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  • Writer's pictureDr Edin Hamzić

⏳ The Long Game: From Fast Death to Slow Death

In this first chapter, the concept of longevity is introduced by Peter Attia. It explains what it is and what it is not. It also introduces two types of death (obviously simplified), as the title explains: “fast death” and “slow death”.


Slow Death & Fast Death

In short, examples of fast causes of death (simplified: "fast death") are violence, accidents, injuries, and other similar types of causes, as well as some other causes that were important throughout history that are not such a big deal for public heath anymore but were fast in their nature of onset, like infectious diseases.


Conversely, slow causes of death (simplified: "slow death") generally take time to develop. Diseases that cause slow death, according to Attia, take time to develop and are developing "under the hood" before the first clinical symptoms become apparent. Here, Attia mentions heart diseases, cancer, diabetes, and other metabolic diseases as well as neurodegenerative diseases.


In this chapter, it is also outlined how modern medicine dealt and still deals very well with cases of “fast death”, but not so well in cases of "slow death" except maybe in managing deaths caused by cardiovascular diseases.


I created Figure 1 just to illustrate how we as humanity are dealing with so-called communicable, maternal, neonatal, and nutritional diseases and injuries in comparison to non-communicable diseases (most of the diseases causing slow death are from this group).


Figure 1 shows the global (worldwide) ranking of death-causing diseases for both sexes and all ages. The left column illustrates the ranking of the top death-causing diseases in 1990 and we can see that among the top 5 diseases, the majority of those were diseases that could be easily fixed by implementing appropriate medical measures and sanitary measures such as respiratory infections, enteric infections and maternal and neonatal deaths.

Fast-forward to 2019, and we see that among the top 5 death-causing diseases only respiratory infections are in position 4 while all others are non-communicable diseases such as cardiovascular, neoplasms, chronic respiratory diseases, diabetes, and others.


global mortality, time change death causing diseases 1990 2019
Figure 1: Global death-causing diseases, 1990 - 2010, both sexes and all ages

To conclude, Figure 1 aims to illustrate what Peter Attia in the book tries to explain how the modern medicine in the last 200 years was very good in dealing with "fast causing death" diseases, but it still struggles with "slow causing death" diseases.


What are the Four Horsemen?


Attia goes on to present how the slow causes of death actually have an early onset in one's life, but it takes time to develop and to become generally clinically visible.

In essence, this slow death happens under the radar, undetected and it takes time to develop.

Four specific diseases or conditions that Attia puts specific attention to and considers extremely important are:

  1. Heart disease

  2. Cancer

  3. Neurodegenerative disease and

  4. Metabolic dysfunctions (with a main focus on Type 2 diabetes)

He actually gives these a special name “Four Horsemen”.


Four Horsemen of the Apocalypse, an 1887 painting by Viktor Vasnetsov. From left to right are Death, Famine, War, and Conquest

He then focuses on explaining how these causes of slow death are the main impediments to acquiring longevity.


Longevity = Healthspan + Lifespan

In this chapter, the concept of longevity is also introduced which does not simply mean adding more years to your life, but also adding more quality in years lived.


In short, it describes longevity as trying to “live longer and live better for longer”.

So, longevity has two main components:

  1. Lifespan refers to how long you live. Simply how many years you add to your life.

  2. Healthspan refers to how well you live, meaning the quality of years lived.


I wrote another article that shortly covers genetics of healthspan, lifespan and longevity with special focus on how to get some insights about these using 23andMe genetic data. You can check it here.


What Is Not Longevity?

Longevity is not about living forever (obviously we all have to die, it is a one-way street) or going living 120 or 150 years, but rather having a longer better-lived life.



In this chapter Attia argues on how basically the philosophy behind the modern medicine is obsolete and it is all about how to stop the patient from dying and how this works well in case of conditions and “fast death" type of diseases and not so good in case of diseases and conditions that are causing “slow death”. He goes on explaining how large amount of resources and effort has been put in applying this approach in case of diseases and conditions causing “slow death”.


Modern medicine is good with managing fast causes of deaths basically fixing bodies, but is doing rather poorly when it comes to slow causes of death like cardiovascular diseases and cancer among others. Peter illustrates how modern medicine did not make extremely large impact when talk about cancer and other slow causing deaths conditions and diseases except for cardiovascular diseases where significant impact was made.


According to Peter, the problem is that modern medicine intervenes too late when we talk about conditions that cause the slow death. The main point of action is prevention. The medicine must be proactive rather than reactive. Changing the mindset actually must be the first step in attacking conditions like diabetes, heart diseases and other slow death causing diseases.


At the very end of this chapter author goes to provide some examples on what can be done to be more proactive:


  • Strategies on how to prevent Four Horsemen

  • How some typically used diagnostics paramteres are not used properly like the usual cholesterol panel

  • Focusing on what Attia calls nutritional biochemistry instead of focusing on diets

  • Understanding importance of protein

  • Importance of exercise. Attia calls exercise the most potent longevity "drug"

  • Importance of emotional health


Finally, author underlines once again that longevity demands a paradigm shift to medicine where one must be proactive toward preventing chronic diseases instead of waiting for them to happen as this is the way to increase healthspan.


Author also underlines how it actually is not actually about being "preventive", but acutally to be proactive in being preventive.


This is in essence what this first chapter of the book is all about according to me :)



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