Outlive: The Science and Art of Longevity

In Outlive, Peter Attia presents, without hyperbole, an ambitious yet actionable and evidence-informed strategy to dramatically minimize the risk and burden of the chronic diseases that rob us of vitality as we age and ultimately end our lives. Amidst a vast wasteland of books on health, is this one any different? In a word, very. There are two reasons why. First, Attia’s knowledge base is unparalleled. He graciously attributes this to the all-star line-up of experts in cardiology, lipidology, oncology, neurology, psychiatry, endocrinology, biochemistry, nutrition, exercise physiology, etc. who’ve tutored him over the years, and whose expertise is shared generously on his podcast. The depth of his dives with them and his fluency in each specialty are extraordinary. But Peter’s superpower is not simply the intellect to master the nuances of each niche. It’s that, plus the broad perspective to integrate that knowledge into the grand landscape of human health—to see the forest and the trees. It’s a rare alchemy of assets: the breadth of a primary care physician, the depth of a specialist, the granularity of a laboratory scientist, and the heart of a teacher. That is Peter Attia. Second, Outlive stands uniquely poised to do what others have not: transform healthcare. Not simply because his tactics for longevity are cutting edge and informed by the best science available—and they surely are. And not because those tactics won’t evolve as science progresses—for they surely will. No, Attia’s contribution will endure because his strategy is as timeless as it is revolutionary, and it will remain relevant as long as our objective is the extension of human health and lifespan. Medicine 2.0, as he calls it, is the conventional paradigm, the model I learned in medical school. It served us well when infection was our greatest threat, and still does against acute disease or trauma. But today’s top killers are chronic diseases that exploit the one factor current treatment paradigms neglect: time. Heart disease, cancer, dementia, and metabolic disease mock our feeble 9th inning attempts to medicate them away after an eight-inning head start. To put more than a modest dent in their devastation, Attia argues, we must attack from the other end of the timeline, long before these diseases manifest clinically—before the game even begins. This is Medicine 3.0, and it truly is revolutionary. To be clear, Outlive is not another sensational anti-establishment exposé on the failures, lies, and corruption of mainstream medicine. Rather, it graciously acknowledges Medicine 2.0’s success. But, noting its inadequacy against modern diseases, Attia has cleverly “back-casted” and reverse engineered a new strategy forward—and it is brilliant. If we do achieve significant improvement in human health and longevity, absent some miraculous sci-fi discovery, it will be because we followed the strategies presented in Outlive, even if its tactics are refined over time. This book is important. It’s carefully compiled, meticulously fact-checked, thoughtfully organized, and masterfully presented. It’s cutting edge, yet careful in its claims. Passionate, yet explicitly non-dogmatic. Deeply personal, yet rigorously clinical. Speaking of personal, I must comment on the final chapter. Those of us who consider Peter superhuman may be surprised—and relieved, perhaps—to learn that he battles the same insecurities and weakness that beset the rest of us mortals. His candid account of recent struggles with emotional health is as inspiring as it is moving and provides precious layers of meaning and perspective to all that comes before it. If chapters 1 through 16 are the how, chapter 17 is the why. Whether serendipitous or providential, that his crisis manifested in time to consummate the finished project is fortuitous for us, as it changes the entire work in a compelling—and beautiful—way. Since discovering The Drive in 2018, I’ve considered Attia’s podcast the most comprehensive and reliable resource for all things health and longevity. It changed the way I live, and how I practice medicine. Going forward, Outlive will be my primary textbook. Thank you, Peter.

