Outlive: The Science and Art of Longevity

I first learned about Dr. Attia through watching the series 'Limitless.' I found the series to be extremely inspiring, and ultimately life-changing. I then stumbled across a Youtube clip where someone was discussing this book, which led to my purchase of it. It is a very thick book with which I took my time reading, in chunks. (I did not read the last two sections on sleep and emotional health). I read through some of the 1 and 2 star reviews on Goodreads. Many mentioned that the book could be significantly shorter and that they did not like all of the personal stories that Dr. Attia shared. However, I found each of the stories to be quite helpful in putting the information into context. And I think the overall intent of this book was/is two-fold. It was not only written to present 'information,' but also Dr. Attia's personal testament of his journey as he learned new things, changed his perspectives, struggles in life, etc. The addition of this deeply intimate information helps to make the book more personable versus cold and mechanic. And who knows, writing this book may have also provided Dr. Attia with some degree of inner peace and resolution. What is so wrong with that? There are many focal points of this book, but for this book review, I will address what I find to be key take away points, and my perspective of those points discussed by Dr. Attia. READABIITY: Some parts of the book could be difficult for people to understand if they do not have a medical background, fortunately I do. For those who do not, and really want to understand, have Internet access handy so that you can cross-reference between the Internet and the book as you go along. NOTE: There are many parts of the book where animal research studies are discussed. I must preface that I struggle reading about animal studies, as I am anti-animal testing activist. But I do understand why the studies are mentioned in the book. PHILOSOPHY: Dr. Attia makes several comparisons between Medicine 2.0 and Medicine 3.0. I think many Primary Care providers who read and subsequently reviewed this book may have felt offended by Dr. Attia's views on what he describes as our current healthcare model (Medicine 2.0). However, Dr. Attia is not pointing fingers and intending to insult Primary Care providers. He is simply pointing out flaws in our current healthcare model and how it should shift to a different focus, which I 100% agree with! For those who chose to be insulted by this, shame on you. If you are a Primary Care provider, it is also not your fault that your practice is based upon Medicine 2.0, as you have to operate within the restrictive system and in accordance with insurance coverage. Embrace the Medicine 3.0 philosophy and save it for the day when, perhaps, our current healthcare model will shift closer to it. Everyone will be better off for it. PREVENTATIVE TESTS: I found it odd when a reviewer mentioned that they know many adults who lived to old ages without any fancy tests. That is a strange thing to write, because Dr. Attia does NOT imply that having a bunch of tests contributes to living longer or healthier. Conversely, he implies that having preventative tests provides knowledge of one's current health state. That knowledge can then enable people to make changes that can contribute to living longer and healthier versus being a ticking time bomb and continuing on the same physiological path. How that reviewer misconstrued these two vastly different concepts is beyond me. This reviewer continued on to say that these seniors also smoked, drank, ate what they wanted, etc. However, I cannot help but wonder about their quality of life, and whether they were active and enjoy(ed) pursing hobbies/interests OR if they were simply 'existing' as couch potatoes. These are two vastly different concepts, and is the focal point that Dr. Attia expresses throughout the book. On another note, Dr. Attia describes the perfect world where everyone has access to a plethora of preventative tests. Many of these preventative tests (scans, blood, etc.) are not covered by typical insurance plans, which means people have to pay out of pocket for them. I do plan to have most of the screening tests done that he recommends, because I want that in-depth knowledge of my current health state. However, doing all of these are just out of reach for many, or until patients reach a certain age (DEXA