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Lifestyle interventions to increase longevity

121 Post author: RomeoStevens 28 February 2014 06:28AM

There is a lot of bad science and controversy in the realm of how to have a healthy lifestyle. Every week we are bombarded with new studies conflicting older studies telling us X is good or Y is bad. Eventually we reach our psychological limit, throw up our hands, and give up. I used to do this a lot. I knew exercise was good, I knew flossing was good, and I wanted to eat better. But I never acted on any of that knowledge. I would feel guilty when I thought about this stuff and go back to what I was doing. Unsurprisingly, this didn't really cause me to make any positive lifestyle changes.

Instead of vaguely guilt-tripping you with potentially unreliable science news, this post aims to provide an overview of lifestyle interventions that have very strong evidence behind them and concrete ways to implement them.

A quick FAQ before we get started

Why should I care about longevity-promoting habits at a young age?

First, many longevity-promoting lifestyle changes will increase your quality of life in the short term. In doing this research, I found a few interventions that had shockingly large impacts on my subjective day-to-day wellness. Second, the choices you make have larger downstream effects the earlier you get started. Trying to undo years of damage and ingrained habits at an advanced age really isn’t a position you want to find yourself in. Third, extending your life matters more the more you believe in the proximity of transformative tech. If the pace of technological improvement is increasing, then adding a decade to your life may in fact be the decade that counts. Missing out on life extension tech by a few years would really suck.

Isn’t longevity mostly just genetics?

That's what I believed for a long time, but a quick trip to wikipedia tells us that only 20-30% of the variance in longevity is heritable.

What sort of benefits can I expect?

The life satisfaction of people who remain independent and active actually increases significantly with age. Mental and physical performance are strongly correlated, meaning maintaining your body will help maintain your mind. The qualitative benefits for life satisfaction of many of these interventions can be so dramatic that it is hard to estimate them. The gulf in quality of life between people maintaining good habits and those who do not widens with age.

How were these recommendations generated?/Why should I believe you?

This post summarizes studies at the intersection of having large effects, large sample sizes, and being well-designed in terms of methodology. The cutoff for an intervention being “worth it” is somewhat subjective given that there is often only a rough estimate of the overall effect sizes of various interventions in comparison to one another. CDC mortality statistics were used to determine the most likely causes of death in various age brackets. The list of things that kill people balloons significantly as you get towards the less common causes of death and I have limited research time. Individuals who face unusual health circumstances should of course be doing their own research and consulting health professionals.

This brings me to my disclaimer:

This post is not intended to diagnose, treat, cure, or prevent any disease. No claim or opinion on these pages is intended to be, nor should be construed as medical advice. Please consult with a healthcare professional before starting any diet or exercise program. None of these claims have been evaluated by the Food and Drug Administration. Suggestions herein are intended for normal healthy adults and should not be used if you are under the age of 18 or have any known medical condition.

Alright, let’s dive in.

 

Things that will eventually kill you

CVD

At the top of our list is cardiovascular disease, or CVD, causing the plurality of all deaths by far. We will break down the controllable components of CVD in terms of lifestyle interventions.

Smoking

This doesn’t need much of an explanation. Responsible for the majority of lung cancers, respiratory diseases, and a huge contributing factor to CVD. Buying an e-cig for yourself or people you know who smoke are possibly the single cheapest intervention for adding years to life. E-cigs have very high success rates in getting people to quit smoking and are absurdly cheap. You can spend under $10 and add 14 years to someone’s life. I buy them just to give away. Recommended products: 12.

Alcohol

Some controversy over possible benefits of small amounts, but large amounts definitely bad. Avoiding alcoholism is a whole subject I won’t tackle here.

Blood Pressure

Second to tobacco in effect size. Blood pressure is one of the things most people ignore. It is extremely cheap and easy to start monitoring your blood pressure, and there are things you can do if you find it to be high. You want your blood pressure to be about 120/70. If you are higher than this there are some simple things you can do. The first is to exercise and eat fish every week, especially salmon. There are also a few supplements that have been found to be helpful.

A quick note about my criteria for inclusion for supplements: I am extremely dubious as to the benefit of most supplements. Study after study shows that most of them are a waste of time and money. The fish example given above is a good illustration. You might ask why you can’t just take fish oil pills. Well it turns out that fish oil pills suck, and you’d need to take approximately 9 times as much to have the same effect as eating fish, at which point they’d have dangerous blood thinning effects. So when I recommend a supplement it has to meet a pretty stringent list of requirements.

1. Large effect seen in multiple randomized controlled trials.

2. Therapeutic dose is a tiny fraction of the toxic dose, or no toxic dose able to be identified because it is so high.

3. Side effects comparable to placebo.

4. Dose size is commensurate with an amount it would be reasonable to ingest in natural form.

So basically I weight any downside risk very heavily given the spotty track record of the general reference class of supplements.

So what passes these criteria for blood pressure?

1. CoQ10, large effect size in multiple studies

http://www.ncbi.nlm.nih.gov/pubmed/14695924

2. Flavonoids/anthocyanins, these compounds are present in things like dark chocolate, fruits, and teas.

http://ajcn.nutrition.org/content/88/1/38.short

3. Garlic

http://www.biomedcentral.com/1471-2261/8/13/

I have personally had success lowering my blood pressure from the 140’s to the 120’s with these supplements keeping my exercise levels constant.

Blood lipids (cholesterol)

Here the conventional recommendations appear to be wrong, or at least somewhat misguided. First, some theory. Blood lipids are composed of a variety of substances, but for our purposes we will stick to the ones tested for in blood panels and how to interpret these numbers. A typical blood panel will report LDL, HDL, and Triglycerides. The simple story of “high LDL bad” does not accurately reflect risk of CVD. The most powerful predictor of CVD in terms of blood lipids is the Triglycerides to HDL ratio.[1][2][3][4][5] The higher the triglycerides and the lower the HDL, the greater the risk. This relationship holds independent of LDL levels, which are usually the focus of cholesterol discussions with health practitioners. As it turns out, there are actually two types of LDL, and distinguishing between them is something not usually performed on a blood test. The reason for the prolonged confusion arises from the correlation between a poor HDL:Triglyceride ratio and prevalence of the unhealthy type of LDL. As a result, potent cholesterol lowering drugs are over prescribed. For people with a healthy ratio of triglycerides:HDL, a total cholesterol between 200-220 (traditionally considered “high”) is actually  correlated with lower mortality,[6] and aggressive lowering with drugs resulted in worse health outcomes. This is not to say that statins (cholesterol lowering drugs) are not useful. On the contrary they seem to be highly helpful for patients recovering from a cardiovascular event, but they have shown no benefit for people with no history of problems.[7] Statins have serious side effects[8] and should not be taken lightly. Be skeptical.[9]

So how does one go about lowering their triglycerides and raising their HDL? Again, exercise and eating fish are awesome here. Excessive fructose intake raises triglycerides, and this relationship is worsened by high BMI. Fiber and resistant starch from fruits, vegetables, and tubers has a positive effect. Intermittent fasting has also shown promising effects here.

BMI/Obesity

There are some controversies here I don’t really want to get into the details of as it is a complex subject. I do want to mention that health interventions should not have an excessive focus on whether one is losing weight. Many of the interventions discussed here have significant effects (for example on insulin sensitivity, c-reactive protein, and fasting blood glucose) even when body composition does not change. Getting BMI below ~27 should be a priority however, as it has wide ranging effects across all other interventions.

Nutrition

This is a big subject, and we’re not even going to attempt to go into detail. This section will focus on the largest high level features of a diet that have positive or negative impact. Processed meat consumption has the single largest negative effect on health. It is shockingly bad, even if you already suspected as such.[1] In contrast, a bit of red meat has actually been found to be neutral. It seems to be that many earlier studies claiming harm from red meat did not adequately separate out the huge effect size of processed meat. Fish and nut consumption appear to be a grand slam for CVD in particular and also just for overall health.[2][3] Pescetarians live significantly longer than vegans,[4] lending support to fish consumption. Outside of specific foods, common micronutrient deficiencies have been indicated in everything from cancer, to immune system suppression, to poorer physical and mental performance, to sleep problems, greater inflammation, and even depression. Really there’s too much material there to cover, there are just pages and pages of studies.

There’s also the bad news that multivitamins mostly don’t do anything. There has not been found an alternative to eating a variety of nutrient-dense whole foods. Though vitamin D supplementation appears to be quite beneficial. Another LW user, John_Maxwell_IV, and I are trying to make this easy with our startup MealSquares.

Blood donation

The studies related to this have some methodological issues but overall the effect size is so large, and the cost and risks so low, that it is worth inclusion. Several studies have indicated that, for men, regular blood donation results in a massive reduction in heart attack.[1][2][3] Other studies have found no such relation.[4] There are also additional health benefits to blood donation.[5] These are just some of the studies on this subject, but on balance after reviewing the evidence, I can say that donating blood once a year is almost certainly worth it if you're a man.  Donating too often is probably bad for you though.

Exercise

This topic is large enough that I am separating out my actual recommendations into another post and purely discussing the health benefits here. Exercise is probably the single most important lifestyle intervention. Even minimal amounts of exercise have very large impacts on longevity and health. We’re talking even walking 15 minutes a day causing people to live longer. Even ignoring quality of life you are looking at a 3-7 fold return on every minute you spend exercising in extended life,[1] perhaps even exceeding that if you are making optimal use of your time. Exercise has a positive impact on pretty much everything that contributes to mortality. I don’t really know how to convince you, the reader, that the future actually exists and that future you will be incredibly angry or sad that you didn’t put in a small effort now for a better life later. But everyone has already told you this your whole life. So I’m going to contrast it with the inverse. Most of the activities that we associate with fun and leisure involve some aspect of physicality, even if it’s just walking around with friends. Losing access to these activities as can and does happen to people represents a massive decrease in quality of life. If you are reading this and you are young, you are able to simultaneously ignore your body’s need for exercise, and demand performance of it when necessary to enjoy yourself. This will not remain true forever. Exercise has a protective effect against exactly the sorts of degenerative injuries that deprive people of their freedom of movement and activity.[2] I don’t care if you start with an exercise habit of one pushup a week, but you must do something.

Let’s move on to some relevant considerations assuming you want to exercise. What sort of exercise should I be doing? Several studies have indicated that endurance athletes enjoy the greatest improvements in longevity. I would agree with this but caution that often the groups in such studies with the best health outcomes are those that do engage in resistance training as well. Soccer and other team sport players, for example, often perform resistance training as part of their overall conditioning. This seems to be overlooked because they do not perform it at the same level of intensity as athletes in the power sports. Long distance skiers and bikers also generally train lower body strength moves at an impressive level compared to the general public, even if it is a level significantly below that of power athletes (e.g. here is an example of a training regime for a competitive skier). My point is simply that you shouldn’t read a study that says “endurance athletes live longer” and assume that all you need to do is run. Strength training also has significant effects on insulin resistance, resting metabolic rate, glucose metabolism, blood pressure, hormone balance, joint health, organ reserve, depression, increases in HDL, reduction in back injuries, sleep quality, and a variety of harder-to-quantify quality of life improvements.[4][5][6][7][8] I go to the trouble to cite resistance training so heavily because I feel that the benefits of cardio are generally well-understood, but I regularly encounter the idea that resistance training is only for people who want to look like a gross bodybuilder.

Hopefully I have established that one should do both endurance and resistance training. Program specifics will be included in the other post as well as info on when benefits taper off.

Edit: Exercise post is up here.

Stress

Stress affects almost every system in your body. It increases disease risk by acting as an immunosuppressant. It directly impacts blood pressure, sleep problems, skin conditions, anxiety, depression, and even heart problems. Chronic untreated stress is often considered a causal factor in many other ailments people are medically treated for. Stress often goes untreated because alleviating it is seen as low priority. Whatever we are doing right now is worth a little stress. This can be true, but over a longer time horizon failing to learn better ways of managing stress really harms us. To confront stressors you must confront ugh fields. Non-productive coping mechanisms are the norm here: procrastination, abuse of substances including food, sleeping too much, blame as a curiosity-stopper etc. Simple strategies for dealing with low level stressors include things such as meditation, gratitude journaling, reflecting on and updating goals, or even just paying other people to deal with a recurring source of stress. Two previous LW posts have excellent advice in this area: How to Be Happy and Be Happier.

If you are depressed and don't know where to start on getting help please take a look at Things that sometimes help if you're depresed.

