obsessed about longevity for the wrong reason. I was not thinking about a long, healthy life ahead; instead, I was mourning the past. I was trapped by the pain that my past had caused and was continuing to cause. I wanted to live longer, I think, only because deep down I knew I needed more runway to try to make things right.”
“I had long subscribed to a kind of Silicon Valley approach to longevity and health, believing [it] possible to hack our biology, and hack it, and hack it, until we become these perfect little humanoids who live to be 120 years old. I used to be all about that, constantly tinkering or experimenting with new fasting protocols or sleep gadgets to maximize my own longevity. Everything in my life needed to be optimized. And longevity was basically an engineering problem. Or so I thought.
My obsession with longevity was really about my fear of dying. . . . I was running away from dying as fast as I could. Yet at the same time, ironically, I was also avoiding actually living. . . . The saddest part is that I wasted so much time being so detached, so miserable, and so misguided. So much time pursuing an empty goal. . . .
I had been obsessed about longevity for the wrong reason. I was not thinking about a long, healthy life ahead; instead, I was mourning the past. I was trapped by the pain that my past had caused and was continuing to cause. I wanted to live longer, I think, only because deep down I knew I needed more runway to try to make things right.”
Read
July 20, 2023Under the gimmicky name of "Medicine 3.o" (vs. present-day 2.0), Dr. Attia advocates for a much more proactive approach toward what he calls "The Four Horsemen":
* Cardiovascular and cerebrovascular disease
* Cancer
* Alzheimer's disease and related neurodegenerative conditions
* Type 2 diabetes and related metabolic dysfunction
Probably one of the horsemen is coming for you already and has begun its advance work (you just don't know it), so his idea is to use tools and strategies available sooner than your regular doctor would recommend (2.0 being more reactive than proactive when it comes to the We-Mean-Business Horsemen, you see).
In addition to tips on what tests to get and how to live longer than you are presently destined to, Attia also dives into familiar territory like exercise, diet, sleep, and so forth. Especially exercise, though. Work, people! If you want to be able to open a jar as an elderly person, keep your balance and not fall, get up out of chairs, walk from A to B without tumbling into C, and so on.
Yes, he has a website with some how-to videos but only a few. Like most writers concerned about your health or your pain or your short and anguished life, he wants to make some money off you too, so here you can...wait for it!...SUBSCRIBE to get more videos!
Introducing the Fifth Horseman: Ka-ching the Kapitalist.
As for the diet and the sleep stuff, I was mostly familiar with it already. Especially sleep. I read a lot about sleep, but there are no sure-fire answers to insomnia, just helpful things you can do, like not go on Goodreads the hour before bedtime and certainly by not taking your phone or other blue-lit screens to your bedroom. (Come on, amateurs!) And keep the bedroom temp at 65 degrees Fahrenheit, why don't you! Easy in winter, but rather brutal in the air-conditioned summer when setting the thermostat THAT low would make you look like a selfish climate-change apologist (who sleeps well and the devil take the hindmost --- read: the rest of the tornado, hurricane, flooding, burning, heating-up world).
The worst part of the book was Attia's personal story. I guess it was meant to humanize him, but it all came across as a bit narcissistic, given how he turned around his life (while turning around the Horsemen, too, including that Fifth One which is doing wonders for his mid-life crisis summer home, sports car, and yacht -- you'd want to live longer, too!).
Anyway, in the end, I have greater faith in the ART than in the SCIENCE. It's the liberal arts major in me, I guess. As for you? If you want to hang around a bit longer, you, like me, might put on your farmer hat and separate the wheat from the chaff here. It's smoothly written (thank you, visible ghost writer Bill Gifford) so goes down easily enough.
* Cardiovascular and cerebrovascular disease
* Cancer
* Alzheimer's disease and related neurodegenerative conditions
* Type 2 diabetes and related metabolic dysfunction
Probably one of the horsemen is coming for you already and has begun its advance work (you just don't know it), so his idea is to use tools and strategies available sooner than your regular doctor would recommend (2.0 being more reactive than proactive when it comes to the We-Mean-Business Horsemen, you see).
In addition to tips on what tests to get and how to live longer than you are presently destined to, Attia also dives into familiar territory like exercise, diet, sleep, and so forth. Especially exercise, though. Work, people! If you want to be able to open a jar as an elderly person, keep your balance and not fall, get up out of chairs, walk from A to B without tumbling into C, and so on.
Yes, he has a website with some how-to videos but only a few. Like most writers concerned about your health or your pain or your short and anguished life, he wants to make some money off you too, so here you can...wait for it!...SUBSCRIBE to get more videos!
Introducing the Fifth Horseman: Ka-ching the Kapitalist.
As for the diet and the sleep stuff, I was mostly familiar with it already. Especially sleep. I read a lot about sleep, but there are no sure-fire answers to insomnia, just helpful things you can do, like not go on Goodreads the hour before bedtime and certainly by not taking your phone or other blue-lit screens to your bedroom. (Come on, amateurs!) And keep the bedroom temp at 65 degrees Fahrenheit, why don't you! Easy in winter, but rather brutal in the air-conditioned summer when setting the thermostat THAT low would make you look like a selfish climate-change apologist (who sleeps well and the devil take the hindmost --- read: the rest of the tornado, hurricane, flooding, burning, heating-up world).
The worst part of the book was Attia's personal story. I guess it was meant to humanize him, but it all came across as a bit narcissistic, given how he turned around his life (while turning around the Horsemen, too, including that Fifth One which is doing wonders for his mid-life crisis summer home, sports car, and yacht -- you'd want to live longer, too!).
Anyway, in the end, I have greater faith in the ART than in the SCIENCE. It's the liberal arts major in me, I guess. As for you? If you want to hang around a bit longer, you, like me, might put on your farmer hat and separate the wheat from the chaff here. It's smoothly written (thank you, visible ghost writer Bill Gifford) so goes down easily enough.
October 15, 2023
Fantastic! One of those you never really finish
January 12, 2024
I expected more from this book.
It is way too long with many repeats and too much information that a usual reader doesn't need and for a specialist, I assume, it is too simple.
The main thing I got from the book is: to pay attention to your nutrition, sleep well, and exercise as much as you can.
It is way too long with many repeats and too much information that a usual reader doesn't need and for a specialist, I assume, it is too simple.
The main thing I got from the book is: to pay attention to your nutrition, sleep well, and exercise as much as you can.
March 29, 2023
An outstanding book, that offers a broad outline of how to prevent or delay the onset of cardiovascular and neurodegenerative diseases, as well as cancer. It includes a concise description of practical techniques, but also a more general framework. Highly recommended.
March 31, 2023
There is a lot of info in the book, but there was nothing new to me.
April 11, 2023
The me myself I author needs an editor.
