Peter Attia's Outlive: An In-depth Review
How to Outlive Peter Attia with the Unaging System
Dr. Peter Attia's book, Outlive1, has climbed to the top of the New York Times bestseller list. Attia was a general surgery resident and studied longevity while running a private medical practice with high-profile clients like Hugh Jackman.
Things Attia Gets Right
His book leverages his long experience to provide examples of what he's seen done right or wrong for help over his career, which he backs up with studies. It's an enjoyable read, with fresh explanations for concepts, even for those familiar with longevity research.
Exercise Most Important
Attia claims exercise is crucial to living a long life. He motivates himself by setting "Centenarian Goals," which are physical activities he wants to be able to do even after he's over 100 years old, such as "pick up a young child from the floor" or "draw back and fire a fifty-pound compound bow." This forward look at what we want to be able to do in our later years is excellent motivation to do today the things that will help us get there.
Solid, Systematic Review
The book's first half reviews the significant challenges to a healthy, long life -- cardiovascular disease, cancer, and dementia. It describes them as Medicine 3.0 (so trendy...), where we no longer need to be worried about being eaten by a tiger or hit by a catapult but must deal with the diseases of prosperity. His overview is current and covers many newer findings about aging, like genes that raise the risk of cardiovascular issues.
Things Attia... Might Want To Think About Some More
Excessive Does It
Attia goes full frontal assault in his attempts to eliminate aging, often losing sight of what's a reasonable risk and what's a bad idea. For instance, he advocates trying to reduce your cardiovascular risk level to the "level found in children."
To do this, he recommends statins to reduce cholesterol, even for those who don't meet the prescription guidelines. He argues that you could have an issue if you're near the cut-off, so you should start taking statins anyway. This ignores the risk, cost, and burden of unnecessary medication considered when the guidelines were set. I get the feeling that if the guidelines were lower, he would advise starting earlier still.
He does say that putting statins (a cholesterol-lowering pharmaceutical) in the water supply would be too much. I think he considered it seriously before deciding against it.
This over-do-it approach heavily influences his exercise recommendations. Noting that physical performance (cardiorespiratory fitness, strength) declines as we age, his answer is to binge on aerobics until cardiorespiratory fitness is at the 98% percentile by age and spend four hours a week lifting weights to build as much buffer as possible. This ignores the fact that winning in the long game of aging is about consistency. Most people asked to spend four hours lifting and four hours running weekly will never start or won't continue long enough to get an aging benefit.
Food Skepticism
Attia has three goals for diet: 1) maintain a reasonable weight, 2) get enough protein to maintain muscle mass, and 3) avoid other metabolic issues, like high cholesterol or blood pressure.
Unfortunately, the focus on weight misses the benefits of a healthy diet. While maintaining a reasonable weight is important, it's not the main benefit of healthy food. From the Harvard Health School ranking of the impact of healthy habits, a good Body Mass Index (BMI) is the fifth best habit, while a healthy diet is two slots higher after not smoking and exercising2.
Attia underestimates the benefits of healthy food by dismissing research on healthy foods as "poor quality" and "bad reporting." He doubts the epidemiological studies, where people complete surveys on what they eat and are tracked for lifespan or diseases. His skepticism is often inconsistent. He calls a study that showed a daily ounce of mixed nuts reduced cancer by 18% an "absurd claim." Twelve pages later, he cites a study showing a daily ounce of mixed nuts reduced all premature death by 28% ("the diet... clearly helped them delay disease and death").
His second goal of getting enough protein to maintain muscle mass is right in principle, but he overdoes it. He recommends starting at 35% of calories from protein, which is triple the Recommended Daily Allowance, even while acknowledging that this amount of protein could harm those with kidney issues.
This pursuit of protein leads him to ignore the adverse health effects of processed and red meat. He disregards the findings of the Harvard School of Public Health and the Word Health Organisation that processed or red meats increase colon cancer by 17%, comparing it to the 1,000 - 2,500% increase in lung cancer from smoking.
But a 17% increase matters. He says elsewhere, "stacking... insights is very powerful." Processed and red meats increase premature death in addition to increasing the risk of colon cancer. Replacing a daily 100g of processed meats with 100g fish gives a net reduction of 40% in premature death, close to the 50% margin he looks for to believe causation.