Supplements that impact stress include

1. Rhodiola Rosea: http://www.sciencedirect.com/science/article/pii/S0944711310002680

2. Ashwaghanda root, which shows promise for chronic anxiety: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3573577/

Sleep

Chronic insomnia is a massive source of stress for many people and poses a huge mortality risk. In one study, people who got chronically less sleep had 3 times the mortality risk as people who slept well![1] You cannot afford to not start optimizing your sleep. It is important that your sleeping place be a quiet, dark, cool environment. You can use simple methods to improve each of these parameters. Forehead cooling has shown great promise in clinical trials.[2] You can accomplish this with a gel pack that is cool (not ice). Even small LED lights in your room impact sleep quality because the melatonin production system is very fragile and sensitive to light.[3] Get tape and cover lights. Try orange glasses to prevent blue light from destroying your endogenous melatonin production after 10pm. Regularize your sleeping and eating schedules. Expose yourself to bright lights in the morning to calibrate your circadian rhythms. Afternoon/early evening exercise is beneficial in making you sleepy. Melatonin pills work for many, but make sure you start with 75mcg (cut these into fourths), rather than the 3mg most pills come in. A teaspoon of raw honey before bed helps prevent some people from waking multiple times throughout the night.

Consider reading this excellent info from Yvain on sleep apnea, especially if you snore excessively or feel very tired even after a full night's sleep.

Cancer

Almost all of the risk factors for cancer have some overlap with CVD, meaning most of the advice above works for cancer too, but there are a few additional considerations worth discussing.

Cancer and UV exposure

One of the surprising results of my research was that conventional wisdom appears to be wrong here. There is not a simple relationship between UV exposure and increased cancers. Specifically, while increased sunlight exposure is correlated with higher incidence of skin cancer, it appears that it is also correlated with a decreased risk of 5 other cancers that are far less survivable.[1] This is a straightforward trade off, getting sun exposure wins by quite a lot. Shade your face to avoid photodamage to your skin and macular degeneration of your eyes.

Breast cancer and testicular cancer

Redacted, see Vaniver's comment here.

Floss

No, seriously. Not flossing is way more lethal than you think.[1] You should also see a dentist regularly, even if you have to pay for your own insurance. (It's surprisingly cheap, e.g. Delta Dental offers plans for under $100/yr; lots of people don't make use of their plan and subsidize the treatment of those who do use theirs). Losing teeth greatly increases your chances of infections over time.


Things that will kill you right now

Avoidable medical errors

Avoidable medical errors might be the second leading cause of death after CVD.[1] This makes a hospital visit possibly the most dangerous thing you can do, especially if you are young. In general, you should not assume that medical staff are competent. Triple check dangerous prescriptions. If you don’t know whether a prescription is dangerous, assume it is. Ask medical staff if they’ve washed their hands (yes, this is actually still a major problem). Sharpie on yourself which side of your body a surgery is supposed to happen on, along with your name and what the surgery is for (seriously). Keep your own records, especially if you have serious medical issues; error rates in medical documentation are ridiculous. Medical equipment is generally cleaned by custodial staff with no medical training who often don't know how a particular device works. Have someone you can call in an emergency who knows about all of this.

While we're discussing medicine, I'll throw in a couple low cost recommendations that give me peace of mind, even if an emergency situation is unlikely. The first is that the Red Cross has created an android/iphone app covering first aid with extensive pictures and videos helping you through the situation. The second is quickclot which can stop severe bleeding much faster than traditional techniques.

Unintentional poisoning

This is mostly acetaminophen poisoning resulting from their mandatory inclusion in pain killers to prevent abuse. Also people misdosing themselves with legal and illegal drugs. Be careful, this outweighs traffic accidents in accidental deaths. Adding the 24 hour emergency poison control line number (1-800-222-1222) to your phone is something you can do right now. It is also worth knowing that SOP for acetaminophen poisoning is high dose NAC, which is freely available on amazon in the US (h/t Tara).

Traffic accidents

Michael Curzi has a great post on this I won’t attempt to reproduce here: How to avoid dying in a car crash. It is definitely worth updating your model of what behaviors are dangerous in a car.

 

Summary of interventions

  1. If you know people who smoke, getting them to vape is the single largest impact you can have on their lifespan.

  2. Pay attention when in your car.

  3. CONSTANT VIGILANCE when dealing with the medical profession and drugs.

  4. Exercise: very high return on first few units of effort, some cardio and some resistance training is best.

  5. Blood donation every 12-24 months for men.

  6. Buy a blood pressure monitor and do blood pressure reduction interventions if needed.

  7. Eat fish, nuts, eggs, fruit, dark chocolate. Supplement Vitamin D3.

  8. Work towards a healthy weight.

  9. If you are losing sleep/are stressed, try one small intervention at a time, and don’t get discouraged.  These interventions are the hardest but potentially the most rewarding. Supplements for stress, anxiety, and sleep are somewhat subjective and vary more in reported efficacy than others; self-experimentation is recommended.

  10. Floss (and see a dentist).

 

Closing

Don’t worry too much. Don’t get down on yourself about health.  This creates an ugh field making you less likely to take action.  The process of becoming healthier is going to make you feel stupid sometimes. This is a marathon and not a sprint; standard habit forming rules apply. Trying to fix 10 things at once is highly stressful! Do not do this! Discuss things that worked for you and didn’t work for you in the past with yourself and with others and come up with a plan. Don’t publicly commit to your plan in the comments, this makes you less likely to do it. Oh, and feel free to argue with me or request more sources.

 

Comments (376)

Comment author: ChristianKl 05 February 2015 12:40:22AM 1 point [-]

How good is the case for eating garlic when one looks at more than just blood pressure?

Comment author: RomeoStevens 05 February 2015 06:01:52AM 0 points [-]

Not sure. It also might help with blood lipid profile: http://www.ncbi.nlm.nih.gov/pubmed/22234974

no other effects that I'm aware of (of sufficient size).

Comment author: michael_b 03 February 2015 06:03:05PM *  2 points [-]

Why should we listen to you and not, say, the Harvard School of Public Health ?

That is, why do you think you did a better job of reading and interpreting the literature and publishing guidelines?

Comment author: RomeoStevens 04 February 2015 11:18:26PM *  2 points [-]

I am having a hard time finding places I disagree significantly with them. Are you referring to sodium? Here is their article on the salt controversy: http://www.hsph.harvard.edu/nutritionsource/the-new-salt-controversy/

"pointing out that the committee’s conclusions discounted effects of sodium reduction on blood pressure."

“Discounting the especially large blood pressure reduction going from 2,300 to 1,500 mg in prehypertensives, hypertensives, older adults and blacks who are especially vulnerable to the effects of high sodium betrays an unbalanced weighing of the evidence.”

-Dr. Frank Sacks

There are a couple problems with this critique.

  1. It does not seem to me after reading the IoM report that they are discounting BP effects. They are explicitly noting that the BP reducing effects are not resulting in the expected mortality reduction if salt had no positive health effects. BP is a proxy measure for CVD and mortality risk. We shouldn't stick religiously to the proxy if we can gain access to the actual underlying thing we care about.

  2. the "especially large reduction" comment seems inappropriate given that the IoM was NOT asked to establish sodium guidelines for people who display an especially high sodium sensitivity or have medical conditions but for the general populace. It also seems to be disregarding the fact that extreme sodium reduction has resulted in higher hospitalizations even in these "at risk" groups. I agree there is ambiguity about where in the 2g-4g consumption level is ideal. I also agree that the recommendation for certain sub-populations might be different. But the evidence of <2g=harm seems pretty solid. This evidence is not exclusively from mortality statistics as Dr. Sacks implies but also from hospitalizations as mentioned.

I have not been able to figure out why the low sodium is being pushed so aggressively. Much of the language used (in that article for instance) leads me to believe that perhaps the belief is that they need to set a very low target in order to effect any change at all. i.e. if we tell them 1500mg maybe they will only overshoot to 2000mg, because they are currently eating 4-5g a day which is definitely harmful. Heavily pushing the salt=bad narrative with no nuance seems dangerous though because there are also people going in the other direction: eating under a gram a day and passing out or having other serious complications. One of the most common hospitalizations being getting lightheaded and falling.

Anyway, was there some other contradiction between my recommendations and the HSPH rec's that you were concerned about?

Comment author: michael_b 06 February 2015 09:15:22AM *  1 point [-]

Sorry for the confusion. I'm picking authorities at random and asking why I should trust you over them, not vouching for any authority in particular. Perhaps I should have asked more bluntly: who are you and why are you qualified to give us health advice?

No offense. :)

I am having a hard time finding places I disagree significantly with them.

More a curiosity than anything: dairy isn't represented at all on the HSPH's "healthy eating plate" but is specifically highlighted in your section on nutrition. Why the discrepancy?

Comment author: RomeoStevens 06 February 2015 09:03:42PM *  0 points [-]

I'm not. I'm a random person who is investigating the advice of professionals and trying to determine the interventions with the highest reported effect sizes in the literature. I'm not running studies myself or claiming anything in the absence of studies.

Milk and eggs is because of the Adventist health study and others:

"mortality from ischemic heart disease was 20% lower in occasional meat eaters, 34% lower in people who ate fish but not meat, 34% lower in lactoovovegetarians, and 26% lower in vegans. "

http://ajcn.nutrition.org/content/70/3/516s.full

Keep in mind that it is perfectly valid to infer that if I disagree with a mainstream source on healthy advice this is minor evidence I am wrong.

Comment author: IlyaShpitser 03 February 2015 07:16:01PM *  2 points [-]

Seconding Anders_H here (will not get into specifics for similar reasons).


Our opinions should not be treated as independent, of course.

Comment author: Anders_H 03 February 2015 07:03:01PM *  5 points [-]

For career reasons, I am unable to give a complete answer to this question (see my contact details). I just want to give the general advice that it may be a good idea to beware of people who use the word "science" and the brand name "Harvard" to promote their personal views on questions that are not answerable without long-term randomized trials with perfect adherance (or alternatively strong causal assumptions that are unlikely to hold in these particular settings)

I am not claiming that aspiring rationalists can necessarily do any better, I just want to make the point that it may be better to admit ignorance (or high-variance priors) rather than appealing to the authority of "Harvard"

Comment author: michael_b 03 February 2015 11:33:56PM *  1 point [-]

Noted. To be clear, the question I'm asking is why is OP a more worthy authority than the rest?

Why should we listen to OP and not follow, say, the UK's NHS healthy living guidelines? I hope the answer is better than "because nobody at the NHS is a member of LW"

Comment author: ChristianKl 05 February 2015 01:50:08AM 4 points [-]

For political reasons the NHS couldn't write things like

In general, you should not assume that medical staff are competent. Triple check dangerous prescriptions. If you don’t know whether a prescription is dangerous, assume it is. Ask medical staff if they’ve washed their hands (yes, this is actually still a major problem). Sharpie on yourself which side of your body a surgery is supposed to happen on, along with your name and what the surgery is for (seriously).

Comment author: michael_b 06 February 2015 09:27:31AM 0 points [-]

Fair point.

Comment author: RomeoStevens 04 February 2015 11:21:00PM 1 point [-]

Ditto for these NHS healthy living guidelines. Where do I contradict them? I had thought my main takeaways were pretty uncontroversial WRT mainstream advice.

Comment author: [deleted] 01 February 2015 04:01:25PM *  1 point [-]

I praise your for the effort.

But I have one problem: how do I explain it to others? People might ask me one day "why are you doing/concerned with that?" and what my reply be? "Some guy on Lesswrong told me, but don't worry it's a rational site!"

That's silly. Instead of spreading one-dimensional awareness, you should instead spread academically correct information and let it do it's course. That way, if someone ever asks me why, I can give them a link, or at least the bottom line. Depending on how curious they are they might even read it and spread it further and who knows.

If anybody's interested about nutrition, I'll vouch for bodyrecomposition, Lyle McDonald's site. The text-to-shit ratio to there is simply great (1:0). If anyone else can share some more "make your life better" advice, sites, or whatever, go ahead!

Here's something that happened to me lately: I couldn't stomach fish. No matter what happened I couldn't take it. Then I just realized it was cooked half-made, and I should've let it burn good and get some real color. The trick was to basically cook it until the significant water content in it is basically out and it gets a lot more bitey, rather than slimy mess that melts in your mouth and leaves your fingers with a nasty unclean feeling. Get a fillet and cut it into several pieces just to make sure you're not putting a big piece so it'll cook evenly, rather than "sushi inside" or whatever you call that when you take a bite and feel it wasn't cooked properly.

