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Attia at the 10Squared facility in Austin, Texas
(Photo: Sarah Karlan)
Attia at the 10Squared facility in Austin, Texas
Attia at the 10Squared facility in Austin, Texas (Photo: Sarah Karlan)

Has Peter Attia Found The Fountain of Youth? Our Writer Tries His Program to Find Out.

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The longevity influencer, doctor, and bestselling author wants to change the way we take care of ourselves. Does it work?

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I can tell you the exact moment when I started thinking about longevity in a serious way. It happened on March 10, 2023, at 10:20 P.M., in a hospital delivery room ablaze with overhead lights. I stood bedside, my hand crumpling under my wife’s grip, as a tiny, screeching alien, an eggplant with eyes—our daughter, Esme—slipped into the hands of the attending ob-gyn. At 56, I became a father for the first time.

Until Es arrived, the grand total of my thoughts about aging could be summed up in a line my father likes to say: “It sucks getting old, but it beats the alternative!” Now as I stared into her little purple face, I wanted every healthy minute I could get. I began to imagine all the things I’d be able to show her—mountains, rivers, books (made of paper), and how to mix the perfect margarita. By the time we got home, I was no longer the center of my universe. She was.

With this new cosmology in mind, I sat down with Peter Attia’s book, , cowritten with ϳԹ contributing editor Bill Gifford. The book has clearly resonated with a lot of people. It sold more than a million and a half copies in less than a year and has been a fixture on the New York Times bestseller list for nearly as long.

Outlive book cover
(Photo: Courtesy Harmony)

I approached it with trepidation. I’ve been writing about health and fitness for more than two decades, and most things that promote “longevity” give me hives. Why we die, and why we don’t, involves enormously complicated science that’s difficult if not impossible to research conclusively. Dudes—it’s almost always dudes—who claim they’ve got it figured out are suspect by default.

Outlive, I soon learned, isn’t about death per se but about decline. Attia believes that you can prevent decline—or, as he puts it, “square the longevity curve”—through an aggressive combination of exercise, lifestyle (nutrition, sleep, etc.), and elements from personalized health care, or what he calls Medicine 3.0. Can getting old suck less? He says that the answer is a resounding yes.

Attia, 51, is a licensed physician who runs a concierge telemedicine practice from his home and fitness HQ in Austin, Texas. To be a patient of his is rumored to run into the six figures annually. (He won’t disclose this number.) He’s also a rising star on the self-improvement influencer circuit, appearing frequently on podcasts hosted by Rich Roll, Andrew Huberman, Tim Ferriss, Joe Rogan, and Rhonda Patrick, among others.

In addition to his guest appearances, Attia produces his own podcast, The Drive, along with a weekly newsletter and a robust stream of social media content. He has a million followers on Instagram alone. You might even have caught him as the doctor on the Disney+ show Limitless with Chris Hemsworth, a.k.a. Marvel’s Thor. Want more? You can sign up for the expanded, members-only version of Attia’s output for $149 a year. Or splurge for his online longevity video course, Early—essentially an enhanced, interactive version of the book—for $2,500.

I spent months immersed in Attia’s ideas, including his book, podcast, newsletter, and the Early program. Some of the advice in Outlive—get vigorous exercise, don’t eat too much or too little—seemed like it had been around since Jack LaLanne pulled on a stretchy unitard and started doing push-ups. But overall I hadn’t seen anything as comprehensive and visionary as Attia’s approach.

In Attia’s view, Medicine 3.0 is a paradigm shift from the pills-and-procedures protocol (Medicine 2.0) that is the current health care status quo. It’s heavy on prevention and arranged into five pillars: exercise, nutrition, sleep, emotional health, and what Attia calls “exogenous molecules” (pharmaceuticals, supplements, and so forth). They’re all important and get appropriate play in the book, but exercise reigns supreme as “the most potent ‘drug’ in our arsenal,” he writes in Outlive. “The data are unambiguous: exercise not only delays actual death but also prevents both cognitive and physical decline better than any other intervention.”

Exercise breaks down further into subcategories: strength, stability, aerobic efficiency, and peak aerobic capacity. The goal is to obtain optimum fitness in each of these, since they’ve been shown to form a powerful shield against our biggest health threats: cardiovascular disease, cancer, metabolic dysfunction, and degenerative neurological disorders—what Attia refers to as “the four horsemen.”

