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TABLE OF CONTENTS
From Theory to Action: Your Personal Guide to Outlive
Your missing action plan to Outlive by Dr. Peter Attia. A guide to prioritize risks, personalize strategy, and outlive disease.
This is part of a series about health
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The Actionable Plan to Implement Peter Attia's Outlive
You grasp the "why" of Outlive, but need the "how".
You understand the urgency of tackling the Four Horsemen of chronic disease, but translating concepts like ApoB optimization and Zone 2 training into a practical plan feels overwhelming. If you fail to build a system, you risk staying stuck in inspiration overload.
But if you succeed, you can create a personalized longevity blueprint to systematically enhance your healthspan. This guide is that system.
Key Takeaways
This guide provides a blueprint to apply the core ideas of Outlive by Dr. Peter Attia to help you Prioritize Your Top Risks using clear data, Personalize Your Strategy with optimal targets, and Learn From Your Results to continuously improve.
Strategy 1: Prioritize Your Top Risks Using Outlive
What This Is
This is the foundational step of using your personal data to identify your top health risks, guided by the principles of Medicine 3.0 from Outlive.
Why It Matters
It focuses your efforts on pathways sorted by the highest annual fatality rates, ensuring you tackle the most significant threats to your healthspan first, a core concept from the book.
How You Can Use It
Use the Starting Point Snapshot to compile your family history and biometrics. This baseline data is crucial for identifying your unique risks related to the Four Horsemen (Atherosclerosis, Cancer, etc.).
Examples (Toggle for more)
- Less Productive: Alex reads Outlive and feels a general sense of urgency. He tries to improve everything at once, gets overwhelmed, and makes no consistent progress on any specific risk factor.
- More Productive: Alex uses the Starting Point Snapshot. His father's early heart attack and mother's Type 2 Diabetes, plus his own BP of 135/85, point him toward prioritizing the Cardiovascular and Metabolic pathways first, as they represent his most immediate risks. He also commits to aggressive cancer screenings, understanding that factors like age or even environmental exposures like radon can create risks that are otherwise "silent killers."
Strategy 2: Personalize Your Strategy Using Outlive
What This Is
This step translates your prioritized risks into a concrete action plan by selecting key metrics and setting ambitious, "optimal" targets that go beyond standard medical advice, a key theme in Outlive.
Why It Matters
A personalized plan with specific targets moves you from vague goals to a measurable, operational dashboard for your health, making it possible to track real progress as you work to outlive disease.
How You Can Use It
Use the Blueprint Scorecard template to document your chosen metrics, define optimal targets in discussion with your doctor, and link them to specific lifestyle actions.
Examples (Toggle for more)
- Less Productive: A doctor tells Alex his numbers are "a little high" but gives him no specific targets. Alex leaves the appointment unsure of what to aim for or how to measure success.
- More Productive: Alex uses the Blueprint Scorecard to create his action list. For his top priority, ApoB (Cardio), his scorecard reads: | Metric: ApoB | Last Result: Unknown | Std Goal: <90-100 | Optimal Target: <60-70 | Actions: Get test! Appx C Actions (Diet-Fats/Fiber, Activity); Discuss target w/ MD. This creates total clarity.
Strategy 3: Learn from Your Results to Outlive
What This Is
This is the dynamic process of implementing your plan, tracking progress against your optimal targets, and refining your strategy over time, which is the essence of the iterative approach in Outlive.
Why It Matters
Health is not a one-time fix. A regular review-and-refine cycle ensures your plan remains effective, adapts to challenges, and evolves as you gather more data about your own body.
How You Can Use It
Implement your plan and start with a Quick Win—one simple, high-impact action you can take today, like scheduling Zone 2 workouts. This builds momentum for the long term.
Examples (Toggle for more)
- Less Productive: Alex tries a few things for a couple of months but doesn't track his actions or results systematically. He doesn't know what worked, what didn't, or what to do next.
- More Productive: Alex implements his plan, tracks his actions, and reviews his progress on his Scorecard every three months. He sees what's working and identifies his biggest challenges (e.g., time management for workouts), allowing him to experiment with solutions and continually refine his approach.
Your Actionable Outlive Checklist
An Actionable Checklist with Scripts & Phrases to Help You Outlive
Phase 1: Prioritize (This Week)
Gather Your Intel: Use the "Starting Point Snapshot" concept to write down your family's health history (heart disease, cancer, diabetes, etc.).
Schedule Your Baseline: Book a doctor's appointment and request labs.
Script for Receptionist: "Hi, I'd like to book an appointment to establish a baseline for my long-term health. I'd specifically like to get labs for ApoB and HbA1c."
