Outlive: The Science and Art of Longevity

Rating: ⭐⭐⭐⭐⭐

📚 GoodReads Info 📚

Please note that like my other book reviews, they’re very “stream of consciousness” and as well crafted as my blog posts.

tl;dr Link to heading

I plan to use this book as the one thing they should read if they'll only read one thing related to everything along the lines of diet, exercised, lifespan, healthspan, longevity, etc. This is the key to proactive medicine, not just preventative medicine.

It’s Peter’s life work. It covers experience, theory, research, history and is nuanced just enough that it manages to give actionable advice without being “religious” about any one particular approach. It is also the best book I’ve come across that genuinely helps build intuition around all these concepts that otherwise only comes with years of experience.

As someone who has been exercising their whole life, and have been following the work of the likes of Andrew Huberman, Matthew Walker, Tim Ferris and others, I still learnt a lot of new things this book and reinforced.

Lastly, Chapter 17 is the most impactful chapter I’ve read in a long time. I plan to periodically re-listen to just that one, because it really hit home on how I’ve been thinking about my life up to this point.

Introduction Link to heading

tl;dr Longevity != Healthspan & Surviving != Thriving

Hearing the amount of effort he put into this book is crazy. I could almost feel the blood and tears he put into the book at various points in time.

The pain, physical, emotional and mental he went through deeply affected both him and his family. The prologue and epilogue attest to this extensively. Part of healthspan is being happy, emotionally, so even if you live a long and healthy (physically) life, one could still argue that the healthspan is short.

As someone who has some “body image issues”, hearing “not skinny” so many times really did get to me. I’m currently in my “not skinny” phase, and I know it’s just a mindset shift to get out of it, since I know what to do, but I feel like all of my willpower is spent in other parts of life right now.

One of the concepts he also drives home is how a nutrition plan should be treated as an investment plan. My personal approach to investing is an ability to sleep at night. I’m not comfortable investing in the S&P500 because I don’t like more than 450 of the companies in it. I also don’t like the idea of investing 99% of my net worth in Bitcoin. There is no right answer to this. It is too individual

The fact that Peter left John Hopkins medical school to work at McKinsey with just a couple of years left show how strongly he believes in proactive medicine, rather than how the medical system works today. I am always frustrated when I go and see a doctor myself and am glad to see that I’m not the only one.

As someone who works in Web3, and frequently things about the differences, I really like to look at this book as Medicine 3.0. Medicine 0.0 is traditional and IMO has a lot for us to learn from. Medicine 1.0 (think middle ages) really didn’t know what it was doing. Medicine 2.0 targets symptoms, not causes and profilirated in the 1900s. Now we’re entering the first stages of Medicine 3.0 and I can’t wait!

Chapter 17 Link to heading

The idea of “eulogy virtues” vs “resume virtues” is something I haven’t heard before but are words to live by.

The way he emphasizes the importance of being great it order to not be worthless was crystal clear to me.

His association with Paul Kanty, David Goggins was eviden.

His anger mascarading as frustration was something I’ve always felt in the past.

I don’t have much to add other than the fact that I understand.

“Myths” Link to heading

There are so many “food myths” or “exercise myths” on the internet because an individual finds something that works for them and then preaches it as religion. The few one line takeaways that I really enjoyed from this book were:

  • Starting the day with protein is key
  • Cryohydrate restriction reduces appetite
  • How much you eat is more important than what you eat
  • If you have to pick between exercise and diet, pick exercise
  • It’s still too early to have longevity biomarkers

Memorable Phrases & Moments Link to heading

  • Dying fast & slow really reminded me of Thinking fast & slow
  • Comparing texting & driving to base jumping really caught your attention

There were a lot of technical details about fat metabolization that I’ve forgotten since reading this book, but here are a few points & notes that I made throughout.

  • Having low Apo B leads to a decreased likelihood in heart disease
  • We can store 1600 calories worth of glycogen, and then we start relying on the body to metabolize fat or muscle
  • Visceral fat is much more important than body fat
  • A person’s capability to store fat determines weather its healthy or not
  • Fructose consumption is REALLY bad for fat gain (something to do with uric acid)
  • Diabetes is a greek word / melting down of the flesh
  • There are different types of fats: those that carry proteins & those that carry lipids
  • Insulin is responsible for pumping glucose from the bloodstream across the cell membrane into the cells
  • Lots of people with a normal BMI are in metabolic danger
  • Solving cancer
    • Lower insulin levels are better for cancer treatment which can be achieved by limiting caloric intake
    • Fasting helps healthy cells resist chemo
    • CAR T cells (genetically modified t cells from patient) are some of the most successful results from Rosenberg’s research for helping

TIL - Secret Terms & Ingredients Link to heading

  • Rapamycin is the closest thing we have to a universal anti-aging drug
    • Rapamycin makes things better rather than only delaying decline
  • Limiting caloric intake is the biggest secret we have found so far for longevity
  • Autophogy is the process of cellular recycling
    • Autophogy decreases with age
    • Exercise, fasting and Rapamycin provokes autophogy to restart
  • Elevated insulin is the closest thing we have to a biomaker to look fo
  • Uricase enzyme removal was an evolutionary advantage for humans: helped us survive winters by easily converting food into fat
    • This is now a disadvantage in the modern world
  • The Hawthorne effect is the equivalent of the observer effect in physics

