Outlive: The Science and Art of Longevity

Written by Peter Attia and Bill Gifford

Narrated by Peter Attia

#1 NEW YORK TIMES BESTSELLER • A groundbreaking manifesto on living better and longer that challenges the conventional medical thinking on aging and reveals a new approach to preventing chronic disease and extending long-term health, from a visionary physician and leading longevity expert
 
“One of the most important books you’ll ever read.”—Steven D. Levitt, New York Times bestselling author of Freakonomics
 
Wouldn’t you like to live longer? And better? In this operating manual for longevity, Dr. Peter Attia draws on the latest science to deliver innovative nutritional interventions, techniques for optimizing exercise and sleep, and tools for addressing emotional and mental health.
 
For all its successes, mainstream medicine has failed to make much progress against the diseases of aging that kill most people: heart disease, cancer, Alzheimer’s disease, and type 2 diabetes. Too often, it intervenes with treatments too late to help, prolonging lifespan at the expense of healthspan, or quality of life. Dr. Attia believes we must replace this outdated framework with a personalized, proactive strategy for longevity, one where we take action now, rather than waiting.
 
This is not “biohacking,” it’s science: a well-founded strategic and tactical approach to extending lifespan while also improving our physical, cognitive, and emotional health. Dr. Attia’s aim is less to tell you what to do and more to help you learn how to think about long-term health, in order to create the best plan for you as an individual. In Outlive, readers will discover:
 
• Why the cholesterol test at your annual physical doesn’t tell you enough about your actual risk of dying from a heart attack.
• That you may already suffer from an extremely common yet underdiagnosed liver condition that could be a precursor to the chronic diseases of aging.
• Why exercise is the most potent pro-longevity “drug”—and how to begin training for the “Centenarian Decathlon.”
• Why you should forget about diets, and focus instead on nutritional biochemistry, using technology and data to personalize your eating pattern.
• Why striving for physical health and longevity, but ignoring emotional health, could be the ultimate curse of all.
 
Aging and longevity are far more malleable than we think; our fate is not set in stone. With the right roadmap, you can plot a different path for your life, one that lets you outlive your genes to make each decade better than the one before.

*Includes a downloadable PDF of charts, graphs, and illustrations from the book, along with other valuable resources

• Language: English
• Publisher: Penguin Random House Audio Publishing Group
• Release date: Mar 28, 2023
• ISBN: 9780593664445

Reviews for Outlive

[Brandon Arrington · Rating: 3 out of 5 stars]

Some great scientific insights as well as practical advice to improve the health span of your life. One of my only critiques is his blind allegiance to unguided evolution, which is really surprising for someone who puts so much stock in studying the incredibly advanced engineering systems designed within our body.

[verber_1 · Rating: 5 out of 5 stars]

Distills much of what I have learned in the last several years as I have tried to understand what practices would lead to a good health span. This isn’t surprising since I have been greatly inspired by Attia’s The Drive podcast. Attia has moved me to be more proactive with my health, especially when it comes to early detection / testing. I have been inspired by his idea of the centenarian decathlon which now informs my fitness goals, and am doing more training in zone 2.

[sean.farrell-735111 · Rating: 4 out of 5 stars]

In this comprehensive and sprawling work, Peter Attia reviews the latest in health science and longevity through the lens of his personal experience. Here, readers will find a prescription for health and longevity backed by the latest science.

[okies-600424 · Rating: 4 out of 5 stars]

The thing that surprised me most about this book is how well it is read by the author - that was a pleasant surprise, as so often I wish the author did not read their own work.

Outlive is a fascinating, informative examination of how to live to maximise good health with longevity being the goal. It's quite detailed medically and yet I was often amazed how Attia managed to explain the specialised knowledge so basically.

I have to agree with the consensus below that Outlive has motivated me to live better, physiologically - and describing exercise, however little, as the most potent ingredient in longevity, jumped out at me too.

[zomgpwnbbq · Rating: 3 out of 5 stars]

Good information but the author is just such a douche bag. I let Mckinsey, bro commentary and basic bitch references go. Unironically quoting David Brooks is where I found my line.

[dilip1kumar-572329 · Rating: 4 out of 5 stars]

An absorbing and hard-hitting work, the author lists the shortcomings of health care as practiced currently (what he calls medicine 2.0), where interventions are made when usually symptoms are visible and the disease or condition has already advanced beyond retrieval, and then goes on to describe the alternative approach, medicine 3.0, wherein preventive action is taken from a young age and good life style choices like a good diet, exercise, and supplements. The book covers not only Type 2 diabetes, which benefits from calorie control and exercise, but also others of the 'four horsemen': heart disease, cancer, Alzheimer's and other neurodegenerative diseases.Being a younger person, everything he says may not appeal or apply to older people (who are probably the majority of readers attracted to this topic), and his personality is apparently fairly aggressive and even obsessive in the intensity with which he approaches things like exercise, so the less robust reader may be well advised to take the prescriptions as only suggestions.