scan, for example). MACRO NUTRITION: As many others mentioned, I do not think that any new/novel information about macro nutrition was presented. Some reviewers got the impression that Dr. Attia is pro-Keto diet. But I did not infer that at all. Conversely, I thought Dr. Attia did a great job with pointing out key advantages and disadvantages of many different types of diets, not just Keto. And I think he made it quite clear that no one type of nutrition regimen/approach is going to work for everyone. This point was made quite clear when he discussed his friend/patient (the Lipidologist) who benefited from a fasting regimen. I also think he did a good job explaining how different macro nutrients affect the body in an easy to understand fashion. I particularly found the information about Fructose and Purine quite interesting. EXERCISE: It was made abundantly clear that Dr. Attia believes that exercise is the foundation for good health, which I agree with! He describes, in detail, how exercise is the best preventative tool for the "Horsemen." Yes, it makes good sense: Exercise = improved blood flow = improved perfusion AND = building and/or maintenance of muscle tissue and maintenance of bone = potential reduced risk for the "Horseman." But in reality, is it really THAT simple? I do not think so. There are so many other factors that come into play. Additionally, what is disheartening, and what other reviewers found discouraging about this, is how complex Dr. Attia makes exercise out to be. While I agree with the benefits of all the different types of exercises he discusses, I also think it is unrealistic for many people to achieve all of it in it's entirety. Again, it comes back to the perfect world where there are no life-stressors, no major time consuming life-demands, not having to work a full-time job, etc. For example, let's talk about a rich celebrity who is one of Dr, Attia's patients: Chris Hemsworth. I am not criticizing or picking on Mr. Hemsworth. Below is just a great example that helps my point hit home here. Does he work a 40-hour week desk job, staring at a computer all day? No. Is he on his feet all day working at a store helping customers? No. Does he come home from that job, after a commute, and have to try to squeeze in a workout? No. Does he have personal trainers and nutritional coaches? Yes. Does he have plenty of time most days to exercise and enjoy leisurely activities? Yes. Is his job as an actor focused on being physically fit? Yes. Is he able to wake up naturally most days instead of being blasted awake by an alarm clock? Yes. Does he have plenty of income to not have to worry about paying the bills? Yes. This is the perfect world that Dr. Attia describes. Not everyone has enough time in the day to devote to exercising like Dr. Attia believes is necessary. I am a poly-outdoorsman, and I am an endurance (non-professional) athlete. I would love nothing more than to have the amazing opportunity to devote as much time as I want to exercise and my outdoor sports versus working a full-time job. However, that is not my reality despite how much I would like it to be. For most people who live in the real world, doing some exercise each day/week just has to be enough because that's all they can do. So to even remotely imply that that amount just isn't enough to obtain a long, healthy lifespan is quite sad. This is where the notion of 'weekend warriors' comes into play. For some, weekends are the only time that people have to exercise and/or recreate in the outdoors. This pattern does not align with Dr Attia's ideology, but doing something on the weekends is better than doing nothing at all. What I do think readers can benefit and take away from this section of the book is to, perhaps, incorporate different exercises into their daily/weekly regimen that they may not have thought of. This is key! For myself, I have now incorporated new things into my exercise regimen because I have a better understanding of how they can have a long-term impact. FINAL THOUGHTS: This is not a concrete book of science. It is a book that discusses some scientific information combined with Dr. Attia's life-experiences. I think it is a well-rounded book because of this. Take whatever information you found useful and run with it! Be as active as you possibly can each day/week, keep your body trim, and feed it with good nutrition. For us "Commoners," that is the best we can do.