I first learned about Dr. Attia through watching the series 'Limitless.' I found the series to be extremely inspiring, and ultimately life-changing. I then stumbled across a Youtube clip where someone was discussing this book, which led to my purchase of it. It is a very thick book with which I took my time reading, in chunks. (I did not read the last two sections on sleep and emotional health). I read through some of the 1 and 2 star reviews on Goodreads. Many mentioned that the book could be significantly shorter and that they did not like all of the personal stories that Dr. Attia shared. However, I found each of the stories to be quite helpful in putting the information into context. And I think the overall intent of this book was/is two-fold. It was not only written to present 'information,' but also Dr. Attia's personal testament of his journey as he learned new things, changed his perspectives, struggles in life, etc. The addition of this deeply intimate information helps to make the book more personable versus cold and mechanic. And who knows, writing this book may have also provided Dr. Attia with some degree of inner peace and resolution. What is so wrong with that? There are many focal points of this book, but for this book review, I will address what I find to be key take away points, and my perspective of those points discussed by Dr. Attia. READABIITY: Some parts of the book could be difficult for people to understand if they do not have a medical background, fortunately I do. For those who do not, and really want to understand, have Internet access handy so that you can cross-reference between the Internet and the book as you go along. NOTE: There are many parts of the book where animal research studies are discussed. I must preface that I struggle reading about animal studies, as I am anti-animal testing activist. But I do understand why the studies are mentioned in the book. PHILOSOPHY: Dr. Attia makes several comparisons between Medicine 2.0 and Medicine 3.0. I think many Primary Care providers who read and subsequently reviewed this book may have felt offended by Dr. Attia's views on what he describes as our current healthcare model (Medicine 2.0). However, Dr. Attia is not pointing fingers and intending to insult Primary Care providers. He is simply pointing out flaws in our current healthcare model and how it should shift to a different focus, which I 100% agree with! For those who chose to be insulted by this, shame on you. If you are a Primary Care provider, it is also not your fault that your practice is based upon Medicine 2.0, as you have to operate within the restrictive system and in accordance with insurance coverage. Embrace the Medicine 3.0 philosophy and save it for the day when, perhaps, our current healthcare model will shift closer to it. Everyone will be better off for it. PREVENTATIVE TESTS: I found it odd when a reviewer mentioned that they know many adults who lived to old ages without any fancy tests. That is a strange thing to write, because Dr. Attia does NOT imply that having a bunch of tests contributes to living longer or healthier. Conversely, he implies that having preventative tests provides knowledge of one's current health state. That knowledge can then enable people to make changes that can contribute to living longer and healthier versus being a ticking time bomb and continuing on the same physiological path. How that reviewer misconstrued these two vastly different concepts is beyond me. This reviewer continued on to say that these seniors also smoked, drank, ate what they wanted, etc. However, I cannot help but wonder about their quality of life, and whether they were active and enjoy(ed) pursing hobbies/interests OR if they were simply 'existing' as couch potatoes. These are two vastly different concepts, and is the focal point that Dr. Attia expresses throughout the book. On another note, Dr. Attia describes the perfect world where everyone has access to a plethora of preventative tests. Many of these preventative tests (scans, blood, etc.) are not covered by typical insurance plans, which means people have to pay out of pocket for them. I do plan to have most of the screening tests done that he recommends, because I want that in-depth knowledge of my current health state. However, doing all of these are just out of reach for many, or until patients reach a certain age (DEXA scan, for example). MACRO NUTRITION: As many others mentioned, I do not think that any new/novel information about macro nutrition was presented. Some reviewers got the impression that Dr. Attia is pro-Keto diet. But I did not infer that at all. Conversely, I thought Dr. Attia did a great job with pointing out key advantages and disadvantages of many different types of diets, not just Keto. And I think he made it quite clear that no one type of nutrition regimen/approach is going to work for everyone. This point was made quite clear when he discussed his friend/patient (the Lipidologist) who benefited from a fasting regimen. I also think he did a good job explaining how different macro nutrients affect the body in an easy to understand fashion. I particularly found the information about Fructose and Purine quite interesting. EXERCISE: It was made abundantly clear that Dr. Attia believes that exercise is the foundation for good health, which I agree with! He describes, in detail, how exercise is the best preventative tool for the "Horsemen." Yes, it makes good sense: Exercise = improved blood flow = improved perfusion AND = building and/or maintenance of muscle tissue and maintenance of bone = potential reduced risk for the "Horseman." But in reality, is it really THAT simple? I do not think so. There are so many other factors that come into play. Additionally, what is disheartening, and what other reviewers found discouraging about this, is how complex Dr. Attia makes exercise out to be. While I agree with the benefits of all the different types of exercises he discusses, I also think it is unrealistic for many people to achieve all of it in it's entirety. Again, it comes back to the perfect world where there are no life-stressors, no major time consuming life-demands, not having to work a full-time job, etc. For example, let's talk about a rich celebrity who is one of Dr, Attia's patients: Chris Hemsworth. I am not criticizing or picking on Mr. Hemsworth. Below is just a great example that helps my point hit home here. Does he work a 40-hour week desk job, staring at a computer all day? No. Is he on his feet all day working at a store helping customers? No. Does he come home from that job, after a commute, and have to try to squeeze in a workout? No. Does he have personal trainers and nutritional coaches? Yes. Does he have plenty of time most days to exercise and enjoy leisurely activities? Yes. Is his job as an actor focused on being physically fit? Yes. Is he able to wake up naturally most days instead of being blasted awake by an alarm clock? Yes. Does he have plenty of income to not have to worry about paying the bills? Yes. This is the perfect world that Dr. Attia describes. Not everyone has enough time in the day to devote to exercising like Dr. Attia believes is necessary. I am a poly-outdoorsman, and I am an endurance (non-professional) athlete. I would love nothing more than to have the amazing opportunity to devote as much time as I want to exercise and my outdoor sports versus working a full-time job. However, that is not my reality despite how much I would like it to be. For most people who live in the real world, doing some exercise each day/week just has to be enough because that's all they can do. So to even remotely imply that that amount just isn't enough to obtain a long, healthy lifespan is quite sad. This is where the notion of 'weekend warriors' comes into play. For some, weekends are the only time that people have to exercise and/or recreate in the outdoors. This pattern does not align with Dr Attia's ideology, but doing something on the weekends is better than doing nothing at all. What I do think readers can benefit and take away from this section of the book is to, perhaps, incorporate different exercises into their daily/weekly regimen that they may not have thought of. This is key! For myself, I have now incorporated new things into my exercise regimen because I have a better understanding of how they can have a long-term impact. FINAL THOUGHTS: This is not a concrete book of science. It is a book that discusses some scientific information combined with Dr. Attia's life-experiences. I think it is a well-rounded book because of this. Take whatever information you found useful and run with it! Be as active as you possibly can each day/week, keep your body trim, and feed it with good nutrition. For us "Commoners," that is the best we can do.

