“One of the most important books you’ll ever read.
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 Attia believes we must replace this outdated framework with a personalized, proactive strategy for longevity, one where we take action now, rather than waiting.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.
But here’s the deal—Attia is not talking about the science that will take people to age 120 and beyond. Instead, his book focuses on the last 10-15 years of your life and how the decisions you make today (and the early identification of potential future health issues,) will determine whether you spend that period sitting around waiting to die, or continuing to do the things you enjoy doing right now. For me, this would be hiking, sports, conversations and meals with friends, and the ability to read a good book.
I’m a big library reader, but I bought this one. I’ll be going back to relook Attia’s videos on exercise, and reread sections on the “Four Horsemen.”
It’s never too late to change.
Thanks Dr. Attia, for also sharing your personal journey.
He's very powerful and empowering at the same time!
Enjoy it!
Thank you Dr.Attia
The most interesting part for me was a deep dive in cholesterol and heart disease related vitals and the discussion of fasting (esp. the inconclusive evidence in studies on monkeys)
This book affirmed for me that the lifestyle demands of following Dr. Attia's prescription for a longer "healthspan" were like way, way, way too hard for me and didn't seem very fun. I really can't commit to giving up drinking, and watching my weight, and exercising every. single. day.
I didn't make it all the way through, pretty much a buzzkill by chapter 3 but you do you.
I truly enjoyed reading this book and recommended it to my friends and colleagues as well. I am excited to take the journey, do the blood test, and build my action plan for a better and healthier life! I wish I knew about this when I was 20.
Thank you for educating us and sharing so many personal stories with us.
I wish I had this book 40 years ago.
well in your golden years you can't beat this book. I was reading it in a hospital waiting room [for my wife] and two doctors asked to borrow it. Pretty good reccomendations right there.
What I found was a great resource, easy to read, follow and understand. I am only on page 100, arguably, not even scratching the surface. But, I am enjoying it so much. The book has relatable anectodes and examples of different concepts, experiences from Peters life as a resident and doctor. I just love it.
It's not complicated and has explanations of clinical terms in parentheses (very helpful). The read is fast and easy, accessible language.
Really fun book so far.
and active 100 year old.
Bob
Dr Attia emphasizes that there are currently many different theories on how to approach improving one's health and outlook, especially in the mental health realm, and his approach takes a broader outlook and focuses on strategy, vs different tactical methodologies. He provides some simple solutions such as tracking various metrics and suggests different tests to get under varying circumstances.
He categorizes medical advancement into medicine 1.0, 2.0 and 3.0. Medicine 2.0 is the reliance on large data and statistical methods. He believes the problem with this approach is that it removes the individuality needed, and this is where medicine 3.0 comes in. In this stage, there is a personal focus on the patient and it also requires a lot from the patient.
Overall, interesting book in a fascinating field. It seems like this topic is still in its infancy, but if these early pioneers turn out to be correct, this will be one of the major milestones in the evolution of the human race!
Dr Attia finishes the book on emotional health with a very well written and honest account of his own arduous recovery from childhood trauma.
Of the books on this subject, and I’ve read several, this is the most straightforward and illuminating. Well worth your time.
Attia writes: “as a surgical resident at Johns Hopkins, I would learn that death comes at two speeds: fast and slow… Ultimately… slow deaths ended up bothering me even more. But this is not a book about death… [but about] longevity… Longevity does not… mean merely notching more and more birthdays as we slowly wither away… In 1900, life expectancy hovered somewhere south of age fifty, and most people were likely to die from “fast” causes: accidents, injuries, and infectious diseases… the odds are overwhelming that you will die as a result of one of the chronic diseases of aging that I call the Four Horsemen: heart disease, cancer, neurodegenerative disease, or type 2 diabetes and related metabolic dysfunction… Longevity has two components. how long you live… [and] the quality of your years… called healthspan… defined as the period of life when we are free from disability or disease… Death rates from cancer, on the other hand, have hardly budged in the more than fifty years since the War on Cancer was declared, despite hundreds of billions of dollars’ worth of… spending on research. Type 2 diabetes remains a raging public health crisis, showing no sign of abating, and Alzheimer’s disease and related neurodegenerative diseases stalk our growing elderly population… None of our treatments for late-stage lung cancer has reduced mortality by nearly as much as the worldwide reduction in smoking that has occurred over the last two decades, thanks in part to widespread smoking bans. This simple preventive measure (not smoking) has saved more lives than any late-stage intervention that medicine has devised… Medicine’s biggest failing is [treating] all these conditions… after they are entrenched—rather than before they take root.”
