Peter Attia's "Outlive: The Science and Art of Longevity" is a comprehensive exploration of the journey of aging, a journey that he likens to a voyage on the Arctic Ocean. As we navigate the vast expanse of our lives, we are increasingly likely to encounter icebergs, formidable obstacles that represent the four primary diseases of aging: cancer, heart disease, Alzheimer's, and metabolic disease. The objective of our journey, Attia suggests, is not merely to survive, but to outlive these icebergs, to avoid them for as long as possible, and to continue our voyage into our tenth decade of life with vitality, vigor, and a deep sense of fulfillment.
The metaphor of the voyage is a powerful one, and Attia uses it to great effect throughout the book. He paints a vivid picture of the potential dangers that lie ahead, the icebergs that can cut our journey short in the fifth or sixth decade of our lives, or force us to spend our final years with a compromised ship that is slowly sinking. The goal is not just to live longer, but to live better, to maintain the integrity of our ship, our body, for as long as possible.
One of the key concepts that Attia introduces in "Outlive" is the idea of insulin resistance. He describes insulin resistance as the best long-range radar we can install on our ships to detect icebergs. Studies have found that insulin resistance is associated with significant increases in the risk of cancer, Alzheimer's disease, and death from cardiovascular disease. In a state of insulin resistance, cancer cells proliferate, brain cells are deprived of the fuel they need, leading to Alzheimer's, and our bodies become more inflamed, accelerating heart disease.
Insulin resistance, Attia explains, occurs when our body must maintain roughly one teaspoon of glucose in the blood at all times. When our blood glucose rises after a meal, our body produces insulin to push the excess glucose into cells. In a healthy body, insulin pushes glucose into muscle cells and fat cells under the skin, known as subcutaneous fat. However, as these cells fill with glucose, it becomes harder and harder to push more in, so the body produces more insulin. Eventually, no matter how much insulin is present, muscle cells and subcutaneous fat cells won't accept any more glucose. This results in high insulin and high glucose levels in the blood, a state of insulin resistance.
In this state, any excess calories get converted into fat and stored in places where fat should not be, like in the liver, between muscle fibers, and between organs in the midsection. This is called visceral fat, and it's highly inflammatory. Attia likens this fat spillover to a tub overflowing with water, getting into the vents, floorboards, and carpets, and destroying the house. As fat spills over into muscles and organs, insulin resistance worsens, causing more fat to accumulate in muscles and organs. It's a vicious cycle, but one that can be broken with the right lifestyle changes.
While it might seem logical to assume that changing one's diet is the best way to avoid insulin resistance and prolong life, Attia argues that the most powerful tool we have is physical exercise. He refers to exercise as "the most powerful longevity drug," a potent remedy that has the greatest power to determine how we will live out the rest of our lives. Going from zero weekly exercise to just 90 minutes per week can reduce the risk of dying from all causes by 14 percent. It's hard to find a drug that can do that.
The right exercise program, according to Attia, can train our muscle cells to absorb more glucose and use fat as fuel, keeping any fat spillover in check. He recommends a balanced exerciseprogram that includes three types of training: Zone 2 training, VO2 max training, and strength training. Most people miss these three forms of training because they either don't exercise, which is the case for 77% of Americans, or they exercise in the gray zone between Zone 2 and VO2 max training and think strength training is just for athletes and bodybuilders.
Zone 2 training
It involves any aerobic exercise that you can sustain while barely being able to hold a conversation with someone. A Zone 2 workout should feel almost hard, without any muscle burn. The longer you can sustain a Zone 2 workout, the more the mitochondria in your muscle cells, the power plants of the cell, learn to use fat as fuel.
VO2 max training
If Zone 2 training feels almost hard, then VO2 max training feels very hard. During VO2 max training, you do an aerobic exercise close to your all-out maximum for four minutes, then go easy for four minutes, and repeat this four times. You will feel like you're dying during a VO2 max training session, but it's worth it. Studies show that people who increase their VO2 max from below average in their age group to above average experience a 50% reduction in all-cause mortality. Attia says VO2 max is perhaps the single most powerful marker for longevity.
Strength training
This is the third form of training that Attia recommends. Strength training vastly improves metabolic health because it produces more lean muscle mass that soaks up excess glucose like a sponge. A 10-year study of 4,500 subjects over 50 found that those with low muscle mass and low muscle strength were three times more likely to die early. Attia says he thinks of strength training as a form of retirement saving. Just as we want to retire with enough money saved up to sustain us for the rest of our lives, we want to reach older age with enough of a reserve of muscle to protect us from injury and allow us to continue to pursue the activities that we enjoy.
To embrace these three forms of training, Attia suggests setting three weekly targets. Set a Zone 2 Target of 45 minutes four days a week. You can use this time to catch up on your favorite TV show while on a stationary bike, treadmill, or rower. Set a VO2 max Target of one day a week, going nearly all out for four minutes, then going easy for four minutes, and repeating this four times. Then once a year, take a VO2 max test with a medical professional and strive to get in the top 5% of your age group. Lastly, set a strength training target to lift heavy weights three times a week, with a focus on grip strength exercises like the farmer's carry (carrying two heavy objects in your hands) and hip-hinging exercises, which involve bending at the hip without bending the spine, like doing deadlifts, squats, or step-ups on a large box. Your goal is to be able to do a farmer's carry, walking around a room for one minute while holding half your weight in both hands.
