The healthspan revolution: how to live a long, strong and happy life
Twenty years ago, Peter Attia was working as a trainee surgeon at Johns Hopkins hospital in Baltimore, where he saved countless people facing what he calls “fast death”. “I trained in a very, very violent city,” he tells me. “We were probably averaging 15 or 16 people a day getting shot or stabbed. And, you know, that’s when surgeons can save your life. We’re really good at that.”
What got to him, he says, were the people he treated who were in the midst of dying much more slowly. “All the people with cardiovascular disease, all the people with cancer: we were far less effective at saving those people. We could delay death a little bit, but we weren’t bending the arc of their lives.”
Attia and his colleagues often worked 24-hour shifts, leaving him starved of sleep. When he managed to get some rest, he had an endlessly recurring dream, in which he found himself in the middle of the city, holding a padded basket and staring up at a nearby building. Eggs rained down on him, and though he tried to catch as many as he could, most of them inevitably smashed on the pavement.
The symbolism did not take much decoding: here was all his unease and anxiety about trying to save people who were inexorably moving towards death, but never getting to the source of the problem – the way they lived. “Trying to catch the eggs before they hit the ground seemed far less effective than going up to the roof and taking the basket of eggs away from the guy who was throwing them,” he says. But in the dream, as in life, that part of the story never happened.
In the US, chronic disease is rampant, and recent figures have shown life expectancy is falling; in the UK, there is a similarly depressing picture. But Attia believes it is possible to turn this around. The day we speak, he is at home in Austin, Texas, where it is 11am. Beyond a cup of coffee, he has yet to have any breakfast, but that does not stop him talking for well over an hour about his key vision: increasing people’s “healthspan”, so that they maximise their chances of avoiding disease, and cut down the share of their lives they spend being frail and infirm, perhaps to as little as six months.
Attia, who was born in Toronto, has just turned 50. He is the founder of an Austin-based setup called Early Medical, which introduces its patients to the kind of treatments and lifestyle changes he advocates. He also hosts a weekly podcast called The Peter Attia Drive, whose recent subjects have included the dangers of poor sleep, the history of the cell and the gravity of the US opioid crisis. Last year, he was one of the stars of Limitless, a Disney + series in which the Australian actor Chris Hemsworth – best known for playing the Marvel superhero Thor – set out on a quest to “combat ageing and discover the full potential of the human body”.
And now there is a book. Outlive, subtitled “the science and art of longevity” is an exhaustive, lucid exploration of Attia’s ideas, created with the help of veteran journalist Bill Gifford. Even if the life changes it describes often seem onerous and complicated, its basic pitch is brazenly simple. We can, Attia says, strike big blows against the “four horsemen” of diabetes, cancer, heart disease and dementia by improving our lives in five “tactical domains”: exercise; “nutritional biochemistry” (ie what and how much we eat); sleep; emotional health; and “exogenous molecules” – or, as they are otherwise known, drugs and supplements.
While what Attia sets out is mostly about how individuals can transform their chances of extending wellness and resilience into old age, it inevitably strays into big questions about how systems of healthcare are organised, and the thinking that drives them.
He divides the historical evolution of illness and treatment into three. What he calls Medicine 1.0 was the shaky way of doing things that humanity relied on for thousands of years: a system based on “direct observation and abetted more or less by pure guesswork”. From the mid-19th century, that model began to give way to Medicine 2.0, which was centred on such innovations as the microscope, the discovery of antibiotics and thorough scientific experiments and research. This is the model we still use, but Attia wants us to move to Medicine 3.0, which “places a far greater emphasis on prevention than treatment”.
What he is proposing has slightly less to do with living longer than people’s quality of existence. “Longevity is such a … I want to say dirty, but it’s such a bastardised term,” he says. “And it just has such a negative connotation. It sort of smells of snake oil and elixirs and, you know, false promises. And what I don’t think gets enough attention is healthspan. Longer lifespan with no improvement in healthspan is a curse, not a blessing.”
Attia is not selling “biological reprogramming technology” – the kind of emerging science that aims at extending life via such techniques as flushing out worn (or “senescent”) cells from the body, or inserting genes into adult cells that convert them into stem cells. In the US, this is attracting no end of private funding, from such enthusiasts as the Amazon founder Jeff Bezos and the tech investor Peter Thiel, who claims to be planning to live to 120. While Attia is “involved with scientists who are doing that type of work”, he says, “it’s amazing to me how many people that I encounter choose to live a relatively unhealthy life today in the belief that that will be their salvation.”
