Let me begin my review in the middle of Outlive. The author  asks us to list the ten tasks we want to do for the rest of our lives. He calls this list the centenarian decathlon. Here’s the top of the list for me: hike up to Third Burroughs Mountain. It’s 9 miles (14 km) in Mount Rainier National Park with 2500 feet (760 m.) of elevation gain. Why? I’m a hiker, and this is my favorite hike worldwide.

I’ve spent a fair amount of time thinking about how to keep hiking as I get older. I turned 65 in 2022; I would like to keep exploring mountains as long as possible, this is just the book to help me achieve my goal. Let me explain why.

First, Attia starts with the concept of healthspan – how well you live. There’s a tight coupling between healthspan and lifespan. As we age, we have left less of each. One difference is that lifespan is a discrete quantity; one day, you are alive, and the next, you are not. In contrast, our healthspan gradually diminishes over time. The author details three vectors (components) of healthspan: physical, cognitive, and emotional. The good news is that we can usually improve these components and our overall healthspan. How we do so is the core of the book.

The book’s first part outlines our current situation and a target goal. The most important lesson I learned: “Tactics without strategy is the noise before defeat.” a quote from Sun Tzu, an ancient Chinese military strategist. Been there, done that, got the T-shirt. So, how can I do better? The author has a great framework: first, objectives, then strategy, and finally, tactics. The author trained as an engineer, became a physician, and has worked in business consulting; his background shows throughout the book. I touched on objectives in the discussion of the centenarian decathlon; how about strategy?

The second part of Outlive is the science that can help you develop a strategy. There is a chapter on the science of centenarians; I think of this as a boundary condition. What are the factors that helped get someone to their 100th birthday? (I have a hiking friend who still gets out on walks at 101, I want to follow in her footsteps.) Next is a chapter on the details of how nutrition affects longevity. The last four chapters cover the science of how most of us die: metabolic disorders such as diabetes, heart disease, cancer, and neurodegenerative diseases. Understanding these problems will help you develop tactics to mitigate some issues. There are no magic bullets in these chapters; instead, it’s a well-researched survey of what we know as of 2022. Now that we know objectives and strategies, what tactics can we employ?

The final part of Outlive lays out four tactics: 

1. Exercise (cardio, strength, and stability)
2. Nutrition
3. Sleep 
4. Emotional health.  

At 260 pages, this is the longest part of the book. It was detailed and beneficial to me. Rather than outline each section, let me list some tactics I am adding to my strategy: 

1. Work on stability, specifically starting with a yoga class. 
2. Use a continuous glucose monitor for a few months to optimize my diet. 
3. Ensure I am getting enough protein intake of lysine, leucine, and methionine.

The last chapter on emotional health was the most impactful in the book. Attia opens up to the reader about his emotional health through the lens of a patient rather than a physician. It touched me deeply; I had some trauma in my teen years when my mom died. Fifty years later, I realized I should address some of these issues rather than wall them off. 

Outlive is a book I will read several times. The book is challenging; I spent four weeks reading the book.

I made a ton of margin notes and back-of-the-book scrawling. There’s a lot to digest, and there are many references. For example, I want to read the paper Hallmarks of Aging by Carlos López-Otín and colleagues. This book catalyzed some great conversations with my friend Bill about healthspan. I will recommend Outlive to anyone interested in taking action to improve their healthspan.  

One closing thought; there’s a missing chapter in the book. I believe social interaction and engagement can improve healthspan’s cognitive and emotional components. My experience is that forty years of marriage have improved my emotional health. I decided to ask ChatGPT: What studies have shown that social interaction and engagement can improve cognitive function and reduce the risk of cognitive decline and dementia in older adults? Here’s the answer: 

“There have been several studies that have shown a positive correlation between social interaction and cognitive function in older adults. For example:

The Rush Memory and Aging Project: This study found that older adults who had higher levels of social activity experienced a slower rate of cognitive decline than those who were less socially active.

The MacArthur Study of Successful Aging: This study found that older adults who were more socially engaged were less likely to experience declines in cognitive function over time.

The Women’s Health Initiative Memory Study: This study found that women who reported higher levels of social engagement had a lower risk of developing cognitive impairment than those who were less socially engaged.

Overall, these studies suggest that social interaction and engagement can play an important role in maintaining cognitive function and reducing the risk of cognitive decline and dementia in older adults.”

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