Fitness sounded like good medicine to me, but the emphasis on exercise also prompted a lot of questions: What kind? How much? How hard? I reached out to Attia’s camp, asking if I could essentially become a patient for a few days and write about his methods. They said no to that—herr doktor is extremely busy—but after months of back and forth they agreed to let me come out for a couple of days last April, to meet him and go through some fitness assessments. I felt like I was doing pretty well—I rode my mountain bike and lifted weights regularly, among other things. But what was I missing? What should I be doing going forward?

The timing was good, because Attia was preparing to open a new facility in Austin called 10Squared, a sort of hybrid testing lab and training center that will cater to his existing patients and a new cohort of select members. His team sent me an NDA ahead of my visit, with the caveat that this would be a black-box project until I’m informed otherwise. This struck me as over the top for what sounded like a fancy private gym, but sure, why not? If that’s what it took to finally get a taste of the secret sauce behind Outlive, show me where to sign.

Attia aiming a bow and arrow
In Outlive, Attia argues that exercise prevents decline better than any other intervention. (Photo: Sarah Karlan)

Popular interest in living longer is hardly new, but it spiked in the past few years. Reasons for this aren’t exactly clear. The pandemic reminding us of our mortality? A growing number of Boomers looking to redline their retirements?

Our fixation on longevity is rising at the same time that our health appears to be sinking. A 2018 study from researchers at the University of North Carolina made waves by concluding that only 12 percent of Americans are metabolically healthy. What’s more, according to data from the CDC’s National Center for Health Statistics, average life expectancy fell between 2019 and 2021, the biggest decline since the early 20th century. Granted, that statistic was affected by COVID-19, but chronic disease played a significant role as well.

The renewed obsession with healthier living has given rise to some longevity-oriented products and services, many with a fitness slant. No doubt the success of Outlive helped prime the market. Equinox, the upscale fitness chain, recently launched a $40,000-a-year wellness and longevity package called Optimize, which includes blood analysis, a personal trainer, and individualized sleep coaching.

In New York City, a startup called Continuum goes one better: for $10,000 per month, you get a precision health plan crafted by AI, a full biometric analysis, massages, nutrient-rich IV drips, and other luxe benefits, laid out in a swanky 25,000-square-foot private gym in Greenwich Village.

I had a hard time reconciling the new longevity bling—and the hefty price tags—with the lives of actual people living to be 90 or 100. I doubted that most of them had ever heard of VO2 max or set foot in a weight room. Maybe they were all just genetic-lottery winners?

I reached out to Dan Buettner, the author of Blue Zones, the bestselling book turned Netflix series that takes a close look at five places in the world where people live the longest. Buettner is a journalist, not a doctor or scientist, but he’d spent ample time with centenarians. He said that he liked Outlive and thought the science was sound, but he was skeptical because following its advice already “requires a person who is two or three standard deviations from the norm when it comes to discipline, income, and presence of mind.”

Attia arrived in the longevity field via a circuitous path. He grew up in Toronto, the son of Egyptian parents who immigrated to Canada. In Outlive he reveals that, as a child, he was physically and sexually abused—he doesn’t say by who, just that it wasn’t a family member. As a teenager he took up boxing, which helped him cope with the trauma. “I got to punch bags, and people, and that channeled my anger,” he writes. Despite this and other outlets, emotional problems followed him into adulthood.

His past helped set him on a course toward medicine. As an undergraduate at Queen’s University at Kingston, in Ontario, he volunteered at a shelter for abused kids. He attended medical school at Stanford University, and then did a prestigious surgical residency at Johns Hopkins before dropping out in his fifth year. Something wasn’t quite working for him in that world. To Attia, traditional medicine seemed entrenched, resistant to new approaches and new ways of thinking. He believed that there had to be a better way.

Attia believes that you can prevent decline through an aggressive combination of exercise, lifestyle, and elements from personalized health care, or what he calls Medicine 3.0. Can getting old suck less? He says that the answer is a resounding yes.

