Is life worth living if we're too broken to enjoy it? That's the main question I asked myself while reading Outlive by Peter Attia, a manual on adding not just years to life but life to years.
Disclaimer: I'm not a doctor. These notes are some actionable key points (probably with plenty of mistakes). Use them as prompts for further reading and discussion, not prescriptions.
Medicine 3.0
Medicine 2.0 patches acute problems after they explode (stents, chemo, dialysis). Medicine 3.0 asks: How do we shrink risk decades before disease shows up?
It leans on five pillars:
- Exercise
- Nutrition
- Sleep
- Emotional health & relationships
- Exogenous molecules (meds & supplements)
If it can't be measured, it can't be improved. Track what matters and iterate.
Key Markers (some, not all)
Insulin
Hormone that escorts glucose out of the blood. Chronically high levels signal insulin resistance → diabetes, heart disease, Alzheimer's, some cancers.
Glucose
Simple sugar that fuels cells. Frequent spikes & high averages accelerate vascular and nerve damage.
Triglycerides
Circulating blood fats. High numbers (≥150 mg/dL) track with insulin resistance.
HDL
"Good" cholesterol that ferries fats back to the liver. Higher is protective. TG:HDL < 1 ≈ metabolically healthy.
Lp(a)
Sticky, hereditary variant of LDL. High levels triple heart-attack and stroke risk—test it once.
VO₂ max
Max oxygen you can use at full tilt. Higher ceiling = lower all-cause mortality.
The Four Horsemen of Death
Horseman #1 — Metabolic Dysfunction
A spectrum from insulin resistance to type 2 diabetes. Wreaks havoc on blood vessels, feeds cancer cells, and accelerates brain decline.
- Insulin is the early alarm—aim for fasting insulin < 8 µIU/mL.
- You can be lean and still metabolically broken—check TG:HDL and uric acid.
- Do: Walk after meals, lift weights, cut liquid sugar, favor protein + fibrous plants, cut fructose.
Horseman #2 — Cardiovascular Disease
Atherosclerotic Cardiovascular Disease (ASCVD): Plaque building up in arteries. Eventually blocks blood flow to heart, brain, limbs.
- ApoB out-predicts LDL-C—Attia targets < 50 mg/dL; "childhood levels" (~30 mg/dL) are the moon-shot.
- Lp(a): If it's high, be extra aggressive on ApoB and blood pressure.
- Do: Zone 2 cardio, VO₂-max intervals, strength, blood-pressure control, ApoB lowering (diet → statins → PCSK9).
Horseman #3 — Cancer
Cells that refuse to stop dividing. Competes for nutrients, evades the immune system, and invades organs.
- Cancer loves inflammation and hyper-insulinemia.
- Do: Fix metabolism, minimize smoking/UV/alcohol, get screened on time (colonoscopy, PSA, low-dose CT, mammogram), and act fast on flags.
Horseman #4 — Neurodegeneration
Gradual loss of neurons (Alzheimer's, Parkinson's). Steals memory, mobility, independence.
- Everything that protects the heart protects the brain—plus skill learning.
- Do: Cardio + resistance + balance work, superb sleep, oral hygiene, continuous learning & social engagement.
Beat them by stacking small edges early—think decades, not months.
Exercise - Building the "Centenarian Decathlon" Body
Exercise is the single most powerful, controllable lever against all four horsemen. Attia frames it as training for the "Centenarian Decathlon"—10 movements you want to perform at 100 (carry groceries, get off the floor, climb stairs, etc.).
Zone 2 cardio
- Mitochondrial density, fat oxidation, insulin sensitivity, drops resting heart rate
- 180 minutes per week minimum. Example: 4 × 45 min brisk cycling/running at a "can talk, can't sing" pace
VO₂ max intervals
- Heart stroke volume, ventilatory capacity, anti-frailty
- 1 session per week (4-6 × 4 min hard / 4 min easy)
Strength
- Muscle mass, bone density, insulin sensitivity.
- 2-3 full-body sessions per week. Target: squat, hinge, press, pull, carry and grip strength. Use reps you can control; chase perfect form, not ego weight.
Stability/Mobility
- Joint integrity, fall prevention (public enemy #1 after 70)
- 10 min daily (dynamic warm-ups, single-leg balance, thoracic rotation, hip/ankle mobility)
Why so much Zone 2? Heart disease risk drops sharply as VO₂ max rises, and the easiest way to raise VO₂ max for most adults is accumulating plenty of steady, sub-lactate work.
Nutrition — More Than a Macro Checklist
Energy Balance
Calories still count. Chronic surplus → fat gain → insulin resistance.
Protein Priority
≥ 1 g per lb of body-weight (2.2 g/kg) split over ≥3 meals keeps muscle protein synthesis humming, blunts glucose spikes, and increases satiety.
Carb Quality & Timing
- Glycemic Index (GI): Measures how quickly a food raises blood sugar levels
- Favor low-GI carbs (fruit, legumes, tubers).
- Front-load carbs around training or earlier in the day for better glycemic control.
- Post-meal walk = cheapest glucose-lowering drug.
Fats—Type Beats Amount
- Extra-virgin olive oil, avocados, fatty fish: anti-inflammatory.
- Limit industrial seed oils (omega-6 overload).
- Keep trans-fats at zero.
Micronutrients & Electrolytes
Eat the rainbow, salt to taste (if blood pressure is normal), and consider vitamin D + magnesium if labs show a gap.
Alcohol & Longevity
- Zero drinks is better.
- If for some reason you need to drink, target <7 drinks/week and <2 drinks/day.
- Ethanol nukes sleep, spikes cancer risk, and torches VO₂ max adaptations.
Sleep Rules of Thumb
Good sleep is non-negotiable brain-wash and hormone reset.
- 8 h sleep opportunity (include time spent falling asleep)
- Aim for the same bedtime seven days a week
- Room ≈ 18 °C (65 °F), < 35 dB noise, blackout dark.
- Last meal ≥ 3 h pre-bed.
- Caffeine curfew: 1 p.m.; Alcohol: 6 p.m. max. Again, zero is better.
- Digital sunset: screens off 2 h pre-bed.
Emotional Health
Loneliness and chronic stress upregulate cortisol, drive inflammation, and shorten telomeres. The fix is social fitness: nurture real friendships, pursue therapy or meditation as needed, and get sunlight + nature.
Track & Tweak
Twice-yearly lab panel: ApoB, Lp(a) (once), fasting insulin, hs-CRP, HbA1c, homocysteine, uric acid, CMP, CBC, thyroid. Pair with DXA or InBody scan plus a VO₂ max test annually. Adjust training, diet, or meds based on the numbers.
I encourage you to grab Outlive for the full context (and proper medical nuance). See you at the finish line.