Unlocking the Secrets of Longevity - Insights from Peter Attia's "Outlive"

By ,
on Apr 27, 2024

In his recent book "Outlive," Dr. Peter Attia delves into the science and art of longevity, providing a comprehensive guide to living longer, healthier lives. Drawing from years of research and personal experience, Attia offers practical advice on nutrition, exercise, sleep, and preventive healthcare. This blog post aims to summarize the key takeaways from 'Outlive' and provide actionable steps to improve your healthspan. It includes additional guidance from the world's most prestigious and high-impact medical sources, ensuring that the data is relevant and recent.

Note: This blog post is currently under development and will be updated with more detailed information and actionable insights.

The Four Horsemen of Decreased Healthspan

Attia identifies four primary causes of decreased healthspan:

  1. Metabolic syndrome
  2. Cancer
  3. Atherosclerotic cardiovascular disease (ASCVD)
  4. Neurocognitive diseases

By focusing on preventing these "four horsemen," we can significantly improve our chances of living longer, more fulfilling lives.

Nutritional Strategies for Longevity

  1. Caloric Restriction: Tracking calories and consuming fewer calories without cutting out specific food groups.
  2. Dietary Restriction: Avoiding certain "forbidden" food groups, depending on the diet followed (e.g., keto diet).
  3. Time Restriction: Eating only during specific time periods, limiting overall intake.

Attia emphasizes the importance of avoiding added sugars, highly refined carbohydrates, processed oils, and calorie-dense foods. He recommends a Mediterranean-style diet rich in whole foods, healthy fats, and adequate protein.

Exercise: The Foundation of Healthspan

Attia breaks down exercise into three key areas:

  1. Zone 2 training: Long, steady endurance work that promotes mitochondrial health and fat utilization.
  2. VO2 max training: High-intensity intervals to improve cardiovascular fitness.
  3. Strength training: Heavy lifting to maintain muscle mass, bone density, and overall functionality.
  4. Stability work: Exercises that improve balance, flexibility, and reduce the risk of injury.

Where to Get Your VO2 max Tested

Various testing methods are available for VO2 max, including lab-based tests, field tests, or estimations based on heart rate or pace. You can get tested at sports performance centers, fitness centers, bike/running shops, medical facilities, or even through mobile testing services. To find locations near you, use Google and search for "VO2 max test You Zip Code". This search should help you narrow down places in your area that offer this service.

As an example, in the St. Louis area, individuals can get their VO2 max tested at the Lindenwood University Human Performance Lab for a reasonable fee. According to their website, the cost for a VO2 max test is $50 for Lindenwood University students, staff, and faculty, and $100 for individuals not affiliated with Lindenwood University (Note: They also offer Dual-Energy X-Ray Absorptiometry (DEXA) scans for $50).

The Importance of Sleep and Stress Management

Attia stresses the significance of getting 7.5-8.5 hours of quality sleep each night. Chronic sleep deprivation can lead to a host of health issues, including metabolic dysfunction, cardiovascular disease, and cognitive decline. He offers practical tips for improving sleep quality, such as maintaining a dark, cool bedroom, avoiding electronic devices before bed, and establishing a consistent sleep schedule.

Managing chronic stress is equally important for longevity. Attia recommends mindfulness meditation, dialectical behavioral therapy, and engaging in relaxing activities like spending time in nature.

Preventive Healthcare: Key Tests and Markers

Attia advocates for a proactive approach to healthcare, which he calls "Medicine 3.0." This involves regular check-ups, comprehensive blood work, and advanced imaging to detect potential health issues early on. By intervening before symptoms manifest, we can significantly reduce our risk of developing chronic diseases.

Blood Tests:

1. ApoB: Primary indicator of potential heart disease.

Apolipoprotein B (ApoB) is a critical factor in lipid metabolism and cardiovascular health. It’s been reported that ApoB is a more accurate marker of the risk of a myocardial infarction than total cholesterol. JAMA Cardiol. 2022;7(3):257–258. doi:10.1001/jamacardio.2021.5080

Target range from Attia's "Outlive":

  • 20-30 mg/dl, or 60 mg/dl without statins.