After bailing from medicine altogether, he took a job with McKinsey and Company, the global management-consulting giant based in New York City. He had a strong penchant for mathematics, which played well at McKinsey, where Attia developed a system of thinking involving frameworks, risk, and probability that would eventually become the foundation of his approach to Medicine 3.0.

Attia was also a serious amateur athlete who pushed his own fitness to the edge. In boxing he competed at an elite junior level. As an adult, he transitioned into endurance sports, throwing himself into cycling and swimming. Among other impressive feats, in 2005 he swam from Catalina Island to Los Angeles—about 20 miles in 10 hours and 34 minutes. More recently, he’s focused on rucking, which involves strenuous hiking with a weighted backpack—in his case, often 50 pounds or more.

He also started moving back toward medicine, this time in private practice. Around 2014, he wrote down his manifesto about health, ideas that would eventually grow into Outlive. The key to a longer life, he realized, was keeping chronic disease at bay. Nothing accomplishes this better than exercise, Attia argues.

This wasn’t merely an overzealous proclamation from a man obsessed with his own fitness. Scientific literature showed clearly how effective exercise could be in preventing, and even treating, chronic disease. Such thinking started to become popular in the modern era thanks in part to books such as W. E. Harris’s Jogging (1966) and Kenneth Cooper’s Aerobics (1968), which helped connect the dots between fitness and health, and is sometimes credited with helping launch the running boom of the 1970s.

The data was so convincing that, in 2007, the American College of Sports Medicine joined forces with the American Medical Association to launch Exercise Is Medicine, a trademarked initiative to help facilitate the adoption of fitness metrics among medical professionals. Doctors, they urged, shouldn’t just check your blood pressure. They should track how much physical activity you get every day.

“There is no chronic disease that exercise doesn’t touch,” says Robert Sallis, a clinical professor of family medicine in Fontana, California, and founder of Exercise Is Medicine. “It makes so much sense that this ought to be a first-line prescription.”

Though they’re great in theory, attempts to rely on fitness as either prevention or therapy haven’t worked well in practice, Sallis says. Busy physicians rarely have time to talk to patients about their diet and physical activity, and if they do the conversation is often brief and vague. “It’s frustrating,” says Sallis. “It’s all about pills and procedures. We’re not putting ads on TV saying, ‘Ask your doctor about exercise.’ ”

My conversation with Sallis reminds me that so much about exercise doesn’t mix well with contemporary culture. We’ve engineered most movement out of our lives; we eat too much, drink too much, stress too much, and sleep too little. For many exercise is arduous and unpleasant, and it has to be stacked on top of other demands, like working a job (or jobs), raising a family, and managing the relentless addictions and distractions of late capitalism.

If that doesn’t make things hard enough, we also aren’t particularly well adapted to exercise, argues evolutionary biologist Daniel Lieberman, author of Exercised: The Science of Physical Activity, Rest, and Health. Viewed through a Darwinian lens, being lazy—that is, conserving energy—is a survival tactic. According to Lieberman, exercise is a “weird” modern contrivance invented to replace eons of physical effort.

As has been true for most of human evolution, exercise—physical activity—must be “necessary” and “fun” to be sustainable, Lieberman writes. Absent those qualities, we’re swimming against an increasingly swift current, if not already being washed downstream.

Attia lifting a kettlebell
(Photo: Sarah Karlan)
A rack of free weights
(Photo: Sarah Karlan)

I arrive in Austin on a cloudless 70-degree day, the kind that provides ample motivation to get after it. Hordes of people are out walking, running, cycling, and paddling around Lady Bird Lake, on the edge of town.

I’m scheduled to meet Attia at a posh golf resort a few miles west of the city. One of his assistants arrives in advance to help me find a suitable spot for the interview; we settle on a quiet bar near the lobby called Jim Bob’s. Attia arrives late, explaining that he was dealing with a patient emergency. He doesn’t seem very psyched to be here. When I ask if we still have the scheduled two hours, he says: “Is this going to take that long?”

In person, Attia is buff and a little imposing. People I’d talked to about him before coming to Austin used words like “intense” and “serious,” and I can see why.

We make zero small talk as we take our seat at a quiet table near the bar, which has a wall full of fancy booze behind it. “It never hurts to be close to the tequila!” I joke, trying to lighten the mood. Attia doesn’t laugh. As we start our conversation, he takes out his phone, sets it on the table, and says that he’s going to record the interview as well.

