Jeff Hirsh Read: January 2023
Inspiration: Wanted to learn more on the true science of being healthy; recommended by a friend
Summary
Written with the help of ChatGPT, below is a brief summary to understand what is covered in the book.
“Outlive: The Science and Art of Longevity”, published in 2023 by physician, researcher and author Peter Attia, is a groundbreaking manifesto on living better and longer that challenges the conventional medical thinking on aging and reveals a new approach to preventing chronic disease and extending long-term health, from a visionary physician and leading longevity expert. The book serves as an operating manual for longevity, as Dr. Peter Attia draws on the latest science to deliver innovative nutritional interventions, techniques for optimizing exercise and sleep, and tools for addressing emotional and mental health. With the right roadmap, Attia outlines how one can plot a different path for their life, one that lets each person outlive their genes to make each decade better than the one before.
Unedited Notes
Direct from my original book log, below are my unedited notes (abbreviations and misspellings included) to show how I take notes as I read.
Longevity is not necessarily about living more years but rather more quality years free of disease/disability, “Healthspan” refers to how long you live free from disability/disease to account for the quality of those years, less appealing to live to 150 if continue to whither away, Attia was a surgeon then took interest in aging process, healthcare is reactionary not proactive which is an issue as only initiate treatment once disease has taken shape and often too late, but there are signs of these ailments years prior, current age of medicine “2.0” began mid 19th century Germ Theory and focused on acute disease treatment, great advances but Medicine 3.0 is to be focused on chronic disease, preventative care, and at an individualized level—vs currently broad studies with generalized conclusions and treatments, last decades not seen all that much in chronic disease space (cancer, heart disease, diabetes), new medicine also about empowering the patient not solely obey doctor’s orders/guidance, issue with current medicine is disease-specific treatment as well as studying when in fact diseases are all related—diabetes, cancer, cardiovascular disease, alzheimer’s all have related underlying factors (such as specific lipoproteins/cholesterol), silos are an issue in chronic disease, “rapamycin” is a molecule involved in extending maximum life—discovered on Easter Island near volcano off coast of Chile 1964 (most isolated land in the world) but took years to come to realize power, slows process of cellular growth/division and present in nearly all that lives—acts on mTOR intracellular protein complex (“mechanistic target of rapamycin”), autophagy=cellular recycling to keep clean of junk but this slows as age which is why develop issues, obesity gets attention but obesity is really just one type of metabolic dysfunction which can be the case for nonoverweight people but is hugely important, BMI determines obesity but more to consider with “MetSyn”/metabolical syndrome, can be obese but metabolically healthy and then all good, MetSyn is the concern (many factors beyond BMI here)—it is about how the body/metabolism direct calories which is energized largely by insulin hormones (secreted by pancreas when body senses glucose), insulin directs glucose to right place, fat not bad in right spots but when overflows then to bad spots, safely storing fat is metabolically healthy—ie thin person can be unhealthy in this way, visceral fat is bad vs total body fat not best view—use DEXA scan annually, insulin is all about fat storage—high resting glucose and high insulin shows not storing/moving properly (“insulin resistance”), cholesterol is essential to life—required to produce cell membranes, hormones, bile acid, 20% of supply in liver, but it is lipid family so cannot travel freely/dissolve and must be carried around via lipoproteins, cholesterol in blood essentially no relation to cholesterol in diet—false science due to fact came from study of rabbits largely which carry cholesterol in diff way in blood, lipoprotein panel and calcium scan are key for cholesterol/true heart risk detection, cancer and heart disease kill 1 in 2 american adults combined, cancer cells do not grow faster than other cells but rather do not know when to stop growing, “metastasis”=ability of cells to travel from one part of body to another and spread, complexity of cancer is the challenge in understanding and especially in prevention, The Cancer Genome Atlast attempt to map tumors but find 2 cases of same stage same cancer can have very diff tumor genomes and require diff treatments, breast and prostate cancer do not kill unless metastatic and to other organs as can live without breast/prostate (lungs, liver, brain, bones), chemotherapy is a systemic (not local) treatment which is why has such bad side effects, key attributes of cancer are how it has metabolic impact (devours glucose) and evades immune system, “immunotherapy” is therapy attempting to boost/harness patient’s immune system to fight disease/infection (like a vaccine), immune system works against foreign/nonself bodies but issue is cancer is technically self/our cells so T cells not attack, new research to separate good self and bad self is key, CAR-T therapy is pioneering approach to alter T-cells and reinsert to be able to detect bad self and fight—showing initial signs of potential but narrow applications, alternate is checkpoint inhibitor drugs which make cancer more visible to immune sysyem (then T cells locate)—Keytruda is one of these drugs that works vs cancer in instances, still only 1/3 of cancers can be treated with immunotherapy and of that only 1/4 actually benefit, ACT is new treatment which effectively adds reinforcements of new t cells that are tailored to fight cancer but expensive, still ways to go but immuno is future of nearing cure unlike chemo where often returns, cancer test trade off bw sensitivity (finding cancer if there, but comes with false negatives) and specificity (telling when don’t have cancer, comes with false positives)—one up and other down, new liquid biopsies detect cancer via blood tests (instead of image testing like ct/mri scan), image testing lacks resolution to truly catch early, Grail (company under