Outlive: The Science and Art of Longevity

Authors: Dr. Peter Attia with Bill Gifford

While humans have always been on the quest to extend their lifespan, the longevity movement is now gaining in popularity. There are many healthcare providers these days who are focused on extending both, the quantity (length) and quality of life and Dr. Peter Attia is one of the more famous ones. In this book he describes how he stumbled into this career choice and all the lessons he learned along the way. 

Dr. Attia's meandering path started in high school where he was determined to become a professional boxer. When that didn't quite pan out, he went to engineering school and graduated with degrees in both math and mechanical engineering. From there he got into Stanford Medical School, specializing in Surgical Oncology.  Who would have guessed that his next stop on this journey would be a McKinsey consultant working in the financial industry. He was keenly aware that many of his relatives had a history of heart disease and several of them had died early. Despite being very fit, he was "not too thin" as he puts it. Realizing that he could very easily have a similar fate as his relatives, he founded Early Medical, a medical practice that is focused on lengthening the lifespan and improving the healthspan of its patients. 

According to Peter, 80% of the deaths in people over 50 who do not smoke, can be attributed to one of these 4 causes. 

1. Cancer
2. Atherosclerotic disease (comprised of cardiovascular disease and cerebrovascular disease)
3. Type 2 Diabetes or related Metabolic dysfunctions
4. Neurodegenerative diseases (Alzheimer’s being the most common)

He refers to the above as the “Four Horsemen”. The prevailing medical wisdom, diagnoses these problems after they have been in your system for many decades and are firmly entrenched and almost impossible to cure. Dr. Attia critiques the current medical practice (Medicine 2.0) as doing too little too late. His approach (Medicine 3.0) is to prevent or significantly postpone the onset of these diseases so you can live a healthy life all the way till you hit the century mark. 
 

The book reads very poorly and is quite repetitive. I am fifty pages into the book and Dr. Attia is still talking about what he will and will not be telling me. I finally got past this and found quite a few nuggets of insight and wisdom that ultimately made the slog worthwhile.  

Dr. Peter Attia is a big fan of rapamycin which is an  inhibitor of the mTOR (mammalian target of rapamycin) signaling pathway, the master regulator of cell growth and metabolism. Research has shown that rapamycin extends lifespan in various tested models, such as yeast, worms, flies, and mice. While it has not been approved for anti-aging purposes in humans, it has been used as an immuno-suppressant for organ transplant patients. It has an interesting discovery story. A team of scientists took soil samples from Easter Island back to Canada where they were analyzed by Suren Nath Sehgal at the Ayerst Laboratory in Montreal. Apparently his work was suddenly stopped without an explanation and he stored it surreptitiously in his refrigerator for several years until there was a change in management that allowed him to continue his work on it. 

The other big bogeyman for longevity is the Metabolic Dysfunctions that typically accompany old age. If you meet 3 or more of the below conditions you have the “metabolic syndrome” problem.

1. high blood pressure (>130/85)
2. high triglycerides (>150 mg/dL)
3. low HDL cholesterol (<40 mg/dL in men or <50 mg/dL in women)
4. central adiposity (waist circumference >40 inches in men or >35 in women)
5. elevated fasting glucose (>110 mg/dL)

Here’s some troubling stats

• 29% of US adults over the age of 65 have type 2 diabetes.
• insulin resistance is a metabolic dysfunction that needs to be treated at the earliest. he argues that hyper insulinemia  significantly increases our chances of getting cancer, Artherosclerosis or Alzheimers.
• Key solutions to insulinemia are to eat less, exercise more and sleep better.

There are some non-sequiturs in the book. Out of the blue, in the chapter on preventing neuro-degenerative diseases, he postulates that regular use of a sauna can reduce your risk of Alzheimer’s by 65%. Wow. 

Ultimately, after meandering through all the four Horsemen, I find that all roads lead to exercise. “OUR MOST POWERFUL TOOL FOR PREVENTING COGNITIVE DECLINE, IS EXERCISE”, the capitalization is Dr. Attia's, not mine. It turns out that it’s not just the quantity of exercise that matters but one also needs a little bit of strength training, cardiovascular exercise, and high intensity training as well.

The next section of the book is focused on nutrition. Dr. Attia goes through the major food groups like carbohydrates, proteins fats, and even caloric restrictions (intermittent fasting) and outlines the good and the bad in each of them. One counterintuitive thing that I learned is that most of us are getting less protein than we need, to maintain our muscle mass. Apparently the US guideline for protein is roughly half of what we need, which is around one gram of protein per pound of body weight per day. It may be too much to get this in one sitting, so he recommends dividing it over many meals. It turns out that intermittent fasting makes it hard to get enough protein. Hence, one of the downsides of intermittent fasting is that you lose muscle mass. 

The next stop on the journey is sleep. Just like exercise, sleep is the other magical ingredient that will stave off many diseases, especially of the neuro-degenerative kind. The science in this chapter is pretty well established, and I recommend the book by Matthew Walker for a thorough exposition of what sleep is and how important it is for us.

While the book is a great summary of the current medical wisdom to live a healthy life, it is a pretty difficult read. Also, you probably already know that better exercise and more sleep will keep you happy and healthy for longer. Pick it up only if you are really eager to delve into the nitty gritty of how food, exercise, sleep and stress contribute to your well-being.