Beyond exercise
Attia also discusses the importance of diet in maintaining health and longevity. He recommends consuming enough protein to match your weight in grams. For example, if you weigh 195 pounds, you need to consume 195 grams of protein every day. However, you must space out your protein intake so you do not consume more than 25% of your daily protein in a single sitting because excess protein gets turned into glucose by the liver. Therefore, aim to consume roughly 50 grams of protein four times a day, around 9 am, 12 pm, 3 pm, and 6 pm. These protein meals can include two chicken breasts, a large piece of salmon, or a large steak.
Attia also advises against eating within three hours of bedtime. He explains that when we eat, our body produces insulin to push glucose into cells. But if we eat close to bedtime, our body is still producing insulin when we are asleep, which is when our body should be burning fat. This can lead to insulin resistance and fat spillover.
In terms of what to eat, Attia recommends sticking to an eating plan that keeps average blood glucose in a safe range. This means avoiding foods that spike blood glucose, like sugary drinks, white bread, and pasta,and instead focusing on foods that are high in fiber and protein, such as vegetables, lean meats, and whole grains. These foods are digested more slowly, resulting in a steady release of glucose into the bloodstream, which can help to prevent insulin spikes and the resulting insulin resistance.
In addition to diet and exercise, Attia also discusses the importance of sleep and stress management in promoting longevity. He explains that sleep is when our body repairs itself, and chronic sleep deprivation can lead to a host of health problems, including insulin resistance, obesity, and cardiovascular disease. He recommends aiming for seven to nine hours of sleep per night and maintaining a consistent sleep schedule, even on weekends.
Stress, too, can have a significant impact on our health and longevity. Chronic stress can lead to inflammation, which is a major contributor to many of the diseases of aging. Attia recommends incorporating stress management techniques, such as meditation, yoga, or deep breathing exercises, into your daily routine to help manage stress levels.
Throughout "Outlive," Attia emphasizes the importance of taking a proactive approach to health and longevity. Rather than waiting for disease to strike and then reacting, he advocates for a preventive approach that involves making lifestyle changes now to reduce the risk of disease in the future. This approach, he argues, is the key to not just living longer, but living better.
In writing "Outlive," Attia spent six years meticulously researching and synthesizing the latest scientific findings on aging, exercise, diet, sleep, and stress. His goal was to create a book that would remain relevant and valuable for decades to come, despite the rapid pace of scientific advancement. He aimed to provide readers with practical, evidence-based strategies for improving their health and extending their lifespan, rather than offering quick fixes or miracle cures.
Despite the challenges and sacrifices involved in writing "Outlive," Attia expresses a deep sense of satisfaction and gratitude for the opportunity to share his knowledge and insights with readers. He acknowledges that the process of writing the book was a significant undertaking, requiring countless hours of research, writing, and editing. However, he also expresses a deep sense of fulfillment and pride in the final product, describing it as a labor of love and a testament to his passion for helping others live longer, healthier lives.
The final chapter of "Outlive:
The Science and Art of Longevity," Peter Attia turns his attention to the often overlooked but vitally important aspects of longevity: mental health and emotional well-being. He likens the mind to the captain of our ship, the one who steers us through the icy waters of life, making decisions that determine our course and ultimately, our longevity.
Attia emphasizes that our mental and emotional health is just as crucial as our physical health in our quest for longevity. He argues that a ship with a troubled captain is likely to veer off course, hit icebergs, or even sink. Similarly, a mind burdened by stress, anxiety, depression, or other mental health issues can lead to poor health decisions, increased risk of disease, and a lower quality of life.
He introduces the concept of "emotional resilience," the ability to navigate through the stormy seas of life's challenges and bounce back stronger. Just as a resilient ship can withstand the harshest of storms, a resilient mind can weather life's trials and tribulations without capsizing. Attia suggests that building emotional resilience involves cultivating a positive mindset, practicing mindfulness, and fostering strong social connections.
Attia also addresses the importance of mental health in maintaining a healthy relationship with food and exercise. He notes that an unhealthy mental state can lead to disordered eating and exercise habits, which can derail our voyage towards longevity. He encourages readers to seek help if they struggle with these issues, reminding us that mental health professionals are like experienced navigators who can help guide us back on course.
In this chapter, Attia also explores the role of purpose and fulfillment in longevity. He suggests that finding a sense of purpose in life, a reason to set sail each day, can add years to our lives and life to our years. He shares research showing that individuals who report a strong sense of purpose and fulfillment tend to live longer, healthier lives.
Attia concludes the chapter, and the book, with a powerful message: Longevity is not just about adding years to our lives, but also about adding life to our years. And a significant part of that equation is our mental and emotional health. He encourages readers to take care of their minds as well as their bodies, to seek help when needed, and to cultivate resilience, purpose, and fulfillment. In doing so, we can not only extend our voyage on the Arctic Ocean of life but also make it a more enjoyable and meaningful journey.
In "Outlive," Attia doesn't just present facts and figures; he paints a vivid picture of what it means to truly live, not just exist. He invites you to embark on the greatest adventure of all - the journey of a long, healthy, and fulfilling life. So, hoist the sails, set your course, and embark on the voyage of a lifetime. With "Outlive" as your guide, you're not just surviving; you're thriving, charting a course towards a future where every sunrise holds the promise of a new day, every sunset marks a day well-lived, and every moment in between is a testament to the art and science of longevity.