Since the beginning of entropic history, we as humans have been searching for the fountain of youth. There are two guaranteed dates that bookend out lives, our birthday and out deathday. The question we face in between is how to push those two dates as far apart as possible.
There is no small amount of literature and no insignificant number of opinions about how to accomplish this goal. After all, we only have one life to live. So, how do we maximize the time both in quantity of years but also in quality of years? These two questions are the driving questions of this book, Outlive by Dr. Peter Attia, MD. He organizes the answer into three basic parts.
Part 1
In Part 1, Dr. Attia seeks to reframe our perspective on health and medicine. We all have a certain amount of time that we are alive. This is called our lifespan. There is a second metric that we find ourselves bounded by and that is our healthspan. This is the amount of time that we are free from death and disease. If you plot a graph of lifespan vs healthspan you can derive a graph that represents your functional ability in life. Our goal, then should be to identify factors that shorten the curve and find ways that maximize our healthspan.
Though life is in many ways unpredictable, for the vast majority of us, our healthspan and thereby our lifespan will be affected and limited by diseases that fall in 4 broad categories, “horsemen diseases.” These are:
1. Cardiovascular Disease
2. Cancer
3. Neurodegenerative Disease
4. Metabolic Disease
Therefore, if we are to optimize our lifespan and healthspan, looking for ways to prevent, detect and treat diseases in these categories becomes of paramount importance. This brings us to part 2.
Part 2
In part 2, Dr. Attia begins to answer the question of maximizing lifespan and healthspan, posed above. He starts by examining a group of people who seem to have cracked the code - centenarians. Is their good fortune borne out of nature or nurture? In the process, Attia explores both the behavioral and genetic components as well as the molecular pathways that lead to each of the horsemen disease. In the process he uncovers various different markers that can be measured and actions that can be taken to modify the risk of disease.
Part 3
Finally, in part 3, Dr. Attia explores the question of what to do to maximize not just your lifespan, but more importantly your healthspan - centered around proper nutrition, stability and fitness. Attia begins with an exercise called the Centenarian Decathlon. He encourages you as the reader to consider what functional abilities you want to have in the last decade of your life (marginal decade). Knowing that there is a predictable, age-related decline in strength and ability, you can work backwards to develop a reserve functional capacity now. In this part he discusses several key factors associated with health maintenance:
1. Stability - the basic foundation for movement and injury prevention
2. Exercise - in the form of strength and metabolic conditioning
3. Nutrition - understanding and prioritizing the proper macronutrients
4. Sleep - our body's method of restoration and repair
5. Emotional health - the piece that makes all others worthwhile.
In this book, Dr. Attia discusses three distinct eras of healthcare and medicine. He describes medicine 1.0 as the era of Hippocrates. It was the understanding that disease was an act of nature and not a malevolent intervention from the god's. As scientific discovery advanced the bounds of medical knowledge, we transitioned to medicine 2.0. We began to understand the biology of disease and provide more treatments. But both medicine 1.0 and medicine 2.0 are reactionary. They look back on what has happened to patients in attempt to restore some form of health. Both medicine 1.0 and 2.0 as reactionary forms of medicine cannot ultimately, completely fix the damage done by pathology. This book is centered around what Attia describes as medicine 3.0 – an attempt at understanding the root causes of chronic disease and preventing them before they even happen.
Most of my career as an emergency physician is solidly built on the principles and practices of medicine 2.0. However, as I have seen disease play out in the ED, I can see that most of the problems that I seek to fix could have been prevented or mitigated through a better lifestyle - specifically related to decreasing the burden of metabolic syndrome. By focusing on lifestyle modifications and a preventative approach to testing and treatment, I think that Attia is on to something here! The health repercussions of simply eating well, working out and getting proper sleep are significant yet often unrecognized or ignored. Unfortunately, in my practice, I don't have the long-term relationship with my patients to implement and follow dietary and fitness trends. But, every opportunity I get, I try to discuss with my patients what Attia presents here. And his approach to fitness, nutrition and sleep has become an important part of my understanding of what it means to live excellently.
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