Comment author: RomeoStevens 01 February 2015 10:04:01PM 2 points [-]

I would refer to the original research rather than my efforts to collect and synthesize it. I linked some of the best research I could find for each point, but it is by no means exhaustive.

Comment author: Vokasak 13 December 2014 07:05:13PM 5 points [-]

Usually I'm content to just lurk and read interesting posts, but here there's finally something well enough into my area of expertise that it worth making an account to contribute to!

The e-cig linked as a suggestion is a (low end, generously speaking) clearomizer system. There's nothing wrong with that, they will work as advertised and be less harmful than tobacco and all that good stuff. And if you're buying e-cigs en masse to hand out to smoker friends you can't beat the price. But it's a bit misleading to say one of these alone will add an arbitrary number of years to a persons life. The heating coils in any kind of ecig don't last forever, and low end devices like the one in the OP tend not to be disassemble-able/customizable. At $5, tossing it out and getting a new one is no big deal, really. But still.

A former smoker with disposable income (read: anyone who could afford to sustain their own tobacco habit in the first place) that's just a bit pickier would get more mileage out of a rebuildable atomizer based mechanical mod system, even a lowerish end one. It'll cost more since you'll have to buy parts individually (think building your own computer), but the increased quality of the experience is well worth it. For example, you'll be able to tweak how much power you're getting (based both on what you buy and how you set things up), instead of being stuck with the woeful 650 mAh battery and criminally high 1.8 ohm resistance in the OP's recommendation. I've spoken with many people who didn't fully give up on cigarettes until they found their way to "advanced user" products like these that give them the exact experience they're looking for.

Of course the exact product that's right for any given person will vary, but I'll link a decent midrange atomizer and mod (or battery tube). You'll need A1 kanthal resistance wire for building coils, available in huge quantities for dirt cheap on eBay and such. You'll also need cotton for your wicks, for beginners it's perfectly fine to buy a bag of organic cotton balls at your local drug store (maybe boil them if you don't trust how "organic" they are). The choice of e-liquid (the stuff you'll be smoking, see OP's second link) is highly subjective and up to personal taste, but I find higher VG juices to be more to my liking. Always buy the best, safest batteries you can Sony VTC4s and VTC5s are the current gold standard for 18650 sized batteries. Most battery chargers should be fine, but I'd recommend something like this

Caveat, especially since this is a post about increasing longevity: There have been a few reported cases of people successfully blowing up their e-cigs with systems like these, but this risk is basically nonexistent if the user practices any kind of battery safety. I trust the members of the LW community know enough about ohm's law to not accidentally build a pipe bomb and then stick it in their mouths. If this remote possibility is a dealbreaker for anybody, there exist "regulated mods" which tend to come in the form of a box. These have electronic chips in them which regulate the flow of energy from your battery and guarantee consistency, but come with some limitations as to how you can build your coils, and the electronics take some power for themselves lowering the overall potential output (think manual vs automatic transmission in cars)

It should be noted that the vape industry is an incredibly fast moving space. A lot of the info and forum posts on e-cigs (especially from more than a year or two ago) is already outdated. Back then a system like the one I linked wouldn't have existed, in part because battery technology wasn't in a place to make it cost effective. If some 2016 future-dweller stumbles upon this comment, don't take it at face value. Research the current equivalents and best practices. They're almost guaranteed to be different. If in any doubt, the vaping community is rapidly growing (chances are they're a dedicated vape shop near you if you're in a remotely large city. There are currently three in Monterey, CA and that town is tiny) and generally very helpful (if somewhat "bro"-y, culturally). If there isn't a shop near you to help you out, there are many impartial product reviews that you could find on YouTube.

Vaping is much more complex and personal than someone completely new to it might at first realize, and your individual needs and experience will vary. In any case, I hope this was helpful, and not just incoherent rambling.

Comment author: RomeoStevens 13 December 2014 10:58:00PM 1 point [-]

Thanks for giving people detailed options! I am liking the mini protank myself. Glass and steel instead of plastic.

Comment author: John_Maxwell_IV 13 July 2014 04:41:17AM *  2 points [-]

Regarding sleep temperature, I've seen contradictory recommendations.

This article references a finding that "finding that facial warming helps send people to sleep". And Wikipedia writes

Some of the few factors known to increase slow-wave sleep in the sleep period that follows them include body heating (as by immersion in a hot tub)...

Though, this guy writes

"A hot bath will increase your skin temperature, which eventually decreases your core body temperature. Do the same thing for yourself that you’d do for a young child—make sure you take a bath a half hour or so before bed time.” — Robert Oexman

And this pdf recommends staying cool.

I experimented with gradually reducing my blanket load while sleeping but I found that past a certain point I would wake up chilly in the middle of the night and put blankets on in order to fall asleep again. So empirically that seemed to disrupt my sleep.

It seems like the outlier data point is the Fast Company quote. I sent an email to the company working on SomNeo to see if they could send me the study they based their decision on. I noticed that the study you cite was a pilot study without that many participants, and results on insomniacs don't obviously generalize to the larger population.

Comment author: John_Maxwell_IV 08 May 2014 10:59:08PM 2 points [-]

On the topic of whether it's useful to worry about longevity when you're young: I just saw this article in the NY Times, which suggests that it is.

Comment author: John_Maxwell_IV 09 April 2014 05:26:20PM *  0 points [-]

This paper and this one (I haven't read either) make me wonder if living in a consistently warm climate is beneficial, especially as one grows older.

Comment author: Vaniver 09 April 2014 06:12:34PM 0 points [-]

From paper 1:

The decline in seasonality of coronary mortality in the US since 1970 may be linked to increasing access to microclimatic control (air-conditioning) in countering the environmental effects of cold.

It looks like it's relatively easy to control the amount you're temperature-shocked, and they talk some about cold adaptation but I didn't see it quantitatively linked to the other parts of the paper.

In general, cold is more dangerous than heat, and while hot climates have historically had worse diseases and bugs than cold climates, it's not obvious to me that's still the case. There probably is something to retiring to Florida.

Comment author: ancientcampus 10 March 2014 07:39:53PM *  1 point [-]

Very nice article! Regarding the benefits of alcohol: for those curious, it is well established at this point that alcohol is actually protective against arterial plaque; it just has all sorts of other problems. This is just for kicks mostly, but I read a publication that said that for people who have ALL the following criteria:

Male (No women because alcohol increases risk of breast cancer)

45 years Does not smoke No family history of addiction or substance abuse No personal history of addiction or substance abuse "Occasional drinker" (has a couple drinks a month) Never binge drinks No history of liver, pancreatic problems, or several other problems I can't remember

They said it is likely tat 1-2 drinks per day, no more than 2 per day, and no more than 10 per week, will actually increase life expectancy.

Additionally, it's just alcohol in general that helps. Red Wine had no significant impact over other alcohols.

Comment author: John_Maxwell_IV 14 July 2014 02:13:20AM *  2 points [-]

It looks like there is a new meta-analysis that concludes that alcohol is bad for your heart (original paper). (I haven't read it.)

Comment author: erratio 08 March 2014 12:55:51AM *  5 points [-]

I notice that I am confused about what makes a post worthy of being Promoted. This post is well-researched and has an incredibly high score and lots of interesting comments. Is it that MIRI/CFAR/et al are afraid that someone might implement these and later sue if they don't get results, or somerthing?

As it is, Main but not Promoted is currently the least visible location on the site.

Comment author: Eliezer_Yudkowsky 08 March 2014 04:27:01PM 4 points [-]

Well, I was surprised by the flossing claim, looked it up and found a correlational study with control variables. Give me my choice of control variables in a correlational study and I will prove that smoking cigarettes prevents lung cancer. And I was a bit worried about other items listed even before then. So I decided not to promote.

Comment author: CCC 08 March 2014 04:47:52AM 4 points [-]

Honestly, I'm surprised that there aren't more posts tagged 'longevity' on this site. Cryonics is wildly popular here, as a way to continue one's existence in the future, after one's physical body gives out; however, simply surviving long enough for someone to invent a cure for aging seems to be another way to solve the same problem and, moreover, one which can be worked concurrently with cryonics.

Comment author: scav 10 March 2014 01:36:17PM 3 points [-]

Also, nobody knows whether people currently being cryonically preserved by current methods can ever be thawed and healed or uploaded into an emulator. It would suck to die and get frozen a year before they realise they were doing it all wrong.

Comment author: iarwain1 06 March 2014 03:29:31PM 5 points [-]

Regarding driving safety: A couple of years ago I asked my old driving instructor if he knew of a good book on driving safety I could use to increase my skills. He pointed me to some of Fred Mottola's guides at the National Institute for Driver Behavior. I ordered pretty much all of the reading / course material he has available, and I thought they were excellent. There's a lot of little tips for marginally increasing safety, and he focuses a lot on developing good habits so it doesn't require constant vigilance.

In order to get the full benefits of his program you'll probably need to repractice a lot of your driving skills to unlearn your bad habits and replace them with good ones. It's probably a worthwhile investment though given the risks. (I'll also add that mortality rates for car accidents don't include life-altering injuries, which are also extremely high-risk.) But even if you don't do the full program, he has some short guides that focus on the 10 most important habits of good driving.

Note that they mostly sell to drivers ed teachers rather than individuals. I was actually the first person they ever sold to as an individual, and they didn't really know how to deal with me. So they just sent me a couple of copies of everything, and I gave them out to some of my relatives.

Comment author: oge 13 December 2014 09:37:49PM 0 points [-]

Hey [iarwain1] I'm interested in trying out the driving guides. Could you please recommend one of the books to start with before buying the rest? Also, do you happen to know of anyplace where I can take a "simulated accident" course (in the Bay Area, if possible)?

Comment author: iarwain1 14 December 2014 01:17:58AM 1 point [-]

The Ten Habits book is the main one, but there's also the Zone Control system which is mostly a very expanded version. Here's the product list. Don't buy the mirrors.

Comment author: Gunnar_Zarncke 04 March 2014 10:41:49PM 0 points [-]

Buying an e-cig for yourself or people you know who smoke are possibly the single cheapest intervention for adding years to life. E-cigs have very high success rates in getting people to quit smoking and are absurdly cheap. You can spend under $10 and add 14 years to someone’s life. I buy them just to give away.

I have bought such an e-cig and gave it to a friend. It was received positively. It also prompted a discussion about the (unknown?) effects of e-cigs. Even though this was only cited as an often given counter-argument I nontheless wonder what the research behind e-cigs shows? Can you provide references that back your claim of getting people to quit?

Comment author: RomeoStevens 04 March 2014 11:12:05PM *  2 points [-]

Effect in people not intending to quit: http://www.biomedcentral.com/1471-2458/11/786

Comment author: [deleted] 04 March 2014 06:39:16PM 0 points [-]

Are you planning to do a post on nutrition later?

Are waterpiks as good as flossing?

Comment author: RomeoStevens 04 March 2014 07:00:00PM *  0 points [-]

I'll discuss some more nutrition stuff in the exercise post. But nutrition is a giant can of worms I don't want to get too deep into.

I've heard conflicting things about waterpiks. Here is a small study indicating that it is effective. I do need to expand the oral hygiene section to discuss both waterpiks, oil rinsing, and alcohol mouthwashes.

Comment author: iarwain1 06 March 2014 05:41:20PM 0 points [-]

My dentist told me that waterpicks are not effective, but I don't know what he based that on. If the data proves otherwise I'd love it, since I find regular flossing to be really annoying.

Comment author: CronoDAS 04 March 2014 05:04:39AM 0 points [-]

I really don't like flossing. Can I substitute antiseptic mouthwash instead?

Comment author: arundelo 04 March 2014 01:57:42PM 0 points [-]

I used to hate flossing too:

  1. Bleeding gums
  2. Pain in my fingers from wrapping floss around them
  3. Pain in my lips and cheeks from stretching my mouth open to reach back teeth

The bleeding gums go away after flossing regularly for a while. After trying several other flossing tools, I found one that solves the other two problems: the Reach Access Flosser. Its sole downside is that you have to periodically replenish your supply of disposable heads, but this is not very expensive, and the reward is healthier teeth.