It was very engaging for me, the first chapters recalled a favorite quip of a colleague, “I’m in violent agreement with you!”. The personal examples were very illuminating, especially one’s not fitting into the standard narrative for treatments and outcomes. Technically this review is for the spiral bound version; I have bought the kindle version also for review and markup, and copies of the standard hardcover given as gifts to physicians and others. So, I’m an enthusiast. But I also want to point out that like many other advocates of new approaches for improved health under the span of the longevity curve, there is a certain element of Rudyard Kiplings “The Blind men and the elephant” which I feel compelled to comment on, as to me it seems there is missing information based to some extent on the combination of who and how modern medical training is implemented, and in some cases a clear lack of knowledge of detailed knowledge of nutritional fundamentals and their relationship to specific chronic diseases. An interesting personal example Dr. Attia relates is with regards to the wife of a very close friend of his, whose wife had been diagnosed with breast cancer that had spread to the lymph nodes, and had enrolled in a trial site for a special investigative treatment project. Every other patient enrolled in this project died, except her… why? Well, she alone had investigated and read everything she could find about the impact of nutrition on cancer, and put together a diet which optimized the nutrition for her body, not for her cancer, and which kept insulin and blood glucose levels low, and eliminated added sugar and all refined carbohydrates. This success on her part was noted, but not really followed up on and not investigated by the authors of the study, and the follow up report hardly discussed metabolism and metabolic therapies at all. Now, to me, that is rather curious, and perhaps indicative of a lack of historical perspective- for example, possibly no knowledge of the research conducted by Dr. Ewan MacGregor in England in the 1980s which focused on nutrition and orthomolecular vitamin support for the body, and against the cancer, and on breast cancer patients deemed “untreatable” greatly extended the duration of life and quality of life compared with the control group. For me, this is a personal point, given my wife’s older daughter’s recurrence of hormone positive breast cancer after 4 years at simultaneous stage IV since the last MRI check six month earlier. On a more personal note, after having an unusual form of heart attack (presenting in the manner it most often does for women) on a return flight from business, and discovering at a pre surgical EKG that I now had an inverted spike on my T-wave, indicative of a right bundle branch block, I started investigating the likely prognosis as well as metabolic contributors. Dr. Attia notes how difficult it can be to ascertain early stage development of arterial plaque well before an actual cardiac event, but seems unfamiliar with some past research. Humans are primates, and like other primates, must ingest all the vitamin C needed, because unlike most other animals, we don’t make it in our liver. Hmmm, how much vitamin C should we ingest? Animal studies show how the typical range of generation is on the order of 20-40 mg/kg of body mass- though some, like goats, are much higher, and the presence of any pathologies, like an infection or injury to heal, raises it substantially. Yet, the official RDA amounts to about 1.2 mg/kg of vitamin C, just enough to prevent frank scurvy. When I questioned my wife’s cardiologist on this topic, or my own primary care doctor, they had no idea what was normal and necessary to support healthy bodily function for healing and fighting infectious disease. There was a paper addressing this topic, specifically for the prevention of heart disease, published by Dr. Matthias Rath and Linus Pauling back in 1992, using vitamin C and two amino acids. I’ve been using it for about 20 years. I gift our doctors interesting books- most recently Dr. Attia’s book last October, along with one describing the therapy for prevention of heart disease. . I think my doctor took that as a challenge, as he then ordered an Electrocardiogram with Iodine flow, the gold standard for evaluating basic heart issues related to blood vessel function and overall heart behavior. This is not ordered normally, unless there are functional symptoms in the patient like angina, shortness of breath, other symptomatic issues pointing to some degree of heart failure- issues I do not have. Results came back as I expected, but probably not as he expected for someone in their mid seventies. No arteriosclerosis or evidence of plaque or calcification, all chambers of normal size and function. All of my friends of my age have significant issues, and have stents, blood thinners, and in one case a pacemaker. Bottom line? Buy and read this excellent book, but don’t stop there- expand your knowledge so that you can be the advocate and practitioner for your own continued good health and that of loved ones.

