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MANY YEARS AGO, a Wall Street Journal article quoted a source as saying, and I paraphrase, “Young-old age should last as long as possible, while old-old age should last 15 minutes.” Those of us who have visited nursing homes can all relate to this.
Public health initiatives and medical breakthroughs have extended lifespans significantly over the past 100 years. In his bestselling book Outlive: The Science and Art of Longevity, Peter Attia argues that we should focus not just on lifespan, but also on healthspan. The latter is a measure of how well we live, not necessarily how long.
Attia emphasizes that “longer lifespan with no improvement in healthspan is a curse, not a blessing.” His goal is to increase people’s healthspan so that they maximize their chances of avoiding chronic disease, thereby reducing the portion of their lives that they spend frail and infirm.
Attia believes that healthspan is about preserving these three elements of life for as long as possible:
As an expert in longevity and preventive medicine, Attia has researched the ways we can achieve greater healthspan. He identifies four chronic conditions that have emerged in the developed world as the greatest contributors to reduced healthspan. His “four horsemen of the Apocalypse” are:
These four diseases account for more than 80% of deaths among those over age 50 who don’t smoke. Reducing their toll is a primary focus of Attia’s work. Much needs to be done.
Western medicine seems more focused on curing disease than preventing it. As an example, Attia cites how our medical system has evolved in the treatment of Type 2 diabetes. A person approaching middle age might see his blood sugar rise over time. At some point, the patient is defined as pre-diabetic and later diabetic.
No good comes from being diabetic—it’s a risk factor for all four horsemen. Once the patient has a diagnosis of diabetes, the medical system intervenes, potentially spending thousands of dollars. Yet, for years, the patient was marching steadily toward this point, and prevention could have averted both the physical and financial costs.
The book traces the evolution of medicine. Medicine 1.0 is how disease was treated up to the mid-1800s. This medicine had no foundation in science. Rather, it was based on “direct observation and abetted more or less by pure guesswork.”
Medicine 2.0, the current industry practice, waits until someone has become sick before initiating treatment. Modern medicine has a phenomenal ability to diagnose and treat complex diseases and respond to medical crises. It’s adept at dealing with trauma and infection.
Attia believes that what he terms Medicine 3.0 should focus on identifying negative trends early so we can zero in on prevention. In the diabetes example, early intervention might prevent the disease entirely before it can cause irreparable damage.
There is much evidence—and also much hype—around prevention. He says the greatest surprise in his research is the incredible power of exercise. When he began his dive into the evidence, he expected exercise to be important. What surprised him was how vital it is to our health.
On the flipside, he found that many claims about nutrition are based on weak studies. No doubt, proper nutrition is important, and he identifies some clear dos and don’ts. But fad diets or the constant drip of headlines saying this or that is or isn’t good are just noise.
The book can be read at two levels:
We can always learn and improve our current lifestyle. I would have benefited from reading this book at age 40 rather than 65. Even so, reading it now, I see that my health goals track well with Attia’s recommendations.
As a numbers person, I’ve always monitored my health measures: body mass index (BMI), blood pressure, cholesterol, glucose, triglycerides, and PSA, a measure of prostate health. If you don’t know your current state, it’s hard to map a path to improvement. I have also done well with aerobic fitness, but struggled with strength training.
Goals for how you live after 65 can also be defined in terms of function. This can mean completing daily activities without becoming short of breath, being able to get down on the floor—and then back up again—to play with grandkids, and managing household chores and bills without assistance. If these are your goals, too, what you do in the 20 years before retirement can determine your success.
Long ago, I identified that there’s a consistent theme in articles about disease prevention. For almost any chronic disease, the prescription starts the same: don’t smoke, maintain a normal BMI and blood pressure, exercise, minimize alcohol consumption, eat sensibly and get enough sleep. These universal principles are covered in great detail in the book. It’s never too late to start them.
I was introduced to Attia’s thinking through a podcast that I was, coincidently, listening to at the gym. The book is 496 pages long and some parts went into greater detail than I was willing to absorb. I did make some changes in my approach to exercise as a result of reading it, however. As much as I don’t like it, I’ve upped my strength training at the gym. The book also encouraged me to continue refining my diet.
Howard Rohleder, a former chief executive of a community hospital, retired early after more than 30 years in hospital administration. In retirement, he enjoys serving on several nonprofit boards, exploring walking paths with his wife Susan, and visiting their six grandchildren. A little-known fact: In May 1994, Howard was featured—along with five others—on the cover of Kiplinger’s Personal Finance for an article titled “Secrets of My Investment Success.” Check out his previous articles.