I started using this maybe something like five years ago, and it turned me into a flosser after decades of being a non-flosser, so I'm an evangelist for it now.

Comment author: CronoDAS 06 March 2014 01:57:15AM 0 points [-]

I mostly have problems with #1.

Comment author: EHeller 04 March 2014 07:34:42AM 0 points [-]

I lost some manual dexterity in one of my hands, and my dentist recommended a water flosser. I think waterpik is the brand, seems to work well.

Comment author: RomeoStevens 04 March 2014 05:26:04AM 0 points [-]

You can sort of substitute oil rinsing, but I'm not positive they have exactly the same disease prevention effects. It's certainly better than nothing.

Comment author: CronoDAS 04 March 2014 06:10:08AM 0 points [-]

Listerine and similar antiseptic mouthwashes are supposed to be effective against gingivitis and tooth decay, which is why I asked.

Comment author: iarwain1 06 March 2014 05:54:38PM 0 points [-]

Listerine doesn't work vs gingivitis for me.

Comment author: RomeoStevens 04 March 2014 06:17:49AM 0 points [-]

While I don't think the evidence is as strong as the language in this article would imply, I do err on the side of the alcohol being bad. http://www.naturalnews.com/025581_mouthwash_cancer_alcohol.html#

Comment author: CronoDAS 04 March 2014 06:33:24AM *  0 points [-]

I guess I might as well use an alcohol-free mouthwash, then.

(I've heard that "Natural News" has a tendency to publish crankish alternative medicine stories, so I went to Google; there is some evidence indicating a link, but it's pretty weak and might not actually mean much of anything.)

Comment author: ChrisHallquist 03 March 2014 03:11:00AM 1 point [-]

How much have you looked into potential confounders for these things? With the processed meat thing in particular, I've wondered what could be so bad about processing meat, and if this could be one of those things where education and wealth are correlated with health, so if wealthy, well-educated people start doing something, it becomes correlated with health too. In that particular case, it would be a case of processed meat being cheap, and therefore eaten by poor people more, while steak tends to be expensive.

(This may be totally wrong, but it seems like an important concern to have investigated.)

Comment author: RomeoStevens 03 March 2014 05:13:02AM 1 point [-]

My process is to collect a list of confounders by looking at things controlled for in different studies, and then downgrading my estimation of evidence strength if I see obvious ones from the list not mentioned in a study. This is probably not the best way to do this but I haven't come up with anything better yet.

Comment author: Eliezer_Yudkowsky 02 March 2014 05:53:09PM 0 points [-]

I clicked through to your recommendation to floss and saw an associational study with a set of control variables. This is such a horribly bad sign that it makes me doubt the rest of your post.

Comment author: Anders_H 04 April 2014 08:07:31PM *  6 points [-]

I understand your skepticism about associational studies. Clearly, the likelihood ratio from seeing a positive result in such a study should be tiny in most cases. But just out of curiosity, if you automatically discount all cohort studies, where do you expect evidence on the causal effects of lifestyle interventions to come from?

Nobody questions that doing a randomized controlled trial would provide much stronger evidence, but a RCT with a lifestyle intervention as the exposure and mortality as the outcome would take decades to complete, would require a very large sample size, and would have several potential threats to its validity, including low adherence to treatment assignment and loss to followup. Furthermore, you would need a separate arm for every possible variation of the intervention, and you would need to do one of these trials for every possible lifestyle intervention

In the absence of an RCT, the best we can do is a properly designed and properly analyzed cohort study.

As far as I know, instrumental variables are the only other option that is seriously considered, but there are very few perfect instruments, and in most realistic epidemiologic settings, using a weak instrument is probably worse than doing a cohort study. If you want to go into a further discussion on this, as a starting point, see the article "Instruments for Causal Inference: An Epidemiologist's Dream?" by Miguel Hernan and Jamie Robins, and focus on the section on how minor violations of unverifiable assumptions can blow up the bias.

I am not suggesting that cohort studies are the answer, but rather that we only have four options:
Either (1) Conduct a lot of very expensive randomized controlled trials on every possible lifestyle intervention and wait a couple of decades for the results, or (2) do associational studies, or (3) Postulate that we understand physiology and biochemistry well enough that we can learn about the effects of lifestyle intervention simply by reasoning, or (4) accept that we are unable to learn about the effects on lifestyle interventions on longevity

Personally, I am leaning towards option 4, but I am willing to accept properly conducted cohort studies as weak evidence, at least to give us some idea about what randomized trials would be most promising.

What really confuses me about your comment, is that you doubt the rest of his post simply because he cited a cohort study, when it was obvious from just reading the title of the post that the only evidence he could possibly have on the effect of lifestyle interventions, would necessarily come from associational studies.

Comment author: gwern 30 August 2015 02:15:40AM 3 points [-]

Either (1) Conduct a lot of very expensive randomized controlled trials on every possible lifestyle intervention and wait a couple of decades for the results,

RCTS are less expensive than you think and correlational approaches more. The alternative is that instead, we run lots and lots of very expensive enormous national surveys and countless analyses of the form 'blueberry consumption associates with better health (again)' which still wind up being wrong something like 2/3rds the time, which wrongness itself wastes even more money by sending researchers down dead-ends (looking for the exact flavenoid which improves health) and distorting the general populations' expenditures & quality of life & trust in science. Correlational trials are only a bargain if you're trying to maximize citation count and confusion.

On a more positive note: #4 is unacceptable because human life is so valuable. Each year of life is worth scores of thousands of dollars, and good knowledge about lifestyle interventions like resistance exercise or aspirin can be applied to the entire American population of 300 million people indefinitely. So it's worth paying for lots of trials from any kind of cost-benefit perspective.

And of course there's all sorts of ways to optimize these trials to reduce the already-trivial cost of running them: factorial trials (why study just one intervention at a time?), trials designed ahead of time to fit into meta-analyses so they can borrow strength, informative priors on parameters like effect size (eg any RR <0.90 is implausible for these kinds of interventions), sequential trials to re-allocate across arms (like Thompson sampling) or just to halt early once enough information has accrued for a decision-theoretic judgement that an intervention has proven useless or useful (and can be rolled out to the population), and use of exotic covariates (the genetics of placebo response looks very interesting for increasing power)...

Comment author: Anders_H 30 August 2015 02:43:26AM *  1 point [-]

I agree with almost all of this. I do however think that it would be very hard to convince a sufficient number of people to let their lifestyle choices be assigned by chance, and even harder to convince them to adhere to the assigned randomization arm over several decades.

Note that if you use a factorial design, you are limiting yourself to study only joint interventions. For example, if you conduct an experiment where you first randomly assign alcohol, and then randomly assign smoking, you will be able to figure out the joint effect of these interventions and the interaction between them, but you will not be able to estimate the overall effect of using alcohol, because part of that effect may be mediated by an increased chance of taking up smoking. This can make it difficult to interpret the trials, particularly if we use high dimensional factorial designs.

I am also skeptical of re-allocation across arms, but I'll have to read up on Thompson sampling.

Comment author: IlyaShpitser 04 February 2015 12:02:05PM 0 points [-]

What about (2'): "do associational studies, but try to implement assumptions needed for g methods to work via study design." That is, make sure exposures are given only given the observed past, there isn't interference by construction, etc.

Comment author: John_Maxwell_IV 10 March 2014 05:12:35PM 0 points [-]

Out of curiosity, do we have hard data on the reliability of this vis-a-vis RCTs?

Comment author: RomeoStevens 03 March 2014 05:16:15AM *  6 points [-]

Floss does have the weakest evidence going for it, hence its position last on the list. It stayed above the "worth it" line due to the low cost and risk. I also believe it has an impact on quality of life even if the mortality effect turns out to be small. I do need to add a discussion of this to my post at some point.

Comment author: John_Maxwell_IV 16 March 2014 12:51:15AM 2 points [-]
Comment author: Dorikka 09 August 2014 05:22:17PM 1 point [-]

Necroposting, but do you have any more information on mouthwashes as a source of risk? The one I use (Crest pro health) doesn't appear to contain chlorohexadine, but does contain another chlorine compound (cetylpyridinium chloride).

Comment author: zedzed 17 December 2014 02:38:02PM 1 point [-]

Wikipedia says cetylpyridinium chloride is an antiseptic. Assuming the blood pressure-raising mechanism is, in fact, killing off beneficial microbes, then we would expect cetylpyridinium chloride to have similar effects.

Comment author: [deleted] 02 March 2014 03:13:40PM 0 points [-]

Ok, so basically, I need to floss more and drive less recklessly (when I drive at all, which is rarely). But other than that, I'm doing good at targeting longevity.

steeples fingers

Eeeeexcellent. Everyone who claims to aim for immortality or personal happiness but doesn't exercise, turn in your rationality card right now.

I can't claim any super-insightful techniques for actually building good habits and making good decisions, personally. My main technique is just to make a decision by putting myself in the shoes of future-me and asking what he's going to care about more.

Comment author: Xodarap 01 March 2014 06:36:41PM 2 points [-]

Ovo-lacto vegetarians live significantly longer than vegans

Where does it say that the difference is significant? The only mention of this I see in the cited paper is table 7, and the CIs there overlap a great deal. (And it goes on to say that the numbers should be "interpreted with caution because of the uncertainty of the dietary classification of subjects in the Health Food Shoppers Study".)

Comment author: RomeoStevens 02 March 2014 03:17:25AM *  -1 points [-]

A lot of these studies point to the same small amounts of data. This article for example discusses a new study that again reanalyzes the Adventist study data http://www.nleducation.co.uk/resources/reviews/vegetarians-live-longer-and-healthier/

We don't really have anything better though. And what little evidence we have points towards ovo-lacto and pescatarians having better health.

Comment author: [deleted] 21 July 2014 10:39:10AM *  1 point [-]

BTW, this article suggests that legumes have some positive effect on longevity, fish might have a smaller such effect, meat may have a negative effect, alcohol has a rather broad confidence interval (which I suspect is because they're trying to model a non-monotonic effect with a linear model), and none of the other food groups they considered have much of an effect.

Comment author: RomeoStevens 21 July 2014 05:37:27PM 0 points [-]

I would guess that legume consumption is positive for the elderly because their folate absorption declines with age (along with other B vitamins like b12). I wonder if anyone has tried to test that yet.

Comment author: Xodarap 02 March 2014 05:26:35PM *  1 point [-]

And what little evidence we have points towards ovo-lacto and pescatarians having better health

Um, the article you linked seems to say that vegans are healthier:

  • Vegan All-cause mortality: HR 0.72, 95% CI 0.56-0.92
  • Pesco All-cause mortality: HR 0.81, 95% CI 0.69-0.94
  • Lacto-ovo All-cause mortality: HR 0.91, 95% CI 0.82-1
  • [Meat eaters presumably have an HR of 1]

The difference might not be significant, so I don't know that we would call this conclusive proof. But it seems like if you're going to lean one way, it would be towards vegans being healthier.

Especially since "animal products are bad" is a much simpler model than "animal products are bad, except for these few exceptions."

Comment author: RomeoStevens 21 July 2014 05:45:15PM *  -2 points [-]

This overview of studies is a reasonable place to look: http://www.veganhealth.org/articles/dxrates

Note the conclusion: even though several RR's look better for vegans, the data can't yet make a strong case that veganism is actually better than pesc or ovo-lacto vegetarian diets. In particular, 1.0 RR is often within the 95% CI.

This is also worth looking at if I forgot to link it anywhere else: http://ajcn.nutrition.org/content/93/1/158.short

Comment author: Xodarap 31 July 2014 02:30:40PM 1 point [-]

Right. So given that we don't actually have any evidence to support claims like "Ovo-lacto vegetarians live significantly longer than vegans" don't you think it makes sense to remove those claims?

Comment author: RomeoStevens 31 July 2014 07:21:17PM 0 points [-]

No, I'm in agreement with the article that this meta analysis is the best data we have. It finds significant improvements for fish, dairy, and eggs vs vegans.

Comment author: Lumifer 31 July 2014 07:38:52PM 0 points [-]

this meta analysis is the best data we have

It's 15 years old. I'm pretty sure there is more data available today.

Comment author: RomeoStevens 31 July 2014 08:02:01PM *  0 points [-]

There's a 2012 meta-analysis of longevity which did not separate out vegans, and a 2014 meta-analysis on blood pressure which also did not separate out vegans. If you have any pointers I'm glad to look at more.

