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Outlive: The Science and Art of Longevity Hardcover – March 28, 2023
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“One of the most important books you’ll ever read.”—Steven D. Levitt, New York Times bestselling author of Freakonomics
Wouldn’t you like to live longer? And better? In this operating manual for longevity, Dr. Peter Attia draws on the latest science to deliver innovative nutritional interventions, techniques for optimizing exercise and sleep, and tools for addressing emotional and mental health.
For all its successes, mainstream medicine has failed to make much progress against the diseases of aging that kill most people: heart disease, cancer, Alzheimer’s disease, and type 2 diabetes. Too often, it intervenes with treatments too late to help, prolonging lifespan at the expense of healthspan, or quality of life. Dr. Attia believes we must replace this outdated framework with a personalized, proactive strategy for longevity, one where we take action now, rather than waiting.
This is not “biohacking,” it’s science: a well-founded strategic and tactical approach to extending lifespan while also improving our physical, cognitive, and emotional health. Dr. Attia’s aim is less to tell you what to do and more to help you learn how to think about long-term health, in order to create the best plan for you as an individual. In Outlive, readers will discover:
• Why the cholesterol test at your annual physical doesn’t tell you enough about your actual risk of dying from a heart attack.
• That you may already suffer from an extremely common yet underdiagnosed liver condition that could be a precursor to the chronic diseases of aging.
• Why exercise is the most potent pro-longevity “drug”—and how to begin training for the “Centenarian Decathlon.”
• Why you should forget about diets, and focus instead on nutritional biochemistry, using technology and data to personalize your eating pattern.
• Why striving for physical health and longevity, but ignoring emotional health, could be the ultimate curse of all.
Aging and longevity are far more malleable than we think; our fate is not set in stone. With the right roadmap, you can plot a different path for your life, one that lets you outlive your genes to make each decade better than the one before.
- Print length496 pages
- LanguageEnglish
- PublisherHarmony
- Publication dateMarch 28, 2023
- Dimensions7.24 x 1.52 x 9.29 inches
- ISBN-100593236599
- ISBN-13978-0593236598
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Editorial Reviews
Review
“In Outlive, Peter Attia explores the science of not just prolonging life, but also prolonging aliveness. Attia makes the crucial connection between overall health and relational health.”—Esther Perel, New York Times bestselling author, psychotherapist, and podcast host of Where Should We Begin?
“Finally, there is a modern, thorough, clear, and actionable manual for how to maximize our immediate and long-term health. Firmly grounded in data and real-life conditions, Outlive makes obvious which actions we all need to take, and just as important, what all we need to pay attention to in order to live a long, vital life. As the most accurate and comprehensive health guide published to date, Outlive is not just informative, it is important.”—Andrew Huberman, PhD, professor, Department of Neurobiology at Stanford University School of Medicine, creator of the Huberman Lab podcast
“Dr. Peter Attia is my doctor and also my friend. He is a specialist in longevity and someone I trust with my life. What separates him from others is his pursuit of quality of life from all angles—physical, emotional, mental, relational, and spiritual health. This incredible book is a call to action and a reminder to always participate, and never be passive. It will arm you with the tools you need to live a long, meaningful, and fulfilling life.”—Hugh Jackman
“In Outlive, Peter Attia has delivered the definitive look at the complex subject of longevity. Comprehensive and rigorous, Outlive is full of surprising insights into the diseases of aging that will likely kill most of us, and the tactics and techniques that can help us live longer and in better health. Attia’s writing surprises and delights us, while provoking a new way to think about longevity.”—Siddhartha Mukherjee, author of the Pulitzer Prize winner The Emperor of All Maladies and the New York Times bestseller The Song of the Cell
About the Author
Bill Gifford is a veteran journalist and author of the New York Times bestseller Spring Chicken: Stay Young Forever (Or Die Trying). His work has appeared in Outside, Scientific American, Bloomberg Businessweek, Men’s Health, and numerous other publications.