Script for Receptionist: "Hi, I'd like to book an appointment to establish a baseline for my long-term health. I'd specifically like to get labs for ApoB and HbA1c."
Identify Your Top Risk: Based on family history and fatality rate logic, name your #1 "Horseman" to focus on first.
Phase 2: Personalize (Within 30 Days)
Discuss Optimal Targets: Review your lab results with your doctor.
Phrase for Your Doctor: "Based on my family history and the principles in Outlive, I'd like to aim for an optimal ApoB target rather than just the standard range. What are your thoughts on a target of <70mg/dL for me?"
Phrase for Your Doctor: "Based on my family history and the principles in Outlive, I'd like to aim for an optimal ApoB target rather than just the standard range. What are your thoughts on a target of <70mg/dL for me?"
Create Your Scorecard: Use the "Blueprint Scorecard" format to list 3 key metrics, your results, and your optimal targets.
Define 1-2 Actions: For each metric, list a specific action from your "Action Levers" (e.g., "3x weekly 45-minute Zone 2 cardio sessions").
Phase 3: Learn (Every 90 Days)
Schedule Your Review: Put a recurring "90-Day Blueprint Review" in your calendar.
Implement a Quick Win: Start one small, manageable action from your plan today.
Review and Refine: At your 90-day review, ask: "What was my biggest obstacle?" and adjust one tactic to solve it for the next 90 days.
Outlive Checklist
- The Personalized Longevity Blueprint
- This is your high-level action plan, containing the tools below, designed to provide clarity, structure, and a system for a longer, healthier life.
- Starting Point Snapshot: A worksheet to compile your unique health data (family history, lifestyle, metrics). It's important because it creates the essential baseline for all strategic decisions.
- Blueprint Scorecard: Your operational dashboard to document metrics, set optimal targets, and list foundational actions. It's important because it makes your longevity strategy concrete and measurable.
- Action Levers Repository (Concept): A collection of specific lifestyle strategies (like Zone 2/5 training, stability work, nutrition). It's important because it connects your goals to proven, actionable tactics.
Outlive Toolkit
Appendix A: Key Pathways & Metrics
This table outlines key health pathways critical for longevity, mapping them to the "Four Horsemen" concept of major age-related disease risks where applicable. Its purpose is to provide a framework for proactive health assessment and informed discussion with your physician.
Here’s how to read the table
- Pathway / Horseman (System Deaths/yr): Identifies the broad health system or risk category (like Cardiovascular or Metabolic Dysfunction) and the estimated total associated deaths per year in the US, indicating its overall mortality impact.
- The table is sorted by prevalence of fatality and evidence quality of metric, helping you prioritize items by importance. For instance, cardiovascular is the first row here because it has the highest rate of deaths for the general population, about 991k+/year deaths.
Linked Key Diseases (Deaths/yr) & Associated Conditions: This crucial column lists the specific health outcomes addressed by monitoring this pathway. It's structured to show priority between primary mortality and associated conditions. In general, to help you prioritize, spend outsized effort on getting your primary mortality metrics to a good place before associated conditions or items further down the list (unless you have personalized risk factors. that bring those higher).
- Primary Mortality Focus: Lists diseases with the highest direct contribution to mortality within this pathway (e.g., Heart Attack, Stroke, specific Cancers, Dementia, Kidney Failure). Addressing these is a logical first priority for extending lifespan.
- Associated Conditions Assessed: Lists other significant health issues monitored by this pathway's metrics. These may have lower direct death tolls but are often critical contributing risk factors for the primary killers, significantly impact healthspan (quality of life), or represent important secondary risks (e.g., Atrial Fibrillation, NAFLD, Frailty, Hearing Loss). Managing these is essential for prevention and overall well-being.
- Key Risk Factors: Lists factors known to increase the risk of developing the linked diseases. Understanding your personal risk factors helps tailor preventative strategies. (Sorted approx. High-to-Low score).
Assessment Focus & Metrics (Quick /// Comprehensive): Details the tests and assessments used. It reflects the two focuses described above (Primary Mortality vs. Contributing Risk/Healthspan) and includes two levels of assessment depth that acknowledges that certain metrics are easier to get than others:
- Quick (Initial): These are generally simpler, more accessible, or more frequently performed tests providing baseline or screening information (e.g., Blood Pressure, basic blood work like FBG, screening questionnaires). The focus is on ease and frequency to get initial insights.
- Comprehensive: These are typically more detailed, less frequent, or follow-up tests used for deeper investigation, diagnosing issues flagged by quick metrics, or assessing specific high-risk situations (e.g., CAC Scan, Colonoscopy, DEXA Scan, detailed sleep studies).