He has really met people like that? “Oh my God: spend more time in Silicon Valley. You know, it’s like these people are spending all of this time and money on these endeavours, and yet they’re not exercising. They’re not sleeping well, and they’re not taking care of their stress, and all these other things that are killing them anyway. But they have this belief: ‘Well, it’s OK, because this thing is going to rescue me.’
“And I say: ‘Look, I’m not going to be the judge of whether that will or won’t rescue you. But let’s incorporate risk management. Let’s think about hedging.’” In other words, rather than placing all your faith in the future of cuttingedge science, it might be a safer bet, if you want to avoid the most trying kind of later-life, to do things that are possible in the here and now.
In the book, Attia writes enthusiastically about Rapamycin, an antifungal agent produced by a soil bacterium first discovered on Easter Island in the south-eastern Pacific. It is commonly used as an immunosuppressant after organ transplant operations, but experiments on animals suggest it may enhance a biological process that slows with age known as autophagy, or cellular recycling – on the face of it, a much simpler potential means of arresting ageing than the kind being funded by Bezos et al. Attia uses it himself at low doses, and has prescribed it to some of his patients. “The most notable sideeffect at the doses and frequencies for that purpose are mouth ulcers called aphthous ulcers,” he says. “And they occur in about 10% of people. I’m one of the 10%. So I do get them from time to time, but quite infrequently and usually only in the context of trauma – like if I bite my lip.”
One of his big themes is the kind of genetic screening that can alert people to their susceptibility to lifelimiting conditions, so they can take risk-reducing action – something seen in the Hemsworth series, when the actor is confronted with the fact that he is carrying two copies of a gene that make him up to 10 times more likely than most other people to develop Alzheimer’s disease. Hemsworth later hinted that it had played some part in his recent decision to take a break from his profession.
“It comes down to a philosophy of: ‘Do you or do you not believe that you have some agency over prevention of this disease?’” Attia says. “I think the evidence is quite clear that we have enormous agency over our risk of Alzheimer’s disease and other forms of dementia, including vascular dementia and small vessel dementia. We understand the things that increase risk.”
One good way of pushing that risk down is exercise – and in particular, Attia insists, the activity that even ardent gym-goers often leave to the grunting meat-heads: lifting weights.
“Strength is such an important part of ageing,” he says. “I mean, if you look at the majority of people over the age of 75 and 80, you’ll be so struck by how many activities they can’t do because they lack strength. It can be as simple as: ‘Why can’t most people at a certain age not even get up off the floor?’ They simply don’t have the strength in their hip muscles … The data is unambiguous on this. And when you compare strong with not-strong, the survival difference and the mortality difference is in the order of 200%.”
When it comes to questions about food and eating, Attia’s book is surprisingly noncommittal (“I once believed that diet and nutrition could cure almost all ills, but I no longer feel that strongly about it,” he writes). His key advice is that people should avoid being “overnourished”, which in most cases means reducing their overall energy intake, via a mixture of caloriewatching, restricting certain types of food (eg carbs) and intermittent fasting. The latter comes with a clear warning: that it may be one of the easiest ways to cut calories, but it risks damaging his treasured muscle mass. This leads on to his belief in maximising protein intake, and the benefits of an omnivorous diet.
But what, I wonder, about vegans? “You’re just going to have to work a lot harder and pay attention to amino acid quality,” he says.
Which means? “You’re going to have to go through nutrition labels and say: ‘Am I getting enough lysine and methionine [both amino acids, with a range of health benefits]?’ That’s basically what we do with our patients who don’t eat meat – make sure they’re hitting certain gram targets for each of those.”
Finally, what of sleep? In the book, Attia writes about the long years he spent neglecting it. “Until 10 years ago, yeah,” he says. “Of all the things I write about, that one is probably the one where people are closest to understanding the [correct] point of view. I think that there’s a growing consensus over the past five years that to not sleep is not just a drain on your performance, but also a drain on your health.
“It really makes sense when you consider what an evolutionary sacrifice it was for us to sleep. Think about evolution, and how ruthless it is in optimising your ability to procreate, forage for food and protect yourself – three things you can’t do when you’re sleeping. And yet, somehow, we didn’t outevolve a way to spend eight hours in an unconscious state. It’s a very compelling evolutionary argument for why this thing must matter.”