Dr. Peter Attia has written a valuable treatise on a fundamental failure of our healthcare system: We have built a system designed primarily to treat illness rather than prevent it. Medicine 2.0, as Attia calls it, is largely reactive. It focuses on treating us once we become ill or develop chronic disease. Neither conventional medical protocols nor the payment systems that support them devote enough attention to preventing disease in the first place. Medicine 3.0, he argues, is the answer. Outlive is packed with practical guidance on how to eat, exercise, sleep, and maintain our mental health, all with the goal of extending not just our lifespan but our healthspan—the years we remain healthy, active, and vital. Medical professionals I’ve spoken with about the book generally agree that Attia is on the right track. Each section begins with one or more stories designed to illustrate his thesis. Many are personal, giving the book a confessional quality. The chapters that follow are packed with data, guidelines, and lessons for maintaining health well into our senior years. I’ve already incorporated much of what he recommends into my own routines. I have two criticisms. First, Attia relies heavily on stories to make his points. Stories can be effective teaching tools, but there are simply too many of them. They make an already substantial book longer than necessary and, at times, obscure rather than clarify the ideas he is trying to convey. That leads to my second criticism: the book’s most useful material—the data, recommendations, and practical “how-tos”—is scattered throughout lengthy, discursive chapters. Even when the advice is sound, the way it is presented makes it difficult to absorb, organize, and recall. If half the stories were eliminated, this roughly 400-page tome could probably be reduced to something closer to 250 pages without sacrificing much of its substance. Better yet, I would like to see a concise 200-page version—or even a 50-page companion guide—that distills the book’s key principles and recommendations into something readers can easily consult and use. Despite these shortcomings, Outlive succeeds at something important: It makes a compelling case that staying healthy requires a more proactive approach than simply waiting for disease to appear and then treating it. The ideas are worth knowing. I just wish they were easier to find and remember.