Avg-Risk Screen? & Silent Progression?: This vital column indicates likelihood this disease will get missed by (or caught too reactively) by standard medicine 2.0 techniques.
- Whether a standard, validated screening test exists for the general population at average risk (Yes/No/Limited).
- Whether the primary conditions in this pathway often progress silently, meaning significant damage can occur before obvious symptoms appear (Yes/No). A "Yes" here underscores the critical need for proactive assessment – waiting for symptoms for these conditions can be too late for optimal outcomes.
Keep in mind four critical notes
- Physician Discussion is Crucial: This table provides a framework. Personalize all metrics, targets, screening, and risk assessments with your physician.
- Optimal Targets: Targets listed (marked *) are often aggressive, aiming for optimal health/longevity, requiring medical guidance. They are discussion points.
- Interconnectedness: Pathways are linked; dysfunction is rarely isolated. Metrics in one section may inform risks in another.
- Horsemen: Framework for major age-related disease risks (Atherosclerosis, Cancer, Neurodegeneration, Metabolic Dysfunction).
Acronym Definitions
- AAA US: Abdominal Aortic Aneurysm Ultrasound
- Abs: Antibodies (Thyroid)
- AD: Alzheimer's Disease
- Afib: Atrial Fibrillation
- ALT/AST: Alanine/Aspartate Aminotransferase (Liver Enzymes)
- ApoB: Apolipoprotein B
- BP: Blood Pressure
- CAC: Coronary Artery Calcium (Score)
- CAD: Coronary Artery Disease
- CGA: Comprehensive Geriatric Assessment
- CKD: Chronic Kidney Disease
- CLD: Chronic Liver Disease
- Cog: Cognitive
- CPET: Cardiopulmonary Exercise Test
- CVD: Cardiovascular Disease
- DEXA: Dual-energy X-ray Absorptiometry (Bone Density)
- ECG / EKG: Electrocardiogram
- eGFR: Estimated Glomerular Filtration Rate (Kidney Function)
- FBG: Fasting Blood Glucose
- FRAX: Fracture Risk Assessment Tool
- HbA1c: Hemoglobin A1c (Glycated Hemoglobin)
- Holter: Holter Monitor (Ambulatory ECG)
- hs-CRP: High-Sensitivity C-Reactive Protein (Inflammation Marker)
- HTN: Hypertension
- MD: Medical Doctor
- MI: Myocardial Infarction (Heart Attack)
- MRI: Magnetic Resonance Imaging
- NAFLD/NASH: Non-Alcoholic Fatty Liver Disease / Non-Alcoholic Steatohepatitis
- Opt: Optimal
- PSG: Polysomnography (Sleep Study)
- Psych: Psychiatric
- Qual: Quality
- Quest: Questionnaire
- TSH: Thyroid Stimulating Hormone
- UACR: Urine Albumin-to-Creatinine Ratio (Kidney Function)
- US: Ultrasound
- VO2 Max: Maximal Oxygen Uptake (Fitness Measure)
Longevity Pathways Table
Pathway / Horseman (System Deaths/yr) | Linked Key Diseases (Deaths/yr) & Associated Conditions | Assessment Focus & Metrics (Quick /// Comprehensive) | Key Risk Factors (Sorted High-Low Score Approx.) | Avg-Risk Screen Caught? Silent Progression? |
1. Cardiovascular / Horseman #1 (Atherosclerosis) | Primary: Atherosclerosis -> CAD/MI (~700k/yr), Stroke (~160k/yr). | Primary Mortality Focus (MI, Stroke): BP (<115/75 mmHg); Triglycerides (<80 mg/dL) LDL Cholesterol (<80 mg/dL) /// ApoB (<30-70 mg/dL)*, CAC Score (0) **cholesterol, HDL, and LDL, while important are deprioritized since they’re less reliable than the above measures | HTN (5), Smoking Hx (5), High ApoB/LDL (5), Age (4), Diabetes (4), Genetics (3), Sedentary (3), Poor Diet (3) | Yes (BP; AAA risk groups) / Yes (Atherosclerosis) |
(~991k+ total CV deaths) | Associated Conditions Assessed: HTN, Afib (~26k/yr), AAA Rupture (~5k/yr). | Contributing Risk / Condition Focus (Afib, AAA): ECG (check arrhythmias and ischemic changes; Quick ECG covers some Afib) /// Holter Monitor (If symptoms), AAA US (Risk-based) | ㅤ | ㅤ |
--- | --- | --- | --- | --- |