Attia writes: “The metabolic derangement that leads to type 2 diabetes also helps foster and promote heart disease, cancer, and Alzheimer’s disease… all “diets” are similar… protein becomes critically important as we age… Exercise is by far the most potent longevity “drug.” No other intervention does nearly as much to prolong our lifespan and preserve our cognitive and physical function. But most… don’t do nearly enough—and exercising the wrong way can do as much harm as good…”
Attia writes: “there have been two distinct eras in medical history, and [we are] on the verge of a third… Hippocrates’s major contribution was the insight that diseases are caused by nature and not by… the gods… Medicine 2.0 arrived in the mid-nineteenth century with the advent of the germ theory of disease... [and] eradicated deadly diseases such as polio and smallpox… Yet Medicine 2.0 has proved far less successful against long-term diseases such as cancer… lifespans have nearly doubled since the late 1800s, [almost] entirely from antibiotics and improved sanitation... if you subtract out deaths from the eight top infectious diseases… overall mortality rates declined relatively little over the course of the twentieth century… [The goal of] Medicine 3.0—is… to be thriving… throughout the latter half of our lives… Lifespan… is binary: you’re alive, and then you’re dead. It’s final. But before that happens… most people suffer through a period of decline that… is like dying in slow motion… while actual death is inevitable, this deterioration… is less so… If you increase your muscle strength and improve your cardiorespiratory fitness, you have also reduced your risk of dying…”
Attia writes: “[Exercise] components [are]: strength, stability, aerobic efficiency, and peak aerobic capacity. We want to maintain physical strength, stamina, stability across a broad range of movements, while remaining free from pain and disability… exercise [is] the most potent longevity “drug” in our arsenal, in terms of lifespan and healthspan. The data are unambiguous: exercise not only delays actual death but also prevents both cognitive and physical decline, better than any other intervention…”
Attia writes: “data comes from studies of… people who have lived to the age of one hundred and beyond, often in good health… many of them get to enjoy one, or two, or even three Bonus Decades…. Researchers… [found that] individuals [had] very little in common with one another genetically… Natural selection has endowed us with genes that work beautifully to help us develop, reproduce, and then raise our offspring [but] after the age of reproduction, natural selection loses much of its force… [Yet] a handful of potential longevity genes… are possibly relevant to our strategy. One [gene]… called … APOE (apolipoprotein E) that is involved in cholesterol transport and processing, and it has three variants: e2, e3, and e4… The e2 variant of APOE… seems to protect its carriers against dementia—and it also turns out to be very highly associated with longevity… FOXO3 belongs to a family of “transcription factors,” which regulate how other genes are expressed—meaning whether they are activated or “silenced.”… When FOXO3 is activated, it in turn activates genes that generally keep our cells healthier. It seems to play an important role in preventing cells from becoming cancerous as well.”
Attia writes: “gene expression can be influenced by your environment and your behaviors… a 2007 study found that older people who were put on a regular exercise program shifted to a more youthful pattern of gene expression after six months. This suggests that genetics and environment both play a role in longevity and that it may be possible to implement interventions that replicate at least some of the centenarians’ good genetic luck… think of centenarians as the results of a natural experiment that tells us something important about living longer and living better… The experiment entails taking a random collection of human genomes and exposing them to a variety of environments and behaviors. The centenarians possess the correct combination of genome X required to survive in environment Y (perhaps with help from behaviors Z).”
Attia writes: “Protein aggregates have been implicated in diseases such as Parkinson’s and Alzheimer’s disease, so getting rid of them is good; impaired autophagy has been linked to Alzheimer’s disease… and also to amyotrophic lateral sclerosis (ALS), Parkinson’s disease, and other neurodegenerative disorders… 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… The FDA has given the green light for a clinical trial of another drug with potential longevity benefits, the diabetes medication metformin… studies appeared to confirm… that patients on metformin appeared to have a lower incidence of cancer than the general population… diabetics on metformin actually lived longer than nondiabetics[striking!].”
Attia writes: “In the late 1970s, the average American adult male weighed 173 pounds. Now the average American man tips the scale at nearly 200 pounds… According to the [CDC] more than 40 percent of the US population is obese… another third… is overweight (BMI of 25 to 30)… visceral fat is linked to increased risk of both cancer and cardiovascular disease… fat-storage capacity seems to be influenced by genetic factors… our metabolism, as it has evolved over millennia, is not equipped to cope with our ultramodern diet, which has appeared only within the last century or so… We needed to… endure periods of time without much food, and natural selection obliged, endowing us with genes that helped us conserve and store energy in the form of fat… to survive periods of famine, cold climates, and… illness and pregnancy.”
Attia writes: “At some point, our primate ancestors underwent a random genetic mutation that effectively switched on their ability to turn fructose into fat… This newfound ability to store fat enabled them to survive in the colder climate… But in our modern world, this fat-storage mechanism has outlived its usefulness… It is very difficult to get fat from eating too many apples, for example, because the fructose in the apple enters our system relatively slowly, mixed with fiber and water, and [we] can handle it normally… I test my patients’ levels of uric acid, not only because high levels may promote fat storage but also because it is linked to high blood pressure… While heart disease is the most prevalent age-related condition, it is also more easily prevented than either cancer or Alzheimer’s disease… atherosclerotic disease… still kills more people than cancer in the [US] each year… Heart disease remains our deadliest killer, … [but] this should be the tenth leading cause of death, not the first.”
