I picked up this book after several of my most health-conscious friends began recommending it: a number of my Ragnar friends that I Marco Polo with, a husband and wife who’ve faced some serious health scares, a friend who’s lost a lot of weight and stopped vaping. There’s a range of people who’ve found this book useful. What we all have in common is we’ve all hit or are about to hit 50, or as my friend Neil puts it, we’ve “entered that part of life where you’re aware you’re not immortal, but you’re not ready to give up yet.”
Here are my key takeaways from Attia’s book:
The four horsemen of American morbidity are heart disease, cancer, neurogenerative disease, and type 2 diabetes. If you’re going to die in America, chances are it’s one of these four that will be the cause. We shouldn’t think of these as binary (i.e., we have heart disease or we don’t), but as existing along a continuum (i.e., our lifestyles and bringing us closer to or further from them). Not having a disease isn’t optimal if we’re on the brink of diagnosis.
Modern medicine (which Attia terms Medicine 2.0) is very good at treating short-term and/or acute problems. But it is terrible at preventing us from developing and exacerbating illness. For example, doctors will prescribe medications for type 2 diabetes, and insurance companies will pay for it. But even a patient who’s predisposed to type 2 diabetes would have to be incredibly proactive to discover specific exercises that could help prevent it, and an insurance company would never pay for their gym membership.
There is a difference between lifespan and healthspan. Someone operating under Medicine 2.0 may life into their 90s, but their last decade could be languishing in illness, immobility, and dependency. Adopting Medicine 3.0, however, can extend a person’s healthspan, which may mean they live just as long, but without the languishing decline.
We should develop our own Centenarian Decathlons – activities we want to be able to do in our old age – and work on them today.
There are a number of specific things each of us can be doing today to extend our healthspans. These actions and attitudes include go beyond “diet and exercise.” In fact, even though I work out 4-5 times a week, I was surprised at the amount of exercise I should be doing right now. If I want to be able to pick up a 30 lbs. grandchild in my 80s, I need to be regularly and easily lifting 50 lbs. today. Stability and balance are important to develop because they help prevent falls. Other physical focuses include muscle density and grip strength, because once they go, the ability to lift and carry things decreases rapidly. Sleep is incredibly important.
There are a number of tests I’m going to look into:
a. To understand risk of heart disease, request apoB & Lp(a) testing, even if you have to pay out of pocket for it. This is a more accurate indicator than the standard lipid profile of total cholesterol, HDL (“good), LDL (“bad”), and Triglycerides.
b. Find out my A1C (90-day glucose) and an oral glucose tolerance test.
c. Get a Coronary Artery Calcum (CAC) score.
d. Understand my Vo2max (maximal aerobic fitness level).
“The older you are, the healthier you were.”
Outlive includes lots of charts, graphs, and other data which gives me confidence in Attia’s expertise, but also leave me saying, “Just tell me what to do, and I’m just going to trust you on this.”
If found the final chapter of Outlive the most poignant and the most shocking. In it, Attia makes the argument that there’s no reason to strive for long life if we’re not doing all we can to improve the quality of our lives. He talks candidly about being sexually abused as a young boy, that he didn’t deal with that trauma until much later in life, and how the risk of losing everything forced him into the therapy needed to cope with it. The chapter was very raw and Attia makes himself very vulnerable. At various times I found myself liking him less, and liking him much more as a person. Ultimately, this chapter on mental health is maybe the most important of the entire book.
If you like this book, check out Attia’s podcast The Drive, check out his website, and watch this TED talk.
I’ve had this book on my shelf for a while. Thanks for the review and highlights.