When it comes to merging medicine and fitness, part of the problem, as Attia sees it, is that most physicians don’t know how to manage it—or if they do, they aim too low. There are lots of unanswered questions about exercise as we get older. How much, and what kind, is optimal versus merely sufficient?

When I bring up that the federal physical-activity guidelines recommend a relatively modest 150 minutes a week, Attia interjects: “I would never say that.”

“I know you wouldn’t. But that’s the baseline for a lot of doctors.”

“Well, that’s sort of the first failure,” Attia says. “Instead of telling people what to do, we should be telling them what we’re going to be measuring them against. So it’s more important to say, We want you to have a VO2 max that is above this range. We want you to have muscle mass that is above this range. We want you to have these strength metrics above this range. And then the question becomes: How much are you willing to put into this?”

Attia doesn’t just want you to exercise. He wants you to train. I mention that I know a lot of fit, active people in their fifties, sixties, and beyond who spend ample time running, hiking, or cycling, but not much else.

“I think you always want to differentiate between recreation, play, and training,” he says. “I think recreation and play are really important. They’re the why. But to do those things you have to train.

“Look at the greatest tennis player who ever lived, Novak Djokovic,” he continues. “To be the world’s best tennis player, you have to be very strong. You have to be very supple. You have to have great balance. You have to have an amazing aerobic base of fitness. You have to have incredible anaerobic power. And just playing tennis isn’t enough to do that. And so it goes for everything that a person might want to do, whether it’s skiing or playing pickleball or, in my case, driving a race car or doing archery.”

Attia isn’t suggesting that we all strive to become the world’s best tennis player, but he does want us to be the best old people we can be. In Outlive he talks about what he calls the Centenarian Decathlon. This is a list of things you’d like to be able to do on your 100th birthday, or whichever final decade you reach. The idea behind the decathlon is to develop broad, well-rounded fitness, as opposed to defaulting to things you’re already good at, or simply enjoy.

“We’re not talking about creating immortal souls who, in their eighties, look like 20-year-olds,” Attia says. “That’s science fiction. But you can be 80 and still have the body of a 60-year-old. How do we make that the norm as opposed to the exception?”

While you can start or expand your program at any age, it’s preferable to cultivate a high level of fitness early in your life, when your body is more adaptable. As you age, you can adjust your training to sustain it, but train you must. You can follow your progress—or perhaps lack of deterioration is a better way to look at it—using a suite of fitness metrics, the same way you track blood biomarkers as an indication of your general health.

I ask him what he thinks of the criticisms I’ve seen aimed his way, like the idea that he may be peddling a fantasy about longer, healthier life spans, given how complex the subject truly is. “I’m not really familiar with these criticisms,” he says. “But if you’re asking why should we do what we do to stave off a declining health span, I guess my question would be, What’s the alternative? Just accept it? So if someone asks me, Why do you exercise? I would say, What would you propose instead? To not?”

Attia answers my questions dutifully, even thoroughly, but the vibes are off. His foot jitters. His teeth are very white. I get flustered and lose my train of thought a couple of times. I’d arrived hoping for a couple of hours of Medicine 3.0 stoke, but I leave feeling like I’ve been to a Medicine 2.0 doctor’s appointment—impersonal and perfunctory.

The experience gets me contemplating the degree to which we have to quarterback our own health. As Attia writes in Outlive, Medicine 3.0 “demands much more from you, the patient. You must be well informed, medically literate to a reasonable degree, clear eyed about your goals, and cognizant of the true nature of risk. You must be willing to change ingrained habits, accept new challenges… You confront problems, even uncomfortable or scary ones, rather than ignoring them until it’s too late.”

Gulp.

That evening I take a long walk around downtown Austin. A full moon is creeping up between tower cranes, and it casts a shimmering reflection across Lady Bird Lake. A crowd has gathered along the guardrail of the Congress Avenue Bridge to watch a famous attraction: the nightly swarm of more than a million Mexican free-tailed bats, the largest urban colony in North America, which live in the trusses. I wedge into a view spot until the bats emerge in a great pulse, rushing around the bridge and shoreline trees in a dusky murmuration. I think of bringing Esme here when she’s older to see the bat show—this and so many other natural wonders still ahead of her.

