The two books reviewed below fall under the theme of longevity and aging well. The first book presents a broad argument for transforming how medicine is practiced by focusing on preventing the development of chronic disease rather than treating chronic disease when it occurs. The second book offers a practical guide to maintaining mobility with age, which is associated with improved health in old age. As always, the purpose of these reviews is not to provide direct medical advice. The opinions of the authors do not necessarily reflect the opinion of Dr. Harmon and/or Harmon Facial Plastic Surgery. Instead, we have found that these books ask interesting questions and are also entertaining.
Book Reviews: The Centenarian Decathlon
Dr. Jeffrey Harmon
Outlive: The Science and Art of Longevity by Peter Attia MD
Dr. Peter Attia arrived at his current career as a clinician, author, and podcast host circuitously, leaving general surgery residency at Johns Hopkins University to work in consulting then returning to medicine years later. He is a fitness fanatic with a love for boxing and Formula 1 (F1) racing – Dr. Harmon never truly appreciated the athleticism required to drive F1 cars until he read this book – which is reflected in the pages of this book. His clinical practice model reflects his belief that medicine as it is currently practiced does not adequately address the core causes of poor health in our later years. Dr. Attia intervenes intensely with his patients as early as possible to maximize their healthy functionality for as long as possible. He calls this disease prevention model Medicine 3.0. He contrasts this with Medicine 2.0, which he argues was developed approximately one hundred years ago to treat infectious diseases as well as chronic diseases after they have developed.
The book explains the purpose and goals of Medicine 3.0, discusses the causes of heart disease, cancer, and neurodegenerative diseases such as Alzheimer’s, and proposes solutions to reduce our risk of such diseases.
Dr. Attia advocates for more extensive testing for cholesterol abnormalities and problems with glucose management as well as more aggressive treatment of these conditions. He feels that, by the time lab values demonstrate there is a problem with cholesterol and/or glucose management according to current guidelines it is already too late to adequately treat and prevent future complications, which can include not only heart disease but also cancer and neurodegenerative diseases. He feels that an intensive exercise regimen and a focus on building muscle mass as well as maximizing an individual’s oxygen use capacity (i.e., VO2 Max) are key to the prevention of chronic disease. He also feels that a finely measured, data-driven, individually optimized diet is also important focused on minimizing glucose spikes with meals.
He also advocates for earlier screening for cancer (e.g., colon, breast) than current guidelines recommend. He argues that survival rates for cancer are so much higher when caught early that the cost of earlier screening is justified. Dr. Attia’s arguments inspired Dr. Harmon to have a conversation with his primary care physician about advancing his screenings. It remains to be seen whether and when the medical subspecialty governing bodies and insurers will adopt new screening guidelines in the future.
The most important insight from the above sections of the book is the extent to which vascular disease as caused by high cholesterol, persistently elevated blood glucose, and high blood pressure contribute to the development of heart disease, cancer, and neurodegenerative diseases. For example, the relationship between vascular disease and neurodegenerative diseases such as Alzheimer’s Disease is gaining increasing attention in the medical literature.
Two of the most unique and valuable chapters in the book discuss the importance of sleep and maintaining good emotional health. These two areas are the most personal for Dr. Attia, and he highlights significant stories from his own life that illustrate the importance of getting good quality sleep as well as addressing problems with emotional health. Dr. Harmon agrees wholeheartedly with the importance of both and hopes patients understand the importance of emotional self-care in addition to physical self-care.
Overall, the book is a powerful argument for setting a goal of not only a long life but a healthy, functional and, therefore, fulfilling life. Dr. Attia deviates infrequently into areas that are more controversial. For example, he places patients on the immunosuppressive agent tacrolimus – a medication commonly used in patients who have undergone an organ transplant – due to his review of data that he feels makes a strong argument that it can increase our functional lifespan. This is not something most physicians would recommend. And while there are many well-argued and potentially transformative solutions to disease prevention in this book, many are dependent on involved and expensive testing and technological solutions (e.g., constant blood glucose monitor, VO2 Max testing) that are not intuitive to most people and, therefore, unlike to be adopted by most without the intense engagement of a primary care provider.
Built to Move: The 10 Essential Habits to Help You Move Freely and Live Fully by Kelly Starrett and Juliet Starrett
Built to Move, a spiritual cousin to the previously reviewed book The Blue Zones by Dan Buettner, also complements the arguments made in Outlive. In fact, the authors of Built to Move reference Dr. Peter Attia’s concept of a “Centenarian Decathlon” when discussing their primary thesis, which is that maintaining the ability to move fluidly in many positions is a core physical goal and predictive of maintaining good functional health in old age. For his part, Dr. Attia also includes a chapter in his book arguing for maintaining good mobility with age to prevent injury.
Dr. Harmon had become interested in the above thesis prior to reading Built to Move, as will be exhibited by a blog post he is currently working on with a physical therapist on ergonomics in facial plastic surgery. His interest originates from one of the most difficult choices he has made, which was to stop rowing in college. He was a nationally competitive rower in high school and was recruited to row lightweight crew at Cornell University. Rowing is one of Dr. Harmon’s great passions, which is why it was so difficult for him to gradually lose that passion over time as the toll of the required weight loss and the need to work so hard to prepare for the MCAT and medical school weighed on him. He also noticed teammates struggling with chronic back pain, often taking long breaks from the team, never fully recovering prior to their return. And while Dr. Harmon did not injure his back, he had a sense that he was highly likely to if he continued. Somewhat strangely for someone his age, his primary concern was whether he would be able to hold his grandchildren in the future, an ability which is highly correlated with functional health in old age.
The authors of Built to Move, Kelly and Juliet Starrett, list ten “Vital Signs” that are indicative of abilities that are predictive of good functional health. They recommend exercises to promote optimal performance with each sign. The Vital Signs include:
1. Getting up and down off the floor – Highly predictive of mortality in old age, the authors recommend sitting on the floor more often with the hips extended in order to encourage standing up from sitting.
2. Breathing – The authors recommend slow, diaphragmatic breathing through the nose.
3. Extending your hips – See Vital Sign 1.
4. Walking – The authors advise taking 10,000 steps per day.
5. Future-Proofing your neck and shoulders.
6. Diet – The authors recommend 800 g of fruit and vegetables per day as well as a weight-based approach to determining the appropriate amount of protein intake per day.
7. Squatting.
8. Balance.
9. Movement-Rich Environment.
10. Sleep – The authors recommend 7 to 9 hours of consistent sleep each night.
The prescribed exercises are intended to anchor the regular cardiovascular and strength training multiple governing bodies recommend we get each week. The exercises are easy to perform at home with off-the-shelf or inexpensive products like PVC pipes and foam rollers. The authors also advise testing yourself to gauge your improvement and set goals. Their arguments appear sound – though Dr. Harmon is not a physical therapist and cannot speak professionally about specifics – and the prescriptions are easy-to-understand and implement. It is for that reason that this is one of the most practical books Dr. Harmon has ever read. Dr. Harmon has a deep respect for adequate, restorative sleep as well as a well-balanced diet rich in micronutrients and with adequate protein – see the previous post on diet and facial plastic surgery for the perspective on diet of a registered dietician. The exercises recommended in Built to Move may help Dr. Harmon maintain the high surgical standards he holds himself to for many years while also allowing him the functional capacity to enjoy playing with future grandchildren.
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It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about your face or neck.
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This blog post is for educational purposes only and does not constitute direct medical advice. It is essential that you have a consultation with a qualified medical provider prior to considering any treatment. This will allow you the opportunity to discuss any potential benefits, risks, and alternatives to the treatment.