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Agree with it all! Here is an interesting video of the way to have a good “healthlife”…
https://www.youtube.com/watch?v=Ie_Ia5UUbJ0
I am 72 (male) and joined F45 early this year, where the majority of clients are women ranging in age from 20’s on up (mostly 20’s and 30’s). They do weights, body resistance and cardio for 45 minutes at a time. Hence the 45 in F45. Not only does it help you keep you fit, it gives you a natural high. It is best to forget your age and keep exercising if you can
I’d like to reinforce the notion that losing muscle mass and bone density is not a ‘given’ with aging. At age 73, I’m as strong as I was in my 30-40’s by being dedicated to weight training with high resistance. 8 pound dumbbells aren’t the answer.
In addition I recommend balancing this out with regular meditation, yoga or contemplative prayer. Mind AND body!
If you do not work out, you WILL lose muscle mass and bone density. The key is to do what you are doing
“8 pound dumbbells aren’t the answer.”
I agree. At age 73, are you able to bench press your own body weight?
I am, and I didn’t first achieve that until I was past 60. You can actually get stronger as you age. At 67, I set a PR yesterday for my incline press. (Bit sore today!)
Along these lines, I recommend “Younger Next Year” by retired lawyer Chris Crowley and Dr. Henry Lodge. Crowley has also teamed up with other medical professionals with a series of related books, importantly including the “Younger Next Year Back Book.” Along with some initial PT, the latter has helped me recover completely from a disabling back ailment that had me reduced to a walker for a month last spring and now enables me to contemplate participating in lengthy cross-country ski “races” again this winter at a fairly advanced age (74 later this month), having never lettered in anything in high school or beyond. I put “races” in quotes, as I’m just looking for “participation points.”
I’m a big fan of Peter Attia. For those who prefer video to reading, Peter has countless hours of video on YouTube. He interviews health experts so you get their perspectives in addition to Peter’s.
Peter does the deepest of dives in some of his videos and he loves acronyms so I pass on those videos that provide more info than I want, but they are there for those who are interested.
Thank you Howard for your article, I will be adding it to my reading stack.
One aspect of this topic that I rarely see covered is the evolution, as we age, of advance directives.
My desires at age 50 were different than what my desires will be later this year when I turn 70. Then 80, then probably 90. I want interventions reduced over time while still differentiating between chronic conditions and acute.
I would appreciate your thoughts and any possible resources you can recommend.
You make an excellent point that your desires are likely to change over time. The key to advance directives is to review them periodically and especially after any change in your health or your family. I wrote 2 HD articles about directives a while back: Giving Directions – HumbleDollar and Final Act – HumbleDollar
At the time you do a review, you should have a conversation with your doctor, contemplate what he says about your current health, and then have a discussion with your family. In the end, your directions should not only reflect your health but how you personally feel about your health and how you feel about the prospects of recovery if you were to have a heart attack, stroke, etc.
Terrific article, thanks.
When I was a young professional, a colleague once said, “why would I waste my life trying to extend it?” I used that comment for years to justify not exercising, but now realize that thinking is flawed.
Just as important as extending lifespan, exercise (combined with a proper diet) delivers improved health, helping people to live full, enjoyable lives.
Now retired in my fifties, my goal is to live a long, active, and healthy life for decades to come. Attia’s book provides a helpful roadmap.
Sounds interesting Howard. Is there a Cliff notes version?
I am 79 and am blessed to have pretty good health despite having asthma since age 3, major knee surgery at 36, and lower back issues since my 20s. I have always put a lot of effort into staying in shape and having a good diet.
However, physical challenges confront me more as I age. There are a lot of things I can no longer do or if I try, I pay the price. Jogging, tennis, basketball and soccer are just a few examples. Nonetheless, I accept my limitations, and am thankful for the many things I can do, albeit not as well as I could 25 years ago.
A few years when I had my annual urology exam, the doctors first question was “how is your stream”. I had to think for a minute and answered, “Doc I guess it is ok, but it is not like it was 25 years ago”. The doctor replied, “do you have anything that is working like it was 25 years ago?”. Having a good sense of humor is important.
As a retired Physical Therapist I can tell you that at one gets older one of the most important exercises is balancing exercises. Simply twice a day setting a timer for 5 minutes and facing your sink and alternating balancing on one leg then the other with your eyes open. When that is no longer challenging change to eyes closed but be ready to grab the sink if necessary. If your knee can tolerate it simply performing 25 step downs on a stair and then 25 step ups will help to keep your legs strong. If this is too much for your knee try going from sitting in a low chair to standing 25 times twice a day without utilizing your arms to assist is an excellent alternative.
