Outlive by Peter Attia, MD Summarized

I read Outlive, you may not need to. Here is my brief summary.

If you listened to Peter Attia on the Tim Ferriss Show (#661), you have most of what you need to know. If you need to dig into the biological details, then get the book. If you need to do a deeper dive into a specific concern to you, such as cancer or heart health, then read the book. However, if you are like me, mostly healthy, and just want to get some actionable items, then this summary may be enough.

Attia’s core thesis is that exercise is the biggest lever for longevity. I was planning on putting together an outline of his exercise guidance, but the great YouTube channel Productivity Game beat me to it.

Book Summary: Outlive by Productivity Game  (YouTube)

You can access the supporting exercise videos from the book on his site – no password is required.

For heart health, Attia likes the Apolipoprotein B (ApoB) marker more than LDL. I see on Ulta Lab Tests, this test only costs $35. I’ll order one later this year. Whenever the cholesterol topic comes up, comments can get heated. I don’t know what the truth is. I’m just passing this info along.

Attia used to love low-carb ketosis and fasting. Now he promotes high protein and is less enamored with fasting. I questioned this point in an earlier post. Don’t eat a few hours before bed and keep your blood glucose in a safe range. Maybe use a continuous blood glucose monitor for a few weeks to learn what foods can spike your glucose and then avoid those.

Probably the only thing in the book that surprised me was learning about Attia’s issues with anger. His emotional health journey is covered in the final chapter.

One thing I noticed that was missing from this book was a discussion on the longevity benefits of dietary fiber.

For me, I’ll take these actions:

  1. Add the ApoB test to my next blood panel. I suspect it will be fine.
  2. Increase my Zone 2 cardio and then work on my VO2 Max. This should be easier to do outdoors now that the weather is improving in Seattle.
  3. Continue testing if higher protein will improve my DEXA score and recoverability. I should know by winter if this makes any difference.
  4. Incorporate some of the movement exercises he shared on his video page.

Part of me thinks his core thesis that exercise is the biggest lever in longevity is really selection bias. People with high VO2 Max and strength are likely those folks that already lean, have good sleep, have dietary discipline, and are energetic. I explain my position on selection bias in The Problem With Boot Camp Training. Despite my skepticism, I see the end goals of strength and cardio fitness as worthy goals, even if it doesn’t add additional longevity.

This is not a book I’ll be keeping for reference. I’ll be passing my copy along, either to a friend or to the library.



Add yours

  1. My wife is less enamoured with exercise than I am. She certainly doesn’t overthink it like I am prone to do. In her words, I worry so much about living longer and the right type / amount of exercise required to do it, that I may yet die from the stress brought on by the worrying.
    As she rightly said, in a world where there are countless children who do not live to see adulthood, I should consider myself fortunate to have reached so far, and anything else is a bonus.
    Yet Mr Attia, in terms of over thinking and worrying about these things, is like me, but on steroids. I wonder just how much his deep dive into this topic, and his ever changing approach, based on the “latest science” is actually negatively impacting on him in terms of his ultimate goal?

  2. @Stuart – Attia does have a practice and makes an income from people that want their health questions answered. I don’t view that as worrying or overthinking. He pivots when he sees new data. That is a rare trait in health influencers.

  3. Thanks for the review. I actually just started the book today, but have noticed the shift to more protein in some of his recent videos, and admit I have raised my protein intake a.little – ~130 grams/day. Not overly high, but any more is a PITA.

    I agree @Stuart – I waver between tracking, monitoring, planning and a few simple actions that I can just do and forget about.Sometimes I get a little mental over it, and that can’t be good.

  4. MAS,
    Attia may well follow the science, but sometimes the science and real world application don’t always marry up well.
    He went from being an extreme endurance athlete to scaling it back when it was theorised that there was an reverse J curve with too much / too intense cardio and mortality. He still however promoted zone 2 work for between 45 minutes and an hour, which he personally did on an indoor bike trainer or on an incline treadmill. This inspired me to do the same ( I tend to do most of my cardio indoors) and typical me, I worried whether I should do an hour ( Was 45 minutes enough? Would I be missing out if I didn’t put in my that extra 15 minutes per session? Could I get away with 50 minutes? Etc).
    Since then Attia has decided that there is no reverse J curve and has increased his cardio to up to two hours on week days and several hours at a time at weekends. He, I think still partially wears his “performance” hat, despite saying that everything is geared towards longevity. An indication of that was on a Q&A video he did, where someone asked if they could vary cardio machines to relieve boredom. His answer was that yes they could, but performance would suffer / not be as good as a result. If your goal is longevity only…who cares?
    I went the other way. His anal retentive approach to it, I decided was not sustainable. I go no longer than 40 minutes ( that’s including a 5 minute warm up) on a cardio piece, and most often only 35.
    I do believe in the reverse J curve idea between too much cardio and longevity benefits popularised by James O’Keefe and Carl Levie. O’Keefe’s thoughts on keeping it minimal and just then get out and move more seem far more reasonable. If you had to go to the lengths that Attia goes to, hours on an indoor bike, just to see some benefit, in my opinion you would start to question the process. Those extra years would almost be taken up via exercising.
    This is where the 80/20 rule comes into play. You’d get most of the results and the low hanging fruit from 30 minutes of cardio, most days. Attia is clearly after the remaining few percent, but I still wonder if his “obsessive search is misguided.

  5. @Stuart – I suspect you are correct.

    I think he has a selection bias problem, but I’m willing to try some of his ideas while rejecting others.

    My guess is if Attia were advising a patient on how to get taller, he would recommend they play more basketball, because the best basketball players are the tallest. LOL.

  6. MAS,
    When it comes to his exercise for longevity prescriptions, Attia reminds me of one of those authors on sites like T Nation and Men’s Health etc, who write about the benefits of weight training for general health for the normal working man with a family, then who proceed to lay out a program that, in reality an Olympia level bodybuilder might baulk at.

  7. @Stuart – The more I think about, the more I see it.

    If one follows all his exercise recommendations, by definition, they would have to have already been in great health. He can filter out 99% of the population.

    I recall Charles Poliquin wouldn’t take on a new strength client unless they showed him 6 months of training logs first. I’m certain he is a smart fellow, but that act absolutely increased his odds of having success.

  8. Would living an extra, say, five years really matter much in the end? 🙂

  9. Aaron Ashmann

    May 12, 2023 — 6:28 pm

    Jim, yes it would…. we could be at escape velocity for longevity within 40 years. Imagine that the first treatments might allow us to function like a centarnarian and live to 100-110..The next treatments might turn back the clock. 5 years could mean a lot.

  10. Aaron, I see your point. I think Kurzweil has a similar outlook. I guess I personally don’t feel that a longer life is a better life. I’m good with my 77 years +/- a few years. I don’t think I need escape velocity. Of course, I’m not 77 yet. 🙂

  11. I have a single “life rule” that has served me well:
    Always be looking for the point of diminishing returns and when you find it, stop there.

  12. @Grubby, that is a great rule for life applicable across the board, thanks for sharing

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.