2. Cancer / Horseman #2 (Cancer) | Primary: See Cancer Map (Part 2) for major killers. Total ~348k+/yr across major cancers listed. | Refer to Longevity Cancer Coverage Map (Part 2) (Metrics inherently target primary mortality risk for each specific cancer listed) | Refer to Longevity Cancer Coverage Map (Part 2) (Varies by cancer type) | Refer to Longevity Cancer Coverage Map (Part 2) |
(~348k+ total related deaths from Map) | (No separate 'Contributing Risk' category as metrics target primary cancer risk directly) | ㅤ | ㅤ | (Varies by cancer type) |
--- | --- | --- | --- | --- |
3. Neuro-Endo-Stress / Horseman #3 (Neurodegeneration) | Primary: Cognitive Decline/Dementia (AD proxy ~135k/yr). | Primary Mortality Focus (Dementia): Cog Screen /// Neuroimaging? (Symptom/indication based) | Age (5), Genetics (4), Vascular Disease (#1) (4), Hearing/Vision Loss (3), Poor Sleep (3), Chronic Stress (3) | No/limited / Yes (Cognitive decline often gradual/silent) |
(~185k+ total deaths listed) | Associated Conditions Assessed: Mood Disorders/Suicide (~50k/yr), Hearing Loss, Sleep Disorders, Thyroid Dysfunction. | Contributing Risk / Healthspan Focus (Mood, Sensory, Sleep, Thyroid): Hearing Screen, Mental Health Screens, Sleep Quest.(>7.5h qual?)*, TSH /// Audiogram, Psych Eval, Actigraphy/PSG, Free T4/Abs | Thyroid Issues (2) | ㅤ |
--- | --- | --- | --- | --- |
4. Metabolic / Horseman #4 (Metabolic Dysfunction) | Primary: Type 2 Diabetes (~103k), NAFLD/NASH -> CLD/Cirrhosis (~57k). Note: Major driver of CVD (#1) & CKD (#5) risk. | Primary Mortality Focus (Diabetes, Cirrhosis): HbA1c** (<5.3%), Liver US/FibroScan **is one of the most reliable indicators and easily obtainable through a blood test. As a result, I remove FBG, which is a less reliable indicator. | Obesity/Visceral Fat (5), Poor Diet (High Sugar/Processed) (5), Sedentary (4), Age (3), Genetics (3) | Yes (Diabetes Risk Screen) / Yes (Insulin resistance/NAFLD) |
(~160k+ total related deaths listed) | Associated Conditions Assessed: Components of Metabolic Syndrome. | Contributing Risk / Condition Focus (Metabolic Syndrome Components): Waist Circ., BP (Covered in #1) | ㅤ | ㅤ |
--- | --- | --- | --- | --- |
5. Organ & System Integrity | Primary: CKD (~55k), Osteoporosis / Fracture Risk (~35k proxy via complications). | Primary Mortality Focus (CKD, Fracture Complications): eGFR, Urinalysis, FRAX /// UACR, DEXA | Age (5), Low Activity (4), CKD Risk (Diabetes, HTN) (4), Poor Nutrition (3), Smoking (3), Low Estrogen (3) | Yes (Osteoporosis DEXA Screen) / Yes (CKD, Osteoporosis) |
(~90k+ total deaths listed) | Associated Conditions Assessed: Frailty, Glaucoma, Low Fitness (VO2 Max). | Contributing Risk / Healthspan Focus (Frailty, Vision, Fitness): Grip/Gait, Vision Screen, Activity Level /// Eye Exam, CGA, CPET/Accel.(High VO2 Max Target- for age 20s-30s: 50-60 mL/kg/min) | ㅤ | ㅤ |
--- | --- | --- | --- | --- |
6. Inflammation & Immune Health | Primary: None directly. Role: Amplifies risk for ALL Horsemen (esp. #1). | Primary Impact Focus (Systemic Inflammation as Risk Amplifier): hs-CRP (<0.5-1.0 mg/L)* | Chronic Infection (Periodontal) (4), Obesity (4), Poor Diet (4), Smoking (3), Chronic Stress (3) | No (hs-CRP measures status) / Yes (Inflammation) |
(0 direct deaths, but amplifies other risks) | Associated Conditions Assessed: Periodontal Disease, Immune Dysregulation. | Contributing Risk / Condition Focus (Oral Health Link): --- /// Periodontal Exam | Autoimmune conditions (Variable) | ㅤ |
Appendix B: Cancer Surveillance Map
This is similar to Appendix A, but focused specifically on cancers, many of which lack good screenings under the medicine 2.0 paradigm. Once you get symptoms and discover the cancer, many of these cancers tend to be lethal. As a result, cancer surveillance, unfortunately, requires a high burden on the individual to screen and catch early.
