A life well lived

In Greek mythology, Tithonus was granted the wish of eternal life, but in the absence of youthful characteristics (which were not expressly sought), immortality was a curse, not a blessing. Historians have recorded that "loathsome old age pressed full upon him", and he was confined to a locked room, babbling ceaselessly. The moral underlying that fable – it is the quality of life that matters, not longevity – echoes the spirit that runs through this best-selling book by Stanford-trained physician Peter Attia, with co-author Bill Gifford.

In an earlier time, Attia points out, most people were likely to die from "fast causes": accidents, injuries, and infectious diseases. Since then, advances in medical science have enabled humans to live longer: many life-threatening diseases are now fully curable or can be managed well, and lifespans have risen across geographies. But if that life is not lived well and in good health, does merely marking time on the planet count as life at all?

Over time, "slow death" has supplanted "fast death". More of us will likely live longer but will die as a result of a chronic disease associated with ageing – what Attia calls the Four Horsemen: heart disease, cancer, neurodegenerative disease, or type 2 diabetes. If we seek longevity, he argues, "we must understand and confront these causes of slow death".

In Attia's reckoning, exercise is the "most powerful longevity drug". And all of us ought to be training for what he calls the 'Centenarian Decathlon'. This is a framework he uses in order to organise his patients' "physical aspirations for the later decades of their lives" – especially in their 'Marginal Decade', a period when they are otherwise unable to participate in activities they once loved, be it gardening, riding a bicycle, or playing chess.

Attia guides readers to think of the Centenarian Decathlon as the 10 most important physical tasks they will want to be able to do for the rest of their lives. It could be mundane activities of daily living: get up off the floor without help, using at most one arm for support; or lift up a child from the floor. Or it could be some light-duty outdoor activity: go hiking up a hilly trail, for instance.

He then presents the case for drawing up an actionable operating manual for the practice of longevity by potentially extending one's lifespan by a decade and one's "healthspan" – the period of one's life when one is free of disease or disability – by a couple of decades.

In this, a central pillar that Attia leans on is what he calls Medicine 3.0, a new way of thinking about chronic diseases, their treatment and how to maintain long-term health. Medicine 3.0 aims not just to "patch people up and get them out the door, removing their tumours and hoping for the best", but rather to prevent tumours from appearing and spreading in the first place.

In Part 3 of the book, 'Thinking Tactically', Attia equips readers with an armour to shield themselves from the Four Horsemen. The armour comprises Exercise, Nutrition, Sleep and Emotional Health. Attia marshalls a compelling argument for good health practices. He grounds these arguments in sound science and explains the workings of the body and the genetic make-up, and cites tests and studies that support his case.

Every chapter in the book provides a wealth of information, history and anecdotes, resting on a strong foundation of statistics. We learn, for instance, about a sickly 16th-century Italian merchant who, under medical supervision, gave up gastronomical excesses and cut back his food intake to just 12 ounces a day. That improved his health dramatically, and his experience is recorded in his autobiographical tract.  Anecdotes like these are easily relatable; they will find ready resonance in all our social circles.

Attia's book is a life-saving – and healthspan-expanding – manual that should appeal to anyone looking to live not just long but in good health as well. 

Gina Krishnan is an independent journalist and writes on healthcare.