Excerpt. © Reprinted by permission. All rights reserved.
The Long Game
From Fast Death to Slow Death
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
I’ll never forget the first patient whom I ever saw die. It was early in my second year of medical school, and I was spending a Saturday evening volunteering at the hospital, which is something the school encouraged us to do. But we were only supposed to observe, because by that point we knew just enough to be dangerous.
At some point, a woman in her midthirties came into the ER complaining of shortness of breath. She was Black, from East Palo Alto, a persistent pocket of poverty in that very wealthy town. While the nurses snapped a set of EKG leads on her and fitted an oxygen mask over her nose and mouth, I sat at her side, trying to distract her with small talk. What’s your name? Do you have kids? How long have you been feeling this way?
All of a sudden, her face tightened with fear and she began gasping for breath. Then her eyes rolled back and she lost consciousness.
Within seconds, nurses and doctors flooded into the ER bay and began running a “code” on her, snaking a breathing tube down her airway and injecting her full of potent drugs in a last-ditch effort at resuscitation. Meanwhile, one of the residents began doing chest compressions on her prone body. Every couple of minutes, everyone would step back as the attending physician slapped defibrillation paddles on her chest, and her body would twitch with the immense jolt of electricity. Everything was precisely choreographed; they knew the drill.
I shrank into a corner, trying to stay out of the way, but the resident doing CPR caught my eye and said, “Hey, man, can you come over here and relieve me? Just pump with the same force and rhythm as I am now, oaky?”
So I began doing compressions for the first time in my life on someone who was not a mannequin. But nothing worked. She died, right there on the table, as I was still pounding on her chest. Just a few minutes earlier, I’d been asking about her family. A nurse pulled the sheet up over her face and everyone scattered as quickly as they had arrived.
This was not a rare occurrence for anyone else in the room, but I was freaked out, horrified. What the hell just happened?
I would see many other patients die, but that woman’s death haunted me for years. I now suspect that she probably died because of a massive pulmonary embolism, but I kept wondering, what was really wrong with her? What was going on before she made her way to the ER? And would things have turned out differently if she had had better access to medical care? Could her sad fate have been changed?
Later, as a medical resident at Johns Hopkins, I would learn that death comes at two speeds: fast and slow. In inner-city Baltimore, fast death ruled the streets, meted out by guns, knives, and speeding automobiles. As perverse as it sounds, the violence of the city was a “feature” of the training program. While I chose Hopkins because of its excellence in liver and pancreatic cancer surgery, the fact that it averaged more than ten penetrating trauma cases per day, mostly gunshot or stabbing wounds, meant that my colleagues and I would have ample opportunity to develop our surgical skills repairing bodies that were too often young, black, poor, and male.
If trauma dominated the nighttime, our days belonged to patients with vascular disease, GI disease, and especially cancer. The difference was that these patients’ “wounds” were caused by slow-growing, long-undetected tumors, and not all of them survived either—not even the wealthy ones, the ones who were on top of the world. Cancer doesn’t care how rich you are. Or who your surgeon is, really. If it wants to find a way to kill you, it will. Ultimately, these slow deaths ended up bothering me even more.
But this is not a book about death. Quite the opposite, in fact.
More than twenty-five years after that woman walked into the ER, I’m still practicing medicine, but in a very different way from how I had imagined. I no longer perform cancer surgeries, or any other kind of surgery. If you come to see me with a rash or a broken arm, I probably won’t be of very much help.
So, what do I do?
Good question. If you were to meet me at a party and ask me that, I would do my best to duck out of the conversation. Or I would lie and say I’m a race car driver, which is what I really want to be when I grow up. (Plan B: shepherd.)