Acronym Definitions
- AFP: Alpha-Fetoprotein
- Bx: Biopsy
- CBC: Complete Blood Count
- CRC: Colorectal Cancer
- DRE: Digital Rectal Exam
- EBV: Epstein-Barr Virus
- FIT: Fecal Immunochemical Test
- GERD: Gastroesophageal Reflux Disease
- HCC: Hepatocellular Carcinoma
- hCG: Human Chorionic Gonadotropin
- Hep C/B Ab: Hepatitis C/B Antibody
- HIV: Human Immunodeficiency Virus
- HPV: Human Papillomavirus
- Hx: History
- IBD: Inflammatory Bowel Disease
- Imaging Acronyms: LDCT (Low-Dose CT), CT (Computed Tomography), MRI (Magnetic Resonance Imaging), PET (Positron Emission Tomography), US (Ultrasound), EUS (Endoscopic Ultrasound)
- LDH: Lactate Dehydrogenase
- MCED: Multi-Cancer Early Detection (Emerging blood tests)
- MGUS: Monoclonal Gammopathy of Undetermined Significance
- PSA: Prostate-Specific Antigen
- RNA: Ribonucleic Acid
- SPEP/UPEP/sFLC: Serum/Urine Protein Electrophoresis / Serum Free Light Chain Assay
- Tx: Treatment
- UTI: Urinary Tract Infection
Cancer Surveillance Map
Physician Discussion Crucial
Discuss all personal risks, screening options (including emerging (and less validated) tests like Multi-Cancer Early Detection or MCEDs marked with *), and symptom awareness thoroughly with your physician. Illustrative start ages are discussion points.
Cancer Type (~Deaths/yr) | Key Risk Factors (Score 1-5) | Quick & Comprehensive Metrics (Initial /// Comprehensive) | Potential Detection: MCED* / Imaging? | Avg-Risk Screen & Symptom Onset |
Lung Cancer (~130k) | Radon (4), Occup. exposures (3-4), Secondhand smoke (3), Family Hx (2-3), Prior lung disease (2), Air pollution / Fumes / Cooking Meat (2) | Risk Assessment (Ongoing) /// LDCT (50+ by request, NON-Guideline for non-smoker) | MCED*, LDCT, CT, PET | No (Non-Smoker) / Yes (Silent) |
Colorectal (CRC) (~53k) | Age (4), IBD (4), Family Hx (3-4), Diet (Proc./Red Meat ↑, Fiber ↓) (3), Obesity (3), Alcohol (2) | FIT (40); Risk Assessment /// Colonoscopy (40-45) | MCED*, CT, MRI, PET (Staging/Recur.) | Yes / Yes (Silent) |
Pancreatic (~51k) | Smoking Hx (past) (5), Chronic Pancreatitis (4), Family Hx (4), New Diabetes >50 (3), Obesity (2-3) | Risk Assessment (Ongoing) /// EUS / MRI (Primarily high-risk genetic syndromes or symptoms) | MCED*, US (EUS), MRI, CT, PET | No / Yes (Very Silent) |
Prostate (~35k) | Age (4), Family Hx (3-4), African Ancestry (3) | PSA (40-45); DRE /// MRI/Biopsy (If PSA high or suspicious DRE) | MCED*, MRI, CT, PET (Staging) | Yes (Shared Decision) / Variable |
Liver (HCC) (~30k) | Chronic Hep C/B (5), Cirrhosis (5), Alcohol (4-5), NAFLD/NASH (4), Hemochromatosis (3), Aflatoxin (3) | Hep C Ab Test (18+); ALT/AST (Assess NAFLD Risk - 35); Risk Assessment /// HCV RNA Test (If Ab+); Liver US/Elastography (Risk factors); AFP Blood Test? (High risk surveillance only) | MCED*, US, CT, MRI | No (Risk Factors Only) / Yes (Silent) |
Leukemia (~23k) | Prior Chemo/Radiation (4), Genetic Syndromes (4), Benzene exposure (3-4) | CBC w/ Diff (Baseline Young Adult); Risk Assessment /// Bone Marrow Biopsy (If indicated) | MCED* | No / Variable (Acute rapid) |
Non-Hodgkin Lymphoma (~20k) | Immune Suppression (4), Age (3), Infections (HIV, EBV) (3), Pesticides (2-3), Family Hx (2) | Risk Assessment (Ongoing) /// Lymph Node Biopsy (If indicated); Assess Incidental Imaging Findings | MCED*, CT, PET, MRI | No / Variable |
Brain & Nervous Sys. (~19k) | Radiation Exposure (4), Family Hx (rare syndromes) (4), Age (3) | Risk Assessment (Ongoing) /// MRI / CT of Brain (If indicated by symptoms) | MCED*, MRI, CT | No / Variable (Symptoms often prompt Dx) |
