outlive - the science & art of longevity

Outlive – The Science & Art of Longevity (A Book Review)

It’s rare when a book makes me change things in my life.

Today, I’m reviewing a book that did exactly that.  

If you’re interested in living a longer and healthier life, I encourage you to read Outlive. More importantly, apply some of the lessons you’ll learn while reading it.  It’s a powerful book.  Powerful enough, perhaps, to change your life.

Outlive – The Science & Art of Longevity (Amazon Link – I’ll get a small commission at no charge to you if you order) was written by Peter Attia, MD, a medical doctor who has dedicated his life to finding the medical truths behind longevity.  He separates fact from fiction and provides a deeply researched and well-documented book on his findings.  It’s a bit of a heavy read, with a significant amount of medical terminology mixed in.  I found it manageable, however, and the medical explanations add validity to the concepts presented.

Attia is a longevity expert who focuses on prevention.  I love his concept of “Medicine 3.0,” where prevention becomes the priority versus the current “treatment” focus of the medical industry.  Attia refers to the current industry practice as “Medicine 2.0”, where the medical industry waits until someone has become sick before being treated (diabetes is a classic example).  It’s a visionary concept from a visionary doctor.

“Rethinking medicine to live better longer” is the book’s byline, and it’s a perfect summary of Attia’s approach.

Groundbreaking work, this.

If you’ve read enough, feel free to buy Outlive now (Amazon Affiliate link).  If you’d rather read my detailed review of the book, read on.

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Outlive – The Science & Art of Longevity

I struggle with how to summarize this book.  In my typical review, I’ll provide a chronological summary of the book’s content.  The truth is, there is simply too much information in this book to do that effectively.  If you don’t believe me, check out the Tweet that Roger Whitney (The Retirement Answer Man) sent after he’d read the book:

Outlive photo from Roger Whitney

In Roger’s weekly email, he made the following statement about Outline (bold emphasis added by me):

“Where to begin? This was the most highlighted and tagged book that I’ve ever read. Peter Attia is a physician with a lot of curiosity about extending our health, not just our longevity. The book’s first half is a lot of science, and the second half shares many practical tips. This book is helping me completely rethink how I approach my health.”

A powerful book, indeed.

Below I’ll provide a summary of the areas in Outlive that resonated with me.  Note there are significant elements of the book that I won’t address for the sake of simplicity.

Outlive Has A Unique “Flow”

Attia takes a unique approach to the flow of the book.  He argues that too many self-help books focus on the tactics without first thinking about your objectives and strategy.  He starts the book with a strong argument that we do medicine wrong (which outlines his objective for this book).

He encourages the medical industry to consider moving to Medicine 3.0, which focuses on proactive prevention rather than reactive treatment (the hallmark of Medicine 2.0).  Throughout the book, he shares the approach he uses with his patients, starting with extensive bloodwork and physiological testing he does with every patient.  His “Medicine 3.0” tests focus on things that Medicine 2.0 doesn’t consider, and it’s making a difference.  

I had my annual bloodwork done while reading the book, and I looked at the results with a far more discerning eye than I’ve done in the past.

One thing to point out:  the first half of the book is “heavy.”  It includes a lot of medical terminology and reads, at times, more like a textbook than a novel.  I encourage you to approach it as a challenge and work to understand it – you’ll find your effort rewarded when you get to the second half of the book, which focuses more on tactics. 

Lifespan Vs. Healthspan

Attia focuses on helping his patients achieve a long “Healthspan” vs. traditional medicines approach on Lifespan.  What good is a long life if you’re stuck in a wheelchair for your last 10 years? Attia’s approach seeks to resolve this conflict by increasing the odds that you’ll be as healthy as possible throughout the duration of your life.

I’ve always thought in terms of “healthspan,” but didn’t have a name for it until I read this book.

Focusing on doing the things you can do now to maximize your odds of a long “healthspan” should be a goal for each of us, and Attia’s book will help with both the thinking and the tactics required to meet this goal.

The Four Horseman

Attia explains that four key diseases are your real enemies, and modern medicine (2.0) has done little to weaken their effectiveness.  In fact, modern society has only strengthened their ability to negatively impact our healthspan (e.g., processed foods).  Focus on these four, and you’ll greatly increase your odds of a longer and healthier life.  The four are:

  • Metabolic Syndrome (e.g., Cholesterol, glucose, etc.) 
  • Heart Disease
  • Cancer
  • Alzheimer’s and Other Neurodegenerative Diseases

In Part II of the book, Attia dedicates 150 pages to the deadly four horseman.  He explains how they work, why our modern society actually makes them more potent, and steps we can take to reduce their effectiveness.  He gets down to the cellular level in explaining how they work and why his recommended actions work. 

