6 surprising things I learnt from the book Outlive by Peter Attia
how to live stronger for longer
Since I learnt that I am pre-diabetic a few years ago, my wife and I have read a lot of books to understand the reasons and ways to get healthier. So when I started reading Outlive by Peter Attia, I was not expecting to discover new things. But I was surprised to find a great number of things that helped me rethink my health strategically. In addition to that it had surprising insights that could help improve my metabolic health.
Before I continue further if you’re not familiar with metabolic health, I want to introduce it. If you’re already familiar you can skip this section.
Metabolic Health
Human metabolism is the set of chemical processes that occur within our bodies to convert food into energy and support various bodily functions. It involves the breakdown of nutrients, such as carbohydrates, fats, and proteins, to produce energy and other essential molecules. When we talk about metabolic health, we are primarily concerned with how effectively our bodies utilize and regulate energy and nutrients. When metabolism is healthy, your body can flexibly switch between all these energy sources (glucose, fat and protein) to generate energy. When it is unhealthy, it will be dependent primarily on glucose. Poor metabolic health can lead to various metabolic disorders, including obesity, type 2 diabetes, metabolic syndrome, and cardiovascular diseases.
So here are some of the things that blew my mind
Importance of muscles for metabolic health
Skeletal muscle, or the muscle on our skeleton (contrasted with muscle in internal organs like heart or lungs) is essential for glucose clearance and is responsible for taking in over 80% of glucose we eat as food (1, 2, 3). This means if you’re trying to improve your metabolic health, one of the best things you can do is to work out to build muscle. The book goes on to talk about the things that are important in strength training like grip strength, loading and unloading carefully, pulling and hip hinging (exercises where you move around your hips like squats)
Importance of moderate intensity exercise for metabolic health
We use more fats than glucose to generate energy when we are doing moderate intensity exercise (technically called zone 2). Zone 2 exercise refers to physical activity that is performed at a moderate intensity, which is typically around 70% of a person's maximum heart rate.
But when we exercise at high intensity, our muscles switch to burning glucose exclusively to fuel it. This blew my mind. I used to do any exercise at full throttle, which meant I was only working out on glucose.
If you use an Apple watch, for aerobic workouts, you can see the zone you’re working out in. You can walk uphill, bike or swim for training in zone 2.
Silent decline of strength
Over the next 30 or 40 years, your muscle strength will decline by about 8 to 17 percent per decade—accelerating as time goes on. Now you probably don’t think about briskly walking up a flight of stairs, but in no time, you will have trouble walking on a steep incline. This realization of how fast and how silent the decline was one of the most surprising things for me.
Peter suggests we start thinking about the things you want to do till you’re 100. This helps create a concrete goal and the metrics for various components you need to train for. The components he suggests are - strength, aerobic efficiency (zone 2), peak aerobic capacity (described below) and stability (described below). We’ve already seen the first two above. Let’s see the other two below.
Importance of peak aerobic capacity
In addition to building muscle and doing zone 2 cardio exercises, you also need to work on your peak fitness. This is measured in something called Vo2 max or the maximum amount of oxygen your body can use. This practically determines what you can and cannot do. You need Vo2(max) of 33 to be able to briskly climb stairs. The average 40 year old only has a Vo2(max) of just above 30. This means it will already become difficult to climb stairs comfortably at 40.
The worst part is that this declines precipitously as we age. The good news is that you can train to improve it.
So starting with a high value and maintaining it high can mean that we are functionally younger. To train this, Peter suggests you do this workout two times a week
Ride a bike or jog for four minutes at the greatest pace you can sustain for this amount of time. Then ride or jog four minutes on easy setting which should be enough for your heart rate to come back down to below the 100 bpm. Repeat this four to six times and cool down. (32 min - 48 min). Make sure you always go below 100 bpm before increasing the pace again and also give enough time to warm up and cool down before you do this.
Importance of stability
Attia says strength is important, but stability training should come first (like, six months of it before ever picking up a weight). Why? Stability is the secret sauce that allows you to create the most force in the safest manner possible.
One of the key goals of stability training is to regain mental control, conscious or not over key muscles and body parts. By having that control, you load your body correctly. You’re able to react quickly when you slip and save yourself from a fall. You can do all your exercises without hurting yourself in the process.
This starts with breathing and specific exercises to get awareness of various parts in your body. Peter has a visual explanation for the things you can do to increase stability here Outlive Videos - Peter Attia
You’re not eating enough Protein
The current RDA of protein is 0.8 gm per kg of body weight. It is the minimum amount to meet your basic nutritional requirements. But that is not the optimal amount. The optimal amount is around 2.2gm per kg of body weight. If you eat more protein than required, it is just excreted as urea but does not increase your weight. So eat more protein to build muscle, feel more full and be healthy.
To train all four components, Peter recommends the following training plan each week:
Stability: one hour, split into 5 to 10 minute blocks done before your other workouts
Strength: three 45 to 60 minute full body workouts targeting all major muscle groups
Aerobic Efficiency: four 45 to 60 minute zone 2 cardio workouts
Anaerobic Performance: one 30 minute VO2 max workout
If you’re interested in staying stronger for longer, I would definitely recommend this book. I’m curious to know if these were surprising to you too. What surprising things have you learnt about health and fitness, let me know in the comments.
Thanks to my wife Gayatri and my friend Saandeep for reading an early draft of this and providing feedback.