That book actually might be worth reading. I was avoiding it because of his association with some people I can't stand (Vinay Prasad and John Ioannidis).
He seemed reasonable on his own podcast.
As someone who worked in health care and has to periodically evaluate what to do with my incidental meningioma...I understand healthspan versus lifespan.
I agree, anyone mentioned in the same sentence as VP gets my hackles up, but eventually Attia won me over. Ioannidis is an even weirder and sadder story: he's always been a provocative contrarian, but 10-15 years his reputation was much better, and I think he was generally viewed as an honest broker trying to improve statistical rigor in the life sciences. Unfortunately over the last few years, especially during the pandemic, he seems to have been overtaken by bias and ideology. Covid does seem to have broken a lot of people's brains :/
Great review! Your approach to books like this is similar to mine - authors have to pass a series of “tests” for me before I will consider them to be credible sources. A big vote in favor of this guy Attia is that he doesn’t sell supplements or “miracle cures”!
Based on your review, I’m likely to read this.
And just out of curiosity, which DHA/EPA fish oil are you taking? I’ve been taking one for years, made by Biotest Labs called Flameout, but always interested in learning about alternatives! 😉
As I've previously written about supplements, they are totally unregulated in the US, so you really want to make sure you do your research on quality and testing. I looked at a number of fish oil supplements available at my grocery store (Publix) and settled on Nature Made Omega 3 Fish Oil 1200 mg. I picked that one for several reasons:
- Concentration of Omega-3/DHA/EPA in line with recommendations for starting dose
- Ingredients and potency are verified by the third-party non-profit US Pharmacopeia
- They follow Good Manufacturing Processes (GMP)
- They purify to remove mercury and other possible harmful environmental substances
(Standard disclaimer: I have no financial or other affiliation with this product or any other supplements/medications)
I like Attia, and have been curious about Outlive, but I’ve spent most of my last four years reading books related to my specific health condition. “Lifespan” concerns took a backseat for me when I was just trying to keep my head above water re: long COVID. But your review has me thinking a bit differently about this. I am still concerned about “healthspan” and so I’m glad you described that here. I just may pick up his book after all.
Thanks Eric! I’ve stalled out reading outlive but will try to engage with it this summer! Your review seems excellent, and perhaps the best aspects are the heavily referenced returns to the basics of nutrition, exercise, sleep, and mental health… with the latter often considered too soft a consideration, so kudos there.
I don’t like the sense he gives that primary care doctors and medicine in general don’t emphasize these things. Sure a lot of docs suck and don’t spend the time counseling us about the above, but it’s certainly not like he is the first guy in the room to preach quality of life over quantity. When people come to us with a broken car and ask us to try to fix it, they already know that perhaps they should have been keeping up with maintenance all along! It’s also a common burnout pathway to jump ship and start a holistic practice or wellness schtick while ordering lots of expensive but less actionable blood tests so people think you really know your sh*t, and mainstream primary care docs just don’t get it. But we stick with USPTF and other major cost/benefit/harm analyses.
And one final thought, I don’t bother with fish oil, but rather try to incorporate more nuts, olive oil, salmon, avocado, etc. the evidence for fish oil is weak at best:
Hey Ryan, thanks for the insightful comments! I'm really glad to see a physician chiming in since I'm obviously not a human doc.
I can see how Attia gives off that impression about primary care docs and it is probably annoying to those in the trenches attempting to do this stuff every day. From my minimal experience with veterinary primary care and as a patient, I would say the issue is not that GPs don't know this stuff or want to help patients with it, but more an issue of *TIME*. A 15-30 minute visit is really tough to squeeze in these nuanced conversations at the level of detail he goes into. Not to mention insurance likely does not reimburse generously for those time-sucking discussions!
I have had physicians tell me "get 30 minutes of exercise 3-4 times a week," but I've never once had any one go into detail about the pros/cons and differences in approach between Zone 2 aerobic training and VO2 max training, let alone strength training. My sense is many physicians don't feel comfortable giving ultra specific recommendations about fitness and frankly some probably don't view that as part of their job. This opens the door to a world of non-medical opinions from physical therapists, coaches and trainers, random friends/family, and the broader internet, where lots of crazy misconceptions get thrown out. Attia is probably unique in that he is a former serious boxer and lifelong high performance athlete and that is a cool benefit of his viewpoint.
