Life After Full-time Work Blog

Learn about preparing for life after full-time work through posts from Don's upcoming book.

#192 An Added Decade Of Healthy Life

That’s what Dr Peter Attia says we can get

Dr Peter Attia (MD, rather than the PhD that most of the people I write about have!) has written a #1 best-seller. It’s called Outlive: the science and art of longevity. I heard him interviewed about it by Steve Levitt (yes, a PhD! I loved his book Freakonomics, and regularly listen to his podcast People I (Mostly) Admire.) I hoped the brilliance of Levitt’s interview would save me the time of reading Attia’s book. It was indeed a wonderful interview. I heard it a second time, and took notes. Here’s what I wrote down.


Attia says, quite simply, that longevity ought to be only half about length of life; we should be just as concerned about quality of life.

Medicine has extended the length of life, but when you look at chronic diseases (like type 2 diabetes, cardiovascular disease, cancer, neurodegenerative disease), medicine doesn’t have a playbook that works very well. And that extension of life, since 1900, has been mostly via the removal of infectious diseases, with only a year or two added in connection with those chronic diseases. Modern life, for all its wonders, has also brought a lot of things that add to our susceptibility to chronic diseases: worse nutrition, less movement, far more light and less sleep, chronic stress.

So an excellent focus should be on prevention, and we don’t talk much about that: what’s cancer prevention, what’s dementia prevention? Where’s the risk assessment and risk management, as we’re used to seeing in finance? And by the way, that includes the risk of doing nothing. Example: you don’t tell people it’s OK to smoke until the risk of cancer rises to 5%, and then please stop smoking. Don’t start! Similarly, with cardiovascular disease, we shouldn’t have the attitude of accepting anything until the risk rises to a threshold and then begin to treating it; we should eliminate as much as possible right from the start.

Example: diabetes is defined as having your hA1C count at least 6.5. That’s already a 4-alarm fire. Deal with it much earlier.

If we adopt this prevention approach, it could add 10 years to life expectancy. (I think that’s a guess rather than a mathematical estimate. The interview didn’t clarify where this number comes from, though it’s undoubtedly an attention-grabber.)

What do we learn from long-lived people? For those who live up to around 80, genetics has nothing to do with age at death. Long-life genetics only come into play much later; and what we learn from those long-lived people is that their genes are of a kind that delay the onset of chronic disease. The lesson is that you have to live longer without disease, rather than stretch out the time you live with a disease. Hence: improved quality of life, not just longer life.

What can do you about risk management, right from the start? Five things. Exercise, sleep, nutrition, exogenous molecules, and emotional health.

Exercise: Both aerobic exercise and strength training matter. And they have a colossal impact.

Let’s use VO2 max as a measure for aerobic exercise. Those in the bottom 25% have mortality rates (that is, the probability of death in the coming year) 5 times as high as those in the top 2.5%. Make a less extreme comparison: those in the bottom 25% have mortality rates 2.75 times as high as those in the top 25%. That’s a bigger difference than non-smokers versus smokers.

For lean muscle mass, comparing those in the top 25% to those in the bottom 25% (which on average translates into a difference of 15 pounds of lean muscle mass), we find a difference for a 70-year-old, in the probability of death in the next decade, of 20% versus 50%: in other words, there’s more than a doubling of the 10-year death rate from lacking 15 pounds of lean muscle mass. Muscle is not only something that makes us physically healthier (think of recovering from a fall), but it also is a very important organ for disposing of glucose, to prevent us from becoming insulin-resistant and diabetic.

Sleep: It’s not wasted time, to be minimized. It really has to be useful, if you think about it from the perspective of evolution. Why has evolution preserved sleep? After all, spending a third of life unconscious brings risks: you can’t reproduce, you can’t forage for food, you can’t protect yourself against predators. So it must have big benefits! I myself have written about what happens during sleep, and its benefits. And it’s much more than that. The data show that poor sleep, in either quantity or quality, causes poor health, particularly in areas like insulin resistance, dementia and cardiovascular disease.

Nutrition: There’s much less clear science about the impact of nutrition. What we do know is that too much and too little nutrition can both be catastrophic to our health. We should pay less attention to managing our total caloric intake, and more to managing protein intake, since protein is the essential building block for some of the most important structures in our body, like muscle. (Attia added other stuff about manipulating energy balance for our metabolic health, meaning how does our body know how much energy to store, where to store it, and how to go back and access it when it needs it. I didn’t understand this at all.)