Fascinating stuff that will motivate you to make some changes in your life.

Thinking Tactically

After laying out the facts, Attia dedicates the final 150 pages of Outlive to presenting his recommended tactics. Using the metaphor of your “Centenarian Decathlon” (a multi-faceted approach to increasing your Healthspan), he walks through a framework of principles that will make a difference in your life.  He dedicates a chapter to exercise, which seems obvious.  What isn’t so obvious, however, is why exercise should be considered “The Most Powerful Longevity Drug,” an argument made effectively by Attia.  An example comes from the following quote on page 217:

“More than any other tactical domain we discuss in this book, exercise has the greatest power to determine how you will live out the rest of your life.”

Powerful writing, that. 

More importantly, Attia gets into the details.  Strength training vs. cardio?  High-intensity cardio or longer periods of lower intensity?  What type of exercise should you pursue to have the maximum impact on improving your healthspan?  Why is V02 Max important, and what can you do to improve yours (or slow its inevitable decline)?  He had a chart in the book that impacted me so much I Googled the source and found this original source. I reached out to creator Jayson Gifford and received his permission to share the chart in today’s post:

why it's hard to run as we age

When I studied that chart, a light bulb went off in my mind.  NOW I understand why it’s so much harder for me to run at 60 years of age – my VO2 max is naturally declining and my body is less efficient in converting oxygen to fuel my physical activity.  Take a few minutes to study the chart – I found it to be one of the most impactful charts I’ve ever seen.  As we age, activities we once found easy consume a higher % of our VO2 capacity.  Finding a way to maintain a higher VO2 will make activities easier than if we do nothing and let aging’s natural progression run its course.

Attia continues the tactical approach with chapters on the importance of stability, nutrition, sleep, and emotional health.  His transparency on the personal challenges he’s faced on the emotional health front was raw and powerful.  He doesn’t just preach but rather shares his own personal struggles with refreshing honesty.

Three Changes I’ve Made Since Reading Outlive

This book will only improve your life if you actually apply some of the things you learn while reading it.  To demonstrate, I thought it appropriate to share three specific changes I’ve made as a result of Attia’s book:  

1. Embrace long, slow exercise:  I’ve always enjoyed swimming and hiking but felt they weren’t “hard enough” workouts.  My typical workouts (Spin and cross-fit/Weights, 3x per week) are high-intensity in nature, and I always feel good when I’ve put in a hard workout. 

Attia makes a strong argument, however, that our most effective exercises are actually of the long and slow variety since it’s only through this type of workout that our bodies learn to effectively convert stored fat into energy.  Since reading that section of the book, I’ve come to embrace my long swims.  It’s also made me feel less guilty about buying my e-MTB since the use of the e-motor on the hills keeps me in the sweet spot of a moderate heart rate where the fat-burning is maximized (instead of going anaerobic as I frequently did prior to having the e-boost).

 2. Add more protein to my diet:  Attia states that almost all of us under-consume protein, and our muscles deteriorate faster as a result.  Our muscle fiber inevitably deteriorates as we age, but adding protein to our diets can slow the process. I also learned the importance of “feeding” our muscles with protein after we work out.  I added strength training to my workout routines several years ago, but I never realized the value of refueling them with protein during the recovery period.  Based on his comments, I’ve added high-protein shakes to my recovery routine after weight-lifting exercises.   

3. Taking Fish Oil:  Attia recommends everyone take fish oil, especially if you have high triglycerides.  Mine are borderline, but I figured taking a daily supplement of fish oil is an easy addition and can’t do any harm. 

Two Opportunities To Improve Outlive

Medical terminology:  Attia credits co-author Bill Gifford for helping him simplify some of the medical terminology in the book.  Even with that, it’s a heavy read.  Given the general audience for whom this book is written, I’d have liked to have seen a bit more “layman definition” for some of the medical explanations given. It’s not a book you can read casually, but rather one in which you’ll find yourself concentrating hard to keep some of the terminology straight in your mind.  That said, it’s worth the effort.