You could make similar points about nutrition and sleep. It's easy to say "eat less, make sure it's balanced, fruits and veggies are best," but few MDs/DOs/PAs I've been to have the time or interest to get into the nitty gritty of meal planning and tracking the changes in response to goals over time. This is where I think Outlive shines: giving patients that level of detail and hand-holding from someone who actually IS a doctor and not totally full of crap.
I appreciate the thoughts on fish oil and linking the Cochrane systematic review! Fish oil supplementation is something I've been considering for a while. To get a little more in depth on my thought process, I have autoimmune disease (Grave's), rashy and easily irritated skin, and a variety of other vague inflammatory conditions (microscopic colitis) that are probably influenced by stress and lifestyle. So I was hoping that in addition to the possible cardiovascular and lipid benefit, increasing my Omega-3 FAs could help those conditions as well.
From what I read, the evidence is stronger that eating fish and other foods rich in Omega-3s has some protective effect against cardiovascular disease compared to supplements (so either it is more complex than those specific molecules, supplements are too variable in content and dosing, or both), and I do try to eat those when possible. However, I travel a ton (often more than 50% each month) and stuff like fresh salmon or other fatty fish is not always readily available, so adding a supplement seemed like an easy way to get some potential benefit consistently. It looked like the main adverse effect is a small risk of bleeding in some patients, but I'm young and healthy without a family history or personal predisposition to bleeding, so it seemed like modest hypothetical benefit at very low risk.
I dunno! I plan on discussing that and some of these other strategies with my pMD at my annual physical in August. We'll see what they say based on their assessment of my record.
Attia an incredible communicator. Great review! I wasn’t going to read but will put it on my list.
Great inputs, Eric! Thanks. Attia's book has been on my to-read list for a while.
That book actually might be worth reading. I was avoiding it because of his association with some people I can't stand (Vinay Prasad and John Ioannidis).
He seemed reasonable on his own podcast.
As someone who worked in health care and has to periodically evaluate what to do with my incidental meningioma...I understand healthspan versus lifespan.
I agree, anyone mentioned in the same sentence as VP gets my hackles up, but eventually Attia won me over. Ioannidis is an even weirder and sadder story: he's always been a provocative contrarian, but 10-15 years his reputation was much better, and I think he was generally viewed as an honest broker trying to improve statistical rigor in the life sciences. Unfortunately over the last few years, especially during the pandemic, he seems to have been overtaken by bias and ideology. Covid does seem to have broken a lot of people's brains :/
Great review! Your approach to books like this is similar to mine - authors have to pass a series of “tests” for me before I will consider them to be credible sources. A big vote in favor of this guy Attia is that he doesn’t sell supplements or “miracle cures”!
Based on your review, I’m likely to read this.
And just out of curiosity, which DHA/EPA fish oil are you taking? I’ve been taking one for years, made by Biotest Labs called Flameout, but always interested in learning about alternatives! 😉
Thanks, I'm glad you found my review useful!
As I've previously written about supplements, they are totally unregulated in the US, so you really want to make sure you do your research on quality and testing. I looked at a number of fish oil supplements available at my grocery store (Publix) and settled on Nature Made Omega 3 Fish Oil 1200 mg. I picked that one for several reasons:
- Concentration of Omega-3/DHA/EPA in line with recommendations for starting dose
- Ingredients and potency are verified by the third-party non-profit US Pharmacopeia
- They follow Good Manufacturing Processes (GMP)
- They purify to remove mercury and other possible harmful environmental substances
(Standard disclaimer: I have no financial or other affiliation with this product or any other supplements/medications)
I like Attia, and have been curious about Outlive, but I’ve spent most of my last four years reading books related to my specific health condition. “Lifespan” concerns took a backseat for me when I was just trying to keep my head above water re: long COVID. But your review has me thinking a bit differently about this. I am still concerned about “healthspan” and so I’m glad you described that here. I just may pick up his book after all.