My focus as a physician is on longevity. The problem is that I kind of hate the word longevity. It has all sorts of terrible associations, with a centuries-long parade of quacks and charlatans who have claimed to possess the secret elixir to a longer life. I don’t want to be associated with those people, and I’m not arrogant enough to think that I possess some sort of easy answer to this problem, which has puzzled humankind for millennia. If longevity were simple, then there might not be a need for this book.
I’ll start with what longevity isn’t. Longevity does not mean living forever. Or even to age 120, or 150, which some self-proclaimed experts are now routinely promising to their followers. Barring some major breakthrough that, somehow, someway, reverses two billion years of evolutionary history and frees us from time’s arrow, everyone and everything that is alive today will inevitably die. It’s a one-way street.
Nor does longevity mean merely notching more and more birthdays as we slowly wither away. This is what happened to a hapless mythical Greek named Tithonus, who asked the gods for eternal life. To his joy, the gods granted his wish. But because he forgot to ask for eternal youth as well, his body continued to decay. Oops.
Most of my patients instinctively get this. When they first come to see me, they generally insist that they don’t want to live longer, if doing so means lingering on in a state of ever-declining health. Many of them have watched their parents or grandparents endure such a fate, still alive but crippled by physical frailty or dementia. They have no desire to reenact their parents’ suffering. Here’s where I stop them. Just because your parents endured a painful old age, or died younger than they should have, I say, does not mean that you must do the same. The past need not dictate the future. Your longevity is more malleable than you think.
In 1900, life expectancy hovered somewhere south of age fifty, and most people were likely to die from “fast” causes of death: accidents, injuries, and infectious diseases of various kinds. Since then, slow death has supplanted fast death. The majority of people reading this book can expect to die somewhere in their seventies or eighties, give or take, and almost all from “slow” causes. Assuming that you’re not someone who engages in ultrarisky behaviors like base jumping, motorcycle racing, or texting and driving, the odds are overwhelming that you will die as a result of one of the chronic diseases of aging that I call the Four Horsemen: heart disease, cancer, neurodegenerative disease, or type 2 diabetes and related metabolic dysfunction. To achieve longevity—to live longer and live better for longer—we must understand and confront these causes of slow death.
Longevity has two components. The first is how long you live, your chronological lifespan, but the second and equally important part is how well you live—the quality of your years. This is called healthspan, and it is what Tithonus forgot to ask for. Healthspan is typically defined as the period of life when we are free from disability or disease, but I find this too simplistic, too binary. For example, I’m as free from “disability and disease” as when I was a twenty-five-year-old medical student, but my twenty-something self could run circles around fifty-year-old me, both physically and mentally. That’s just a fact. Thus the second part of our plan for longevity is to maintain and improve our physical and mental function.
The key question is, Where am I headed from here? What’s my future trajectory? Already, in midlife, the warning signs abound. I’ve been to funerals for friends from high school, reflecting the steep rise in mortality risk that begins in middle age. At the same time, many of us in our thirties, forties, and fifties are watching our parents disappear down the road to physical disability, dementia, or long-term disease. This is always sad to see, and it reinforces one of my core principles, which is that the only way to create a better future for yourself—to set yourself on a better trajectory—is to start thinking about it and taking action now.
Product details
- Publisher : Harmony; First Edition (March 28, 2023)
- Language : English
- Hardcover : 496 pages
- ISBN-10 : 0593236599
- ISBN-13 : 978-0593236598
- Item Weight : 1.85 pounds
- Dimensions : 7.24 x 1.52 x 9.29 inches
- Best Sellers Rank: #6 in Books (See Top 100 in Books)
- #1 in Aging Medical Conditions & Diseases
- #2 in Longevity
- #2 in Anatomy (Books)
- Customer Reviews:
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About the author

Peter Attia, MD, is the founder of Early Medical. He received his medical degree from the Stanford University School of Medicine and trained at the Johns Hopkins Hospital in general surgery. He also trained at the NIH as a surgical oncology fellow at the National Cancer Institute, where his research focused on immune-based therapies for melanoma. He serves on the editorial board for the journal Aging. He is the host of The Drive, one of the most popular podcasts covering the topics of health, medicine, and longevity.