Attia writes: “The reason they’re called high-and low-density lipoproteins (HDL and LDL, respectively) has to do with the amount of fat relative to protein that each one carries... it’s not the cholesterol per se that causes problems but the nature of the particle in which it’s transported… Another major misconception about heart disease is that it is somehow caused by the cholesterol that we eat in our diet… The humble egg… has remained in nutritional purgatory for decades, even after reams of research papers showing that dietary cholesterol (and particularly egg consumption) may not have much to do with heart disease at all… The vast majority of the cholesterol in our circulation is actually produced by our own cells… dietary guidelines finally… conceded (in 2015) that “cholesterol is not a nutrient of concern for overconsumption.” Glad we settled that… the American Heart Association guidelines still favor LDL-C testing instead of apoB. I have all my patients tested for apoB regularly, and you should ask for the same test the next time you see your doctor… We are fortunate that many of these conditions can be modulated or nearly eliminated—including apoB, by the way—via lifestyle changes and medications… I take a very hard line on lowering apoB, the particle that causes all this trouble. (In short: get it as low as possible, as early as possible.)… if we all maintained the apoB levels we had when we were babies, there wouldn’t be enough heart disease on the planet for people to know what it was… In my clinical experience, about a third to half of people who consume high amounts of saturated fats… will experience a dramatic increase in apoB particles, which we obviously don’t want. Monounsaturated fats, found in high quantities in extra virgin olive oil, macadamia nuts, and avocados (among other foods), do not have this effect... The point is not necessarily to limit fat overall but to shift to fats that promote a better lipid profile… But for many patients... lowering apoB… cannot be accomplished with diet alone... Statins are far and away the most prescribed class of drugs for lipid management... statins… are very helpful drugs for reducing apoB or LDL concentration in many patients... For people who can’t tolerate statins, I [prescribe] bempedoic acid (Nexletol),”
Attia writes: “Like heart disease, cancer is a disease of aging. That is, it becomes exponentially more prevalent with each decade of life… there were more cancer deaths among people between forty-five and sixty-four than from heart disease… The problem we face is that once cancer is established, we lack highly effective treatments for it. Our toolbox is limited… surgery is of limited value when cancer has metastasized, or spread. Metastatic cancers can be slowed by chemotherapy, but they virtually always come back… Cancer cells… stop listening to the body’s signals that tell them when to grow and when to stop growing… a gene called PTEN, which normally stops cells from growing or dividing (and eventually becoming tumors), is often mutated or “lost” in people with cancer, including about 31 percent of men with prostate cancer and 70 percent of men with advanced prostate cancer. Such “tumor suppressor” genes are critically important to our understanding of the disease… not only is breast cancer genetically distinct from colon cancer (as the researchers expected), but no two breast cancer tumors are very much alike… With a few exceptions… solid organ tumors typically kill you only when they spread to other organs… Prostate cancer kills only when it becomes metastatic… Once cancer has spread, the entire game changes… excess weight is a leading risk factor for both cancer cases and deaths, second only to smoking… Obesity itself is strongly associated with thirteen different types of cancers… [For] colorectal cancer (CRC)… About 70 percent of people who are diagnosed with CRC before the age of fifty have no family history or hereditary conditions linked to the disease… Of all the Horsemen, cancer is probably the hardest to prevent”
Attia writes: “In the [US], about 6 million people are diagnosed with Alzheimer’s disease… 1 million have been diagnosed with Parkinson’s... Exercise is the only intervention shown to delay the progression of Parkinson’s… Having type 2 diabetes doubles or triples your risk of developing Alzheimer’s disease, about the same as having one copy of the APOE e4 gene… APOE e4… seems to accelerate other risk factors and driver mechanisms for Alzheimer’s… Curiously, APOE e4 was not always a bad actor… The e3 mutation showed up about 225,000 years ago, while e2 is a relative latecomer, arriving only in the last 10,000 years… In environments where infectious disease was a leading cause of death, APOE e4 carriers may have been the lucky ones, in terms of longevity… The single most powerful item in our preventive tool kit is exercise… Strength training is likely just as important… I now tell patients that exercise is… the best tool we have in the neurodegeneration prevention tool kit… Sleep is also a very powerful tool against Alzheimer’s disease... Sleep disruptions and poor sleep are potential drivers of increased risk of dementia… There is a growing body of research linking oral health… with overall health… The conundrum we face is that our environment has changed dramatically over the last century or two, in almost every imaginable way—our food supply and eating habits, our activity levels… Our genes no longer match our environment. Thus, we must be cunning in our tactics…to… thrive”
Attia writes: “exercise has the greatest power to determine how you will live out the rest of your life… even a fairly minimal amount of exercise can lengthen your life by several years. It delays the onset of chronic diseases, pretty much across the board, but it is also amazingly effective at extending and improving healthspan… So if you adopt only one new set of habits based on reading this book, it must be in the realm of exercise…”
Attia writes: “each of us needs to be training for the Centenarian Decathlon… [Decide on] the ten most important physical tasks you will want to be able to do for the rest of… your life… [Consider a] long list of physical tasks that might include some of the following: Get up off the floor under your own power… Lift a twenty-pound suitcase into the overhead compartment of a plane… [from say] more than fifty different items.... [then] select which of these tasks [you] want to be able to perform… in [your] ninth… decade. [then] come up with a list of ten… to become a different sort of athlete altogether: an athlete of life… I structure my training around exercises that improve the following… Grip strength… to be able to lift the weight up and put it back down, slowly and with control… Pulling motions… Hip-hinging movements... I focus on these four foundational elements of strength because they are the most relevant to our Centenarian Decathlon… studies suggest that grip strength—literally… how hard you can squeeze something with one hand—predicts how long you are likely to live… It’s not about telling you what to eat; it’s about figuring… out what works for your body and your goals—and, just as important, what you can stick to…”
Attia writes: “Nutrition is relatively simple.... 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… Beyond that, we know relatively little with complete certainty. Read that sentence again, please… a lot of the old cliché expressions are probably right: If your great-grandmother would not recognize it, you’re probably better off not eating… Plants are very good to eat. Animal protein is “safe” to eat. We evolved as omnivores; ergo, most of us can probably find excellent health as omnivores.”
