Curia Reads: Peter Attia's Outlive: The Science & Art of Longevity
Dr. Attia presents his approach in a new 496-page book called Outlive: The Science & Art of Longevity. The Austin-based doctor practises what he calls medicine 3.0, aggressively treating the causes of diseases early and emphasising prevention rather than waiting for symptoms to manifest. In Outlive, he goes deep on the four primary causes of slow death: heart disease/stroke, metabolic dysfunction, neurodegenerative disease, and cancer. But he goes deepest on exercise, specifically what strength and fitness levels are associated with longer, happier lives. Spoiler alert: He recommends way more exercise than the government guidelines, ideally ten to 12 hours a week.
Exercise is by far the most potent longevity ‘drug,’ ” says Peter Attia, M.D. in his interview with Men’s Health about his book. Attia is a surgeon turned physician who focuses on extending health span—stretching the portion of life when you’re able to do what you want to do versus being frail and weak. “The data are unambiguous: Exercise not only delays actual death but also prevents both cognitive and physical decline better than any other intervention. It is the single most potent tool we have in the health-span-enhancing toolkit—and that includes nutrition, sleep, and meds.”
Here are some of the key takeaways and excerpts from his book and his interview with Men’s Health:
Peak aerobic cardiorespiratory fitness, measured in terms of your VO2 max (the maximum amount of oxygen your body can utilise during intense exercise), is perhaps the most powerful marker for longevity, says Dr. Attia. A 2018 study in JAMA that followed more than 120,000 people found that higher VO2 max was associated with significantly lower mortality. The study also determined that someone of below-average VO2 max for their age and sex (that is, between the 25th and 50th percentiles) is at double the risk of all-cause mortality compared with someone in the top quartile.
Dr. Attia says your VO2 max is a good proxy measure of physical capability: It indicates what you can—and cannot—do. Studies suggest that VO2 max will decline by roughly 10 percent per decade after your 20s and up to 15 percent per decade after age 50. Increasing your VO2 max makes you functionally younger. So having average or even above-average VO2 max has long-term ramifications. Dr. Attia’s goal for his patients is to be at an excellent level for the decade (or two) below their age. Many smartwatches can estimate VO2 max, but a real test (e.g., the Cooper 12-Minute Run) is better and VO2-max charts are easy to find online.
Age-related muscle loss—which starts insidiously in your 40s and picks up the pace in your 50s—is called sarcopenia, from the Greek words for “poverty of the flesh,” says Dr. Attia. Think of strength training as a form of retirement saving, he says. Just as you want to retire with enough money saved up to sustain you for the rest of your life, you want to reach an older age with enough of a “reserve” of muscle to protect you from injury and allow you to continue to pursue the activities that you enjoy—in addition to acting as a buffer against the natural age-related decline in muscle mass. The larger the reserve you build up early on, the better off you will be over the long term. Dr. Attia structures his patients’ training around three 45- to 60-minute weekly total-body strength sessions, which emphasize the following key tenets.
Dr. Attia recommends that patients do one hour of dedicated stability work weekly and five to ten minutes at the beginning of other workouts. He notes that there’s no one-size-fits-all approach and it’s about targeting your body’s weak areas. Often he practices exercises endorsed by the Postural Restoration Institute, such as breathing drills and exercises that create symmetrical range of motion for different limbs, and what’s called dynamic neuromuscular stabilization—moves babies learn, like squatting and crawling. He also does standard core training and foot and balance exercises. He likens stability work to a software upgrade for any movement you’re doing. Practices like yoga, tai chi, and dynamic stretching can help, too.
Here’s a quick summary of the ‘Health Span Essentials’ that Attia goes into great detail in his book:
Health Span Essentials
Dr. Attia practises what he calls medicine 3.0, an aggressive approach to preventive health care versus the main man-killers.
Metabolism: An annual DEXA scan for body-fat percentage and bone density. It’s critical because strong bones indicate robust health, and excess weight is a leading risk factor for cancer, second only to smoking, according to the American Cancer Society. Dr. Attia also recommends an annual oral glucose tolerance test to assess insulin resistance.
Heart: An apolipoprotein B (apoB) blood test, the best indicator of heart-attack risk. He also tests Lipoprotein(a), or Lp(a), the most prevalent hereditary risk factor for heart disease.
Brain: A test for the APOE4 genotype, which can increase the risk of Alzheimer’s disease.
Cancer: Early screening, including colonoscopies starting at 40.
Sleep: To prevent “social jet lag,” which can be damaging to your overall health, try to wake up and go to bed at the same time each day, even on weekends.
Supps: Dr. Attia takes eight milligrams of rapamycin once per week for its potential antiaging benefits, including reducing inflammation and improving the body’s cancer surveillance.
Alcohol: Limit alcohol to four to seven servings per week—ideally never more than two per day.
Driving: When at an intersection while driving, look left, right, then left again before entering. The most common way to be killed as a driver is to be hit by another car from the left at an intersection.