August 11, 2023
A slew of longevity books hit the markets over the last few years, each with interesting specifics about what can be done to extend the clock on our lives. Attia expands on these earlier writings in two ways. First, he perfectly frames the iterations of our healthcare system - 1.0, 2.0, and now 3.0. Additionally, he looks at numerous specific recommendations (drug trials and human demographics for health conduct) but also takes a long hard look at two behaviors that are the core of best practices for a long, healthy life - diet and exercise.
American healthcare is now in the midst of 2.0, which treats symptoms once they arrive. Sick care extends a sick life, but not by much. Attia knows that early intervention into visible problems much earlier in life leads to less sick care and a longer and extended healthy life healthcare 3.0. The main challenge of 2.0 is that it may extend lives by many years, but those years will still be sick years. Instead, 3.0 extends lives with unhealthy years, focusing early on issues produced by poor health behavior and early recognition of sickness indicators.
The picture drawn of the maturity levels of healthcare may be the most important message to the patient. If your current care is via a 1.0 or 2.0 doctor, and even if you are relatively young, finding a 3.0 doctor could extend the healthy years of your life by a couple of decades. -Tom L.
American healthcare is now in the midst of 2.0, which treats symptoms once they arrive. Sick care extends a sick life, but not by much. Attia knows that early intervention into visible problems much earlier in life leads to less sick care and a longer and extended healthy life healthcare 3.0. The main challenge of 2.0 is that it may extend lives by many years, but those years will still be sick years. Instead, 3.0 extends lives with unhealthy years, focusing early on issues produced by poor health behavior and early recognition of sickness indicators.
The picture drawn of the maturity levels of healthcare may be the most important message to the patient. If your current care is via a 1.0 or 2.0 doctor, and even if you are relatively young, finding a 3.0 doctor could extend the healthy years of your life by a couple of decades. -Tom L.
May 19, 2023
I hesitated to write a review for a long time because the book had so much potential. But as I kept reading it I kept getting more and more disappointed.
I'll start this review with what I think is a good part of the book: the first two chapters. They give a framework for thinking about health (i.e. not just lifespan but also healthspan, as Attia talks about often on his podcast), and overview (with minimal detail) the 4 major killers (which Attia calls the "Horsemen diseases"). Ignoring the occasional fact or tidbit that is out of place in these overview chapters, the high level overview is well written, well edited, and contains a good way of framing the problem.
The rest of the book does not live up to the outline presented in the overview. In the strictest sense it does follow this outline, but it doesn't deliver on the promised depth, understanding, comprehensiveness, and insight.
An alternate title for the book could have been "A really detailed chapter on cardiovascular/cerebrovascular disease and then a bunch of musings." It was very clear that the detail achieved in the early chapter about cardiovascular/cerebrovascular disease was not carried through for the rest of the book. Attia himself says that because of his family history, he cares a lot about cardiovascular/cerebrovascular disease, and I think that is extremely clear from the discussion of mechanism, function, and prevention. The chapter on cancer, in contrast, is much less detailed, rigorous, and frankly much less insightful.
There are a few chapters devoted to exercise. If you have listened to Attia's podcast you know he is obsessed with exercise, and these chapters don't even try to hide his biases there. I'm not a gym rat (and never will be) but don't shy away from exercise and I felt like these chapters basically told me that if I'm not exercising all the darn time to these specifications then I'm doing something wrong. Sure, exercise is great for healthspan and lifespan (the mechanisms which are discussed in the cardiovascular/cerebrovascular disease chapter), but I didn't gain much insight into how to make this practical by reading these chapters.
Lastly, I felt like a book on longevity that does not address mental health and social connection in a scientific way is severely missing the point. The discussion about centenarians and the last chapter about emotional health are missing discussions about family connection, friendships, lower stress living, community, etc. that have been shown to correlate with healthspan and lifespan. (The last chapter on emotional health in this book, while vulnerable for Attia personally, isn't actually helpful to someone interested in longevity).
As I got to the end of the book I realized that the book is more like a giant blog post about Attia's life and what he understands about longevity (but actually more like cardiovascular health) from a physical standpoint (and how exercise can help those things) rather than a holistic overview of things we know that influence longevity.
Overall I was disappointed; I had listened to many episodes of Attia's podcast and was hoping to get an overview of many topics comprehensive to the science of longevity. Instead I got a detailed discussion about cardiovascular/cerebrovascular disease, some parts of Attia's life story, and a justification of Attia's obsession for exercise. I won't be recommending this book to anyone.
I'll start this review with what I think is a good part of the book: the first two chapters. They give a framework for thinking about health (i.e. not just lifespan but also healthspan, as Attia talks about often on his podcast), and overview (with minimal detail) the 4 major killers (which Attia calls the "Horsemen diseases"). Ignoring the occasional fact or tidbit that is out of place in these overview chapters, the high level overview is well written, well edited, and contains a good way of framing the problem.
The rest of the book does not live up to the outline presented in the overview. In the strictest sense it does follow this outline, but it doesn't deliver on the promised depth, understanding, comprehensiveness, and insight.
An alternate title for the book could have been "A really detailed chapter on cardiovascular/cerebrovascular disease and then a bunch of musings." It was very clear that the detail achieved in the early chapter about cardiovascular/cerebrovascular disease was not carried through for the rest of the book. Attia himself says that because of his family history, he cares a lot about cardiovascular/cerebrovascular disease, and I think that is extremely clear from the discussion of mechanism, function, and prevention. The chapter on cancer, in contrast, is much less detailed, rigorous, and frankly much less insightful.
There are a few chapters devoted to exercise. If you have listened to Attia's podcast you know he is obsessed with exercise, and these chapters don't even try to hide his biases there. I'm not a gym rat (and never will be) but don't shy away from exercise and I felt like these chapters basically told me that if I'm not exercising all the darn time to these specifications then I'm doing something wrong. Sure, exercise is great for healthspan and lifespan (the mechanisms which are discussed in the cardiovascular/cerebrovascular disease chapter), but I didn't gain much insight into how to make this practical by reading these chapters.
Lastly, I felt like a book on longevity that does not address mental health and social connection in a scientific way is severely missing the point. The discussion about centenarians and the last chapter about emotional health are missing discussions about family connection, friendships, lower stress living, community, etc. that have been shown to correlate with healthspan and lifespan. (The last chapter on emotional health in this book, while vulnerable for Attia personally, isn't actually helpful to someone interested in longevity).
As I got to the end of the book I realized that the book is more like a giant blog post about Attia's life and what he understands about longevity (but actually more like cardiovascular health) from a physical standpoint (and how exercise can help those things) rather than a holistic overview of things we know that influence longevity.
Overall I was disappointed; I had listened to many episodes of Attia's podcast and was hoping to get an overview of many topics comprehensive to the science of longevity. Instead I got a detailed discussion about cardiovascular/cerebrovascular disease, some parts of Attia's life story, and a justification of Attia's obsession for exercise. I won't be recommending this book to anyone.
