“Outlive: The Science & Art of Longevity” by Peter Attia, MD (with Bill Gifford)

Outlive: The Science and Art of Longevity is a fascinating book that tackles the age-old question of “how can we live better and longer?” Advocating for a more proactive approach to medicine, the book discusses the chronic diseases that are commonly associated with aging and suggests tactics and strategies that people can take towards maintaining their physical and cognitive capacity as they age.

Dr. Peter Attia received his medical degree from Stanford Medicine and trained at The Johns Hopkins Hospital in general surgery. He also trained at the National Institutes of Health as a surgical oncology fellow at the National Cancer Institute, where he focused his research on immune-based therapies for melanoma.  He is the founder of “Early Medical,” an intensive 12-week module program that provides people with education and tools to create their own longevity playbook, and currently hosts a podcast called “The Drive,” which covers topics relating to health and medicine.

The focus of this book is on longevity—how long you live and how well you live. In the book, Dr. Attia identified heart disease, cancer, neurogenerative disease, and type 2 diabetes (and related metabolic dysfunction) as the “Four Horsemen,” because these conditions will be the cause of death for a vast majority of people. To combat these conditions, Dr. Attia offers a different approach to medicine, which is referred to as “Medicine 3.0.” Under this approach, the goal of medical interventions is to act as early as possible to prevent people from developing one of the chronic diseases.

At the heart of “Medicine 3.0” is the need to think about and plan for the later decades of a person’s life.  This involves adopting strategies and tactics to prevent the onset of disease and minimize serious threats to a person’s longevity. Dr. Attia identified four tactical areas to help people maintain their physical and cognitive capacity.  These include exercise, food and nutrition, sleep, and emotional health. By concentrating on these areas, people can develop strategies that help them live longer and better lives.

Dr. Attia’s information on the chronic diseases of aging is thought-provoking and applicable to everyone (as we are all aging).  Two of the biggest threats to longevity were identified as cancer and heart disease—with most people dying from one of these two diseases.  However, as Dr Attia suggests, if we take a more proactive and aggressive approach to screening for such chronic diseases, we can try to prevent such diseases from occurring or treat them before they become unmanageable. This includes doing calcium scans for heart disease or possible blood tests for cancer before there is an official finding or diagnosis. To adopt this approach though, we would have to shift how the system of medicine is currently being practiced—with testing and insurance covering medical issues as they arise.  

The information provided on metabolic dysfunction, including insulin resistance and type 2 diabetes, is jarring. According to Dr. Attia, over 11 percent of the US population has clinical type 2 diabetes, including more than 29 percent of adults over age 65. This statistic is particularly concerning as people with diabetes also have a much greater risk of also developing heart disease, cancer, and dementia. As such, taking proactive steps to prevent metabolic dysfunction from occurring may also decrease a person’s risk of also developing one of the other three chronic diseases (as all are fueled in some way by metabolic dysfunction). To get someone’s “metabolic house in order,” Dr. Attia recommended using the following tactics: 1) developing an exercise plan that promotes peak aerobic cardiorespiratory performance, 2) finding the right meal plan that takes into consideration the quantity and quality of a person’s diet, 3) continuous glucose monitoring, and 4) getting enough quality sleep.

Overall, the book provided a lot of useful and relevant information on the “Four Horsemen” of chronic diseases and why it is important to take proactive steps to prevent the development of such conditions as we age. To live a longer and better life, people may need to adopt better habits and routines. The medical profession may also need to take a more aggressive approach to screening for and treating conditions before they develop or are diagnosed.

Aging is an inevitable part of life, but a person’s health and longevity are never guaranteed.  I recommend this book to anyone who is interested in learning more about the chronic diseases associated with aging and wants to identify the best strategies and tactics to maintain a person’s physical, mental, and emotional health. Such knowledge and planning can be both informative and lifesaving.