Part 3 of My Review: Attia’s Magnum Outlive Opus

As we conclude my review of "Outlive," we delve into two often-neglected wellness aspects: quality sleep and robust emotional health. (Part 1 , Part 2 .)

Getting Some Zzz’s

Peter Attia challenges the common perception of sleep as merely a "nice to have" or "necessary evil," stressing its integral role in overall wellness—physical, mental, and emotional. The consequences of poor sleep are profound, a fact only recently gaining widespread recognition.

As a night shift-working ER doctor with a penchant for coffee (none after 2pm 1pm is my rule), far be it from me to lecture anyone about sleep quality and health. But I will say that I generally concur with Peter; insomnia and sleep issues are 95% sleep hygiene and stress reduction, and while pills and chemicals might be a quick fix to encourage drowsiness and some sleep, they’re generally very, very bad long term. Alcohol, benzodiazepines, and the Z-drugs (like zolpidem, or Ambien) are linked to lots of not great diseases, including dementia.

This chapter is a really solid overview of sleep importance and sleep hygiene; in the former, think of sleep as a dishwasher for your brain, cleaning out waste products and preparing your mind and body for a new day. For the latter: avoid alcohol, avoid screens near bedtime; make your bedroom dark and cool. CBT-I , a newer branch of cognitive behavioral therapy, can be quite successful at tackling many causes of anxiety by addressing sleep expectations and anxieties. (I learned some basics about how CBT-I works by asking ChatGPT to behave as a CBT-I therapist!)

Emotional Health, or: Why I Really Loved Outlive

As I said in Part 1, all throughout Outlive, I had a really critical eye —?I didn’t want to like it; I thought Attia was one of the many podcast/social media doctors that engaged in hucksterism . But while I was pleasantly surprised that most of his views were pretty reasonable, I didn’t get much of a sense for Attia the person. Outlive was a very dry read (as one might expect of medical non-fiction). But at the very end of the book, that all changes.

Without revealing too much (to preserve the personal nature of the content and encourage reading), I can say that Peter discusses his own personal demons very candidly. He also talks about others’ demons increasing in our society, like depression, suicide, and self-destructive behaviors. There is more of this type of suffering nowadays. More isolation and loneliness. He writes:

It took me a while to recognize this, but feeling connected and having healthy relationships with others, and with oneself, is as imperative as maintaining efficient glucose metabolism or an optimal lipoprotein profile. It is just as important to get your emotional house in order as it is to have a colonoscopy or an Lp(a) test, if not more so. It’s just a lot more complicated.

It’s a two-way street between emotional and physical health. In my own practice, I witness firsthand how many of my patients’ physical and longevity issues are rooted in, or exacerbated by, their emotional health. I see it on a daily basis. It is harder to motivate a patient who is feeling depressed to go and start an exercise program; someone who is overstressed at work and miserable in their personal life may not see the point of early cancer screening or monitoring their blood glucose levels. So they drift along, as their emotional misery drags their physical health down along with it.

My own situation was almost the opposite: I was doing everything to live longer, despite being completely miserable emotionally. I was as physically healthy as I’d ever been, circa 2017, but to what end? I was on a horrible path, both emotionally and in terms of my interpersonal relationships. The words of my therapist, Esther Perel, rang in my head practically every day: “Why would you want to live longer if you’re so unhappy?”

And certainly for me, one of the reasons this chapter resonated with me was that I saw bits and pieces of myself in Peter. While our circumstances are different, some of his descriptions and symptoms resonated with me. While Peter goes into depth about dialectical behavioral therapy , there are lots of similarities with cognitive behavioral therapy which has really helped me as well. While I have not experienced the same trauma he has, his streaks of perfectionism and negative self-talk are some of my brain’s favorite past times, too.

I think some of these traits are quite intertwined (and I might suggest selected for and encouraged) with the medical training system. In some ways, this makes sense: you cannot be sloppy or tolerant of mistakes when peoples’ lives are on the line. But these traits cannot be turned on when you walk into the ER and off when you sign out; they bleed into the rest of our lives and cause us internal strife and interpersonal struggles with our families, friends, and ourselves.

I’d also like to applaud Peter for telling his full story — including what in medicine we might call a “transient response.” He recalls going to intensive therapy for a short time, thinking he was “all-better,” and then relapsing to some degree — having a very self-destructive, significant decompensation filled with rage, anger, and suicidal ideation during the stresses of COVID. He recognized that he needed more time and more work, and he checked himself back in. (The telling of this story alone is a sign of growth; there’s almost nothing worse to a perfectionist than public acknowledgment of needing more help — negative self-talk might label it “failure.”)?

RuPaul says “vulnerability is power” because it allows people to see you as a complete person, and I think that’s what this final chapter does for Peter Attia. (Never thought you’d see a RuPaul-Outlive comparison, did you?) ?

In Conclusion, Putting in the Work

In Outlive, Dr. Attia discusses all the work he’s had to do to improve his mental and emotional health and the relationship with his family. He also says that it takes daily, intentional effort. There is not a shortcut. He journals. He practices mindfulness. He is aware of his triggers and fixes that worsen or improve his “window of distress tolerance,” as he describes it.

I really think this is the overall theme of his book, really: Living long and living well is hard work, and there is no shortcut. Want to be healthier? You’ve gotta walk up that hill and lift heavy weights (literally and figuratively). You have to invest the time and effort and re-organize your life around exercise, diet, and sleep so that they are priorities, not afterthoughts. Even one’s insulin or A1C or lipid levels can be thought of as personal challenges that require attention and work.

There is something to the human experience about overcoming adversity, and I’m so thankful that Peter not only improved his, but shared his journey with the rest of us.

As always, thanks for reading; I highly recommend the audiobook version. Peter narrates the book wonderfully –?and it's free with a Spotify premium account!

Part 1: https://www.dhirubhai.net/pulse/skeptics-review-peter-attias-outlive-graham-walker-md-z6rsc/

Part 2: https://www.dhirubhai.net/pulse/part-2-more-meat-potatoes-skepticism-peter-attias-graham-walker-md-dslzc/