Comment author: Lumifer 31 July 2014 08:12:55PM *  0 points [-]

No pointers, sorry. But for fun I searched PubMed for "vegan" and it came up with 3200 hits...

Random example thought not meta.

Comment author: RomeoStevens 01 August 2014 12:44:51AM *  0 points [-]

again look at confidence bounds. Most of the studies you'll find to simply lack the statistical power to make concrete recommendations. Fish seems unambiguously good and shows the largest effect sizes vs vegans (e.g. http://archinte.jamanetwork.com/article.aspx?articleID=1710093), I agree that ovo-lacto evidence is weaker, but I'll maintain that there is slight evidence in favor of it. Given that a diet including fish, eggs, and milk, is much much easier to adhere to it remains something I recommend. Remember that my approach to nutrition in the OP is that effect sizes are small and you should focus your efforts elsewhere.

I do appreciate you taking the time to argue this point, smacking various claims with a hammer is essential.

Comment author: RomeoStevens 03 March 2014 05:19:54AM 0 points [-]

I guess I completely failed to discuss that the studies I linked to do not constitute the entire set of studies I drew from for the recommendations. I will expand on some of the points when I have time.

Comment author: orthonormal 20 July 2014 04:10:48PM *  0 points [-]

Reminder to expand on this. (Someone sent me a link saying that eggs are terrible for life expectancy, and I found it dubious so I came back here to look for links to studies.)

Comment author: RomeoStevens 21 July 2014 05:46:18PM *  0 points [-]

Link added to parent thread. Still have more to investigate. This area is extremely frustrating because of the decade-plus lead times on studies.

Comment author: Xodarap 04 March 2014 01:34:26AM *  2 points [-]

Sounds good.

Just reading the wikipedia page#Health_studies) on eggs seems to indicate that evidence for their health benefits is questionable at best, (and even though you were trying to make the argument that eggs were healthy you couldn't find the evidence to do so at first) so given that you're only mentioning "the largest high level features of a diet that have positive or negative impact", I'm not convinced eggs are worth including at all.

Comment author: RomeoStevens 04 March 2014 05:29:04AM *  0 points [-]

Yeah, I believe choline is more important than the conventional wisdom suggests given its interaction with various nootropics. It's really hard to get enough without eggs. Eggs are also absurdly bioavailable compared to everything else.

Comment author: Wei_Dai 20 July 2014 10:46:36PM 0 points [-]

Yeah, I believe choline is more important than the conventional wisdom suggests given its interaction with various nootropics. It's really hard to get enough without eggs.

It seems pretty easy to supplement with soy lecithin. Is there any reason not to do that?

Comment author: RomeoStevens 21 July 2014 08:11:13AM 0 points [-]

Not particularly for choline other than my normal anti-processed-food-until-proven-otherwise heuristic, but eggs do also contain lots of b12, selenium, and a smaller amount of a ton of other nutrients.

Comment author: Pablo_Stafforini 21 July 2014 09:07:55PM *  0 points [-]

Eggs are very high in methionine, though, and there's evidence that methionine restriction can increase both mean and maximum lifespan. Some very knowledgeable folk, like Michael Rae, have dropped eggs from their diet for this reason.

Comment author: RomeoStevens 21 July 2014 11:49:14PM *  0 points [-]

Thanks for the pointer, I am reading the rat and mice studies. So far the evidence seems weaker than the CR evidence, which is pretty bad.

Comment author: orthonormal 04 March 2014 05:58:24AM 1 point [-]

How many eggs per week would you need to eat in order to avoid choline deficiency?

Comment author: RomeoStevens 04 March 2014 06:19:21AM 0 points [-]

I eat 2-3 eggs a day. You do get a little choline from other sources.

Comment author: orthonormal 04 March 2014 04:57:34PM 1 point [-]

Er, that's not what I asked; averting a deficiency presumably takes less consumption than that. Do you have evidence about choline levels, and what does that evidence say about how many eggs you'd need to eat per week to avoid it?

Comment author: RomeoStevens 04 March 2014 06:57:25PM *  0 points [-]

Averting an acute deficiency is completely different from optimal for health. I don't have a simple cite saying this amount of choline is optimal. I have an impression based on peoples response to extra choline.

Edit: to clarify, choline is not the sole reason I strongly recommend eggs. It is possible to get enough choline without eggs, but the fact that the overwhelming majority of the populace does not meet the adequate intake makes me suspect most diets don't fulfill this.

Comment author: Qiaochu_Yuan 04 March 2014 06:47:37AM 1 point [-]

The last time I tried doing this I ended up with some constipation. It's possible I wasn't drinking enough water at the time, though.

Comment author: [deleted] 01 March 2014 05:43:04PM *  0 points [-]

It seems to be that many earlier studies claiming harm from red meat did not adequately separate out the huge effect size of processed meat.

And here I've been thinking getting the chicken sandwich at Subway or eating smoked turkey sandwich meat was healthy. [Edit: Because of this post, I will not be doing that anymore.]

But I am not really convinced that eating red meat can be healthy. It seems safer to keep it as an "occasional indulgence." Edit: That first link was not clear. Here's another.

Comment author: timujin 01 March 2014 10:56:31AM 5 points [-]

Get tape and cover lights. Try orange glasses to prevent blue light from destroying your endogenous melatonin production after 10pm.

I have always been confused about this one part. Seems like this is the place to ask, for once.

Where do these exact o'clock figures always come from when people are talking about sleep optimizing?

I mean, 10pm by which clock? Certainly, the position of arrows on my watches does not influence melatonin production. Is it calibrated by amount of daylight? But in the area I live in, 10pm can be a middle of the night or not-even-sunset, depending on time of the year, and the number given is a constant and doesn't depend on calendar. Is it calibrated by biological 'internal clock'? But it has different settings in different people. I go to sleep at 2am (and feel sleepy and dizzy if I don't) and wake up at exactly 9am with no alarm clock. Does the advice still apply to me? Does it assume some sort of 'normal' internal clock settings? Then what are they and why is it never explicitly mentioned? Please, help me resolve this confusion. Where did the numbers come from?

Comment author: RomeoStevens 01 March 2014 11:08:21AM 0 points [-]

completely arbitrary. You want to be doing it at a consistent time several hours before you want to be asleep.

Comment author: timujin 02 March 2014 09:31:40AM 0 points [-]

That's cool, but I am still curious about from whence exactly you got the number.

Comment author: RomeoStevens 03 March 2014 08:16:58PM *  0 points [-]

I have heard it repeated several times and personally put them on at 10:30 in order to fall asleep around 1:30.

Comment author: brazil84 01 March 2014 10:06:05AM 0 points [-]

As it turns out, there are actually two types of LDL,

Of course there are. For pretty much every X which is associated with human health, closer investigation will reveal that there are two types of X -- "Good X" and "Bad X."

Comment author: soreff 25 October 2014 07:06:54AM 0 points [-]

for potassium, would potassium-40 be considered the bad kind? :)

Comment author: RomeoStevens 01 March 2014 10:29:29AM 0 points [-]

Sure "healthy" and "unhealthy" as a demarcation gives the reader no info, but I already felt like I was delving into details a bit too much. I didn't want to turn it into a paper on the wonderful world of blood lipids.

Comment author: brazil84 02 March 2014 12:17:27AM 0 points [-]

Yes, I wasn't criticizing your essay so much as making a general observation.

Comment author: brazil84 28 February 2014 06:58:13PM 2 points [-]

By the way, it seems to me that we need to think in more detail about the relationship between happiness and stress. For example, I have pretty high-stress job (I am a litigation attorney) but at the same time it's a lot of fun most of the time and I am reasonably happy with it. How many more years could I expect to live if I were a trust fund baby?

A few studies have been done on the relationship between retirement age and longevity. As I recall, the best studies seem to show little or no relationship once you eliminate consideration of individuals who retire early for health reasons. It occurs to me that stress or lack of stress can cut both ways. If you have a sense of purpose in life it can make you feel happy. But once you have a sense of purpose, things will invariably come up which frustrate your objectives in large and small ways. Which is stressful. On the other hand, if you are completely apathetic you will be free from stress. But you won't have any sense of purpose or meaning.

Comment author: RomeoStevens 28 February 2014 08:25:57PM 5 points [-]

My understanding is that how you respond to stress is a better predictor than total amount of stress.

Comment author: brazil84 28 February 2014 08:41:41PM 5 points [-]

My understanding is that how you respond to stress is a better predictor than total amount of stress.

That raises an interesting question. Just from simple observation, it's clear that a lot of people respond to stress by engaging in unhealthy behaviors like binge eating, excessive alcohol consumption, etc. So if stress is correlated with health problems, perhaps the causation is indirect.

Comment author: RomeoStevens 01 March 2014 01:11:53AM 6 points [-]

We do have some reasons to expect direct causation such as inflammation and immunosupression.

Comment author: Pablo_Stafforini 28 February 2014 02:10:11PM *  2 points [-]

This is a useful post. Thank you for writing it.

You claim that "Eggs and whole milk are very nutrient dense." I think that's quite a controversial statement. Here are the nutrition facts for 100 Calories of whole milk and spinach:

Comment author: RomeoStevens 28 February 2014 08:37:29PM *  2 points [-]

Two points that came up in my research:
1. whole milk and eggs are associated with significantly lower mortality for vegetarians, and somewhat lower mortality for the general populace.
2. fruit has twice the effect of vegetables on mortality risk per serving.

I am basically highly dubious of the proposition that we are supposed to munch on leaves all the time. Past and extant hunter gatherer groups eat tubers, fruit, and nuts as their plant material. We simply don't see these groups pursuing leafy greens as a significant calorie source.

Comment author: Pablo_Stafforini 04 April 2014 09:38:59AM *  0 points [-]

I am basically highly dubious of the proposition that we are supposed to munch on leaves all the time. Past and extant hunter gatherer groups eat tubers, fruit, and nuts as their plant material. We simply don't see these groups pursuing leafy greens as a significant calorie source.

Do we have data on the eating habits of hunter gatherers to draw such detailed conclusions about the nutritional composition of their diets? Personally, I think we should rely primarily on prospective epidemiological studies about the health effects of various types of foods on different cohorts, rather than on speculative historical studies about our Pleistocene ancestors.

I don't think anyone is claiming that people should regard "leafy greens as a significant calorie source". Rather, the claim is that people should eat lots of vegetables (not just leafy greens, by the way), where "lots" is something like the NHS "five [portions] per day" recommendation--which only 10% of young Britons comply with. That's maybe 500 grams of vegetables per day. Even if you eat that many veggies, the calories derived from vegetables would only constitute 5-10% of your total daily calories.

Comment author: Lumifer 04 April 2014 03:32:07PM *  1 point [-]

Do we have data on the eating habits of hunter gatherers to draw such detailed conclusions about the nutritional composition of their diets?

The shape of the human teeth and the specifics of the human digestive tract are pretty good indicators of what we evolved to eat. It is rather obvious that humans did not evolve eating only plants.

Comment author: Pablo_Stafforini 04 April 2014 05:48:30PM *  0 points [-]

Sure, but that is not what is being discussed here. I asked for historical evidence bearing on the question of whether we should eat lots of vegetables, which RomeoStevens seems to dispute on the basis of evolutionary considerations. The evidence you supplied is only relevant for challenging the claim that we should eat only vegetables--an entirely different claim, considering that vegetables would represent only 5-10% of total calories in a vegetable-rich diet.

Comment author: Lumifer 04 April 2014 05:55:10PM 1 point [-]

historical evidence bearing on the question of whether we should eat lots of vegetables

What is a "vegetable" pre-agriculture and pre-gardening?

we should eat things other than vegetables--a claim which no one, here or elsewhere, seems to have ever disputed.

Vegans certainly put out claims that we should eat only plants.

Comment author: Pablo_Stafforini 04 April 2014 06:15:21PM *  0 points [-]

Vegans certainly put out claims that we should eat only plants.

I have been a vegetarian for 14 years (and a vegan, intermittently, for a total of 3-4 years), and during all this time, which involved reading countless books and papers on human nutrition, and meeting vegetarians and vegans at talks and conferences in various countries, I haven't ever encountered the claim the we should only eat vegetables. It's possible that you are right and vegans do make such claims, but I would need a few references to accept a statement that contradicts my experience to such a degree.

Comment author: Lumifer 04 April 2014 06:26:55PM 1 point [-]

I am consistently using the word "plants" and you are consistently talking about "vegetables".