Outlive: The Science and Art of Longevity is a really good book with an incredible amount of valuable information about health, aging, and longevity. I truly appreciate the depth and science behind it—you’ll learn a lot, and it definitely makes you think differently about long-term health. That said, this is not an easy read. It’s dense and very detailed. I even ordered the CliffNotes/summary to help, and honestly, those weren’t an easy read either. This is a book you need to take slowly and digest in pieces. I do recommend it because the information is excellent and eye-opening—just go into it knowing it takes focus and effort. Worth reading, but be prepared.

In Outlive, Peter Attia presents, without hyperbole, an ambitious yet actionable and evidence-informed strategy to dramatically minimize the risk and burden of the chronic diseases that rob us of vitality as we age and ultimately end our lives. Amidst a vast wasteland of books on health, is this one any different? In a word, very. There are two reasons why. First, Attia’s knowledge base is unparalleled. He graciously attributes this to the all-star line-up of experts in cardiology, lipidology, oncology, neurology, psychiatry, endocrinology, biochemistry, nutrition, exercise physiology, etc. who’ve tutored him over the years, and whose expertise is shared generously on his podcast. The depth of his dives with them and his fluency in each specialty are extraordinary. But Peter’s superpower is not simply the intellect to master the nuances of each niche. It’s that, plus the broad perspective to integrate that knowledge into the grand landscape of human health—to see the forest and the trees. It’s a rare alchemy of assets: the breadth of a primary care physician, the depth of a specialist, the granularity of a laboratory scientist, and the heart of a teacher. That is Peter Attia. Second, Outlive stands uniquely poised to do what others have not: transform healthcare. Not simply because his tactics for longevity are cutting edge and informed by the best science available—and they surely are. And not because those tactics won’t evolve as science progresses—for they surely will. No, Attia’s contribution will endure because his strategy is as timeless as it is revolutionary, and it will remain relevant as long as our objective is the extension of human health and lifespan. Medicine 2.0, as he calls it, is the conventional paradigm, the model I learned in medical school. It served us well when infection was our greatest threat, and still does against acute disease or trauma. But today’s top killers are chronic diseases that exploit the one factor current treatment paradigms neglect: time. Heart disease, cancer, dementia, and metabolic disease mock our feeble 9th inning attempts to medicate them away after an eight-inning head start. To put more than a modest dent in their devastation, Attia argues, we must attack from the other end of the timeline, long before these diseases manifest clinically—before the game even begins. This is Medicine 3.0, and it truly is revolutionary. To be clear, Outlive is not another sensational anti-establishment exposé on the failures, lies, and corruption of mainstream medicine. Rather, it graciously acknowledges Medicine 2.0’s success. But, noting its inadequacy against modern diseases, Attia has cleverly “back-casted” and reverse engineered a new strategy forward—and it is brilliant. If we do achieve significant improvement in human health and longevity, absent some miraculous sci-fi discovery, it will be because we followed the strategies presented in Outlive, even if its tactics are refined over time. This book is important. It’s carefully compiled, meticulously fact-checked, thoughtfully organized, and masterfully presented. It’s cutting edge, yet careful in its claims. Passionate, yet explicitly non-dogmatic. Deeply personal, yet rigorously clinical. Speaking of personal, I must comment on the final chapter. Those of us who consider Peter superhuman may be surprised—and relieved, perhaps—to learn that he battles the same insecurities and weakness that beset the rest of us mortals. His candid account of recent struggles with emotional health is as inspiring as it is moving and provides precious layers of meaning and perspective to all that comes before it. If chapters 1 through 16 are the how, chapter 17 is the why. Whether serendipitous or providential, that his crisis manifested in time to consummate the finished project is fortuitous for us, as it changes the entire work in a compelling—and beautiful—way. Since discovering The Drive in 2018, I’ve considered Attia’s podcast the most comprehensive and reliable resource for all things health and longevity. It changed the way I live, and how I practice medicine. Going forward, Outlive will be my primary textbook. Thank you, Peter.

I read Outlive and then listened to the audiobook, and I found it packed with thoughtful, science-backed information about healthspan, longevity, and how to think differently about aging. Dr. Attia presents complex medical concepts in a way that’s approachable but never dumbed down. The sections on metabolic health, exercise, emotional well-being, and personalized medicine were especially valuable. It's not a "quick fix" or trendy wellness book—it’s more of a long-term framework for making smarter decisions about health. If you're looking for more, the subscriber-only podcast content is an amazing companion. The deep dives on topics like fasting, lab testing, and exercise physiology expand on the book and help connect the dots. Pros: Clear, science-based guidance Practical frameworks you can actually apply Narration on Audible is excellent Companion podcast content adds real depth Cons: You’ll want the concierge health service after you’ve finished it, but alas cannot afford it! Bottom line: Whether you're just starting to think about longevity or you’re deep into health optimization, Outlive is a well-researched, thoughtful guide that holds up to multiple reads (or listens). Highly recommend both the book and the audiobook!