Bladder (~18k) | Smoking (Primary) (5), Occup. Exposures (Aromatic Amines) (4), Age (3), Family Hx (2), Chronic UTIs (2) | Urinalysis (40 - low spec.); Urine Biomarker Tests?* (Discuss w/ MD); Risk Assessment (Exposures) /// Cystoscopy (If indicated) | MCED*, CT, MRI (Staging) | No / Variable (Hematuria often early) |
Esophageal (~16k) | Barrett's (5), Smoking (N/A here) (5), Alcohol (+ALDH2 Def.) (3-4), Chronic GERD (3), Obesity (3), Hot Liquids (2?) | Risk Assessment (GERD/Barrett's Hx); Cytosponge?* (Discuss w/ MD) /// Upper Endoscopy (Surveillance if Barrett's; or symptoms) | MCED*, CT, PET, US (EUS) (Staging) | No / Yes (Silent) |
Kidney (~14k) | Smoking (N/A here) (4), Obesity (3), Hypertension (3), Family Hx (3), Dialysis (3), Exposures (2) | Urinalysis (40 - low spec.); Risk Assessment (Ongoing) /// Abdominal US / CT / MRI (Often incidental; surveillance if high risk) | MCED*, US, CT, MRI | No / Yes (Often Silent) |
Multiple Myeloma (~13k) | MGUS Precursor (5), Age (4), African Ancestry (3), Male Sex (2), Family Hx (2), Obesity? (1-2) | Risk Assess. (MGUS Hx?); Basic Blood/Urine Tests (CBC, Ca, Protein, Kidney Func. - 40s) /// SPEP/UPEP/sFLC (Specific protein tests - 40s? If risk/suspicion); Bone Marrow Biopsy (If indicated) | MCED*, CT, MRI, PET (Bone lesions) | No / Yes (Often presents w/ complications) |
Stomach (Gastric) (~11k) | H. pylori (4), Family Hx (3), Diet (High Salt/Smoked/Pickled) (3), Pernicious Anemia (2) | Risk Assessment (Diet, H. pylori status?) /// Upper Endoscopy w/ Biopsy (If high risk or symptoms) | MCED*, CT, PET, US (EUS) (Staging) | No / Yes (Silent) |
Oral (~11k) | Tobacco (N/A here) (5), Heavy Alcohol Use (4), HPV Infection (4) | Annual Dental Visit / Self-Awareness /// Oral Exam (Dentist) (Annually); Biopsy (If lesion found) | MCED* (Primarily visual exam) | Yes (Visual Exam) / No |
Skin (Melanoma) (~8k) | UV Exposure (5), Many/Atypical Moles (4), Fair Skin (3), Family Hx (3), Immune Suppression (3) | Skin Self-Exam (Teenager+) /// Clinician Skin Exam (20s); Biopsy (If suspicious) | MCED* (Primarily visual exam) | Yes (Visual Exam) / No |
Thyroid (~2k) | Radiation (childhood) (4), Genetic Syndromes (4), Family Hx (3-4), Female Sex (3), Age (20-55) (3) | Neck Self-Exam / Clinical Neck Palpation (Ongoing); TSH /// Thyroid US (If nodule/suspicious); Fine Needle Aspiration Biopsy (If indicated by US) | MCED*, US | No / No (Usually slow/good prognosis) |
Testicular (~0.5k) | Undescended Testicle Hx (4), Age (15-35 Peak) (4), Family Hx (3), White Race (2) | Testicular Self-Exam (Monthly from Teenager) /// Scrotal US; Tumor Marker Blood Tests (AFP, hCG, LDH) (If mass found) | MCED*, US, CT (Staging) | No (Self-Exam Rec.) / No |
Appendix C: Key Actions
Longevity Medicine Action Levers: Foundational Pillars & Integrated Pathway Strategies
This appendix complements the "Longevity Health Pathways" table by detailing the core lifestyle habits ("levers") that influence your health metrics and longevity outcomes. The goal is to identify the most effective actions you can take based on your specific health priorities.
Introduction: How to Use This Appendix
- Identify Your Priority Pathways: First, review the "Longevity Health Pathways" table (Appendix A). Which pathways show areas needing the most improvement, especially concerning the Primary Mortality Focus conditions (like CVD, Dementia, Diabetes, CKD)?