Lack of specific actionable advice:  Attia is quick to explain that this is not a simple “quick fix” book.  He doesn’t recommend any specific diets or any specific exercise routines.  Rather, he focuses on principles and the biological implications of different sorts of tactics.  In fairness, he states early on that he won’t give detailed personal recommendations, and reading about the extensive tests he conducts with each of his patients before making recommendations gives you insight into his “why”.  While I understand his reasoning, I would have liked to have seen some additional tactical advice, perhaps with “conditional qualifiers” to explain what personal situations would warrant which tactics. 

Outlive – Conclusion

If you’re interested in maximizing your “healthspan” (healthy years of life), you should read Outlive – The Science & Art of Longevity (Amazing Link). Attia is a longevity expert and you will learn more than you’d imagine about the biological realities of aging, and what you can do to slow the process.  The value of his wisdom FAR exceeds the price of the book.

You’ll find yourself wanting to vote to move the medical industry into the world of “Medicine 3.0”, where the experts focus on prevention rather than waiting for a disease to present itself before focusing on treatment.  While that’s likely a long way off, the reality is you can apply a bit of “Medicine 3.0” by learning from this book and applying what you learn to your own life.  

At times, Outlive is a heavy read, but challenge yourself.  It’s worth the effort, and…

…your life will be better as a result.

PS – If you’d like another perspective on the book, check out this review from Chris Mamula at Can I Retire Yet.

Previous Book Reviews (Book images are Amazon affiliate links, the blue title is a link to my book review)

 Taking Stock

Reimagining Retirement

 Retirement Planning Guidebook

 Retirement Heaven or Hell

Growing Young

 Choose FI:  Your Blueprint to Financial Independence

Money For The Rest of Us

 The Simple Path To Wealth

 Younger Next Year


  1. Thank you for this recommendation! You may have inspired many of us to become healthier! What important work you do. I will enjoy the science behind the conclusions. A book I read entitled What Your Food Ate (David R Montgomery and Anne Bikle is a book I found informative about how important the hidden details can be to our health.

    1. Thanks for the suggestion of another book to read, Julie! And, if my words inspire even a few of my readers to focus on improving their health, I’ll consider it a success.

  2. Fritz – I have read this book three times (audio) and each time I pick up something new. As a fitness person who like to push myself it was good to hear that exercise is the one thing that’s guaranteed to help with health span and life span. Glad you latched onto this one and great review. I even bought and sent a copy to my internist. He’s really good at the medicine 3.0 concept.

    1. David, I enjoy tracking your on Strava – you’re a Beast! Thanks for reading my blog.

  3. Fritz, I’m glad you reviewed this treasure of a book. I have it in a prominent position in my home office for easy access and go to it often. I’ve been a fan of Peter Attia’s podcast for a couple years and it’s also a great resource.

  4. This is in my embarrassingly tall stack directly to my right along with countless others. I realized it would be heavy after watching some a Rich Roll/Attia podcast video, and would require time, dedication and concentration, but it sounds like I need to make the time rather than waiting for it to magically appear. Thanks for the nudge, Fritz.

    1. Jonathan, I had a similarly intimidating pile of books next to my bed for the first 3 years of my retirement. I stopped buying books for a while and finally whittled it down. Just bought 3 more books this week…pile is back. 😉

  5. I’ve been getting his emails for a while. Meds are for symptoms and doctors who understand health are rare. Take control of your heath and this book is a good start if you aren’t doing that. I swim 30 laps, 3-4 times a week using a swimmers snorkel so I don’t hurt my neck turning to breath. Light weights and stretch every day to correct your old man posture. Just lay flat.

    1. I’m intrigued by the swimmers snorkel. Have considered getting one, but I do all of my swimming in the beautiful open water of nearby Lake Blue Ridge, and I enjoy watching the mountains and trees go by. Neck’s holding up well so far, but still something I’m considering….

  6. I read the book when it first came out. I listen to his podcast and also Huberman Lab podcast. It is fantastic. I do more resistance work and eat more protein. I have always been healthy and want to stay that way. I work in healthcare and see the end results of the pandemic of metabolic disease; a slow and ugly death. Hurrah to Peter for writing this book and to you Fritz for spreading the word!
    Take ownership of your bodies and health every one!

    1. Thanks for your encouragement to the readers, Queenie. As one who works in healthcare, they should heed your advice!

  7. Hey Fritz,
    My kids’ swim team coach recommended this book to me. I’m about 90 pages in as of last night. Looking forward to the Four Horseman section and any tactics. At 48, it’s a good time to put the strategies to work (or a few years late).

