Outlive (by Peter Attia) is a book on longevity. In the book, Attia frames longevity in terms of 3 components:
- Lifespan, or how long one lives;
- Healthspan, or how long one lives while still being physically and cognitively “fit”; and
- Emotional health, since living longer doesn’t seem worthwhile if you’re unhappy.
The majority of the book is concerned with improving healthspan, which Attia argues will necessarily increase lifespan.
The first half or so of the book is devoted to describing what Attia calls the “4 Horsemen” of decline, which are:
- Metabolic dysfunction (e.g. diabetes)
- Atherosclerosis (e.g. heart disease)
- Cancer
- Neurodegenerative diseases (e.g. Alzheimers)
And the second half of the book describes areas of intervention to improve healthspan and potentially address these horsemen. Attia’s areas of intervention are:
- Exercise (zone 2 cardio, VO2 max training, strength training, stability training)
- Nutrition
- Sleep
- Supplements/medications (which he acknowledges but doesn’t really describe in-depth here)
- Mental health interventions (e.g therapy)
Overall, I thought the book was…ok I guess? It’s obviously very thorough, but I mostly didn’t care about the first half of the book. Attia’s argument in presenting his thorough descriptions of the 4 horsemen are that we ought to understand what we’re trying to overcome before developing longevity strategies and tactics. But I’m not really sure that’s true. I don’t think I actually need to know, on a cellular level, how diabetes works before adopting a strategy of “don’t eat too many calories and be sure to get enough protein.” I’m sure there are people who geek out over the biology and chemistry of it all, but it wasn’t really for me.
Beyond that, the takeaways were mostly things I felt like I already knew. Get enough protein. Don’t eat too many calories. There’s no single optimal diet. Practice strength training and cardio and VO2 max training. Get enough sleep. I’m being somewhat flippant here — Attia certainly provides more than this — but it’s not totally unreasonable to boil down the key takeaways to these handful of platitudes.
I did really appreciate Attia’s “Centenarian Decathalon.” This is a though exercise where we consider the 10 (or so) activities we want to be able to do when we’re “elderly.” We then engage in some backwards planning and consider, given some inevitable age-related decline, how we need to be training today to allow ourselves to participate in those activities.