The next morning, I drive to 10Squared for my VO2 max test and a couple of strength assessments. I’m also scheduled for a DEXA scan, which will reveal my muscle-to-fat ratio, but that’s happening off-site, at a facility called the Fitness Institute of Texas, part of the kinesiology department at the University of Texas.

10Squared is a private facility for a very exclusive clientele, located in a small office complex in an Austin suburb. It’s not exactly Equinox, but I thought it was an interesting template for the way doctors might integrate fitness for their patients. One side of the modest space contains a squat rack, a chin-up bar, some free weights and kettlebells, and assorted other resistance-training equipment. The other side contains a stationary bike, a treadmill, a rowing machine, and diagnostic machinery. The place is strictly business, and it’s where Attia’s clients, many of whom live elsewhere, can fly in, go through a few days of testing, evaluation, and coaching, and then head home to dial in their personalized programs. Not surprisingly, nobody would tell me what it costs, or how one goes about becoming a client there, other than to say that there’s a “screening process.”

I’m greeted by Luke Bennett, 10Squared’s amiable CEO. A former physician for Formula 1 race teams and an MD from Australia, Bennett is in his fifties but looks younger. He sets me up on a stationary bike and pulls a tight-fitting respiration mask down over my head to capture and measure my breath as I hammer away. I’ve done this before, but it’s been a while—like 15 years—and I’ve forgotten how claustrophobic it feels.

VO2 max measures the amount of oxygen your muscles can utilize at peak effort. It’s the benchmark of cardiovascular fitness because it’s a picture of how well oxygen moves through your system. You can’t game the results. It has also, somewhat recently, become a useful predictor of longevity. If some fitness is good, is more better? Apparently so. Numerous studies have found that higher VO2 max scores correlate with longer life.

The test lasts about 12 minutes, starting easy and increasing in difficulty by increments until you tap out from exhaustion. You aren’t supposed to talk—“unless there’s an emergency,” Bennett says—but you can indicate your exertion level by pointing at a reference sheet. By the time I’m pointing at the highest level (Very, Very Hard), I’m huffing and sweating like a racehorse.

My score tops out at 41.6, which strikes me as low, but Bennett says it’s actually pretty good for a guy my age. I’m quietly thrilled to see my report sheet include the word “excellent.” Still, I’m a bit short of the Elite category, which requires hitting 50 or above. In Outlive, Attia states that he wants his clients to aim for a VO2 max score in the Elite zone for their gender but two decades younger. In my case, that would mean a score of around 53, a daunting target based on what it took to hit 41.

That seemed highly improbable, but Bennett assures me I can get there, or close. And what, I ask, might it require? Something in the range of four to six hours of Zone 2 work, plus at least one Zone 5 interval session, per week, he says.

Zone 2 is the quasi-magical aerobic threshold, where it’s possible to burn fat as fuel more than you’re burning carbohydrates. Zone 2 is the kind of effort you can sustain for a long time. Zone 2 is pretty easy. I love Zone 2.

Zone 5 training is quite hard, but it’s mercifully brief. A popular Zone 5 workout involves four minutes of maximum effort followed by four minutes of recovery, done a total of four times. One of my big takeaways from testing is realizing how these zones actually feel. What I thought was Zone 2 was probably more like Zone 3 or even 4. My easy workouts have not been easy enough, I discover, and my hard sessions are not hard enough. I’ve been trapped in the middle, a metabolic no-man’s land.

Once I’ve recovered, I move on to a few strength tests. These are simple exercises, including a dead hang and carrying a loaded hex bar. Strength is another vital component of the longevity strategy, in large part because strength and muscle mass inevitably deteriorate as we age. I’d long thought of lifting weights as essential for athletic performance, regardless of your sport, but I hadn’t considered the impact on healthy aging. Not only does preserving lean muscle deliver metabolic benefits, but it also helps keep us mobile and stable. Falls are the leading cause of death after age 65—the fifth horseman.

Not surprisingly, given my cyclist’s approach to upper-body development, I fare less well at strength. The goal for the arm hang is two minutes. That doesn’t sound like much, but it’s surprisingly difficult. I don’t even make it to one minute.

