Book Review: Outlive the Science and Art of Longevity by Peter Attia and Bill Gifford


Reading Outlive changed my view of Peter Attia – even before hitting the bombshell plot twist in the final chapter.

As a fan of his podcast, I was fully expecting this book to be a factual, practical, and detailed dive into healthy aging strategies. No nonsense about biological immortality, just solid advice for reaching 100 in robust health.

It did not disappoint.

Yet, alongside this, the driven and serious side of Attia’s on-screen persona crumbled, revealing a nuanced, rich and – at times – vulnerable individual beneath. Anecdotes, failures, moving stories of friends and loved ones and intense self-reflection bought the detailed coverage of the diseases that kill us, nutrition, exercise, and sleep to life.

Outlive Review Book CoverFresh Perspectives

Reducing my copious notes to just five takeaway points for this review of Outlive was a challenge.

Themes include the abject failure of the current medical system, the unstoppable rise in metabolic syndrome, a fresh perspective on exercise and the significance of preventative health screening.

I’ll be revisiting the sections on chronic disease. They are information-dense to the point where reading them in a single session became overwhelming. The practical advice from the more general sections is actionable. Peter outlines a framework of principals. You can then apply this to nutrition, toxins, sleep, exercise, and emotional health.

Five Take Aways from my Review of Outlive: The Science and Art of Longevity by Peter Attia

The five key takeaways below are points that triggered deep thinking or perspective change while I was reading Outlive.

They cover varied topics, though won’t sum up the entire book. After this section, you’ll find my thoughts on the plot twist referenced above – though without any spoilers.

There is one final actionable takeaway there.

Peter Attia Book Review

Outlive by Peter Attia #1: Metabolic Syndrome as a Train

There are stations on the train line linking excess sugar consumption and death.

This starts with insulin resistance, goes through non-alcoholic fatty liver disease, then NASH / diabetes. As the train travels, your risk of death from one of the four horsemen (cancer, heart disease, stroke, and neurological diseases) rapidly increases.

Even if you are lucky enough to dodge these bullets – the accumulated damage to your blood vessels, neurones and cell signalling pathways is immense.

Most people are already on this train. The SAD (Standard American Diet) almost guarantees that the slow journey from healthy to metabolically compromised is underway.

Early symptoms, up to NAFLD and pre-diabetes are reversable. Lifestyle changes are required. They begin with taking personal responsibly for your health outcomes. As many as one in four people have NASH (nonalcoholic steatohepatitis), which happens when NAFLD progresses. Untreated, this can lead to cirrhosis.

Attia is careful to point out that obesity and metabolic health are nuanced – though not one and the same:

“But not everyone who is obese is metabolically unhealthy, and not everyone who is metabolically unhealthy is obese. There’s more to metabolic health than meets the eye”.

The big takeaway here is that the standard diet (not just in the US, but worldwide) is directly linked to the progression of metabolic syndrome. And that metabolic syndrome directly causes chronic health conditions that will massively reduce the quality of your life, and eventually kill you.

Fructose Link to Fatty Liver Disease

#2 – A Perspective Flip of Stability Training

Anyone familiar with Peter Attia will have high expectations of the chapters on exercise.

They did not disappoint, the information was so rich, I’ll need to revisit it for specifics.

It turned out, I was thinking about ‘Stability’ all wrong.

This is a core component of what Attia calls the ‘Centurion Olympics’. He has set a list of goals for his 100th birthday. Then worked backwards through the decades to see what training is required.

Strength training (for muscles), Vo2 max (circulatory) and Zone 2 (endurance) are components, along with stability training.

I thought my planking and core workouts – along with stretching and squats – ticked this box.


Peter disagrees.

Stability starts with the feet, providing a stable platform (yours probably don’t). It then includes good form in situations where major muscles are activated. Squats, stepping blindly from a height and lifting weights are all included.

Without that good form, we are at risk from injuries – especially in later life. We lose the good form as children, and without specialist training, getting it back is a challenge.

If you are unclear how dangerous setbacks which force inactive periods are in later life, then Outlive contains stories which bring this phenomenon to life. Reoccurring references are made to ‘Sophie’s mum’, an active / healthy older person whose end started with a simple injury. This triggered a period of inactivity, causing a rapid spiral into frailness and eventually death.

Stability Training Outlive

#3 – Medicine 2.0 vs Medicine 3.0: Treating Underlying Causes, Not Symptoms

Whack-a-Mole medicine was already on my radar.

It is a major theme in Outlive. Attia calls legacy medical care ‘Medicine 2.0’. He is scathing of it in that intense, serious way that only Peter can pull-off. Imagine that stare, his BS detector fully activated on his YouTube videos… now multiply and repeat it in different contexts throughout the book.

I’m sure you get the idea.

