Outlive contains Peter Attica’s strategy and tactics to maximize both lifespan and (more importantly) health-span. He’s not just concerned with seeing people become centenarians, he wants people to live healthy until they die.

The chief way to accomplish this is to minimize the biggest threats. He calls these threats the four horsemen, the cause of 80% of deaths in people over 50 who do not smoke:

1. Atherosclerotic disease (think heart disease)
2. Cancer
3. Neurodegenerative disease (think Alzheimer’s disease)
4. Foundational disease (think diabetes)

Rather than issue a specific plan, Attica recognizes that people are unique with unique physiologies. What works for someone may not work for another. He takes time to explain the challenges to longevity, along with suggestions regarding the most likely way to combat them. Along the way, he debunks many popular diet and health myths.

Attia is a passionate advocate of regular exercise: endurance, VO2 max, strength, and flexibility. It’s difficult to imagine how anyone could possibly exercise as frequently as Attia recommends—and this is coming from an active person!

The bigger challenge I have with this book regards the teleology of longevity. There’s a desire to live longer and healthier while you live. But to what end? He circles the answer in his final chapter on mental health, but never lands on anything substantial. I suppose it’s unfair for me to expect a philosophical discussion of this sort in a medical book, but I couldn’t help but think: why? Why do you want to stretch your years a few more—the end result is the same.

Outlive is packed full of information, written in an engaging voice. I regularly found myself thinking through my habits and tendencies in light of the data presented. As for the deeper question, it may be beyond the mandate of this book but it’s a much more important answer to search for.

Attia, Peter with Bill Gifford. Outlive: The Science & Art of Longevity. Harmony Books, 2023.