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Outlive by Peter Attia	2024-10-23	2024-10-23		book	book	Outlive	Peter Attia	read

Outlive by Peter Attia

• 🏷️Tags : #10-2024 #book

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Summary

[!summary] Summary 3 Sentences only!

• What are the main ideas?
• If I implemented one idea from this book right now, which one would it be?
• How would I describe the book to someone else?

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Ideas and Thoughts

[!info]+ Inspiring Questions

• Did you think about other concepts from other books?
• Do the concepts fit to your past, to your memories?
• Can you relive them and reflect them from a different angle?

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Clippings

[!info] Import Clippings from Kindle Annotate Clippings with thoughts and cross references

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Notes

Medicine 2.0 vs Medicine 3.0

Medicine 2.0 is reactive, only reacting to problems once they appear. Medicine 3.0 on the other hand is proactive, trying to do things today in order to delay or prevent problems in the future. !

Healthspan is the quality of life. Lifespan is the length of life.

Flaws of Medicine 2.0

• helps us live longer with the disease
• Looks at each disease separately (especially the four horsemen)
  • Diabetes is a major risk factor for cancer and Alzheimer‘s
  • All is related to the biological process of aging

Goals of Medicine 3.0

• look at all diseases at once. What can I do to reduce the risk of all of them significantly?

The Four Horsemen

Cardiovascular Disease Cancer Diabetes Neurodegenerative Disease

Healthspan

Three vectors that span a space:

1. Cognitive Health
2. Physical Health
3. Emotional Health

You can only be healthy if you are healthy in all three of those.

Maybe the following definition (my own idea)? Health = min(cognitive health, physical health, emotional health)

Objective -> Strategy -> Tactics

Tactics are short term and precise plans on how to achieve a simple goal. Strategy on the other hand is the long term plan, without precise implementation to a complex problem. The boxing analogy: strategy: make better, fitter and younger boxer tired by provoking him and enduring minimal damage yourself until you can finish him because you have much more energy left. Tactic: provoke by hitting him in a very simple way ( you don’t hit a champion like that), tire him out by only dodging but not really attacking

—- Aging is a major risk factor for the four horseman, because your body is not equipped anymore to fight them off.

—- Our Strategy:

• avoid the three pillars of Healthspan decline simultaneously
• Focus on improving healthspan, the lifespan benefits are closely related and follow automatically. Also Lifespan is binary: you’re alive or dead, no qualitative measure
• Understand the four horseman in detail, to know our strengths to fight against them

Tactics

In Medicine 3.0, our tactics must become interwoven into our daily lives. We eat, breathe, and sleep them - literally. By peter Attila

• Exercise
• Nutrition
• Sleep
• Emotional Health
• Exogenous Molecules (drugs, hormones and supplements)

Exercise

Breakdown because its a very broad term:

• Strength
• Stability
• Aerobic Efficiency
• peak Aerobic capacity

Exercise is the most important tactic: it benefits all pillars of healthspan:

Datadriven

Sources

• Observe Centenarians
• Animal models (lab mice)
• Human Studies of the four horsemen
  • how do they start?
  • Progress? What fuels them?
  • What underlying factors do they share?
  • What are the treatments used? And how can we infer tactics to do prevention?
  • We want to know them inside out
• Studies of aging (human and animal)
  • Molecular and mechanistic
  • Drugs or exercise that fight against it
• Mendelian Randomization:
  • what allels of a gene induce higher risks of a disease

Centenarians

• They shift the aging curve by 1-3 decades, but in the end they still often die of the four horseman. This can be interpreted as being younger at any stage in life.
• They mostly are very healthy at ages above 100, scoring well in cognitive tests and daily tasks tests. This means their healthspan is still large
• The older you get, the healthier you have been
• 20-30% of the longevity might be explained by genes
• We try to copy the phenotype despite not having their genotype
• Old relatives indicate higher chance of getting old as well
• Suffering stage at the end is very short

Genes

Most of them do something in cholesterole or glucose metabolism

1. APOE
2. CETP
3. APOC3
4. FOXO3 (page 78)

What centenarians get with their genes we want to achieve otherwise, mostly through training and nutrition.

Eat Less, Live Longer?

Rapamycin

• do research about rapamycin #todo/p

Also known as:

• sirolimus as a coating of arterial stents.
• Everolimus: kidney cancer

Rapamycin tends to slow down cellular growth and division. It works directly on a intracellular protein complex called mTOR (mechanistic Target Of Rapamycin). mTOR can be found nearly across all species of the planet, meaning it is very important, also for us. Rapamycin acts like a switch for mTOR.

mTOR

It’s Job is to balance an organism’s need to grow and reproduce against the availability of nutrients. When food is plentiful, mTOR is activated and the cell goes into growth mode (create new proteins and cell division). When the nutrients are scarce mTOR is supressed and the cell goes into a recycling mode, breaking down unused cellular components and cleaning the house

Slowdown of Aging in Mice

In 2009 a study was published where rapamycin was used to extend life of mice - 13% for females, 9% for males. And the study was experimentally repeated across the globe by other groups.

This did not really come as a surprise, because rapmycin has the same effect as eating less (suppressing mTOR). And it had already been shown countless times that eating less results in longer lives for lab animals. The first person to document the process was Alvise Cornaro in the 16th century.

