1: Imagine we go to the doctor. We are tested for Type 2 diabetes.

Suppose our hemoglobin A1c test result is 6.5 percent or higher. In that case, we will receive “extensive treatment, including drugs that help the body produce more insulin, drugs that reduce the amount of glucose the body produces, and eventually, the hormone insulin itself, to ram glucose into their highly insulin-resistant tissues,” Peter Attia writes in his book Outlive.

What if the test results come back at 6.4 percent?

We don’t have type 2 diabetes at all. 

Instead, we are diagnosed with prediabetes, “where the standard-of-care guidelines recommend mild amounts of exercise, vaguely defined dietary changes, possible, use of a glucose control medication called metformin, and ‘annual monitoring’– basically, to wait and see if the patient actually develops diabetes before treating it as an urgent problem.”

2: Peter believes we’ve got it all wrong. 

“Type 2 diabetes is merely the last stop on the line,” he notes. “The time to intervene is well before the patient gets anywhere near that zone; even prediabetes is very late in the game.”

Modern medicine treats diabetes “like a cold or a broken bone,” he notes, “where we either have it or we don’t.” 

Intervention only happens at the point of diagnosis.

Why is this okay?

“I believe that our goal should be to act as early as possible, to try to prevent people from developing type 2 diabetes,” Peter writes. “We should be proactive instead of reactive in our approach.”

Yesterday, we looked at the differences between fast death and slow death. For most of human history, most people died from “fast” causes: accidents, injuries, and infectious diseases of various kinds.

In today’s world, slow death dominates. “The odds are overwhelming that we will die as a result of one of the chronic diseases of aging,” which Peter refers to as “the Four Horsemen: heart disease, cancer, neurodegenerative disease, or type 2 diabetes and related metabolic dysfunction.” 

3: Fighting fast death is very different from fighting slow death. 

Unfortunately, “modern medicine does not really have a handle on when and how to treat the chronic diseases of aging that will likely kill most of us,” Peter writes.

The answer is to start much, much earlier. 

“Medicine’s biggest failing is in attempting to treat all these conditions at the wrong end of the timescale—after they are entrenched—rather than before they take root. As a result, we ignore important warning signs and miss opportunities to intervene at a point where we still have a chance to beat back these diseases, improve health, and potentially extend lifespan.”

Each of the four horsemen is “intricately complex, more of a disease process than an acute illness like a common cold,” Peter observes. “The surprise is that this is actually good news for us, in a way. Each one of the Horsemen is cumulative, the product of multiple risk factors adding up and compounding over time.”

The really good news?

“Many of these same individual risk factors, it turns out,” Peter notes, “are relatively easy to reduce or even eliminate.”

More tomorrow.


Reflection: Of the people I know who have died, how many died from fast death vs. slow death? For those who died of causes related to slow death, how effective was the treatment they received? Did the treatment substantially add years to their lives?

Action: Discuss with a friend or colleague.

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