This entire review has been hidden because of spoilers.
November 21, 2023
This was kind of like a less fun and more rambly version of sleep book plus obesity code, with more detail about exercise added.
I like the idea that we should think about our future health goals and be more proactive about setting ourselves up well before problems actually occur, but this point could’ve been made in way less space.
I appreciate the authors honesty about his personal and mental health struggles, but it’s also hard because when you read the book he definitely sounds like a total nut. Who has time to do his insane exercise regimen?? I feel like Matthew walker wrote the sleep book with a lot of love and wonder for the idea of sleep, but Peter attia writes about exercise from a place of obsession and need for control and it’s kind of telling. Also WOW sounds like his wife has had to put up with a lot.
I think the biggest change this book had for me is that I think I need to eat more protein so I can gain more muscle mass, and I might also add a few of the supplements (fish oil and mg). And I might try to do constant glucose monitoring for fun.
I like the idea that we should think about our future health goals and be more proactive about setting ourselves up well before problems actually occur, but this point could’ve been made in way less space.
I appreciate the authors honesty about his personal and mental health struggles, but it’s also hard because when you read the book he definitely sounds like a total nut. Who has time to do his insane exercise regimen?? I feel like Matthew walker wrote the sleep book with a lot of love and wonder for the idea of sleep, but Peter attia writes about exercise from a place of obsession and need for control and it’s kind of telling. Also WOW sounds like his wife has had to put up with a lot.
I think the biggest change this book had for me is that I think I need to eat more protein so I can gain more muscle mass, and I might also add a few of the supplements (fish oil and mg). And I might try to do constant glucose monitoring for fun.
July 6, 2023
We all know the message, but is Peter Attia compelling enough for the average person to make hard changes to live a maximally healthy, long life? Outlive acknowledges its subject matter sometimes lacks clear answers, but the answers it does provide are unequivocal.
Want the best chance for a happy, healthy, physically active, and engaged life into centenarian years?
1. Have a high VO2 max for your age (Endurance exercise - Strong correlation)
2. Have plenty of muscle tissue and be strong (Resistance exercise - For activity, stability, and metabolism - glucose sink)
3. Don't be obese
4. Eat food healthy for you, not too much
5. Don't smoke or drink - Outliers prove nothing
6. Sleep 8 hours a night
7. Improve the mind - Possibly therapy
8. Be social
9. Start now
Recommended. A Medicine 3.0 mindset is helpful for planning optimum future healthspan and lifespan.
Want the best chance for a happy, healthy, physically active, and engaged life into centenarian years?
1. Have a high VO2 max for your age (Endurance exercise - Strong correlation)
2. Have plenty of muscle tissue and be strong (Resistance exercise - For activity, stability, and metabolism - glucose sink)
3. Don't be obese
4. Eat food healthy for you, not too much
5. Don't smoke or drink - Outliers prove nothing
6. Sleep 8 hours a night
7. Improve the mind - Possibly therapy
8. Be social
9. Start now
Recommended. A Medicine 3.0 mindset is helpful for planning optimum future healthspan and lifespan.
April 15, 2023
This is one of those books that I think everyone should read. What’s the point of living longer, if we aren’t living fuller, healthier lives? I found this both informative and reaffirming. Prevention is key to living a better life, and you will learn every single way to go about this by reading this book!
September 26, 2023
Peter Attia has a useful combination of skills; he is a medical doctor who is also a math geek (he nearly became an engineer), and he's an athlete who trains with intense dedication. He makes an excellent point about the binary nature of medical diagnoses, calling the current standard of treatment "medicine 2.0", an approach designed to treat acute conditions, but not well suited to preventing chronic conditions from becoming acute. For that, we need what he calls medicine 3.0. Medicine 2.0 says if one's fasting blood glucose is > 126mg/dl, that person is diabetic; at less than 126, they are not diabetic. Attia says that adults should be concerned if their glucose is close to 100, and they should be aiming for 80 or less; the point is that most of these test results are on a spectrum, and if we wait until we exceed the magic number of 126, it may well be too late to reverse the trend toward diabetes with exercise and diet changes. Attia spends a lot of text explaining how to interpret cholesterol results, genetic markers for Alzheimer's, and many other test results, and he explains which tests are most useful, and which are really not very helpful at all.
Dr. Attia emphasizes how important exercise is to remaining healthy as we age, and he pushes strength training hard, making the point that if we do nothing to retain muscle mass as we age, we will lose strength through a natural process of atrophy. If one does nothing to retain strength, we eventually end up unable to complete simple tasks like lifting a suitcase, and it is the myriad of small tasks requiring strength that allow a person to remain independent in old age. Attia also pushes the need for aerobic training because of the clear benefits to the vascular system and hence to the brain. More and more research is showing most mental decline to be a side effect of poor cardiovascular health in combination with other metabolic problems like diabetes or pre-diabetes.
Attia covers cardiovascular health in detail, including tests that he recommends in addition to the normal LDL and HDL readings. He addresses cancer, and the correlation between good metabolic health and avoiding cancer. But he returns again and again to the importance of exercise, and how it is the most important thing a person can do to preserve good health as they age. There is a great deal of densely written, data-filled text on this subject, and as a former somewhat-competitive runner, I follow where he is going with regard to VO2 Max, etc, but he makes a great point, which is, we should want to be decathletes, not marathon runners. Because the decathlete is relatively fast, but also strong, and nimble, and as normal humans, that's what we need, not the specialization of the marathoner. There is a lot of helpful information about training for strength, and aerobic fitness, and stability. All good stuff.
There are two sections on nutrition, which I really enjoyed, and then a section on the importance of good sleep and how to get it. Finally he deals with emotional health. This is the most personal section; I am often surprised to learn of the trauma other people are carrying, and it turns out Dr. Attia is another high-performing individual who was a victim of abuse at a young age, and he describes his long-delayed treatment and therapy to deal with the lasting effects of the abuse.
I would recommend this book to anyone who is trying to improve their fitness, their health, and their chances of living into old age as an active and healthy individual.
9/26/2023 edit: Having now read Ultra-Processed People, I have less confidence in some of Attia's assertions, because I learned from that book that Attia was a part of a start-up that attempted to prove that obesity was caused primarily by sugar consumption. The testing that his organization did ultimately disproved that theory, much to Attia's chagrin, and he lost millions he had invested in the start-up. So his assertion in the book that exercise is more important than diet may not be unbiased, and may be a reaction to getting burned betting on a diet hypothesis. That said, his comments about binary diagnoses still seem right to me, particularly with regard to diabetes.
Dr. Attia emphasizes how important exercise is to remaining healthy as we age, and he pushes strength training hard, making the point that if we do nothing to retain muscle mass as we age, we will lose strength through a natural process of atrophy. If one does nothing to retain strength, we eventually end up unable to complete simple tasks like lifting a suitcase, and it is the myriad of small tasks requiring strength that allow a person to remain independent in old age. Attia also pushes the need for aerobic training because of the clear benefits to the vascular system and hence to the brain. More and more research is showing most mental decline to be a side effect of poor cardiovascular health in combination with other metabolic problems like diabetes or pre-diabetes.
