A Review of Outlive, by Peter Attia
Actionable suggestions and other insights from Peter Attia’s Outlive
First, my review. It’s a good book, I really liked the ending where he talks about living a life that’s worth living and building your obituary resume instead of your achievements resume. There’s a lot of good advice in here for the layman, it could be boiled down to a checklist but the anecdotes go a long way to hammer the advice home.
Basic Premises
Medicine 2.0 is the current paradigm in medicine. It focuses on acute treatment of disease and extending life at the last second. We can start now on Medicine 3.0 which focuses on prevention and increasing both our lifespan (time lived) and healthspan (time with quality life).
The ruiners of lifespan are broken down into 4 categories Peter calls the 4 horsemen.
- Diabetes type 2
- Cancer
- Alzheimer’s and other dementia types
- Heart Disease
All of these are heavily influenced by your diet and lifestyle. NAFLD or non-alcoholic fatty liver disease is a precursor to all of these and a direct result of metabolic dysfunction. They are also all influenced by insulin resistance.
Across the board Attia argues that exercise will be your number 1 driver of health. Do everything you can but if you have to start somewhere start with exercise.
Exercise
Zone 2 Cardio - zone 2 cardio improves the body’s ability to burn fat and helps to maintain good glucose levels and insulin sensitivity. Aim for at least 2 hours per week but there really isn’t an upper limit on the amount of zone 2 you can do. Especially if you’re overweight or NAFLD adjacent.
V02 Max - V02 max is a good predictor of longevity and can be improved over time. Spend 4 minutes a few times a session at threshold once per week to improve V02 max.
Strength training - Strength training gets more important as one gets older. Maintaining muscle mass as one gets older is good for falls and for hanging on to things. Strength train at least 2 times per week but prefer 4+ times per week. Focus on your personal goals but important things for your healthspan are carries, squats/lunges, and grip strength.
Tests and Indicators
Continuous Glucose Monitor - these were recently approved for non-prescription use in the United States. They can be purchased for less than $100 per month and are easy to install and monitor.
mTOR - a protein complex that regulates cell cleanup. When there is an abundance of calories mTOR is present and growth occurs. When mTOR is reduced growth stops and cells are cleaned and recycled. mTOR1 induces cellular autophagy (recycling) but mTOR2 induces reduced immune system. Cycling Rapamycin seems to help eliminate the immune system response. High weekly doses are better than low daily doses.
ALT - ALT is a liver enzyme that can indicate that the liver is under stress. Good levels are under 25 IU/l for women and 33 IU/L for men, these don’t reflect the modern ‘normal’ ranges but are adjusted to reflect healthy ranges. ALT can be found with a blood test.
ApoB + LDL - Testing these two via a blood test can tell you about your cholesterol as well as your risk for cardiovascular disease.
There are a ton of tests to be done but they’re all covered here in this reddit post
Drugs and other interventions
Rapamycin - supresses the mTOR protein complex which allows cells to be cleaned and recycled.
Calorie Restriction - could induce mTOR reduction but not recommended as the lack of protein and other important cellular building blocks is likely worse in the long run.
Personal Insights
Peter puts a lot of emphasis on stability. I’m young now and really don’t see a lot of use in this in my own life currently. I think generally athletic people struggle little with stability and time can be spent strength training or recovering instead. Stability often forces people to relearn the movement patterns that they’ve known for a long time and have good practice in. The human body is nowhere near symmetrical so why try to make every single movement you do symmetrical to a T. Unless your technique is really bad you can probably skip.