Illumina) looking for cancer markers in otherwise healthy (hardest task) via their “Galleri test” to check cell-free DNA patterns (needle in ten haystacks), Galleri has very high specificity (few false positives) but low sensitivity (even if says no cancer, still may), Alzheimer’s is neurodegenerative disease which once sets in have to known ways to reverse/slow let alone prevent, Parkison’s fastest growing neuro disease, Dr Alois Alzheimer first note disease of “forgetfulness/senility” in 1906 but not really gain traction til 60s as senile dementia via Alzheimer’s disease (neuronal tangles how it looks in brain), most common cause see as amyloid-beta and tau accumulation but odd as drugs to target fail to help so new doubts, blood flow to brain (vascular causes) and glucose metabolism (metabolic causes) in the brain newly viewed as in correlation with neurodegen of alzheimer’s—track this and enhance via drugs to stem alz development as new theory, brain has huge energy requirements (2% of mass 20% of energy), also tricky as brain has cognitive and mvmt “reserves” that kick in as age and mask neurodegen identification, is true that keeping stimulating mentally helps, have larger preventative kit for Alz than cancer, exercise key to prevention of Alz as maintains glucose homeostasis and improves vasculature, sleep great too, new evidence showing brushing and flossing teeth/oral health helps Alz and overall health, dry saunas great, cardio and weight training both important to do more of—some studies even say weight training more so, key in maximizing oxygen delivery capacity, muscle protects bones and falling is leading cause of accidental death for 65+ so muscle mass key here as preserving healthspan, muscle tends to fall precipitously post age 65 for those not exercising, “prehab” should be real where go to physical therapy to prevent injury before needed, most useful to engage in broad exercises for cardio, strength, balance, etc, important to be focused in training and do more now to prep for inevitable decline to come, zone 2 training is where can have a conversation but mildly difficult—do 4x per week 30 mins on bike or treadmill at this level—if feeling the burn then too intense for zone 2 which is key pillar for endurance, then focus on VO2 max—2x per week 3-8 mins jog/row/bike and whatever level can sustain for 4 mins then more relaxed 4 then back and repeat 4-6 sets (interval training), want to train endurance and VO2 max (VO2 tells you your oxygen capacity), get VO2 max high now as expect 10% decline per decade in VO2 max, building muscle today helps set best foundation for inevitable decline–important to focus on muscle contraction and extention in movements, grip strength is hugely important–farmer carry, dead hang, etc, stability is centerpiece but not just ab workouts–hip hinges, single leg exercises, breath control all a part of stability, spine mvmt/strength, most neglect stability even if in “good shape”, nutrition is one of the areas with least certainty–why 40k “diet/nutrition” books on Amazon, all tell you diff things and studies are so frequently flawed, main issue with all studies of diet via epidemialogy is inability to separate correlation from causation, also cannot untangle how millions of nutrients interact with each individual, really is “nutritional biochemistry” question and we have no idea given myriad factors internally that are unique as well as external factors, news headlines should more or less be ignored entirely on specific foods, any experiment also not long-term enough to conclude causal, also “17% increase in xyz” really is nothing vs correlation say of smoking and lung disease which is 1000x-2500x correlation, 3 approaches to diet: caloric restriction (count cals), dietary restriction (in the news, carbs free, no sugar), time restriction (fasting), can still overeat on dietary restriction, calorie counting has to be done perfectly/meticulously, alcohol has no benefit at all, carbs best in morning and best to be ones with fiber, no such thing really as too much protein, recognize 2 people can do same diet with totally diff results, omega 3 supplements are great for proper fats, cannot substitute plant protein for animal given types of amino acids and ability for body to use the protein differs if from plants (less effective), most diet studies are from mice which simply is not the same as humans, intermittment fasting usually results in protein deficiency, good rule of 1g per pound of body weight (but spread out over 4 instances per day), carbs are primary fuel/energy source and protein for structure/building muscle via 20 essential amino acids (9 of which must come from diet), fasting tends to kill muscle quickly, diet comes down to metabolically healthy or not, under or overnourished, undermuscled or adequately muscled, if metabolically healthy then nutritional intervention not do much—just about not eating bad, diets help those metabolically unhealthy (ie most Americans)or overnourished, most are overnourished and undermuscled, sleepless night function equivalent of being legally drunk, poor sleep has very bad effects on metabolic health—supresses leptin (tells you full) in favor of ghrelin (tells you hungry), poor sleep means under and over sleeping—best to be 7.5-9 hrs, sleep good for heart as well as brain, REM sleep protects emotional equilibrium and information processing—”sleep on it” is scientific, but it is about quality not just quantity of sleep, sleeping 10+ hrs likely indicates poor quality/other issues, enhance quality of sleep via: no phones/screens, maximize darkness, cold temp (~65) with hot shower before into cool bed, no alcohol, distance from stress activities (work/news), morning person or night owl is really genetic, 8 -9 hrs in bed, consistent wake time best, mental health and emotional health are not the same, emotional is more broad regulation of emotions and interpersonal relationships vs mental describes states like depression or chronic anxiety, David Brooks concept of “resume virtues” vs “eulogy virtues”—for accolades vs for how others truly view us, cannot separate emotional health from longevity—why do you want to live so long if unhappy, emotional health requires proactivity and recgonition—change thoughts/mindset to behavioral change, remove self-centered views and be mindful/empathetic, longevity is about a desire to be around for an optimistic/positive/healthy future
