Outlive: The Science and Art of Longevity

by Peter Attia

I test my patients’ levels of uric acid, not only because high levels may promote fat storage but also because it is linked to high blood pressure. High uric acid is an early warning sign that we need to address a patient’s metabolic health, their diet, or both.

This means keeping watch for the earliest signs of trouble. In my patients, I monitor several biomarkers related to metabolism, keeping a watchful eye for things like elevated uric acid, elevated homocysteine, chronic inflammation, and even mildly elevated ALT liver enzymes. Lipoproteins, which we will discuss in detail in the next chapter, are also important, especially triglycerides; I watch the ratio of triglycerides to HDL cholesterol (it should be less than 2:1 or better yet, less than 1:1), as well as levels of VLDL, a lipoprotein that carries triglycerides—all of which may show up many years before a patient would meet the textbook definition of metabolic syndrome. These biomarkers help give us a clearer picture of a patient’s overall metabolic health than HbA1c, which is not very specific by itself.

But the first thing I look for, the canary in the coal mine of metabolic disorder, is elevated insulin.

Religion is a culture of faith; science is a culture of doubt. —Richard Feynman

Diet and nutrition are so poorly understood by science, so emotionally loaded, and so muddled by lousy information and lazy thinking that it is impossible to speak about them in nuanced terms at a party or, say, on social media.

Richard Feynman being asked at a party to explain, briefly and simply, why he was awarded his Nobel Prize. He responded that if he could explain his work briefly and simply, it probably would not have merited a Nobel Prize.

I encourage my patients to avoid using the term diet at all, and if I were a dictator, I might ban it entirely. When

Instead of diet, we should be talking about nutritional biochemistry.

We can think of this new approach as Nutrition 3.0: scientifically rigorous, highly personalized, and (as we’ll see) driven by feedback and data rather than ideology and labels. It’s not about telling you what to eat; it’s about figuring out what works for your body and your goals—and, just as important, what you can stick to.

In an interview with the CBC, the normally soft-spoken Ioannidis was brutally direct: “Nutritional epidemiology is a scandal,” he said. “It should just go into the waste bin.”

The Bradford Hill criteria are (1) strength of the association (i.e., effect size), (2) consistency (i.e., reproducibility), (3) specificity (i.e., is it an observation of disease in a very specific population at a specific site, with no other likely explanation?), (4) temporality (i.e., does the cause precede the effect?), (5) dose response (i.e., does the effect get stronger with a higher dose?), (6) plausibility (i.e., does it make sense?), (7) coherence (i.e., does it agree with data from controlled experiments in animals?), (8) experiment (i.e. is there experimental evidence to back up the findings?), and (9) analogy (i.e., the effect of similar factors may be considered). *4 If you’d like to try, Google

But sleep disturbances, in turn, may help create conditions that allow Alzheimer’s to progress. Insomnia affects 30 to 50 percent of older adults, and there is ample research showing that sleep disturbances often precede the diagnosis of dementia by several years; they may even appear before cognitive decline. One study linked poor sleep quality in cognitively normal people with the onset of cognitive impairment—just one year later. Meanwhile, superior sleep quality in older adults is associated with a lower risk of developing MCI and Alzheimer’s disease, and with maintaining a higher level of cognitive function. Successfully treating sleep disturbance may delay the age of onset into MCI—by about eleven years, according to one study—and may improve cognitive function in patients already diagnosed with Alzheimer’s disease.