Summary: Outlive: The Science and Art of Longevity by Bill Gifford and Peter Attia

• The book is a guide to living longer and better, based on scientific research and personal experience of a longevity expert.
• The book covers the main diseases of aging, the factors that influence them, and the strategies to prevent and reverse them.
• The book is informative, engaging, and empowering, and encourages readers to take charge of their own health and pursue their goals and passions.

Outlive (2023) is a comprehensive guide to living a longer, healthier, and more fulfilling life. Drawing on cutting-edge science and practical advice, it empowers you to optimize your exercise, nutrition, sleep, and emotional health for maximum longevity.

Introduction: Unlock the secrets to living a longer and better life.

Our modern world has brought us a host of deadly diseases – cancer, heart disease, and type 2 diabetes are just a few. And even though we now have a better lifestyle than our ancestors, some things about our world are causing our health to suffer.

The main issue is that our environment has changed a lot in the last couple of centuries but our genes are still the same. Take fructose, for example. It used to be our friend when it came in fruit and honey, but now it’s everywhere in our food, causing us to store more fat than we need. And it’s not just modern food that’s not great for our health – how much we move, our sleep habits, and even the effect of social media on our emotions are having a major toll. So we need to come up with a game plan to live well in this weird new world.

This summary focuses on the four main areas you can concentrate on to improve your health: exercise, nutrition, sleep, and emotional health. Now, you won’t find a one-size-fits-all plan here because everyone’s different. Instead, this summary will help you build a framework to manage these four aspects of your health. There’s not just one specific diet or exercise ideology you should follow, and you should be open to testing and changing tactics as needed. The ultimate goal? To live longer and better, making each decade of your life even better than the one before.

An athlete of life

You’ve probably heard of the many benefits of regular exercise. But did you know how important it is for living a long life? Well, it turns out that even a little bit of exercise can make a huge difference. Not only does exercise strengthen your heart and muscles – it improves circulation and benefits your brain by producing a molecule called BDNF – brain-derived neurotrophic factor – which helps with memory.

All in all, exercise is like this magical potion that can help you live longer, healthier lives, and it’s not even about picking sides between cardio or weights – it’s all about finding exercise habits that work for you individually.

Now, here’s the amazing part – even just a little bit of regular exercise can make a huge difference and actually lengthen your life by several years, delay chronic diseases, and even slow down or reverse cognitive decline. Simply going from zero to 90 minutes a week can lower your risk of dying from any cause by 14 percent!

And of course, being super fit means you’re much less likely to die than if you’re a couch potato. Studies show that the fittest people have the lowest mortality rates. In fact, having a low level of cardiorespiratory fitness is more dangerous than smoking.

You might be thinking, “I’m old, how am I supposed to start lifting weights?” Well, it turns out strength training is really important for everyone, even the elderly and frail. It can improve mobility and physical function, which can help prevent falls and other health problems.

Here’s a fun way to think about staying active as you age: become an athlete of life! Imagine you’re training for a centenarian decathlon, a list of ten physical tasks you want to be able to do when you’re 100 years old. These might be climbing stairs, getting up off the floor, or hiking a trail. This will help you set goals for your fitness journey and keep you motivated.

So, pick your ten events and start training for them. It’s all about being well-rounded and staying active in different ways. That way, you’ll be much more likely to be fit and healthy at 100 years old – and break the stereotype that old age has to be all about decline and misery.

The three dimensions of fitness

So now that you know the importance of a lifelong love of exercise, let’s get into some specifics that you can apply to your training regimen. There are three key dimensions of fitness – aerobic endurance and efficiency, strength, and stability. It’s essential to train in all of these areas to maintain health and strength as you age.

Aerobic endurance and efficiency can be improved by training with zone 2 cardio, a specific intensity level that can be sustained for longer periods. This implies a moderate intensity level, usually requiring 60 to 70 percent of your maximum heart rate. In other words, at this pace, you should still just about be able to hold a conversation but definitely not sing a power ballad.

This type of training promotes using fat as fuel and is important for nonathletes, as it builds endurance and helps prevent chronic diseases. An example of zone 2 training is walking briskly for six to ten miles daily. To start, two 30-minute sessions per week can provide significant benefits. To make zone 2 training more enjoyable, try listening to podcasts or audiobooks during your workouts.

