The Science of Longevity: Top 5 Takeaways from Dr. Peter Attia

What does it take to live a long, healthy life? The Rogue Scientist shares the Top 5 takeaways from longevity expert Peter Attia’s new book.

I discovered Peter Attia a couple of years ago when he was a guest on one of my favorite podcasts. I honestly don’t recall which podcast, but it had to be one of three possibilities: Tim Ferriss, Rich Roll, or Andrew Huberman, all of whom delve deeply into health topics using long-form discussions.

Who is Dr. Peter Attia?

Attia is a physician who worked in traditional medicine as a surgeon, left medicine for a while, and returned in order to focus on longevity. He has the rare combination of understanding medicine (and therefore disease) as well as understanding science and how we study disease empirically.

He’s most interested in longevity. That is, he’s devoted his career to increasing lifespan (length of life) and healthspan (how long you stay healthy).

This spring, he released Outlive: The Science and Art of Longevity, a book that took him many, many years of painstaking research and writing.

I’m still making my way through the book, but between reading Attia’s book and hearing him interviewed on my podcasts, certain concepts emerged again and again.

So, I’ve cobbled together 5 great takeways on how to live a longer, healthier life, according to Peter Attia.

And at the end, I will also share the #1 predictor of longevity.

Takeaway #1 – One of Four Diseases Will Likely Kill You

What will kill us has changed over time.

According to Attia, life expectancy has doubled since 1900, from age 40 to 80. Modern medicine, right? Yup. However, many think that if we continue as we have, it will double again after another 100 or so years, right?

Not so fast.

If you strip out the top 8 infectious disease causes of death, there’s very little change in mortality between 1900 and now (2023). This means that modern medicine has proven awesome at treating acute illness and infectious disease, thanks to the scientific wonder of things like antibiotics and vaccines.

However, modern medicine hasn’t done so well at preventing chronic disease. And it’s chronic disease that will kill the vast majority of us.

What is chronic disease? These are conditions that creep up on us slowly and insidiously over the decades. According to Attia, if you’re over 40 and don’t smoke, there’s an 80% chance you’re going to die from one of these four chronic diseases, which he dubs the “Four Horsemen”:

  1. Cardiovascular disease, the #1 killer in the US and across the globe
  2. Cancer, the #2 killer in the US and most countries
  3. Neurodegenerative disease, which includes Alzheimer’s and other forms of dementia
  4. Metabolic disease, including Type 2 diabetes. 

To drive his point home, Attia cites that:

  • Cancer survival is barely 5% better than it was in 1970.
  • To date, there are limited treatments (and no cure) for neurogenerative disease.
  • In fifty years, Type 2 diabetes has gone from affecting 1% to 10% of Americans.

If you want to live longer, your best course of action is to prevent (or at least delay) the Four Horsemen. But how do we do that?

Takeaway #2 – Shifting from Medicine 2.0 to 3.0

Attia’s book, and framework, focuses on what he calls Medicine 3.0.

Medicine 1.0 is pre-modern medicine, lasting until the late 1800s, where medicine had no basis in science.

Medicine 2.0 is the medicine we grew up with, focused on treatment of disease. As mentioned in Takeaway #1, Medicine 2.0 has had a HUGE impact on life expectancy, basically doubling it in little over a century. However, it’s had relatively little impact on preventing chronic disease, which, again, is what will kill most of us in the modern age.

Medicine 3.0, according to Attia, focuses on prevention and, more importantly, early detection and intervention.

Example: Type 2 Diabetes

For example, your hemoglobin A1c (HbA1c) measures your blood glucose levels over the last 3 months. 5.7% or below is normal, 5.7-6.4% indicates prediabetes, and 6.5% or above signals Type 2 diabetes.

However, Attia points out (correctly, in my experience) that most providers (operating under Medicine 2.0 principles) won’t act until you reach the 6.5% level and are officially diabetic. By contrast, Medicine 3.0 would intervene when A1c reached 5.7 or 5.8, rather than waiting for disease to set in after years of metabolic disorder.

Which leads us to Takeaway #3.

Takeaway #3 – A Shift to Evidence-Informed Medicine?

You’ve probably heard of evidence-based medicine. This means that health providers treat illness based on well-established scientific evidence. This is a good thing, as it prevents quackery and the kinds of things that went on during Medicine 1.0 (e.g. bloodletting, lobotomies, etc.).  

