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Summary of Outlive

A

Summary of Peter Attia MD’s book

The Science and Art of Longevity

GP SUMMARY

Summary of Outlive By Peter Attia MD: The Science and Art of Longevity

By GP SUMMARY© 2023, GP SUMMARY.

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Author: GP SUMMARY

Contact: GP.SUMMARY@gmail.com

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Editing, proofreading: GP SUMMARY

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NOTE TO READERS

This is an unofficial summary & analysis of Peter Attia MD’s “Outlive: The Science and Art of Longevity” designed to enrich your reading experience.

 

DISCLAIMER

The contents of the summary are not intended to replace the original book. It is meant as a supplement to enhance the reader's understanding. The contents within can neither be stored electronically, transferred, nor kept in a database. Neither part nor full can the document be copied, scanned, faxed, or retained without the approval from the publisher or creator.

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This eBook is licensed for your personal enjoyment only. This eBook may not be resold or given away to other people. If you are reading this book and did not purchase it, or it was not purchased for your use only, then please purchase your own copy. You agree to accept all risks of using the information presented inside this book.

Copyright 2023. All rights reserved.

 

INTRODUCTION

 

The dream is about a surgical resident at Johns Hopkins Hospital who is trying to catch falling eggs from above. The attending surgeons at Hopkins specialized in serious cases like pancreatic cancer, and their weapon of choice was the Whipple Procedure, which involved removing the head of the patient's pancreas and the upper part of the small intestine. Despite their efforts, they are unable to catch all the eggs, and the dream keeps ruining their sleep.

This book is about a surgeon who was determined to become the best cancer surgeon, but found himself torn between the complexity of these surgeries and the futility of achieving success. He had a dream about the falling eggs and realized that the only way to solve the problem was not to get better at catching them, but to try to stop the guy who was throwing them. Ultimately, he realized that we needed to approach the situation in an entirely different way, with a different mindset, and using a different set of tools. He made his way back into the medical profession with a fresh approach and new hope.

PART I

PART I

From Fast Death to Slow Death

 

The most important details in this text are the details of the first patient the narrator saw die in their second year of medical school. The narrator was spending a Saturday evening volunteering at the hospital, and a woman in her mid-30s came into the ER complaining of shortness of breath. The nurses and doctors began running a "code" on her, snaking a breathing tube down her airway and injecting her full of potent drugs in a last-ditch effort at resuscitation. The resident doing CPR then asked the narrator to come over and relieve him, and the narrator began doing compressions for the first time in their life on someone who was not a mannequin. However, nothing worked and the woman died right there on the table, as the nurse pulled the sheet up over her face and everyone scattered as quickly as they had arrived. This experience haunted the narrator for years.

As a surgical resident at Johns Hopkins, the author learned that death comes at two speeds: fast and slow. In inner-city Baltimore, fast death was meted out by guns, knives, and speeding automobiles, while slow death was caused by slow-growing, long-undetected tumors. Despite this, the author is still practicing medicine, but in a different way from how they had imagined. Their focus as a physician is on longevity, and they are working to improve access to medical care. The most important details in this text are that longevity does not mean living forever, or even to age 120, or 150.

 

It also does not mean merely notching more and more birthdays as we slowly wither away, as was the case with Tithonus, who asked the gods for eternal life but forgot to ask for eternal youth as well. In 1900, life expectancy hovered somewhere south of age fifty, and most people were likely to die from "fast" causes. Today, slow death has supplanted fast death, and the majority of people reading this book can expect to die somewhere in their seventies or eighties, give or take, and almost all from "slow" causes. The Four Horsemen of aging are heart disease, cancer, neurodegenerative disease, or type 2 diabetes and related metabolic dysfunction. To achieve longevity, we must understand and confront these causes of slow death.

Healthspan is the period of life when we are free from disability or disease, and our plan for longevity is to maintain and improve our physical and mental function. One of the main obstacles in anyone's quest for longevity is the fact that the skills that our colleagues and I acquired during our medical training have proved to be far more effective against fast death than slow death. We were less successful at helping our patients with chronic conditions, such as cancer, cardiovascular disease, or neurological disease, evade slow death than we were with acute problems. The problem was that we approached both sets of patients with the same basic script: our job was to stop the patient from dying, no matter what. This ethos is ingrained in anyone who goes into medicine, and we approached our cancer patients in the same way, but often it was clear that we were coming in too late.

