In Outlive: The Science & Art of Longevity, Dr. Peter Attia summarizes the current state of the American medical system and offers a fresh approach to extending and improving life. By focusing on basic, evidence-based practices, Outlive provides a fairly comprehensive reference for improving overall health and longevity.
Medicine 3.0
Contemporary American medicine, which Attia terms Medicine 2.0, does a remarkable job of extending the lives of sick people. Surgery, radiation therapy and pharmaceuticals revolutionized treatment of heart disease and cancer without making us generally healthier. As Attia points out, medicine should aspire to do more than drag out the lifespan of very sick individuals. In contrast, Attia’s Medicine 3.0 seeks to minimize the risk of death and illness. It does so mainly by avoiding the so-called Four Horsemen diseases: cardiovascular disease, cancer, Alzheimer’s disease and type 2 diabetes. In doing so, Attia aims to extend his patients’ (and readers’) healthspans, allowing them to add years or even decades to their lives while doing the activities they enjoy instead of squandering those years in pain, illness and infirmity.
To that end, Attia begins by explaining what medicine currently understands about each of the Four Horsemen. He summarizes how each disease arises, how it is detected, and the latest research on prevention and treatment. Based on this information, he then provides lifestyle tactics for preventing or delaying the onset of Four Horsemen diseases. For the most part, these lifestyle practices are frequent exercise (cardio and strength training), proper nutrition and adequate sleep. And while Attia doesn’t shy away from pharmaceutical interventions—such as statins to lower high cholesterol—the bulk of his preventative measures fall under these everyday practices. The book closes with a chapter on emotional health, in which Attia details his own psychological struggles.
The Basics of Health and Longevity
In Outlive, Attia is speaking my language. I want to address almost all of my health concerns with foundational practices like diet, physical movement and sleep. As Attia points out, such lifestyle habits provide numerous and varied health benefits with almost no side effects. But there are times when I would want the very best allopathic medical care, such as if I develop cancer. And Attia does well to point out examples of when pharmaceutical interventions can complement already beneficial lifestyles.
In other words, I want a doctor like Attia. I often feel like I’m falling through the cracks of the medical system. I’m generally healthy, so few doctors will recommend radical interventions. If I have one or two biomarkers out of the reference range, I’m most likely to hear that I don’t need to worry because I’m relatively young and in good health or that I should just wait and get those markers retested in a few months. Instead, I want to learn how those biomarkers relate to each other. I want to know how I can intervene now to prevent any early warning signs from getting worse. In Outlive, Attia does just that by explaining the connections between the Four Horsemen diseases and proposing tactics to address symptoms and their underlying causes before they progress to full-blown disease.
Exercise Over Hacks
Speaking of tactics, Attia shares my appreciation for the mounting evidence that exercise is basically the most powerful drug available. Study after study shows that strength, stability and cardiovascular fitness reduce the risk for myriad diseases and extend longevity. For that reason, Attia dedicates three of the seventeen chapters in Outlive to the benefits of exercise and the most significant exercise-induced physical adaptations. Even as a regular exerciser, these chapters got me thinking about the abilities I want to preserve as I age.
I was also glad to see the absence of short-term hacks anywhere in the book. Attia’s prescription for longevity boils down to exercise, nutrition, sleep and emotional health. Like him, I believe the vast majority of health benefits come from consistent attention to these practices rather than searching for the latest shortcut.
Evidence and More Evidence
The final chapter on emotional health offers a vital lesson on the importance of emotional health. But it is a jarring departure from the other chapters in the book, and not only because it is so personal to Attia. The rest of Outlive succeeds because Attia proves so adept at clearly communicating scientific mechanisms and cutting-edge research. In contrast, the emotional health chapter lacks that evidence-based focus. There is evidence linking good emotional health to longevity, and it is surprising that such research is never addressed in this chapter.
I’m also used to seeing links to additional evergreen resources in books like these. While Attia makes passing mention of a few videos on his website, the content there is sparse, and the link is easily forgettable. Perhaps Attia believes Outlive is comprehensive and requires no supplementary content. He’s not far off, but I would have liked some suggestions about how to put the information in this book into practice (e.g. sample blood panels or doctors who share his Medicine 3.0 view).
All that being said, Outlive is a thorough guide for how to think about aging healthfully and living fully. It’s the rare book I expect to return to again and again for reference as I grow older.
Rating: 5/5 stars