However, as amazing as modern medicine is, the industry as whole is very slow to change. For example, many medical residents still work 80+ hours a week and for 24 hours at a time, despite tons of evidence for how lack of sleep impacts performance (and health).

Currently, Medicine 2.0 is still glued to the RCT (randomized controlled trial) as its minimum standard for evidence.

As I explain in my article on the types of scientific studies, RCTs are the gold standard for determining cause and effect. They work great in situations that are short-term and relatively straightforward. When you want to test the effectiveness and safety of a drug or vaccine, RCTs work great.

However, as Attia points out, RCTs don’t lend themselves well to the study of chronic disease and the Four Horsemen. Why? Because chronic diseases are long-term and not straightforward.

To conduct an RCT for chronic disease outcomes, you’d need a ridiculously LONG time horizon (like multiple decades). Such studies would be pretty much impossible to conduct, logistically speaking, not to mention insanely expensive.

Attia suggests taking the data we have from all types of research (not just RCTs) and combining the insights we’ve gleaned, and then developing a framework that is “evidence-informed.”

In this framework, we would intervene far sooner to prevent the development of chronic disease, instead of waiting until disease has set in.

Takeaway #4 – Get Your Muscle On

Attia spends a lot of time talking about muscle. As in, how much muscle mass you have. The more, the better.

Young people naturally have good muscle mass, but beginning as early as age 25, you begin to lose it if you don’t do something to keep building it. You may not notice this slow loss of muscle until you get to middle age and get full view of your dad bod or begin sustaining injuries.

I sometimes play the “how old are they” game, where I try to guess a person’s age. Most people look for obvious signs, such as gray hair, wrinkled skin, or weight gain. However, you can dye hair, wear sunscreen, and stay thin. I look at their build.


Older people often lack muscle mass, and you can tell, even underneath clothing. (They also don’t “move” like younger people do, which is related to fitness and muscle).

Why is muscle so important?

Building and maintaining skeletal muscle is important for many reasons. For example:

  • Muscle supports your joints, preventing injury
  • Muscle strengthens bones
  • Muscle burns calories better than fat does
  • Muscle helps manage blood sugar. Muscles love glucose, and more can mean better insulin sensitivity, reducing your risk of Type 2 diabetes.

For more details, check out this article.

Takeaway #5 – Studying Centenarians

A centenarian is a person who’s managed to live to their 100th birthday. Here are a few facts about these unique folks, pulled from Attia’s book:

  • According to the Census Bureau, there were just under 100,000 centenarians in the US as of 2021. This represents only 0.03 percent of the population, or 3 in 10,000 people.
  • There are only 300 “super-centenarians” (those living to 110 or more) worldwide.
  • Only one person has lived to 120 or more that we know of: Jeanne Calment, who was French. She lived to 122.

Why do centenarians live longer? The short answer is we don’t really know. However, we have some useful clues.

Genes don’t play a huge role in longevity; however, it seems that the older you get, the more genes matter. For example, genetic relatives of centenarians are FAR more likely to reach 100 than the rest of us.

But that still leaves a LOT of room for lifestyle and other things we can control. Blue zones—places that have an unusually high number of centenarians—tend to share certain things in common, such as higher activity levels and more community involvement for these 100+ folks.

One thing is clear: Many centenarians will succumb to one of the Four Horsemen, like the rest of us. However, they do so much later in life (like decades later).

You can see where the role of early prevention comes into play here. You take control of what you can in order to increase your probability of a longer and healthier life. This is what Attia’s book focuses on.

The #1 Predictor of Longevity

According to the evidence we’ve gathered so far, there is one factor that stands above the rest in its ability to increase healthspan and prolong life. Hint: it’s NOT diet.

It’s exercise.

The benefits of exercise are too many to list here. Just get out there and get moving.

Go check out Attia’s book, and may you live long and prosper.

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Related Articles and Resources

Outlive: The Science and Art of Longevity

The Blue Zones, Second Edition: 9 Lessons for Living Longer From the People Who’ve Lived the Longest

The Rogue Scientist

Christie Hartman is a writer and scientist specializing in science-based health. A biology major as an undergrad, she completed her PhD in behavioral genetics at the University of Colorado Boulder. Before starting her writing career, she worked as a scientist and professor at CU’s School of Medicine, where she studied the genetic contributions to substance abuse and antisocial behavior.

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