The goal for the hex-bar carry is similarly challenging: carry your body weight—in my case 186 pounds—for 60 seconds. Once again I come up short. Not to worry, Bennett tells me. With a dedicated lifting regimen, I can meet these standards as well.

As I’m finishing the strength exercise, Attia arrives for a photo session. “He’s here!” one of his assistants calls out. I’m curious what he thinks of my results, but he doesn’t seem very interested and merely nods when Bennett says, lightheartedly, that I did pretty well for an old guy.

The author during his VO2 max test at 10Squared
The author during his VO2 max test at 10Squared (Photo: Sarah Karlan)
The author during his VO2 max test at 10Squared
(Photo: Sarah Karlan)

In the afternoon, I drive over to the Fitness Institute of Texas for my DEXA scan. 10Squared sends clients there since the machine, which costs more than $100,000 new, isn’t part of Attia’s inventory. DEXA has become a popular way to analyze body composition, because the imaging technology is considered the gold standard for this kind of measurement.

Rachel Watson, the Fit Institute’s upbeat director, is in charge of my body composition analysis. After Outlive was published, the institute saw its requests for scans nearly double, she tells me. The Fit Institute is happy to oblige (for a modest $75). It works with UT to provide research data, so collecting it from the public is a convenient source of information. The institute also offers VO2 max testing, group workouts, and nutrition coaching.

As we chat about fitness trends, Watson writes something down on a pad. “What’s the buzzword everyone’s talking about these days?” she asks.

I’m stumped, so after a moment, she flips the pad around to show me: longevity.

“It’s what everyone is fixated on now,” she says.

“Ah,” I reply, feeling dumb. “Of course.”

I lie on the table and try to remain still while the scanning bar moves slowly over me from head to toe. A few minutes later, Watson and I sit down at her desk to review my results. The data is enlightening, and better than I expect. At 186 pounds, with an overall body-fat composition of 15.4 percent, I fall right between Very Lean and Athletic. Watson is particularly happy with my visceral fat score, which tabulates fat accumulation around the midsection and organs. The average for men my age is 2.62 pounds. I come in at 1.21. She draws a smiley face next to the number.

“Now for the bad news,” she says.

“U-dz.”

“You’re pear-shaped.”

Watson shows me how the numbers align with my body parts. Most of my mass is located around my butt and thighs: a cyclist’s build. I could use some work on my upper body, arms, and shoulders if I want to attain the coveted V look.

“Don’t feel too bad,” she says cheerily. “Most men your age are apple-shaped. Their body mass is collected around their midsection.”

My disappointment must have lingered, because Watson reassures me that I am actually doing great. And did I know the Fit Institute also offers online strength-training classes?

I return home from Austin feeling fit but also realizing that fitness is just one piece of a complex puzzle. It left me pondering: Am I healthy? The truth is I’m not sure. I haven’t had a proper checkup in a few years. Chronic disease is insidious because it often begins—and may creep along for years—without any obvious signs.

With renewed motivation, I text my doctor, a very nice but very Medicine 2.0 kind of guy, about scheduling an appointment. I want to put together a “Big Workup,” I write. He replies that he’ll give me a call, but I don’t hear from him.

When it comes to sizing up your long-term health risks, family medical history matters a lot. Mine reveals a stark reality. My mother, a registered nurse, died in 2013 from breast cancer, at 75. My father, in his eighties, is still alive but lives alone and struggles to walk, fallout from a knee replacement gone bad and compounding cardiac problems. My sister, who’s a year younger than me and is my only sibling, fought weight issues for years until she recently began using Mounjaro, one of the vaunted GLP-1’s, like Ozempic, used to treat Type 2 diabetes and, increasingly, obesity. In the course of a year, she lost more than 100 pounds—the most astonishing physical transformation I’ve seen in real life. It’s clear that I don’t come from genetically impervious stock. The horsemen are right there over my shoulder, breathing down my neck.

Dan Buettner, the author of Blue Zones, said he liked Outlive and thought the science was sound, but he was skeptical because it “requires a person who is two or three standard deviations from the norm when it comes to discipline, income, and presence of mind.”

