Outlive — The Science & Art of Longevity
Research on ageing — and how we might prevent it — is booming right now. Scientists around the globe are racing to find markers of ageing processes in every organ of our body. Some are experimenting with molecules that kill inactive cells or prolong lifespan in mice by mimicking starvation.[1]
From this, a concept has emerged that is no longer restricted to research, but has made its way into the public sphere: longevity. Individuals like millionaire Bryan Johnson are going to extreme lengths trying to escape the ageing process. Because of cases like his, the word “longevity” is now loaded. Some people obsess over the idea of prolonging their lives by any means necessary; others are more wary.
In his book “Outlive” Dr. Peter Attia shares a simpler vision of what longevity could mean for each of us. His main concern is the inability of people to enjoy the last decade of their lives due to health concerns that prevent them from doing the things they love. He argues that we should aim to extend what he calls our “healthspan”, referring to the time of our life that we spend in good health. This demands a radical shift in the way we approach health and medicine. In contrast to the way medicine is practiced today - treating people once they show symptoms of disease -, Dr. Attia’s version of “Medicine 3.0” would be proactive and come into play years or decades earlier. Because this is not yet a reality in most modern healthcare systems, the author encourages readers to come up with their own, personal strategy to increase their health span.
After this general introduction, the author characterizes the four most common diseases people often suffer from as they get older: metabolic syndrome, heart disease, cancer, and Alzheimer’s. He explains the intricacies of these diseases and the challenges we face when dealing with them without too many technical details.
Dr. Attia then switches gear and devotes several chapters to the power of exercise in preventing disease. Over the last decades, research has made huge progress in this area thanks to both epidemiological (population-based observations) and experimental evidence. The author presents the latest findings in cardio, strength, and stability training. He encourages the reader to design their own “Centenarian Decathlon” — a set of physical activities he or she still wants to be able to do in old age. Using this as a starting point, Dr. Attia explains how to devise a strategy and concrete tactics to make success more likely.
The author also tackles the delicate topic of nutrition. I have noticed on social media that many people are frustrated with the contradictory statements of various, often self-proclaimed, nutrition experts. Generalizations about specific food items abound, leading consumers to doubt every choice they make. Dr. Attia avoids this by stating upfront that, for the most part, the effects of nutrition are highly individual and that guidelines applying to everybody are almost impossible to give. He sticks to concepts such as caloric or time restrictions, which might work for some people. The only thing nutrition-related that he is adamant about is the need to consume enough protein.
The last two chapters explore sleep and emotional health, highlighting that well-being and resilience throughout life are simply impossible without these two building blocks.
“Outlive” benefits from the combination of personal stories from Dr. Attia’s own medical practice and an evaluation of the most relevant findings from research. He also admits to his own past shortcomings in taking care of his physical and mental health. This makes for a relatable yet informative read. At the same time, this approach raised a concern for me because readers outside the field of medicine or clinical research might struggle to distinguish between anecdotal evidence and strategies that were proven effective in trials.
Another, more fundamental, problem with Dr. Attia’s approach concerns access and equality. The author frequently mentions his own exercise regime and how he tracks his own health data (e.g., dedicated stability training and glucose monitoring). Unfortunately, many healthcare systems suffer from chronic underfunding and neglect. Most people simply cannot access the resources Dr. Attia has at his disposal. These resources include committed doctors who have the time to devote enough time to each patient, personal trainers, technical equipment, and even just time and space. In my opinion, these issues are too important to not be addressed, especially in the context of his book.
To be fair, Dr. Attia provides some free resources on his website, and I am convinced that he really cares about the issue and wants to empower people to take better care of themselves.
So, I would not reject Dr. Attia’s vision outright. It’s an ideal, after all, and we need ideals to have something to strive for. We have already entered the age of personalized therapies; why not strive for personalized preventive medicine as well? And why shouldn’t we employ exercise, nutrition, sleep, and emotional health as our main tools for extending our health span and possibly our lifespan? More and more healthcare professionals, doctors, and patients are demanding this type of healthcare. It is true that genetics determine our health to a certain degree and that external circumstances exert strong influences. This doesn’t imply, however, that we have zero power over our own health and well-being. We need to be proactive about it — not only for the moment but for the last years of our lives as well.
[1] Nielsen JL, Bakula D and Scheibye-Knudsen M (2022) Clinical Trials Targeting Aging. Front. Aging 3:820215. doi: 10.3389/fragi.2022.820215