- Understand Foundational vs. Integrated Strategies: This appendix is now structured into two main parts:
- Section 1: Foundational Health Pillars & Habits: These habits form the bedrock of health, supporting all pathways and enabling targeted interventions to be effective. Consistent effort here is crucial for long-term health and addresses many "Contributing Risk/Healthspan" factors noted in the Pathways table.
- Section 2: Optimizing Key Longevity Pathways - Integrated Strategies: This section provides specific, actionable strategies for each pathway. For your priority pathways, it highlights the Top Targeted Levers (actions with strong, direct effects on the Primary Mortality Drivers) alongside the Critical Foundational Support (the most crucial habits from Section 1 needed for success in that specific pathway).
- Apply an Integrated Approach: While addressing primary mortality risks is paramount, Foundational Habits must be addressed concurrently. Improving sleep or stress management might be required to successfully lower blood pressure or improve insulin sensitivity. Use the integrated strategies in Section 2 for your priority pathways.
- Discuss with Your Physician: Use this information to have informed conversations about creating a personalized action plan.
Section 1: Foundational Health Pillars & Habits (Essential Support for All Pathways)
These habits form the bedrock of health, supporting overall well-being and enabling targeted interventions to be effective. Consistent effort across these areas is key.
- A. Quality Nutrition Base:
- Focus: Prioritize whole, unprocessed foods (vegetables, fruits, legumes, nuts, seeds, quality protein sources, healthy fats). Maximize nutrient density.
- Limit: Minimize ultra-processed foods, added sugars, refined carbohydrates, excessive unhealthy fats.
- Hydration: Ensure adequate daily fluid intake (primarily water).
- B. Consistent Physical Activity:
- Base: Minimize sedentary time. Incorporate regular movement throughout the day.
- Mix: Aim for a balanced routine including moderate cardio (Zone 2), strength training, and some stability/mobility work.
- C. Prioritized Sleep:
- Goal: Aim for 7-9 hours of high-quality, consistent sleep per night.
- Strategy: Optimize sleep hygiene (dark, quiet, cool room; consistent schedule; wind-down routine). Address potential sleep disorders (like sleep apnea).
- D. Effective Stress Management:
- Goal: Develop sustainable strategies to mitigate chronic stress.
- Tools: Incorporate regular practices like mindfulness, meditation, breathwork, time in nature, engaging hobbies, setting boundaries.
- E. Strong Social Connection:
- Goal: Cultivate and maintain meaningful relationships.
- Action: Prioritize quality time with supportive family, friends, and community members.
- F. Optimized Environmental Inputs:
- Goal: Minimize exposure to known toxins (pollutants, endocrine disruptors).
- Action: Be mindful of air/water quality, food sources, and household products. Optimize helpful inputs like safe sun exposure for Vitamin D (test levels).
Section 2: Optimizing Key Longevity Pathways: Integrated Strategies
For your priority pathways identified in the "Longevity Health Pathways" table (Appendix A), focus on these integrated strategies, which combine targeted actions with essential foundational support.
Pathway 1: Cardiovascular & Vascular Health (Horseman #1)
- Primary Mortality Drivers: Atherosclerosis leading to Coronary Artery Disease/Heart Attack (CAD/MI) & Stroke.
- Top Targeted Levers:
- Dietary Precision: Aggressively reduce saturated/trans fats & sodium; increase soluble fiber, potassium, healthy fats (MUFA/PUFA).
- Exercise Specificity: Consistent Zone 2 cardio plus Zone 5/HIIT.
- Medical Management: Discuss optimal ApoB/lipid and BP targets and necessary medications with your physician. Address sleep apnea if present.
- Inflammation Control: Directly target sources (see Pathway #6 levers).
- Critical Foundational Support: Quality Nutrition Base (A), Consistent Physical Activity (B), Prioritized Sleep (C - esp. apnea), Effective Stress Management (D).
Pathway 2: Cancer (Horseman #2)
- Primary Mortality Drivers: Specific cancers (Lung, CRC, Pancreatic, Breast, Prostate, etc. - see Cancer Map in Appx A).
- Top Targeted Levers:
- Screening Adherence: Diligently follow appropriate screening protocols (Colonoscopy, LDCT if high-risk, Mammogram, PSA discussion, Skin checks, etc.).
- Address Key Risks: Treat Hepatitis C; manage weight/metabolic health (NAFLD link); rigorous sun protection; HPV vaccination; moderate alcohol.
- Specific Symptom Vigilance: Be aware of and promptly report key warning signs for relevant cancers. Know family history.
- Critical Foundational Support: Quality Nutrition Base (A - whole foods, fiber), Consistent Physical Activity (B), Optimized Environmental Inputs (F - minimize toxins), potentially Stress Management (D) and Sleep (C) for immune function.
