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Outlive: The Science and Art of Longevity 


Dr. Peter Attia’s long-awaited book about longevity is finally out, and it doesn’t disappoint. I first saw him on Rich Roll’s podcast. Dr. Attia is an interesting guy, very smart, and with a diversified background. He started out as an undergrad in aerospace engineering at Stanford (one floor up from the floor where my Applied Mechanics division was headquartered, but some years later). A moving volunteer experience recounted in the book caused him to switch into medical school, and he became a cancer surgeon. He left medicine for a few years to work in the world of finance, to which he was well-suited because of his strong mathematics background from his engineering education. He then switched back to medicine, and became involved in applying medicine to help patients achieve healthy aging, which he continues with today.

He is also a remarkable athlete, and what is most evident is how he launched himself with full intensity into whatever sport he pursued, including boxing, cycling, and swimming. Peter admits that if he had continued with cycling, for example, he would have continued to improve his time trial results but probably would have ended up unable to straighten up from years of being hunched over the bars, because he cared about his results more than health. This ended with a wake-up call in his late 30s. After he completed the challenging swim from Catalina island to the mainland, his wife gently pointed out that despite all his exercise, he was becoming “not thin”. This caused him to get various health biomarkers like cholesterol, triglycerides, and blood sugar checked, and the results were disappointing.

So he pivoted into longevity, and since then, his primary athletic interest has been what he calls the “centenarian decathlon”. Inspired by the Olympic decathlon, this is multiple fitness events he practices, with the end goal of being healthy and fit when he reaches 100. Dr, Attia encourages his patients (and readers) to think of the activities they’d like to be able to perform when they are much older and helps them come up with their own activities to achieve them. For example, to be able to pick a grandchild off the floor when you are 90+ requires maintaining muscular strength, while being able to go up stairs requires enough aerobic fitness as well as strength.

He emphasizes that various diseases of civilization like cardiovascular disease, cancer, type II diabetes, dementia, and frailty (loss of both muscle and bone mass), are what contribute the most to shortening our lifespans in the modern world. But they also prematurely reduce our quality of life. Dr. Attia covers the latest medical knowledge on the diseases of civilization, and how they relate to aging, in part II of the book. I found this to be very enlightening reading. He describes how the quality of scientific evidence is not always as good as we would like. Ideally, there should be decades-long double-blind interventional studies on everything, but we must make do with things like population studies or shorter interventional studies. But I learned a lot about how to better interpret the data that are available. For example, population studies can show a correlation between something, say eating a particular food, and the likelihood of getting a disease. But this does not necessarily prove causation. But he shows how more insight can be teased out using techniques like Mendelian randomization

Then in part III, he covers measures to address the diseases of civilization and achieve healthy aging. First are several superb chapters on exercise, including cardiovascular, strength, and stability training. There is so much good and novel information here that I will cover it in detail in a future post.

Next are chapters on nutrition. First of all, Dr. Attia laments the fact that various competing diets have followers with cult-like beliefs (with which I totally agree). Also, through his practice, he has found people are all different in their response to nutrition. He gives a lot of insight into how nutrition relates to health and thinks we all need to find what works best for us.

One area that will perhaps be controversial is his recommendations on protein. Dr. Attia thinks the requirements for protein to prevent muscle loss with aging are much higher than the typical government recommendations. I agree with that and discussed it here. This is also discussed in Dr, Valter Longo’s book The Longevity Diet. Dr. Longo recommends mostly plant-based protein intake but recommends supplementing it with fish to get enough to prevent muscle loss. Dr. Attia’s recommendations for protein are significantly higher than Dr. Longo’s, however.

I was a little disappointed Dr. Attia did not mention the Blue Zones, populations around the world that live significantly longer and healthier than the average person in the modern world. Their lifestyles differ from the average society in more than just nutrition, of course, but I would have liked to have heard Dr. Attia’s take on these populations and what we can learn from them.

After nutrition there is a detailed chapter on the importance of good quality sleep and measures we can take to get it. I agree that this is a vital area not always covered in discussions of longevity. Finally, he discusses emotional health. This is largely in the form of his own personal journey in this area, a moving story of its own. We can gain good insights from this story, and from what Dr. Attia has learned working with his patients in this vital area.

I highly recommend this book. It is challenging reading because there is a lot of detail, but He presents it at a good level for understanding by non-specialist readers.

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