Attia covers cardiovascular health in detail, including tests that he recommends in addition to the normal LDL and HDL readings. He addresses cancer, and the correlation between good metabolic health and avoiding cancer. But he returns again and again to the importance of exercise, and how it is the most important thing a person can do to preserve good health as they age. There is a great deal of densely written, data-filled text on this subject, and as a former somewhat-competitive runner, I follow where he is going with regard to VO2 Max, etc, but he makes a great point, which is, we should want to be decathletes, not marathon runners. Because the decathlete is relatively fast, but also strong, and nimble, and as normal humans, that's what we need, not the specialization of the marathoner. There is a lot of helpful information about training for strength, and aerobic fitness, and stability. All good stuff.
There are two sections on nutrition, which I really enjoyed, and then a section on the importance of good sleep and how to get it. Finally he deals with emotional health. This is the most personal section; I am often surprised to learn of the trauma other people are carrying, and it turns out Dr. Attia is another high-performing individual who was a victim of abuse at a young age, and he describes his long-delayed treatment and therapy to deal with the lasting effects of the abuse.
I would recommend this book to anyone who is trying to improve their fitness, their health, and their chances of living into old age as an active and healthy individual.
9/26/2023 edit: Having now read Ultra-Processed People, I have less confidence in some of Attia's assertions, because I learned from that book that Attia was a part of a start-up that attempted to prove that obesity was caused primarily by sugar consumption. The testing that his organization did ultimately disproved that theory, much to Attia's chagrin, and he lost millions he had invested in the start-up. So his assertion in the book that exercise is more important than diet may not be unbiased, and may be a reaction to getting burned betting on a diet hypothesis. That said, his comments about binary diagnoses still seem right to me, particularly with regard to diabetes.
September 22, 2023
It's a book with some serious flaws. It doesn't matter, you should read it anyway.
OK, what "flaws" do I mean? The biggest issue is shaping the actual message. It's a book that's supposed to help you ("an average Joe/Jane") extend your lifespan/healthspan - so as you're a random person, it should not assume any particular familiarity with medicine, nutrition, etc. However, it has to convince you somehow, and of course, it can't w/o a bit of science - chemistry, biology, but not only. So the book is not fully comprehensible by design: you read it, you make smart facial expressions ("oh, it sounds so convincing"), but in the end, what really matters is not the scientific proofs and clinical trial data, but how frequently certain statements are re-iterated ("American book for Americans" :>) and how passionate (/certain) the author is.
I may be a bit unfair here (the author DOES his best to make the book approachable & comprehensible), but I still think that it's main value is purely motivational :)
But wait, I claimed it's a book you should read anyway. Why so? Everyone needs a good shake-down & I adore this book's messaging: prevent instead of treating. Think ahead. Be prepared. Be realistic. Measure what matters (e.g., glucose levels). Don't fall into "latest reports from American scientists", but always validate the sensational headlines. I love how rational Attia sounds, e.g., in his chapter about fasting - credibility level 500%.
What didn't I like? I think the last chapter (about mental health) has its issues. Not only it's short & stacked at the end like something scribbled in the corridor, a quarter before the publisher's deadline. It's also far less "inspired" - I'd say. There are many better books on that particular topic. Much better ones.
AAaaaaaanyway. "Outlive" is a must live. For everyone beyond 40. Maybe even 35. Or rather 30. Just read it, ffs.
OK, what "flaws" do I mean? The biggest issue is shaping the actual message. It's a book that's supposed to help you ("an average Joe/Jane") extend your lifespan/healthspan - so as you're a random person, it should not assume any particular familiarity with medicine, nutrition, etc. However, it has to convince you somehow, and of course, it can't w/o a bit of science - chemistry, biology, but not only. So the book is not fully comprehensible by design: you read it, you make smart facial expressions ("oh, it sounds so convincing"), but in the end, what really matters is not the scientific proofs and clinical trial data, but how frequently certain statements are re-iterated ("American book for Americans" :>) and how passionate (/certain) the author is.
I may be a bit unfair here (the author DOES his best to make the book approachable & comprehensible), but I still think that it's main value is purely motivational :)
But wait, I claimed it's a book you should read anyway. Why so? Everyone needs a good shake-down & I adore this book's messaging: prevent instead of treating. Think ahead. Be prepared. Be realistic. Measure what matters (e.g., glucose levels). Don't fall into "latest reports from American scientists", but always validate the sensational headlines. I love how rational Attia sounds, e.g., in his chapter about fasting - credibility level 500%.
What didn't I like? I think the last chapter (about mental health) has its issues. Not only it's short & stacked at the end like something scribbled in the corridor, a quarter before the publisher's deadline. It's also far less "inspired" - I'd say. There are many better books on that particular topic. Much better ones.
AAaaaaaanyway. "Outlive" is a must live. For everyone beyond 40. Maybe even 35. Or rather 30. Just read it, ffs.
April 5, 2023
"There comes a point where we need to stop just pulling people out of the river. We need to go upstream and find out why they’re falling in" --
Without question, this is the most comprehensive, yet digestible book on medicine / improving your life. I have found so many adjacent books written in this space to exaggerate claims, embellish science, and use vague advice to fit people's paradigm on why what they do is the one and only way.
Sure, I admit I have been a Peter Attia disciple for years, ingesting as much of his content as possible, and implementing his approaches to medicine, exercise, and longevity. Nonetheless, he is able to practically lay out where medicine fails society today and the steps we can individually and collectively take to improve our own lives. I particularly found his last chapter on emotional health to be one of the most insightful and sobering collections of thoughts I have read in a while.
Without question, this is the most comprehensive, yet digestible book on medicine / improving your life. I have found so many adjacent books written in this space to exaggerate claims, embellish science, and use vague advice to fit people's paradigm on why what they do is the one and only way.
Sure, I admit I have been a Peter Attia disciple for years, ingesting as much of his content as possible, and implementing his approaches to medicine, exercise, and longevity. Nonetheless, he is able to practically lay out where medicine fails society today and the steps we can individually and collectively take to improve our own lives. I particularly found his last chapter on emotional health to be one of the most insightful and sobering collections of thoughts I have read in a while.
May 2, 2023
Allow me to summarize:
1. You’re gonna die!
2. Eat less.
3. Some people have better genes than you do and can have bourbon for dessert every night.
4. Abdominal fat is bad.
5. Smoking is bad.
6. You’re gonna die!
7. Sleep more.
8. Insurance companies suck and won’t pay for preventative care but will pay for surgeries that may have been unnecessary if they had paid for preventative care.