Caloric Restriction (CR)

Experiment where one group can eat whatever whenever they want. The CR group gets all the nutrients needed for life, but 20-30% fewer total calories. Good results across the studies (15-45% longer lives and remarkably healthier animals). For us this probably does not apply as a strategy, because it is difficult to do it over a long timespan and you might be more susceptible to infections and other diseases, because you are not in a safe lab environment.

Cellular Aging

10 - Thinking Tactically

Absorb what is useful, discard what is useless, and add what is specifically your own.

• Bruce Lee

Orientation Questions:

1. are you over- or undernourished (calorie count)?
2. undermuscled or adequately muscled?
3. Metabolically healthy or not?

What would I say about myself?

1. slightly over
2. undermuscled (okay VO2 max and endurance)
3. I think yes

11 - Centenarian Decathlon

This chapter helps patients to define their own goals towards building an exercise routine and willpower now by visualizing tasks and passions as a 90 year old.

• #todo/p copy list of examples from book

• 1 min dead hang

12 - Training 101

It is impossible to produce superior performance unless you do something different from the majority.

• Sir John Templeton

Cardio

Includes low power endurance (Zone 2) as well as maximal aerobic effort (VO2 max).

Aerobic Efficiency: Zone 2

Glucose and fatty acids can be the fuel for our muscles. There are several metabolic pathways for glucose but only microcosms can convert fatty acids into energy. Zonte 2 exercise is mostly done by our slow twitch muscle fibers ( type 1). They are extremely dense with microcomputers and can therefore metabolize fat very well. When the pace increases, more and more type 2 muscle fibers start to join the effort. This are less efficient and more forceful and produce way more lactate because of a different way of producing ATP. When lactate turns into lactic acid you feel the muscle burning. Zone 2 can also be defined by the maximum effort without accumulating lactate.

VO2 Max

VO2 max describes the maximum output of our body.

!

Strength

Steady decline of muscle mass, muscle strength and muscle speed starting in your thirties. It’s hard to gain muscle when you’re older, but possible to keep it when you already have it. Accidents, diseases and other breaks in training leads rapidly to muscle loss. This is why it’s crucial not to get injured.

Bone density diminishes on a parallel path to the muscle. We care about this because we want to slow down this decline. Strategy to fight against:

1. Optimize nutrition, focusing on protein and total energy needs (see nutrition chapters).
2. Heavy loading-bearing activity. Strength training, especially with heavy weights, stimulates the growth of bone-more than impact sports such as running (though running is better than swimming/cycling).
   Bones respond to mechanical tension and estrogen is the key hormone in mediating the mechanical signal (weight bearing) to a chemical one telling the body to lay down more bone.
3. HRT, if indicated.
4. Drugs to increase BMD, if indicated.

Rucking is a sport where you hike with a heavy pack. Helps bone density growth as well as cardiovascular training and strength training for legs and trunk.

Focus strength training:

1. Grip strength
2. Concentric and eccentric movement
3. Pulling motion ( rows and pull ups)
4. Hip-hinging movements (dead lifts)

Stability

This is the solid foundation that prevents us from getting injured. Stability makes us bulletproof.

By sitting in Chairs all the time we forgot the optimal way of moving our bodies. Thats the theory of DNS (Dynamic Neuromuscular Stabilization).

• www.rehabps.com
• Www.posturalrestoration.com

Breathing

Breathing is the foundation of stability.

• Mr. Stay Puft
• Sad Guy
• Yogini

15 Putting Nutritional Biochemistry into Practice

Macro nutrients

Alcohol

Carbohydrates

The goal is to keep average glucose below 100 mg/dl with standard deviation of less than 15 mg/dl ( corresponds to HbA1c of 5.1%).

Protein

Its the one macronutrient you shouldn’t ignore. Its the only one where there is a recommendation of 0.8g per kg of body mass. But if you want to maintain muscle you should eat double to triple (1.6-2.2 g/kg). For me with 80 kg this is 120-180 g. Make sure to include all the essential amino acids in your diet, especially leucine, lycine (3-4g per day) and methionine (1g per day). If you want to increase mass, you need 2-3g per serving, four times a day of leucine.

Notes and Thoughts

• easy biomarker test device to use at home (like theranos?) #idea/startup

Actionpoints

• Healthcheck with biomarker analysis: what is ideal (not normal) #todo/p ⏫
• Understand mendelian randomization #todo/p
• Study the four horseman in detail to understand the biological process underneath #todo/p

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Erste Reaktion

Ich habe heute das Buch fertig gelesen. Die letzten Kapitel waren sehr Praxis orientiert. Insgesamt bin ich begeistert davon wie Peter Attia das Buch aufbaut und bin grundsätzlich überzeugt von seiner Herangehensweise ans Gesund leben. Vor allem das er emotionale Gesundheit als gleich wichtig oder sogar als wichtiger betrachtet als körperliche Gesundheit finde ich faszinierend. Logisch übertreibt er gewisse Punkte und Geschichten aus seinem eigenen Leben. Es bringt mich jedoch dazu selber über mein Leben und meinen Zustand zu reflektieren. Wie ist meine emotionale Gesundheit? Ich glaube momentan nicht die beste.

Definition Alter: wenn man in die Zukunft denkt ist man jung, wenn man in der Vergangenheit denkt ist man alt.

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Cross References

Outlive Peter Attia 
-file: "Outlive by Peter Attia.md"