Finished reading: Outlive by Peter Attia, MD 📚

The book Outlive by Peter Attia, MD is a guide to learning and planning for a long, healthy life. It is very detailed and covers the science behind it, as well as providing actionable advice. This post includes some of my notes from the book and the author’s other content.

“There comes a point where we need to stop just pulling people out of the river. We need to go upstream and find out why they’re falling in. —Bishop Desmond Tutu

Here’s an example schedule of the recommended training from this book. This is the minimum time you need to spend to get the benefits that will extend your life. Of course, any exercise is better than none!

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Objectives, Strategies, and Tactics

Simply seeing your physician every year for an annual physical is not enough. This only evaluates what’s happening with your health now. You need to be proactive if you want to live longer. If you want to play the long-game with your life, you need to start with your objective, then define a strategy, then define tactics.

Your objectives would inlude defining what you want to be able to do in your old age. Common examples include picking up and playing with grandchildren, walking your dog, not be in pain, etc.

You then reverse-engineer your objectives and create a strategy. The strategy is the higher level approach to how you will achieve your goals. What will you learn, what ways will you approach the problems.

The tactics are the things you do day-to-day and week-to-week that will help you achieve your objective.

Insulin Resistance

Insulin resistance is a major contributor to cancer, Alzheimer’s, heart disease, and other medical conditions. It occurs when the body’s cells don’t respond correctly to insulin, which results in too much glucose entering the muscles and organs.

Surprisingly, exercise is the most effective way to combat insulin resistance, not nutrition.

Zone 2 Training

Zone 2 training involves low-intensity exercise that is active enough for you to have a conversation without running out of breath. It is typically 70-85% of your peak heart rate.

During Zone 2, most of the work is done by your “slow-twitch” muscles that are rich in mitochondria. The mitochondria are “the power plants of the cell” and Zone 2 training can help them use fat as fuel.

To benefit and improve your health, you need at least 3 hours of Zone 2 training per week, split into four 45-minute sessions.

VO2 Max Training

VO2 Max is the highest rate at which a person can use oxygen during strenuous exercise. It is an indicator of aerobic fitness and endurance performance.

Achieving VO2 Max can be done by working at maximum intensity for four minutes, followed by a four-minute rest period. Repeat this cycle four times per week and measure your VO2 Max annually to measure progress. Apple Health and other fitness trackers have built-in VO2 Max measurements, though they may be less accurate than tests you can get at a medical facility.

Having a VO2 Max below average doubles the risk of death, which is even greater than the risk posed by smoking.

If your new to exercising, focus on Zone 2 Training for 6 months before starting VO2 Max Training.

VO2 Max is perhaps the most powerful marker for longevity. - Peter Attia, MD

Strength Training

Strength training increases muscle mass, which uses excess glucose. As we age, we lose muscle, so the more muscle mass we can build while we’re younger, the more we’ll have stored for our later years.

To maximize the benefits of strength training, perform exercises 3 days per week with a focus on grip strength. Examples of exercises that target concentric, eccentric, and isometric strength include farmer’s carry, deadlifts, and more. Eccentric strength is especially important to prevent injuries, such as the ability to stop yourself from falling.

It’s also important to note that strength training is not effective if we don’t consume enough protein in our diet. Aim for about 1g of protein per pound of total body weight per day (2.2g/kg/day).

Stability Training

Stability is essential for training, as it helps to prevent injury and is necessary for strength and performance. When we lack stability, we might be strong, but we are wasting energy in the wrong places, such as joints and other muscles, which prevents us from reaching our full potential. 1

To ensure stability, dedicate 10-15 minutes of your day to stability training and one hour twice a week. Focus on Dynamic Neuromuscular Stabilization (DNS), which is based on natural movements.. 2

Nutrition

When it comes to nutrition, there are some key principles to follow. One of them is getting enough protein. Protein is the most important macronutrient and we often don’t consume enough of it. As we age, it becomes even more important to aim for 1g/lb/day (2.2g/kg/day) of protein, based on our current body weight. This should be spread out throughout the day, as excess protein can be converted into glucose.

In addition to protein, strive to eat healthy most of the time. Whole foods are preferable to processed food. However, the best approach is to monitor your own nutrition and adjust according to what works for you.

Getting nutrition wrong has far more negative consequences than getting it right. 3

Sleep

We need to sleep between 7 1/2 and 8 1/2 hours each night. Sleep deprivation can lead to insulin resistance. High stress can lead to poor sleep, which can further increase stress levels.

Studies show that sleeping less than 6 hours is associated with a 20% higher risk of heart attack. People who sleep less during middle age years are more likely to develop dementia later in life.

A couple of hours before bedtime, turn off unnecessary lights, especially LED, and replace blue lights with warmer colored lights. Get at least half an hour of sunlight during the day, which will also help with sleep. Keep your room and bed cool while sleeping.

Breathing

Breathing is essential for balance, motion, and power. It also reflects our emotional state. Long, slow breaths can suggest relaxation, while short, quick breaths can suggest anxiety.

An ideal inhalation engages the entire rib cage and abdomen simultaneously.

Mental Health

Investigate Dialectical Behavior Therapy (DBT), a therapeutic approach designed to help people process trauma. It can also be beneficial for those with less severe emotional health concerns. 4

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