[nmarun-1 · Rating: 4 out of 5 stars]

"Exercise is by far the most potent longevity drug." - I can't agree more with this. So if you're someone who wants to get back on the health track, this book gives some good pointers. If you're already on a routine however, you'll get a confidence boost that you're on the right track.

Author does provide details about cholesterol consequences, glucose and insulin interaction, chemotherapy impact and alcohol effects. I did find a good number of those interesting. The book also advocates to treat sleep as an investment that'll reap benefits even in the long run.

"Focus not only on 'resume virtues' but also on 'eulogy virtues'." - quite thought provoking.

[nelsonalva · Rating: 5 out of 5 stars]

"Family pathology rolls from generation to generation like a fire in the woods taking down everything in its path until one person, in one generation, has the courage to turn and face the flames. That person brings peace to his ancestors and spares the children that follow."

It is the best book on health and wellness I have read, difficult to review due to its extensive subject matter. Exercise, diet, sleep, mental health; these are aspects we do not give the necessary attention to. Either because we do not consider them important enough or because we believe we are doing well. In Outlive, Peter Attia makes you realize the true importance of each of these aspects but also teaches you specific methods (most of the time detailed) that allow you to find balance in each of them. It is a book about longevity for all ages that teaches you how to lay the foundation for a long life but whose even more important lesson is that it is of no use to live a long time if your existence is miserable.

A book that could be three different books. To read and reread, to gift and educate. (Translated from Spanish)

[dooney-2 · Rating: 4 out of 5 stars]

Easy to read and a good introduction to the subject. Better than 3 1/2 stars, but not quite up to 4. That Dr. Attia includes his personal story is important and elevates the book overall. For more detail, one should listen to Dr. Attia's podcast, which I find more beneficial overall. Still, I have no regrets over reading this. The book serves an important service in bringing together scientific ideas about longevity and the idea of what it means to live a good life.

[tytania-2 · Rating: 4 out of 5 stars]

Dr. Peter Attia is an oncology surgeon, a data guy, and an extreme athlete with trauma in his past. That all plays into his approach to longevity: lots and lots of screening, monitoring, and "training" for old age as if you were training for a sporting event.

The chapters on exercise and nutrition were fantastic. My favorite quote: "Cardio or weights? Low-carb or plant-based? Olive oil or beef tallow? I don't know. Must we really take sides?" This is NOT a book telling you the One True Secret to long life; it all depends. Some certainties though: Exercise is the best medicine. If your metabolism is not functioning well, make it a priority to get that under control. Screen for everything, screen early, screen often.

Then come chapters on sleep and emotional health. I had really been looking forward to the chapter on sleep, as it's kind of a bugaboo for me. I had grown to feel I could trust his opinions, and I wanted know what he thought about better sleep through pharmaceuticals. He had stated in an early chapter that he had nothing against using medications in general where appropriate, such as statins; so it felt promising that I wouldn't get some knee-jerk anti-medication attitude.

I started reading the chapter one night shortly before bedtime, and didn't get up to any of the advice; just lots of emphatic "Sleep is crucial! Quality, uninterrupted sleep! It's a must! You risk Alzheimer's if you don't get it!" Nice scary nightmares to put a random chronic insomniac to sleep with.

The next night I delved in further. Alas, he's anti-Ambien. Ambien sleep isn't REAL sleep and yadda yadda yadda. However to give him credit, he had positive things to say about trazodone.

The whole sleep chapter was disappointing and did not feel nearly as data-driven as the previous chapters. It just felt like he got it in his head that sleep was very important to health and decided it warranted a whole chapter on a par with exercise & nutrition, but he didn't want to put any work into it.

For the emotional health chapter, I commend him for telling so much of his personal story. This chapter was driven by his own experience and that was OK.

I guess the real overarching theme of the book, though, was that everyone is different, and you must find what works for YOU. Your exercise ability, your own metabolic reactions - these are going to determine the "right" exercise and diet for you. He could have been a LITTLE more understanding about chronic insomnia, though, and respected that different things work (and don't work) for different people. As I said, a bit of a bugaboo for me…

[jennifer_long-1 · Rating: 5 out of 5 stars]

Lots of valuable research presented in a clear, relatable manner. I appreciated the whole body and mind approach to longevity and making it a life worth living. I went down many rabbit holes while reading this book. I appreciate that there is a lot of extra media supplemental material on his website if you want it. His differentiation between Medicine 2.0 (reactionary at the manifestation of symptoms) and Medicine 3.0 (early detection and prevention) is a key mind shift for everyone. That is the focus of the first section followed by research about The Four Horseman (cancer, heart disease, metabolic issues like diabetes, and neurodegenerative diseases like Alzheimer's). The final part goes into what you can do for prevention. The book's style gives you the TL;DR version (like exercise is key!) and then dives into details if you want them (the need for stabilization and proper form). I'm glad to have found this book. I imagine it will add many years to many lives.

