Of all the longevity doctors out there, Peter Attia strikes me as one of the most trustworthy. So, years ago, when I heard him say that he was writing a book, I knew I was going to read it as soon as I could. I got the book shortly after it came out and finished it in a little over two weeks. In this video, I’ll talk about the things that I found the most interesting in Peter Attia’s book on longevity, “Outlive”.
Peter is frustrated with the current medical system that begins treating patients once they are already sick. He calls this “Medicine 2.0” and believes that the system should change to help people prevent diseases in the first place, which he refers to as “Medicine 3.0.” Although he talks about a lot of things that can help people heal after getting sick, his book is mainly about prevention.
Heart disease is the leading cause of death in the United States, and Peter was especially afraid of it because a lot of the men in his family died of heart disease at relatively young ages, and his own father had a cardiac event at some point, although he fortunately survived. The good news is that medicine is advancing quickly in this area, and heart disease is becoming easier to treat and to prevent.
Peter talks about the benefits of following a ketogenic diet that is mostly composed of monounsaturated fats like extra virgin olive oil, macadamia nuts, and avocados. I think it’s safe to say that most people who follow a ketogenic diet mainly eat saturated fats. Although some people can handle saturated fats without an issue, a large percentage will see their triglycerides rise because of the saturated fats, which is bad for the heart.
A ketogenic diet is probably also good for the brain and may help prevent Alzheimer’s disease. In a state of ketosis, the brain begins to use ketones for fuel, which can be beneficial because, even though the brains of people with Alzheimer’s disease can no longer metabolize glucose, they can still metabolize ketones. This can improve cognition and memory in people with early-stage Alzheimer’s, according to Peter.
The problem is that a ketogenic diet is already very restrictive. Having now to restrict the kind of fats you can consume can definitely add to the challenge. But consuming plenty of extra virgin olive oil and nuts, even if you’re not on a ketogenic diet, can do wonders for your heart and brain.
Peter is skeptical of many human clinical trials but says that he finds the PREDIMED trial to be quite convincing. The PREDIMED trial was a study conducted in Spain that divided 7,447 people between the ages of 55 and 80 into three groups. All of the subjects were at high risk of developing heart disease but had no heart disease at enrollment. Two of the three groups had to follow a high-fat Mediterranean diet, one
In a study, one group was required to consume a liter of olive oil per week, while another group had to consume the same amount of calories as the first group did from olive oil, but in the form of nuts. The control group was instructed to follow a low-fat Mediterranean diet. The study was intended to last six years, but it was halted after four and a half years when it became evident to the researchers that the olive oil and nut groups were becoming healthier, while the low-fat group’s health was deteriorating. The olive oil and nut group not only had a significantly lower incidence of major cardiovascular events but also showed improved memory. In contrast, the low-fat group experienced worse cardiovascular health and memory decline. It would have been unethical to continue the low-fat diet for the control group. In summary, for better brain and heart health, it is advisable to eat plenty of healthy monounsaturated fats, such as those found in nuts and olive oil. Additionally, daily flossing and regular sauna use can help prevent neurodegeneration and heart disease.
Peter, who was once skeptical, is now more convinced of the benefits of good oral hygiene and sauna use. People with good oral health tend to be healthier overall. Microbes that cause gum disease and cavities in the mouth, such as Porphyromonas gingivalis, are often found in other parts of the body, causing various problems. For instance, this microbe is frequently found in the brains of individuals with Alzheimer’s disease. Using a sauna at least four times a week for a minimum of 20 minutes at high temperatures (179 degrees Fahrenheit or 82 degrees Celsius or hotter) could potentially improve brain and heart health. Finnish studies have shown that men who use the sauna regularly have fewer cardiac events than those who use it less often or not at all.
To assist those with elevated triglycerides and LDL cholesterol, Peter discusses the benefits of certain statins, such as Crestor, as well as other medications like Nexilitol, Zetia, PCSK9 inhibitors, and Vascepa. These medications all work to lower LDL cholesterol in some way. Vascepa, in particular, is interesting because it is derived from fish oil and contains a high dose of pharmaceutical-grade EPA, an omega-3 fatty acid that helps lower LDL and triglycerides.