When I ask Attia how much it costs to sign up for treatment at Early Medical, he sounds rather coy. “It varies – it’s not a fixed fee. It’s a little more in the first year and then the cost sort of ratchets down because we’re doing more work early on.”
Whatever the wonders of his prescriptions, cynics might picture his clients spending half their lives necking supplements, monitoring their sleep, watching their calorific intake and lifting weights, and conclude that even if you have the time, money and inclination, doesn’t the kind of life he advocates require an impossible amount of work?
“We try to encourage our patients not to go all in and be very extreme out of the gate because what we’re interested in is implementing sustainable changes,” he says. “I always tell them: ‘Look, I don’t want you to be 10 out of 10 for a month and then two out of 10.
I’d rather we find out what seven out of 10 is, if you think that that’s what could be maintained indefinitely.’” The point, he says, is to “slowly alter habits one at a time in ways that are somewhat incremental, but that over time compound into significant changes.”
And then there are big social questions. Attia says he believes in the kind of two-tier medical systems whereby everyone has access to a basic level of care, but there are ample opportunities for people with enough money to access the kind of techniques and treatments he offers. But I wonder: as the science advances, won’t that mean those wealthy enough to embrace his kind of thinking running around into their 80s and 90s, while less moneyed people are left to decay – like the kind of society we have now, only more so?
“Your base system has to be preventive and it has to be preventive early,” he says. “And by the way, the most beneficial things that you’re going to do to extend lifespan and healthspan don’t actually cost much money.”
A pause. “Go exercise! How much does it cost to really educate people to exercise? That doesn’t matter how much money you have. Now, I’m not so naive as to think that a single mom who’s working three jobs won’t have less time to exercise. Clearly, there will be gaps in outcomes, but I don’t think those gaps have to be enormous.”
This last thought is left hanging in the air, as he prepares for his first solids of the day. When I ask what he’s having, we return to where we started, with eggs, though this time Attia is in control, and seeking a simple but effective dose of his beloved protein. “An omelette,” he says. “Plain. I don’t put anything in it.”
Outlive: The Science and Art of Longevity is published by Vermillion (£22). To support the Guardian, buy your copy from bookshop.theguardian.com. Delivery charges may apply
Longer lifespan with no improvement in healthspan is a curse, not a blessing
Peter Attia
early gesture at signifying what was important, which to an 11-year-old me was the name of my pet hamster. That Hotmail address was primarily used to access Neopets and talk to friends on MSN Messenger.
It was through MSN that, at the age of 13, I met my first true friend.
I wasn’t without friends growing up, but my friendship with K was the first time I had felt a kinship deeper than anything I had experienced outside of my siblings. She was a schoolmate of a friend who had recently transferred from private school. K and I became fast friends. We talked constantly, we exchanged hundreds if not thousands of emails and we created our own world nobody else understood. In some of my first forms of public self expression, we created web pages that we found edgy and that our classmates found somewhat upsetting.
K was not healthy. Her life revolved around her illnesses that were a result of a rare form of cancer she had as an infant. Her mobility was limited and she was on more medication than I have seen to this day, something she dealt with through a sense of humour darker and more powerful than that of anyone I knew at school. I owe so much of my sense of self to her. It was through being friends with K that I began understanding the ways people adapt to life’s harsh circumstances, something that became clear when she got a heart transplant at the age of 13.
When K died, in our first year of university, I was alone in my mourning. At that point in our lives, she was extremely popular. We would email each other frequently about how nobody knew us the way we knew each other. I dealt with her death by turning inwards, never talking about it to anyone and being alone with a sadness I didn’t have the words to express. Years later, when I felt ready to revisit our shared past, I realized I couldn’t access my old Hotmail account where we shared our deepest pre-teen feelings.
I was distraught and consumed by guilt. I was the only historian of our short-lived universe and now it was lost for ever. But after experiencing a second type of mourning, I came to the understanding that it didn’t truly matter that these emails couldn’t be accessed.
I could have spent the last 15 years revisiting and rediscovering our shared past, believing that was the most important link I have to that period of my life. But I’ve never been one to tie too much meaning to any object either tangible or digital. I purge my apartment with very little thought to what I’m throwing out, much to the horror of many people I know. What remains of K’s digital footprint barely matters any more, because it never really did. I’m still innately drawn to anyone who reminds me of her and I still feel her influence on me even as I age. With or without those emails, my love for my friend has not been lost, even as specific details continue to fade.
