Book Review: Outlive by Peter Attia, MD

The longer I practice financial planning, the more I understand that if you don’t preserve your health in retirement, all our talk of goals and spending plans is for naught. You can’t travel, enjoy time with your grandkids, or generally remain active if you do not preserve your health. Furthermore, healthcare for retirees is a major expense, so maintaining health can have direct financial benefits as well. Your health and your financial plan cannot be separated.

Outlive

For these reasons, Peter Attia, MD’s book Outlive is the most important non-money financial planning book I have read in a very long time. Dr. Attia provides new ways to think about health and longevity and provides a framework for thinking about exercise, diet, sleep, and emotional health to help us not only live longer but remain healthier and more active throughout retirement.

Focus on “Healthspan”

Attia urges us to focus not just on lifespan – how long we might live – but on “healthspan,” how long during our life we can remain healthy and active. For the last few generations, lifespan has become longer, but our health still tends to drop off earlier. This leads to what Attia terms “the marginal decade,” where we are still alive but not healthy enough to take advantage of the time we have. Our medical science is very good at treating conditions once they arise, keeping us alive, but is not designed well to prevent those conditions from arising in the first place. 

The four horsemen: coronary disease, diabetes, cancer, and cognitive decline

The book contains an in-depth analysis of what Attia terms the four horsemen: coronary disease, diabetes, cancer, and cognitive decline. Long-term strategies to stave off the arrival of these conditions are the key to maintaining healthspan throughout our lifespan. While much of the science behind this discussion is new or incomplete (particularly around Alzheimer’s Disease), the author finds common threads between all four conditions. This largely arises from our modern lifestyle: we live in a society where much of our physical work is handled by machines and, for most Americans, food is abundant. This situation gives rise to metabolic imbalances that contribute directly to coronary disease and diabetes and point the way toward susceptibility to cancer and cognitive decline.

Dr. Attia’s prescription for dealing with all four of these common old age issues is the same: exercise, diet, and proper sleep. 

Exercise should focus on maintaining our lean muscle mass, maintaining our cardiovascular health, and encouraging stability. To help us picture what this should look like, the author encourages the reader to write down their version of what he calls the “Centenarian Decathlon:” ten physical things we would like to be able to do in our last decade of life. This could include picking up our great-grandchildren, climbing two flights of stairs, or putting our own luggage in a plane’s overhead storage. 

Because our bodies naturally decline, we must aim for higher goals while we’re young to have these abilities later in life. For example, if we want to pick up a 30-pound child when we are 85, we need to train in our fifties to lift and carry significantly more. To climb stairs at 90 we may need to ride our bike intensely for four-minute stretches now.

Exercise is Key

Exercise is the closest thing Attia has found to a panacea for longevity. While the author paints broad strokes of what our exercise for longevity should look like, he leaves it to the reader to determine the specifics. We should strength train for lean muscle mass, along with exercises that promote balance and core strength.

We should do long low-intensity aerobic workouts to burn glucose. He goes into the science behind this, but in short, this exercise – think brisk uphill walking – has great metabolic benefits. This coupled with shorter, high-intensity workouts builds our lung capacity. However, what those specific exercise routines should look like is left up to the reader to develop on their own.

Diet is Important

Likewise, Attia is agnostic about the specific diets we choose but argues that most Americans need to improve how they eat.

“Nutrition is relatively simple… don’t eat too many calories, or too few,” while getting enough protein and essential nutrients. Whether that means cutting calories, eliminating certain foods, or restricting when you eat will vary from one person to another. Rather than get caught up in the specifics, he boils it down to finding the right diet that works for you and that you can maintain for the long term to achieve a healthy weight and metabolic state. Most of us are overweight and not metabolically healthy and need to improve our diets by whatever means necessary.

Better Sleep

The third tool Attia urges us to use for improved healthspan is better sleep. With this aspect of health, the author is more specific, outlining strategies for improved rest in addition to the usual dose of science behind how and why we need to improve. He sees proper sleep as a superpower for longevity and cognitive health, and an aspect where we can make a positive influence with some effort.

Final Thoughts

I’m sure I’m not alone in wishing that Attia’s book included daily exercise charts and a definitive diet for me to try to follow. But, as he points out, there are hundreds (thousands?) of diet and exercise resources out there. We can use his broad framework to figure out what is right for us, and his scientific approach to WHY we need to improve these areas of our lives is worthwhile even if we must do some of the work and research ourselves.

Despite the lack of a specific workout plan and diet prescription, Attia’s work does provide the broad strokes for behavior change if we want to maintain our health well into old age.  

When new clients meet with us, their main concern is usually some form of “Can I retire and not run out of money?” Of course, this question drives much of our financial planning. However, in 25 years in the industry, the number of people I’ve known who didn’t get to enjoy retirement because their health deteriorated long before their money was anywhere close to depleting far outweighs the financial concerns. This makes Outlive an important book. I’ll be rereading it and taking more notes. But first I need to dust off my stationary bike and get in an interval workout.

Do you have any book recommendations on retirement, exercise routines, or diet? Please share them!

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