I recently finished reading Dr. Peter Attia’s “Outlive: The Science and Art of Longevity”. If you’re in any way interested in the health and fitness community, you’ve probably come across Attia and/or “Outlive”.
These kinds of characters pop up on YouTube and podcasts all the time and I, for the most part, simply scroll past them (more so due to a lack of time than because of any kind of animosity or ill will). However, there was just something about Attia and the subject matter that really attracted me when I first saw Dr. Andrew Hubermann’s tweet announcing the upcoming release of the Outlive book.
I actually kept the tab with that tweet open on my computer for a few months. Then, as fate would have it, an acquaintance from a completely unrelated friend group suggested that we read it for our now-defunct book club.
Now I had to read the book….and I’m very glad I did.
The Peter Attia book literally holds the secret to living a longer and “better” life while also pointing out the yuge, oftentimes self-imposed, roadblocks that stand in our way.
I’m willing to bet the house that anyone who reads the book and makes an earnest effort to implement even a couple of his suggested lifestyle “additions” will see their overall health and quality of life improve.
Table of Contents
Outlive Book Length/Layout
“Outlive: The Science and Art of Longevity” (aka “The Peter Attia Book”) isn’t a short book, but it also isn’t a “long read”. At ~500 pages (including front material, references, and acknowledgements), it resembles a college textbook more than an engaging, and at times, leisurely read.
Thankfully, Attia is a very engaging writer, generously sprinkling personal, relevant, (and relatable) anecdotes throughout his text. Also, for those who are genuinely interested in the subject matter, the Outlive book is a breath of fresh air, expanding on an engaging topic without excessive use of jargon or difficult-to-decipher statistics.
Outlive is divided into one, relatively short introductory section (mainly focused on his background information and context for better understanding the content to come) and two larger sections (focused on the most pressing and threatening chronic health conditions of the modern world and ways to combat them, respectively).
For those who are especially interested in a particular content item or area, the book is largely non-linear in nature making it easy to skip around (as I did) without getting lost.
The Four Horsemen
Dr. Peter Attia’s overarching theme is the “failure” of what he refers to as “Medicine 2.0”, (modern medicine’s general operating procedure). He claims that Medicine 2.0 is overly concerned with attempting to treat medical issues after they have already manifested. This approach is in contrast to the Medicine 3.0 operating state he endorses (and hopes will be adopted on a larger scale) where issues are eradicated before they become a threat.
While Medicine 3.0 is his preferred widespread health and wellness approach, four specific health conditions (affectionately referred to as the “Four Horsemen”) are singled out as being the biggest health threats to the modern world. These include diabetes, cancer, neurodegenerative disease (ex. Alzheimer’s Disease), and metabolic dysfunction.
From here, Attia discusses what is and is not known about each condition while also presenting his take on the degree to which each ailment can be treated and, more importantly, prevented. The information is harrowing to say the least. It is also equal parts frustrating; for the most part, these conditions are preventable.
Portions of this section of the text reminded me of the “Sick Aging Phenotype”, particularly the “Phat Phil” character from Andy Baker’s’ “The Barbell Prescription” (check out our review of this excellent text here!) In both cases, there is discussion of how certain unhealthy lifestyle choices, usually associated with the convenience and excesses of the modern, Western world, can manifest these deadly conditions.
The difference? In the Outlive book, the case studies aren’t based on some made up caricature like Phat Phil; they involve real people.
Real people like my mother who sadly passed away from breast cancer in 2018.
With tears in my eyes, I could see Mom in almost all of the case studies Attia presented. An otherwise capable woman who had encountered some adversity and had simply given up and slowly started to shut down…physically, mentally, and emotionally.
Peter Attia doesn’t relegate the dangers of a lack of exercise and the “SAD” (Standard American Diet) to some meme or cliche overweight and under exercised Wal-Mart shopper.
This stuff is affecting real people who we all know and who we probably really care about.
This makes this book different.
So besides, ya know, not dying early (and, by extension, in a depressingly painful and drawn out manner), what objective is Dr. Attia endorsing in the Outlive book?
Enter the “Centenarian Decathlon”
In the earlier portions of the book, Attia discusses some of the health markers and habits of people who have made it to 100 years old. This is followed by an exercise in imagining what he would like to be able to do as a spry 100-year-old.
For Attia, these activities include hiking 1.5 miles, picking up a young child, and opening a jar, although he encourages the reader to develop their own list of Centenarian Decathlon “events” that they would like to partake in once they’ve clicked over into the triple digits.