Attia writes: “some clinical trials have provided some useful bits of knowledge. One of the… clinical trials… show a clear advantage for the Mediterranean diet—or at least, for nuts and olive oil… The study was meant to last six years, but in 2013… halted it prematurely, after just four and a half years, because the results were so dramatic… The group receiving the olive oil had about a one-third lower incidence (31 percent) of stroke, heart attack, and death than the low-fat group, and the mixed-nuts group showed a similar reduced risk (28 percent). It was therefore deemed unethical to continue the low-fat arm of the trial. By the numbers, the nuts-or-olive-oil “Mediterranean” diet appeared to be as powerful as statins…”
Attia writes: “SAD, the Standard American Diet [is] almost as devastating to most people as tobacco when consumed in large quantities… The farther away we get from the SAD, the better off we will be… The real art… [is] finding the best mix of macronutrients… [and] an eating pattern [that one] can sustain… our four macronutrients: alcohol, carbohydrates, protein, and fat… Alcohol serves no nutritional or health purpose but is a purely hedonic pleasure that needs to be managed. It’s especially disruptive for people who are overnourished... it’s an “empty” calorie source that offers zero nutrition value… chronic drinking has strong associations with Alzheimer’s disease, mainly via its negative effect on sleep… it loosens inhibitions around other kinds of food consumption…”
Attia writes: “Many studies have found powerful associations between insufficient sleep (less than seven hours a night, on average) and adverse health outcomes ranging from increased susceptibility to the common cold to dying of a heart attack… As important as sleep is for the body, it may even be more so for the brain. Good sleep, in terms of not only quantity but quality, is critical to our cognitive function… there is a growing body of evidence that sleeping well is essential to preserving our cognition as we age and staving off Alzheimer’s disease.”
Unlike those other books, Outlive explains the biological science that drives our health span and the strategies and tactics we can use to expand it. Rather than offering “to do” list of diets or exercises or theories about imminent lifespan breakthroughs, Outlive teaches us how to think about the things that matter—and why they can make a difference.
Attia is refreshingly blunt. More than just explaining the medical science, he revels in providing the nuances needed to help us apply it to our own lives. I particularly appreciated his explanations about the roles of cellular science and nutritional biochemistry and the importance of sleep.
This is a valuable book for all ages. Although Attia clearly wants people in their 30s and 40s to understand the value of starting early, he makes clear that we can benefit from his principles at any age. I am in my seventies and I am already applying his advice. Of course, I wish I had done it sooner.
While Attia is a brilliant medical doctor, you do not need to be a science nerd to appreciate his arguments. His coauthor Bill Gifford does a good job of making almost all the book understandable and enjoyable to read.
My biggest surprise in reading Outlive was Attia’s vivid emphasis on the high cost of ignoring what he calls emotional health. While Attia hints throughout the book at some of his own personal struggles, the final chapter and the epilogue provide powerful insight about this important topic that should be mandatory reading for driven "type A" personalities and all of us who know them.
If you are someone who subscribes to Petter Attias podcast and a paid subscriber you’ll find a lot of repetition especially if you have listened and read a lot of his stuff. I like the reminders and written text in one place too.
The one new thing I hadn’t seen him speak about was his mental health as a subscriber to everything else he does I found this to be the most impactful and amazing stories. It makes him much more human and relatable.
Once you are done reading this review or book get out and exercise!! I’m now going for a Zone 2 run ;)
Peter Attia M.D. takes us on a journey, from the science of longevity to the art of longevity as he intertwined what he discovered and teaches us what we can do.. His style of writing makes for a very good read. I applied what he discussed because he convinced me of the effectiveness of following what he provided as solutions. I agreed with his premise that in order to have that long life it's important to live well and to live with purpose. I recommend this book because it is the best information to guide us.
There are many books that try to speak to these same types issues but this one seems to have made the concepts much easier to wrap my head around.
A very thorough and thoughtful way to bring people a lot useful information which is quite actionable by most people.
Thanks
I liked the technical parts of the book, though I confess many of them were somewhat over my head and, as a Christian, I don't really buy into the evoultionary references.
That said, I really liked the tactics sections where Peter gave practical strategies for improving overall health and staving off the Four Horsemen. My favorite section was the Emotional Health portion of the book. Thank you, Peter, for being transparent. I know this section was not easy to write, but I am so glad you did! Thank you!
I pray this book transforms the thinking of the medical community..... it is about time.
Synopsis: Outlive by Dr. Peter Attia is one of the best books on health and wellness I’ve ever read. Attia’s principle goal is to show readers that we are on a precipice: continue on our path as we have in the last 50 years and, as a whole, suffer more from cancer, diabetes, heart disease, and neurodegenerative disease, or move past treating symptoms once they’ve arrived and focus on preventative measures to help us age without these diseases.
Bold premise? Yes. Accomplished? Also, yes.
Over the course of 4oo pages, Attia details what we face as we get older: The Four Horsemen - perhaps not the four horsemen of the apocalypse from lore, but the new Four Horsemen of the Health Apocalypse. As cancer rates rise, so too, do cases of neurodegenerative diseases (like Alzheimer’s), Type 2 Diabetes (and other metabolic dysfunctions), and heart disease. The problem, Attia presents, is that these diseases are not acute - meaning that they take decades to develop. While someone may have a sudden heart attack, the mechanisms to create the environment that caused the heart attack have been brewing for years.
This is where Attia pushes for the move from Medicine 2.0 to Medicine 3.0. Currently, we are living primarily in the world of Medicine 2.0 - treating symptoms and focusing on the present, not what our health could look like in 10, 20, or 30 years. Medicine 3.0, however, should begin as soon as we become aware of it - or sooner. Medicine 3.0 wants humans to avoid the Four Horsemen by using exercise, nutritional biochemistry (not diet - he discusses why in the book), and emotional well-being to set us up for living to age 100 and beyond.
Why does this book beguile? Written by a doctor, Outlive by Peter Attia, pushes the boundaries of what’s typically acceptable in medicine today. He acknowledges how challenging it may be to get a DEXA scan from your doctor, and shares why you aren’t receiving proper nutritional advice from your primary provider. Attia hits on so many things in the medical system today that frustrate me: poor tracking of health metrics, treating symptoms and not causes, little to no specialized nutritional advice, and a pill-for-everything instead of viewing a patient holistically.