9. Maybe you should start thinking about dying sooner?
This started off promising but it ended up being a lot of scientific jargon mixed with things that either I already knew or could have reasonably assumed to be true (people who live long lives don’t get bad diseases until later in life — well, yeah!) I was hoping for something inspirational but this book just depressed me. I don’t want to think about dying as much as this guy clearly does. DNF.
1. You’re gonna die!
2. Eat less.
3. Some people have better genes than you do and can have bourbon for dessert every night.
4. Abdominal fat is bad.
5. Smoking is bad.
6. You’re gonna die!
7. Sleep more.
8. Insurance companies suck and won’t pay for preventative care but will pay for surgeries that may have been unnecessary if they had paid for preventative care.
9. Maybe you should start thinking about dying sooner?
This started off promising but it ended up being a lot of scientific jargon mixed with things that either I already knew or could have reasonably assumed to be true (people who live long lives don’t get bad diseases until later in life — well, yeah!) I was hoping for something inspirational but this book just depressed me. I don’t want to think about dying as much as this guy clearly does. DNF.
March 28, 2023
Excellent review
Excellent update on how to stay he
althy your entire life. Highly recommended. Peter Attia understands the human body. Great plan for longevity.
Excellent update on how to stay he
althy your entire life. Highly recommended. Peter Attia understands the human body. Great plan for longevity.
March 13, 2024
For years I tossed Peter Attia in with the Silicon Valley über-rich who consume three spinach shakes a day because they want to see what the 24th century is like. Maybe I’ll feel different when I’m eighty, but at no point in my life have I felt like living to two-hundred.
So why read this book now?
----------
I originally published this review on my Substack The Unhedged Capitalist - check out that article to read this review with images and better formatting...
https://theunhedgedcapitalist.substac...
----------
The cover is cool, and ancient wisdom teaches us that the surest way to judge a book is by its cover. But perhaps more importantly, COVID convinced me that the American healthcare system is at least halfway broken. I would trust modern medicine to,
Give me a hip transplant
Patch up a stab wound
Set a broken leg
But wouldn’t trust it to,
Treat me for a mild disease
Prescribe a proactive treatment so I never get sick in the first place
Be judicious in its prescription of pills with unusual side effects
As we’ll see in this review, Peter Attia expresses a similar concern about our medical system and Outlive is an excellent guide for those who would prefer to stay happy, healthy, and out of the hospital.
First, here is a nutritional change I successfully implemented this summer.
I’d been going out to eat too much and decided that I should start cooking more. However, the immensity of the task overwhelmed me. I tried to imagine how I would make myself dinner every night for the next three decades, and I just couldn’t envision that reality. The task was too monumental. So I would give up and get takeout.
The revelation happened when I realized that, much like a reformed alcoholic passing on spirits, I didn’t have to think about an infinite future. All I had to do was ask myself: can I make dinner tonight?* And the answer is inevitably, yes of course. The rest of my life is an uncertainty, but I’m sure I can take care of it today.
*The inspiration for this thinking came from David Goggins. In the context of running and pushing himself forward even when he feels like his body is at its breaking point, Goggins asks himself: can I take one more step? And the answer, almost certainly, is yes. Take a big task and break it down into small parts.
Although this mindset shift comes across as childishly simple, for me it’s made all the difference. I’ve cooked more dinners in the last three weeks than I cooked in the last three months prior to that.
Cool! Now, on to four key lessons that I learned from Outlive.
1 - How our medical system fails
Our medical system’s greatest flaw, according to Attia, is that it’s primarily designed to help patients once they’re already sick.
Attia points out that while a traumatic and possibly fatal event like a heart attack appears to happen suddenly, the conditions that caused it have been building for decades. The same thing is true for diabetes, a stroke, or any number of other medical infirmities.
Unfortunately, rather than set a thirty-year-old on the right track so that they don’t have a heart attack when they’re sixty, modern medicine demands that the patient is already sick before they can be treated. Not a brilliant methodology, is it?
“Come back when you’re half dead!” Is the motto of what Attia refers to as Medicine 2.0. Whereas Attia’s preventative Medicine 3.0 approach says, “You’re healthy now! That’s amazing, let’s keep it that way.”
But Medicine 2.0 does treat you once you get sick, right? Well, it tries… But apart from some crucial developments in the 20th century, we’ve not actually made much progress in extending the average person’s lifespan.
Aside from a few small exceptions (we’ve made admirable progress with leukemia), we’re not great at treating life-enders like cancer or Alzheimer’s which is why prevention is so important.
2 - Healthspan vs. lifespan
Peter Attia draws a distinction between healthspan and lifespan.
Lifespan is how long you live, not factoring in quality of life.
Healthspan is how many quality years of life you have.
For example, say that two people live to eighty-five…
Debbie begins experiencing debilitating medical problems at age seventy-three. These medical damnations make the rest of her existence deeply unpleasant since she’s unable to do any of the activities that make life worth living. She had a lifespan of eighty-five and a healthspan of just seventy-three.
Becky doesn’t begin experiencing debilitating medical problems until age eighty-three. Although she lives just as long as person Debbie, she has an extra decade of healthspan!
Rather than aiming for an excessively long life, Peter urges us to think about how we can extend our healthspan. By taking steps to maintain our health into old age, we will extend our lifespan as well.
3 - The centenarian decathlon
The centenarian decathlon asks what physical activities do you still want to be able to perform at eighty? Ninety? One-hundred? What can you do now that you want to continue doing for the rest of your life?
Let’s say that you want to climb four flights of stairs when you’re eighty. Back that out to the present. If you’re fifty it means you should be able to comfortably climb eight flights of stairs. If you’re thirty, you should be able to sprint up eight flights of stairs.
I just made up those requirements but that’s OK because the centenarian decathlon is two-thirds art and one-third science. Everyone ages differently and there may be no guidelines for how to extrapolate your current fitness level into what it will become when you’re older.
You may be able to get some decent guidance from a doctor or physical therapist about how much strength you’ll lose over time, but we don’t even necessarily require professional advice to start planning for our own centenarian decathlon. Each of us can think about the buffer we’ll need to build into our body to account for the irreversible loss of muscle mass and bone. You want to pick up a toddler at eighty? Well then you should probably be able to lift a seventy pound weight off the floor at forty. Can you do that?
In addition to the centenarian decathlon, Peter also introduced me to an ostensibly simple idea that actually carries a surprising amount of weight. You should contribute to your health account the same way you contribute to your retirement account. If you exercise now and keep your body in shape, that extra muscle mass, flexibility and bone strength will return untold dividends as you age.
4 - Exercise is crazy important
Peter Attia couldn’t be any clearer on this point: exercise is the single most decisive factor in longevity. More important than good genetics, high-tech pharmaceuticals or a perfect diet.
According to Peter, rucking may be one of the most effective all-around exercises to stay in shape. However, he quickly goes on to say that if loading a backpack with heavy weights and walking long distances isn’t your particular brand of vodka, that’s fine too.