Exogenous molecules: by which Attia means drugs, hormone treatments, supplements. No further discussion of these.

Emotional health: Here Attia goes from being the doctor to being the patient, as he has had lifelong struggles that affected his emotional health; and he underwent what he calls immersive therapy, that he says broke him – and I guess (though he doesn’t actually say it) rebuilt him. Levitt asks: why don’t we systematically teach skills about managing emotional health to our kids in our K-through-12 curriculum, given how important it is to life? Attia doesn’t answer directly. He says emotional health has an impact on length of life: think of the deaths that are attributable, directly or indirectly, to despair.

And he quotes his therapist: “What is the purpose of living longer if you’re so miserable?” And Attia adds: “What’s the point of this, if your kids hate you? What’s the point of this, if people think you’re a jerk? I know firsthand from having spoken to some of the most successful people in the world that a lot of them aren’t that happy. They’re stuck on this treadmill of having to prove themselves all the time. I worry that’s a recipe for getting to the end of your life and realizing you’ve made a mistake. And I’m very guilty of this. I’m not going to sit here and suggest that I have figured this out. No, it’s going to be a struggle for me forever, just as it would be a struggle if I were an alcoholic who got sober but had to always be diligent and vigilant about maintaining sobriety.”


Powerful, heartfelt, emotional words!

Being the numbers guy that I am, I want more numbers on quantifying the benefits of much of what he recommends, given that he goes so far with the exercise stuff. And I understand that in his book he goes much further with the exercise stuff. Levitt says: “Outlive completely transformed my approach to growing old. Peter Attia is among the most brilliant people I’ve ever met, and he’s succeeded in packing a life’s worth of insights into this book. It promises to be one of the most important books you’ll ever read.” My personal trainer and personal friend Zack Kelly tells me I have to read the book. I guess I’ll do that.



To live longer, you need risk management right from the start, not waiting until you show symptoms and then starting to manage yourself. There are five areas of life in which this mantra holds: exercise, sleep, nutrition, exogenous stuff (like drugs and other treatments) and emotional health. Dr Peter Attia, in giving this perspective, says that we can get an additional ten years of healthy life from it.


I have written about retirement planning before and some of that material also relates to topics or issues that are being discussed here. Where relevant I draw on material from three sources: The Retirement Plan Solution (co-authored with Bob Collie and Matt Smith, published by John Wiley & Sons, Inc., 2009), my foreword to Someday Rich (by Timothy Noonan and Matt Smith, also published by Wiley, 2012), and my occasional column The Art of Investment in the FT Money supplement of The Financial Times, published in the UK. I am grateful to the other authors and to The Financial Times for permission to use the material here.

4 Responses to “#192 An Added Decade Of Healthy Life”

  1. Ted Harris says:

    I am convinced that this approach makes a difference. Beyond our individual genetic composition (which largely determines our physical being- and even our personality) and major external impacts, a significant key to optimizing our existence is “management” – which I find more easily said than done.

    • Don Ezra says:

      Yes, management is a good way to express it. And yes, more easily said than done. But at least recognizing it is a start!

  2. Luis Cerritelli says:

    I don´t understand why neither you or Peter Attia mention a key factor for longevity which is HAVING A VERY STRONG REASON OR PURPOSE FOR WANTING TO LIVE TODAY AND TO STAY ALIVE TOMORROW. Medical doctors know that “exogenous stuff” don´t cure, they only help your body do the work. The same thing applies to the emotional or spiritual part of your body: it needs help to heal efficiently. The help it needs is motivation to keep going. No matter how old you are, your body must receive the message through your emotional glands, that it is important for you to stay alive and fit to be able to do what you want to do. Your motivation to stay alive can be 100% banal or laudable that doen´t matter because the message is the same: I NEED TO STAY ALIVE AND FIT.

    • Don Ezra says:

      Excellent observation, thank you! The reason I didn’t mention life’s reason/purpose is that I was reporting on the interview and Peter Attia’s ideas. I have indeed mentioned it elsewhere: visit #178 Do You Need A Life Of Purpose? There I distinguish between having a “big P” Purpose (a sort of Life’s Mission) and having multiple “little p” purposes (which probably defines most of us). Check it out!

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