Otis Chandler's Reviews > Outlive: The Science & Art of Longevity

Best book I've read on this topic. Really changes your thinking on all sorts of health topics. I've followed Peter Attia's podcast for a while, but this is an excellent summary of all his best knowledge on health. He gave me a new goal and word - healthspan! Forget living a long time, the goal is to have a healthy body for as long as possible.

But the biggest takeaway from the book is exercise is the biggest lever on healthspan. I would have thought diet and exercise were close, but no, exercise is orders of magnitude the biggest lever. And this applies to reducing risk from all the "4 horseman" as he calls them (cancer, metabolic syndrome, alzheimers and brain degenerative diseases, and cardiovascular disease).

"Study after study has found that regular exercisers live as much as a decade longer than sedentary people. Not only do habitual runners and cyclists tend to live longer, but they stay in better health, with less morbidity from causes related to metabolic dysfunction."

One benefit of exercise is that it boosts your metabolism, which basically makes your body run healthier and be better at repairing itself. Interestingly, on the subject of taking supplements, Dr Attia was mostly negative on that with one exception, that he had a whole chapter about: rapamycin. I want to learn more about this drug.

"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. But as we get older, autophagy declines. Impaired autophagy is thought to be an important driver of numerous aging-related phenotypes and ailments, such as neurodegeneration and osteoarthritis. Thus, I find it fascinating that this very important cellular mechanism can be triggered by certain kinds of interventions, such as a temporary reduction in nutrients (as when we are exercising or fasting)—and the drug rapamycin."

Strength is also super important, as muscle mass and bone density decay significantly after age 50, and it's very hard if not impossible to gain back later. Dr Attia recommends that whatever age you are (20s to 80s) it's best to build strength. His goal for his patients is to be in the top 5th percentile of strength for their age. Strength is another top predictor of healthspan - in a way it even defines it as if you are strong you can still hike/bike/surf/etc, and if you can't do the things you love you will lose your zest for life.

"One of the prime hallmarks of aging is that our physical capacity erodes. Our cardiorespiratory fitness declines for various reasons that begin with lower cardiac output, primarily due to reduced maximum heart rate. We lose strength and muscle mass with each passing decade, our bones grow fragile and our joints stiffen, and our balance falters, a fact that many men and women discover the hard way, by falling off a ladder or while stepping off a curb."

To improve strength, Dr Attia does and recommends consistent weight training, with a lot of focus on stability, as the most important thing is to be strong in a way that avoids injury as we do other things. He also does things like rucking, which sounds interesting and I may have to get into - the thesis here is our ancestors did a lot of carrying of heavy things, and it's really good for us therefore, but we don't do it as much anymore. Goal: be able to carry half your body weight in each hand for 1 minute.

In my half-ironman training in the past few years I've done a lot of zone 2 bike rides, and I continue to do them. But I didn't realize they were actually really good for you outside of building base cycling form. Dr Attia does multiple zone 2 workouts per week. I love this, because it gives me permission to just go a long slow bike ride and know that is improving my fitness across the board. And of course, I use those to listen to audio books and podcasts - win/win!

"As fundamental as zone 2 training is for professional cyclists, however, San Millán believes that it’s even more important for nonathletes, for two reasons. First, it builds a base of endurance for anything else you do in life, whether that is riding your bike in a one-hundred-mile century ride or playing with your kids or grandkids. The other reason is that he believes it plays a crucial role in preventing chronic disease by improving the health and efficiency of your mitochondria"

The biggest correlated predictor of longevity number that we have is VO2 max. Dr Attia says his goal is to get to the top 2 percentile of VO2 max for his age. I love this, and this is my new goal in life. My Garmin watch says I'm 90th percentile, so I have more to climb!

"It turns out that peak aerobic cardiorespiratory fitness, measured in terms of VO2 max, is perhaps the single most powerful marker for longevity."

Good tip: "Where HIIT intervals are very short, typically measured in seconds, VO2 max intervals are a bit longer, ranging from three to eight minutes—and a notch less intense."
And: "The tried-and-true formula for these intervals is to go four minutes at the maximum pace you can sustain for this amount of time—not an all-out sprint, but still a very hard effort. Then ride or jog four minutes easy, which should be enough time for your heart rate to come back down to below about one hundred beats per minute. Repeat this four to six times and cool down."

Alcohol is one of my weaknesses as I love a nice bottle of wine with a nice dinner. And I've listened to podcasts on the topic and read a book about it: Drink. My French teacher (and most French in general) swear that a small amount of wine is good for you, but the science is clear - alcohol is a net negative even in small amounts. But small amounts is much better for you than large amounts, and so if you are going to drink, Dr Attia recommends:

"I strongly urge my patients to limit alcohol to fewer than seven servings per week, and ideally no more than two on any given day, and I manage to do a pretty good job adhering to this rule myself."

Dr Attia highly recommends trying a GCM, which I haven't done yet but am very interested in.

One thing I didn't know is you can't overeat protein - if you do so your body just excretes it. However if you overeat carbs or fats your body has to store those, and this is the major cause of weight gain. His chapter on how to measure your blood results and eat healthier was nothing new but a good overview.

"Putting all these changes into practice typically means eating more olive oil and avocados and nuts, cutting back on (but not necessarily eliminating) things like butter and lard, and reducing the omega-6-rich corn, soybean, and sunflower oils—while also looking for ways to increase high-omega-3 marine PUFAs from sources such as salmon and anchovies."

I have been a fan of occasionally doing 8/16 fasting as a tool for losing weight or if I just had a big late dinner the night before. But as a regular tool, despite the popularity of fasting in the last few years, Dr Attia is not a big fan, as it causes too much muscular decay. I still think its a useful occasional tool, but not a regular habit to adopt.

"As a result of this and other research, I have become convinced that frequent, prolonged fasting may be neither necessary nor wise for most patients. The cost, in terms of lost lean mass (muscle) and reduced activity levels, simply does not justify whatever benefits it may bring. My rule of thumb for any eating pattern, in fact, is that you must eat enough to maintain lean mass (muscle) and long-term activity patterns."

Dr Attia's last chapter was on mental health, where he was quite vulnerable and shared his own issues with abuse and depression, which led to a lot of anger. I think a lot of successful people are driven by trying to prove something in this way. Was a really good reminder that we all are probably not spending enough time paying attention to our mental health - it's as important as exercising, eating well, and sleeping well. So those are the big 4!

Overall, great overview and one I may be re-reading parts of it. I was already applying a lot of this, some of it I was aware of but not applying so great reminder. And I learned some new things too.
But mostly and overall, it's a strong case for living healthy now. If we are healthy now, we can find all kinds of things in the future to look forward to doing.

"“I think people get old when they stop thinking about the future,” Ric told me. “If you want to find someone’s true age, listen to them. If they talk about the past and they talk about all the things that happened that they did, they’ve gotten old. If they think about their dreams, their aspirations, what they’re still looking forward to—they’re young.” Here’s to staying young, even as we grow older."