Eric Topol in his Ground Truths blog reviews Outlive by Peter Attia:
Seems that a big focus is on exercise and fitness (Topol quotes Attia as writing “I now consider exercise to be the most potent longevity “drug” of our arsenal”), and this figure is included:
The information for the above seems to come from this (paywalled) paper:
https://www.sciencedirect.com/science/article/abs/pii/S0735109722052603
The above page has this figure not behind the paywall:
Thanks for posting!
People tend to take away the wrong message…that you have to be extremely active.
The real take home is that any activity is quite helpful.
As a side note, if you don’t want to go into the lab and get VO2 Max measured, the Apple Watch and iPhone have an algorithm that is a reasonable approximation.
What do you think of Fitbit’s Cardio Fitness algorithm versus Apple’s?
Side note, but I really like Eric Topol. I started following both him and Bob Wachter early in the pandemic. I’ve learned a lot from both of them.
I just started reading the white paper last night and fell asleep 
Listened to this book (and it’s a doozy) during my morning walks over the last month. Big takeaways for me were the importance of balance and bone health, SLEEP and quality sleep, some interesting newer research into Alzheimers (hearing loss, saunas!) and some bloodwork that my doctor doesn’t currently do. Otherwise, his advice is pretty much to exercise, stay mentally healthy, don’t eat crap, and stay on top of all preventative testing. It’s a good book and helped me refocus on a few areas, especially balance and quality sleep, but it is mostly stuff you know if you pay attention to this kind of stuff.
tl;dr I have been considering buying the book and am Attia-curious but as a pretty healthy 60yo I just don’t feel like I need a new thing to obsess over.
Thanks for the book review. I have been toying with buying it, but in lieu of spending money I’ve gone on a two-week deep dive of Attia’s podcasts and podcast appearances, as everyone on the fitness and health thread knows.
I started paying attention to Andrew Huberman, but he got too wonky for me. I am not going to get that deep into brown fat and cold showers and all the things he was pushing. Once he started endorsing various things, such as supplements, that was it for me as it felt like a conflict of interest and made his advice feel biased. So then I switched to Attia, who I first heard on a Huberman podcast, and, while he’s still more wonky than I can deal with for too long, I have gleaned a lot of what feels like worthwhile info. I didn’t even know that my Apple watch measured my VO2 Max before last week, but how excited was I to learn that I am above the 90th percentile for women in my age group. I figure I’m doing something right!
Where I can’t decide how much I want to pursue with him is doing the 80/20 zone 2/zone 5 breakdown. I actually did a little experiment today with a short aerobic workout to see how it breaks down in the various zones. First thought – the Apple watch zone 2 is NOT what I had calculated as my zone 2. I figure the Apple watch is more accurate, considering it knows my height and weight and has every workout that I’ve done for years, but it had me more than 10 points higher than the calculation I made based on an internet search. And it was a narrower window than I had been using. My second thought – I figured I would be better at regulating my heart rate in zone 2 than I was. I worked out for 10:30 after my regular workout so that my heart rate already would be elevated and I would have less time in zone 1 and could get right to it. I ended up with basically two minutes in zone 1, six in zone 2 and two in zone 3.
I’ll be curious to see what everyone else thinks. I have access to some of the la-di-da testing he talks about and am considering getting my VO2 Max officially measured, which also would give me a more accurate zone breakdown.
Also, I’m still unclear on the blood testing. Is he saying ApoB? Is that what we’re supposed to know? I already do DXA scans so know I have great bone health. And I’ve been working on my sleep. I have a little too much LDL though my ratio is in range. I really feel like I have devoted enough time to this and don’t want another rabbit hole.
I listen to Attia and Huberman and agree, enjoyable but a little nutty sometimes too. I often enjoy their guests more than them.
I brisk walk daily, swim a few days a week to get VO2 Max, am trying to be better about lifting (hate it), and I do balance exercises daily. I take HRT because of sleep issues and a family history of bone loss, other than that, I don’t eat crap or drink other than an occasional glass of wine 
I am going to ask about ApoB.
Here’s my main thought though. You and I, we’re doing great I’m very proud of us. Compared to the vast majority of the country and the developed world, we are so healthy. I think both Huberman and Attia are obsessed to an unhealthy extent and while I should probably be a little more sympathetic, Attia does talk about some of his emotional struggles in his book and it made me think of his advice a little differently. So that’s where I’m landing on all this, take what you can but don’t get into the minutia, it isn’t healthy!
