Review of Outlive

For many people…the last ten years of life are not a particularly happy time. … Their cognitive and physical abilities may be weakening or gone. Generally, they are unable to participate in the activities they once loved… I call this the Marginal Decade, and for many, if not most, it is a period of diminishment and limitation.¹

I didn’t know whether I was going to be interested in this book, because I’ve never been especially interested in maximizing my longevity. Sure, if I could just pop a pill to live an extra decade, I’d do it; but it’s not something I care enough about to put in a bunch of effort or drastically change my lifestyle. I’m just not that scared of death.

I’m pretty scared of suffering, though, so the goal of avoiding a decade of misery resonates with me much more effectively. And according to Attia, the same things that tend to increase our lifespan also tend to increase the proportion of our lifespan in which we are healthy.

Attia calls the major enemies of longevity “the Four Horsemen: heart disease, cancer, neurodegenerative disease, [and] type 2 diabetes and related metabolic dysfunction.”² The main argument of the book is that the best way to avoid or mitigate these is to take action decades before we’re actually diagnosed with them.

I have no hope of summarizing the book effectively; much of the value and motivational effect lie in the details. But here are a few points that stood out to me:

• Zone 2 cardio, VO2 max training, and strength training are all crucial; and because our VO2 max and muscle mass naturally decline as we age, we should seek to build them to levels much higher than we presently need so that they will be at levels adequate for daily life when we are old
• There are several metrics, monitoring tools (like continuous glucose monitoring), and tests (like determining your APOE variant) that seem worth trying proactively even if you aren’t exhibiting any health issues
• We should eat much more protein than is commonly recommended, and it must be “spread out over the day”³
• Metabolic health is tied into basically everything

There’s a vivid passage regarding that last point:

It’s almost as if you have a bathtub, and you’re filling it up from the faucet. If you keep the faucet running even after the tub is full and the drain is closed (i.e., you’re sedentary), water begins spilling over the rim of the tub, flowing into places where it’s not wanted or needed, like onto the bathroom floor, into the heating vents or down the stairs. It’s the same with excess fat. As more calories flood into your subcutaneous fat tissue, it eventually reaches capacity and the surplus begins spilling over into other areas of your body: into your blood, as excess triglycerides; into your liver, contributing to NAFLD; into your muscle tissue, contributing directly to insulin resistance in the muscle…; and even around your heart and your pancreas…⁴