I plan over the next few weeks to send out some posts (or blogs in modern terminology) looking at what I have learned from a book by Peter Attia called ‘Outlive’ as well as the excellent but highly scientific podcasts he does with leading experts in the fields of diabetes, HRT, cardiovascular disease, lipids and dementia.

We tend to think about longevity as a measure of how long we live. Whilst this is true, we need to start thinking about health span. Health span is the measure of the period during which we can undertake the things we enjoy with a reasonable level of physical, cognitive and mental good health. We assume our longevity and health span are predetermined but this is very far from the truth.

It is thought that at least 40% of dementia is preventable and this may be a significant underestimate. Similarly, heart disease is dependent largely on three factors, smoking, high blood pressure and high cholesterol. Without these we could largely prevent heart disease in our natural life span.

Diabetes contributes to both heart disease and dementia and type 2 diabetes is both preventable and reversible in humans. If this is the case, why are we not preventing these huge drags on both longevity and health span.

Peter Attia calls current medicine, Medicine 2.0. Medicine 2.0 followed Medicine 1.0. Medicine 1.0, refers to the good old days when we had four ‘humors’ (called ‘blood’, ‘yellow bile’, ‘black bile‘and ‘phlegm’), leaches, and bloodletting.

Medicine 2.0 introduced germ theory that led to huge developments in infectious disease reduction. It recognised the causes of diabetes, cancer and heart disease. Treatment has improved significantly. Probably 15% of patients with metastatic solid tumours now live ten years. In 2000 this figure was less than 1%. Some cancers such as breast cancer, leukaemia and testicular tumours are curable in a very significant percentage of patients, where once they were a death sentence at diagnosis. Heart failure once had a prognosis similar to that of advanced lung cancer but now people live for years as a result of drugs developed since the 1970s. What Medicine 2.0 is not good at is preventative medicine.

An example of this, is that we wait until a patient has a one in five risk of a heart attack or stroke within the next ten years, before we offer a statin. Yet we know that coronary artery disease is present in some teenagers, it just does not manifest as a heart attack until the sixth or seventh decade. Why are we waiting to offer preventative treatment in high-risk patients?

We also wait until a patients’ Hba1c levels cross the arbitrary number of 48, before we call them diabetic and offer preventative medication. Medicine 2.0 has had the knowledge for decades that insulin resistance is a continuum that starts long before the Hba1c level of 48 is reached. During that time, insulin resistance is having a significant impact on the heart, liver, and brain.

Over the next few weeks, I will write with information gleaned from some of the leading experts in their fields about what can be done to prevent the impact of the four ‘horsemen’ as Peter Attia calls them, most significantly, heart disease, cancer, neurogenerative diseases including dementia and metabolic syndrome/ diabetes.

If this has sparked your interest below are the details of both Dr Attia’s podcast & book. They are technical at times; the podcasts are more scientific in their language, but you can join him as a subscriber for ‘Ask me anything’ discussions which are slightly less technical.

I hope to make this information accessible to the non-scientist. Other longevity experts are available, I just find Peter Attia hugely interesting with his encyclopaedic knowledge of his subject.

 ‘Outlive, the science and art of longevity’. By Peter Attia and Bill Gifford

‘The Drive’ podcast by Peter Attia

Dr Allan Fox