Lifestyle interventions to increase longevity

[RomeoStevens]

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: 1, 2.

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.

[Gunnar_Zarncke]

I wondered what “processed meat” means exactly and looked it up in one of the studies:

“Red meat” was defined as unprocessed meat from beef, hamburgers, lamb, pork, or game and excluding poultry, fish, or egg; “processed meat” was defined as any meat preserved by smoking, curing, or salting or addition of chemical preservatives, such as bacon, salami, sausages, hot dogs, or processed deli or luncheon meats, and excluding fish or eggs; and “total meat” was defined as the total of these 2 categories.

I also looked up “resistance training,” but it is not clear exactly what is meant, and I have to assume that it is strength training.

I recommend adding this post to the boring advice repository.

[[deleted]]

So is ground beef that is wrapped in a package like this usually processed or unprocessed meat?

[mare-of-night]

Where I’ve heard the term used, it’d be unprocessed. As someone who can’t eat the usual meat preservatives at all for health reasons, I can tell you for sure that typical plastic wrapped hamburger meat isn’t preserved with anything (which, based on the examples, would probably be the reason why processed meat is bad for you).

[Gunnar_Zarncke]

I think it counts as unprocessed.

[CronoDAS]

So a McDonalds hamburger is “unprocessed” meat, then?

[juliawise]

Their website says the ingredients are beef, salt, and pepper.

[Gunnar_Zarncke]

It appears that the beef patties indeed do not contain additives: http://​​designtaxi.com/​​news/​​353751/​​McDonald-s-Reveals-How-Its-Beef-Patties-Are-Made/​​

[Gunnar_Zarncke]

If the beef were created and processed freshly then yes. But as I understand McDonalds the “beef” of the hamburger arrives heavily pre-processed at each “restaurant” and I’d bet that it incorporates salt, artificial smoke, heating, flavoring and what not.

[taryneast]

Does the hamburger incorporate salt?

[Antiochus]

Looks like I’m going to have to rethink my lunches.

[Scott Alexander]

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.

[Qiaochu_Yuan]

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).

[Qiaochu_Yuan]

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.

[Eliezer Yudkowsky]

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

[Scott Alexander]

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.

[Eneasz]

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)

[Mathieu Tarral]

Hey,

you can try this:
https://​​en.wikipedia.org/​​wiki/​​Mandibular_advancement_splint

way less invasive than CPAP, and easier to sleep with

[MarkL]

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)

[MartinB]

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.

[[deleted]]

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

[MartinB]

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 :-)

[Jonathan_Graehl]

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?

[RomeoStevens]

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.

[TylerJay]

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?

[RomeoStevens]

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.

[[deleted]]

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.

[RomeoStevens]

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

[[deleted]]

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).

[RomeoStevens]

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

[RomeoStevens]

Over the last year I have become dramatically better at instilling habits in myself. I posit two main reasons for this. The first is understanding the habit formation process, as summarized by Kaj Sotala here. The second is learning to create plans that are more robust against random failure. I used to model myself as a coherent agent with some set amount of willpower to expend on the various things I found unpleasant. More recently, I model myself as a bunch of sub-agents with different goals. The subagent that tends to make plans for what I’m going to do this week is NOT the same sub-agent that will actually have to do these things. So now I make plans that can take into account a low motivation sub-agent being in charge. Sometimes this is as simple as a part of your plan that says “IF you don’t want to go to the gym THEN you will go to the gym anyway.” Yes, seriously. Sometimes it is making the activation costs of a particular action easier by removing friction from your process. Sometimes it is modeling my future self as an idiot who can’t stop eating cookies and doing things like preemptively throwing cookies away.

How would I actually go about forming a new habit? Let’s use flossing as an example. Trying to remember to floss after I brushed didn’t work. At all. So I had to start strategizing. My sub-agents didn’t have sufficient motivation to care. So I started reading up on the benefits of flossing and looking at images of flossed vs unflossed surfaces in a mouth. This created enough of an emotional connection that I started feeling like I really needed to floss. But I still forgot. Remembering to floss after I brushed was still not working, so I changed it. I put the floss in my room. That way it was available over a much longer period of time in the evening. IF I forgot to floss THEN I would floss in the morning. I thought about positive things while flossing, longevity and building effective habits and having clean teeth. After a few weeks, flossing was finally a habit. I didn’t have to think about it anymore and was able to start working on a new habit.

[AndekN]

Let’s use flossing as an example. Trying to remember to floss after I brushed didn’t work. At all.

I had the same experience for years. Every six months or so I would read an article like this one reminding how important it is to floss, visit a dentist or something similar. Then I promised to myself that from now on, I’d floss daily. And then I’d forget to actually do it.

