Outlive, by Peter Attia MD. Book review.

Outlive aims to teach us how to live a longer healthy life.  I like the book because it fits my goals.  I am not afraid of death, but for as long as possible I wish to remain active. To achieve this goal, I need to be strong both mentally and physically.  I have been listening to Peter Attia for several years. He is an MD (and engineer,) smart, charismatic, and his explanations fit my way of thinking  (1).  The book is well organized, although, to my taste, it could be shorter by reducing the number of anecdotes.

As I was reading, I realized that the correct audience are my three middle-aged children.  They are old enough to be aware of aging, yet still have enough time to implement the advice in the book.  Perhaps this review will motivate them to read it.

The book is organized around Objective, Information, Strategy, and Tactics. 

Objective

Delay death, and get the most out of our extra years. The rest of our lives becomes a time to relish rather than to dread.

Information 

Aging is a process of deterioration of both mind and body. Eventually, the deterioration leads to illness and death.  The four main causes of death in western society are heart diseases , cancer, neurodegenerative disease (Alzheimer),  and Type 2 diabetes.  Attia named them the four horsemen [of the apocalypse.]  The book dedicates at least one chapter to each horseman, describing its causes and treatments.  The common thread in these chronic illnesses is that they are a result of a mismatch between the modern environment and our genetic makeup. 

Strategy

Today's medical practice does a good job of tackling acute disease, yet it is not equipped to handle chronic diseases.  To increase our healthspan, we need to develop a new style of medicine, which Attia names Medicine 3.0.   Since chronic illness starts to develop many years before it is recognized and treated, Version 3.0 focuses on early detection and early prevention.  It uses data to provide individuals with advice which minimizes the risk of intervention, while maximizing the reward (years of health).

Tactics

If we want to outlive our life expectancy and live it better, we will have to work.

The tactics entail five tools:  Exercise, nutrition, sleep, emotional health, and exogenous molecules (a fancy name for drugs and supplements).  Attia aims to provide general principles for these tools, rather than exact recipes, though in many cases he does provide detailed advice.

Exercise

Exercise is, by far, our most effective tool.  It is more potent than any known medication.  It can offset many adverse lifestyle factors.  Exercise reduces our risk of illness and death from any of the horsemen.  In addition, to be able to execute the activities we wish to do in our last years, we need to build some reserve now.  That includes both aerobic fitness and strength. 

We want to be able to walk uphill with our grand (or grand-grand) children, as well as pick them up when we desire.  Strong muscles also help avoid accidental falls, and the resulting bone fractures.  Interestingly, grip strength has a very high correlation to reduced mortality risk.  

          Attia provides some advice on how, how much, and how often to exercise.

Nutrition

Nutrition is a fuzzy science.  The experiments are not clear, and the effects are not large.  Bad nutrition habits can make us ill, but as long as we avoid the Standard American Diet (SAD), all other diet religions provide about the same benefit.  Instead of a diet, Attia recommends these simple 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 and toxins" 

All macronutrients and their qualities are discussed.  Special attention is placed on consuming sufficient protein.  For active people, sufficient daily quantity is 2.2 grams per Kg of body weight.  That's nearly three times the medical advice. 

Sleep

High quality sleep is essential to our health.  Attia provides advice on how to achieve it. 

Emotional health

“Why would you want to live longer if you’re so unhappy?”

A lot of this chapter is devoted to Attia's long road from child abuse to therapy, but the lesson may apply to any of us.  Emotional health will affect our physical health and longevity.

[In a separate but related reference, I learned that chronic stress causes a faster rate of telomere shortening, and therefor accelerates aging.  Stress relief methods such as meditation, are highly recommended (2)]  

Medication and supplementation

The book does not dedicate a chapter to this tool.  Attia prescribes medication to patients who do not respond to the other tools.

Notes:

1.  The theory behind this book seems solid to me.  However, over the years I realized that Attia is a bit fanatic about ideas he believes are true, and more than a bit obsessive in his activities.   In the book he claims that he has reformed these tendencies.  Nonetheless, if any of the ideas or suggestions in the book seem wrong to you, feel free to further investigate and or reject them. 

2.  The Stress Prescription, by Elissa Epel, Penguin books 2022.