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.

Book review: Eat Like The Animals

By David Raubenheimer and Stephen J. Simpson

The two entomologists describe a fascinating, 30-year research journey, that took them  from studying insect nutrition to postulating the cause of the human obesity epidemic.  Along the way, they performed experiments as well as observations in the wild, progressing from insects to primates (including humans).  The book is easy and entertaining.  I recommend it.

The authors invented a concept which they named Nutritional Geometry.  They concluded that many species, including humans, have more than one appetite.  In humans they count five:  Protein, Carbohydrates (CH), Fat, Salt, and Calcium.  Each appetite regulate the food intake to meet a natural target, and thus achieve a healthy balanced diet.

They discovered that in many species, the dominant appetite is the one for protein.  They named this effect Protein Leverage.  If balanced food is available, the animal will eat a balanced diet.  However, when the only available food sources are low in protein (and therefore high in CH or fat), the animal will eat more food, until it reaches its protein target.  This results in consuming more energy than necessary, and consequently becoming fat.  Conversely, if the food sources are too rich in protein, in order to hit the target, the animal will eat less, and loose weight.  The fiber content of fruits and vegetables is the one ingredient  that limits the amount of CH and fat that the animal can consumes.  Fiber physically fills the stomach till no more can be ingested.  Humans clearly exhibit the protein leverage phenomenon.  

Obesity Epidemic Thesis

1. The blame lies with ultra processed food (UPF), and its manufacturers 
2. The average target level for human protein consumption is 15% of total energy intake.  Since the 1970s, humans consumed a few percent less than this target. 
3. Protein leverage predicts that we eat more CH and fats to compensate.  The consumption data fits the prediction, and accounts for the increase in obesity.
4. When protein leverage causes hunger and a need for more food we turn to UPF. UPF is designed to be commercially successful, not to make us healthy.  As such it has the following characteristics:

• Engineered to be super tasty, it includes salt, fat, sugar, and many gruesome-sounding industrial ingredients.
• Low in protein.  Forces us to eat more. 
• Low in fiber.   Allows us to eat a more.
• Low cost (protein is expensive)
• Long shelf life.  (Fiber reduces shelf life).
• UPF manufacturers follow the tobacco industry in confusing the public regarding the effects of their products.

The solution?

Eat enough protein.  Your appetite will tell you when to stop.  As for the rest, the book recommendations fit a Michael Polan quote which I love:

• Eat FOOD  (not industrial products)
• Not too much
• Mainly fruits and vegetables.

Behavioral Advice

The book concludes with behavioral advice on how to loose weight, and data on the protein contents of various foods.

Since loosing weight is not my main focus, I will not expand on this, except for one detail:

Although the average target for protein is 15%, this number increases as we age.  Over the age of 65 the recommended target is 20%.

An aside.  The authors must have intercepted my emails.  They cite "The three pillars of health" as:

• Sleep
• Exercise
• Nutrition

Controversy

The authors conducted a very large mice experiment.  It took five years to conclude, provided lots of data which confirmed the protein leverage theory.  They observed a marked difference in lifespan between mice eating the high protein vs the low protein food. 

• Mice eating low protein foods became fat, but lived longer.  (Especially if the extra energy came from CH not fat)
• Mice feeding on high protein food, stayed slim, had better reproductive capabilities, but lived shorter lives.

The book extends "More protein=Shorter life" to human health.  This raised controversy in nutrition circles.  The main objections are that  a.  Humans are not mice, and b.  The data on humans is not yet clear.   The field of Nutrition has many religions, and this will add fuel to the already burning fires.  How fun.

 

 

 

 

The Basic Laws of Human Stupidity

 The Basic Laws of Human Stupidity is a book by Carlo M Cipolla, who was a UC Berkeley professor of economics.

The book is short and humorous.  It explains the frustration I often felt in encountering acts of stupidity.  It describes five basic laws:

1. Always and inevitably everyone underestimates the number of stupid people in circulation.
2. The probability that a certain person is stupid is independent of any other characteristic of that person
3. A Stupid person is a person who causes losses to another person or a group while himself deriving no gain and even possibly incurring losses.
4. Non-stupid people always underestimate the damaging power of stupid individuals
5. A stupid person is the most dangerous type of person.  (A stupid person is more dangerous than a bandit.)

 The author divides the universe into four personalities based on the individual's actions.  Does the action cause gain or loss to the individual and does it cause gain or loss to the other person.  It can be drawn on a page using the ubiquitous four quadrants method.

The stupid is more dangerous than the bandit because the bandit's actions are predictable, allowing us to defend ourselves.  The acts of the stupid are irrational and therefore unpredictable.  Furthermore, acts of big-time bandits lean towards the "intelligent" side and do not cause greater harm than their gain. Thus they have a net-zero impact on society. The acts of a powerful stupid person can hurt organizations and societies.    

This reminds me of a saying, not from this book, and whose source I do not remember.  Reciting it reduced my stress on many occasions:  "Never attribute to malice anything that can be explained by stupidity"  If the book won't help, I am sure this saying will.

 

  

Habits

For anyone seeking improvement in any endeavour, I'd like to recommend the book Atomic Habits, by James Clear.  Its logical reasoning and practical advice, prompted me to change my habits.
The book makes the case that small changes, implemented over a long period, can lead to large transformations, and that habits are the tools to accomplish this task.  The author suggests four rules for forming a habit:
1.  Make it Obvious
2.  Make it Attractive
3.  Make it Easy
4.  Make it Satisfying
The list almost seems trivial, but each rule is followed by research and anecdotes.  Those help clarify the rule, and provide guidance on how to implement it.

After completing this portion of the book, I was enthused, and started using the method.  However, I faced a dilemma.  For years, I have tried to practice the Buddhist concept of  Mindfulness'.  Now, it occured to me that mindfulness and habit are exact opposites.  I wondered whether I have to choose  between the two.  The 'advanced' portion of the book dispelled my concern.  It clarified, that the application of the two concepts are separated by space and time.  Some activities may not be worth the effort of mindfulness (1), and can be safely done as a habit.   In other, more important activities, after a habit forms, it serves as a stepping stone, freeing mental resources for mindful improvements.

I decided to focus on a small number of habits that I would like to promote: Meditation, Music, and Muscle.  Over the last two weeks, I have been consistently meditating morning AND evening, practicing my sax daily, and exercising regularly.

Note :
1.  Buddhists are often instructed to be mindful of trivial activities, such as chewing.  In my unlearned opinion, this is only a training tool.