Pathway 3: Neuro-Endo-Stress (Horseman #3)
- Primary Mortality Driver: Neurodegenerative Disease (e.g., Alzheimer's/Dementia).
- Top Targeted Levers:
- Vascular Health Optimization: Implement strategies from Pathway #1 (critical link).
- Sensory Input: Address hearing loss promptly with aids; regular vision checks.
- Cognitive Engagement: Actively pursue mentally stimulating activities, lifelong learning.
- Hormonal Balance: Address thyroid issues if present (TSH/T4/Abs tests).
- Critical Foundational Support: Prioritized Sleep (C - essential for brain clearance), Effective Stress Management (D - cortisol impacts), Strong Social Connection (E - buffer), Consistent Physical Activity (B - increases BDNF), Quality Nutrition Base (A - brain nutrients, gut-brain axis).
Pathway 4: Metabolic Regulation (Horseman #4)
- Primary Mortality Drivers: Type 2 Diabetes complications, NAFLD/NASH leading to Cirrhosis. (Major driver of #1 & #5 risks).
- Top Targeted Levers:
- Dietary Precision: Strict limitation of added sugars & refined carbohydrates; prioritize fiber; adequate protein; optimize meal timing/macros.
- Exercise Specificity: Consistent Strength Training plus Zone 2 cardio.
- Body Composition: Focus on reducing visceral adipose tissue.
- Critical Foundational Support: Quality Nutrition Base (A - non-negotiable), Consistent Physical Activity (B - non-negotiable), Prioritized Sleep (C - impacts insulin sensitivity), Effective Stress Management (D - cortisol impacts glucose).
Pathway 5: Organ & System Integrity
- Primary Mortality Drivers: Chronic Kidney Disease (CKD), Osteoporosis/Fracture complications.
- Top Targeted Levers:
- Kidney Protection: Strict management of BP (#1) and Blood Glucose (#4); adequate hydration; avoid NSAID overuse.
- Bone Health: Optimize Vitamin D & Calcium intake (Test Vit D!); prioritize weight-bearing exercise & strength training; adhere to DEXA screening.
- Fall Prevention: Include balance/stability exercises; address vision/hearing issues (#3). Maintain muscle mass (protein + strength training).
- Fitness (VO2 Max): Incorporate Zone 5/HIIT.
- Critical Foundational Support: Consistent Physical Activity (B - esp. strength/stability), Quality Nutrition Base (A - protein, calcium/Vit D), Optimized Environmental Inputs (F - Vit D).
Pathway 6: Inflammation & Immune Health
- Primary Impact: Systemic Inflammation (Amplifies risk for all Horsemen, especially #1).
- Top Targeted Levers:
- Targeted Anti-Inflammatory Diet: Emphasize Omega-3s, polyphenols, spices; strictly limit inflammatory triggers (processed foods, sugar, unhealthy fats).
- Oral Hygiene Excellence: Regular brushing, flossing, AND professional periodontal exams/cleanings.
- Critical Foundational Support: Quality Nutrition Base (A), Prioritized Sleep (C), Effective Stress Management (D), Consistent Physical Activity (B - modulates inflammation).
For more, check out Outlive by Dr. Peter Attia.
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I share notes on purposeful living, exploring relationships, parenting, and health, beyond my work as an innovation adviser. (And yes, I chose the ‘Wu Wei’ because it's also a cheesy pun on my last name!)
Outlive FAQ
Frequently Asked Questions About Applying Outlive
How do you prioritize which risks from Outlive to focus on first?
Prioritize based on a combination of your personal and family health history and the principle of tackling disease pathways with the highest annual fatality rates first. For most people, this means focusing on atherosclerosis (heart disease) before other risks, unless you have a strong genetic predisposition elsewhere.
What is the most important first step after reading Outlive?
The most crucial first step is to gather your own data. Compile your detailed family health history and get a comprehensive blood panel that includes, at a minimum, ApoB (for cardiovascular risk) and HbA1c (for metabolic health). Action cannot be personalized without this baseline.
What is a "Quick Win" I can implement from Outlive today?
A great quick win is to schedule three 45-minute Zone 2 cardio sessions into your calendar for the next week. This single action is high-leverage for metabolic and cardiovascular health and builds immediate momentum.
When Not to Use This Guide?
This guide is intended for building a proactive, long-term health strategy and is not a substitute for professional medical advice, diagnosis, or treatment. Do not use it to self-manage an acute medical issue or a previously diagnosed disease without the direct guidance of your physician.
This is not medical advice.
Physician Discussion is Crucial: The resources below provide a framework. Personalize all metrics, targets, screening, and risk assessments with your physician.
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