Next up are VO₂ max workouts – these are training sessions designed to increase the maximum amount of oxygen that your body can use during exercise. This sort of exercise typically involves high-intensity interval training, otherwise known as HIIT. What exactly is that? In HIT, you alternate between periods of high-intensity exercise and rest. What’s more, HIT is associated with longevity and functional capacity. To get started, try supplementing zone 2 work with one or two VO₂ max workouts per week, consisting of intervals lasting three to eight minutes at maximum sustainable pace, followed by easy exercise.

It’s important not to forget about strength when it comes to exercise – it’s crucial for protecting against physical frailty and injury in old age. Muscle mass and bone density decline over time, so it’s essential to incorporate heavy resistance training to improve muscle fibers and maintain bone health. Exercises like rucking – hiking with a loaded backpack – or carrying heavy metal weights can help strengthen the body.

Last but not least, grip strength is a vital aspect of overall strength and is also linked to longevity. To improve grip strength, try exercises like farmer’s carries and dead-hanging from a pull-up bar. Also, focus on eccentric strength and pulling motions, as well as hip-hinging movements like single-leg step-ups and split-stance Romanian deadlifts. That might sound like a lot to take in, so definitely learn these exercises from a knowledgeable trainer or use instructional videos as a resource.

By incorporating these training methods and focusing on aerobic endurance, strength, and stability, you can set yourself up for a fulfilling and active life as you age.

Revamping your diet

Now that you have your exercise regimen cut out for you, let’s shift gears and take a look at all things diet. A big problem Americans face these days is what’s known as the Standard American Diet, or SAD. It’s loaded with sugar, refined carbs, and processed oils, which can lead to overeating and poor health. To break free from the SAD trap, you can try caloric restriction, dietary restriction, or time restriction. Remember, each approach has its pros and cons, so choose what fits your lifestyle best.

Caloric restriction is the most flexible option but requires tracking everything you eat and resisting the urge to cheat. Dietary restriction involves cutting specific foods but only works if it leads to a caloric deficit. Time restriction, like intermittent fasting, can backfire if you overeat or don’t get enough protein.

Let’s flip this around for a minute and switch focus to what you should be eating. First up is protein – it’s essential for building and maintaining muscle, especially as we age. Aim for at least one gram of protein per pound of body weight daily, or 2.2 grams per kilo. Spread your protein intake throughout the day, and choose high-quality sources like whey protein isolate over soy protein isolate. Eating enough protein can also help you feel full, so you’ll consume fewer calories overall. Remember, protein helps you feel full and maintain muscle mass, especially as you age. And animal sources of protein are more effective than plant sources, so keep that in mind.

Next up are fats. Not all fats are created equal! We need a mix of saturated, monounsaturated, and polyunsaturated fats, with a focus on omega-3s for heart and brain health. Opt for extra virgin olive oil, avocados, and nuts, while cutting back on butter, lard, and omega-6-rich oils like corn, soybean, and sunflower.

Time-restricted eating, or fasting, can be helpful, but it’s not for everyone. There are short-term eating windows, alternate-day fasting, and longer-term fasting. Intermittent fasting and time-restricted eating are popular weight-loss methods, but their effectiveness and potential downsides are debatable. Fasting triggers physiological and cellular mechanisms like insulin level drops and cellular repair gene activation. Still, prolonged fasting can lead to muscle loss. Having said all that, fasting can work for weight loss, but it must be approached with caution and precision. It’s probably best to consult your doctor before beginning a fasting regimen.

Lastly, let’s talk about adopting what Attia calls a Nutrition 3.0 mindset. It’s all about finding the right balance that works for you. Don’t overthink it – focus on reducing overall energy intake, getting enough protein, and finding the right mix of fats. Also, remember that exercise and spending time outdoors are just as important for your health. Ultimately, there’s no one-size-fits-all approach, so it’s up to you to find your own balance.

The power of sleep

Armed with the essentials for exercise and nutrition, it’s time to delve into the profound impact sleep has on your health and well-being. Attia’s eyes were opened to the significance of sleep for both physical and cognitive health after flirting with death – having gone without sleep for 60 hours, he found himself dozing off at the wheel and narrowly avoiding a serious car accident. This harrowing experience should serve as a powerful reminder for everyone to reevaluate their relationship with sleep and prioritize it as a vital component of a healthy lifestyle.

Anecdotes aside, there are plenty of studies showing the negative effects of lack of sleep – indeed, it’s been linked to an increased risk of things like heart attacks, type 2 diabetes, and even workplace accidents. It’s not just about feeling tired – it’s about your overall health. For example, one study showed that sleeping less than seven hours a night can increase your risk of dying prematurely by 12 percent. The statistics don’t lie – sleep-deprived drivers cause around 20 percent of all car accidents, and sleep deprivation also leads to more workplace accidents and medical errors.