Peter does not talk extensively about anti-aging supplements and medications in his book, but he does mention the importance of omega-3 fatty acids. A good omega-3 supplement will contain both EPA and DHA. EPA is beneficial for heart health, while DHA is important for brain health. Peter suggests that DHA could potentially prevent neurodegenerative diseases such as Alzheimer’s, Parkinson’s, and dementia. Therefore, taking a high-quality omega-3 supplement may be a wise choice, especially since very few people have optimal omega-3 levels, and achieving such levels would require consuming large amounts of fish.
To consume optimal levels of omega-3, Peter recommends eating fatty fish such as sardines. He doesn’t mention specific brands, but I’ve heard him express trust in Nordic Naturals and Carlson’s. For vegans or vegetarians, an algae-derived omega-3 supplement is advisable.
Probably the most important thing one can do to prevent not only heart disease but also neurodegeneration and cancer is to exercise. According to Peter, exercise is beneficial for almost everything. It is the best thing you can probably do to increase your lifespan and health span. Exercise is the best longevity drug. If you love to eat things that you probably shouldn’t, the more you exercise, the more you can indulge without harming your health.
Everything from aerobic training to endurance exercise to strength training will benefit your health and significantly reduce all-cause mortality. Additionally, those who exercise tend to be more muscular, which can protect the body from injuries caused by falls. Older people, who are often not very muscular, are more susceptible to injuries or even death from falls. Falls are a serious issue, causing the most accidental deaths in those aged 65 and older.
However, exercise can do more harm than good if done incorrectly. Performing the wrong movements can lead to injuries, which may prevent you from continuing to exercise and enjoying its health benefits. Therefore, don’t force yourself to lift more weight than you can handle. Focus on performing every movement correctly to prevent injuries. It’s not a bad idea to film yourself exercising occasionally to ensure that you’re doing the movements correctly, rather than something that could cause trouble in the long run.
There are different theories about what causes neurodegenerative diseases such as Alzheimer’s and dementia. For example, substances called amyloid-beta and tau are often found in the brains of patients with neurodegeneration. However, scientists, including Peter, are not entirely sure what causes these diseases. It is known that people who carry the ApoE4 gene are at a higher risk of developing Alzheimer’s disease than those who don’t. Nonetheless, not all ApoE4 carriers are destined to get the disease, especially if they also carry the FOXO3 gene, which can help prevent the development of diseases. Moreover, many people who carry the ApoE4 gene but not the FOXO3 gene never develop the disease.
Therefore, regardless of your genetics, there’s no need to panic. For the time being, neurodegeneration can’t be cured, and there is no known way to stop the disease from advancing once symptoms start, which is usually around age 65 for most people. However, maintaining a healthy lifestyle, including regular exercise, may help reduce the risk or delay the onset of such diseases.
There are quite a few things one can do to prevent neurodegeneration, and I’ve already talked about the heart and brain benefits of using dry saunas, flossing, omega-3 fatty acids, ketones, monounsaturated fats, and exercise. It is no coincidence that a lot of the things that are good for the heart are also good for the brain. Plain and simple, what’s good for the heart is good for the brain. Although there are a few things that I haven’t mentioned that are, for the most part, good for the brain: B vitamins and vitamin D could both potentially help prevent dementia and Alzheimer’s disease. Also, grip strength is correlated with better cognitive function for some strange reason and could also help prevent neurodegeneration.
As you would expect, getting good and sufficient sleep—six to nine hours per night—is good for the brain and pretty much everything else, but especially the brain, as it can help clear the brain of tau and amyloid-beta. Peter wrote an entire chapter on the importance of sleep and basically explains how it can help prevent neurodegeneration, heart disease, and even depression and car accidents. In the end, a sleepless state is like being drunk; studies show that poor quality sleep can increase the risk of heart attack, type 2 diabetes, Alzheimer’s disease, elevate triglycerides, lower testosterone, and weaken the immune system. On the other hand, after a good night’s sleep, you have better endurance, stronger muscles, a higher VO2 max, and you’re less likely to get injured. To quote Peter, “Good sleep is like a performance-enhancing drug.
