Live Long, Live Young

Outlive a book by Dr Peter Attia, MD

First time I heard of Dr Peter Attia was a few years ago in Tim Ferriss’s podcast. Peter talked about longevity and so many complex scientific medical terms that was complex and I felt lost. I guess I was not ready, nor was Peter was ready to bring science of longevity in a layman’s language.

Leap frogging to present, two things changed, I became ready to take health seriously and Peter learned to talk science like a story.

Peter starts the book by naming 4 most deadly disease as 4 horsemen of disease: 1) Heart 2) Cancer 3) Alzheimer 4) Foundational Disease- Like Insulin led diabetes etc.

Insulin alone as at top 7 deadly disease but it triggers so many of horseman disease.

Peter suggest our current Medical 2.0 system looks at next 10 year horizon for a disease control taking actions accordingly, ideally one should look at Medical 3.0 and next 30 years as healthy life.

Peter also touches upon living for a 100 and says Women live longer and have 4:1 centenarian numbers vs men but they lose cognition, might be related to muscle loss. Genetics is a key cause of keeping you healthy making you live 100 - you are lucky if your grand parents really lived long and genetics can also be a trouble maker - be wary if you have been ignoring a family history of genetic illness.

Most scary part of the book is those staggering numbers of deaths but most heartening was how all these 4 horsemen connects with metabolic health, which is under our control.

Metabolic Syndrome is a measure of your health -

1) Glucose Level >110 mg/dL

2) Hi Triglyceride >100 mg/dL

3) High blood pressure >130/85

4) Waist circumference >40 inch male & >35 inch female

5) Low HDL Cholestrol < 40 mg/dL male & <50 mg/dL female

If out of 5, you are crossing 3 check list - you have metabolic syndrome and not in good health- whether you are slim or fat.

A common disease of fatty liver also an indication of fat coming to body and not leaving - which is sign to be aware and take care. It is now a days happening without obesity and non-alcoholics as well.

Later part of the book Peter discusses in details about these 4 horsemen disease.

First horsemen Biggest killer Heart Disease - difficult to predict but have seen improvement in treatment and reduction in death.

LDL Cholesterol not bad in itself, however it contains materials which gets stuck at arteries and start oxidation - which is difficult to identify and advance tests like CT Engiogram will be able to detect.

Common practice is to see if LDL/VLDL etc are <100 mg/dL but ideally it should be as low as what children have 10-15 mg/dL.

Increasing HDL doesn't help but reducing LDL does. Peter himself had a genetic history of heart disease and Ketogenic diet helped him. However it may not suit to a certain set of patients and their parameters can get worsen.

2nd Biggest horsemen disease - Cancer. No advancement in terms of %age of saving life has been achieved by medical science in decades.

A cell becomes rouge and continues to outgrow fooling immune system and ultimately spreads throughout the body via metastasis and causes death. Radiologists able to detect cancer cell - because these cells consume a lot of glucose and a glucose concentration is a way to detect them. A new study has found out fasting before a chemotherapy is more effective.

If in 70s-80s smoking was a key reason for cancer, obesity is the new smoking. Insulin and body inflation triggers situation for cells to go rouge. New ways of immunotherapy of boosting immune system to target specific cancer cells showing positive signs.

Early screening is the easiest way to save a lot of life, but cost and false positive remains a key deterrent. Peter makes a bold statement and suggest no one should die from colon cancer, giving example of Chadwick Boseman Black Panther protagonist early death from colon cancer. Colon cancer, which is 3rd deadliest cancer if form age of 40 colonoscopy tests are performed - most easier method to detect a physical form of early cancer.

3rd horsemen disease - Alzheimer, a neuro-degenerative disease like dementia and parkinson’s generally happens post age 65+, which kills around 6mn US citizens. It was earlier considered non treatable but recent studies suggest exercise and mind exercises like learning a foreign language helps.

A key reason is low blood flow to brain, brain which only weighs just 2% but consumes 20% of energy, because of diabetes or heart disease.

PREVENTION: Exercise, eat well and stay happy we all know, but it is missing specifics and specifics matter.

EXERCISE: There is no upper limit of how much exercise can help - as much as you can. It starts helping at any age and at any level of exercise, as simple as walking.

There are a few measures which are found to be directly correlate to long life e.g. your grip strenth called farmer’s grip and VO2 max etc.

VO2 max is how much your blood is supplying oxygen to your blood measure in ml/kg. If in your young age you can be extremely fit with VO2 max touching close to athletic levels of 50 - you are going to live long. A smart watch with a 20 min of rigorous walking and jogging combo will give you your VO2 max.

"If you want to lift your grandkid of 15kg weight at your age of 70, you should be lifting close 2-3X of grand kid weight now. It shook me and I understood a lazy way to do exercise does help, but intentional and specific is what we need."

With exercise not only we should increase muscle mass but muscle strength as well - with old age there is significant muscle strength loss 2-3X more faster.

STABILITY: There is not so much talked about phenomenon of stability. Most elderly fall and end up spending last days in beds, killing them fast. Stability starts with proper breathing. Second important is our feet stability. Wearing shoes throughout life we have reduced surface area of our toes and our toes are more narrower - leading to more falls. Peter suggests a few good exercise to increase stability in the link here - https://peterattiamd.com/outlive/videos/

NUTRITIONAL BIOCHEMISTRY or DIETING -

Least researched field. What we know for sure - eat lean protein, eat not too much or too less and avoid eating toxic.

All big news headlines that we get on eating these foods increases cancer occurrence and all - it output epidemiology studies (means for searching for specific purpose to treat or understand those disease an output is suggested). It is very difficult to conduct a diet studies n human because of compliance issue. Think what you eat 3 days back? Or did you follow eating low carb for 3 months?

Cigarette causing cancer studies output was dramatic, it showed increased cancer propensity by 1000-3500% while most studies on diet suggest a meager 10-15% increase, non conclusive.

A few specific studies like Spanish oil study was done at large scale with easy compliance to use Olive Oil, Eat Nuts etc - which suggested Olive Oil and Nuts are super beneficial in reducing death from heart disease.

3 approaches CR (Caloric Restriction), DR (Diet Restrictions) & TR (Time Restrictions) are the 3 key approaches for nutritional biochemistry aka what we generally call dieting. .

A CR works if you are metabolically healthy. DR, a low carb or high fat Keto diet helps. A major need is taking atleast 2X the body weight of protein, probably animal based protein (Whey, Meat etc) which fully gets absorbed and has all essential 9 amino acids which lacks in Plant based Protein which is also difficult to digest.

Another rude shock to me was how Intermittent Fasting is not the best way to go about. As during IF our protein intake suffers and we lose a lot of muscle. And even 16:8 hours is not very beneficial unless you are very unhealthy and that is the only way left.

Additionally Peter focuses on sleep and suggest a sleep of at-least 7.5-8.5 hours to get optimal benefit from sleep. If sleep was not important it could have been eliminated by nature but it is not.

Lastly Peter touched upon Emotional well-being, considering it is most imp -as if you are sad and not motivated you will not be willing to improve upon yourself.

My actions: Peter helped me motivate for more rigorous exercise routine. We focus so much time on exercise but not so much on dieting - I started putting more time preparing better meals, eating more protein etc. He also encouraged early screening. Along with Monika Halan’s reco to buy health insurance I added free annual health checkup. I also did annual health checkup for family member and helping my mom take medicines to reduce her cholesterol.

I am marking Outlive as early read - to keep motivated to live long, live healthy.