The best exercise is whatever we enjoy the most, fits into our schedule and the one that we’ll stick with for the next bunch of decades.
Almost nobody should worry about exercising too much, claims Attia, but we should all worry about exercising too little.
Bits & bobs
Here’s an assortment of things, like the splatters of paint that decorated my living room in college after we got drunk and shot paintballs in the house.
Thinking may delay the onset Alzheimer’s...
Using our brains to engage with complex problems, like learning a second language, may be one of the most effective methods we have of delaying the onset of Alzheimer’s. Keep reading Substacks y’all!
How that’s handshake? Grip strength is an easy and accurate proximate measure of overall strength.
Nutrition: good enough is good enough
Outlive provides only basic nutritional guidance. According to Peter, the same diet will affect every person differently so providing generic advice is almost impossible. Furthermore, Peter also claims that despite whatever flashy headline you’ve read about eggs, bacon, broccoli or whatever the hell else, we actually know precious little about nutrition. He goes on to claim that many of the studies “proving” that a certain food is good or bad are methodologically flawed.
My takeaway is that when if you want to live longer your diet should be good enough. Once you’ve got your food intake halfway in order, go exercise!
Conclusions
I genuinely appreciate living in an era of antibiotics, shoulder transplants, and perhaps most of all: surgical anesthetic. Since I was a boy one of my worst fears has been a brash surgeon cutting off my leg with a hacksaw while I bite down on a leather strap so I don’t scream hard enough to blow out my vocal cords. I’m so thrilled to live in an age when that almost certainly won’t be my fate!
That being said, maybe this is a macabre but the way our medical system manages our health reminds me of this famous Monty Python skit. The cart master - a proxy for the medical system - isn’t interested unless you’re fully dead. Just like a doctor might say: you’re too healthy, come back later when it’s worse.
Thankfully the solution to this medical malarkey is easy! Read Outlive, take notes and update your lifestyle accordingly. Exercise more, get your nutrition in order and invest as much time into your health retirement account as you do your IRA.
None of us are guaranteed a long healthspan, but if we put in the work we can all give ourselves the best possible chance of being just as feisty at eighty as twenty-eight.
So why read this book now?
----------
I originally published this review on my Substack The Unhedged Capitalist - check out that article to read this review with images and better formatting...
https://theunhedgedcapitalist.substac...
----------
The cover is cool, and ancient wisdom teaches us that the surest way to judge a book is by its cover. But perhaps more importantly, COVID convinced me that the American healthcare system is at least halfway broken. I would trust modern medicine to,
Give me a hip transplant
Patch up a stab wound
Set a broken leg
But wouldn’t trust it to,
Treat me for a mild disease
Prescribe a proactive treatment so I never get sick in the first place
Be judicious in its prescription of pills with unusual side effects
As we’ll see in this review, Peter Attia expresses a similar concern about our medical system and Outlive is an excellent guide for those who would prefer to stay happy, healthy, and out of the hospital.
“I think people get old when they stop thinking about the future,” Ric told me. “If you want to find someone’s true age, listen to them. If they talk about the past and they talk about all the things that happened that they did, they’ve gotten old. If they think about their dreams, their aspirations, what they’re still looking forward to—they’re young." Here’s to staying young, even as we grow older.
First, here is a nutritional change I successfully implemented this summer.
I’d been going out to eat too much and decided that I should start cooking more. However, the immensity of the task overwhelmed me. I tried to imagine how I would make myself dinner every night for the next three decades, and I just couldn’t envision that reality. The task was too monumental. So I would give up and get takeout.
The revelation happened when I realized that, much like a reformed alcoholic passing on spirits, I didn’t have to think about an infinite future. All I had to do was ask myself: can I make dinner tonight?* And the answer is inevitably, yes of course. The rest of my life is an uncertainty, but I’m sure I can take care of it today.
*The inspiration for this thinking came from David Goggins. In the context of running and pushing himself forward even when he feels like his body is at its breaking point, Goggins asks himself: can I take one more step? And the answer, almost certainly, is yes. Take a big task and break it down into small parts.
Although this mindset shift comes across as childishly simple, for me it’s made all the difference. I’ve cooked more dinners in the last three weeks than I cooked in the last three months prior to that.
Cool! Now, on to four key lessons that I learned from Outlive.
1 - How our medical system fails
Our medical system’s greatest flaw, according to Attia, is that it’s primarily designed to help patients once they’re already sick.
Medicine’s biggest failing is in attempting to treat all these conditions at the wrong end of the timescale—after they are entrenched—rather than before they take root. As a result, we ignore important warning signs and miss opportunities to intervene at a point where we still have a chance to beat back these diseases, improve health, and potentially extend lifespan.
Attia points out that while a traumatic and possibly fatal event like a heart attack appears to happen suddenly, the conditions that caused it have been building for decades. The same thing is true for diabetes, a stroke, or any number of other medical infirmities.
Unfortunately, rather than set a thirty-year-old on the right track so that they don’t have a heart attack when they’re sixty, modern medicine demands that the patient is already sick before they can be treated. Not a brilliant methodology, is it?
There are few insurance reimbursement codes for most of the largely preventive interventions that I believe are necessary to extend lifespan and healthspan. Health insurance companies won’t pay a doctor very much to tell a patient to change the way he eats, or to monitor his blood glucose levels in order to help prevent him from developing type 2 diabetes. Yet insurance will pay for this same patient’s (very expensive) insulin after he has been diagnosed.
“Come back when you’re half dead!” Is the motto of what Attia refers to as Medicine 2.0. Whereas Attia’s preventative Medicine 3.0 approach says, “You’re healthy now! That’s amazing, let’s keep it that way.”
But Medicine 2.0 does treat you once you get sick, right? Well, it tries… But apart from some crucial developments in the 20th century, we’ve not actually made much progress in extending the average person’s lifespan.
Medicine 2.0 has proved far less successful against long-term diseases such as cancer. While books like this always trumpet the fact that lifespans have nearly doubled since the late 1800s, the lion’s share of that progress may have resulted entirely from antibiotics and improved sanitation - if you subtract out deaths from the eight top infectious diseases, which were largely brought under control by the advent of antibiotics in the 1930s, overall mortality rates declined relatively little over the course of the twentieth century.
Aside from a few small exceptions (we’ve made admirable progress with leukemia), we’re not great at treating life-enders like cancer or Alzheimer’s which is why prevention is so important.
2 - Healthspan vs. lifespan
Peter Attia draws a distinction between healthspan and lifespan.
Lifespan is how long you live, not factoring in quality of life.
Healthspan is how many quality years of life you have.
For example, say that two people live to eighty-five…
Debbie begins experiencing debilitating medical problems at age seventy-three. These medical damnations make the rest of her existence deeply unpleasant since she’s unable to do any of the activities that make life worth living. She had a lifespan of eighty-five and a healthspan of just seventy-three.