Until the medical system, and more importantly, the medical insurance system catches up to Medicine 3.0 (which is probably less profitable than Medicine 2.0), those interested in longevity and preventative measures, may live in the nebulous realm of what I call, Medicine 2.75. Medicine 2.75 is where the patient, like you and me, must take our health into our own hands. Using tools like Everly Well and Empowered DX Labs, you can purchase your own at-home testing kits to monitor what’s important to you. You may have to find a more forward-thinking primary care provider to help order the right tests and scans and then take your nutrition into your own hands. It’s quite a bit of work for the average person, but well worth it to live long and enjoyable lives.
I love Attia's evolving knowledge. For instance, for years he emphasized nutrition as more important than fitness; now, he acknowledges that you can greatly improve poor health through nutrition, but the additional gains are limited, once you've corrected a poor diet. On the other hand, you can greatly improve poor health & prognosis through fitness, but you can also continue to improve your quality of life/resilience/freedom through fitness, even after you've reached a healthy baseline. Bottom line: Dr. Peter Attia makes science-informed advice accessible.
The Bible says that we are to be sanctified in spirit, soul, & body, and it, obviously, is the foundation for it all. Nothing else is relevant without the Scriptures. That said, Outlive (essentially 411 pages of content) is extremely helpful concerning the sanctification of the body for the whole of a person's life. The body of the Believer is a human temple in which the Spirit of God dwells & does His work. We cannot neglect and abuse it without damaging our usefulness as a whole to our Master. Whereas The Real An+hony #auci details a system built on stealing the lives of people in exchange for massive profits (a corruption that embodies spiritual wickedness in high places), Outlive encourages & teaches people to take charge of the care of their own bodies, not from a moral but from a scientific, statistical standpoint.
I wrote this to my Mother; we share a passion for such resources: "Well, I finally finished Outlive. I'm going to have to read it again. It seems like I've missed so much because there is so much to gain. Balance is a recurring word & theme for me, and this book seems to really emphasize it in the best of ways aside from the most important one - a true relationship with God. I pray now for Attia's conversion."
Oftentimes, I'm troubled at the lack of attention to individual physical health by otherwise good Christians. We all have blind spots, and I'll admit that this has been one of mine. God has admonished me about it, and with His help, I will purposely pursue better physical health in order to serve Him at the highest level for the maximum amount of time He allows. This is, in fact, a major part of stewardship. If I am to manage the resource of time, I must be as present as humanly possible to have the opportunity.
John 10:10 KJV — The thief cometh not, but for to steal, and to kill, and to destroy: I am come that they might have life, and that they might have it more abundantly. (Attia distinguishes between lifespan & healthspan.)
This book helped me to understand things in a more linear way beginning with his background, in conjunction with, his vast amount of medical knowledge. I am not in the medical field and am just interested as a lay person in the science and art of feeling as best possible. Quite a lot of the podcast goes over my head but the book allows me to comprehend more information. Audio is usually my best approach to learning but this book has shown me to look back at reading for education.
One of my favorite parts of reading this is that Dr. Attia does not dumb down the material and instead we rise up to understand it even if takes a few times going back over it! Everyone that has been to my house and even ready the first few pages and heard me talk about it, has gone home and ordered a copy. They asked to read mine when I am done and I, who normally shares and passes 99% of my books along said no- I am keeping it! I have less than 10 books and don't like clutter but this one will stay in my small but very special library.
Thank you!
I want to become the healthiest I possibly can, by returning to bike riding, weight lifting and table tennis. But, this is where Dr. Attia comes in. With his amazing background is various rigorous training programs and exceptional results, he has a personal perspective that few , if any, other authors can match. With 482 pages, including a much appreicated index, he expands on a lot of studies and info, allowing the reader to make their own decisions. I am not concerned at all about my lifespan, but very concerned about my healthspan. I see too many people using walkers, and barely alive, unable to "enjoy life." If I can't continue to enjoy life, I don't want to be here. Last November, I started a table tennis group at the local senior center. As Dr. Attia points out, it is up to me to control my destiny. About 5 years ago, my DEXA scan put me in the top 1%, for my age. That's thanks to weight lifting, on and off, since high school. Wonder where I am now? His emphasis on exercise, and how to do it, is worth the price of the book alone. Everything else just adds to the value of the book. My intention is to modify the Keto Diet, that I started on January 1st this year, and focus on the valuable "essential" health issues. Keto is unnecessarily restrictive. Dr. Steven Gundry's book: "Unlocking the Keto Code," dispells a lot of false Keto restrictions. I highly recommend both Gundry's and Attia's books. Outlive may get into the top 5 health books that I have purchased in the last 20 years. And there have been over 100. I hope to update this review as the months roll by. Hopefully, by this Christmas, I will be way ahead of where I am now, and can add more useful information. I started and ran a heath club, "Achieve Better Health Club, for over 7 years in The Villages, Florida. I was able to watch, and help, many people improve their quality of life, by making even simple changes in their life style. So can you! OUTLIVE will help. Good luck, and YOU COME FIRST.
The book starts out with an overview of what the author calls the Four Horsemen of the diseases of aging: heart disease, cancer, neurodegenerative disease, type-2 diabetes and related metabolic disfunction. He advocates for a new era of medicine, which he calls Medicine 3.0: helping people live well longer without disease. Currently medicine just helps us live longer with disease.