Marlowe Granados: ‘My early 20s are trapped somewhereinthe memory prison of an iPhone 4’
Up until I was about 20, I had been pursuing becoming a real photographer. My father gave me a camera when I was a child, and I stuck to using 35mm film throughout my teens. I would plaster my room with photos of my friends participating in underage debauchery, much to the chagrin of my mother (whose eyes narrowed whenever she glanced at the walls). I dabbled in showing prints at group shows and putting together photobooks, but over time photo developing shops became scarce, and the cost to continue was becoming exorbitant. Out of financial necessity and youthful indecision, my interests shifted; I dropped photography, moved on to writing and started exclusively taking photos on my iPhone.
I got my first iPhone in my first year at university in London, at around the same time as my best friends. It suddenly gave us access to a new era of documentation. We could get on to Instagram (which we’d heard so much about) and post photos directly to our Facebook feeds.
I lived in London for six years – some of the time in university and some of the time working several lowpaying jobs at once. Halfway through my time, I was pickpocketed outside a club in Dalston. They took my phone and nothing else. The moment I realized it was gone, I knew that the faithful documentation of my life had disappeared. I did not believe in the virtues of backing up, or the cloud, or even plugging my phone into a laptop. I took the position that software updates were so Apple could slowly make your phone’s model obsolete (this was not entirely conspiratorial). Years of my time in London were suddenly erased.
I took a few days to grieve the loss and got upgraded to a new phone. By the weekend, as I was working my shift as a hostess at a hotel restaurant, someone lifted my new phone from the host stand, and, according to the Find my iPhone tool, made their way to Whitechapel. I took it as a fateful sign that maybe this technology just wasn’t meant for me, a person who should not have anything of value on her person as it is vulnerable to being misplaced or stolen. At that moment I was out some money from the loss and trying to scrape together more to buy a third, lower-end model. This was a problem I could finagle my way out of. It never occurred to me that there might be a longterm consequence.
We underestimate how much our memory is couched and filled in by photographs. So much of my teenage years I can remember perfectly, with visual aid from physical photographs. As a writer, when I am in the process of taking inspiration from a memory, I often revisit photos of that era. A chronicle of outfits, scenery, or food can summon a specific atmosphere that might be fuzzy due to time or too many cocktails. As I look back on my 20s, there is a peculiar gap. I can hardly pinpoint a specific event from age 22 to 24, as though the years marbled and slipped out of mind. I’m certain that things happenedto me. I’m the kind of person things happen to! But there was no distinct, crystalline structure for those memories because all this time I had been depending on photographs to furnish them. Those years of mine were trapped somewhere in east London, in the memory prison of an iPhone 4.
“When people rely on technology to remember something for them, they’re essentially outsourcing their memory,” Linda Henkel, a psychology professor at Fairfield University, explained on NPR. “They know their camera is capturing that moment for them, so they don’t pay full attention to it in a way that might help them remember.”
This isn’t the first claim that technological advances might decimate our memory. In Plato’s The Phaedrus, Socrates complains that the written word will ruin our ability to remember. Relying only on what was left on paper will leave us to become “tiresome company” when not exercising our actual memories.
I agree that we are a new kind of tiresome, but how much of that is our fault? In this age of information, I wonder what our capacity for stimulation might be. As someone who was a photographer and now a writer, I don’t know whether I have ever been able to keep a memory perfect, without shaving it down or shedding a few details along the way. The loss of those years to the digital sands of time is regrettable, but I have some faith that away from screens, the fog may lift.
Sloane Crosley: ‘I experienced abject panic at the loss of thousands of words and months of work’
You really haven’t lived until you’ve been on hold with a customer service representative long enough to take a shower. In 2009, I lost the first three chapters of a novel when my computer crashed. The immediate result of this was denial (surely, if I just pressed the right keys in the right order … ) followed by abject panic at the loss of thousands of words and months of work, followed by an epic call with someone from the computer company.