Exercise & Muscle Link to heading

  • VO2 is critical to longevity
  • Higher V02 may be more important than any other biomarker
  • Having more muscle is a key figure in increasing health
  • healthy mitochondria uses fats gor energy in sone2
  • Lactate production is what defines zone2 cardio
  • Chromic blood glucose elevation damages organs
  • Strength vs Power vs Muscle
    • Strength is lost 2.5x faster than muscle
    • Power is lost 2x faster than strength
    • Power is lost 5x faster than muscle
  • Long steady cardio builds a good VO2 base
  • Exercise enables glucose to cross the cell membrane without insulin

Quotes Link to heading

tl;dr Old people talk about the past, young people talk about the future.

“I think people get old when they stop thinking about the future,” Ric told me. “If you want to find someone’s true age, listen to them. If they talk about the past and they talk about all the things that happened that they did, they’ve gotten old. If they think about their dreams, their aspirations, what they’re still looking forward to—they’re young.”

tl;dr We need a health strategy, not just a plan.

“To achieve our objectives, we first need to have a strategy: an overall approach, a conceptual scaffolding or mental model that is informed by science, is tailored to our goals, and gives us options. Our specific tactics flow from our strategy, and the strategy derives from our objective. We know what the objective is by now, but the strategy is the key to victory.”

tl;dr Wise words from Sun Tzu

Strategy without tactics is the slowest route to victory. Tactics without strategy is the noise before defeat. —Sun Tzu

tl;dr Be careful what you plan for

“Everyone has a plan until they get punched in the mouth.” Advice George Foreman could have used.”

tl;dr Reference to an Olshansky!

“We’re trying to attack heart disease, cancer, stroke, and Alzheimer’s one disease at a time, as if somehow these diseases are all unrelated to each other,” says S. Jay Olshansky, who studies the demography of aging at the University of Illinois–Chicago, “when in fact the underlying risk factor for almost everything that goes wrong with us as we grow older, both in terms of diseases we experience, and of the frailty and disability associated“with it, is related to the underlying biological process of aging.”

tl;dr Using socks for travel.

Back when I used to fly every week, I tried a clever trick that Michael Rintala showed me: put two tennis balls in an athletic sock about four to six inches apart, and position them just about at the level of my kidneys, or where my thoracic spine meets my lumbar spine. Then, with every breath I try to make sure I expand fully enough to feel the tennis balls on both sides. The idea is that it cues your breathing. When I did this, I could get off a five-hour flight and feel as if I had not been sitting for longer than about five minutes. (It also kept my seatmates from talking to me when I was trying to work.) It’s worth trying on a long flight or drive.

tl;dr A couple of Feynman references.

“Religion is a culture of faith; science is a culture of doubt. . - Richard Feynman

tl;dr Medicine 1.0 vs Medicine 2.0

“The shift from Medicine 1.0 to Medicine 2.0 was prompted in part by new technologies such as the microscope, but it was more about a new way of thinking. The foundation was laid back in 1628, when Sir Francis Bacon first articulated what we now know as the scientific method. This represented a major philosophical shift, from observing and guessing to observing, and then forming a hypothesis, which as Richard Feynman pointed out is basically a fancy word for a guess.”

tl;dr I’m a Yogini

UNCONTROLLED. These folks have extreme passive range of motion (i.e., flexibility)—and extremely limited ability to control it. They can often do a toe touch and put their palms flat on the floor, but because of their lack of control, these people are quite prone to joint injuries. They are always trying to find themselves in space, fidgeting and twitching; they compensate for their excessive flexibility by trying to stabilize primarily with their neck and jaw. It is very hard for them to put on lean mass (muscle). Sometimes they have very high anxiety, and possibly also a breathing pattern disorder.”

tl;dr Attachment disorders hit too close to home

The most important thing about childhood trauma is not the event itself but the way the child adapts to it. Children are remarkably resilient, and wounded children become adaptive children. The problems begin when these adaptive children grow up to become maladaptive, dysfunctional adults. This dysfunction is represented by the four branches of the trauma tree: (1) addiction, not only to vices such as drugs, alcohol, and gambling, but also to socially acceptable things such as work, exercise, and perfectionism (check); (2) codependency, or excessive psychological reliance on another person; (3) habituated survival strategies, such as a propensity to anger and rage (check); (4) attachment disorders, difficulty forming and maintaining connections or meaningful relationships with others (check). These branches are often fairly obvious and easy to spot; the tricky part is digging down to the roots and beginning to disentangle them. All of this is highly individual; everyone responds and adapts to trauma in a unique way. And it’s not as if there is some sort of pill that can make someone’s trauma, or their adaptations to it, simply go away. It requires hard work—and, as I would come to understand, it can also take a very long time.