Peter is disgusted with the universal practice of medicating symptoms without examining underlying causes. Add inflexible testing levels – for example treating a condition at 100 units per ml of blood, yet totally ignoring signs at 99 units – and the disfunction is obvious. Poor population-level screening for chronic diseases is yet another failure.

The case for upgrading from Medicine 2.0 to Medicine 3.0 is compelling. That said, challenging the behemoth of the medical establishment is no trivial task.

My takeaway from this is that moving from Medicine 2.0 to 3.0 is a personal choice.

Get tested, get personal monitoring, set goals, and change your behaviour to avoid future conditions. Don’t wait to develop symptoms, get them treated – then return to the doctor a year later with new symptoms triggered by the same underlying problem that was untreated the first time around.

#4 – Outlive Review: Nutrition is Far from Solved

Information about diet and eating habits is both detailed and nuanced.

If you were expecting information on keto or low carb / high protein options, you’ll find them discussed. This is in a wider context of ‘what works for you’ and nutritional biochemistry.

Attia uses the terms ‘overnourished’, and ‘undernourished’.

Polarising terms are avoided completely. For me, nutrition is as tribal as politics. Factions strongly believe that anyone not following their specific regimen is either stupid or misguided. Information in this chapter contradicts every fanatic at some point – from vegan through to carnivore. I felt that Peter handled this skilfully, and as with the other chapters, there are hidden gems along the way.

The single biggest take-away is that nutrition is way too complex, and confounded by far to many individual and environmental factors to be considered ‘solved’.

Once you understand this, seeking the ‘correct’ diet for healthy aging becomes favouring one narrative over the others.

Instead, you can think of this in terms of your nutritional biochemistry – working backwards from there while keeping an open mind as our understanding of food improves.

 “Diet and nutrition are so poorly understood by science, so emotionally loaded, and so muddled by lazy thinking that it is impossible to speak about them in nuanced terms…” (Chapter 14, Nutrition 3.0)

In the second chapter on nutrition, Attia covers dieting strategies including restricting calories, restricting specific foods, and eating during a specific time window. The pros and cons of each will help you choose what mix of strategies work best for your own goals.

Intentional Nutrition 3.0

#5 – Vo2 Max Training and Healthy Lifespan

Exercise information in Outlive is excellent.

It covers the why of each form of exercise, and the biological pathways involved in the beneficial effects. Zone 2 training (moderate cardio) was explained in detail – including how it boosts mitochondrial function.

When it comes to Vo2 Max, I’m behind the curve.

My circuit training does leave me out of breath and with an elevated heart rate. Honestly, it is more like a Zone 4 or high Zone 3 than Max. Yet training at maximum capacity and all-cause mortality are significantly correlated. Adding endurance multiplies the health benefits. Peter goes ‘Rucking’, which involves hiking and running with a 60-pound rucksack on his back.

I’m adding Vo2 Max training to my routine. There is a test site at a local university, I want to get two to three months training under my belt before getting tested. Watch my Age Well Times blog for the results.

After reading the exercise chapter, you’ll have a great understanding of why Vo2 Max, resistance training, stability training and Zone 2 exercise are important.

Without each of these, you’ll be leaving healthy aging benefits on the table.

Outlive Review: The Final Chapter Plot Twist

I’m not going to include spoilers.

What I will say is that you won’t see Peter Attia in the same light once you complete Outlive. And you might apply the same kind of perspective flip to others.

After all, once you find out why Peter is so intense, so serious and frequently angry – it not only becomes understandable, you’ll wonder why you never considered why in the first place. Next time you meet someone that seems unreasonable, or even out of line, the same logic is easy to apply.

There is one more takeaway from this chapter. Peter has a developed a technique for when his anger flares: Do the opposite of what the red mist of anger tells you to do. If you feel like lashing out (verbally), compliment, if you feel like walking away – dive in (and so on).

I love this idea, and am actively looking for opportunities to use it. While I’m not a hugely angry person, I certainly have the potential for a sharp tongue in my tetchy moments!

Angry Attia tips

Outlive Review: Final Thoughts:

With sky-high expectations, I was wondering whether Outlive would stand out from the huge list of longevity and healthy aging books out there.

It beat those expectations.

Your views will be challenged, from their framework through to the tiny details. This is a practical book, though the ‘art’ in the title is there for a reason. There are no clear answers in longevity. By working backwards from our final decades, we can plan for a robust future – and minimise our chances of a slow, painful decline.

Reading Outlive has real potential to make you healthier.

Reading the final chapter of Outlive might just make you a better person.


As usual I don’t include commercial links here at the Age Well Times. This is to satttay unbiased in my book reviews.

If you enjoyed this review, I’d genuinely appreciate a share on your favourite social media platform.

Please join me on Twitter – @MarkAWT

Here is Peter’s Podcast Channel on YouTube

And Peter’s Twitter: @PeterAttiaMD


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