Book Review: Outlive, by Dr. Peter Attia

The time to repair the roof is when the sun is shining – John F. Kennedy

Who doesn’t want to live long? All of us do. But what are we doing about it? Pretty much nothing. Most of us wake up about our health only when something goes wrong, and our daily routine gets affected. But by that time, it is too late.

Outlive, by Dr. Peter Attia takes a deep, hard look at what he calls the science and art of longevity. The author, a doctor and surgeon by profession, quit his medical practice out of disappointment with modern day science and started a practice where he focuses on showing his clients a path to a healthy and long life. The author believes modern day science suffers from severe shortcomings in the way it approaches health and suggests an alternative approach (that he calls Medicine 3.0) that focuses on prevention rather than cure.

To be sure, the lifespans of humans have increased significantly over the last two hundred years, thanks to advancements in medical science. But most of these successes have been achieved by conquering “fast death” – prevention or cure of infectious diseases of various kinds, treatments of injuries, emergency care of accident victims or responses to natural calamities and so on. We have learnt to fix broken bones, wipe out infections, replace damaged organs and decompress serious spine and brain injuries.

But we are markedly less successful in helping patients with chronic conditions. All these issues are caused by metabolic dysfunction, primarily due to a mismatch between our genetic evolution and modern-day lifestyle. Face it - most of us are going to die of what the author calls The Four Horsemen (from the biblical Four Horsemen of Apocalypse) – Type 2 diabetes, heart disease, cancer, or Alzheimer’s (or some variants & combinations of these). This is “slow death” – where medical intervention happens too late in the day, and the treatment is symptomatic, without addressing the root cause. While Fast Death diseases can be cured totally and patient’s condition restored back to where it was before the disease took hold, Slow Death treatment has just one goal today – to stop the patient from dying. The patient never goes back to Being Healthy again.  Most of our final years of life – “The Marginal Decade” – will be just spent battling one or more of these Four Horsemen.

Medicine 3.0

In comes Medicine 3.0 – which focuses on the two components of Longevity viz., Lifespan i.e., how long you live, and Healthspan i.e., how well you live. 

It is an approach that places far greater emphasis on prevention rather than treatment. It considers patient as a unique individual and offers solutions that suit his own specific case. There is no one-size-fits-all formula here, but an advice on how to look at your own individual risk of contracting these ailments and how to prevent them. The author says his goal is to present an actionable operating manual with which, you can potentially increase your lifespan by a decade and healthspan by two. It would be ideal if not only the lifespan is long, but if lifespan & healthspan perfectly overlap. That is what we should be aiming for.

With this background, the book then takes a deep dive into the inner workings of each of the Four Horsemen. How and when do they begin? What forces drive them? How are they sustained – and how can they be delayed or prevented? This part is pure science, and the book goes deep into the molecular biology behind each disease. I found this fascinating, despite the text becoming a bit technical at times. To an extent, this is inevitable given the nature of the topic, and it goes to the credit of the author that he has tried to make the subject as easy as possible for a layman to understand, without either losing the scientific angle or making the content too superficial. One can easily get the drift of what is being said, even if not being able to follow every word literally. 

Having analyzed the four slow killers in-depth, the next part of the book focuses on Solutions.

It starts with a study of Aging itself, which I found very interesting. What exactly does aging means? What happens when we age (grow)? Can the process be slowed down, and how? I had never thought of these things before.

As we grow older, the deterioration in healthspan occurs along three vectors – cognitive, physical and emotional. Medicine 3.0 tackles this through five broad domains – exercise, nutrition, sleep, emotional health, and medication. The book then discusses each of these topics (except medication) in considerable detail. For example, what are different types of exercise, and why do they work? What happens when we sleep and why is sleeping well so important? Is there such a thing as a perfect diet? The book doesn’t simply prescribe solutions (for example, take this diet or do that exercise) but explains the science behind everything and lets the reader decide what is best for her.

The book busts many myths and misunderstandings surrounding all issues Health. Surely, the book will inspire you to do more for your health. At times, it can also scare the hell out you, as you realize how you are going to die! There are plenty of references to latest research in medicine and molecular biology, information about recent and even ongoing clinical trials, survey findings and everything in between. Be clear, this is a science book written for the layman, NOT just a self-improvement motivational book that tells you to eat good food and exercise more. Even for those who studied medicine a few years ago, the book is a wonderful update on the latest happenings in their field.

As I finished reading the book, my mind kept going back to my late father-in-law, a healthy man of 75 who had no ailments, never went to a doctor, and took no medicines. Late one evening four years ago, he took his dinner as usual, went to bed and never woke up. To use the language I learnt in the book, his healthspan perfectly overlapped with his lifespan. Blessed are the people who die like this. This is the blessing the book is trying to give you. Take it.