Thanks Eric! I’ve stalled out reading outlive but will try to engage with it this summer! Your review seems excellent, and perhaps the best aspects are the heavily referenced returns to the basics of nutrition, exercise, sleep, and mental health… with the latter often considered too soft a consideration, so kudos there.
I don’t like the sense he gives that primary care doctors and medicine in general don’t emphasize these things. Sure a lot of docs suck and don’t spend the time counseling us about the above, but it’s certainly not like he is the first guy in the room to preach quality of life over quantity. When people come to us with a broken car and ask us to try to fix it, they already know that perhaps they should have been keeping up with maintenance all along! It’s also a common burnout pathway to jump ship and start a holistic practice or wellness schtick while ordering lots of expensive but less actionable blood tests so people think you really know your sh*t, and mainstream primary care docs just don’t get it. But we stick with USPTF and other major cost/benefit/harm analyses.
And one final thought, I don’t bother with fish oil, but rather try to incorporate more nuts, olive oil, salmon, avocado, etc. the evidence for fish oil is weak at best:
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003177.pub5/full
Thanks again! Will try to resume reading soon;)
Hey Ryan, thanks for the insightful comments! I'm really glad to see a physician chiming in since I'm obviously not a human doc.
I can see how Attia gives off that impression about primary care docs and it is probably annoying to those in the trenches attempting to do this stuff every day. From my minimal experience with veterinary primary care and as a patient, I would say the issue is not that GPs don't know this stuff or want to help patients with it, but more an issue of *TIME*. A 15-30 minute visit is really tough to squeeze in these nuanced conversations at the level of detail he goes into. Not to mention insurance likely does not reimburse generously for those time-sucking discussions!
I have had physicians tell me "get 30 minutes of exercise 3-4 times a week," but I've never once had any one go into detail about the pros/cons and differences in approach between Zone 2 aerobic training and VO2 max training, let alone strength training. My sense is many physicians don't feel comfortable giving ultra specific recommendations about fitness and frankly some probably don't view that as part of their job. This opens the door to a world of non-medical opinions from physical therapists, coaches and trainers, random friends/family, and the broader internet, where lots of crazy misconceptions get thrown out. Attia is probably unique in that he is a former serious boxer and lifelong high performance athlete and that is a cool benefit of his viewpoint.
You could make similar points about nutrition and sleep. It's easy to say "eat less, make sure it's balanced, fruits and veggies are best," but few MDs/DOs/PAs I've been to have the time or interest to get into the nitty gritty of meal planning and tracking the changes in response to goals over time. This is where I think Outlive shines: giving patients that level of detail and hand-holding from someone who actually IS a doctor and not totally full of crap.
I appreciate the thoughts on fish oil and linking the Cochrane systematic review! Fish oil supplementation is something I've been considering for a while. To get a little more in depth on my thought process, I have autoimmune disease (Grave's), rashy and easily irritated skin, and a variety of other vague inflammatory conditions (microscopic colitis) that are probably influenced by stress and lifestyle. So I was hoping that in addition to the possible cardiovascular and lipid benefit, increasing my Omega-3 FAs could help those conditions as well.
From what I read, the evidence is stronger that eating fish and other foods rich in Omega-3s has some protective effect against cardiovascular disease compared to supplements (so either it is more complex than those specific molecules, supplements are too variable in content and dosing, or both), and I do try to eat those when possible. However, I travel a ton (often more than 50% each month) and stuff like fresh salmon or other fatty fish is not always readily available, so adding a supplement seemed like an easy way to get some potential benefit consistently. It looked like the main adverse effect is a small risk of bleeding in some patients, but I'm young and healthy without a family history or personal predisposition to bleeding, so it seemed like modest hypothetical benefit at very low risk.
I dunno! I plan on discussing that and some of these other strategies with my pMD at my annual physical in August. We'll see what they say based on their assessment of my record.