With each of the Four Horsemen, the author reviews the most recent research on how to increase "healthspan," with advice for exercise, nutrition, sleep, and emotional health.
The author is never prescriptive, so you can just pick strategies that make sense for you. In my case, on the nutrition front, I have increased the protein in my diet. In exercise, which he breaks down to strength, stability, aerobic efficiency, and peak aerobic capacity, I have added a one-minute dead-hang, and a four-minute farmer's carry.
The book is well written and appealing. He passes along the fact that "cholesterol in the diet doesn't matter at all unless you happen to be a chicken or a rabbit." There are also many interesting tidbits of knowledge--such as the importance of grip and toe strength.
The author never hides his past mistakes, faults and foibles. He is clearly compulsive. At one point in his past, he concentrated so much on bicycle performance that he became "useless at everything except pedaling my road bike as fast as possible." The moral: diversify your exercise routine with at least 10 different activities. He calls this the "centenarian decathlon."
Some may find his personal revelations unsettling--such as when he gets so depressed, he requires three psychotherapists. To me, it makes the author charmingly human.
I have been much on course with this in my own life for years. I look at least a decade younger than my peers. I once had a bad case of metabolic syndrome, and thanks to a new breed of preventative healthcare centers - Forward Healthcare in my case -- to supplement traditional healthcare, I have great energy and am lean and fit. Yet this book gave me a greater understanding of what I was doing right and fine-tuned some things I didn't know I was doing wrong. We were all born without a manual for our bodies, and now we are starting to get one.
I have just one comment in a chapter concerning the loss of mental acuity as we age. This is undoubtedly inevitable, but something else is also happening in parallel. As a hyper-modern society, we have all experienced the inability to remember an actor's name from a famous movie. It seems obvious, and it's on the tip of our tongue. Is this a sign of loss of mental acuity and memory? Maybe for some, but it's also how the brain works for many, prioritizing what we deem important and fading away that which isn't. With websites, iPhones, Siri, and IMDb - do you think the brain thinks we need to remember all this info, which can be quickly looked up with our electronic assistants? Recall the era decades ago when many people could do long division in their heads. Then came calculators, and we all became "dumb" until we realized we could utilize the freed-up cognitive abilities for higher-level calculations and creativity. Your quantum computer in your head knows what you need when you need it - and if it knows you are on a TV trivia game show, then your memory will be optimized for that.
I became aware of Peter Attia about five years ago when a friend suggested I listen to an episode of The Drive. For those who are unfamiliar with Attia, this is his weekly podcast. After listening to it I was hooked and immediately became a subscriber and began listening to archived episodes. I spend a lot of time commuting and to date I’ve probably listened to two-thirds of the interviews and the Ask Me Anything discussions. So when I received the notification that his long-awaited book was finally going to be published I preordered my copy. Once it arrived I got out my pen and highlighter and went to work.
I believe I can speak from a position of strength when it comes to commenting on this book. I have walked a similar career path. Like Attia, I’ve been trained in basic science research. I earned a PhD under the mentorship of the great Philip Gollnick, PhD, one of the pioneers of modern exercise science. Similar to Attia, I’ve also been trained in medicine and surgery having completed a medical degree and a surgical residency in orthopedics.
Attia is a voice in the wilderness shouting the message of Medicine 3.0, a philosophy based on the guiding principles of preventing the onset of chronic disease. He defines the time from birth to the onset of chronic disease as healthspan. The period of time from birth to death is lifespan. The goal of Medicine 3.0 is to increase healthspan so that it encompasses most, if not all, of lifespan. Medicine 3.0 is proactive whereas Medicine 2.0 (where we are now) is reactive. Medicine 2.0 begins treatment of an illness or disease only after it has been diagnosed, after the damage has begun. Medicine 3.0 is based on preventing, or delaying, the onset of disease or illness so that treatment is avoided.
How does Attia recommend we go about maximizing healthspan? He believes this can be accomplished by focusing on doing everything possible to prevent what he terms, the four horsemen: metabolic syndrome (type-2 diabetes), cardiovascular disease, cancer, and neurodegenerative diseases (Alzheimer’s, Parkinson’s, etc.). The book is broken up into sections devoted to each of the horsemen. A final section, where Attia opens up and presents some of his personal journey, is devoted to emotional health. The importance of this section cannot be overstated. Emotional health probably should be considered the fifth horseman (but that would wreck the Four Horsemen of the Apocalypse metaphor).
He focuses on ways to prevent cognitive decline, the slowing of our mental processing speed as we age. An emphasis is placed on exercise, aerobic and strength training, as an intervention. Exercise increases cardiovascular and respiratory function and decreases the loss of muscle size and strength. It also increases bone density and deceases osteopenia and osteoporosis. In short, regular exercise reduces frailty. As frailty increases our risk of mortality increases. He makes the claim that the single most important thing anyone can do to improve healthspan is to exercise on a regular basis. It is better than any drug you can take (with the possible exception of rapamycin), nutrient, or diet.
Attia and his co-author Bill Gifford tone down the technical aspects of some of the medical topics to make it more accessible to a lay audience. However, this does not detract from the quality of the information. If anything it makes the book better by reaching a broader audience. If a reader wants more detailed information on a topic they can easily obtain it by culling through the archives of The Drive where in depth interviews with preeminent physicians and scientists are available. He employs a team of highly skilled analysts that are constantly reading the latest scientific publications looking for high-quality research pertinent to his mission. He is at the forefront of Medicine 3.0.
If you want to learn more about your physical and emotional health with the goal of living better and longer then read Outlive, the Science & Art of Longevity.