Here are a few things you can do to sleep better every night:
- Sleep in a dark room—the darker, the better.
- Sleep in a cold room.
- Avoid alcohol. Peter recommends avoiding alcohol as much as possible. He doesn’t think it’s healthy, not even an occasional glass of red wine. Although a drink every now and then won’t ruin your health, drinking at night is especially bad because it will ruin your sleep. Alcohol might help you fall asleep faster, but it isn’t good quality sleep.
- Avoid drinking coffee late during the day and especially at night. This one actually depends on your caffeine tolerance, as some people can drink coffee with no negative impact on their sleep. But nonetheless, my guess is that caffeine will ruin a lot of people’s sleep, so it’s worth mentioning.
- Abstain from stimulating electronics late at night. Don’t spend time on social media or playing video games at least two hours before going to bed. Non-stimulating ones, such as TV, might not be as bad. Some sleep experts recommend turning off all screens a few hours before going to bed, but according to Peter, this might not be absolutely necessary.
For more information on sleep and how to improve it, I recommend you read “Why We Sleep” by Matthew Walker.
I now want to talk about cancer. There’s an entire chapter on cancer in “Outlive.
But unlike heart disease and neurodegenerative diseases, Peter unfortunately doesn’t give us a list of medicines or precise ways to prevent cancer. That’s because cancer is a complicated disease. All diseases are, don’t get me wrong, but one type of cancer can be very different from another. Some treatments work on certain cancers but not on others, and some cancers are easier to detect in early stages than others. Cancer is the second leading cause of death in the United States, and even after decades of research, survival rates haven’t improved very much.
It isn’t because killing cancer cells is super complicated; in fact, killing them is not as hard as many people think. The problem is that killing malevolent cells involves killing benevolent ones as well, and if you kill enough benevolent cells, you kill the patient. What researchers want to figure out is how to spare normal cells and only kill the cancerous ones.
Nonetheless, here are a few things Peter says one can do to help prevent cancer: Exercise, as I already said, is probably the best longevity drug, and it could help prevent cancer and other age-related diseases. Moving on, calorie restriction—there appears to be a strong link between calories and cancer. In one very long study conducted by the University of Wisconsin, the researchers separated a group of rhesus monkeys into two groups. One of them was allowed to eat as much food as they wanted, while the other was calorie-restricted and fed about 25 percent fewer calories. The calorie-restricted group lived longer and had much less cancer than the ad libitum group of monkeys. The calorie-restricted group had a 50 percent lower incidence of cancer.
You should also not smoke, don’t become obese, and don’t become insulin resistant. These last three really shouldn’t come as a surprise. Nonetheless, cancer is much harder to prevent than other age-related diseases. There might be evidence showing that one could somehow starve cancer, but Peter doesn’t think so. Cancer cells always seem to be able to obtain the energy supply they need, which is why he recommends getting screened for cancer often—every two or three years or so, depending on your age—in order to intervene early when there is a chance of controlling or even eliminating the cancer, rather than the way it is typically done now: coming in at a late stage when the odds are already stacked against the patient and hoping for a miracle.
With that said, some cancers are trickier to detect in the early stages than others, and no single diagnostic test is 100 percent accurate. So, it is advisable to get more than one test—ultrasound, MRI scans, and 4K blood tests when screening for prostate cancer, for example.
With all that said, for those who already have cancer and are being treated with chemotherapy, there is one thing you can do… (The sentence seems to be cut off and needs additional information to be completed.)
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To make it work better, one might consider fasting or following a fasting-mimicking diet—a diet that restricts calories for a set period of time to trick the body and cells into thinking they aren’t being fed. Fasting with cancer might not seem like a good idea, but it probably is. When chemotherapy is given to patients who are fasting or on a fasting-mimicking diet, they respond better to the treatment. Cancerous cells become more vulnerable, and normal cells become more resistant.
