The Art and Science of Fitness | Demystifying the longevity craze

The philosopher Stephen Cave, in his book Immortality: The Quest to Live Forever and How It Drives Civilization, suggests that there are four “immortality coping strategies” which have driven human civilisations from the very beginning. The first strategy is to try to live forever. The second is to be reborn physically after we die (also seen in the beliefs of Hinduism). The third: our bodies can die but our souls are immortal. And then the fourth is for those who are a bit more realistic but want to live forever, through their legacy, whether through their offspring, work or monuments.

Understanding Peter Attia’s longevity model

The new kid on the “longevity” block, Peter Attia in his book, Outlive: The Science and Art of Longevity, makes some excellent points which I broadly agree with. However, in my view, he falls victim to the pressure to justify his price tag and pushes proactive screenings and medications that, in some cases, do more harm than good.

It is rumoured that he charges his clients $150,000 per annum for mostly basic advice. I have no problem if his clients are ready to shell out that kind of money, but it’s his attitude that gives away what he is after. As much as Attia talks about people’s health spans improving after following his intensive regimens, there is no evidence to prove that they are more beneficial than simply being physically active, focusing on strength training, eating better, resting and recovering well and having better mental health.

If we’ve known all this for ages, why do people pay huge amounts for such common sense? As much as I am cribbing about Attia’s fees, my consultations aren’t cheap by any means, at least in the Indian context. Why would anyone pay me for me to tell them to listen to their body, to put one step in front of another? People who can afford it pay for the privilege of personalised medicine. This can be considered dumb because the insights are not new. But it’s smart because it is optimised to overcome a key trait of the human condition: forgetfulness. Irrespective of the amount, people should create systems for themselves to do the right thing i.e. to focus on fitness, join a group to put more positive peer pressure, put their running shoes next to their bed, use online fitness apps such as Strava, whatever it takes for them to do the right thing.

When asked by Dhruv Khullar in his article in The New Yorker titled ‘How to Die in Good Health’, if his practice would further expand the divide between the rich and the poor, Attia responded, “I’ve never concerned myself with that. I don’t think it’s unimportant, but it’s absolutely not a problem I’m interested in addressing.” Attia defends himself by pointing out that his podcast is free and his book is not very expensive. It reminds me of my entrepreneur friends who keep going on and on about the target audience. It simply can’t be everyone. Attia has clearly got this figured out.

Attia calls modern medicine “Medicine 2.0,” where the focus is on treatment and is passive. According to Attia, Medicine 1.0 was practised during the time of the Greek scholar Hippocrates, where diagnosis and treatment were based on observation, anecdotes and guesswork. Back then, science wasn’t as evolved, but different parts of life were connected a lot better than today. Look at Ayurveda or any other traditional medicine, the onus was on the patient to play a far more proactive role than western medicine. Exercise, breath, food, laughter, air, loving care, and society were integral to treatment.

Attia brands his approach as “Medicine 3.0”, which would proactively intervene to delay the onset of the four main reasons for chronic diseases in today’s world, i.e. cardiovascular diseases, cancer, neurodegenerative diseases (Alzheimer’s and Dementia) and metabolic diseases. This would further lengthen lifespan (quantity of life) and improve healthspan (quality of life).

In the interview, Attia recounts that while filming an episode of the longevity docuseries Limitless, Chris Hemsworth (the chap who plays Thor in Marvel movies), learned from Attia that he has a gene associated with a roughly eight-hundred-per-cent increase in Alzheimer’s risk. Afterwards, Hemsworth took time off from acting. This tempts me to get screening done for death. One thing I have learnt in life and medical practice is that fear of pain, disease or death is far worse than the actual self itself.

When it suits any of these longevity crusaders, they use evidence-based medicine to their advantage, and at other times totally ignore it. For example, Attia takes Rapamycin, a drug that affects the immune system and is normally used by organ-transplant patients; the drug has seemed to lengthen the lives of laboratory animals. However, animal experiments are unreliable indicators of how drugs work in humans, and rapamycin is not endorsed by the US Food and Drug Administration as a longevity medicine. It’s alright if he does it, but it’s different if his followers are encouraged to do the same too.