As I mentioned, I am not sure what counts as a vegetable in the pre-gardening world. Some tubers, probably, anything else?

Comment author: Vaniver 04 April 2014 09:32:32PM -1 points [-]

As I mentioned, I am not sure what counts as a vegetable in the pre-gardening world.

According to Linnaeus...

Comment author: Pablo_Stafforini 04 April 2014 06:54:49PM 0 points [-]

In the context of nutrition, the terms 'vegetable' and 'plant' are used interchangeably. As the Wikipedia article on 'vegetable' reads: "In culinary terms, a vegetable is an edible plant or its part, intended for cooking or eating raw."

It seems that this exchange has served no useful purpose. I suggested that we should eat lots of vegetables, and everything that was said in reply to that claim was either irrelevant or relevant but not supported by evidence.

Comment author: Lumifer 04 April 2014 07:45:22PM 0 points [-]

In the context of nutrition, the terms 'vegetable' and 'plant' are used interchangeably.

Nonsense. Vegetables are parts of plants, just as, for example, fruits, berries, nuts, and seeds (including grains) are. You are not calling walnuts vegetables, are you?

Comment author: Lumifer 28 February 2014 08:46:18PM 2 points [-]
  1. fruit has twice the effect of vegetables on mortality risk per serving.

Huh?

I rather suspect fruit here is working a proxy for something else (maybe wealth).

Nutritionally, the major difference between fruits and vegetables is that fruits have MUCH more sugar. In particular, fructose which doesn't have a sterling reputation, to put it mildly.

Comment author: RomeoStevens 28 February 2014 08:52:29PM 3 points [-]

http://jn.nutrition.org/content/136/10/2588.short
http://www.neurology.org/content/65/8/1193.short

Yup. Surprised me a bit too when I first saw it. Fructose effects are not linear. The liver has some ability to process a certain amount of fructose every day, it is going well beyond this limit that is harmful. 5 servings of fruit is probably going to be 30-50g of fructose, which has been proposed as the approximate amount we can process.

Comment author: CurtisSerVaas 16 January 2016 12:16:36AM 0 points [-]

The Perfect Health Diet people largely agree. http://perfecthealthdiet.com/2012/01/is-it-good-to-eat-sugar/

Their recommendation is a max of 25g fructose or 15% of carbohydrates should be fructose.

Comment author: Lumifer 28 February 2014 09:01:37PM *  0 points [-]

Yup.

Yes, I understand there are studies. That doesn't make me trust their conclusion. I don't have time to dig into these papers right now, but I wonder how well they controlled for e.g. socioeconomic status and latitude.

Comment author: Nornagest 28 February 2014 09:18:06PM *  3 points [-]

Wealth doesn't look likely to me -- vegetables aren't a lot cheaper than fruit where I live, unless we're talking potatoes and such, and those usually aren't counted as vegetables in these analyses.

I would be interested in what fruits and vegetables are respectively displacing in the diet. If a lot of these people are eating fruit for dessert instead of e.g. cake, or for breakfast in place of Pop Tarts, then dramatic longevity effects wouldn't surprise me but also wouldn't be an unqualified endorsement of more fruit for everyone.

Comment author: Lumifer 28 February 2014 09:38:06PM 3 points [-]

vegetables aren't a lot cheaper than fruit where I live

Carrots, cabbage, onions, squash -- not cheaper than fruit?

But yes, I don't think it's purely a matter of money but may be a matter of culture as well.

I would be interested in what fruits and vegetables are respectively displacing in the diet.

Yep, a very good point.

Comment author: Nornagest 28 February 2014 10:10:14PM 2 points [-]

Carrots, cabbage, onions, squash -- not cheaper than fruit?

I just looked these up on Safeway's online store for my area, and found carrots at about 80 cents a pound, cabbage at a buck a pound, onions at about 56 cents and squash at about a dollar. (You can squeeze a bit more out of some of these if you're buying in 10-pound increments, but I consider that impractical for individuals or small families.) Compare to cheap apples at $1.09 a pound, grapefruit at $0.66, or bananas at about $0.85.

Fruit does go a lot higher -- if you're buying berries or tropical fruit, you can easily be spending five or six bucks a pound. But if you're mainly looking for frugality, you have plenty of options in each category. I expect this to be skewed a bit by season, too -- there aren't many cold-season fruits.

Comment author: Jonathan_Graehl 28 February 2014 07:24:49PM 0 points [-]

Fair point, but how long does it take to eat+digest (cooked or uncooked) 100 calories of spinach compared to 100 calories of whole milk? How much does it cost? Etc.

I agree that you shouldn't count the vitamin-fortification of milk as part of the value unless it turns out that milk is an especially good transport for what's added to it.

Comment author: Pablo_Stafforini 28 February 2014 07:59:41PM *  0 points [-]

Fair point, but how long does it take to eat+digest (cooked or uncooked) 100 calories of spinach compared to 100 calories of whole milk? How much does it cost? Etc.

Yes, I agree those are relevant considerations. I'd just keep them separate from the issue of nutrient density.

Comment author: ephion 28 February 2014 03:27:44PM *  7 points [-]

I've downvoted your post due to use of a misleading graphic (EDIT: Downvote retracted after your reply). The graphic is comparing low fat milk, not whole milk, while whole milk has much more nutrition than low fat milk. Additionally, nutrient density can refer to both nutrients/calorie, nutrients/volume, and nutrients/price. All are important measures. Spinach wins on nutrients/calorie, but the other two, not so much.

Whole milk, for example, has 124IU of Vitamin D while the chart only lists 2.4 IU, which approximates the 1% fat figure from Google's nutrition information.

This is what 200 calories of whole milk looks like. This is 200 calories of eggs. This is 100 calories of spinach.

Spinach has little protein (0.9g/serving), while eggs and milk both contain 8g and 7g per serving. This extremely important number is missing from the chart. A cup (30g) of spinach (standard serving size) contains 7 calories, so you'd need to multiply your numbers in the charts by 0.07 to get the expected nutrition per serving of spinach. A serving of whole milk (8oz/244g) is around 148 calories, so we'd need to multipy by 1.48 for a serving:serving comparison. Doing this, the differences in nutrient content are much smaller for most nutrients, and milk 'winning' several of them.

A gallon of whole milk (16 servings) costs ~$3 in my town, and a 10oz bag of spinach (roughly 9 servings) costs ~$2. The price per calorie, per gram protein, and for most micronutrients is smaller for milk than spinach.

Spinach is, of course, great to eat and very healthy. But so are milk and eggs. That they compare so favorably to your chosen food when using more realistic comparisons supports "milk and eggs are nutrient dense."

Comment author: [deleted] 28 February 2014 09:55:40PM 0 points [-]

Why should I care what someone's semi-arbitrary idea of what a serving is is?

Comment author: Jiro 28 February 2014 11:40:48PM *  0 points [-]

Because people eat by servings, not by fixed numbers of calories. Comparing by semi-arbitrary servings isn't perfect, but it's better than not comparing by servings at all, and you haven't offered any serving sizes that you believe are better, so semi-arbitrary is the best we have.

Comment author: [deleted] 01 March 2014 03:29:29PM 1 point [-]

Because people eat by servings, not by fixed numbers of calories.

Who eats 30 grams of spinach and then stops?

Comment author: Jiro 01 March 2014 07:46:58PM -1 points [-]

That doesn't mean that people don't eat by servings, it means that 30 grams isn't a good serving size.

Furthermore, since we're comparing different foods, the fact that 30 grams may be too small is compensated for by the fact that the serving size for milk is a cup, which is also too small.

Comment author: Nornagest 01 March 2014 12:31:11AM *  2 points [-]

Servings are fine for candy bars, but they're almost totally meaningless if we're talking about fungible ingredients like spinach; those are going to be used in all sorts of ways, almost all of them different from whatever the relevant regulatory body had in mind. (Milk and eggs are a bit less so since they're often consumed in quanta of one egg or a glass of milk, but neither one's exactly an uncommon ingredient.)

I'm not sure there's a perfect way of comparing nutrient density under these circumstances, but volume is probably what I'd go for; you can only fit so much on a plate, so ingredients generally displace each other on a volume basis. For leafy greens in particular I might use cooked volume, since they usually cook way down.

Comment author: Pablo_Stafforini 28 February 2014 04:30:09PM *  4 points [-]
  • I originally used whole milk in my graph, but later removed it because the data was for fortified milk. (Clearly, in assessing the nutrient density of a food, one should exclude whatever nutrients are added in supplement form by manufacturers.) I have now found data for unfortified whole milk, and have updated my original comment with a graph displaying nutrition data for that type of milk.

  • Whole milk does not contain significantly more vitamin D than low fat milk does. The figure you quote corresponds to fortified whole milk, which for the reasons mentioned in the preceding bullet point should not be used in this context. And even if we used both fortified whole milk and fortified low fat milk, it would also be false to say that former contains significantly more vitamin D than the latter does.

  • Nor is the nutrient content of whole milk higher than that of low fat milk; if anything, the opposite is the case. Here's an isocaloric (100 Cal.) comparison of the nutrient content of whole milk and low fat milk:

  • According to Wikipedia, "Most commonly, nutrient density is defined as a ratio of nutrient content to the total energy content." That source also provides other definitions, while noting that they are less commonly used. But none of those definitions include the two alternative definitions you provide yourself. Nor have I seen those definitions used in journals or respectable discussion groups, like the Calorie Restriction Society mailing list. I think it's unfair to claim that my graph is misleading--and downvote me accordingly--for relying on the most commonly accepted definition of that expression, instead of using definitions which are rarely if ever used by knowledgeable authorities.

  • Everything else you write might support your argument if price or volume were relevant metrics for assessing the nutritional density of foods. It doesn't support your argument under adequate definitions, and sometimes provides extra support for my own position (for instance, 100 Calories of spinach contain (much) more, not less, protein than 100 Calories of whole milk).

Comment author: fubarobfusco 28 February 2014 05:12:27PM 2 points [-]

Clearly, in assessing the nutrient density of a food, one should exclude whatever nutrients are added in supplement form by manufacturers.

Most of the milk I see for sale is fortified with vitamins A and D. I would want studies regarding milk's health effects to report on the same sort of milk that I can buy in a store.

Comment author: Pablo_Stafforini 28 February 2014 05:17:41PM *  0 points [-]

I think that for the purposes of assessing the claim in question ("Eggs and whole milk are very nutrient dense"), unfortified versions of those foods should be considered. Otherwise, we should also regard cereals and many other foods as "very nutrient dense", simply because manufacturers decide to fortify them in all sorts of ways. (And I note that it's generally not a good idea to obtain your nutrients from supplements when you can obtain them from real food instead.)

In any case, even if we used data for fortified milk, it would still be false, in my opinion, that "whole milk is very nutrient dense." Vitamin D levels make a minor contribution to overall nutritional density.

Comment author: shokwave 02 March 2014 12:26:31AM *  0 points [-]

I suspect the real issue is using the "nutrients per calorie" meaning of nutrient dense, rather than interpreting it as "nutrients per some measure of food amount that makes intuitive sense to humans, like what serving size is supposed to be but isn't".

Ideally we would have some way of, for each person, saying "drink some milk" and seeing how much they drank, and "eat some spinach" and seeing how much they ate, then compare the total amount of nutrients in each amount on a person by person basis.

I know this is not the correct meaning of nutrient dense, but I think it's more useful.

Comment author: Pablo_Stafforini 02 March 2014 02:14:14AM *  0 points [-]

I think the best we can hope in this context is to have a number of distinct and precise metrics--like nutrients per calorie, nutrients per dollar and nutrients per bulk--, feed these to intuition, and decide accordingly. In other words, when it comes to food, I think we should make decisions according to a "rational" rather than a "quantified" model, given the difficulties of coming up with adequate definitions of a "serving size". Your approach wouldn't work, I believe, because how much people eat of a given food often depends on the presence or absence of other complement and substitute foods.

Comment author: Jiro 02 March 2014 07:38:45AM -1 points [-]

Googling quickly brings up http://www.cnpp.usda.gov/Publications/NutritionInsights/insight11.pdf

Serving size is defined as follows:

  1. Amount of foods from a food group typically reported in surveys as consumed on one eating occasion;
  2. Amount of foods that provide a comparable amount of key nutrients from that food group, for example, the amount of cheese that provides the same amount of calcium as 1 cup fluid milk;
  3. Amount of foods recognized by most consumers (e.g., household measures) or that can be easily multiplied or divided to describe a quantity of food actually consumed (portion);
  4. Amount traditionally used in previous food guides to describe servings.

