Do you want to live forever? Part Two

About a month back, I posted a blog on the book “Lifespan” and also “The Great Age Reboot” prompting many friends to suggest “Outlive” by Peter Attia, MD, which I have now read.   Outlive is a longer and more in-depth treatise on the personal journey of its author, with much more detailed discussion on exercise, stamina, stability, and sleep.  Like The Great Age Reboot, it also emphasizes emotional health.  Attia is quite critical of what he calls medicine 2.0, based on arbitrary test thresholds and treatment after health problems have surfaced.  He suggests much more anticipatory treatment of all health issues, medicine 3.0, starting much younger and more proactively.  This goes for colon screening, screening for heart issues, and sleep patterns to name a few.  

Like the other authors he emphasizes diet and obesity as a cause of cancer, neurodegenerative disease, diabetes, and heart disease.  However, Attia places much more emphasis on exercise and discounts all the diet books out there with the “perfect diet” plan as unproven nonsense.  He suggests that while Mediterranean diets tend to be better for us, and some occasional fasting, but there is no “one-size-fits-all”.  Some of us are more prone to cholesterol problems, others are more prone to weight gain.  At the same time, we are advised not to eat three hours before bedtime and to consider that when we take in calories matters.  There are foods out there we should never eat, like high fat sugary foods, but he is also critical of too much drinking and calls the red wine studies as marginally supported at best.  His suggestion, which will be tough for many of us, is no more than five drinks per week of wine or beer and no more than two in any given day.  He says alcohol has almost no benefit whatsoever, can interfere with late night sleep, and contains a lot of calories that the body cannot handle efficiently.  As to supplements, he lists the same ones as Lifespan, but adds one called Rapamycin, that was discovered in the soil of Rapa Nui aka Easter Island.  Rapamycin is not yet approved by the FDA but is said to extend lifespan.

Among his longer treaties is the importance of sleep and its negative long-term impact on brain health when deficient.  In his medical residency days, he went for long stretches with minimal sleep.  Now he understands that pulling all nighters and missing sleep in your 40’s or 60’s can do lasting damage to the brain that will show up later in life, including neurodegenerative diseases.   He suggests at least 6.5 hours to 7.5 hours of sleep per night for adults and ideally aiming for 8 hours, so that the brain can heal and clean itself.  

With respect to exercise, he provides some great examples of calculations for tasks we may want to do as we age. For example, put a 20-pound carryon bag in an overhead airline compartment, pick up a grand kid, carry in the groceries all when we are 80 or 90, and then he reverse engineers the amount of strength we must have at younger ages in order to be able to accomplish these tasks, based on the muscle strength atrophy pattern that is impossible to avoid.  Putting on muscle becomes more difficult with age.  He also admits to being somewhat extreme in overdoing weightlifting or bike riding and that anything extreme will also have consequences.  It is possible to wear out joints, distort the vertebrae, or miss too much sleep all in the name of competition or faux machismo, all of which we will pay for later.   Attia does provide a long-detailed discussion of how to exercise and tests to perform, from grip strength and hanging on a bar, to being able to stand on one foot with eyes closed for more than 15 seconds or raise your big toe without raising the others and stamina in general. 

He concludes that the race to live to 100 is possible, but the earlier you start the better your chances.  Genetics matter, but like Sinclair and Roizen suggested, these can be overcome.  It is not merely lifespan we want, but cognizant healthy and active lifespan or “healthspan”.