After reading The Power of Habit (the book Kaj Sotala summarised in his article linked above) I realised that just trying to remember would never work. Instead, I needed to create a cue. I did this by placing the floss in front of my facial cleanser. Then, every evening when I reached for the cleanser (this already was a habit for me), my hand would hit the floss. That reminded me to floss and only after flossing I would clean my face. And it worked. I don’t have to think about flossing anymore: after a month it had become a habit and now, after six months or so it’s starting to feel weird that there was a time I didn’t floss every day.

[LucasSloan]

The first is understanding the habit formation process, as summarized by Kaj Sotala here.

Link?

[RomeoStevens]

fixed.

[pinyaka]

The subagent that tends to make plans for what I’m going to do this week is NOT the same sub-agent that will actually have to do these things. So now I make plans that can take into account a low motivation sub-agent being in charge.

Can you talk more about this? How do you think about sub agents? How do you make plans for them? I mean, do you write plans down, visualize doing something in a particular setting, etc.? What are your planning sessions like?

[RomeoStevens]

I used IFS frameworks at the beginning. http://​​en.wikipedia.org/​​wiki/​​Internal_Family_Systems_Model

Now that I am used to doing it regularly and have built up some internal trust, I can often just ask around internally about how different parts feel about an action and get coherent answers.

[pinyaka]

Thanks, that looks interesting. How did you learn specific IFS techiniques? Did you attend a workshop, work with a therapist, read books, extensively google stuff, etc.?

[RomeoStevens]

Sessions with friends, reading stuff online mostly. I refer to it as psychotherapy lite because it is pretty hard to do wrong. The goal is to explore and see if anything surprising pops up. I might be missing some useful stuff from not having read any of the books yet. But part of the reason I haven’t is because even with the basics I found tons of low hanging fruit.

[Gunnar_Zarncke]

Judging from the votes and quality couldn’t this go to Main? At least with minimum further streamlining?

And if not why not?

[curiousepic]

Now that it’s in Main, I’m wondering why it hasn’t yet been promoted? The current situation is low-visibility, given LW reading trends.

[D_Malik]

On eating more fish: How worried should I be about mercury poisoning? Is it worthwhile to carefully select fish for low mercury content?

For instance, one guy on /​r/​fitness reports that 2 cans of chunk light tuna a day gave him mercury poisoning; while you’re not recommending that much fish, I’d expect that health detriments appear long before full-blown mercury poisoning.

(I’m not expecting you in particular to tell me this, I just want to know if someone on LW has already done this research.)

[juliawise]

For pregnant women, these days they’re recommending oily, low-mercury fish like salmon, herring, and sardines. Chart

[aelephant]

I would recommend against eating canned food to limit your exposure to Bisphenol A.

I would also not eat tuna every single day for such an extended period of time!

[taryneast]

supporting data ?

[aelephant]

Bisphenol A and human health: a review of the literature

[taryneast]

I can’t access the actual article, though the abstract certainly indicates that BPA is harmful.

Does the article include evidence showing that eating canned food is a significant exposure risk?

What kinds of cans specifically? what kinds of foods?

Are there other significant sources of BPA?

[aelephant]

Here’s a randomized trial from JAMA showing more than 1000% increase in urinary BPA after consuming canned soup: http://​​www.ncbi.nlm.nih.gov/​​pmc/​​articles/​​PMC3367259/​​

BPA used to be in a lot of plastics, but I think it has been phased out. Perhaps someone else can confirm or refute that.

Another source is transdermally through handling receipts. I’ve heard of at least one health conscious workplace giving their cashiers wooden tongs to handle the receipts. Best practice would probably be to email them instead. Saves paper too.

[RomeoStevens]

Oh yeah, salmon is easily the best for health benefits AFAIK. I should include this in the post.

[Prismattic]

Must be wild salmon, not farmed salmon. The difference in Omega ³⁄₆ ratio is immense.

[[deleted]]

Is tuna all right if I have a hard time getting salmon? I can get tuna salad at the grocery store or tuna sandwiches for lunch comparatively easily, but salmon can be expensive here.

[[deleted]]

I was going to recommend kipper, but this says it’s not that much better than tuna. It’s still better, at least in terms of mercury.

This PDF says canned sardines have 1 gram EPA+DHA per 100g, whereas herring has slightly more and tuna is all over the place.

Not very good evidence for kipper vs. sardines (I buy kipper just because I can’t stand sardines, though I’ll look out for salmon now that it’s been mentioned), but either looks to be preferable to tuna.

[RomeoStevens]

Tuna has among the highest mercury content per serving IIRC.