But let’s switch gears and get back to the positives. Studies have shown that we need about seven and a half to eight and a half hours of sleep each night. With good sleep, your physical and cognitive performance can improve, including things like athletic performance and memory consolidation. Also, sleep helps to keep your metabolism in check and reduces the risk of chronic health problems such as metabolic dysfunction, type 2 diabetes, heart disease, and obesity.

Many people search for that magic pill to put them to sleep, but the reality is, many sleep aids out there don’t actually improve sleep quality. In fact, some can even harm your sleep, like Ambien or Valium. So, what can you do to improve your sleep naturally?

First, it’s essential to evaluate your sleep habits. Use sleep trackers or take sleep questionnaires like the Pittsburgh Sleep Quality Index to figure out how you’re doing. Don’t forget, everyone’s different – some of us are morning people, while others are night owls. So, try to work with your natural rhythm.

Now onto some more concrete tips. It’s definitely a good idea to cut down on blue light exposure before bed, maybe by swapping out those LED bulbs for warmer ones. Keep your bedroom cool, around 65 degrees Fahrenheit or 18 degrees Celsius – and make sure your bedroom is as dark as possible. Try to avoid screens an hour before bedtime – that late-night social media scroll isn’t helping.

Be mindful of what you consume, too. Keep caffeine and alcohol in check, as they can mess with your sleep. And finally, don’t forget to manage stress – meditation can be a game-changer for winding down.

Even superstar athletes like LeBron James prioritize sleep for peak performance. He reportedly sleeps about 12 hours a day with a special mattress and pillows! So, take a page out of LeBron’s playbook and create a sleep routine that works for you. Stick to it, and you’ll be on your way to better sleep and improved overall well-being.

Embracing emotional health

You’ve reached the final component of longevity – emotional health. When you think about being healthy, you probably focus on your physical well-being, but your emotional health is just as important, if not more so. After all, what good is living a long life if you’re not happy or fulfilled?

For example, someone struggling with depression might not see the point of getting a cancer screening or monitoring their blood sugar levels. On the other hand, someone who’s physically fit might not realize how emotional issues can impact their overall health. So, if you’re dealing with emotional or mental health struggles, don’t hesitate to seek professional help. It’s crucial to address these issues to maintain good physical health.

Dealing with emotional health can be tricky. Unlike physical health, it’s hard to recognize and diagnose. That’s why you need a proactive and individualized approach. Look out for signs of emotional health issues, seek help early, and commit to daily practices that promote long-term emotional well-being.

There are a number of tools to monitor and maintain emotional equilibrium. Medications, meditation, and psychedelics can help, but they’re not quick fixes. They should be seen as part of real psychotherapy, like dialectical behavior therapy or DBT. This is a proven method that helps regulate emotions and tolerate emotional stressors. DBT is built on four pillars: emotional regulation, distress tolerance, interpersonal effectiveness, and self-management, all linked to mindfulness. It’s important to remember, though, that change takes time and effort. Practicing daily and working through issues in therapy is key to achieving true recovery.

Another thing to consider is self-reflection. Many people struggle with self-hatred and the need for external validation. It’s essential to work on your relationship with yourself and recognize how your past experiences shape your present behavior. Take childhood trauma, for instance. It can show up in various forms, like addiction, codependency, and attachment disorders. It’s important to address such issues, but this can be a real challenge. So what can you do? Look out for signs of emotional health issues, seek help early, and commit to daily self-reflection or meditation. And remember, healing takes time, so be patient with yourself during the process.

Lastly, let’s go back to longevity. To stay “young” and healthy, focus on looking toward the future and pursuing your dreams and aspirations. Find activities that bring you joy and fulfillment, like spending time in nature, practicing mindfulness, or journaling.

Remember, emotional health is just as important as physical health. Take care of yourself and don’t be afraid to seek help if needed. With time, patience, and the right tools, you can make progress toward a happier and healthier life.

Insights from Outlive by Peter Attia, MD

In the following book summary, you’ll learn how to live into your 100s with your health intact.

“Longevity has two components. The first is how long you live, your chronological lifespan, but the second and equally important part is how well you live—the quality of your years (healthspan).” – Peter Attia, MD

To live well into your tenth decade, you must avoid the four aging diseases: cancer, heart disease, Alzheimer’s disease, and metabolic disease. Insulin resistance is the lead domino for all four aging diseases.

