The Science and Art of Longevity

Mostly art thou. 

This is a description of a book:

Outlive: The Science and Art of Longevity

By Peter Attia, with Bill Gifford

(Harmony, 482 pages, $32)

Never mind a troubled banking system and wobbly stock market -- there are other things to worry about. Not least, U.S. life expectancy is at its lowest point since 1996. Covid-19 contributed to the decline, but its effects were magnified by a trend that has been evident for years: elevated incidence of heart disease, diabetes and other ominous conditions, some exacerbated by an obesity epidemic that few public-health officials want to confront. Today people in the U.S. have shorter life spans than the citizens of nearly every other developed country.

What can be done about this state of affairs? That's the question insightfully addressed by Peter Attia in "Outlive: The Science and Art of Longevity." Along the way, he takes a critical look at the American healthcare system and at our not-so-salutary lifestyle choices. His intent is not to scold, though, but to improve our habits and health -- to help us achieve a longer life.

Dr. Attia, an Austin, Texas-based, health-focused podcaster and former surgeon, begins with a kind of genealogy, tracing the evolution of medical knowledge through history -- in part to help us grasp just where we are now and what the future might look like. 

What he characterizes as "Medicine 1.0" started with Hippocrates and lasted nearly two millennia. It consisted of little more than observation and guesswork and "missed the mark entirely." 

"Medicine 2.0" began in the mid-19th century, with the germ theory of disease, and developed to include the scientific testing of cures as well as, in the 1920s and after, the discovery of penicillin and other potent antibiotics. Dr. Attia calls Medicine 2.0 "a defining feature of our civilization, a scientific war machine that has eradicated deadly diseases such as polio and smallpox."

As Dr. Attia ruefully notes, we're still living in the second age. For all its triumphs, Medicine 2.0 routinely fails to treat or cure many long-term conditions, including most forms of cancer. Modern doctors are trained to solve "the problems of an earlier era" -- that is, acute illnesses and injuries with fairly short event horizons. For cancer patients, by contrast, we are "always coming in too late."

Treating patients after they've been diagnosed is Dr. Attia's central indictment of American medicine. 

"We ignore important warning signs and miss opportunities to intervene." He observes that the median age of a cancer diagnosis is 66 but that cancer (discovered too late) kills more people between the ages of 45 and 64 than heart disease, liver disease and stroke, combined. 

Like other health advocates, he pushes for early screening, particularly for colorectal cancer, since it is one of the easiest of the major cancers to detect. Indeed, "Medicine 3.0," the next era in medicine if Dr. Attia has his way, will be "proactive" and focus on prevention. It will also avoid one-size-fits-all treatment protocols of the sort that are common today.

Of course, the obstacles to longevity go beyond diagnosis timing and heathcare practices. Americans are plagued by heart disease, neurodegenerative aging and Type 2 diabetes partly because the standard American diet -- shortened to SAD in Dr. Attia's narrative -- contributes to each of these conditions. The dynamics of evolution add to the problem. In our ancestral past, Dr. Attia notes, it was wise to seize on nutrients when they were abundant, to improve the chances of survival. But the genes formed by evolution aren't suited to our present environment, in which many people "have access to almost unlimited calories."

Even so, Dr. Attia shies away from giving detailed dietary advice, beyond recommending that we not consume fructose-sweetened beverages (such as sodas and fruit juices). Instead he focuses on broad guidelines, such as ensuring that our diet -- he prefers the term "nutritional biochemistry" -- doesn't compromise muscle. 

One way to avoid muscular weakening, he says, is to consume double the amount of protein the federal government recommends.

Eating habits are less important to Dr. Attia than exercise, "our most potent tool for extending life span." 

He points to evidence showing that people who exercise regularly can live up to 10 years longer than those who are sedentary. 

One reason is that exercise benefits our mitochondria (the source of energy in the body's cells) and improves the way we metabolize glucose and fat. 

He cites studies (all of the book's claims are backed by abundant research citations) showing that exercise-based interventions have been more effective than several classes of pharmaceuticals in reducing mortality from coronary heart disease, diabetes and stroke. 

He features some unconventional measures of fitness, such as grip strength. It helps predict life span, he says, since it is an "indicator of general robustness and the ability to protect yourself if you slip or lose balance."

There is another aspect of our well-being that Dr. Attia addresses: emotional health. Getting our "emotional house in order," he says, is as important as getting a colonoscopy or some other diagnostic test, though it's "a lot more complicated." Here he transforms himself from physician to patient, describing the struggles he had in his teenage and college years ("off-my-rocker depressed") and, recently, the difficulties he faced with the advent of Covid and its restrictions. During one morning call, he "just snapped" and spun into "a radical, self-destructive episode," an event he conveys with admirable candor. ("I tore my T-shirt to pieces. I screamed.") He cautions that finding emotional equilibrium over time isn't easy. He practices something called dialectical behavioral therapy, which emphasizes controlling one's emotions. All such tools and strategies, he notes, "must be learned, and refined, and practiced daily."

So there is a good deal that each of us can do for ourselves, in Dr. Attia's telling, from consuming lots of protein to taking vigorous walks and monitoring our mental states -- getting a grip, one might say. But most of us will eventually enter the healthcare system, and it is in this realm that new thinking is most needed. Dr. Attia's prevention-focused Medicine 3.0 is a promising place to start.

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Mr. Rees is editor of Food and Health Facts and a senior fellow at Dartmouth's Tuck School of Business." [1]

1. Heaven Can Wait
Rees, Matthew.  Wall Street Journal, Eastern edition; New York, N.Y. [New York, N.Y]. 30 Mar 2023: A.15.