The Unaging Assessment
Exercise
Let's start with exercise since I agree with Attia this is the best place to start and where the most health and longevity can be gained.
Attia is spot on in recommending regular aerobic exercise, and his descriptions of VO2 max and mitochondria are excellent and explain why aerobics is essential. As mentioned above, he does overdo it, advising four hours of running a week. Even half an hour, done every week, achieves longevity benefits. Doing four hours weekly doesn't increase longevity further, but does not decrease the benefit, so giving a 👍 here, as he reduces premature death by 27%.
Attia also correctly identifies High-Intensity Interval Training (HIIT) as important. This time he names the proper exercise and an appropriate amount, only recommending one session weekly. His HIIT protocol -- 4 minutes full effort, 4-minute breaks, 4-6 times -- could be cut about in half with the same benefit, but he's close to ideal. A ⭐️ for this, reducing premature death by another 50%!
Attia goes overboard in his gym time. Strength Training is vital for healthy aging, but spending four hours per week in the gym is stressful on the body -- so much so that it shortens your life more than if you had never gone. Once or twice a week for a total time of about 60 minutes is best. The group doing the most strength training didn't live statistically longer than not lifting at all. Attia spends four hours weekly lifting weights, which puts him solidly in the overtraining group3. 👎 for overdoing the gym.
On the last category of physical activity, Low-Intensity Physical Activity (mostly walking), Attia is silent. It's a frequent oversight among athletes to think once they've lifted, run, and sprinted, they can spend the rest of their week in a comfy chair. Not so. The benefits of daily walking are significant (65% early death reduction for 12,000 steps daily) and are not captured by running or sprinting. Attia overlooks this opportunity for a healthier life 😭.
Multiplying his increases and decreases for physical activity, Attia reduces his early death risk by 55%. Solid.
Diet
Attia doesn't describe his diet in as much detail as his exercise routine, but we can make some guesses from his treatment of carbs, protein, and fats.
For carbs, Attia recommends the usage of a Continuous Glucose Monitor (GCM) to monitor glucose levels and keep them low. Many of the glucose regulations strategies are directly diet related (sleep well, avoid stress...). Since he aims to eat 50g of fiber a day (!), he probably gets the full three servings of vegetables, 2.5 servings of fruit, and four servings of whole grains that provide longevity benefits. A ⭐️ here, as this reduces his premature death risk by 11%, 10%, and 25%, multiplying to a 40% reduction in premature death.
On protein, he strives for four servings of protein daily, so given his acceptance of processed and red meat, I'd guess Attia is getting at least two servings of red meat, one serving of processed meat, as well as an egg and two cups of dairy (as whey) daily. That's an overall increase of 20%, 40%, 15%, and 10%, which multiplies to a 113% increase in premature death. 👎
Attia recovers a bit when he covers fats, emphasizing the importance of mono-unsaturated and poly-unsaturated fats as part of the diet. He mentions nuts (despite his skepticism above) as an excellent way to increase healthy fats. 👍 as he reduces premature death by 17%.
Further life extensions available from beans (16%) and fish (10%) are missed. 😑
Multiplying his increases and decreases for diet, we get a net premature death increase of 6%. Oops. Room for improvement!
Other Stuff
Since Attia doesn't quantify interventions with the impact on premature death, his other interventions drift off into obscure trainings, like Dynamic Neuromuscular Stabilization (learning to move like a baby) or toe yoga (lift your big toe with the others on the floor...). Perhaps useful as a one-off effort for someone with challenges, but unlikely to increase lifespan for the masses.
Another chapter focuses on sleep. This falls into the "probably good" category, but for the majority (~90%) who sleep six or more hours a night, further tuning is unlikely to give a significant longevity benefit4.
Attia misses many interventions or actions that have a material impact on longevity. No mention of saunas, daily flossing and nightly tooth-brushing, coffee, or avoiding too much TV or sugary beverages.