This is one of the best books I have read. to help me understand my own choices that will affect my health for years to come. I am a doctor myself, but Dr. Attia has a way of explaining things and tying them together that made the book fun to read and great to understand the big picture.

It was very engaging for me, the first chapters recalled a favorite quip of a colleague, “I’m in violent agreement with you!”. The personal examples were very illuminating, especially one’s not fitting into the standard narrative for treatments and outcomes. Technically this review is for the spiral bound version; I have bought the kindle version also for review and markup, and copies of the standard hardcover given as gifts to physicians and others. So, I’m an enthusiast. But I also want to point out that like many other advocates of new approaches for improved health under the span of the longevity curve, there is a certain element of Rudyard Kiplings “The Blind men and the elephant” which I feel compelled to comment on, as to me it seems there is missing information based to some extent on the combination of who and how modern medical training is implemented, and in some cases a clear lack of knowledge of detailed knowledge of nutritional fundamentals and their relationship to specific chronic diseases. An interesting personal example Dr. Attia relates is with regards to the wife of a very close friend of his, whose wife had been diagnosed with breast cancer that had spread to the lymph nodes, and had enrolled in a trial site for a special investigative treatment project. Every other patient enrolled in this project died, except her… why? Well, she alone had investigated and read everything she could find about the impact of nutrition on cancer, and put together a diet which optimized the nutrition for her body, not for her cancer, and which kept insulin and blood glucose levels low, and eliminated added sugar and all refined carbohydrates. This success on her part was noted, but not really followed up on and not investigated by the authors of the study, and the follow up report hardly discussed metabolism and metabolic therapies at all. Now, to me, that is rather curious, and perhaps indicative of a lack of historical perspective- for example, possibly no knowledge of the research conducted by Dr. Ewan MacGregor in England in the 1980s which focused on nutrition and orthomolecular vitamin support for the body, and against the cancer, and on breast cancer patients deemed “untreatable” greatly extended the duration of life and quality of life compared with the control group. For me, this is a personal point, given my wife’s older daughter’s recurrence of hormone positive breast cancer after 4 years at simultaneous stage IV since the last MRI check six month earlier. On a more personal note, after having an unusual form of heart attack (presenting in the manner it most often does for women) on a return flight from business, and discovering at a pre surgical EKG that I now had an inverted spike on my T-wave, indicative of a right bundle branch block, I started investigating the likely prognosis as well as metabolic contributors. Dr. Attia notes how difficult it can be to ascertain early stage development of arterial plaque well before an actual cardiac event, but seems unfamiliar with some past research. Humans are primates, and like other primates, must ingest all the vitamin C needed, because unlike most other animals, we don’t make it in our liver. Hmmm, how much vitamin C should we ingest? Animal studies show how the typical range of generation is on the order of 20-40 mg/kg of body mass- though some, like goats, are much higher, and the presence of any pathologies, like an infection or injury to heal, raises it substantially. Yet, the official RDA amounts to about 1.2 mg/kg of vitamin C, just enough to prevent frank scurvy. When I questioned my wife’s cardiologist on this topic, or my own primary care doctor, they had no idea what was normal and necessary to support healthy bodily function for healing and fighting infectious disease. There was a paper addressing this topic, specifically for the prevention of heart disease, published by Dr. Matthias Rath and Linus Pauling back in 1992, using vitamin C and two amino acids. I’ve been using it for about 20 years. I gift our doctors interesting books- most recently Dr. Attia’s book last October, along with one describing the therapy for prevention of heart disease. . I think my doctor took that as a challenge, as he then ordered an Electrocardiogram with Iodine flow, the gold standard for evaluating basic heart issues related to blood vessel function and overall heart behavior. This is not ordered normally, unless there are functional symptoms in the patient like angina, shortness of breath, other symptomatic issues pointing to some degree of heart failure- issues I do not have. Results came back as I expected, but probably not as he expected for someone in their mid seventies. No arteriosclerosis or evidence of plaque or calcification, all chambers of normal size and function. All of my friends of my age have significant issues, and have stents, blood thinners, and in one case a pacemaker. Bottom line? Buy and read this excellent book, but don’t stop there- expand your knowledge so that you can be the advocate and practitioner for your own continued good health and that of loved ones.