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Reviewed in the United States on May 1, 2023
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First, Attia starts with the concept of healthspan - how well you live. There's a tight coupling between healthspan and lifespan. As we age, we have left less of each. One difference is that lifespan is a discrete quantity; one day, you are alive, and the next, you are not. In contrast, our healthspan gradually diminishes over time. The author details three vectors (components) of healthspan: physical, cognitive, and emotional. The good news is that we can usually improve these components and our overall healthspan. How we do so is the core of the book.
The book's first part outlines our current situation and a target goal. The most important lesson I learned: "Tactics without strategy is the noise before defeat." a quote from Sun Tzu, an ancient Chinese military strategist. Been there, done that, got the T-shirt. So, how can I do better? The author has a great framework: first, objectives, then strategy, and finally, tactics. The author trained as an engineer, became a physician, and has worked in business consulting; his background shows throughout the book. I touched on objectives in the discussion of the centenarian decathlon; how about strategy?
The second part of Outlive is the science that can help you develop a strategy. There is a chapter on the science of centenarians; I think of this as a boundary condition. What are the factors that helped get someone to their 100th birthday? (I have a hiking friend who still gets out on walks at 101, I want to follow in her footsteps.) Next is a chapter on the details of how nutrition affects longevity. The last four chapters cover the science of how most of us die: metabolic disorders such as diabetes, heart disease, cancer, and neurodegenerative diseases. Understanding these problems will help you develop tactics to mitigate some issues. There are no magic bullets in these chapters; instead, it's a well-researched survey of what we know as of 2022. Now that we know objectives and strategies, what tactics can we employ?
The final part of Outlive lays out four tactics:
Exercise (cardio, strength, and stability)
Nutrition
Sleep
Emotional health.
At 260 pages, this is the longest part of the book. It was detailed and beneficial to me. Rather than outline each section, let me list some tactics I am adding to my strategy:
Work on stability, specifically starting with a yoga class.
Use a continuous glucose monitor for a few months to optimize my diet.
Ensure I am getting enough protein intake of lysine, leucine, and methionine.
The last chapter on emotional health was the most impactful in the book. Attia opens up to the reader about his emotional health through the lens of a patient rather than a physician. It touched me deeply; I had some trauma in my teen years when my mom died. Fifty years later, I realized I should address some of these issues rather than wall them off.
Outlive is a book I will read several times. The book is challenging; I spent four weeks reading the book. I made a ton of margin notes and back-of-the-book scrawling. There's a lot to digest, and there are many references. For example, I want to read the paper Hallmarks of Aging by Carlos López-Otín and colleagues. This book catalyzed some great conversations with my friend Bill about healthspan. I will recommend Outlive to anyone interested in taking action to improve their healthspan.
One closing thought; there's a missing chapter in the book. I believe social interaction and engagement can improve healthspan's cognitive and emotional components. My experience is that forty years of marriage have improved my emotional health. I decided to ask ChatGPT: What studies have shown that social interaction and engagement can improve cognitive function and reduce the risk of cognitive decline and dementia in older adults? Here's the answer:
“There have been several studies that have shown a positive correlation between social interaction and cognitive function in older adults. For example:
The Rush Memory and Aging Project: This study found that older adults who had higher levels of social activity experienced a slower rate of cognitive decline than those who were less socially active.
The MacArthur Study of Successful Aging: This study found that older adults who were more socially engaged were less likely to experience declines in cognitive function over time.
The Women's Health Initiative Memory Study: This study found that women who reported higher levels of social engagement had a lower risk of developing cognitive impairment than those who were less socially engaged.
Overall, these studies suggest that social interaction and engagement can play an important role in maintaining cognitive function and reducing the risk of cognitive decline and dementia in older adults.”