The book has the most up to date knowledge on Cancer, Heart Disease, Metabolic Disease, and neurodegenerative disease. It also covers exercise, diet, and emotions. There are a few things missing though.
•Medicine 3.0 is basically just the natural holistic way of viewing the human body that many natural practitioners have used for decades. Doctors are never going to admit they were wrong about supplements, preventative medicine, probiotics, vitamin C, etc. They will just slowly integrate "natural" into their practice and call it by new names. I am fine with this. I don’t think people in the natural world need a “You were right,” just so long as people get better care.
•EMF exposure hasn't filtered into Peter’s world yet. It ruins both sleep and metabolism, and makes everything Peter is trying to help worse. Once EMF exposure goes mainstream, a lot of these conditions will make more sense. They will be easier to treat and reverse, thank God.
•I am not convinced Statins outweigh the risks. Besides, there is a drug called cholestyramine which will lower LDL effectively. It's non-systemic, might have liver benefits, and helps against mold exposure. You never need to touch a statin if you don’t want to. He never mentions Cholestyramine, why? I have tried to find out but no luck yet.
•Peter describes many of the common diets out there like IF, keto, and vegan. He boils them all down to creating some type of calorie deficit and ignores the microbiome. This isn’t his fault. Little is known about the microbiome other then you should have a “healthy” and diverse one. My own experience working with the microbiome tells me that it is THE KEY to understanding why certain diets help some and not others. Once more microbiome knowledge goes mainstream, the calorie deficit explanation will go out the window.
•The last chapter on Emotional Health is maybe the most important of the book, especially for ambitious people. Not much to say about it other then this quote:
"when the will of God crosses the will of man, somebody has to die"- Elisabeth Elliot
Highly recommended book!
Having listened to the audiobook, and now reading the hard copy, I can honestly say that if given the chance to have lunch with Peter Attia I wouldn’t waste that time regurgitating the health, medical, science, and fitness topics he has taught us over the years and wrote so eloquently in this book, and it truly is the longevity bible. I would spend that time chatting to a friend, someone who I feel I can relate to as a son, a husband, a father, a brother, and a friend. It took listening to him in his own voice, in his own words, to see the person that is Peter Attia, and as much as I “fan girl” (my wife and daughters gave me this name) the brilliant accomplished scientific doctor that is Peter Attia, I think the man, husband, father, and friend to many, is equally amazing.
So yes, this book consolidated his years of research, experience, and interviewing the most accomplished experts in every field that we consider important to all things health, fitness, and longevity, is in my opinion the gold standard starting today, the new bible that will change your life if you apply the lessons, and I do! For me it forced me to think about so many other things we don’t typically think about, like the difference between what we put on our resume compared to what people will say about you when giving a eulogy. The life lessons in the last few chapters are as applicable as the science and I have begun a new approach life thanks to this book.
So what if I, as a moslem, will be “adding” a final chapter to the book, so as to discuss it within my circle, that imparts a transcendental framework to our quest for a long life beyond the raising of a strong healthy physical horse. If you believe that your existence totally ends with death, it makes perfect sense to embark on a quest to lengthen your life, beyond which there is nothing. But if you belief as I do that there is an eternal component to our essence that continues beyond the entombment of our bodies, then your horizon and end point is limitless. Is the martyr who died defending his people and his family against oppression and tyranny at age 20, achieving a dismal Attia-style longevity, a loser, a tragic figure who fell victim to unfortunate conflicts, or is he worth a thousand longevity-focused horses? To exclusively pamper the animal (body) and ignore the horseman (soul) is to put the cart before the horse. In addition, to preach that we should persevere in trying to lengthen life a few more years, and spend a whole lifetime doing it, strikes me as wasting your life in order to lengthen it.
My advice to friends and family is this: Go ahead and double click on exercise and nutrition; huff and buff to raise your VO2 max, and be stable with firm resolve as you prioritize DNS. But do bear in mind that you are making the horse strong to serve the horseman, and not the other way around. We are not mere shells: eat, move, sleep, copulate, repeat. Get yourself a more spacious framework. Be in control as your phosphorylated spirit commandeer the horse so that the both of you can stand, marsh, live, and die with nobility and honor. “Outliving” to me is a transcendent term, to outdo and go beyond the bounds of your biological carbon-based body, to achieve escape velocity through a noble righteous life on Earth that propels your soul to heaven when biology fails you, so as to justify the reason that God commanded the angels to bow to Adam.
Of course, this is not a book about religion, and of course we agree less on religion than we do nutrition, and of course moslems are a zealot punch (attempt at self-deprecating humor), and of course as a physician I would love to read the 2000 page version (sorry, Penguin Random House). But from my perspective this is a beautifully written book by an author that I and my kids grew to love and admire, one who does not do anything half-way. Read it and reread it but put the material to practice by moving a good amount in between reading spurts.
In a word, very. There are two reasons why.
First, Attia’s knowledge base is unparalleled. He graciously attributes this to the all-star line-up of experts in cardiology, lipidology, oncology, neurology, psychiatry, endocrinology, biochemistry, nutrition, exercise physiology, etc. who’ve tutored him over the years, and whose expertise is shared generously on his podcast. The depth of his dives with them and his fluency in each specialty are extraordinary. But Peter’s superpower is not simply the intellect to master the nuances of each niche. It’s that, plus the broad perspective to integrate that knowledge into the grand landscape of human health—to see the forest and the trees. It’s a rare alchemy of assets: the breadth of a primary care physician, the depth of a specialist, the granularity of a laboratory scientist, and the heart of a teacher. That is Peter Attia.