Longevity in the ancient age

Entrepreneurs in the longevity space worldwide want us to believe that living until a very old age is a new phenomenon, but it is not. Methuselah, a name synonymous with longevity, is a figure in Judaism, Christianity, and Islam. Methuselah supposedly lived up to 969 years of age.

Not to be left behind, according to the Hindu scriptures there are seven immortals, also known as the Chiranjeevis: Ashwatthama, Mahabali, Ved Vyasa, Hanumana, Vibhishana, Kripacharya and Parshurama. They are believed to be still walking the planet Earth, fighting against evil until the end of the current age known as the Kali Yuga.

I think that we all believe that we are “immortal till we die”, i.e. we live our lives in denial. The knowledge about death has to be passed on from one generation to another, which is done through complex language that humans have evolved to communicate with each other.

Anurag Mishra, a psychiatrist, psychoanalyst and founder of the Livonics Institute of Integrated Learning and Research, has a different point of view. He questions if we humans really are as smart and special as we think. “There are degrees of awareness. Most of the time humans are not emotionally aware of their own or other’s mortality. Animals live out their life cycles with a degree of awareness. They play, compete, migrate to different parts of the world in different seasons and mate and die. So, I believe they are aware of their mortality and sometimes they are aware of human mortality as well.”

The spectre of mortality: Lessons from 9/11

One evening in September of 2001, while I was working in the department of holistic medicine at a major hospital in Delhi, suddenly a colleague barged in yelling, “Turn on the television, now”. The same shocking scene was being played on a loop on all the channels – a passenger aeroplane crashing into one of the two tall buildings. In a few minutes, there was live coverage of the other tall building being hit by another aeroplane. The Twin Towers had come crashing down.

This one incident sent shivers down the spine of not only the Americans but the whole of humanity. This wasn’t the first time that everyone around the world felt extremely vulnerable and this wasn’t going to be the last. In 1912, the unsinkable Titanic sank on its very first voyage, and in 2020 came Covid-19, which at that time seemed to be an apocalypse for humanity, bringing us all to our knees. We all think that whatever we do is the be-all and end-all of everything in this life. Forget about missing out on the bigger picture, we don’t even acknowledge the perspectives of others around us.

Such incidents remind us that we are mere mortals, no matter how much we stay in denial about our deaths. Rather than fighting death, and trying to make it longer, we need to follow what Blaise Pascal, the inventor of the mechanical calculator, said: “Don’t try to add more years to your life. Better add more life to your years.”

So, rather than talking about fancy treatments of celebrity doctors, such as drugs only cleared for animals but not humans, blood transfusions and constant monitoring, what we need is to get people to be physically active, improving their mental health, their eating and sleeping habits. And this can never happen if we think about an individual in isolation, after all, we are social animals. With the same effort, time and money, you can either have a sharpshooter approach, that’ll change the world for a handful, with a good chance of even missing the target, as compared to a shotgun approach, which will almost definitely get each of the low hanging fruits, drastically changing their lives for good.

Attia and I aren’t very different: we know about the importance of physical activity, how important it is to set goals, and how you are more likely to follow those goals once committed to publicly. In The New Yorker article, Attia talks about his plans to trek the treacherous eighty kilometres through the night from Utah Beach, in Normandy, to Omaha Beach, in less than twenty-four hours in June this year. My target for this year is a near-impossible goal. My best official time for a half marathon is 1 hour 18 minutes, a personal record I set in 1993, a mere 31 years ago. This year, in defiance of my advanced age, I plan on beating it.

Furthermore, I plan on getting inactive people to reach ‘marathon’ (have a marathon in inverted commas because marathon by definition is 42.195 kms) targets of 5km, 10km, 21km or even 42 km over the next nine months. The physical achievements and physical benefits are a good by-product, but the main objective is to make people believe in themselves and to do something that they have thought was impossible.

You shouldn’t waste too much time thinking. After all, you have but one life, at least that we know of. Everyone is different. We all need to chart our own course. And in the end, we will all die. But let’s live before that.

Dr Rajat Chauhan (drrajatchauhan.com) is the author of The Pain Handbook: A non-surgical way to managing back, neck and knee pain; MoveMint Medicine: Your Journey to Peak Health and La Ultra: cOuch to 5, 11 & 22 kms in 100 days

He writes a weekly column, exclusively for HT Premium readers, that breaks down the science of movement and exercise.

The views expressed are personal