ApoB and LDL-c are the same for most of us but not all of us.
Cholesterol is not water soluble. It needs to be encapsulated to flow properly in blood. Think about it as an egg…shell, the apoprotein encapsulation, and white and yolk contents, the cholesterol. It is the shell that is thought to be atherogenic. The cholesterol is just a proxy.
Some people have a lot of small particles, quail eggs if you will. It’s uncommon, but likely to be overlooked if you just measure whites and yolks. In that case ApoB will not equal LDL-c and is probably better to follow. Some also advocate for LDL-p, the number of particles.
The problem I have with Attia is that he’s just as trained in that stuff as I am, not at all. He’s a surgical oncologist who never practiced. The literature is not settled, but he speaks as though it is.
In my non-expert opinion, it’s worth getting an ApoB once to see if it is concordant with your LDL. If it is, as mine is, follow LDL. If not, follow ApoB.
The other thing he recommends is Lp(a). It’s a genetically inherited dyslipidemia with no treatment. It’s roughly 5x more atherogenic than LDL. If you have it, as I do (20% of the popn does), then LDL/ApoB needs to be treated more aggressively.
Clear as mud? 
I agree 100%! Anxiety about longevity is likely to shorten your longevity!
Agree. Midlife crisis? Recognizing they are going where everyone else is going eventually?
Btw… Lots of $$ has been raised by some stealth mode biotech companies pitching longevity cures to rich folks who are not ready to embrace their mortality.
That made much more sense than anything I’ve heard from them. I guess at my next checkup I can ask about it.
@Izzy74 I found his anger issues interesting (he’s talked about them on podcasts). Not surprised AT ALL. He’s trying to channel an unhealthy obsession into a healthy one, which I suppose is better, but it’s still an obsession!
Or want a magic pill or something that requires less effort for them than exercise and eating vegetables?
It is important to distinguish between causation and correlation. Persons with high VO2 max having a lower average mortality rate does not necessarily mean that fitness level or VO2 max has a strong influence on mortality. It may instead mean that things that are correlated with VO2 max / fitness are primary drivers.
For example, smoking is known to decrease VO2 max. Consistent with this, the study mentions that 32% of persons with low VO2 max smoke compared to 14% of persons with high VO2 max. If a lifetime of smoking decreases a person’s VO2 max, is it it that decrease VO2 max that primarily increases their mortality risk? Or does there increased mortality risk more relate to the lifetime of smoking and conditions associated with smoking, such as lung cancer?
Similarly I expect cardio athletes tend to have a lower body fat percentage than the average American. Not having a high body fat may be more of a driver than having a better VO2 max. Athletes also tend to have better nutrition, better general genetics, make more an effort to live a generally healthy lifestyle, get more sleep on average, etc. There could also be relationships such as people who are in poor enough health to put them at high risk of mortality tend to feel poorly enough to not be up for heavy exercise. The lack of exercise can be an effect, rather than a cause.
This makes it difficult to draw conclusions about whether VO2 max/fitness is a primarily a root cause of increased mortality vs primarily a correlation of increased mortality risk, based on the listed information.
It would be nice if they did a regression analysis that controlled for some of the factors above, such as smoking or body fat. Future studies could also try changing VO2 for 1 group and not other, then seeing how mortality rate changes.
What are the findings about saunas?
I know this type of guy in real life – a bro who went to medical school but realized seeing patients was a grind. Wished he had been a tech-millionaire or entrepreneur instead like some of his buddies. So hatched a plan to market and sell “longevity.”
In other words, a charlatan.
I don’t think he’s a charlatan, but I do think he has issues and is a little extreme. His general advice, I think, is excellent.
It’s a weird finding but I would think some more research is called for.
Agree. Attia strikes me as a little haunted, obsessed, but not a charlatan.
Ouch. I wouldn’t call him a charlatan. Nothing wrong with making money. I think most of what he says has a basis in fact and is good advice for gaining/maintaining health, even if to the extreme. He’s not pushing magic liver pills.
Well, I listened to the 5 mins of the audiobook from Amazon and I’ve heard one of his podcasts, so I bought the book. I need to read a book anyway. 
Meh, $20 could be down the tubes, but I’m going to check it out. Even if it contains just one kernel of knowledge, that would be worth it to me.
I believe that I’m set in the facets of sleeping, eating, exercising, etc., but you never know. I may actually learn something. 
