1. The Long Game: From Fast Death to Slow Death

   - Cancer is complex with many subtypes, not one disease. Prevention remains difficult as mutations seem random.

   - Metabolic issues like obesity and insulin resistance raise cancer risk, providing one angle for prevention.

   - New immunotherapies like checkpoint inhibitors help ...

   - We reduce energy intake via calorie restriction (CR), dietary restriction (DR), or time restriction (TR).

   - CR requires tracking every calorie, very difficult long-term. DR eliminates foods, but compliance varies.

   - TR/fasting works for some but risks muscle loss if protein...

   - Metabolic dysfunction underlies obesity and is linked to the "Four Horsemen" diseases. It must be addressed first.

   - Metabolic dysfunction is affecting 1 in 4 people globally.

   - But it's overlooked since early stages may not change standard blood tests. We must detect issue...

   - The APOE e4 gene variant significantly increases Alzheimer's risk but is not deterministic. Other genetic and lifestyle factors also matter.

   - Prevention is currently our only option against Alzheimer's. Key strategies include optimizing vascular and metabolic health, exercise, slee...

  - It aims to optimize healthspan (quality of life), not just lifespan. Medicine 2.0 just prolongs life.

   - Patients must be active participants and "captains" of their health in Medicine 3.0, not passive.

   - Medicine 3.0 represents an evolution in mindset, not just technology. W...

   - Centenarians delay onset of cancer, cardiovascular disease, diabetes by up to 30 years compared to averages.

   - We can't copy some of their vices, but can learn from their ability to resist chronic diseases for so long.

   - Tactics like nutrition, exercise, sleep can help buil...

   - Film yourself to compare intent to reality. Narrow the gap via focused drills.

   - For the sedentary, exercise can profoundly improve capacity and function - it makes people younger.

   - Stability gives the confidence to enjoy life and not fear falling. It lets us keep doing wh...

   - Autophagy declines with age but can be stimulated by exercise, fasting, rapamycin - improving cellular health.

   - Rapamycin is already approved for humans but side effects have limited its use for longevity. New studies show it may enhance immunity.

   - Dogs are being tested s...

   - Restricting calories extends lifespan in nearly every animal tested, by 15-45%. This points to a link between nutrition and longevity.

   - The drug rapamycin, discovered in soil on Easter Island, also extends lifespan in mice and other animals.

   - Rapamycin acts on the mTOR pr...

   - Strength training is like retirement saving - it builds a "reserve" of muscle and bone to protect us as we age.

   - Muscle strength declines 2-3x faster than mass. Power declines even faster. So heavy weights are key.

   - Bone mineral density and muscle mass decline in parallel...

    -Carb tolerance is highly individualized. CGM helps determine ideal carbohydrate intake.

   - Increase intake of MUFAs like olive oil. Supplement EPA/DHA. Titrate to goal RBC levels.

   - Avoid too much fructose, especially in liquid form.

   - Find a sustainable balance of ...

   - Heart disease is the #1 global killer but need not be - it should rank much lower with the right prevention.

   - Atherosclerosis (The buildup of plaque in the arteries, which leads to heart attacks and strokes. ) begins in youth but progresses slowly before causing events like heart a...

   - We actually know little for certain about nutrition. Most studies are flawed, leading to confusion.

   - Clinical trials have poor compliance over long periods. Results average out individual variation.

   - Healthy user bias skews many studies. Healthy people tend to have health...

   - The first step is believing you can change. Then commit to the ongoing hard work of unpacking trauma, altering self-talk, reframing situations, and replacing knee-jerk reactions with thoughtful responses.

   - Make emotional health as much a priority as physical fitness. This is impera...

   - Alzheimer's disease is the most common form of dementia, affecting over 6 million people in the US. Other neurodegenerative diseases like Lewy body dementia, Parkinson's, ALS, and Huntington's also cause dementia.

   - The origins and causes of Alzheimer's are not fully understood. The...

   - Medicine is transitioning from an era focused on infectious diseases (Medicine 2.0) to one focused on chronic diseases (Medicine 3.0).

   - Medicine 2.0 evolved to treat acute injuries and infections but has made little progress against chronic illnesses like heart disease and cancer.

 - Medicine 3.0 says lower apoB as early and as much as possible. Like smoking, address the root cause regardless of short-term risk.

   - Extremely low LDL-C levels are safe; plaque likely wouldn't occur if everyone had childhood LDL-C levels (10-20 mg/dL).

   - Diet, exercise, and d...

