Doctor Peter Attia is one of the foremost thinkers and communicators re: health, longevity and preventive medicine – you can find his work e.g on his website, podcast, Youtube etc. He published in March 2023 his book – “Outlive – the science and art of longevity”.
Others have written thorough reviews of the book (e.g. on Amazon) so I won’t try to do that as the extensive material in the book could end up overwhelming. Instead this post focuses on a few key concepts from the book.
Concept #1 – Health-span
Instead of focusing on Lifespan – where the last years of a long life can be plagued by tiredness, sickness and low energy – our Objective should be on increasing Health-span. This means we could live a slightly longer life, but also have the energy and strength to be able to do our favorite activities in our last decade. Whether that is hiking with friends, learning new skills, picking up a grandchild or just living independently, I think that is an admirable goal.
Concept #2 – the Four Horsemen
With the Objective of increasing our Healthspan in mind – what are the main causes of death in modern societies that we need to focus on preventing? Those are what Peter calls the Four Horsemen of chronic disease, which combined account for about 80% of all cause mortality (ACM):
#1 – Cardiovascular disease (CVD):
- Is the leading cause of death for both men and women, accounting for about 25% of ACM
- Common types are: Coronary heart disease, stroke and heart failure.
- Causes and factors include: High blood pressure, High cholesterol, Smoking, Diabetes, Obesity, Physical inactivity, Family history
# 2 – Cancer
- Is the second leading cause of death for both men and women, accounting for about 22% of ACM
- Common types are: Lung, Breast, Colorectal, Prostate or Pancreas cancer
- Causes and factors include: Age, Smoking, Diabetes, Obesity, Physical inactivity, poor diet, Family history/genetics, Environmental toxins
# 3 – Neurodegenerative disease, dementia
- Is the third leading cause, accounting for about 8% of ACM
- Common types are: Alzheimer’s, Lewy Body Dementia, Parkinsons
- Causes and factors include: Age, Head injury, Diabetes, Obesity, excessive alcohol, poor diet, Family history/genetics, Environmental toxins
#4 – Metabolic syndrome and insulin resistance
“insulin resistance itself is associated with huge increases in one’s risk of cancer ( up to twelvefold ) , Alzheimer’s disease ( fivefold ), and death from cardiovascular disease ( almost sixfold ) — all of which underscores why addressing, and ideally preventing , metabolic dysfunction is a cornerstone of my approach to longevity”
- Metabolic syndrome is a group of risk factors that increase your chance of developing CVD (#1), cancer (#2), neurodegenerative disease (#3), diabetes, obesity.
- Causes and factors include:
- Abdominal obesity. This means having a waist circumference of more than 35 inches for women and more than 40 inches for men.
- High blood pressure. Blood pressure of 130/80 mm Hg (millimeters of mercury) or higher is considered high.
- High blood sugar. Blood sugar levels of 100 to 125 milligrams per deciliter (mg/dL) after fasting overnight are considered prediabetes. Levels of 126 mg/dL or higher on two separate occasions are considered diabetes.
- High triglycerides. Triglycerides are a type of fat found in the blood. Triglyceride levels of 150 milligrams per deciliter (mg/dL) or higher are considered high.
- Low high-density lipoprotein (HDL) cholesterol. HDL cholesterol is often called “good” cholesterol because it helps remove bad cholesterol from the blood. HDL levels of 40 mg/dL or lower for men and 50 mg/dL or lower for women are considered low.
- If you have three or more of these risk factors, you have metabolic syndrome, as do about 40% of Americans.
Concept #3 – the best medicine is exercise
There are many tools covered in the book to live a healthy life, and to prevent the Four Horsemen – e.g reducing stress, sleeping well, eating a healthy diet, and having meaningful relationships. However one tool stands above the others in terms of impact: exercise.
Any exercise is better than none, and ideally you should do both cardio and strength/ weights training.
Cardio training:
A study found that someone below – average VO2 max for their age and sex is at double the risk of all – cause mortality compared to someone in the top quartile ( 75th to 97.6th percentiles ). Thus , poor cardiorespiratory fitness carries a greater relative risk of death than smoking.
Strength training:
Subjects with low muscle strength were at double the risk of death , while those with low muscle mass and / or low muscle strength , plus metabolic syndrome , had a 3 to 3.33 times greater risk of all – cause mortality
Preventing #1 – Cardiovascular disease (CVD)
John Ioannidis , a Stanford scientist found that in randomized clinical trials, exercise – based interventions performed as well as or better than multiple classes of pharmaceutical drugs at reducing mortality from coronary heart disease , prediabetes or diabetes, and stroke.
To note: The book does go into detail also on the importance of reducing LDL-cholesterol (more specifically APO B) – if needed through medication.
Preventing #2 – Cancer
..I suspect that the association between obesity , diabetes , and cancer is primarily driven by inflammation and growth factors such as insulin . Obesity, especially when accompanied by accumulation of visceral fat, helps promote inflammation , as dying fat cells secrete an array of inflammatory cytokines into the circulation.
What I am saying is that we don’t want to be anywhere on that spectrum of insulin resistance to type 2 diabetes , where our cancer risk is clearly elevated . To me , this is the low – hanging fruit of cancer prevention, right up there with quitting smoking . Getting our metabolic health in order is essential to our anticancer strategy.
Preventing #3 – Neurodegenerative disease
The single most powerful item in our preventive tool kit is exercise , which has a two – pronged impact on Alzheimer’s disease risk: it helps maintain glucose homeostasis , and it improves the health of our vasculature.
The epidemiology linking strength and cardiorespiratory fitness to lower risk for neurodegeneration is so uniform in its direction and magnitude that .. .. I now tell patients that exercise is, full stop and hands down , the best tool we have in the neurodegeneration prevention tool kit .
Conclusions
I don’t want to sound hyperbolic, but IMO this book should be essential reading for every human being. This book should be taught in class-rooms around the world, until every-one understands these concepts thoroughly, because they are so fundamental for our health.