[Longevity Club] Outlive
Outlive: The Science and Art of Longevity
Dr. Peter Attia
Three-Sentence Summary
Longevity is a luxury activity, as the presumption is that the subject has reached the 3-4 level of Maslow's Hierarchy of Needs. The objective of longevity is to live longer with great health. Exercise, nutrition, and monitoring the body stats are the most effective and easiest actions we can take now.
Who Is This Book For?
People who have known me for a long time know that I am very keen on the topic of longevity. Even though I am not among those vanguards who measure and monitor every aspect of their life, I am actively trying and adapting new methods.
This book will be the starting point of my Longevity Club. It is not the first book on this topic. But it is definitely one of the most essential foundational knowledge providers. That means a mindset shift and a strategy before tactics.
Major Concepts
Whenever I talked about longevity with a new friend, she would pop a seemingly rhetorical question: what is the point of living that long miserably? Well, I am not sure whether she is trying to point out that I am living a miserable life or that she genuinely believes that life will definitely suck in the long run. What I know is that I am not going to answer it. However, one thing will always linger around when we talk about longevity. The life quality.
The author provides three functions related to individuals: cognitive, physical, and emotional. They are grouped as healthspan. The last one is important but covered far less than the first two due to the difference in the subject fields.
Let’s have a look at the graph below to see our objective of longevity.
The objective is to achieve minimally 100 years old with only deterioration at the end of life—the blue dotted curve. Current mainstream medical treatments can only improve a little compared to doing nothing at all (black solid curve vs. red dotted curve). What’s worse is that they only prolong the miserable part (the right end of the black solid curve).
Our lifespan has doubled in the past century, and the main contributor is the invention of antibiotics. Let’s see another plot I take from the book.
Our medicine has not advanced far, though, for the four strongest opponents of our health: heart disease, cancer, neurodegenerative disease, and type 2 diabetes and related metabolic dysfunction. They are the reasons why the long life looks like the black solid curve than the blue dotted curve.
This leads to the proposal of Medicine 3.0. To put it in perspective,
MED 1.0: science-based treatment than the act of god,
MED 2.0: procedures (e.g., surgery) and medications,
MED 3.0: prevention-based customized treatment.
This reminds me of a quote, about 2000 years ago, from the ancient Chinese medical textbook
上医治未病，中医治欲病，下医治已病。 The supreme healer cures the illness that is still obscure, the good healer cures the illness that is about to break out, fully manifested illness the least able tries to cure*. —《黄帝内经》*
I can’t help but share a side story related to the Chinese King of Medicine, Sun Simiao. Su is also the primary advocate of the above principle quote. He lived a little longer than 100 years and is mostly famous for his contribution to Chinese medicine. Guess what? He is also credited as the inventor of powder explosives. And he died soon after the invention. I will let your imagination fill the gap.
Back to the book.
After identifying the objective and knowing the strategy of MED 3.0, what can we do in a concrete way?
Here is the extremely short summary of actions from the book. In later posts, I will cover each of them in greater detail.
Exercise, exercise, exercise. Hands down, it is the most effective way before great breakthroughs in medicine. Exercise means a group of workouts that cover all the aspects of strength, stability, aerobic efficiency, and peak aerobic capacity. Any weak point is a door to injury or illness.
Nutrition. No diets have been proven scientifically related to longevity, as long as you balance the fats, protein, and carbs. Keto, Mediterranean, fasting, vegetarian, etc., short-term might show some progress in certain measures, but long-term research in the human body is still not there.
Sleep is not negotiable.
Take care of your emotional health.
Exogenous molecules (drugs, hormones, supplements). Like nutrition, the research is not there. And highly possible, the solution is very individual.
Be aware of your health. This action unfolds in two directions: tracking the past and current progress and preparing for future medicine.
The first is easy to follow. You must know where the body stands in terms of health conditions. The sad fact is that the current base health check doesn’t cover all the aspects that we need to know unless symptoms show. To name an example, an annual DEXA scan will help to know visceral fat (besides other things), which is highly related to heart diseases.
The second direction is highly related to the goal of prevention. If you are following the topic of longevity, you must also have heard of Bryan Johnson—who claims to be the most measured human in the world. The millionaire sold his company and started to work on his health. A few years later, at the age of 47, his body (claimed with facts) is like an 18-year-old. What do we learn from him? Longevity medicine is at the beginning that’s why only millionaires can afford it. Longevity is also very individual, and you can’t apply the same protocol for everyone to reach the same goal. There are some strategies we can learn from his million-dollar experiment, but we have to tweak them to fit our bodies. Measurement gives you bits-by-bits knowledge of your body, and by the time you need it, you will not regret the effort.