Numidica's Reviews > Outlive: The Science and Art of Longevity

Peter Attia has a useful combination of skills; he is a medical doctor who is also a math geek (he nearly became an engineer), and he's an athlete who trains with intense dedication. He makes an excellent point about the binary nature of medical diagnoses, calling the current standard of treatment "medicine 2.0", an approach designed to treat acute conditions, but not well suited to preventing chronic conditions from becoming acute. For that, we need what he calls medicine 3.0. Medicine 2.0 says if one's fasting blood glucose is > 126mg/dl, that person is diabetic; at less than 126, they are not diabetic. Attia says that adults should be concerned if their glucose is close to 100, and they should be aiming for 80 or less; the point is that most of these test results are on a spectrum, and if we wait until we exceed the magic number of 126, it may well be too late to reverse the trend toward diabetes with exercise and diet changes. Attia spends a lot of text explaining how to interpret cholesterol results, genetic markers for Alzheimer's, and many other test results, and he explains which tests are most useful, and which are really not very helpful at all.

Dr. Attia emphasizes how important exercise is to remaining healthy as we age, and he pushes strength training hard, making the point that if we do nothing to retain muscle mass as we age, we will lose strength through a natural process of atrophy. If one does nothing to retain strength, we eventually end up unable to complete simple tasks like lifting a suitcase, and it is the myriad of small tasks requiring strength that allow a person to remain independent in old age. Attia also pushes the need for aerobic training because of the clear benefits to the vascular system and hence to the brain. More and more research is showing most mental decline to be a side effect of poor cardiovascular health in combination with other metabolic problems like diabetes or pre-diabetes.

Attia covers cardiovascular health in detail, including tests that he recommends in addition to the normal LDL and HDL readings. He addresses cancer, and the correlation between good metabolic health and avoiding cancer. But he returns again and again to the importance of exercise, and how it is the most important thing a person can do to preserve good health as they age. There is a great deal of densely written, data-filled text on this subject, and as a former somewhat-competitive runner, I follow where he is going with regard to VO2 Max, etc, but he makes a great point, which is, we should want to be decathletes, not marathon runners. Because the decathlete is relatively fast, but also strong, and nimble, and as normal humans, that's what we need, not the specialization of the marathoner. There is a lot of helpful information about training for strength, and aerobic fitness, and stability. All good stuff.

There are two sections on nutrition, which I really enjoyed, and then a section on the importance of good sleep and how to get it. Finally he deals with emotional health. This is the most personal section; I am often surprised to learn of the trauma other people are carrying, and it turns out Dr. Attia is another high-performing individual who was a victim of abuse at a young age, and he describes his long-delayed treatment and therapy to deal with the lasting effects of the abuse.

I would recommend this book to anyone who is trying to improve their fitness, their health, and their chances of living into old age as an active and healthy individual.

9/26/2023 edit: Having now read Ultra-Processed People, I have less confidence in some of Attia's assertions, because I learned from that book that Attia was a part of a start-up that attempted to prove that obesity was caused primarily by sugar consumption. The testing that his organization did ultimately disproved that theory, much to Attia's chagrin, and he lost millions he had invested in the start-up. So his assertion in the book that exercise is more important than diet may not be unbiased, and may be a reaction to getting burned betting on a diet hypothesis. That said, his comments about binary diagnoses still seem right to me, particularly with regard to diabetes.