But was the book any good? I am the least qualified to say. And yet the only one who will ever be qualified to say. I know it was – or was meant to be – a post-apocalyptic comedy in which a mysterious woman shows up on the doorstep of a man who’s been living alone in an abandoned mansion. She falls in love with him but he refuses to sleep with her, even though she may be the last woman on Earth. It doesn’t sound so terrible, as I type it now, but everything is in the execution. And one of the first requirements for great literature is that it exist.Over the course of four painful hours, during which only one of us was getting paid, a patient woman coached me through the resuscitation of my files while I bit my nails.
I took a shower during a planned absence, while she consulted a more techsavvy colleague, keeping my phone perched on the far corner of the bathroom sink in case her voice broke through the hold music. I suppose things could have been worse. We could have been on the phone long enough for her to go home and take a shower.
When she got back on the line, I felt as if hope was in sight, my novel nearly brought back to life. She said, blasé as can be, “OK, now just copy your hard drive on to the disc.” I laughed and said “what disc?” My laptop didn’t have a disc drive. She’d presumed a different model. Then, as if this barely animated piece of hardware could hear the tone of my response, it crashed again. This time for good.There were pieces of the novel on notepads and in Word documents I’d emailed to myself. My remedial version of “backing up”. But the story never congealed again in quite the same way. Not that I put a Herculean effort into it. I don’t suspect those chapters were headed somewhere spectacular.
The good news is that humor writing – or writing that is humorous, which is a different animal – is steeped in observation. Which means that some of that lost novel has appeared again over the years, in different guises, as I have moved through the world with my eyes open. There are several phrases or images from it, little cameos, in my new novel, Cult Classic. These are moments that seemed eerily familiar when I wrote them. It’s a gratifying feeling, akin to remembering one’s dream late in the day, even several days later. Which is itself a feeling akin to finding money in your pocket. It’s your money. Not more money. Not someone else’s money. But how exciting to finally have it back, to spend it any way you choose.
Sam Wolfson: ‘I opened up Apple Music and it was all gone’
I am exactly the kind of man who agonises over playlists. As a teenager, I read Nick Hornby’s High Fidelity, about a man who prioritises the order of a mixtape over tending to his relationships, and failed to understand that the character was supposed to be obsessive and pathetic. I thought I was embodying Rob’s cool, controlling vibe when, as a teenager, I would spend hours planning the music for a party, consider the guestlist and the mix of tastes, and then smoulder with nerd rage when someone would yank the aux cord to play some psytrance.
In adulthood, the playlists I made started to be less about other people and more about me – I would add to them painstakingly over many years. I found the perfect songs that could gently transport me from the frantic final emails of Friday afternoon to the first sip of alcohol on Friday evening, an emergency running playlist of non-stop nipple chafers for when my regular running playlist wasn’t motivating enough.
In the mix were songs that had changed my life. The ones that soundtracked blissful spring nights in the pandemic, when dancing round the kitchen was a full evening’s entertainment. Songs that filled up the newly acquired space after a miserable break-up when I had to get used to being alone more. I even had one playlist, “Songs to wake me from a coma”, of music that carries such great psychic weight (Lil Star by Kelis, Point of View by DB Boulevard, The Rat by The Walkmen) that I thought it might come in handy should I experience brain trauma.
Then, at the end of 2021, I moved from London to New York and everyone I met would say the same thing: “Can you Venmo me for that”, “I’ll pay the bill and just get me on Venmo”, “Just pay your rent on Venmo”. It turned out the country that houses Silicon Valley can’t work out how to do instant bank transfers. But to download Venmo, I had to change locations on the Apple App Store – no big deal. I clicked through all the warnings and terms and conditions without reading them and moved to a US account. Then I opened up Apple Music, and it was all gone.
It might not seem that big a deal, losing playlists. After all, the music is all still in the cloud. But despite many attempts I simply can’t remember all, or even most, of the songs that I had. It’s a strange kind of loss, these little pieces of autobiography, a decade in the making, lost to a glitch in the system.
I’ve tried to start again, finding homes for Fireboy DML next to Fontella Bass, Unknown T snuggled with Gerry Rafferty. But there’s no sense of history. My old playlists were refined and redrafted. Now they feel perfunctory, a contact sheet rather than a photo album.
The only upside is now, rarely, when I’m at a party or listening to the radio, I’ll hear one of the lost songs. It feels like the hand of heaven, a little part of myself that I can slot back into place. Which I suppose is quite a nice way to feel about overhearing 2007’s minor Groove Armada single Song 4 Mutya.