“Studies have found that 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).” – Peter Attia

You can avoid insulin resistance and prolong your life by committing to a longevity training program that includes the following:

1. Zone 2 training
2. VO2 max training
3. Strength training (with a focus on developing grip strength and hip-hinging exercises).

“More than any other tactical domain we discuss in this book, exercise has the greatest power to determine how you will live out the rest of your life…Going from zero weekly exercise to just ninety minutes per week can reduce your risk of dying from all causes by 14 percent. It’s very hard to find a drug that can do that.” – Peter Attia

Zone 2 training for longevity

Zone 2 training involves any aerobic exercise on a stationary bike, treadmill, rower, or outside for 45 minutes, four days a week at a pace you can sustain while barely being able to have a conversation with someone. Zone 2 training time is a good time to watch your favorite TV show. A zone 2 workout should feel “almost hard” without any “muscle burn” (excess lactic acid in the muscles). As you do zone 2 training, you are training the mitochondria in your muscle cells (the cell’s power plants) to use fat as fuel.

VO2 max training for longevity

VO2 max training involves doing any aerobic exercise close to your all-out maximum for four minutes, go easy for four minutes, and repeat four times. You will feel like you’re dying during a VO2 max training session but it’s worth it! People increase their VO2 max from below average in your age group, to above average, experience a 50% reduction in all-cause mortality. Attia says, “VO2 max is perhaps the single most powerful marker for longevity.” Take an annual VO2 max test with a medical professional (search “VO2 max tests near me” on Google) and strive to get in the top 5% of your age group.

Strength training for longevity

Strength training vastly improves metabolic health because it creates more lean muscle mass that soaks up excess glucose like a sponge. A 10-year study of 4,500 subjects over fifty found that those with low muscle mass and strength were three times more likely to die early. Set a strength training target to lift heavy weights three times a week. Focus on grip strength (exercises like the farmers carry – carrying two heavy objects in your hands) and hip-hinging exercises (exercises that involve bending at the hip without bending the spine – like deadlifts, squats, or step-ups on a large box). Your goal is to be able to do a farmer’s carry for one minute while holding half your body weight in each hand.

“I think of strength training as a form of retirement saving. Just as we want to retire with enough money saved up to sustain us for the rest of our lives, we want to reach older age with enough of a ‘reserve’ of muscle (and bone density) to protect us from injury and allow us to continue to pursue the activities that we enjoy.” – Peter Attia

Eating for longevity

No diet is proven to prolong life for everyone. But there are three eating rules anyone without kidney damage can follow to extend life:

1. Consume enough protein to match one’s weight in grams (triple the daily recommended minimum) to maintain lean muscle. For example, I weigh 195 pounds, so I need to consume 195 grams of protein every day. However, I must space out my protein intake so I do not consume more than 25% of my daily protein in a single sitting (excess protein gets turned into glucose by the liver). Therefore, I aim to eat roughly 50 grams of protein four times a day (around 9 AM, 12 PM, 3 PM, 6 PM). Peter Attia says, “One macronutrient, in particular, demands more of our attention than most people realize: not carbs, not fat, but protein becomes critically important as we age.”
2. Don’t eat within three hours of bedtime. Eating too close to sleep reduces sleep quality.
3. Stick to an eating plan that keeps average blood glucose in a safe range. One week every few months, I will measure my blood glucose after I eat common meals with a simple drugstore glucose monitor. I’ll take a glucose measurement at 30-minute intervals for up to 2 hours after each meal to see if what I ate spiked my glucose levels above 160 mg/dL on the meter (which would lead to an insulin spike) and see if my average glucose throughout the week is above 100 mg/dL. If either is true, I will eliminate foods like refined carbohydrates and add more whole foods to my weekly eating plan.

“The time to repair the roof is when the sun is shining.” – John F. Kennedy www.ProductivityGame.com

Summary

Exercise, a balanced diet, quality sleep, and emotional health are crucial components of living a longer, healthier life. Exercise improves your circulation and brain function, while a well-rounded diet, including protein, healthy fats, and caloric restriction, can help you maintain muscle mass and overall health. Prioritizing your sleep and creating a consistent routine promotes physical and cognitive performance. Your emotional health is just as vital, and addressing issues like depression or trauma can contribute to your overall well-being. By focusing on all these areas, you can work toward a fulfilling, active, and healthy life.