In Austin, Attia told me that one of the biggest aha moments of his professional life was realizing that centenarians last as long as they do because favorable genetic profiles tend to keep chronic disease at bay. They die of the same causes as everyone else, but it just happens later. Attia didn’t buy that it’s because they live in blue zones or eat a special diet. “People love to rattle off the esoteric behavior of centenarians,” he said.

The trick to emulating the long-lived, then, is to keep putting money into our fitness 401(k)s, so to speak. Jack LaLanne died in 2011, at the age of 96, from pneumonia, but reportedly he kept working out until a few days before his death. Could we all be like Jack?

“There are lots of people in the last decade of their life who are wonderfully happy with their children and their grandchildren, all those things,” Attia said. “But I just don’t meet many people whose bodies aren’t aching and who aren’t thinking, God, I wish I could do something about this. And the truth of it is, most of those people didn’t do all they could to reduce the probability of that. We’re not talking about creating immortal souls who, in their eighties, look like 20-year-olds. That’s science fiction. But you can be 80 and still have the body of a 60-year-old. How do we make that the norm as opposed to the exception?”

Great question. I had some ideas, and exactly none of them involved six-figure training programs or the elite VO2 max of a 37-year-old. As much as I enjoyed reading Outlive, and as strongly as I believed health care was ripe for a Medicine 3.0 revolution, I also knew that sometimes disrupting a status quo could backfire.

Case in point: On May 30, shortly before this story went to press, Attia posted a group photo on Instagram that included his “dear friend” Kevin Spacey—the embattled Oscar-winning actor accused of sexual misconduct. Spacey had been acquitted in several court trials, but Attia’s supportive post prompted widespread anger and questions about Attia’s judgment, including more than 3,000 mostly negative comments on Instagram.

Generally speaking, I didn’t want to confuse the message with the messenger; there is plenty to admire in Attia’s voluminous content. As one person on Reddit succinctly put it: “Use wellness and longevity influencers as a conduit to discovering interesting research(ers) and for general entertainment purposes. Otherwise apply a healthy dose of critical analysis like you should with anything.”

Undergoing strength assessment
Undergoing strength assessment (Photo: Sarah Karlan)

In my case I realized, happily, that I had already cobbled together my own low-budget Medicine 3.0 lifestyle. I live in Santa Fe, a small city nestled against the west flank of the southern Rockies, and cultivate a fitness-first lifestyle. I have easy access to trails for hiking and biking, which I try to do often; it’s Zone 2 pretty much every time I step out the door. For Zone 5, I just need to find a steep hill. My wife and I love to cook, and we default to a whole-foods diet without thinking much about nutrition. We enjoy an occasional drink or two. We socialize in person often. Good sleep is a priority, not an afterthought.

Twice a week, I drive an hour to work out at a facility called Elevate PHW (Performance Health Wellness), alongside clients who range from pro athletes to seniors with walkers. My friends are incredulous that I commute to a gym. I try to explain that, in addition to a great space and community, Elevate provides motivation and quality programming, which are both essential. I don’t particularly like lifting weights, and there are many days when I have to drag myself in. But I always go and am always glad; Elevate makes something I never enjoyed both necessary and fun.

I know my situation is unique, but the point is that many roads can lead to the same place. Ideally, the fight against age-related entropy is built into our routine and doesn’t demand a lot of mental energy figuring out what to do. What makes it work is consistency and sustainability.

“There is no short-term fix,” Blue Zones’s Dan Buettner told me. “If you want to live longer, you have to think about things you are going to do on a daily basis for decades.”

Our species has made some great progress, but we’ve landed in a place and time that undermines our health: sedentary, anxious, increasingly toxic. More insidiously, health—and by extension fitness and longevity—tends to break along socioeconomic fault lines, a disparity that grows every year. With enough resources, the wealthiest can buy a better body. But what about everyone else?

We tend to underestimate what it takes to implement meaningful change, which is often as dependent on our environment as it is on our behavior. Medicine 3.0 feels like an individual solution, but in reality it’s a subversive and radical systemic proposition that seeks to disrupt long-established institutions and hierarchies. It makes me wonder what kind of world my daughter is going to inherit. I hope I’m around long enough to find out.

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From July/August 2024
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Lead Photo: Sarah Karlan