[brewbooks · Rating: 5 out of 5 stars]

Let me begin my review in the middle of Outlive. The author asks us to list the ten tasks we want to do for the rest of our lives. He calls this list the centenarian decathlon. Here’s the top of the list for me: hike up to Third Burroughs Mountain. It’s 9 miles (14 km) in Mount Rainier National Park with 2500 feet (760 m.) of elevation gain. Why? I’m a hiker, and this is my favorite hike worldwide.

I’ve spent a fair amount of time thinking about how to keep hiking as I get older. I turned 65 in 2022; I would like to keep exploring mountains as long as possible, this is just the book to help me achieve my goal. Let me explain why.

First, Attia starts with the concept of healthspan – how well you live. There’s a tight coupling between healthspan and lifespan. As we age, we have left less of each. One difference is that lifespan is a discrete quantity; one day, you are alive, and the next, you are not. In contrast, our healthspan gradually diminishes over time. The author details three vectors (components) of healthspan: physical, cognitive, and emotional. The good news is that we can usually improve these components and our overall healthspan. How we do so is the core of the book.

The book’s first part outlines our current situation and a target goal. The most important lesson I learned: “Tactics without strategy is the noise before defeat.” a quote from Sun Tzu, an ancient Chinese military strategist. Been there, done that, got the T-shirt. So, how can I do better? The author has a great framework: first, objectives, then strategy, and finally, tactics. The author trained as an engineer, became a physician, and has worked in business consulting; his background shows throughout the book. I touched on objectives in the discussion of the centenarian decathlon; how about strategy?

The second part of Outlive is the science that can help you develop a strategy. There is a chapter on the science of centenarians; I think of this as a boundary condition. What are the factors that helped get someone to their 100th birthday? (I have a hiking friend who still gets out on walks at 101, I want to follow in her footsteps.) Next is a chapter on the details of how nutrition affects longevity. The last four chapters cover the science of how most of us die: metabolic disorders such as diabetes, heart disease, cancer, and neurodegenerative diseases. Understanding these problems will help you develop tactics to mitigate some issues. There are no magic bullets in these chapters; instead, it’s a well-researched survey of what we know as of 2022. Now that we know objectives and strategies, what tactics can we employ?

The final part of Outlive lays out four tactics:

Exercise (cardio, strength, and stability)
Nutrition
Sleep
Emotional health.
At 260 pages, this is the longest part of the book. It was detailed and beneficial to me. Rather than outline each section, let me list some tactics I am adding to my strategy:

Work on stability, specifically starting with a yoga class.
Use a continuous glucose monitor for a few months to optimize my diet.
Ensure I am getting enough protein intake of lysine, leucine, and methionine.
The last chapter on emotional health was the most impactful in the book. Attia opens up to the reader about his emotional health through the lens of a patient rather than a physician. It touched me deeply; I had some trauma in my teen years when my mom died. Fifty years later, I realized I should address some of these issues rather than wall them off.

Outlive is a book I will read several times. The book is challenging; I spent four weeks reading the book.

I made a ton of margin notes and back-of-the-book scrawling. There’s a lot to digest, and there are many references. For example, I want to read the paper Hallmarks of Aging by Carlos López-Otín and colleagues. This book catalyzed some great conversations with my friend Bill about healthspan. I will recommend Outlive to anyone interested in taking action to improve their healthspan.

One closing thought; there’s a missing chapter in the book. I believe social interaction and engagement can improve healthspan’s cognitive and emotional components. My experience is that forty years of marriage have improved my emotional health. I decided to ask ChatGPT: What studies have shown that social interaction and engagement can improve cognitive function and reduce the risk of cognitive decline and dementia in older adults? Here’s the answer:

“There have been several studies that have shown a positive correlation between social interaction and cognitive function in older adults. For example:

The Rush Memory and Aging Project: This study found that older adults who had higher levels of social activity experienced a slower rate of cognitive decline than those who were less socially active.

The MacArthur Study of Successful Aging: This study found that older adults who were more socially engaged were less likely to experience declines in cognitive function over time.

The Women’s Health Initiative Memory Study: This study found that women who reported higher levels of social engagement had a lower risk of developing cognitive impairment than those who were less socially engaged.

Overall, these studies suggest that social interaction and engagement can play an important role in maintaining cognitive function and reducing the risk of cognitive decline and dementia in older adults.”

[annbury_1 · Rating: 5 out of 5 stars]

This is one of those books that could change your life. I don't know if it will change mine: at 78, I'm a little old to initiate new long behaviours intended to add to my life span. But it may. His message is that exercise, nutrition, sleep, and emotional health can profoundly affect your lifespan, and even more important, your healthspan -- the number of years you remain independent and can do things you love. This is bolstered by extensive description and analysis of the diseases of old age that kill most of us, and by extensive explanation and description of what you can do about it. His prescriptions for action are daunting, demanding lots of time and lots of discipline. But I think they will actually change my behavior. One reason that this book is so powerful is that it is so personal, which is one reason why it is such a fascinating read. I can't recommend it too highly.