Just spent the first 2 hours skimming and appreciating his thorough and compreshensive book. Have excellent health at 86. Now I am working up a compreshensive program for the rest of my life. Most people think I am 15 to 20 years younger. I take only one prescription drug, NP Thyroid, 120 mg/day, thanks to removing 1/2 of a thyroid lobe about 35 years ago. But, I take a ton of supplements, including Catalyn and Cardio Plus, from Standard Process. Their food based supplements are probably some of the best in the US. Tending to my wife the last 2 years as she went down hill, I neglected my health (unnecessarily). But, now that she is gone, I can focus on me. I want to become the healthiest I possibly can, by returning to bike riding, weight lifting and table tennis. But, this is where Dr. Attia comes in. With his amazing background is various rigorous training programs and exceptional results, he has a personal perspective that few , if any, other authors can match. With 482 pages, including a much appreicated index, he expands on a lot of studies and info, allowing the reader to make their own decisions. I am not concerned at all about my lifespan, but very concerned about my healthspan. I see too many people using walkers, and barely alive, unable to "enjoy life." If I can't continue to enjoy life, I don't want to be here. Last November, I started a table tennis group at the local senior center. As Dr. Attia points out, it is up to me to control my destiny. About 5 years ago, my DEXA scan put me in the top 1%, for my age. That's thanks to weight lifting, on and off, since high school. Wonder where I am now? His emphasis on exercise, and how to do it, is worth the price of the book alone. Everything else just adds to the value of the book. My intention is to modify the Keto Diet, that I started on January 1st this year, and focus on the valuable "essential" health issues. Keto is unnecessarily restrictive. Dr. Steven Gundry's book: "Unlocking the Keto Code," dispells a lot of false Keto restrictions. I highly recommend both Gundry's and Attia's books. Outlive may get into the top 5 health books that I have purchased in the last 20 years. And there have been over 100. I hope to update this review as the months roll by. Hopefully, by this Christmas, I will be way ahead of where I am now, and can add more useful information. I started and ran a heath club, "Achieve Better Health Club, for over 7 years in The Villages, Florida. I was able to watch, and help, many people improve their quality of life, by making even simple changes in their life style. So can you! OUTLIVE will help. Good luck, and YOU COME FIRST.

