Outlive: The Science and Art of Longevity

Attia tells the story of the mythical Greek prince of Troy, Tithonus. He asked the gods for immortality. However, since he did not also ask for eternal youth, “his body continued to decay” (10). This story illustrates the two key concepts of longevity: chronological lifespan (which is what Tithonus asked for) and healthspan (which is what Tithonus failed to ask for). Attia’s primary argument is that we should not only want to live longer, but to live better for longer.

He notes that “to live to the age of one hundred without our mind and our body intact is not something that anyone would willingly choose” (46). Outlive is thus a call to action for the practice of longevity. Attia emphasizes that his “intent here is not to tell you exactly what to do; it’s to help you learn how to think about doing these things” (18).

He presents a three-part approach to longevity. The first part is an individual’s objective. The overall objective is to live longer with a good quality of life. Each person defines what “good quality” means to them. Strategy involves research and figuring out a way to achieve our individual objectives related to longevity. Attia suggests strategy is more difficult than tactics, and needs to extend both lifespan and healthspan. Attia focuses on strategies in Part 2. Here, he provides the biological mechanisms that predispose people to the Horsemen diseases as well as discussions about how these diseases progress. Doing so enables people “to know our adversary [Horsemen diseases] inside and out” (211), which helps them with the final approach to longevity.

The final part is tactics. Tactics are what people do to achieve longevity. He focuses on five tactical domains: exercise, nutrition, sleep, emotional health, and exogenous molecules. Attia considers exercise to be the most powerful longevity tool and encourages everyone to exercise (especially if they currently do not). One powerful statistic that Attia cites is that adding just 90 minutes of exercise each week reduces a person’s risk of dying from all Four Horsemen diseases by almost 15 percent. Habitual exercisers “tend to live longer, but they stay in better health, with less morbidity from causes related to metabolic dysfunction” (218). Attia breaks exercise down into its most important components for longevity: aerobic efficiency and endurance, strength, and stability. He argues for increasing limits in each component to achieve extended lifespan and healthspan and provides suggestions for how to do so.

Attia concludes that we know very little about nutrition itself. As a result, he vehemently disagrees with fad diets. Instead, Attia argues that people need to create their own meal plans based on tweaking the three major levers of diet (caloric restriction, dietary restriction, and time restriction) and the four main carbohydrates (alcohol, protein, fats, and carbohydrates).

Sleep is one of the most under-utilized tactical domains, yet decades of research have shown that sleep is critical to living longer and living better for longer. Good quantity and quality sleep ensures good metabolic, heart, and brain health. Lack of sleep has profound negative consequences including increasing the risks of the Horsemen diseases.

Emotional health is the most important component of healthspan. When someone is in emotional equilibrium, they are happy and have strong relationships with themselves and others. Using his own personal story, Attia underscores that poor emotional health likely shortens healthspan, since few people want to live longer if they are unhappy. In urging readers to consider all of these factors in their quest for better health and longevity, Attia urges readers to approach their health in a way that considers how to make their life a happy one, not just a long one.