 

We did everything possible to prolong their lives, deploying toxic and often painful treatments right up until the very end, buying a few more weeks or months of life at best. Modern medicine has thrown an unbelievable amount of effort and resources at each of these diseases, but it is not enough. We have made progress in reducing mortality rates from cardiovascular disease, but death rates from cancer have hardly budged in the more than fifty years since the War on Cancer was declared. Type 2 diabetes remains a raging public health crisis, and Alzheimer's disease and related neurodegenerative diseases stalk our growing elderly population. However, we are intervening at the wrong point in time, well after the disease has taken hold, and often when it's already too late.

 

We need to step in sooner to try to stop the Horsemen in their tracks. The standard-of-care treatment guidelines of the American Diabetes Association specify that a patient can be diagnosed with diabetes mellitus when they return a hemoglobin A1c (HbA1c) test result of 6.5 percent or higher, corresponding to an average blood glucose level of 140 mg/dL (normal is more like 100 mg/dL). However, this is not the right way to approach type 2 diabetes, as it belongs to a spectrum of metabolic dysfunction that begins long before someone crosses that magical diagnostic threshold on a blood test. The best time to intervene is before the eggs start falling, as I discovered in chapter 6.

On September 8, 2009, Peter was standing on a beach on Catalina Island when his wife, Jill, told him that he should work on being a little less not thin. He had ballooned up to 210 pounds, a solid 50 more than his fighting weight as a teenage boxer. Blood tests revealed that he had become insulin resistant, below the 5th percentile for a man his age, and his life was in danger. This moment on the beach marked the beginning of his interest in longevity, as he had amputated the feet of people who had died in their forties from cardiovascular disease. I fell in love with my daughter and soon learned that my risk factors and genetics likely pointed to an early death from cardiovascular disease.

 

I became obsessed with understanding nutrition and metabolism, and sought out experts in these fields to mentor me on my quest for knowledge. I also studied the true nature and causes of atherosclerosis, cancer, and Alzheimer's disease. My biggest takeaway was that modern medicine does not have a handle on when and how to treat the chronic diseases of aging, and that each one of the Horsemen is cumulative, the product of multiple risk factors adding up and compounding over time. Medicine's biggest failing is in attempting to treat all these conditions at the wrong end of the timescale, rather than before they take root. We ignore important warning signs and miss opportunities to intervene at a point where we still have a chance to beat back these diseases, improve health, and potentially extend lifespan.

 

Despite billions of dollars in research funding, mainstream medicine has gotten crucial things wrong about their root causes. The typical cholesterol panel is misleading and oversimplified, and millions of people are suffering from a little-known and underdiagnosed liver condition that is a potential precursor to type 2 diabetes. Addressing our metabolic health can lower the risk of each of the Horsemen, and exercise is the most potent longevity "drug." However, emotional suffering can decimate our health on all fronts. The author's goal is to create an actionable operating manual for the practice of longevity, a guide that will help people outlive their life expectancy and enjoy better health. They believe that science is making huge leaps in understanding of aging and of the Horsemen diseases, but the tricky part is knowing how to apply this new knowledge to real people outside the lab.

 

Their approach to longevity is firmly rooted in science, but there is also a good deal of art in figuring out how and when to apply our knowledge to you, the patient. Longevity demands a paradigm-shifting approach to medicine, one that directs our efforts toward preventing chronic diseases and improving our healthspan. This approach has the potential to change the lives of individuals and relieve suffering in society, but only if and when patients and physicians demand it. Only by altering our approach to medicine can we get to the rooftop and stop the eggs from falling.

 

Rethinking Medicine for the Age of Chronic Disease

The most important details in this text are the story of a patient in the ICU with severe sepsis who was being kept alive by gentamicin, a powerful IV antibiotic. The patient's blood levels of gentamicin had dropped to the point where he needed another dose, so the patient's nurse asked the ICU fellow to give him the medication at 4:30 a.m. Instead, the attending physician gave the patient a tongue-lashing for trying to improve the way we delivered medication to a very sick patient. This was the beginning of the end of the patient's frustration with medical training.