This book is fantastic. Anyone with an interest in learning how to live a healthier, longer life should buy a copy and study it. That’s what I did. After reading it I ordered a second copy and gave it to my primary care physician because I wanted him to know where I was coming from in terms of being a patient and how I want to live my life. Outlive, is a goldmine of healthcare information. I became aware of Peter Attia about five years ago when a friend suggested I listen to an episode of The Drive. For those who are unfamiliar with Attia, this is his weekly podcast. After listening to it I was hooked and immediately became a subscriber and began listening to archived episodes. I spend a lot of time commuting and to date I’ve probably listened to two-thirds of the interviews and the Ask Me Anything discussions. So when I received the notification that his long-awaited book was finally going to be published I preordered my copy. Once it arrived I got out my pen and highlighter and went to work. I believe I can speak from a position of strength when it comes to commenting on this book. I have walked a similar career path. Like Attia, I’ve been trained in basic science research. I earned a PhD under the mentorship of the great Philip Gollnick, PhD, one of the pioneers of modern exercise science. Similar to Attia, I’ve also been trained in medicine and surgery having completed a medical degree and a surgical residency in orthopedics. Attia is a voice in the wilderness shouting the message of Medicine 3.0, a philosophy based on the guiding principles of preventing the onset of chronic disease. He defines the time from birth to the onset of chronic disease as healthspan. The period of time from birth to death is lifespan. The goal of Medicine 3.0 is to increase healthspan so that it encompasses most, if not all, of lifespan. Medicine 3.0 is proactive whereas Medicine 2.0 (where we are now) is reactive. Medicine 2.0 begins treatment of an illness or disease only after it has been diagnosed, after the damage has begun. Medicine 3.0 is based on preventing, or delaying, the onset of disease or illness so that treatment is avoided. How does Attia recommend we go about maximizing healthspan? He believes this can be accomplished by focusing on doing everything possible to prevent what he terms, the four horsemen: metabolic syndrome (type-2 diabetes), cardiovascular disease, cancer, and neurodegenerative diseases (Alzheimer’s, Parkinson’s, etc.). The book is broken up into sections devoted to each of the horsemen. A final section, where Attia opens up and presents some of his personal journey, is devoted to emotional health. The importance of this section cannot be overstated. Emotional health probably should be considered the fifth horseman (but that would wreck the Four Horsemen of the Apocalypse metaphor). He focuses on ways to prevent cognitive decline, the slowing of our mental processing speed as we age. An emphasis is placed on exercise, aerobic and strength training, as an intervention. Exercise increases cardiovascular and respiratory function and decreases the loss of muscle size and strength. It also increases bone density and deceases osteopenia and osteoporosis. In short, regular exercise reduces frailty. As frailty increases our risk of mortality increases. He makes the claim that the single most important thing anyone can do to improve healthspan is to exercise on a regular basis. It is better than any drug you can take (with the possible exception of rapamycin), nutrient, or diet. Attia and his co-author Bill Gifford tone down the technical aspects of some of the medical topics to make it more accessible to a lay audience. However, this does not detract from the quality of the information. If anything it makes the book better by reaching a broader audience. If a reader wants more detailed information on a topic they can easily obtain it by culling through the archives of The Drive where in depth interviews with preeminent physicians and scientists are available. He employs a team of highly skilled analysts that are constantly reading the latest scientific publications looking for high-quality research pertinent to his mission. He is at the forefront of Medicine 3.0. If you want to learn more about your physical and emotional health with the goal of living better and longer then read Outlive, the Science & Art of Longevity.

Great book for over all ideas on living a longer & healthier life. And very informative on many medical issues that pertain to the aging process!

