For something a little different, this month I’ve been reading this bestselling non-fiction book about health and longevity. This book has made enough of an impact that it’s doing the rounds within the rationalist community that I frequent and my wife has been obsessed with health and fitness lately so I thought I should read this myself. It has won major kudos for being scientifically rigorous and up to date and indeed the back of the book is crammed with references. It’s probably possible to read up on all this for free elsewhere but it is valuable to have all this knowledge compiled in one place. As the book itself states however, its aim is to equip the reader with the knowledge and the tools needed to make meaningful health decisions, but as there can be no single plan that works for everyone, this book may disappoint those looking for an easily actionable list of things to do. Indeed if you’re someone in generally good health and already getting all of the fundamentals right, this book remains interesting but it doesn’t all that much.

This book consists roughly of one part anecdotes and lived experiences by the author Peter Attia and one part an overview of the current state of the art in longevity research. It’s full of technical detail and is scientifically accurate but geared to be readable to laymen. With the assistance of co-writer Bill Gifford, the personal stories help humanize these details. I’m rather skeptical of Attia’s personal stories as they come across as humble bragging about how his main weakness is being too hardworking. Sure, he talks about how he has been an awful husband and father with a raging temper. But he’s still a successful doctor who’s also supremely fit, has broken swimming records, engages in archery and likes to race sports cars. I do admit that I’m a sucker for his stories about meeting and collaborating with scientists, visiting Easter Island as a form of pilgrimage to honor the discovery of the rapamycin antibiotic and the anecdotes from his time as a resident doctor. In addition to providing a human context in which to place the medical information and advice, they help to establish Attia’s credentials as someone who knows what he is talking about, so this isn’t just a regurgitation of information that anyone can get from a Google search.

The thrust of Attia’s message here is that he is dismissive of contemporary medicine, what he contemptuously calls Medicine 2.0. Instead of waiting for patients to become sick and treating their specific illnesses, he advocates for a more proactive approach and a far more ambitious goal. We should aim to live as long and as healthily as the Centenarians, he says, and what they get through their genes, we must achieve through hard work. To that end, he delves into the most common causes of death, what he calls the Four Horsemen, namely cancer, metabolic disorders, cardiovascular disease and neurodegenerative disorders. The book does a deep delve into what each of these diseases actually are, what their causes are and what the best current treatments are. Sadly as he notes, there isn’t much that can be done when a cancer has metastasized or there is a confirmed diagnosis of Alzheimer’s disease. So the key strategy is to prevent them from occurring in the first place. Attia calls for early and frequent use of the most technologically advanced diagnostic tools to detect the earliest signs of disease and even genetic testing to determine if a patient is predisposed to develop certain conditions. Attia’s knowledge of and access to cutting edge procedures, drugs and equipment is impressive indeed.

It turns out that though the causes of death and poor health may be varied, the common factor is still the familiar one. We live in an age of plenty with too much food and too little exercise. There might be nothing new in his admonitions to watch our diets and exercise more but he is very thorough in laying out the research proving why they’re so important. It’s worth emphasizing a couple of points however. No matter how much exercise you already do, Attia probably thinks you should do more as strength training is a big deal for him. In line with that, he’s a big fan of protein, arguing that most people don’t consume enough to maintain and build their muscles. The rationale is that everyone inevitably loses muscle mass as we age so it is critical that we build up as much of a reserve as we can to ensure that we are able to do all of the same physical activities that we enjoy and are used to. Finally, he reminds us of how critical it is to get enough good quality sleep every night and to take care of our emotional health. He notes that the health effects of neglecting either of these priorities are easily observed in our biomarkers.

So how helpful is this book anyway? I suppose who those who are obese or physically inactive, the comprehensiveness of the scientific evidence just might be what it takes to get them to change their lifestyles. Then again, it might do nothing since it’s advice that we’ve all heard innumerable times before. For those who are already generally healthy and fit, it can be shocking to realize how much more exercise Attia expects you to do. Apart from that there is relatively little that is novel and immediately actionable, save perhaps for some suggestions of exercises to improve what he calls stability with the help of online videos. One potentially contentious point is that he seems to be in favor of taking some drugs such as Metformin and statins even before being diagnosed with diabetes or heart disease as a preventative measure. He also suggests using some devices, such as a Continuous Glucose Monitor, which may not be widely available yet outside of rich countries.

Browsing through the commentary and reviews, I found few very damning criticisms, probably because Attia is offering mostly sound advice and isn’t selling any miracle cures. One point worth noting that his own longevity clinic charges clients something on the order of US$150,000 a year and so the number and types of tests, medical services and drugs he proposes for clients reflect that level of resources. I note myself that simply following the type of exercise regimen suggested in the book will be very taxing on the schedule of anyone who also needs to work full time and has other problems in life to deal with. Another valid point might be that his perspective might be too masculine with its strong emphasis on exercise and protein intake and without consideration of the different ways in which men and women might age differently. At one point, he mentions being in favor of hormone replacement therapy for post-menopausal women. I expected him to return to the point in greater detail later, but he never does.

For our part, we’re not rich but we should be able to do at least some of what he recommends and we do have the time to exercise. We thought we’ve been doing okay in terms of exercise so having to ramp up our efforts significantly as per the recommendations here has been quite trying. We’ll also try to look into some of the diagnostics mentioned depending on their availability in Malaysia. All this is to say that I found this book useful, its information plausible and intend to follow its advice. I may not be the perfectionist that Attia is so I won’t beat myself up for not being a sports freak, but I do want to live as long as I reasonably can and this makes for a solid foundation to build towards that goal.