Dismiss biomarkers that say you are ‘fine’ and live long

At a time when gluttony, addiction to sugar and sloth have made a large number of people unhealthy, we must dismiss what modern medicine says is “normal” about us, and instead find ways to be exceptionally healthy. This is the message in a new book Outlive: The Science and Art of Longevity by Peter Attia, a physician and founder of Early Medical, which helps people live long if they so wish.

He is a doctor who is frustrated with the mediocrity of modern medicine, which he calls Medicine 2.0 with mild contempt. It is in the business of prolonging death, which is glorious and lucrative, and not prolonging a healthy life, which is less melodramatic. Meanwhile, modern food is filled with things that can kill us. We are ancient bodies that ingest new toxins. “Our genes no longer match our environment,” Attia writes, “Thus, we must be cunning in our tactics if we are to adapt and thrive in this new and hazardous world.” Cunning is an excellent choice of word. The world, which is incapable of showing love without sugar, and reassures us that our lipid profile is ‘normal’ because a large proportion of people are worse, is an inadvertent conspiracy against us. In response, we must constantly educate ourselves, be wary of some foods, hike, swim and cycle, and lift weights. Should living be so much work? But then, we must look at it as a form of self-absorption. Taking care of ourselves is a better form of self-obsession than boring people with tales from our past or being paranoid about digital privacy.

Attia accepts that genes play a major role in deciding our longevity and its quality, but our “cunning” can be as influential as the cards we have been dealt at birth. We need to eat like literates, develop aerobic and muscle strength, take help from some magic drugs and supplements, and try to be happy so that we do not commit the slow suicide widely known as “living it up”.

I’ve followed Attia’s pronouncements for a few years. Not long ago, he had a theological disdain for fast carbs and was a believer in the ‘keto diet’ and intermittent fasting, which deplete the body of glucose reserves and induce it to burn fat. But now Attia has a more compassionate view—not towards sugar, but towards the diversity of our bodies and the fact that not everyone can handle hardship just because they want a long healthy life. Also, we cannot be sure of anything about food. On nutrition, “…we know relatively little with complete certainty,” Attia writes. But what we know is enough to link excess consumption with early death or a prolonged joyless old age.

Modern medicine lulls people into a false sense of well-being through biomarkers that emerge from blood tests. For instance, medicine classifies people as non-diabetic, pre-diabetic or diabetic. People are deemed fine, until one day they are not. But they were headed for trouble all along. “It is absurd and harmful to treat this disease like cold or a broken bone, where you either have it or you don’t; it’s not binary,” Attia writes. So too with cardiovascular disease. It’s a spectrum. Most people deemed fine are probably already in the early stages of the disease, headed for a day when they will suddenly become heart patients, or fall dead.

The terms “good cholesterol” and “bad cholesterol” that are given to LDL and HDL, Attia points out, are meaningless. In fact, what he is most interested in your blood report to assess if you actually risk early mortality are two markers in blood most Indians don’t order from the lab—the levels of apolipoprotein B and a lipoprotein called LP (a). The level of LP (a) in your blood stream is genetically predetermined, and if it is high, there is nothing you can do about it. Even so, Attia feels that knowledge is useful. Once you know you are at high risk, you should then try to lower other markers, even to the level of an infant’s.

Apart from food, what alters one’s fate is what Attia calls “the most powerful longevity drug”—exercise. He does rigorous exercises and is yet to develop compassionate views on it. He hates the fact that people think exercise is a broad ambiguous thing. It is a set of specific things, each with a distinct function. To live long and well, he says, one has to develop a large capacity to ingest oxygen, through aerobic exercises like running, cycling and swimming, one has to build muscle strength by lifting weights and increase grip strength by dangling from a bar, etc, and one must improve the body’s flexibility and stability.

In our ‘cunning’ to survive our civilization, its food and the mediocrity of modern medicine, Attia says we must include drugs. Not all medicine, he feels, need the inconvenience of disease. He mentions two with hope, rapamycin and metformin. Rapamycin is usually prescribed to those who have undergone an organ transplant, to stop the body from attacking the new organ. Metformin is prescribed to people diagnosed with diabetes. They appear to have a beneficial effect on healthy people, too. They are not yet cleared by regulators as health supplements, but rich bio-hackers in the US might already be taking them. And there are other such crypto-molecules that hold a lot of promise.