    I’m also a swimmer and do about 2000 meters 2-3 times a week in the summer, but I struggle to keep it up the rest of the year. Swimming at least once a week between now and May is my new fitness goal. Also, a day of strength training. Hoping this book will inspire me to stick to the program.

    1. Craig, great to see you on my site, thanks for stopping by. You’re almost through the difficult part, it starts picking up speed in the second section. I hope it motivates you as much as it did me. I’m with you on being a “summer swimmer” – I only do open water swimming in our local lake, so my season is limited by my fortitude. Typically can stretch it from mid-April to early-November, though, so it’s not too bad. Good luck adding that strength training – I added it 3 years ago and have never felt better. Important step.

  8. Hey Fritz,
    Thanks, might have to check it out.

    Since you are interested in this area, have you watched “Live to 100: Secrets of the Blue Zones” (https://www.imdb.com/title/tt28523129/)?
    My takeaways are: MOVE! (pretty much anything except extended periods of sitting in seating with backrests), avoid all processed foods, moderation in all, and a positive outlook.

    We are very fortunate to live in a modern blue zone so hope some of the goodness rubs off on us!

    1. Joe, we actually had one of our Mastermind meetings on that book. I saw it’s now on Netflix, planning on watching it soon. Moving and eating right are, indeed, the keys.

  9. We’ve listened to Attia on various podcasts. It’s difficult not to find him overwhelming but you did a great job of giving a succinct overview of his recommendations.
    For women in particular, especially as we age, consuming more protein is high on the list. We lose bone density at a fast rate and conventionally we are not ingrained with the idea of lifting weights, which is needed for bone mass. Combine that with conventional doctors advising to eat more fiber we tend to shy away from protein and worry about the fat in protein foods which is actually good for us.

    1. Mrs G!! Thanks for stopping by and reiterating the importance of protein. It’s an element I completely missed until reading this book. Why am I not surprised you were aware of it before me? Nice chatting with you this week – looking forward to seeing you next Spring!

  10. Thanks, Fritz, for converting “all the flour into bread” for we the people to eat! The one difference we made regarding point #3 is to use Krill Oil & not fish oil. Dr Mercola has shown that fish oil processing only allows about 20% absorption. Krill oil has a much greater uptake of Omega 3s & they don’t absorb toxins as much from the sea. Happy Trails!

    1. “Flour into bread”…I like that. Thanks for the tip on Krill Oil. First I’ve heard of it, but will definitely be checking it out.

  11. Nice review Fritz, I’ve been along on the ride with Attia since he started his podcast many years ago and have literally listened to every single one. Some of the very heavily detailed ones get very technical and complex but I always learn something. Our country is very sick, the obesity crisis is creating depression and chronic disease at an alarming and increasing rate. The deck is stacked against us with a food industry only interested in addicting us to processed junk, and a pharma industry that secretly doesn’t mind us being sick at all as it pads their pockets. Throw on top of that our modern sedentary knowledge-jobs that have us sitting still all day and a screen culture that tempts us to do the same even when we’re not working and the whole thing is leading to a predictable health disaster.

    As you know, I write about health a lot. I was obese most of my life. Now in my 50’s I’m a thin, fit, age-group athlete who actually competes in races and sometimes gets results (or even a win here and there). If I changed my life that drastically – trust me, anyone can, of course unless they have a physical disability that prevents them from exercising. So if you’re reading this and you think your current condition is what you’re stuck worth because of genetics, that’s not true. You CAN change. I’m not gonna blow smoke up your ass and say it’s easy, it’s not. But with work and discipline and a faith that it can be done, you can do it.

    1. Great comment, Dave. I’ve been inspired by your story (and your writing), and suspect many others have been, as well. Thanks for setting an example for all of us! It’s desperately needed in our insanely unhealthy society today.

  12. I have been following Peter for awhile via Tim Ferriss and his work with medicine 3.0 is “spot on” more preventative measures vs “fix it when it breaks” approach of current western medical practice. I jumped on the book when it got released (since the book is a less expensive option vs his concierge doctor fees). The upside is he will change his mind and direction on protocols if there is no appreciable upside.

    1. Thanks for the additional insight on Attia. I’d heard of him, but this was the first work of his that I consumed. May have to check out his podcast, I’ve heard good things (tho, in reality, I seldom listen to podcasts anymore now that I’m retired an no longer have those 3 hours of daily commuting – thank God!)