Thanks David. I learned that balancing technique in yoga. I often will practice it while waiting on the microwave or something else. I do get weird looks when doing it while waiting on something in the store. I will try the 5 minute drill.
The Cliff notes version can be found in the numerous articles and podcasts out there that interview Attia or that he has produced himself.
I had the same family doctor for about 25 years through my middle age. When I asked him about some new symptom, he would always start his answer with “As we get older….” He would then explain that whatever was happening simply came from natural aging! There are things we can control and things we can’t. That doesn’t necessarily make it easier to accept.
Thanks, Howard, for the introduction to this book. Having done a little review skimming on Amazon, I’ll probably buy it.
But like all books and articles that focus on health-by-prevention, it will likely frustrate the hell out of me. I have type 1 diabetes, which is not preventable. I got it as a complication from successful treatment for an advanced cancer which was also not preventable. I beat the fast killer by trading it for a slow killer, neither of which were results of lifestyle.
And what I often find with writings like Attia’s is that they don’t tell me enough of how to maintain my quality of life now that I’m already living with the problem. Regular exercise is absolutely crucial of course (learn to love pumping that iron, Howard!) for my ticker and my lungs and my brain, but how it will keep what I’ve already got from ruining my life is often not much discussed in books like this. Will walking help prevent a heart attack? For sure. Will it prevent me from losing my toes — or my feet — to the diabetes when I’m 80? I’ll bet the mortgage that Attia’s book doesn’t discuss it. But it’s what I think about.
The frightening and disappointing thing is that you can do most everything right from a lifestyle perspective and as a result of genetics, environment or just bad luck, you can still end up with a chronic illness. I believe that Attia is talking about reducing the odds that you develop a chronic illness. Nothing is 100%.
Once you have a chronic illness, you are no longer in prevention mode but shift to management mode. But, it still seems that the prescriptions for prevention will apply also to management. No matter what your circumstances, you can’t beat: “don’t smoke, maintain a normal BMI and blood pressure, exercise, minimize alcohol consumption, eat sensibly and get enough sleep.” You have certainly suggested that in your comments. Your doctor can refine the recommendations to make them specific to you.
Good one, Howard. I’m enjoying the book.
Haven’t finished it yet, but the one gap in Attia’s thinking seems to be around diet. You literally are what you eat but he’s punted the topic. Diet has big impact on preventing “the four horseman” of chronic disease.
David if I recall Attia’s advice on ASCVD it was something like “eating a really healthy diet isn’t going to necessarily help, but eating poorly will harm you big time” … so all that broccoli we’re eating isn’t going to keep our veins clean but consuming a bunch of junk food will get you a hall pass to the cardiac unit 🙂
No question what you eat matters. I think he covers this in his discussion of “over nourished” and “under nourished”… with many Americans being over nourished. He also addresses this in his discussion of how to monitor lab values and specifically in his discussion of metabolic syndrome. In many cases, correcting lab values that are out of whack comes down to what and how much you eat. What he specifically avoids is endorsing any particular diet plan. He also discusses how much of what appears in the media about diet is based on weak studies. I’d be interested in hearing why you feel he punted?
I felt what he did write came across as a Medicine 2.0 take on the role of nutrition.
There is more than enough evidence from good nutrition research to give some specific guidance which would move the reader toward longer healthspan. Perhaps in the next edition.
Howard, thanks for an interesting and well-written article. I look forward to investigating the book.
I bought and read Outlive in 2023 and I am glad I did so. I will likely read again in 2024. In the book Dr. Attia noted that physicians use about 2K words that are not common in usage and I found it worth my while to learn the meaning before proceeding with my reading. I have taken to heart the steps he recommends as necessary in medicine 3.0 to improve my health and healthspan.
Thanks for your article Howard.
Long time listener to Attia and the book is great … Without your health life can be a struggle Walking into your doctor’s office well informed can be a very valuable tool
Glad to find another fan. I agree that one value of the book is being conversant with the topics when you see your physician.
If you and Attia think that physicians don’t discuss risks and health trajectories with their patients, you are kidding yourselves the same way those patients are not hearing the discussion.
I hope this helps “open the ears” of patients everywhere.
Howard, this is a good article about an important topic. I fear the challenge that those hoping to encourage better health habits at earlier age face the same obstacle as teachers of better money habits—the student thinks more of present self at the expense of future self. And a frustration for me is the fadish nature of the search for the new “super food”, or the next evil one, whose addition or deletion is the key to good health.
Thanks. I found that the book cut through the noise of the fadish nature of much health advice that you see in the media.