[LucasSloan]

The health benefits of fish outweight the health detriments of mercury until way beyond the level of consumption you’re likely to get to.

Just eat fish.

[Lumifer]

The health benefits of fish outweight the health detriments of mercury until way beyond the level of consumption you’re likely to get to.

Supporting data..?

[zedzed]

(edited to add sources) (edited to add music-nerdery)

Reviewing my notes from Wiseman, I can add the following recommendations for stress:

*Listen to classical music. Actually, if you check the study, only major, baroque music was helpful. I recommend the Brandenburg concerti.

*Spend at least 30 minutes outside on warm, sunny days.

*Laugh at least 15 minutes a day.

*Source: Music can facilitate blood pressure recovery from stress.

*Source: A warm heart and a clear head. The contingent effects of weather on mood and cognition.

*Source A correlational study of the relationship between sense of humor and positive psychological capacities

*Source The Effect of Mirthful Laughter on the Human Cardiovascular System

(background: I’ve trained in classical cello for 11 years. What follows has an inferential distance of 1 for me, and an inferential distance of quite a lot for a layperson. You should probably move along)

If you check out the music study, you’ll notice that it talks about “classical” music, while I’m specifying “major, baroque”. Here’s why.

Classical and baroque music are different. Colloquially, “classical” refers to old music that typically gets played by violins and pianos and flutes and stuff. If you’re versed in music history, “classical” refers to music from the classical period, which has certain defining characteristics that make it quite distinct from other periods, like the baroque period, much like heavy metal and blues quite distinct genres with their own defining characteristics.

The original study used Spring by Vivaldi and Canon in D by Pachelbel as “classical” music. If you’re a layperson, these are perfectly representative pieces of classical music. If you’re a music nerd, these pieces will tell you a lot about the effect of major, baroque music on blood pressure, but generalized to classical music is analogous to saying something like “all vertices of a square form right angles, thus the vertices of all quadrilaterals form right angles.”

Baroque music is different from classical is different from jazz. We know (major, baroque) works and jazz doesn’t; everything else is different enough I’m sketched out about generalizing from baroque to that. Here’s why I’m fine with generalizing from (Vivaldi, Pachelbel) to (major, baroque), but not to the rest of classical.

Baroque music is noticeably lighter than more contemporary music because of (the bows, lack of endpins, use of harpsichord instead of piano, gut instead of metal strings, smaller ensembles, different wind instruments, fewer types of brass instruments, less overpowering brass instruments).

Also, baroque music tends to use just intonation, whereas more contemporary music tends to use equal temperament, and the music tested. This may be important because JI sounds better, even if it’s less flexible. (Physically, JI sound waves a low-reducing integer ratios of each other, whereas ET sound waves form ratios of powers of the twelfth root of 2 of each other, so instead of having 3:2, you have 1:2^(7/​12))

I specify major because it’s more consonant (physically, in major and minor JI, sound waves reduce to low integer multiples of each other; in major, they tend to reduce more, so instead of having 5:4, you have 6:5).

So, until somebody goes out and tests Mozart Symphony no. 40, you’re overstating your case if you claim the study I cited extends to anything beyond major, baroque music. Fortunately, all of the Brandenburg concerti are major and written by Bach, the preeminent baroque composer.

[[deleted]]

*Laugh at least 15 minutes a day.

Does it matter which kind of laughter? Is laughing with others a lot better than doing it alone? Is schadenfreude laughter as good as any other kind of laughter?

[jobe_smith]

That’s a good question. What if it turned out that laughing maniacally after committing an act of villainy was the healthiest of all? Would that change people’s views about altruism?

[TheOtherDave]

I don’t know if it’s healthy, but I find maniacal laughter quite satisfying. Fortunately, I do enough theatre and similar performance that I have many opportunities for it.

[CCC]

Hmmm. It would be sufficient for the maniacal laughter to take place; technically, the villainy is unnecessary, as long as the necessary parts of the brain can be fooled.

One way to do this would be with a computer game; playing civilisation (for example), betraying your computer-player allies, and then laughing maniacally about it.

Alternatively, for more of a challenge (in case overcoming difficult opposition turns out to be a necessary element), one could play a game against human players (Diplomacy might work well here) and laugh maniacally if one achieves victory. (Since the game is structured in such a way that at least one player must eventually achieve victory, someone will have the opportunity to gain the health benefits of the maniacal laughter; one may have additional opportunities during the game to laugh maniacally as well).

[Emile]

Obligatory.

[zedzed]

People who spontaneously use humor to cope with stress have especially healthy immune systems, are 40 percent less likely to suffer a heart attack or stroke, experience less pain during dental surgery, and live four and a half years longer than average… Participants’ blood flow dropped by about 35 percent after watching the stress-inducing films, but rose by 22 percent following the more humorous material.