The most important details in this text are the author's journey to McKinsey & Company, where he was hired to help US banks comply with a new set of rules that required them to maintain enough reserves to cover their unexpected losses. This was in 2006, during the runup to the global financial crisis, and the author felt as if he had wasted a decade of his life, but in the end, this seeming detour ended up reshaping the way he looks at medicine and more importantly, each of his patients. McKinsey originally hired him into their healthcare practice, but because of his quantitative background, they moved him over to credit risk. The most important details are that the banks had done a good job of estimating their expected losses, but nobody knew how to deal with the unexpected losses, which by definition were much more difficult to predict. This led to a project to analyze the banks' internal data and come up with mathematical models to try to predict these unexpected losses on the basis of correlations among asset classes.

 

The project uncovered a brewing disaster in what was considered to be one of their least risky, most stable portfolios: prime mortgages. After six months of round-the-clock work, the big banks were about to lose more money on mortgages in the next two years than they had made in the previous decade. The study of credit risk is a science, albeit an imperfect one, and the medical profession often approaches risk more emotionally than analytically. The ancient Greek dictum "First, do no harm" states that the physician's primary responsibility is to not kill their patients or do anything that might make their condition worse instead of better. However, there are three problems with this: Hippocrates never actually said these words, it's sanctimonious bullshit, and it's unhelpful on multiple levels.

 

The best treatment option is often the one with the least immediate downside risk, and every doctor worth their diploma has a story to disprove this nonsense. During one of the last trauma calls I took as a resident, a seventeen-year-old kid came in with a single stab wound in his upper abdomen, just below his xiphoid process, the little piece of cartilage at the bottom end of his sternum. A quick ultrasound suggested he might have some fluid in his pericardium, the tough fibrous sac around the heart, and if enough fluid collected in there, it would stop his heart and kill him within a minute or two. As he lost consciousness, I had to make a split-second decision to cut into his chest right then and there to relieve the pressure on his heart. Risk is not something to be avoided at all costs, but rather, it is something we need to understand, analyze, and work with.

 

In the case of the seventeen-year-old stab victim, the risk was so asymmetric that doing nothing would likely have resulted in his death. The hasty chest surgery was survivable, and the patient went home four nights later. Hippocrates would have been impressed by the precision steel instruments, antibiotics and anesthesia, and bright electric lights. The notion of a continuous march of progress from Hippocrates's era to the present is a complete fiction. There have been two distinct eras in medical history, exemplified by Hippocrates but lasting almost two thousand years after his death.

 

Medicine 1.0 was based on direct observation and guesswork, and Hippocrates's major contribution was the insight that diseases are caused by nature and not by actions of the gods. Medicine 2.0 arrived in the mid-nineteenth century with the advent of the germ theory of disease, which led to improved sanitary practices by physicians and the development of antibiotics. However, it was far from a clean transition, as it took centuries to meet trench-warfare resistance from the establishment. Ignaz Semmelweis, a Viennese obstetrician, was troubled by the fact that so many new mothers were dying in the hospital where he worked.

The shift from Medicine 1.0 to Medicine 2.0 was prompted by new technologies such as the microscope, but it was more about a new way of thinking. Sir Francis Bacon first articulated the scientific method in 1628, which allowed scientists and physicians to systematically test and evaluate potential cures, then choose the ones that had performed best in experiments. This led to the discovery of penicillin, which was a game-changer and has since been used to eradicate deadly diseases such as polio and smallpox. The recent cure of hepatitis C was also transformational, with most cases now cured by a short course of drugs. The rapid development of effective vaccines against COVID-19 has been remarkable, but Medicine 2.0 has been less successful against long-term diseases such as cancer.

 

Robert J. Gordon analyzed mortality data going back to 1900 and found that if you subtract out deaths from the eight top infectious diseases, overall mortality rates declined relatively little over the

Impressum

Verlag: BookRix GmbH & Co. KG

Tag der Veröffentlichung: 02.06.2023
ISBN: 978-3-7554-4386-5

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Widmung:
Dr. Peter Attia's Outlive provides innovative nutritional interventions, techniques for optimizing exercise and sleep, and tools for addressing emotional and mental health. He believes we must take action now to prevent chronic disease and extend long-term health.