Becky doesn’t begin experiencing debilitating medical problems until age eighty-three. Although she lives just as long as person Debbie, she has an extra decade of healthspan!
I hope to convince you that with enough time and effort, you can potentially extend your lifespan by a decade and your healthspan possibly by two, meaning you might hope to function like someone twenty years younger than you. But my intent here is not to tell you exactly what to do; it’s to help you learn how to think about doing these things.”
Rather than aiming for an excessively long life, Peter urges us to think about how we can extend our healthspan. By taking steps to maintain our health into old age, we will extend our lifespan as well.
3 - The centenarian decathlon
The centenarian decathlon asks what physical activities do you still want to be able to perform at eighty? Ninety? One-hundred? What can you do now that you want to continue doing for the rest of your life?
The Centenarian Decathlon is a framework I use to organize my patient’s physical aspirations for the later decades of their lives, especially their Marginal Decade. I know, it’s a somewhat morbid topic, thinking about our own physical decline. But not thinking about it won’t make it any less inevitable.
Let’s say that you want to climb four flights of stairs when you’re eighty. Back that out to the present. If you’re fifty it means you should be able to comfortably climb eight flights of stairs. If you’re thirty, you should be able to sprint up eight flights of stairs.
I just made up those requirements but that’s OK because the centenarian decathlon is two-thirds art and one-third science. Everyone ages differently and there may be no guidelines for how to extrapolate your current fitness level into what it will become when you’re older.
You may be able to get some decent guidance from a doctor or physical therapist about how much strength you’ll lose over time, but we don’t even necessarily require professional advice to start planning for our own centenarian decathlon. Each of us can think about the buffer we’ll need to build into our body to account for the irreversible loss of muscle mass and bone. You want to pick up a toddler at eighty? Well then you should probably be able to lift a seventy pound weight off the floor at forty. Can you do that?
In addition to the centenarian decathlon, Peter also introduced me to an ostensibly simple idea that actually carries a surprising amount of weight. You should contribute to your health account the same way you contribute to your retirement account. If you exercise now and keep your body in shape, that extra muscle mass, flexibility and bone strength will return untold dividends as you age.
4 - Exercise is crazy important
Peter Attia couldn’t be any clearer on this point: exercise is the single most decisive factor in longevity. More important than good genetics, high-tech pharmaceuticals or a perfect diet.
John Ioannidis, a Stanford scientist with a penchant for asking provocative questions, decided to test this metaphor literally, running a side-by-side comparison of exercise studies versus drug studies. He found that in numerous randomized clinical trials, exercise-based interventions performed as well as or better than multiple classes of pharmaceutical drugs at reducing mortality from coronary heart disease, prediabetes or diabetes, and stroke.
According to Peter, rucking may be one of the most effective all-around exercises to stay in shape. However, he quickly goes on to say that if loading a backpack with heavy weights and walking long distances isn’t your particular brand of vodka, that’s fine too.
The best exercise is whatever we enjoy the most, fits into our schedule and the one that we’ll stick with for the next bunch of decades.
The problem, and we will see this again in the nutrition chapters, is that we have this need to turn everything into a kind of religious war over which is the One True Church. Some experts insist that strength training is superior to cardio, while an equal number assert the opposite. The debate is as endless as it is pointless, sacrificing science on the altar of advocacy. The problem is that we are looking at these hugely important domains of life—exercise, but also nutrition, through a far too narrow lens. It’s not about which side of the gym you prefer. It’s so much more essential than that. - Poor cardiorespiratory fitness carries a greater relative risk of death than smoking.
Almost nobody should worry about exercising too much, claims Attia, but we should all worry about exercising too little.
Bits & bobs
Here’s an assortment of things, like the splatters of paint that decorated my living room in college after we got drunk and shot paintballs in the house.
Thinking may delay the onset Alzheimer’s...
Using our brains to engage with complex problems, like learning a second language, may be one of the most effective methods we have of delaying the onset of Alzheimer’s. Keep reading Substacks y’all!
The more of these networks and subnetworks that we have built up over our lifetime, via education or experience, or by developing complex skills such as speaking a foreign language or playing a musical instrument, the more resistant to cognitive decline we will tend to be. - This is called “cognitive reserve,” and it has been shown to help some patients to resist the symptoms of Alzheimer’s disease.
How that’s handshake? Grip strength is an easy and accurate proximate measure of overall strength.
A study looking at nearly half a million patients in the United Kingdom found that grip strength, an excellent proxy for overall strength, was strongly and inversely associated with the incidence of dementia. People in the lowest quartile of grip strength (i.e., the weakest) had a 72 percent higher incidence of dementia, compared to those in the top quartile.
Nutrition: good enough is good enough
Outlive provides only basic nutritional guidance. According to Peter, the same diet will affect every person differently so providing generic advice is almost impossible. Furthermore, Peter also claims that despite whatever flashy headline you’ve read about eggs, bacon, broccoli or whatever the hell else, we actually know precious little about nutrition. He goes on to claim that many of the studies “proving” that a certain food is good or bad are methodologically flawed.
Nutrition is relatively simple, actually. It boils down to a few basic rules: don’t eat too many calories, or too few; consume sufficient protein and essential fats; obtain the vitamins and minerals you need; and avoid pathogens like E. coli and toxins like mercury and lead. Beyond that, we know relatively little with complete certainty.
My takeaway is that when if you want to live longer your diet should be good enough. Once you’ve got your food intake halfway in order, go exercise!
Conclusions
I genuinely appreciate living in an era of antibiotics, shoulder transplants, and perhaps most of all: surgical anesthetic. Since I was a boy one of my worst fears has been a brash surgeon cutting off my leg with a hacksaw while I bite down on a leather strap so I don’t scream hard enough to blow out my vocal cords. I’m so thrilled to live in an age when that almost certainly won’t be my fate!
That being said, maybe this is a macabre but the way our medical system manages our health reminds me of this famous Monty Python skit. The cart master - a proxy for the medical system - isn’t interested unless you’re fully dead. Just like a doctor might say: you’re too healthy, come back later when it’s worse.
Thankfully the solution to this medical malarkey is easy! Read Outlive, take notes and update your lifestyle accordingly. Exercise more, get your nutrition in order and invest as much time into your health retirement account as you do your IRA.
None of us are guaranteed a long healthspan, but if we put in the work we can all give ourselves the best possible chance of being just as feisty at eighty as twenty-eight.
April 9, 2023
As a long-time avid listener of Peter Attia's podcast (my wife says I'm obsessed), I found "Outlive: The Science and Art of Longevity" to be an excellent distillation of years of research (and hours of listening) into a much more accessible format for lay readers. Although much of the information in the book was a review from the podcast, I still found it to be a valuable resource that I have already recommended to patients, friends, and family. The book covers the most common diseases of civilized society and provides steps individuals can take to improve their personal risk of developing these diseases.