While the amount of food people would eat is not the only factor used, it's a major one.

Comment author: Jonathan_Graehl 28 February 2014 01:40:01PM 0 points [-]

I don't know anything about testicular cancer, but are self-exams useful for breast cancer? I know that the data argues against mammogram-everyone-annually + the ensuing unnecessary surgeries caused by not-harmful tumors or other false positives - no increase at all in life expectancy and presumably there's a significant psychological (and $) cost.

Comment author: RomeoStevens 01 March 2014 01:15:23AM 0 points [-]

I'm not sure. I didn't research this very extensively. If you've already done the legwork it sounds like great material for a post, since it involves making correct tradeoffs based on probabilities.

Comment author: Vaniver 01 March 2014 01:24:03AM *  6 points [-]

Breast self exam is not recommended by the Susan G. Komen foundation, neither recommended nor discouraged by the Memorial Sloan Kettering Cancer Center, and the National Cancer Institute reports no benefit but an increase in biopsies of benign tumors.

Testicular self-exams have not been studied enough for recommendations to be made, according to the American Cancer Society.

Comment author: G0W51 10 December 2014 12:34:14AM 0 points [-]

I think you may have misread the article. According your link, the American Cancer Society states that, "Men with risk factors, such as an undescended testicle, previous testicular cancer, or a family member who has had this cancer should seriously think about monthly self-exams. If you have risk factors, talk it over with a doctor. Each man has to decide for himself whether to examine his testicles each month." It also said it, "does not have a recommendation about regular testicular self-exams for all men." Perhaps you missed the "all."

Comment author: Vaniver 10 December 2014 01:35:56PM 0 points [-]

Perhaps you missed the "all."

The all is implicit from the context of the OP, which was lifestyle interventions to increase longevity for the general population.

Comment author: G0W51 11 January 2015 04:33:28PM 1 point [-]

I don't see why discussing the general population causes "all" to mean "the general population." That said, I understand what you mean, so arguing further seems rather petty.

Comment author: ChristianKl 10 December 2014 02:08:56AM 0 points [-]

The American Cancer Society is made up of members that profit from an increased amount of cancer treatment. The fact that they write something that points people to taking up testicular self-exams doesn't mean that they are having evidence for that.

They protested when the US government reduced breast cancer screening that produced unnecessary operations.

Each man has to decide for himself whether to examine his testicles each month

When medicial society writes something like that it means they don't have evidence for whether it's a useful practice.

If there would be evidence that a particular subgroup would benefit than the article would point it out that the evidence exist.

Comment author: waveman 28 February 2014 11:27:18AM *  3 points [-]

Interesting that there is not much discussion in the comments about weight loss, which is very hard as we all know. And not much discussion about cholesterol either for some reason.

I would just like to point out that Body Mass Index and cholesterol are not very good predictors of risk and that there is some evidence that waist/hip ratio may be a better metric to track.

https://www.mja.com.au/journal/2003/179/11/waist-hip-ratio-dominant-risk-factor-predicting-cardiovascular-death-australia

Comment author: brazil84 07 March 2014 11:20:28PM 0 points [-]

Interesting that there is not much discussion in the comments about weight loss

I agree, but significant permanent weight loss is a very difficult and complex problem. So perhaps it's a matter of what is the low-hanging fruit. Arguably it's a lot easier to get in the habit of flossing or taking vitamin D supplements than it is for a fat person to get thin and stay there.

When people go on health kicks, attempting to lose weight is very frequently the number one priority. Possibly because there is so much stigma associated with obesity. But a good argument can be made that other things, such as exercise, should be a higher priority.

Comment author: Jiro 28 February 2014 03:19:31PM 1 point [-]

Is body mass a good predictor of risk for people who know that they are not in an obvious category where body mass is expected to be a poor predictor? That is, if you exclude the bodybuilders and limit its use to relatively average-appearing people, is body mass then useful?

Comment author: brazil84 07 March 2014 11:32:39PM 0 points [-]

Is body mass a good predictor of risk for people who know that they are not in an obvious category where body mass is expected to be a poor predictor? That is, if you exclude the bodybuilders and limit its use to relatively average-appearing people, is body mass then useful?

I recall reading that BMI correctly assesses obesity in 99% of women and 95% of men. I can try to dig up a reference for this if you like. So the answer to your question would seem to be "yes."

Comment author: Lumifer 28 February 2014 08:37:59PM 6 points [-]

Is body mass a good predictor of risk

BMI is a horrible metric that was never intended to be used for evaluations of individuals (it was supposed to be used for evaluation and comparison of whole populations), is known to scale wrongly with height and basically should just be ignored.

Comment author: brazil84 07 March 2014 11:39:51PM 1 point [-]

BMI is a horrible metric

I recall reading that BMI correctly predicts obesity in 95% of men and 99% of women. Do you disagree with this?

Comment author: [deleted] 02 March 2014 03:23:05PM 1 point [-]

While you are technically correct, that shouldn't function as an excuse to let oneself get overweight. My BMI was just measured a couple weeks ago to be 23.7 (between 18 and 25 is "normal"), and even after you account for the fact that I carry some muscle thanks to a year of strength training, I'm still visibly chubby and the nurse told me to lose weight. I agree with her on this.

Comment author: Lumifer 03 March 2014 04:24:55PM 0 points [-]

While you are technically correct, that shouldn't function as an excuse to let oneself get overweight.

That's a non sequitur.

To quote you from another post

the most common use of ignoring BMI is to let oneself remain overweight

You don't know that. Asserting an opinion and describing reality are two different things.

Comment author: [deleted] 03 March 2014 04:35:00PM 1 point [-]

You don't know that.

I have not run a statistically significant experiment, no, but I have simpler never heard of anyone even ignoring their BMI when it's a reason to eat more and exercise less. You could say that I have more than a completely baseless prior but less than a completely well-evidenced posterior.

Comment author: Lumifer 03 March 2014 04:58:45PM 1 point [-]

I have simpler never heard of anyone even ignoring their BMI when it's a reason to eat more and exercise less.

Huh? You're making no sense.

The great majority of people ignore their BMI because they don't care. A notable number ignores their BMI because they have better metrics. I ignore my BMI because I think that it's a silly number that tells me nothing that I don't already know.

Comment author: Creutzer 02 March 2014 03:28:26PM 5 points [-]

But what you're doing is exactly ignoring the BMI: the BMI is supposed to be normal, but you think you should lose weight.

Comment author: [deleted] 02 March 2014 04:22:06PM 1 point [-]

Yes, that's my point. However, I'm abnormal: the most common use of ignoring BMI is to let oneself remain overweight against the evidence of its health detriments.

Comment author: ephion 28 February 2014 04:15:36PM 2 points [-]

The best metrics are body fat percentage or fat-free mass index.

For what it's worth, even vaguely muscular people are going to blow apart the BMI scale. I'm 5'10" and 190lbs at around 13% body fat. My normal weight range according to BMI is 130-173lbs. If I got down to that without losing any muscle mass, I'd be 5% body fat, which is severely underweight. I was completely sedentary before weight training, and I've only been training powerlifting for 1.5 years with moderate results (ie, I'm not quite as strong as most high school football players).

Comment author: waveman 19 March 2014 05:09:03AM 0 points [-]

The best metrics are body fat percentage or fat-free mass index.

Do you have a comparison study which included hip/waist as well as body fat percentage?

I have some doubt that your claim is true because the distribution of the fat seems to be very important eg fat around the hips is far less damaging than fat around the abdomen.

Comment author: brazil84 07 March 2014 11:37:34PM 0 points [-]

For what it may be worth, I am "vaguely muscular" and my BMI of 23.6 seems about right in terms of assessing my level of overweight.. I do agree that muscularity can foul up the BMI scale but I think it take more than just modest muscularity to do so.

Comment author: RomeoStevens 01 March 2014 01:13:44AM 2 points [-]

even vaguely muscular people are going to blow apart the BMI scale

I disagree, it's fairly hard for people to get much above BMI of 28 while lean. You are likely underestimating your BF, have you done a bod pod or other immersion test?

Comment author: ephion 03 March 2014 03:05:37PM 1 point [-]

I haven't. I use calipers and visual estimation compared to DEXA confirmed images. Calipers, if taken at face value, report me to be at 8-10% BF which is definitely too low. Visually, I currently look like pictures of guys in the 13-15% range, so I add 5% to the calculated result. Even at 16% BF (the highest estimate I can get), I'd be around 7% BF with a BMI of 24.8. That's underfat yet very close to overweight.

Comment author: brazil84 07 March 2014 11:37:38PM 0 points [-]

Would you mind posting a self-pic?

Comment author: RomeoStevens 03 March 2014 07:57:45PM 0 points [-]

ah, you sound more than just vaguely muscular then ;)

Comment author: shminux 28 February 2014 07:48:24AM *  1 point [-]

I wonder if farmed salmon, presumably full of colors and antibiotics, has the same beneficial effect as wild.

Comment author: ephion 28 February 2014 03:48:28PM 6 points [-]

A quick google search indicates that salmon farming has become much better in recent years, and might surpass wild salmon soon. Most of the information on fatty acid profiles that I can find is from 2008, before these advances. The chart on this page indicates that farmed salmon has much more fat with a smaller proportion of omega-3. The total n-3 is close (1.8g farmed vs 1.7g wild), but if most of the extra fat is n-6, then you're not doing much for fixing the 3:6 ratio.

Comment author: Yvain 28 February 2014 07:06:26AM *  25 points [-]

This is good stuff!

One addition I would make to your "sleep" section: between 5% and 10% of Americans have moderate or severe sleep apnea, mostly undiagnosed. Untreated sleep apnea more than doubles mortality through a combination of cardiac problems, stroke, and maybe a cancer-promoting effect as well. There are well-known effective treatments for sleep apnea and it is kind of dumb not to get them.

The main symptoms of sleep apnea are excessive snoring, and feeling very tired during the day even if you slept a normal amount the night before. It is most common in obese and older people but sometimes happens in normal-weight and younger people as well. If you think you might have this condition, probably your highest-priority longevity intervention (after quitting smoking, if you do that) is to go to your doctor and get it checked out.

Comment author: MartinB 28 April 2014 01:33:33PM 2 points [-]

I've got it :-) Actually I read about it before, but delayed going to the doctors for a few years. Afterwards it took about 6month of preliminary testing till I got the appointment in the sleep lab - since it is not an emergency situation. But afterwards the CPAP helped me right away. Its ridiculously effective. (Around the same time I started using f.lux to dim the brigtness of the monitor which is a good idea anyway (redshift for linux), and later got an eye mask to keep lights out.) From the self help group I got some material for the practical questions. And read many sad stories of those who need decades to figure it out. Not all doctors know about sleep apnea. But numbers are rising. One danger ignored is professional drivers who cause accidents by being tired. Might account for 7% of the total traffic accidents. But eitherway if you have it treatment is there. The published papers I read (mostly metastudies) usually deal with compliance rates in combination with some other factor. Medical compliance is stupidly low, many people don't use their CPAP even if it works. But I saw no other treatment options that were seriously explored. A nice feature is that CPAP is purely external, so no changes in your body, no operations and no big problems if you forget it occasionally.

To correct the symptom list above: snoring is a common signal, but not all snoring is from APNEA. You can have it checked out, if its a problem. The mean part is the daytime fatigue, which others will usually assume is due to a lazy lifestyle, partying to long or such. It takes a while to make the leap from daytime fatigue - despite extensive sleeping to an actual problem in the sleep.

And one plus point: you look and sound a bit like Darth Vader while sleeping :-)

Comment author: Qiaochu_Yuan 28 February 2014 10:37:08PM 7 points [-]

feeling very tired during the day even if you slept a normal amount the night before.

Crap. Alright, I sleep alone so I don't know if I snore or not, but I can test this with an iPhone app. Thanks for giving me the push I need to do this (I had briefly considered the possibility of sleep apnea before but didn't see any easy next actions).

Comment author: Qiaochu_Yuan 04 March 2014 06:58:14AM 7 points [-]

Update: I had some trouble with the app the first two nights (it stops recording if you exit it in any way), but I have audio evidence that I snore now (I don't know what counts as excessive). Time to go see a doctor about a diagnosis.

