Aging & Longevity

Key Ideas from Peter Attia’s Book Outlive: The Science and Art of Longevity

Dr. Peter Attia’s book Outlive provides an overview of the latest science on health and longevity combined with practical advice to beat age-related diseases.

By Bennett M. Sherman

Key Points:

  • In his book, Dr. Attia says that age-related diseases arise from four critical conditions of aging — metabolic dysfunction, cancer, neurodegenerative diseases like Alzheimer’s, and heart disease.
  • To detect the risk of these conditions, Dr. Attia recommends monitoring blood sugar (glucose) levels to assess the possibility of having insulin resistance — a condition where the body’s ability to take in glucose from the blood declines.
  • To beat the four types of age-related conditions, Dr. Attia advises how to optimize your exercise and dietary habits.

Dr. Peter Attia, a physician known for his work in longevity medicine, wrote a New York Times bestselling book, Outlive: The Science and Art of Longevity, outlined in a YouTube video. Key points that Dr. Attia outlines in his book include that the majority of age-related diseases arise from metabolic dysfunction, cancer, neurodegenerative conditions, and heart disease. Most of us, if we live long enough, are likely to encounter one of these age-related problems. He says that monitoring blood glucose levels, which serve as an indicator of our likelihood of having one of these critical age-related conditions, can help us detect health problems early. He also suggests taking preventative exercise and dietary measures to make sure we live longer without any of these conditions.

The Importance of Measuring Blood Sugar Levels

Dr. Attia says that we can monitor blood glucose levels to detect insulin resistance — a condition where the body becomes insensitive to the hormone insulin and less efficient at converting glucose to energy. Monitoring whether we have insulin resistance is important, because this condition is a symptom of metabolic dysfunction. According to Dr. Attia, having insulin resistance also increases the risk of cancer 12-fold, neurodegenerative conditions like Alzheimer’s disease 5-fold, and heart disease 6-fold. Accordingly, with insulin resistance, cancer cells proliferate; neurons do not get the fuel they need, leading to neurodegenerative disease; and our bodies get more inflamed, precipitating heart disease. Thus, avoiding metabolic dysfunction associated with insulin resistance can help us stave off the four critical age-related conditions en route to our golden years.

As for insulin resistance and maintaining insulin sensitivity, the body typically maintains about a teaspoon of glucose in the blood at one time. When blood glucose levels rise after a meal, the body produces insulin that facilitates excess glucose getting into cells, namely, liver, muscle, and fat cells under the skin — known as subcutaneous fat.

As more and more glucose accumulates in the blood, no matter how much insulin is present, liver, muscle, and fat cells will not accept any more of it. This precipitates high blood levels of glucose and insulin levels — an insulin-resistant state.

In a state of insulin resistance, any excess calories get converted to fat and packed into places no one should have fat — like the liver, between muscle fibers, and in between organs in the body’s midsection. Fat between organs in the body’s midsection is called visceral fat, and it is highly inflammatory.

Dr. Attia likens the buildup of visceral fat to a tub overflowing with water where the water flows into the floorboards and carpet, destroying the house. As fat gets packed into organs and muscles, insulin resistance worsens, causing a vicious cycle where even more fat accumulates in muscles and around organs.

You can test whether you are in an insulin resistant state by measuring blood glucose with a glucose monitor after consuming a sugary drink like a can of soda. If glucose continues to rise after an hour, you are likely insulin resistant and may be headed toward an age-related condition.

Another way to tell if you are insulin resistant is to measure your blood glucose over a week every few months. While measuring glucose at 30-minute intervals for up to two hours after eating a meal, you should check to see if your glucose levels spike above 160 mg/dL and whether your average glucose is above 100 mg/dL. If either is true, you may be in an insulin resistant state, and you should consult with a physician.

Dr. Attia’s Exercise Recommendations

You may assume that changing your diet is the best way to avoid insulin resistance, but Dr. Attia says exercise has the greatest power to work against insulin resistance. As such, with the right exercise program, we can train our muscle cells to use fat as fuel and absorb more glucose to keep visceral fat buildup in check.

“More than any other tactical domain we discuss in this book, exercise has the greatest power to determine how you will live out the rest of your life,” says Dr. Attia. “Going from zero weekly exercise to just ninety minutes per week can reduce your risk of dying from all causes by 14 percent. It’s very hard to find a drug that can do that.”

Dr. Attia’s ultimate longevity exercise program includes three types of training: Zone 2 training, VO2 max training, and strength training. Zone 2 training involves any type of exercise performed while barely being able to have a conversation, such as rowing or bicycling. For a session of VO2 max training, you can do an aerobic exercise such as cycling, running, or rowing close to your all-out maximum for four minutes and then rest for four minutes, doing this routine four consecutive times. Strength training can be done with external weights or bodyweight.

Dr. Attia recommends setting three weekly targets for each type of training. For Zone 2 training, he recommends doing stationary bike or rower training for 45 minutes for four days a week. He also recommends setting a target of doing a session of VO2 max training one day a week. For strength training, he recommends lifting heavy weights three times a week, focusing on things like grip strength and squats.

Eating a Gram of Protein a Day for Each Pound You Weigh

For your diet, Dr. Attia advises to eat one gram of protein a day for each pound you weigh. Thus, if you weigh 180 pounds, eat 180 grams of protein. He says to space out your protein consumption so that you do not eat more than 25% of your daily intake at each sitting. Otherwise, your liver will convert the protein to glucose. An example would be to eat 25% of your protein intake at 9 AM, 12 PM, 3 PM, and 6 PM. Dr. Attia recommends consuming protein sources like chicken breast, steak, fish, or whey protein shakes.

Dr. Attia also recommends not eating within three hours of bedtime, because eating too close to when you go to bed reduces sleep quality. He says to stick to an eating plan that includes reducing refined carbohydrates and incorporating whole foods like fresh fruits and vegetables that keep blood glucose in a safe range.

Following Dr. Attia’s Exercise and Dietary Recommendations to Lower Blood Glucose

Dr. Attia’s book provides insight into why monitoring blood glucose could help prevent age-related metabolic dysfunction, cancer, neurodegenerative conditions, and heart disease. He also provides practical advice on how to exercise and make dietary adjustments to lower blood glucose levels. Adopting these practices may help you steer clear of age-related conditions to prolong your healthy lifespan.

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