What sets "Outlive" apart from other health books is that it not only tells you what interventions to take to live a healthier life but also explains the reasons behind them which Peter eloquently introduces as studying 'strategy'. As a family doctor, I appreciate the depth of information that "Outlive" conveys and the health 3.0 framework it introduces. One of my greatest challenges as a doctor is convincing someone to make a change in their life today that only decreases their risk of developing a disease in 20-30 years. Traditional treatments for high blood pressure or abnormal lipids (which decrease atherosclerotic cardiovascular disease) involve interventions spanning nutrition, exercise, and medication with a long feedback delay. I suspect that if all of my patients could read this book and understand the disease processes and how interventions could modify them, they would be more inclined to make sustained changes in their lives.
Of course, behavioral change requires someone to be emotionally ready for that change. Even if someone understands the long-term consequences of their diabetes, their emotional health often prevents them from making sustained changes. This is something that Peter begins to address in the last chapter by sharing his personal story. It is inspiring and courageous to include his personal emotional journey given the social stigma in admitting mental health challenges as a physician and someone who excels at generally masculine sports. I can see how someone reading this book who may have never considered pursuing emotional improvement could be inspired to reflect and make positive changes.
However, while Peter's own emotional challenges are aligned with his pursuit of longevity, such as his perfectionism that aligns with rigorous exercise and nutritional adherence, many individuals face the opposite struggle. Unfortunately, the impact of emotional readiness for healthy behavioral change is only briefly addressed in the book, which is my main critique. For instance, I hesitate to share this book with certain loved ones who might feel overwhelmed with shame about their current state before even finishing the first half.
In conclusion, "Outlive: The Science and Art of Longevity" is a must-read for anyone interested in taking control of their health and longevity. While it provides valuable information on how to prevent and manage common diseases of modern society, it also details the reasons behind these interventions. If you are emotionally ready to read this book, it will change your life, as it has mine.
What sets "Outlive" apart from other health books is that it not only tells you what interventions to take to live a healthier life but also explains the reasons behind them which Peter eloquently introduces as studying 'strategy'. As a family doctor, I appreciate the depth of information that "Outlive" conveys and the health 3.0 framework it introduces. One of my greatest challenges as a doctor is convincing someone to make a change in their life today that only decreases their risk of developing a disease in 20-30 years. Traditional treatments for high blood pressure or abnormal lipids (which decrease atherosclerotic cardiovascular disease) involve interventions spanning nutrition, exercise, and medication with a long feedback delay. I suspect that if all of my patients could read this book and understand the disease processes and how interventions could modify them, they would be more inclined to make sustained changes in their lives.
Of course, behavioral change requires someone to be emotionally ready for that change. Even if someone understands the long-term consequences of their diabetes, their emotional health often prevents them from making sustained changes. This is something that Peter begins to address in the last chapter by sharing his personal story. It is inspiring and courageous to include his personal emotional journey given the social stigma in admitting mental health challenges as a physician and someone who excels at generally masculine sports. I can see how someone reading this book who may have never considered pursuing emotional improvement could be inspired to reflect and make positive changes.
However, while Peter's own emotional challenges are aligned with his pursuit of longevity, such as his perfectionism that aligns with rigorous exercise and nutritional adherence, many individuals face the opposite struggle. Unfortunately, the impact of emotional readiness for healthy behavioral change is only briefly addressed in the book, which is my main critique. For instance, I hesitate to share this book with certain loved ones who might feel overwhelmed with shame about their current state before even finishing the first half.
In conclusion, "Outlive: The Science and Art of Longevity" is a must-read for anyone interested in taking control of their health and longevity. While it provides valuable information on how to prevent and manage common diseases of modern society, it also details the reasons behind these interventions. If you are emotionally ready to read this book, it will change your life, as it has mine.
March 9, 2024
This like Being Mortal, is a book I think everyone should read. I am going to compare this favorably to How not to Age. This is much better written thanks to some writing help and he sticks to facts rather than "mights" and "possibilities" One of the things I found interesting is that he strongly criticizes epidemiology as a way to determine what works for longevity and I found his arguments much more compelling than How Not to Age.
So lets take the advice they both agree on, diet and exercise, which, of course, is unsurprising to all of us. Attia makes clear, logical, specific cases for both to combat what he calls the four horsemen, cardiovascular disease, cancer, dementia and related, type 2 diabetes and related. My favorite part was when he expertly showed how exercise was so much more efective than any drug it should be labled a super drug.
My only issue was with the last part which, was decently interesting but did not fit with the rest of the book.
Everyone who wants to live a bit longer and have a better quality of life doing it should read this, which should be everyone.
So lets take the advice they both agree on, diet and exercise, which, of course, is unsurprising to all of us. Attia makes clear, logical, specific cases for both to combat what he calls the four horsemen, cardiovascular disease, cancer, dementia and related, type 2 diabetes and related. My favorite part was when he expertly showed how exercise was so much more efective than any drug it should be labled a super drug.
My only issue was with the last part which, was decently interesting but did not fit with the rest of the book.
Everyone who wants to live a bit longer and have a better quality of life doing it should read this, which should be everyone.
April 10, 2023
More plusses than minuses on this book.
Plusses:
1. It brings together pretty much everything you need to know and do to lead a longer healthier life (healthspan vs lifespan is a good distinction.)
2. It is fairly well balanced between scientific explanations and more down-to-earth understandable explanations.
3. This is important information for everyone. If you have not learned this elsewhere, this is a great one-stop shop.
Minuses:
1. I found Attia to be too long in getting to the point. This book could have been way shorter.
2. There is a lot of name dropping about his rich and famous patients.
3. I greatly respect the last chapter in which Attia basically says he's much more of an asshole than you would know and how he used DBT and therapy to make him less so. I just found it a very strange way to end this book. His issues are quite specific to him. I think a more holistic discussion of emotional health would be of greater service to the reader. Telling us about his therapy from his not one, but two of the most famous therapists in the world(Esther Perel and Terry Deal) is a bit offputting.
Plusses:
1. It brings together pretty much everything you need to know and do to lead a longer healthier life (healthspan vs lifespan is a good distinction.)
2. It is fairly well balanced between scientific explanations and more down-to-earth understandable explanations.
3. This is important information for everyone. If you have not learned this elsewhere, this is a great one-stop shop.
Minuses:
1. I found Attia to be too long in getting to the point. This book could have been way shorter.
2. There is a lot of name dropping about his rich and famous patients.
3. I greatly respect the last chapter in which Attia basically says he's much more of an asshole than you would know and how he used DBT and therapy to make him less so. I just found it a very strange way to end this book. His issues are quite specific to him. I think a more holistic discussion of emotional health would be of greater service to the reader. Telling us about his therapy from his not one, but two of the most famous therapists in the world(Esther Perel and Terry Deal) is a bit offputting.
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