Book Review - Outlive 4.23.23

Dr. Peter Attia’s new book, Outlive, The Science and Art of Longevity, encapsulates everything I strive to communicate with SecondFifty. Outlive is a manifesto on healthy aging from one of the foremost health practitioners in the field. Attia has a thriving medical practice and a podcast where he explores the latest science around what he calls Medicine 3.0. If Medicine 1.0 began with Hippocrates and the “insight that disease was caused by nature and not the actions of the gods”, Medicine 2.0 was marked by the emerging germ theory of disease in the mid-nineteenth century. Better sanitary conditions and the ultimate discovery of antibiotics produced the basic framework on which modern medicine rests today.  This revolution in medicine, with its use of the scientific method, led to fantastic advances in the treatment of disease, eradicating such killers as polio and smallpox, and advancing the effective treatment of HIV and AIDS, and most recently COVID.   Medicine 2.0 is based on the treatment of acute illness, which it does well. The likelihood of dying from a “fast death” (accidents, injuries, infections) has dropped dramatically thanks to the interventions of Medicine 2.0. But today’s killers are chronic illnesses, developed over decades, and only become acute at the point of being life-threatening. As Attia says, "atherosclerosis, for example, begins many decades before the person has a coronary 'event’ that could result in their death. But that event, often a heart attack, too often marks the point where treatment begins.” Having achieved so much over the last hundred years, today medicine 2.0 is failing us. Medicine 3.0 focuses on prevention over treatment. And Outlive is the playbook for implementing its core philosophy. Central to Attia’s approach is delaying the onset of chronic disease from what he calls The Four Horseman: cancer, cardiovascular disorders (heart disease and stroke), metabolic dysfunction (diabetes and it's impact on other organs), and neurodegenerative disease (Alzheimer's and dementia). These are the killers of our time. Avoiding the Four Horseman is the key to longevity and to increasing healthspan.  It’s not enough to live longer, Medicine 2.0 can help with that. But at what cost? The marginal decade, as Attia describes it, is one where life is prolonged with drugs and medical intervention, but during which quality of life is diminished. It’s too little, too late. Cognitive decline, physical decline, and emotional decline are the hallmarks of the last years of life for most of the population. “The important distinction here is that while actual death is inevitable, this deterioration that we’re talking about is less so. Not everyone who dies in their eighties and nineties passes through the valleys of cognitive, physical, or emotional destruction on the way there. They are preventable – and I believe that they are largely optional, despite their ever-increasing gravitational pull over time. Cognitive, physical, and even emotional deterioration can all be slowed and even reversed in some cases with the application of proper tactics." (Outlive, page 47) How do we build and maintain resilience to the Four Horseman? We embrace the five broad domains that comprise the tactics of Medicine 3.0: exercise, nutrition, sleep, emotional health, and, where called for, exogenous molecules (drugs, hormones, or supplements). Attia spends very little time on the latter, but he goes into detail on the other four. Outlive is not an academic treatise, though it is serious, dense and thorough. It's not about living to be 120 years old by mixing dubious chemical cocktails. Far from it. The book is filled with specific and practical strategies for replacing the dreaded marginal decade with a bonus decade of vitality and energy. The philosophy and science are clear and well-articulated. But, as Springsteen says in Thunder Road, "The door's open but the ride ain't free". If you want to live a long and healthy life, you're going to have to take initiative and do some work! Peter Attia is the real deal. This book is must-read. It's up-to-the-minute science, well-written, and factual. Attia covers the Four Horseman in detail, offers specific medical tests, lifestyle adaptations, and interventions to detect them early and avoid them altogether, and provides clear prescriptions for each of his five primary tactics of Medicine 3.0. Attia covers: the concept of the Centenarian Decathlon, Attia's way of illustrating what you need to be doing now in order to preserve the physical attributes you will require for the activities you envision doing later in life. (This one is eye-opening) the importance of exercise to prolong lifespan and preserve cognitive and physical function (and why you are probably doing it incorrectly) why strength training is so important to protect from injury, and how and what to do balance and flexibility and their important role in longevity common tests and diagnostics to avoid, and those to request from your doctor the role of diet in preserving longevity cancer, diabetes, Alzheimer’s, nutrition, emotional health and moreI know, I know…You’ve seen and heard all this before. Nothing new, you say. Trust me, you haven’t. You haven’t seen it wrapped in scientific studies with data to back it up and give it meaning. You haven’t had it brought to life the way Attia does. In closing, in Attia’s words: “My goal is to create an actionable operating manual for the practice of longevity. A guide that will help you Outlive. I hope to convince you that with enough time and effort, you can potentially extend your lifespan by a decade and your healthspan possibly by two, meaning you might hope to function like someone twenty years younger than you.” PS. I thought I would be ahead of the crowd in reviewing this book for the SecondFifty Community. I ordered my copy the first day it came out. But after just two weeks on the market, Outlive is #1 on the New York Times Bestseller List! I guess I missed being the early bird, but on the other hand, you don’t have to take my word for the book’s popularity! There’s more on the horizon. Two upcoming books on longevity promise to be as good as this one. Once I get my hands on them I will review them here. Please pass this newsletter on to someone you know. Let’s grow our community of healthy aging and take our friends along with us. It won’t be as much fun without them! Cheers! George.

Here's a link to the book on Amazon:

Outlive, The Science & Art of Longevity - Peter Attia, MD

As a reminder, I receive no remuneration for recommending this book or from any purchase made through this link.

Stay Strong. Age Well.

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I'm George Harrop, founder of

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