Review: Outlive

 I approached Outlive with the attitude that this was another crank health and nutrition book. To my surprise I found Peter Attia to be a pretty humble guy who's willing to read papers and go back on his previous enthusiasm for say, fasting. What he noticed about fasting was that it was very easy to lose muscle, which meant that it's only suitable for people who are so over-fat that the gains from losing fat outweighs the loss of muscle mass.

The book doesn't make any extravagant promises about shortcuts or quick fixes to your diet or exercise routine if you need to lose weight. Instead, it tries to advocate that your lifestyle and exercise program needs to meet the needs of someone who wants to live a long time in good health. If you dislike exercise or want a quick fix this book is not for you --- one of the charts early on demonstrate that if you still want to do easy activities like hiking in your 70s and 80s, you pretty much have to be in the elite 5% of the population in the top 5% of VO2 max for your age. If that's not daunting to you I don't know what is. (Then again, my Garmin watch constantly tells me I have that, so maybe it's not that hard in a nation which wants to drive everywhere and considers exercise to be something worse than death)

I will note that Attia is a great advocate for exercise. He notes, for instance, that the increased risk of dying from smoking is about 50% for a smoker vs a non-smoker. But the increased risk of dying if you're in the lowest quartile of the population is 100% compared to the population that's the next quartile up. In other words, being the least fit in the population is much worse for you than even being a smoker! For upper two quartiles diminishing returns kicks in and being in the elite 5% only reduces your risk of death by 4X rather than 2X compared to the bottom most quartile.

The nutrition part of the book is also interesting, since it notes that the RDA for protein designated by the FDA is actually the minimum necessary to maintain muscle mass, which means that if you're actually trying to gain muscle you have to double or even triple it! That will offend many vegetarians and vegans as he also goes on to explain how hard it is to get sufficient protein of the right kind on those diets.

There's also a huge emphasis in the book about sleep:

Kirk Parsley observed this when he was a physician to the SEALs. Outwardly, these men appeared to be prime physical specimens, finely honed by their rigorous training. But when Parsley analyzed their blood tests, he was shocked: many of these young guys had the hormone levels and inflammatory markers of men several decades older than them—“old-man blood,” Parsley called it. Because their training exercises and missions often began at odd hours of the night and required them to stay awake for twenty-four hours or more at a stretch, they were chronically sleep deprived, their natural sleep-wake cycles utterly disrupted. (kindle loc 5926)

The book is long and sometimes repetitive, so I don't expect a lot of people to read it, and I expect even fewer people to be able to apply the findings in the book. But then again, most people aren't going to be in the elite 5% of octogenarians who can still go hiking with their grand-children.

A science-based, humble approach to longevity. I therefore recommend this book.