One very promising cancer treatment that Peter talks about is immunotherapy. Unfortunately, it currently only works sometimes and only for certain types of cancer, with pancreatic cancer being one of them—which is great because it has one of the worst survival rates. Peter talks about a friend of his who was diagnosed with pancreatic cancer after surviving colon cancer and was given a few months to live. However, he was treated with immunotherapy, and although he lost his pancreas, he beat cancer a second time and is fortunately still alive. Whoever this guy is, I really hope he never has to go through anything like this ever again; he’s been through enough already.
Anyway, back to immunotherapy. Plain and simple, it consists of helping the immune system recognize and attack cancer cells. When a person is infected with a virus, the immune system will attack it because it can tell that the virus doesn’t belong. In this specific case, this is a very good thing because you don’t want a virus doing its thing inside your body. But sadly, the immune system can often work against the benefit of the person. For example, organ transplant patients will need to take rapamycin, an immunosuppressant drug, because without it, the immune system will come to realize that the transplanted organ doesn’t belong and will attack it the same way it would a virus. The point is that to the immune system, whether something is good or bad is often irrelevant. If it’s good but foreign, like a transplanted organ, it will attack it, and if it’s bad but native, it unfortunately often won’t.
In the case of cancer cells, they might be bad, but they are nonetheless native cells and therefore they “belong.” We do have something called T cells that fight against cancer cells, but it all becomes a problem when the cancer grows and learns to hide from T cells and avoid detection. Researchers have been working on immunotherapy-based cancer drugs and treatments that can teach the immune system to recognize cancer cells and attack them, and a few of them have already been approved, such as adoptive cell therapy and a class of drugs called checkpoint inhibitors. Much more work is needed to improve the efficacy and availability of immunotherapy treatments, but it looks very promising. And what’s great about it is that when immunotherapy works, it really works. When the cancer dies, it will almost certainly not come back.
I want to talk a little bit about continuous glucose monitoring and why Peter thinks it’s important. There are devices that can be implanted in your upper arm to monitor your blood glucose and show it in real time on your phone, which is great for those who want to maintain their glucose levels on the lower side. Having high glucose levels can cause all sorts of health problems. If you can see for yourself the effect that the foods you’re eating are having on your blood glucose, you might think twice before eating a bowl of breakfast cereal or an apple pie. Watching your blood glucose spike can certainly discourage you from eating high-sugar foods, or it might encourage you to do a decent amount of exercise beforehand to compensate for what you’re going to eat, which is great.
The problem is that continuous glucose monitors are not available for people without diabetes; for the time being, you unfortunately require a prescription to buy one. But that will hopefully change sooner rather than later. You can, however, buy a glucose meter without a prescription, and although it won’t show you your blood glucose in real time, you can still see the effects of the foods you’re eating on your blood glucose, just not as precisely. Either way, you will still learn to make better choices, so a glucose meter is a very decent Plan B.
Nonetheless, remember that glucose is just one health marker—an important one, for sure—but it isn’t the only health marker that matters. You can eat a bunch of unhealthy fats that won’t spike your blood glucose levels, but that doesn’t mean you should.
A minute ago, I talked about the benefits of exercising. Now, I want to talk about the benefits of working on your stability. Whatever sport or exercise you enjoy, stability is what will allow you to keep doing it well into old age. Even if you don’t like sports or exercising, it’s still important because the more stable you are, the less likely you are to fall and injure yourself. Peter talks about different stability exercises in his book, but I won’t be explaining them here. I think it’s easier to watch Peter doing these exercises as he explains them. I’ll put a link to these videos in the description.
Now, I want to talk about a drug I mentioned a minute ago: rapamycin. Rapamycin is the longevity molecule Peter is probably most optimistic about. It’s an immunosuppressant drug that was discovered on Easter Island, and although it’s only prescribed to organ transplant patients to prevent their bodies from rejecting the transplanted organ, it has also been shown to prolong the life of different organisms, such as yeast cells and mice. Someday, it could potentially be used as an anti-aging drug. Rapamycin works by inhibiting mTOR, a nutrient-sensing pathway that is activated or suppressed depending on the availability of nutrients.
