"Outlive" by Peter Attia

Review by Borodutch

I have mixed feelings about "Outlive." On the one hand, I like these types of books that share the valuable personal experience of doctors. On the other hand, this book suffers from most of the issues that "Food: What the Heck Should I Eat" by Mark Hyman suffers from. Let's start with the bad.

One of the running themes in the books by various MDs is that they tend to put their anecdotal evidence above scientific research. Doing so is natural to humans. However, I'm distraught that they don't know better. For some reason, I strongly feel that mixing good advice disproportionally with personal opinion outweighs the benefits of the book. I'm also biased — I wrote a book on logic, rationality and more of the same themes as Peter, but backed by science instead of anecdotal evidence.

The issue with not recognizing one's own biases (especially as a practicing doctor) breeds the next set of troubles. For instance, dismissing the research or the whole field (epidemiological longevity research in the author's case) because of some technicalities (in this case, lack of adjustment for confounding variables). I have no idea where this notion of "oh yeah, it's healthy people who tend to eat this and that, not that eating behaviour affects the health" comes from. If you're smart enough to think of confounding variables, don't you think researchers and peer reviewers are competent enough to ask the same question?

I won't argue here — some research lacks adjustment for confounding variables. However, there are enough published papers that do adjust for those. But do you know what various biased MDs do when they see an article that doesn't support their worldview adjusts for the confounding variables? They claim that the confounding variables are wrong and were picked precisely to skew the results toward a desired outcome. You can smell the hypocrisy in the air.

And when the research supports the anecdotal evidence that an MD author has on the hands, no matter the research quality — it shall be correct! There are a ton of biases and fallacies to unpack here to explain why exactly this happens — but I won't bore you with them here. Simply keep in mind that "Outlive" is written by a person who made up their mind before searching for evidence, as opposed to the correct logical way — search for the evidence first and then make up one's mind. However, this fact does not diminish the weight of the evidence collected.

Unfortunately, Attia's book suffers from all the issues above. Let's say one follows all the advice from the book — they will statistically start leading better and more fulfilling lives, which is precisely why I cannot not recommend this book. However, for instance, if you don't dismiss nutrition and follow longevity nutrition research, you will be even better off. Don't fall prey to a single biased MD's opinion, research, research, research. At least read the damn abstracts or make ChatGPT read them for you.

The last part of the book about mental health is very unhinged. Something that made me cringe and say, "TMI!!! TMI!!!" out loud. I understand why the personal anecdote is included in the book. Publishers, editors and co-authors enjoy adding personal stories to the book, especially when they are of "hero journey" or "from rags to reaches" types. In this case, the author describes their fight against workaholism that almost ruined their family.

Unfortunately, whereas the drug addiction fight made sense in "The Wolf of Wall Street," an MD describing their mental battles doesn't quite work. See, we are not associating ourselves with Peter here. We're listening to the summary of his experience and research. We can't "feel" for Peter like we do for Richard Branson in "Losing My Virginity." I hope you understand what I mean here and why I thought this story was entirely out of place in the book.

Also, at one moment, the author talks about compliance issues with the diets — and the next second, he suggests a workout regimen that will take up around 2-3 hours a day. Sure, people forget to take life-saving medications but let me quickly drop out from this zoom call because I have an hour of carrying heavy rocks in the backpack offline. Yeah, never happens, sorry.

Now, to the good parts! Even with all the drawbacks above, why would I still recommend "Outlive" to a typical person? It has excellent tidbits hidden among a lot of biased nonsense, so I always ensure that whoever reads the book by my recommendation continuously checks the references and facts. Here's what I liked:

  • The tests Peter recommends make a lot of sense and should be accounted for by everybody
  • The chapters on protein and muscle mass are very well-written; they will undoubtedly prolong one's healthspan
  • Even though the author gets a lot of things wrong about nutrition (by outright dismissing research or propagating the myth about the bioavailability of plant-based protein), the chapters on exercise are solid
  • Proxies of good health are a valid and interesting point — gum health and grip strength among them (however, the author "accidentally" for a moment forgets the causality and correlation debate he had earlier in the book)
  • Overall, it is always great to read an MD sharing their anecdotal experience with the world — when it isn't used to dismiss the research but instead is used to stimulate further research in the area (smh really hard here)
  • Even though the chapters on mental health are more of an afterthought, I can never hate anyone for bringing up this topic in popular culture

While searching for a summary for the book, I came across a comment that the book itself is a summary. This is complete and utter nonsense. "Outlive" is filled with water so much that one could safely take the book camping and not die of the lack of hydration for a month or so. When someone writes a bullet-point summary of the book, it will be way more valuable and actionable than Peter's published monstrosity. Hey, I had to cut 150 pages of water from my book, but it seems Attia got lucky with their editor! Good for him.

To recap, reading (or listening to) this book will be more beneficial than not doing so to almost anyone. However, take the advice of any MD-written book with a grain of salt and recheck all the facts. Never trust any opinionated piece of knowledge (and professional literature, especially when converted into non-fiction, is always opinionated).