Allowing common sense (with supplementary googling of issues that are mentioned) to be your guide, there is value in the book. The author seems to endorse some views on exercise that I would not take literally. If, for instance, you take his exercise endorsements literally, you are apt to damage your joints. As an example of a bizarre exercise recommendation, the mentions that, when rucking, your rucksack contents should ideally be half of your own body weight. Orthopedic websites say that it should not exceed 10% of your body weight. Again, good luck to your joints if you follow this advice literally. Sometimes there is a sense that the author is rather too "wound up": He recommends taking a camera and tripod along with you to the gym and filming yourself as you exercise in order to improve. He recommends doing this EVERY DAY. Yes, you actually lug a tripod and camera with you to a gym, every day of your life and film yourself to improve your manner of exercising. Unless you are a medical student, you can safely skip over the numerous paragraphs of detailed physiological process that he describes. Some of the terms that he uses again much later in the book are not defined, as if he assumes the reader has memorized their definitions early on. His intensity evidently carries him away with this arcane information. The last "confessional" chapter adds nothing to the book and to the reader who has followed him along to that point, seems somehow embarrassing. Such a chapter really wasn't necessary and has little to do with the thesis of the book. Here's what I take from the book: The number one influencer on longevity is exercise. But if you exercise while defying orthopedic injuries (tendons, joints, etc.) you won't be able to exercise at all. If you're older, the author endorses the view that your protein intake should be approximately double that of the traditional recommendations. (This "double" recommendation occurs on various medical websites as well, if I remember). That's apparently because older people "process" protein less efficiently and because protein helps retain/build lean muscle mass. That, at least, is what I remember reading. BUT there are a number of studies that indicate that higher protein intake of animal-dairy point to a higher incidence of heart disease. On the other hand, plant protein (I don't know the rate of consumption) seems to be associated with a lower rate of CVD. And high protein intake is not advisable if you have kidney disease. And there is no evidence that higher protein intake will help repair tendons, ligaments/joints. Nor will collagen-chondroitin, it seems, although they may confer an anti-inflammatory effect. Joint disintegration is the normal part of aging, as I understand. The book is worth buying because in general, it has good content and the author is earnest in examining everything that does/probably does or doesn't/probably doesn't promote good health and longevity. In addition, his podcast is worth subscribing to. I've found discussions of issues I've always wondered about and have expanded my knowledge of other important areas of health.

The book is great and very well written. After I finished, I started implementing many of the ideas that the authors writes about. It's more than one year now that I'm following several daily routines that have been sparked from the ideas contained in this book, and I feel that my health is improved greatly. Longevity is still a quest and not an already full known science, that's why the author has his own ideas and preferences that may be different from those of others scientists; but if you read different books and follow other longevity experts and doctors, you will find many of the same concepts expressed in this book, and for me this was good consistency check. One of my favorite books of all time, I cannot recommend it enough.

To the point overviews of key domains that make a difference in well being, feeling and longevity. Explained in an easy to read narrative with mature scientific detail and back up. Well balanced and truly believable. I read many books on the subject. This is by far the best.

This is an immensely well researched book on all the variables to maintain your health as you age. Peter Attia explains in a layman manner for us non-medical language to make it easier to grasp. He’s done his research on exercise, nutrition, sleep, mental health, and medicine / supplements with global experts in those fields. I have learnt a lot and implemented many things from this book, which have resulted in better blood biomarkers, sleep, and overall energy / performance levels. This book will really change your life if you’re serious about your health. Buy a copy for yourself and your loved ones.

En tant que médecin, j’ai trouvé “Outlive: The Science and Art of Longevity” particulièrement pertinent. Ce livre offre un mélange parfait de recherche scientifique et de conseils pratiques, fournissant des stratégies éprouvées pour un mode de vie sain. Il rend la science de la longévité accessible et applicable, enrichissant à la fois ma pratique professionnelle et mon bien-être personnel. Hautement recommandé pour les professionnels de santé et toute personne intéressée par une vie plus longue et plus saine.

It is one of those books with the potential to change your lifestyle, to achieve longevity with quality of life. Maybe we already know some things we should do or avoid to escape the diseases that cause the most deaths. However, the author exposes, with the necessary clarity for the layman, which does not make it a useful book for specialists as well, the fundamentals of each attitude. I really liked the part that addresses physical exercises, emphasizing strength, aiming to improve what we will need in old age. Also highlight the importance of sleep and mental health and eating protein. Pleasant reading. Very well written. I recommend it for all people.