The last chapter on emotional health shifts from his medical experiences to his efforts to contain severe perfectionism and anger issues that nearly cost him his work and family, even as he coached people on how to live well. Although it's also hard to quantify the impact of emotional well-being, Attia is right -- this matters more than anything. It's an honest and sympathetic story of a man working to be a better version of himself, winning him a ⭐️ for the book.
FAQs
Q: Has Peter Attia written any books?
A: Yes, Peter Attia has written a book named: Outlive: The Science and Art of Longevity
Q: When was Outlive by Peter Attia published?
A: Outlive book was published on 28 March 2023.
Q: What is the book Outlive about?
A: Dr. Peter Attia’s book "Outlive" explores strategies and practices to enhance longevity and live a fulfilling life. It delves into various aspects such as health, mindset, relationships, and habits to promote a longer and more vibrant existence.
Q: How can the Outlive Peter Attia book help in living longer and healthier?
A: Peter Attia, a prominent medical expert, can help individuals live longer and healthier by providing evidence-based insights on longevity, metabolic health, and preventive medicine through his research, expertise, and educational resources.
Q: What is rethinking medicine to live better longer?
A: “Rethinking Medicine to Live Better Longer" is a concept that challenges traditional approaches to healthcare, advocating for innovative strategies and practices to optimize well-being and extend lifespan through advancements in medical science and lifestyle modifications.
Q: What is the last chapter of Outlive?
A: In the concluding chapter Dr. Peter Attia book, he opens up about his personal battle with depression and highlights the impact of emotional well-being on overall healthspan. He emphasizes that prioritizing preventative measures for emotional health is equally crucial in achieving the goals of Medical 3.0, alongside cognitive and physical maintenance.
Q: What helps people live longer?
A: Several factors contribute to a longer lifespan, including maintaining a healthy lifestyle with regular exercise, a balanced diet, adequate sleep, managing stress, avoiding tobacco, moderate alcohol consumption, and regular medical check-ups.
Q: What does Peter Attia eat in a day?
A: Attia is on a longer fasting period and eating only once a day, he consumes nearly 3,000 calories in a single meal alone. This meal usually consists of: A huge salad. He plies his lettuce with vegetables like tomatoes, cucumbers, and carrots.
Q: What is the secret of living longer?
A: As per Outlive Peter Attia book, while there's no single secret to living longer, adopting a combination of healthy habits such as maintaining a balanced diet, regular exercise, managing stress, fostering social connections, and seeking medical care contribute to a longer, healthier life.
Q: What tests does Dr. Peter Attia book recommend?
A: Peter Attia has recommended various tests and screenings to assess and optimize health. Some common tests he has mentioned in his work include comprehensive blood panels (including lipid profiles, markers of inflammation, insulin sensitivity, etc.), hormone assessments, genetic testing, and advanced imaging techniques (such as coronary artery calcium scoring).
Q: Does Dr. Peter Attia share personal experiences in the book?
A: Yes, Dr. Peter Attia book opens up about his own experiences and vulnerabilities, including his battle with depression, emphasizing the significance of emotional well-being in overall healthspan.
Q: Does the Outlive Peter Attia book address the role of genetics in longevity?
A: Yes, Outlive Peter Attia book delves into the role of genetics in determining lifespan, exploring how lifestyle choices and other factors can influence gene expression and impact longevity.
Q: Is the book suitable for readers without a medical background?
A: Yes, "Outlive" is accessible to readers without a medical background, as Peter Attia presents complex topics in a clear and understandable manner, making the information relevant and applicable to a wide audience.
Q: Does the book provide references to scientific studies?
A: Yes, Peter Attia supports his ideas and recommendations with references to scientific studies, providing readers with evidence-based information and encouraging further exploration of the topics covered.
Q: Can "Outlive" be considered a comprehensive guide to longevity?
A: While "Outlive" offers valuable insights and practical advice, it is important to note that individual circumstances and health requirements may vary. Consulting with healthcare professionals is recommended for personalized guidance.
Q: Does the book address the importance of mental and emotional well-being?
A: Yes, "Outlive" highlights the significance of mental and emotional well-being, discussing the impact of emotions on health and providing insights on how to prioritize and maintain good mental health for an extended lifespan.
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