Reviewed in the United States 🇺🇸 on May 1, 2023
First, Attia starts with the concept of healthspan - how well you live. There's a tight coupling between healthspan and lifespan. As we age, we have left less of each. One difference is that lifespan is a discrete quantity; one day, you are alive, and the next, you are not. In contrast, our healthspan gradually diminishes over time. The author details three vectors (components) of healthspan: physical, cognitive, and emotional. The good news is that we can usually improve these components and our overall healthspan. How we do so is the core of the book.
The book's first part outlines our current situation and a target goal. The most important lesson I learned: "Tactics without strategy is the noise before defeat." a quote from Sun Tzu, an ancient Chinese military strategist. Been there, done that, got the T-shirt. So, how can I do better? The author has a great framework: first, objectives, then strategy, and finally, tactics. The author trained as an engineer, became a physician, and has worked in business consulting; his background shows throughout the book. I touched on objectives in the discussion of the centenarian decathlon; how about strategy?
The second part of Outlive is the science that can help you develop a strategy. There is a chapter on the science of centenarians; I think of this as a boundary condition. What are the factors that helped get someone to their 100th birthday? (I have a hiking friend who still gets out on walks at 101, I want to follow in her footsteps.) Next is a chapter on the details of how nutrition affects longevity. The last four chapters cover the science of how most of us die: metabolic disorders such as diabetes, heart disease, cancer, and neurodegenerative diseases. Understanding these problems will help you develop tactics to mitigate some issues. There are no magic bullets in these chapters; instead, it's a well-researched survey of what we know as of 2022. Now that we know objectives and strategies, what tactics can we employ?
The final part of Outlive lays out four tactics:
Exercise (cardio, strength, and stability)
Nutrition
Sleep
Emotional health.
At 260 pages, this is the longest part of the book. It was detailed and beneficial to me. Rather than outline each section, let me list some tactics I am adding to my strategy:
Work on stability, specifically starting with a yoga class.
Use a continuous glucose monitor for a few months to optimize my diet.
Ensure I am getting enough protein intake of lysine, leucine, and methionine.
The last chapter on emotional health was the most impactful in the book. Attia opens up to the reader about his emotional health through the lens of a patient rather than a physician. It touched me deeply; I had some trauma in my teen years when my mom died. Fifty years later, I realized I should address some of these issues rather than wall them off.
Outlive is a book I will read several times. The book is challenging; I spent four weeks reading the book. I made a ton of margin notes and back-of-the-book scrawling. There's a lot to digest, and there are many references. For example, I want to read the paper Hallmarks of Aging by Carlos López-Otín and colleagues. This book catalyzed some great conversations with my friend Bill about healthspan. I will recommend Outlive to anyone interested in taking action to improve their healthspan.
One closing thought; there's a missing chapter in the book. I believe social interaction and engagement can improve healthspan's cognitive and emotional components. My experience is that forty years of marriage have improved my emotional health. I decided to ask ChatGPT: What studies have shown that social interaction and engagement can improve cognitive function and reduce the risk of cognitive decline and dementia in older adults? Here's the answer:
“There have been several studies that have shown a positive correlation between social interaction and cognitive function in older adults. For example:
The Rush Memory and Aging Project: This study found that older adults who had higher levels of social activity experienced a slower rate of cognitive decline than those who were less socially active.
The MacArthur Study of Successful Aging: This study found that older adults who were more socially engaged were less likely to experience declines in cognitive function over time.
The Women's Health Initiative Memory Study: This study found that women who reported higher levels of social engagement had a lower risk of developing cognitive impairment than those who were less socially engaged.
Overall, these studies suggest that social interaction and engagement can play an important role in maintaining cognitive function and reducing the risk of cognitive decline and dementia in older adults.”