ApoB Target Ranges: Almost a Consensus

Different guidelines suggest varying ApoB targets for different risk categories:

2016 Canadian Cardiovascular Society Guidelines  Source:

  • High-risk individuals: < 80 mg/dL
  • Moderate-risk individuals: < 100 mg/dL

2019 European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) Guidelines  Source:

  • Very high-risk: < 65 mg/dL
  • High-risk: < 100 mg/dL
  • Moderate-risk: < 100 mg/dL

American Heart Association (AHA) and American College of Cardiology (ACC)

Circulation, the most highly influential and respected journal in the field of cardiology, adds to the existing body of literature and states, "the lower the apoB, the better".

How to get an ApoB test

2. Lp(a): Genetic marker for heart attack risk.

Ideal levels: 14 mg/dl.

  • Omega-3 Index (DHA% and EPA%): Indicators of cognitive and cardiovascular health. Target range: 8-12% combined.

Blood Pressure:

  • Target range: 120/80 mmHg or lower.
  • Take readings twice daily for two weeks for accurate assessment.
  • Cost: About $30 for a home blood pressure monitor. Get one recommended by Peter Attia here.

Continuous Glucose Monitoring (CGM):

  • Measures blood glucose levels every few minutes.
  • Target range: Average glucose level of 100 mg/dl or below, standard deviation of 15 mg/dl or less, and avoiding spikes over 160 mg/dl.

DEXA Scan:

  • Measures body fat percentage, visceral fat, and bone mineral density.
  • Target visceral fat in the lowest percentile and aim for positive t-scores in bone density.
  • Cost: About $50 at your local University or Performance Clinics. For example in St. Louis, Missouri there is Lindenwood University Human Performance Lab

CT Angiogram:

  • Measures plaque around the heart.
  • Recommended once between ages 35-40, with a target of zero soft and/or hard plaque.

Cancer Screenings:

  • Colorectal cancer: Colonoscopy by age 40, followed by screenings every 2-3 years.
  • Prostate cancer: PSA blood test, considering additional factors like PSA velocity and density.
  • Breast cancer: Combination of mammograms, ultrasounds, and MRIs, starting no earlier than age 40.
  • Cervical cancer: Annual pap smear starting at age 21.
  • Lung cancer (for current and former smokers): Low-dose CT scan or MRI, starting at age 50 or with a 20 pack-year history.

Affordable DIY Health Tests

You can now carry out many health screenings and tests usually associated with doctor's offices and hospitals, all by yourself, without relying on insurance. This could save you thousands on medical bills. Here are some tests you can perform on your own, as recommended by Dr. Attia:

  1. DEXA Scan: A highly accurate method for measuring body composition, including bone density, muscle mass, and fat distribution. Cost: $50
  2. VO2 Max: A measure of cardiovascular health and physical endurance. Cost: $100
  3. LP(a) and ApoB Tests: Blood tests that provide insights into cholesterol and lipid levels, vital indicators of heart health. Cost: $30
  4. A1c Test: A blood test that gives you a picture of your average blood sugar levels over the past three months, helping detect early signs of insulin resistance or prediabetes. Cost: $35
  5. APOE genotype test: Checks your APOE genotype, a key factor in your risk for Alzheimer's Disease. Cost: $200

Affordable testing services like Marek Health and OwnYourLabs can help you undertake these tests at prices significantly lower than traditional medical costs. For example, a full-body checkup at a medical facility can cost over $2,000, while you can conduct a similar test for just $450 or less.

Here's an example list of comprehensive tests you can perform at home using RUPA HEALTH, a partner of Peter Attia's Early Medical Clinic:

  • Liver Function (ALT & AST tests)
  • Heart Health (ApoB and Basic Lipid Panel tests)
  • Kidney Function (Cystatin C test)
  • Hormonal Balance (Estradiol, FSH, LH, SHBG, and Testosterone tests)
  • Iron Levels (Ferritin test)
  • Thyroid Function (Free T3, Free T4, Reverse T3, Thyroglobulin Antibody, TSH, TPO Antibodies tests)
  • Diabetes Risk (Glucose, Hemoglobin A1c, Insulin tests)
  • Blood Oxygen Carrying Capacity (Hemoglobin test)
  • Inflammation Indicators (hs-CRP, Homocysteine tests)
  • Prostate Health (PSA, Total test for men)
  • Liver or Gallbladder Disease Indicator (Total Bilirubin test)
  • Gout or Kidney Disease Indicator (Uric Acid test)
  • Vitamin D Levels (Vitamin D, 25-OH test)

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