  13. I have listened to several podcasters who have interviewed Peter including Tim Ferris and Rich Roll. I love listening to his ideas and instruction. I have been on the fence about buying the book but did it while reading your review. I will be 70 in December and started working with a trainer/nutritionist a few months ago who has embraced Peter’s ideas and it has made a positive impact on my mind and body. I have been a half marathoner for many years and have knocked 10 pounds off which has helped me improve my running. I have never really done upper body work or strength training and after listening to Peter now understand how important it is in my older age. Thanks for pushing me over the edge to buy the book so I can better understand how to improve my journey to 100.

    1. Roy, I, like you, have been a lifelong runner (Marathon PR 3:56). I’ve changed since retirement and now focus on a much broader selection of workouts (Spin, open water swimming, mountain bike, hiking, cross-fit, weights and the occassional run). I can totally relate to your comment about not doing upper body work or strength training – I was the same for 25 years. Since adding weights and cross-fit to my routine, I feel better at age 60 than at any point in my life. Lift some weights, Roy. You won’t regret it.

  14. Fritz,

    Thank you for the spot on review. I have read Peter’s book. At times, I was overwhelmed with the medical details. With that said I have upped my protein and weight lifting. One thing he recommended in the book was hormone replacement therapy for women to mitigate bone density loss. I spoke to my doctor and have started down this path.

    I love other readers tips on rereading the book to get more take always!

  15. Hi Fritz —

    Thanks for reviewing. It’s an amazing book. It’s important to note that most of the important things we can do for our health are free — pay attention to what we eat, and exercise. I have a community membership at the college which is $300 per year, but that’s a convenience, not a necessity. We are in charge of our health and in many instances the medical profession is lagging behind, trying (or not) to keep up. It’s our job to take care of ourselves.

  16. Fritz, I have been reading through your blog and picked up a copy of your book. Great work and inspirational! Looking forward to the Longevity journey with you 🙂

  17. I was never the hit the gym or heavy on any weight training program. I did ride the train, bus, bike, & walk to work for the about 20 years. After retirement 2 years ago I lost my daily routine and went downhill with no energy. Today I have made it a point to get on the stair machine or walk 30 min. 6 days a week. what a difference a little change can make.

  18. Fritz, I love your periodic encouragements to focus on health as part of a happy retirement. A financial plan is essential, but as we know, money can’t buy health. I commented last year, after one of your fitness focused posts, that the pandemic and sudden forced (but welcomed) retirement knocked me out of a well established, effortless fitness routine of going to my corporate gym M-F and socially square dancing on weekends. This year I slowly made my way back to a local Y, and resumed dancing at various places throughout the week. A bonus is have extra time in retirement access to a pool to swim! . Thank you for your encouragement last year. I now know how hard it can be to start, or in my case, resume a fitness routine. I am so happy to be back in mine and wish it for everyone. For me, surrounding myself with people who are also pursuing health has been key.

  19. Fritz
    I have listened to Peter for awhile, also love the sessions with Beth.
    Somedays due to other priorities: children, marriage, house work…. staying on the program is a struggle.

    Being educated and having common sense, I sometimes thing I must be crazy not making my fitness a higher priority.

    Any executive pieces of advice to turn the corner?

    Thanks G

  20. Hi Fritz
    Appreciate the review of Outlive. Noticed your comments on taking fish oil. Suggest you dig deeply into the research. Fish oil has conflicting clinical trials for effectiveness and limited scientific evidence for stated health claims. Fish oil can be harmful. Fish appear to be the most significant source of human exposure to industrial pollutants such as alkylphenol xenoestrogens, PCBs, pesticides , etc. Here’s a link to help get you started. https://nutritionfacts.org/topics/fish-oil/

    Also here’s an another link about the background of Nutritionfacts.org. https://nutritionfacts.org/about/

    Happy Health

  21. Great post Fritz, glad you made it back from your travels! Looks like a great book, I’ve been interested in this topic of late because I’ve been watching a Netflix Series called ‘Living to 100, Secrets of the Blue Zones’, it’s a fantastic show studying how Centenarians live their lives in different parts of the world. It’s fascinating, in these ‘Blue Zones’, such as Greece and Japan, they have very very low instances of Diabetes and Alzheimer’s and its attributed to them working in gardens, eating non-processed food and walking everywhere. Great stuff! Thanks for sharing the book, I will look into reading it!

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