Comment author: Eliezer_Yudkowsky 28 February 2014 08:09:35PM 2 points [-]

CPAP (auto-adjusting pressure) didn't work on me. What else is there?

Comment author: MarkL 27 May 2014 06:20:15PM *  1 point [-]

Buteyko breathing [1] and high-intensity interval training [2]. YMMV, etc.

[1] http://store.breathingcenter.com/books---in-english/buteyko-breathing-manual-download

[2] e.g. "sprinting" on an elliptical

Sleep apnea is caused by low CO2 tolerance which causes you to breath off too much CO2, and low CO2 levels relax smooth muscle, including the smooth muscle of your throat (which otherwise should actively maintains your airway at all times). The above two practices increase CO2 tolerance.

(Low CO2 tolerance can be caused by many things (e.g. too much mouth breathing from allergies, jobs which require lots of talking or singing or instrument playing, lots and lots of sitting without exercising, chronic anxiety, etc.)

Evidence:

  1. Personal/anecdotal: Intense jaw clenching, tongue soreness, turbinate opening within a few days of starting buteyko breathing, objectively far less moving around during sleep, subjectively deeper more refreshing sleep.
  2. This is how I think (poorly edited rant): http://meditationstuff.wordpress.com/2013/08/05/rant-thought-stopping-truths-e-g-weight-loss/
  3. Clinical trial(s?) show that Buteyko breathing does stuff (e.g. improves asthma symptoms without increasing lung capacity)
Comment author: MartinB 28 April 2014 01:27:03PM 0 points [-]

Did you go to a Sleeplap? They are supposed to fit it, have a pile of different masks to choose from. As far as I know cpap is the way to go with APNEA.

Comment author: michaelcurzi 10 March 2014 09:23:02AM 0 points [-]

I have two relatives that had apnea - one got rid of it by losing weight, the other by having her tonsils removed.

Comment author: Yvain 01 March 2014 01:11:00AM 3 points [-]

Complicated. I think I'm seeing you tomorrow night, I'll talk to you then rather than demand your medical history on a public forum.

Comment author: Eneasz 28 February 2014 09:12:28PM 0 points [-]

UPPP

Not terribly expensive. The recovery is painful. But the pain is temporary, and the improvements are amazing. It was a major turning point in my life, and I'd strongly recommend it to anyone who is considered a good candidate (consult your specialist)

Comment author: Jonathan_Graehl 28 February 2014 07:28:47PM 1 point [-]

I snore when I'm very tired and sleeping on my back (when my jaw relaxes down in that position it's harder to breathe even through nostrils). Any cheap advice for that (besides don't do it)?

Are there harmless allergy meds that would be worth taking for better sleep when I have mild nasal congestion from seasonal pollen etc?

Comment author: RomeoStevens 28 February 2014 08:20:38AM 1 point [-]

Thanks! I believe it was you who pointed out that longevity is only 20-30% genetics that sent me down this rabbit hole to begin with.

Comment author: TylerJay 28 February 2014 04:40:30PM 1 point [-]

If I remember correctly, Yvain argued for a salt intake lower than 1500mg / day, whereas on your meal squares page, you made an argument for having 3000mg / day. Wy do you think you disagree on that one?

Comment author: RomeoStevens 28 February 2014 08:28:44PM 2 points [-]

Differing takes on which evidence is more valid. Many studies say reducing salt is healthy. A few studies say it is unhealthy, and point to the fact that all the other studies actually say "salt reduces blood pressure" and that it turns out that in this particular case the reduction was not correlated to overall mortality. It would seem that reducing salt has detrimental effects that outweigh the blood pressure effect.

Comment author: [deleted] 02 March 2014 04:12:36AM 0 points [-]

Should people with hereditary low blood pressure ignore most of this advice / do the opposite?

For example it seems processed meats --> increased salt intake --> increased blood pressure --> increased mortality, which doesn't apply to people with low blood pressure.

Comment author: RomeoStevens 02 March 2014 04:18:14AM 0 points [-]

The causal pathway is not necessarily (in fact almost certainly not) exclusively via blood pressure, so I wouldn't do this.

Comment author: [deleted] 02 March 2014 07:15:51AM *  0 points [-]

What proportion of it is through blood pressure and could you elaborate on what the rest of the causal pathway is? Trying to decide whether it's worth cutting down on processed meats even though it may result in less protein intake overall (because I can't be bothered cooking / preparing non-processed meats).

Comment author: RomeoStevens 03 March 2014 05:22:16AM 2 points [-]

I wouldn't venture a quantification. Whey protein and eggs?

Comment author: TimFreeman 28 February 2014 06:10:01AM *  6 points [-]

I have experienced consequences of donating blood too often.The blood donation places check your hemoglobin, but I have experienced iron deficiency symptoms when my hemoglobin was normal and my serum ferritin was low. The symptoms were twitchy legs when I was trying to sleep and insomnia, and iron deficiency was confirmed with a ferritin test. The iron deficiency symptoms went away and ferritin went back to normal when I took iron supplements and stopped donating blood, and I stopped the iron supplements after the normal ferritin test.

The blood donation places will encourage you to donate every 2 months, and according to a research paper I found when I was having this problem essentially everyone will have low serum ferritin if they do that for two years.

I have no reason to disagree with the OP's recommendation of donating blood every year or two.

Comment author: [deleted] 28 February 2014 09:34:14PM 2 points [-]

The blood donation places will encourage you to donate every 2 months,

IIRC, where I am they don't even allow you to donate blood if you've already done so in the past three months or, if you're a fertile woman, in the past six months.

Comment author: Vaniver 28 February 2014 05:06:47AM *  6 points [-]

I don’t care if you start with an exercise habit of one pushup a week, but you must do something.

Beeminder Beeminder Beeminder. Having an email reminder to exercise, and a penalty for not doing so, has been tremendously helpful for me- I now actually lift weights three times a week, as compared to just when I remembered to do so on my own.

Comment author: shokwave 28 February 2014 07:04:26AM 4 points [-]

Counterpoint: Beeminder does not play nice with certain types of motivation structures. I advocated it in the past; I do not anymore. It's probably not true for you, the reader (you should still go and use it, the upside is way bigger than the downside), but be aware that it's possible it won't work for you.

Comment author: taryneast 28 February 2014 09:59:04AM 2 points [-]

Yeah. Beeminder doesn't work for me either - nor do most online punishment-based motivators.

My problem with it is that it doesn't punish you for failing to do the thing you need to do. It punishes you for failing to record the fact that you did the thing you need to do.

So if you're time-poor (like me) and still managed to do the thing... but didn't have time to go online and tell beeminder that you did the thing... you still get punished. :(

Comment author: ThoughtSpeed 28 March 2017 08:12:44AM 1 point [-]

Agreed that this is a problem! Thankfully there are a lot of integrations with Beeminder that automatically enter data. You can hook up hundreds of different applications to it through IFTTT or Zapier.

Comment author: Adele_L 23 March 2014 03:17:27PM 1 point [-]

Yeah, I have the same problem with it. When my productivity went up, I actually went off the road because I couldn't be bothered to record it all.

Comment author: OphilaDros 10 March 2014 06:55:44AM 1 point [-]

The beeminder team sends "legitimacy check" emails if you've derailed on your goal which explicitly asks if it was a case of forgetting to enter the data. I've written in once or twice when I've derailed on account of not entering the data on time and have had quick responses from them, and haven't been punished. Were you unaware you could do this?

Comment author: taryneast 23 March 2014 09:33:52AM 0 points [-]

Kind of. I was aware you could appeal the decision, but I felt that would be an imposition on some poor moderator... and given I'm pretty sure this would occur on a regular basis, decided I didn't want to do that.

What would work for me, would be for a short "grace period" in which we could update the decision ourselves. Like I said - fitocracy gives you a week or so to back-date your past workouts. Of course fitocracy doesn't run with a monetary punishment so it's not as bad for you to backdate...

Basically - I conclude that beeminder's mechanic doesn't fit well enough to my likely usage patterns to be worth it.

Comment author: [deleted] 28 February 2014 09:36:05PM 0 points [-]

Have you checked out their Android and iPhone apps? Also, I think if you have a US cell phone number you can add data via SMS.

Comment author: taryneast 09 March 2014 10:48:28AM *  0 points [-]

That still counts as going online to checkin. Other means of getting online aren't the solution.

If it's 11:30pm and I have to be in bed half an hour ago in order to be up in time for work tomorrow - it doesn't matter how many avenues I could take to get online... I still can't spare a minute to do it.

I prefer fitocracy's approach - you can checkin for something you did within the week, but no further back. For beeminder - even allowing for "actually I did do this yesterday" would be better than the current approach.

Comment author: [deleted] 09 March 2014 05:20:58PM 0 points [-]

a minute

That's an overestimate of the time it takes to submit data via the Android Beeminder app by about an order of magnitude, at least if your phone within reach of hand from your bed.

Comment author: taryneast 23 March 2014 09:38:04AM *  1 point [-]

No. It isn't. Even when my iPad is on my bed.

Generally I must:

  1. open my eyes (after my brain spits up the info that I've forgotten to do it)

  2. grab the iPad

  3. switch it on

  4. swipe and type in my PIN

  5. click the main button to get from my alarm-clock screen to the icon-menu

  6. swipe through menus until I get to the app

  7. load the app

  8. then do the updating on the actual app

  9. double-click the home button co I can:

  10. close the app, then click back on my alarm-clock app

  11. switch off.

  12. put the iPad back in position on the bed

  13. close my eyes

  14. try and get back into the restful frame of mind for sleep that I was in before all this.

I count steps 1-13 as being roughly a minute of time. I reckon step 14 is the doozy...

Comment author: Prismattic 28 February 2014 05:18:00AM 3 points [-]

My workplace has a gym. I generally scarf my lunch at my desk and use my actual lunch hour at the gym. This pretty much guarantees that I will go work out at a more-or-less set time every weekday. Between this and a weekly judo class, I typically exercise 6 days a week, without really having to remember anything. (Downside/tradeoff -- less socialization, which, like exercise, reduces stress)

Comment author: brazil84 27 February 2014 11:53:03PM 4 points [-]

I was pretty surprised about blood donation. My intuition is screaming that it must be one of those correlation/causation things where unhealthy people are discouraged from donating blood, but on the other hand, the researchers are all surely very well aware of this issue and must have taken steps to correct for it.

Anyway, have you thought about typically sub-clinical viruses like cytomegalovirus? I recall reading that a CMV infection cuts a few years from your life expectancy. I don't have research to back it up, but I think it's a good idea to avoid having intimate contact (e.g. casual sex) with lots of people.

Comment author: Lumifer 28 February 2014 01:19:33AM 9 points [-]

I was pretty surprised about blood donation.

Males tend to have iron overload which is bad for you. The easiest way to fix it is to bleed on a regular basis.

Women don't have that problem.

Comment author: G0W51 25 October 2014 01:46:52AM 0 points [-]

I suggest you read this article, which suggests that blood donation doesn't decrease mortality.

What do you (or anyone else) think of it?

Comment author: RomeoStevens 03 February 2015 03:56:15AM 1 point [-]

There is a review floating around where some researchers investigated exactly this claim and concluded that the reverse causation effect only accounted for about 30% of the effect. This is one of those situations where the costs and benefits are a massive enough ratio to make it worth the risk that it isn't doing anything IMO.

Comment author: G0W51 05 February 2015 12:49:42AM 0 points [-]

I tried to find it but failed. Do you recall it's title or authors?

Comment author: RomeoStevens 05 February 2015 06:11:49AM 0 points [-]

Sorry I don't. Don't see it with a cursory search in google scholar either.

Comment author: G0W51 07 February 2015 09:43:08PM 0 points [-]

Oh well. I'll still mention this in Immortality: A Practical Guide if that's okay with you.

Comment author: RomeoStevens 07 February 2015 11:48:47PM *  1 point [-]

Oh if you want to cite it I'll look a little harder.

This review actually seems pretty thorough and reports a negative result (though still positive for people who have already experienced a CHD event): http://circ.ahajournals.org/content/103/1/52.full

They discuss why they think positive results happened in previous studies. I'm updating away from the hypothesis as a result of finding this. Blood donation still has enough other studies showing various benefits and essentially no studies showing harm (except for excessive donation, more than twice a year IIRC) that I think it is worth it, but the mortality effects might not be very high.