About the author

Peter Attia, MD, is the founder of Early Medical. He received his medical degree from the Stanford University School of Medicine and trained at the Johns Hopkins Hospital in general surgery. He also trained at the NIH as a surgical oncology fellow at the National Cancer Institute, where his research focused on immune-based therapies for melanoma. He serves on the editorial board for the journal Aging. He is the host of The Drive, one of the most popular podcasts covering the topics of health, medicine, and longevity.

Bill Gifford is a veteran journalist and author of the New York Times bestseller Spring Chicken: Stay Young Forever (Or Die Trying). His work has appeared in Outside, Scientific American, Bloomberg Businessweek, Men’s Health, and numerous other publications.

Genres

Health, Nutrition, Personal Development, Aging Well, Rejuvenation, Healthy Living, Diet, Fitness, Nonfiction, Science, Self Help, Medicine, Biology, Aging Medical Conditions and Diseases, Longevity, Anatomy

Table of Contents

Introduction 1 (6)

Part I
Chapter 1 The Long Game: From Fast Death to Slow Death 7 (13)
Chapter 2 Medicine 3.0: Rethinking Medicine for the Age of Chronic Disease 20 (16)
Chapter 3 Objective, Strategy, Tactics: A Road Map for Reading This Book 36 (23)

Part II
Chapter 4 Centenarians: The Older You Get, the Healthier You Have Been 59 (14)
Chapter 5 Eat Less, Live Longer: The Science of Hunger and Health 73 (15)
Chapter 6 The Crisis of Abundance: Can Our Ancient Genes Cope with Our Modern Diet? 88 (23)
Chapter 7 The Ticker: Confronting—and Preventing—Heart Disease, the Deadliest Killer on the Planet 111 (29)
Chapter 8 The Runaway Cell: New Ways to Address the Killer That Is Cancer 140 (37)
Chapter 9 Chasing Memory: Understanding Alzheimer’s Disease and Other Neurodegenerative Diseases 177 (32)

Part III
Chapter 10 Thinking Tactically: Building a Framework of Principles That Work for You 209 (7)
Chapter 11 Exercise: The Most Powerful Longevity Drug 216 (19)
Chapter 12 Training 101: How to Prepare for the Centenarian Decathlon 235 (28)
Chapter 13 The Gospel of Stability: Relearning How to Move to Prevent Injury 263 (28)
Chapter 14 Nutrition 3.0: You Say Potato, I Say “Nutritional Biochemistry” 291 (16)
Chapter 15 Putting Nutritional Biochemistry into Practice: How to Find the Right Eating Pattern for You 307 (42)
Chapter 16 The Awakening: How to Learn to Love Sleep, the Best Medicine for Your Brain 349 (28)
Chapter 17 Work in Progress: The High Price of Ignoring Emotional Health 377 (32)

Epilogue 409 (4)
Acknowledgments 413 (4)
Notes 417 (14)
References 431 (40)
Index 471

Review

The book is a comprehensive guide to living longer and better, based on the latest scientific research and the personal experience of Dr. Peter Attia, a visionary physician and leading longevity expert. The book challenges the conventional medical thinking on aging and reveals a new approach to preventing chronic disease and extending long-term health. The book covers topics such as:

• The four main diseases of aging that kill most people: heart disease, cancer, Alzheimer’s disease, and type 2 diabetes.
• The role of cholesterol, inflammation, insulin resistance, and oxidative stress in aging and disease.
• The importance of nutrition, exercise, sleep, and emotional health for longevity.
• The benefits of fasting, ketosis, autophagy, and hormesis for cellular health and resilience.
• The potential of gene therapy, stem cells, senolytics, and other emerging technologies for reversing aging.
• The personal stories of centenarians, super-agers, and longevity researchers who have achieved remarkable health outcomes.

The book is an excellent resource for anyone who wants to learn more about the science and art of longevity. It is written in a clear, engaging, and accessible style, with plenty of anecdotes, examples, and practical tips. The book is not a one-size-fits-all prescription, but rather a framework for thinking about long-term health and creating a personalized plan. The book is also honest about the limitations and uncertainties of the current knowledge and the ethical and social implications of extending lifespan. The book is not only informative, but also inspiring and empowering. It encourages readers to take charge of their own health and to pursue their goals and passions with vigor and vitality. The book is a must-read for anyone who wants to outlive their expectations and live better longer.

Summary: Outlive: The Science and Art of Longevity by Bill Gifford and Peter Attia