   - Emotional health is a crucial component of overall healthspan and longevity. Unresolved emotional issues can lead to misery, self-destructive behavior, and early death.

   - Dialectical behavior therapy provides useful tools for emotional regulation and building distress tolerance. Min...

   - But screening is limited - we only have good tests for a few common cancers.

   - Medicine 3.0 says use multiple modalities (colonoscopy, mammogram, MRI, etc.) together to improve accuracy.

   - Liquid biopsies to detect tumor DNA in blood could identify cancers earlier and help ...

   - Total burden of apoB (A protein found on LDL) particles (LDL + VLDL) over time determines risk, not total cholesterol or LDL-C (The concentration of cholesterol inside LDL particles) alone.

   - Lp(a) (An especially damaging lipoprotein particle that increases risk of early heart attac...

   - The objective is to extend lifespan and healthspan - to live longer and better.

   - To achieve this requires first developing an effective strategy, not just rushing to tactics. Strategy derives from the objective.

   - The strategy is to understand and address the aging process...

 - The goal is to empower patients to take action to improve their fitness, nutrition, sleep, and emotional health.

   - Our only aim is to live longer and better. We must rewrite the narrative of decline and figure out a personal longevity plan.

   - Medicine 2.0 offers little real guidance on exercise. We must take responsibility for our fitness.

   - Exercise is true "prehab" - physical therapy before we need it. It's the most powerful longevity tool we have.

   - We train not just to be fit now but to armor ourselves again...

   - The key insight is that we should pursue longevity not out of regret for the past, but for the sake of the future - to fulfill dreams and aspirations.

   - True age is not defined by years lived but by whether one's mindset remains fixed on the past versus looking ahead to future hopes...

   - Alzheimer's can be detected in very early stages through comprehensive cognitive testing. Distinguishing it from other neurodegenerative diseases is important for prevention.

   -While daunting, Alzheimer's is not impossible to prevent. We must embrace the concepts of Medicine 3.0 like...

   - Sleep is essential for brain health and function. Lack of sleep impairs cognitive performance, memory, and emotional regulation.

   - Deep, restorative sleep allows the brain to clear out amyloid-beta and tau proteins, which build up in Alzheimer's disease. Good sleep may help prevent ...

   - To sleep better: make the bedroom pitch black and cool, avoid alcohol and food before bed, reduce evening exposure to blue light from screens, exercise earlier in the day, establish a consistent wake-up time, use relaxation techniques.

   - Addressing sleep issues through changes to sl...

   - Feedback and iteration will help us find your ideal eating pattern for metabolic health.

   - We should focus more on major issues like calories and protein than minor food choices.

   - Our genes haven't changed much, but our environment has, creating a mismatch that leads to "diseases of civilization." We must adapt with smart tactics.

   - The 5 key tactical domains are exercise, nutrition, sleep, emotional health, and pharmaceuticals/supplements. We'll focus on the...

   - Stability enables safe, efficient transmission of force through muscles and bones, not joints. It makes us bulletproof.

   - Stability begins with the breath - it affects posture, spine position, and movement.

   - Grounding the feet and toe strength build the foundation. Balance...

Book Summary of "OUTLIVE: The Science & Art of Longevity" by Peter Attia

   - Fructose and uric acid were once beneficial but now promote fat gain and metabolic issues in excess.

   - We evolved to store fat to survive famines. But now calories and fructose are nearly unlimited.

   - Medicine 3.0 would monitor for earliest signs like fatty liver, inflammat...

   - Centenarians live to 100+ often in relatively good health, delaying chronic diseases for decades.

   - This phase shift in time is key - they stay biologically younger than their age. We want to emulate this.

   - Centenarian longevity is partly genetic luck, but behavior likely ...

  - Exercise strongly correlates with longer lifespan and improved healthspan across physical, cognitive, and emotional domains.

   -Higher VO2 max and greater strength are very strongly associated with lower mortality. Exercise acts like an endogenous drug.

   - We must go beyond gen...

   - Tactics flow from the strategy and include exercise, nutrition, sleep, emotional health. Drugs/supplements are also considered.

   - Exercise is the most powerful longevity "drug." Nutrition matters, but calories are key, not any one diet.

   - Sleep and emotional health are crit...

   - Before heavy lifting, assess movement with tests for stability (next chapter). This is most important.

   - The goal is not big biceps now but rather strength to accomplish tasks and prevent injuries later.

   - We train strength now to build reserves for our Centenarian Decathlo...