Second, Outlive stands uniquely poised to do what others have not: transform healthcare. Not simply because his tactics for longevity are cutting edge and informed by the best science available—and they surely are. And not because those tactics won’t evolve as science progresses—for they surely will. No, Attia’s contribution will endure because his strategy is as timeless as it is revolutionary, and it will remain relevant as long as our objective is the extension of human health and lifespan.
Medicine 2.0, as he calls it, is the conventional paradigm, the model I learned in medical school. It served us well when infection was our greatest threat, and still does against acute disease or trauma. But today’s top killers are chronic diseases that exploit the one factor current treatment paradigms neglect: time. Heart disease, cancer, dementia, and metabolic disease mock our feeble 9th inning attempts to medicate them away after an eight-inning head start. To put more than a modest dent in their devastation, Attia argues, we must attack from the other end of the timeline, long before these diseases manifest clinically—before the game even begins. This is Medicine 3.0, and it truly is revolutionary.
To be clear, Outlive is not another sensational anti-establishment exposé on the failures, lies, and corruption of mainstream medicine. Rather, it graciously acknowledges Medicine 2.0’s success. But, noting its inadequacy against modern diseases, Attia has cleverly “back-casted” and reverse engineered a new strategy forward—and it is brilliant. If we do achieve significant improvement in human health and longevity, absent some miraculous sci-fi discovery, it will be because we followed the strategies presented in Outlive, even if its tactics are refined over time. This book is important. It’s carefully compiled, meticulously fact-checked, thoughtfully organized, and masterfully presented. It’s cutting edge, yet careful in its claims. Passionate, yet explicitly non-dogmatic. Deeply personal, yet rigorously clinical.
Speaking of personal, I must comment on the final chapter. Those of us who consider Peter superhuman may be surprised—and relieved, perhaps—to learn that he battles the same insecurities and weakness that beset the rest of us mortals. His candid account of recent struggles with emotional health is as inspiring as it is moving and provides precious layers of meaning and perspective to all that comes before it. If chapters 1 through 16 are the how, chapter 17 is the why. Whether serendipitous or providential, that his crisis manifested in time to consummate the finished project is fortuitous for us, as it changes the entire work in a compelling—and beautiful—way.
Since discovering The Drive in 2018, I’ve considered Attia’s podcast the most comprehensive and reliable resource for all things health and longevity. It changed the way I live, and how I practice medicine. Going forward, Outlive will be my primary textbook.
Thank you, Peter.
Constantly eating excessive calories a day will shorten your lifespan.
Eating a high-protein diet is essential for satiety and having a healthy degree of muscle.
You should rarely eat sugar and refined carbohydrates.
You should floss your teeth every day because the buildup of bacteria can make you at higher risk for Alzheimer’s disease.
Exercise is an essential youth elixir.
Alcohol is not a nutrient, merely a “hedonic” beverage, which contains ethanol, a “potent carcinogen.” You would be wise to keep your alcohol to a minimum.
High blood pressure will wreak havoc on your organs and shorten your life.
Sleep deprivation will make you fat, accelerate brain dysfunction, and shorten your life.
Work on meaningful connections with your family and friends because these connections make you healthier.
He recommends Terrence Real’s I Don’t Want to Talk About It to discuss how he has had to deal with shame, anger, and depression.
Attia has written a very readable book that combines his growing scientific findings with his own emotional development.
This ability to get answers so easily has forced us as humans to change our focus from finding an answer to instead finding the best answer and solution to our questions and problems.
From finance to medicine, we are inundated with answers to our questions. The issues is, usually these answers lack substance or are downright wrong.
As we become more and more surrounded by these sub-par answers by so called experts, it’s our duty to ourselves to look through the darkness of this trash to find that one shining light. That one light that you can trust. That one light that will guide you, wisely, with a true answer to your question.
When it comes to my personal medical questions, there is only one person I rely on. Doctor Peter Attia.
I have been following Peter since his early days of writing a blog about Keto Diets. His ability to discuss and educate on complex subject matter shined through his writing in those early days. When Tim Farris asked his listeners which one of his podcast guests should have their own podcast, there was no doubt in most listeners minds that it should be Doctor Peter Attia. He has used himself as a guinea pig for the last 15 to 20 years to further the knowledge of his readers and now his listeners.
“An expert is a man who has made all the mistakes which can be made, in a narrow field.” - Niels Bohr
Doctor Peter Attia is a doctor who will give you an educated answer. He is also a doctor who will say the words “I don’t know”, which is a rarity in that industry. He will also sometimes say the craziest words ever spoken by a doctor. “I was wrong.”
When you find an expert in a field that has integrity, honesty, passion, and brains, you better latch on to him or her.
The medical profession is built around profits generated from fixing the problem after it has happened, through magic pills, surgeries, and the endless doctor visits. Peter has taken a different approach. Peter, through his lens of Medicine 3.0, has looked at the very difficult subject matter of prevention.
From his monthly AMA’s on his podcast, to his crazy detailed show notes from his many excellent guests, it all centers on the idea of tackling health and medicine through prevention.
While I will never be a patient of Doctor Attia’s, this book titled “Outlive” is the second best thing. I pre-ordered both a Kindle version and hard copy. I am only through Chapter 4 but can honestly say, this is the best health book I have read in a very long time. I just ordered a few more hard copies to share with family and friends.
To Peter: I sincerely thank you for sharing your knowledge with the world. In the ever changing environment we call medicine, I am blessed to have you as my shining light to guide me to the best practices I can take in my daily living to live the best, most fulfilling, and healthiest life I can live.
I highly recommend this book along with Doctor Attia’s Podcast. You will not be disappointed.