I am a retired Ph.D. scientist and consider myself reasonably well-informed. I have been a long-time subscriber to resources like the Harvard, Mayo Clinic, and UC Berkeley health newsletters. Nevertheless, I learned a lot of new items in every chapter of this book. Dr. Attia and Mr. Gifford present information that many physicians will mention partially, briefly, and often in an almost offhand manner, but the authors of this book make a far more compelling and motivating case for changing one’s approach to living a healthy life. Read it! You will not regret doing so! I also think that the recent negative publicity regarding Dr. Attia’s contacts with Jeffrey Epstein is regrettably overshadowing Dr. Attia’s important work to help so many people. A number of these attacks seem to come from influencers who are trying to boost their own viewership. For example, after Dr. Attia posted his side of the story on X, the very first comment to his post on X came in the form of an attack from Dr. Eric Topol, a respected scientist. Going to Dr. Topol’s X page he has a pinned post promoting his own more recently published book on longevity. Even more curiously, one of Dr. Topol’s previous Youtube podcasts had high praise for Dr. Attia’s book and work. Even later in the podcast when Topol asked Attia questions on some points in the book that are controversial, like the use of full body MRI scans for early cancer detection, Topol accepted and did not push back against Attia’s answers. Topol’s change of heart on X seems rather suspect under the current circumstances. I could also cite other writers in the NY Times and The Atlantic who also appear to be piling on to this sad scrum without doing much detailed reporting for their articles. Those articles clearly show limited familiarity with Dr. Attia’s work. I sincerely hope that this intense badgering does not deter Dr. Attia from his very important work on his website and podcasts where he and his staff provide ongoing higher quality discussions of research on chronic diseases and longevity that are accessible to the educated public. The latest “judicial” practice in this country is to combine the judge, jury, and executioner all into one. People are rightly decrying this practice in Minnesota and then are turning around and committing it in reviews here. Many examples I have seen contain or repeat incorrect or vague “evidence” which have other possible interpretations. In the America that I grew up in, our shared ideal used to be that people were presumed innocent until they were convicted in a court of law. This ideal was upheld because “facts” do not always turn out to mean what they are initially thought to portray. The concept of challenges and cross examination must be allowed to occur before rushing to judgment. Hopefully our country is not succumbing to lynch mob rule, but what I see here in these reviews strongly suggests that it is.

Good high level information for healthy longevity. No real specific details for diet or exercise, but the material can definitely inspire you to dig deeper into your personal health journey. The point of monitoring 5 main metabolic characteristics is well taken, even for young adults. Start early, and don’t wait until your personal physician makes note of your pre-syndrome symptoms, and then still ignores taking action until symptoms become medically treatable. This is the difference the author makes in medicine 1.0 and 2.0. Good read, but only scratches the surface.

The book is great and very well written. After I finished, I started implementing many of the ideas that the authors writes about. It's more than one year now that I'm following several daily routines that have been sparked from the ideas contained in this book, and I feel that my health is improved greatly. Longevity is still a quest and not an already full known science, that's why the author has his own ideas and preferences that may be different from those of others scientists; but if you read different books and follow other longevity experts and doctors, you will find many of the same concepts expressed in this book, and for me this was good consistency check. One of my favorite books of all time, I cannot recommend it enough.

This is an immensely well researched book on all the variables to maintain your health as you age. Peter Attia explains in a layman manner for us non-medical language to make it easier to grasp. He’s done his research on exercise, nutrition, sleep, mental health, and medicine / supplements with global experts in those fields. I have learnt a lot and implemented many things from this book, which have resulted in better blood biomarkers, sleep, and overall energy / performance levels. This book will really change your life if you’re serious about your health. Buy a copy for yourself and your loved ones.

One of the best books I’ve read about health and prevention, based in real science.

En tant que médecin, j’ai trouvé “Outlive: The Science and Art of Longevity” particulièrement pertinent. Ce livre offre un mélange parfait de recherche scientifique et de conseils pratiques, fournissant des stratégies éprouvées pour un mode de vie sain. Il rend la science de la longévité accessible et applicable, enrichissant à la fois ma pratique professionnelle et mon bien-être personnel. Hautement recommandé pour les professionnels de santé et toute personne intéressée par une vie plus longue et plus saine.

It is one of those books with the potential to change your lifestyle, to achieve longevity with quality of life. Maybe we already know some things we should do or avoid to escape the diseases that cause the most deaths. However, the author exposes, with the necessary clarity for the layman, which does not make it a useful book for specialists as well, the fundamentals of each attitude. I really liked the part that addresses physical exercises, emphasizing strength, aiming to improve what we will need in old age. Also highlight the importance of sleep and mental health and eating protein. Pleasant reading. Very well written. I recommend it for all people.