This book by Peter Attia (2023) — Outlive: The Science and Art of Longevity, New York: Harmony — out in Mar/April, is one of the most anticipated works on longevity and health. Attia is a rock-star in the sector, being the top health expert in the Darren Aronofsky / Chris Hemsworth show on longevity, “Limitless”.
“Outlive” is more than 500 pages long and filled with complex scientific concepts and arguments (which, honestly, flew over my head many times). No TLDR will do it justice but I’m gonna bang one out anyway.
Note that I’d consider this book (and others like it) as supremely important for anyone who wants to live a long, healthy and disease-free life. No need to agree with everything Attia says but undoubtedly guys like him set the agenda on how to deal with issues preventing heart disease.
So here goes:
1. Attia wants to promote “Healthspan” which is defined as the ability to keep doing normal and even extraordinary stuff even when you’re in your 60s’ and 70s’ (when normally ppl will be slowing down, getting weaker, etc.).
In chapt 12 he even asks us to list down some activities we hope to continue to be able doing well into our 70s’ or 80s’ (eg, running uphill, lifting a child, etc.). This is slotted between a lot of material about what kinds of exercises you’d need to do NOW so you can succeed in your list LATER.
2. He also introduces the concept of Medicine 3.0 which he contrasts against Medicine 2.0 (duh). 2.0 is about treating a problem only symptoms occur and doing so within a medical or hospitalisation context; it’s about preventing the patient from dying but,
“(Medicine 2.0 intervenes) at the wrong point in time, well after the disease has taken hold, and often when it’s already too late.” (p.12)
Medicine 3.0 is about very early intervention (as in decades earlier) in the form of serious lifestyle changes; ensuring the patient remains strong and healthy and never contracts serious diseases in the first place (until muuuuuuuuch later). Long and short, it’s about reversing our biological clocks (something alien to Medicine 2.0). Discussing some centenarians, Attia says,
“When they were sixty, their coronary arteries were as healthy as those of thirty-five-year olds. At eighty-five, they likely looked and felt and functioned as if they were in their sixties. They seemed like people a generation younger than the age on their driver’s license. This is the effect that we are seeking to mimic.” (p. 65)
3. Attia talks about the 4 Horsemen i.e. the diseases which are the biggest killers of ppl: Cancer, Type 2 Diabetes, Heart Disease and Neuro-Degenerative Diseases.
I’ll discuss one or two of these horsies here, maybe do the final two in another post.
4. Whilst the impact of having good genes is recognised, Attia puts more emphasis throughout on available interventions everyone can perform.
“While your genome is immutable, at least for the near future, gene EXPRESSION can be influenced by your environment and your behaviors. For example, a 2007 study found that older people who were put on a regular exercise program shifted to a more youthful pattern of gene expression after six months.” (p.70)
5. One of the most important interventions is simply to eat less. Caloric restriction promotes “autophagy” (see p.82) or the recycling and repair of cells triggered by a shortfall of glucose. The “Limitless” series shows helpful graphics to explain, but basically when we fast we end starving the “zombie cells” in our bodies and stop their growth; these ‘undead’ cells are sub-par but, by continually eating, we still feed them and promote their spread. By restricting calories, we kill them off and promote the growth and spread of fresh new (or repaired) cells.
Attia, typical in his book, taking the long way round to get to this point. He starts of with a history of a molecule known as rapamycin, talks about experiments involving mice (and their lifespans were prolonged as a result of the molecule) blahblahblah only to reach the part where he details the benefits of caloric restriction.
6. It seems that when we exercise more, we also get to experience the benefits of eating less (so, Malaysians, happy la kan?), not least because exercise also stimulates the production of more MITOCHONDRIA which, among other world-peace producing tasks, prompts the body to seek ALTERNATIVE SOURCES of fuel i.e. not just glocuse (which, remember, feeds zombie cells).
Okay, gonna stop here. Will talk about the 4 horseman in next post. I’m already glucose-drained writing this.
