To enjoy a long and happy life


To enjoy a long and happy life

After reading Dr Peter Attia's new book, JULIANA COETZER has decided to take better care of the vehicle that has to take her to the end of her days.


PETER ATTIA is a well-known author, a speaker on the subject of longevity, and the first medical doctor I have encountered who is critical of the Hippocratic Oath. Not only are the words apparently not Hippocrates' words but “first do no harm" is simply not always valid, says Attia. “Sometimes you have to be cruel to be kind."

He is also someone who gives you a metaphorical whack on the side of the head to make you wake up to the responsibility you have towards your body if you want a long and healthy life.

We need to start thinking differently about ageing and stop associating a long life with disease and deterioration, he says in his new book, Outlive. You can choose between an optimally functioning longer life with a short illness at the end, because we all have to die; or a lengthy debilitating illness that will get you to the end of your days: dying in slow motion, therefore.

Holding your genetic makeup accountable for your longevity is the easy option, but it disregards quality of life. For this, you have to get up from the couch and make some conscious decisions, says Attia.

In earlier times, most people died from a quick incident or illness, with accidents, injuries and infections usually to blame. Nowadays, we consider it young when someone dies in his 70s. The average age of “lights out" is in the 80s and often due to a prolonged, chronic illness.

The author refers to these chronic diseases as the four horsemen, and interestingly, these are figures — in the form of conquest, war, famine and disease — also referred to in Revelation, heralding the end times.

In psychology, four horsemen — criticism, contempt, a defensive attitude and opposition to cooperation — predict the end of a relationship.

Different riders, different scenarios, but with one striking similarity: a destructive path for the rider.

The four horsemen of health

Attia says heart disease, cancer, neuro-degenerative diseases such as dementia and Alzheimer's, and metabolic malfunction (type 2 diabetes, insulin resistance and non-alcoholic fatty liver syndrome) are the four horsemen standing in the way of longevity.

Fortunately, science is constantly developing new methods to detect diseases faster and act preventatively. That's why the news is not damning. There is hope. But it's vital to get to know your body and develop a strategy so you're in control of your rider's pace, says Attia.

The strategy is not out of people's reach and is classified in four  categories: exercise, nutrition, sleep and emotional health.


It is quite sobering to have the physical process of growing older, from the age of 65, described so pertinently:

  • Decrease in cardiorespiratory fitness.
  • Loss in muscle mass and physical strength.
  • Deterioration of balance.
  • Crumbling of bones and stiffening of joints.
  • Weakening of memory.

To slow down this process and protect ourselves from fragility and injury, three to seven hours of exercise a week are essential, according to Attia.

He feels so strongly about this that he says exercise is the most important habit to stave off deterioration, preventing cognitive and physical decline better than any other intervention. It builds the immune system and stimulates the strengthening of muscles and bones that prevents older people from being injured easily.

Exercise also causes you to secrete molecules that stimulate the functioning of the hippocampus, the part of the brain that deals with memory. And it increases the oxygen supply to the brain, heart and lungs. It is particularly important essential for diabetics and helps normalise blood sugar levels.


Mercifully, Attia is not a supporter of diets and does not recommend the same diet for everyone. He believes each person's circumstances are unique and as long as you follow a few rules, you are on the right track.

  • Eat less. This does not mean starving yourself, just that you are keeping your calorie intake in check. You could even count the calories, he suggests. If you consume too many, the surplus is stored in adipose tissue in the liver and muscles. He suggests you choose a food that is high in calories and cut it out permanently. Sugar is a good example. Refrain from food intake for several hours a day. This means insulin levels drastically decrease and the liver is cleansed of excessive fat. This method must be done in consultation with your doctor, because it can lead to loss in muscle mass.
  • Avoid junk food. Attia includes fruit juices in this category, saying  they send too many fructose sweeteners to the stomach and liver, which have difficulty digesting them.
  • Increase your intake of proteins. These are the building blocks of healthy muscle mass. (2.2 grams per kilogram per day is recommended.)
  • Less alcohol. It has no nutritional value and does not contribute to a longer life. But if you really have to, no more than seven drinks per week.


When our brain becomes aware that we are in danger, it secretes stress hormones such as cortisol and adrenaline to protect us. These hormones that initially protect have a negative effect on  heart rhythm and metabolism in the long run. The same hormones are secreted when you have trouble sleeping — your brain believes you are in danger.

Healthy, long, deep sleep is essential for good brain function. The connection between insomnia and dementia and Alzheimer's disease is alarming.

To people who say they will sleep when they are dead, the author says: if sleep is so unimportant, why hasn't evolution dispensed with it?

Emotional health

Attia recounts the struggles he had with his emotional health as an adult, already married with two children, because instead of addressing his childhood trauma he buried it under perfectionism and many accomplishments.

His grandiose industriousness was the mask behind which inferiority and embarrassment lurked. With the help of cognitive behavioural therapy, he finally gained control of his life.

Emotional health focuses on regulating emotions so that the fine ecosystem of interpersonal relationships is optimally healthy, especially in the later years when we need each other more than ever.

And it improves your mood and attitude. Why would you want to live longer if you are unhappy?

Outlive is a doorstop of a book but an important one. The many facts, theories and insights overwhelmed me at times, but I've never been so aware that the vehicle that will carry me to the end of my days needs my attention. Ignorance is unfortunately not bliss in this instance.

♦ VWB ♦

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