Outlive asks readers to confront the ticking time bombs in their own bodies

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Last year, Outlive was The Globe and Mail’s top-selling Canadian non-fiction book and the third bestselling non-fiction hardcover in general.

It’s a particularly impressive feat when you consider this is a book that asks its readers to confront their own mortality – the ticking clock of age and the ticking time bomb of what might be unfolding, possibly silently, in their own bodies – and their capacity for absorbing complex medical jargon. Knowing your LDL from your HDL is only the beginning, fellow travellers on the road to immortality (or just not dying prematurely).

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The dangled carrot, of course, is what Peter Attia promises in the subtitle: To teach you the “art and science of longevity,” something this Toronto-born, now Texas-based physician has spent much of his career studying. The pursuit is personal, with its genesis in the sudden deaths of two of his uncles in early midlife from heart attacks, and sparked from vague awareness to action by his own realization in his mid-30s that he might be sleep-walking toward a not dissimilar fate.

His work has given him a perspective on why the search for immortality (or at least a long life) is such perennial catnip to the human species: “I don’t think any of us can really grasp the concept of finitude,” he said. “Everything that happens is in front of us. To the left or right of us. As such, we are simply not equipped to fathom a world in which we don’t exist.”

It’s a logical absurdity, Attia continues, since rationally we know the world existed before we did and will continue after we don’t, but “emotionally this is almost unfathomable for most of us, myself included.”

Where some might scream into the void or stuff down the existential panic with fried foods, Attia chose to channel it into writing a book about what he’s learned and has been implementing in his own life and for patients in his own medical practice, which is exclusively devoted to lengthening life. Spoiler alert: It’s Erasmus’s adage “prevention is better than cure,” but far more proactively – and starting much younger – than the medical establishment usually advises.

Getting this book published, however, was akin to asking a lifelong sweet tooth to give up their daily sugar fix in order to ward off diabetes, one of Attia’s life-limiting “four horsemen.” (The others are cardiovascular disease, Alzheimer’s disease and cancer.)

“This project was really about writing three books. The first version I wrote alone. I thought it was excellent! So technically and scientifically rigorous!” says Attia. “But the publisher said it was far too technical and would not reach a broader audience. They also felt it lacked any sense of story or personal connection.”

Version two entailed bringing on a co-author, the seasoned journalist and editor Bill Gifford, who helped translate the science into layperson-ese and draw out threads of Attia’s own story. (While your eyes might glaze over at the cholesterol marker chat, you almost certainly won’t forget the visceral description of Attia’s first brush with fatty liver disease in a patient who barely drank.) Still, the project stalled when he vacillated over including a chapter about an emotional rock-bottom that came when he was physically at his healthiest, and after four years of work, his publisher dropped him.

But, as with the strategies he offers in Outlive, a glimmer of possibility was on the horizon, in the form of a friend – the founder of talent agency Creative Artists, Michael Ovitz – who read the manuscript and passed it on to Diana Baroni, an executive at publisher Penguin Random House.

“While Bill and I ended up basically rewriting the book over the next two years, we ended up with the best possible version of Outlive,” says Attia, who jokes that the “perfectionism” that can come from being a doctor obsessed with scientific rigour can be a double-edged sword. “It certainly held me to a very high standard in doing the research for the book, a process that never stopped,” he says. “But if you take it too far, you’ll never take your grubby paws off the manuscript!”

It was only when he was recording the audiobook version – something he’d resisted, despite being the host of the popular podcast The Peter Attia Drive – that the seven-year-long slog to publication caught up with him.

“Nothing hit me harder than when I finished reading the epilogue for the audiobook. I really didn’t want to read the audiobook. Correction, I would have rather had daily root canals to avoid it,” he says. “But everyone I trust said I needed to do it and that my podcast listeners deserved it. I also realized that one day my grandkids would be able to hear it, and that made it very special.”

Other emotional milestones on this journey, particularly since the book became an international bestseller, include the daily experience of being stopped on the street by grateful strangers – “I can’t recall the last day that didn’t happen,” says Attia – and the hundreds of notes he’s received from readers.

“The one that really stood out and moved me the most was a note from a 14-year-old girl who read the book and asked if I could send her dad some words of encouragement,” says Attia. “He was going through some very hard times and she felt the message of the book, and in particular the final chapter, could help him.”

He obliged, sending him a signed copy and a video message. “A week later he sent a very moving note with a smiling picture of him and his daughter,” continues Attia. “Stories like this completely abrogate the discomfort of writing the book.”

And for the “new year, new me” contingent who might be reading this? You’ll want to pick up Outlive, of course, but Attia also offers up this advice, gratis: Get a move on.

“The data are unambiguously clear that exercise has a greater impact on both length and quality of life than any other intervention we can dream up,” he says. “And as a corollary to that, being unfit – lacking in muscle mass, strength and cardiorespiratory fitness – has a more negative bearing on your health than smoking, having high blood pressure or type 2 diabetes.”

Long live us all.