MTOR plays a crucial role in the availability of nutrients, signaling the body whether conditions are favorable for protein production and cell division. When MTOR is inhibited, the body conserves energy, leading to a slower rate of cell division or a complete halt, and initiates the recycling of damaged proteins through a process known as autophagy. Both calorie restriction and fasting have been shown to extend the lifespan of various organisms, and, like rapamycin, they inhibit MTOR and activate autophagy. Therefore, a molecule that mimics these effects without the need for fasting or calorie restriction is highly intriguing.
However, a significant drawback of taking rapamycin daily, as organ transplant patients do, is immunosuppression. Studies suggest that this downside can be avoided by taking rapamycin or a rapamycin analog, such as everolimus, intermittently—perhaps once a week at a high dose rather than daily at a low dose. This regimen can provide longevity benefits without compromising the immune system. MTOR consists of two complexes: MTOR complex 1 and MTOR complex 2. Daily intake of rapamycin inhibits both, whereas intermittent dosing predominantly inhibits MTOR complex 1, which is the target for promoting a longer and healthier life.
Another molecule of interest for longevity is metformin, a medication used to treat type 2 diabetes. Metformin regulates blood sugar by enhancing the body’s response to insulin and reducing sugar production in the liver and absorption in other organs. Observations indicate that type 2 diabetics taking metformin have a lower incidence of cancer and generally live longer than non-diabetics. A clinical trial called TAME (Targeting Aging with Metformin) aims to determine whether metformin can delay the onset of age-related diseases such as cancer, heart disease, and dementia by administering it to healthy individuals aged 65 to 79 over a six-year period.
Lastly, the topic of fasting is addressed. Peter, in his book, briefly mentions practicing prolonged fasting, which he used to do for three days monthly and for seven days every quarter. However, he no longer recommends prolonged or even intermittent fasting for most of his patients due to the potential loss of muscle mass, which he deems not worth the risk. He emphasizes that protein is the most important macronutrient for growing and maintaining muscle mass, and it should be consumed adequately every day and throughout the day when possible, which is challenging within a short eating window. While fasting has many benefits, such as lowering insulin levels and emptying the liver of glycogen, Peter believes that these do not outweigh the importance of maintaining muscle mass.
Intermittent fasting has its benefits, such as suppressing mTOR and activating autophagy. However, there are also a few negatives, including the loss of muscle mass. Additionally, many people believe they can eat whatever they want as long as they fast for 16 hours a day and only eat within an eight-hour window. It’s important to remember that it’s still possible to gain fat and harm your body during that time, so caution is necessary.
I trust Peter Attia; he seems like a very trustworthy and likable guy, in my opinion. However, I have to admit that some of his views sound a little bizarre to me. I am no expert, but most longevity researchers I listen to and trust would probably disagree with him. Both David Sinclair, a Harvard professor of genetics and author of the book “Lifespan,” and Dr. Steven Gundry, a heart surgeon and author of “The Plant Paradox” and “The Longevity Paradox,” believe that excessive protein, especially animal protein, can be problematic. They also believe that fasting is one of the healthiest practices one can adopt.
Some people have even managed to cure themselves of cancer without chemotherapy by fasting for extended periods. For example, in the book “My Battle Against Cancer,” Guy Tenenbaum explains how he survived stage 4 prostate cancer by undertaking several prolonged fasts, some lasting up to 20 days. Although he lost most of his muscle mass and his testosterone levels dropped to zero, he survived. However, this was not part of a clinical trial.
All I’m saying is that Peter Attia’s arguments on fasting and protein left me feeling a little confused, not only because of what David Sinclair and Stephen Gundry say but also because in the Blue Zones—regions with the longest-living people—people don’t consume that much protein, and in at least one of them, they fast relatively often. Yet, in “Outlive,” Peter doesn’t discuss the Blue Zones, which also left me feeling a little confused.
Either way, I learned a lot from the book, and I really enjoyed it. I highly recommend it to anyone interested in longevity. And Peter Attia, if you’re watching this, thank you so much for your work. As always, thank you so much for watching. Let me know your thoughts in the comments section below, leave a like, and don’t forget to subscribe. Until next time.