This is effective for a couple of reasons.
First, it emphasizes the number of seemingly innocuous activities that become exponentially harder for most people as they age and as their health starts to decline. It doesn’t quite create a “scared straight” effect we all knew and loved from Maury, but it’s pretty close.
Prepare to be a “kick-(butt) 100 year-old” now or resign yourself to assisted living in the future.
Second, it provides something tangible to work towards.
For most of us, competitive physical activity ended after the final out of our high school baseball careers (I played football, but you get the point!) Others keep it going for a bit longer, playing college ball or by doing activities like CrossFit into middle age.
Regardless of your athletic abilities and longevity, you can probably agree that still being able to carry groceries into your house in your later years is more important than your all-time best “Fran” time.
Ultimately, we are encouraged to “get in shape” for the events of our older years now or we risk “losing” at them when the time comes.
As someone who has always deferred to “exercise” over “nutrition” in the grand scheme of the health and wellness spectrum (shamelessly pushing against the whole “you can’t out-train a bad diet!” meme), I was happy (nay…vindicated!) to read Attia’s take on exercise:
“Exercise is by far the most potent longevity ‘drug’” Attia attests before stating “no other intervention does nearly as much to prolong our lifespan and preserve our cognitive and physical function.”
It should come as no surprise that exercise is one of the solutions posed to combat the Horsemen.
More specifically, having a high VO2 max appears to be the biggest contributor to longevity with those in the bottom quartile of VO2 being five times more likely to die (from any cause at any given moment) than someone in the top 2.3 percent of VO2 max.
After discussing the importance of exercises (as well as the importance of stability, nutrition, sleep, and emotional health), Attia discusses the “right” ways of maximizing each of these areas while also pointing out some problems associated with their current standards and sensibilities associated with them. There isn’t a distinctive “Training 3.0 > Training 2.0” type of argument, but best practices for helping the reader make it to 100 are systematically laid out.
This is another area where the Outlive book really excels. While many of the action items discussed in the solutions portion of the book may be slightly daunting to the untrained, chronically underslept, etc. none of them are simply out of the realm of possibility. Attia isn’t telling the 45-year-old reader that he has to be Tom Brady to significantly increase his longevity; he just needs to get a little stronger, drink a little less, and get some more sleep.
As a way of promoting these solutions, Attia has graciously written articles and developed videos discussing and, in some cases, even modeling some of the exercise movements and regimens that he argues will best contribute to our longevity.
For those who have been in this space for a while, none of these solutions will come across as overly groundbreaking. However, the actionable nature of each of the solution components really makes you want to go out and get started (as you’ll see from my personal experience, below).
Having just recently finished this book, I can’t say that I have put too much of the suggestions into practice. With that being said, I did check out a VO2 max online calculator (far from perfect, but the best I got right now) and inputted my weight and recent 2,000-meter row PR into it.
Being that this level of VO2 max is correlated with the largest reduction in all-cause mortality, I’m feeling pretty good about myself at the moment!
I also completed a 2-minute pull-up bar hang (what Peter Attia likes to see from his 40 year-old clients) and did some long farmer’s carries with (almost) my full body weight.
According to the Outlive book, I’m doing pretty well!
After reading, I’m also very interested in having some of the suggested bloodwork and other medical tests done, particularly those that can point to early indicators of the Four Horsemen conditions. Unfortunately, finding someone to perform these tests is a bit trickier in a non-Western, underdeveloped country (such as the one I currently live in) and I will need to be much more deliberate in my planning and research.
When I first started reading this book, I commented to my wife, “isn’t this what Greg Glassman had been screaming from the rooftops for years? Isn’t this why he created CrossFit?”
I also wondered if I was just going to be reading a clone of “The Barbell Perscription”.
Thankfully I preserved and made my way to the personal anecdotes and the real people these conditions afflict.
Dr. Peter Attia’s ability to make all of this…real is what makes the book.
I’m not sure what the numbers of the Peter Attia podcast, Peter Attia diet, or Peter Attia workout routine have done since the Outlive book has come out, but I’m hopeful that more people are recognizing the reality of our damaged health and medical systems.
If you want to dominate the Centarain Decathlon (and every decade in between) or want someone in your life who is likely to “fail” the 40-year old version of the event to turn things around, give this one a read. Fred and I are definitely on the same page with this one!