I want to become the healthiest I possibly can, by returning to bike riding, weight lifting and table tennis. But, this is where Dr. Attia comes in. With his amazing background is various rigorous training programs and exceptional results, he has a personal perspective that few , if any, other authors can match. With 482 pages, including a much appreicated index, he expands on a lot of studies and info, allowing the reader to make their own decisions. I am not concerned at all about my lifespan, but very concerned about my healthspan. I see too many people using walkers, and barely alive, unable to "enjoy life." If I can't continue to enjoy life, I don't want to be here. Last November, I started a table tennis group at the local senior center. As Dr. Attia points out, it is up to me to control my destiny. About 5 years ago, my DEXA scan put me in the top 1%, for my age. That's thanks to weight lifting, on and off, since high school. Wonder where I am now? His emphasis on exercise, and how to do it, is worth the price of the book alone. Everything else just adds to the value of the book. My intention is to modify the Keto Diet, that I started on January 1st this year, and focus on the valuable "essential" health issues. Keto is unnecessarily restrictive. Dr. Steven Gundry's book: "Unlocking the Keto Code," dispells a lot of false Keto restrictions. I highly recommend both Gundry's and Attia's books. Outlive may get into the top 5 health books that I have purchased in the last 20 years. And there have been over 100. I hope to update this review as the months roll by. Hopefully, by this Christmas, I will be way ahead of where I am now, and can add more useful information. I started and ran a heath club, "Achieve Better Health Club, for over 7 years in The Villages, Florida. I was able to watch, and help, many people improve their quality of life, by making even simple changes in their life style. So can you! OUTLIVE will help. Good luck, and YOU COME FIRST.
Top reviews from other countries



Die Themen drehen sich um „The Four Horsemen“, die Hauptursachen für, wie er es nennt, „Slow Death“: Herzerkrankungen, Krebs, Neurodegenerative Erkrankungen, Metabolisches Syndrom. Im Vordergrund stehen immer Vorsorgemaßnahmen.
Besonders gut hat mir die Erklärung vom Cholesterinkreislauf und den Lipoproteinen gefallen. Das macht es viel besser nachvollziehbar warum man ApoB testen sollte, und nicht LDL.
Der größte Hebel scheint Sport und Bewegung in Form von Cardio-, Kraft- und Stabilitätstraining zu sein (der sogenannte „Centenarian Decathlon“), gefolgt von Ernährung und Schlaf. Einige Übungen werden textuell beschrieben, es gibt aber auch Links zu Videos auf seiner Webseite.
Zum Beispiel wird für den Bereich Cardio folgendes Pensum vorgeschlagen: 4x45 Minuten pro Woche sollte man ein „Zone 2“ Ausdauertraining machen, wobei mit Zone 2 der Laktatbereich zwischen 1,7 und 2 gemeint ist. Einmal pro Woche sollte man im maximalen Bereich trainieren (VO2max Training): 4 Minuten hohe Intensität gefolgt von 4 Minuten leichter Intensität bis der Puls unter 100 fällt, 4 Sätze.
Stabilitätstraining ist wichtig um Verletzungen vorzubeugen, er empfiehlt das Konzept von DNS (dynamic neuromuscular stabilization) beim dem auch Atemübungen eine zentrale Rolle spielen.
Das Kapitel über Ernährung fand ich am schlechtesten, ist sicher auch das kontroverseste Thema im Buch. Warum er mindestens 1,6 g Protein pro kg pro Tag empfiehlt war für mich nicht nachvollziehbar (das ist das doppelte was Ernährungsgesellschaften als Minimum empfehlen). Er gibt auch keine konkrete Studie an, sondern schreibt nur es gibt „reichlich Evidenz“. Aber der Schlusssatz hat mir wieder gefallen: „denk nicht zu viel über Ernährung nach, geh’ lieber trainieren“.
Das letzte Kapitel dreht sich um „Emotional Health“, er schreibt über seine eigene Therapie und wie wichtig das Thema ist. Seine Erkenntnis: Longevity ist meaningless if your life sucks.

