The time to repair the roof is when the sun is shining.

Ric Elias was one amongst 155 passengers on the US Airways flight that had emergency landed in the Hudson River during the month of January 2009. None of the passengers had any hope of surviving but for the pilot who single-mindedly tried to avert the disaster, and eventually saved everyone on the ill-fated flight. Ric’s outlook on longevity changed that day as he realized that, like the courageous and skillful pilot, all it needs is to think about what lies ahead at any moment in time. Ric later remarked, ‘I think people get old when they stop thinking about the future.’ The quest for longevity is when people think about their dreams, their aspirations, and what they still look forward to – they are young. Simply put, overcoming fear of dying is longevity. 

Then there is a centimillionaire tech entrepreneur named Johnson, 46, who has spent most of the last three years in pursuit of deflecting death. Over $4 million has been spent by him on a life-extension system called Blueprint, aimed at vanquishing the ravages of time on his body. A team of doctors enforce a strict health regimen that includes gulping 111 pills a day to deaccelerate any act of ageing. Johnson’s quest is to turn his whole body over to an anti-aging algorithm. He believes death is optional, and he is not opting for it. The data compiled thus far suggests that Blueprint has been successful as it has given him the bones of a 30-year-old, and the heart of a 37-year-old. Only time will tell how far longevity experiment takes him to counter the popular adage that a man who has a long life has not lived enough.

With average life expectancy well into the late seventies, interest in prolonging life has provoked a new way of thinking. However, quest for increasing lifespan does not run concurrently to improving health span. Notching more and more birthdays while nursing an ageing life is a grim reminder of a hapless mythical Greek named Tithonus, who asked the gods for eternal life but forgot seeking eternal youth as well. The subject of longevity is undoubtedly complex, and there is no single pathway to achieving such an ambitious goal. Yet there is a sizeable number who have hit a century of survival, but for a vast majority living longer and living better continues to remain a distant dream. Longevity has puzzled humankind for millennia.            

Taking a deep dive into the world of longevity, longtime physician and surgical oncologist at the National Cancer Institute Dr Peter Attia has kept in view the Horsemen diseases viz., cancer, diabetes, heart and neurogenerative diseases. The very process of aging itself is what makes us vulnerable to these diseases, while also affecting our health span. Invariably, one has to pass through the valleys of cognitive, physical, or emotional destruction while negotiating old age. However, these are preventable provided proper tactics is applied in the early years. ‘The time to repair the roof is when the sun is shining’. 

What makes this definitive enquiry that merges health span with lifespan in creating an interesting narrative on longevity is the openness with which both professional expertise and personal experience has been taken into account. Attia refers to Medicine 2.0 as a quick-fix mentality, short-term fixes for immediate problems like an infection or a broken bone. Sticking with this mentality can make one go only thus far and no further, leaving one on forever the merry-go-round of fad diets, trendy workouts, and miracle supplements. A shift in mindset to Medicine 3.0 requires an entirely different strategy.

Outlive provides an update on how far Medicine 2.0 has gone in addressing the Horseman diseases, which has supplanted fast death with slow death by adding few more years to life. Quoting innumerable studies and surveys, Attia explores the science of not just prolonging life but extending aliveness. It is in this respect that sleeping and emotional health gets prominence as performance-enhancing substance, not only physically but cognitively. Not without reason evolution has made both of these non-negotiable. Attia seems to have missed out on including the science and art of correct breathing in impacting both health span and lifespan.

Attia enlists five broad domains in Medicine 3.0: exercise, nutrition, sleep, emotional health, and health supplements. His Medicine 3.0 thesis is that if we address our emotional health, and do so early on, we will have a better chance of avoiding clinical mental health issues, and our overall health will benefit a great deal. However, dealing with emotional health is harder than physical health. The trouble is that people are often less able to recognize the need for emotional health, as there are unrecognizable signs and symptoms reflecting their condition. Antidepressants and mood stabilizers can often deploy, but mindfulness meditation is what can make all the difference.

Outlive is a tool book on how to live a long, meaningful, and fulfilling life. It is a groundbreaking manifesto on staying young, even as we grow older. Much of the source of our condition is in our own head, the impact of our own unguarded thoughts. In the first century AD, Seneca had expressed it a bit differently: ‘we suffer more often in imagination than in reality.’ Attia provokes his reader.to consider that there is no pharmacological magic bullet to treat all the scary stuff that we often talk about. Medicine 2.0 is relevant, but it doesn’t tell us everything we need to know about bodily processes that takes decades to unfold. Having tread long years in the world of medicine, Attia foray into the world of Medicine 3.0 is as ingenius so reflective in making a strong case for not only living longer but living better too. Attia leaves the reader to resolve if life is better lived as cool-headed Ric Elias or an agitated Johnson.        

Outlive: The Science & Art of Longevity
by Dr Peter Attia
Vermilion/Penguin, London
Extent: 482, Price: Rs. 799.

First published in the Hindustan Times, March 7, 2024.