[benkuhn]

Are you referring to the “Mozart Effect” studies? That’s what I found in the book (or at least the parts of the preview that were accessible), but Mozart is actually classical, not baroque. The effect seems to be small and specific to one particular type of task, according to this Nature meta-analysis:

Rauscher et al. 1 reported that listening to ten minutes of Mozart’s music increased the abstract reasoning ability of college students, as measured by IQ scores, by 8 or 9 points compared with listening to relaxation instructions or silence, respectively1. This startling finding became known as the ‘Mozart effect’, and has since been explored by several research groups. Here I use a meta-analysis to demonstrate that any cognitive enhancement is small and does not reflect any change in IQ or reasoning ability in general, but instead derives entirely from performance on one specific type of cognitive task and has a simple neuropsychological explanation.

As a side note, if you’re going to cite studies it would be great to continue Romeo’s trend of actually linking to the relevant studies, since there’s not enough info in your comment to find the ones you’re referring to and I don’t own Wiseman. I don’t really trust Wiseman (or pop-sci books in general) to interpret findings with anything remotely resembling rigor.

[zedzed]

See edit.

Thanks for suggesting I put in sources. It didn’t occur to me, but it really should have.

I generally don’t trust pop-sci either, but Luke recommended Wiseman repeatedly, and since I trust Luke, I see Wiseman as a way of getting useful results without the work of reading all the science myself, much the same way I just give to Givewell’s recommended charities rather than evaluate them myself. I could, but they have a comparative advantage, and I’m guessing you’ll agree doing the verification is expensive. If there’s a flaw in this reasoning, I’d appreciate a head-ups. Thanks!

[benkuhn]

For clarity, I don’t trust Wiseman since I’ve never read anything and my prior for pop-sci is low. Luke’s endorsement is a positive update to his credibility.

Fully verifying is expensive, but spot-checking is cheap (this post took me about 10 minutes, e.g.). Similarly, most people barely check GiveWell’s research at all, but it still matters a lot that it’s so transparent, because it’s a hard-to-fake signal, and facilitates spot-checking.

Re: music—it looks like you were referring to a different study on the benefits of listening to music than the one I found in Amazon’s preview of Wiseman. “Listen to classical music ” would have been another high-VoI addition to the OP.

Further studies indicate that “self-selected relaxing music” has the same effect, and that it’s probably mediated by general reduction of SNS arousal. This suggests that (a) if you’re doing an SNS-heavy task, like difficult math, you may not want to listen to music at the same time; (b) anything else you would expect to move you around the autonomic spectrum should work the same way (e.g. meditation). On the other hand, neither of the studies asked subjects to do anything while listening to music, so it’s unclear whether the effect would stay visible. A possibly interesting meta-analysis is here. If doing anything while listening to music makes the effect go away, then I would guess that meditation or the autonomic-spectrum navigation that CFAR teaches is a more efficient way to reduce blood pressure.

I don’t know if Wiseman went into any of those in his book, but my take-away is to do some research before installing any new habit.

[Will_Sawin]

Difficult math is SNS-heavy?

[benkuhn]

At least according to Val, activating System 2 requires SNS activity.

[Anomylous]

Anecdote: My mom once tried to invoke the Mozart effect by putting on his music while me and my sister were doing schoolwork, hoping that it would make us more productive. It had just the opposite effect—we sat there and enjoyed the music, rather than doing our math assignments.

[Vokasak]

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.

[Angela Pretorius]

You appear to be very knowledgeable about vaping. Can I ask you for some personal advice?

My husband tried to switch to e-cigs on several occasions. Every time he was back to smoking within a couple of days. He has been using cheap clearomiser e-cigs, and he says the vape liquid leaks into his mouth and leaves a nasty taste, and I suspect that the nicotine content of his vape liquid is too low.

I have been trying to persuade him to try buproprion or more expensive e-cigs or vape liquid with a higher nicotine content.

These are the replies that I usually get: ‘I can quit without bupropion. I am smoking at the moment because of stressful event X, and I will quit on date Y when my life will be less stressful’ ‘I will have the same problems with the expensive e-cigs’ ‘I’m not really addicted to nicotine. I am just a puffer and I don’t draw the smoke deep into my lungs. I only smoke to keep my hands busy/​deal with stress/​keep me awake at work.’

[RomeoStevens]

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

[NancyLebovitz]

Sunlight leads to less cardiovascular disease. (nitric oxide)

Sunlight leads to less cardiovascular disease Vitamin D.

And see if you can have someone in your life who can advocate for you in medical matters if you’re not in good enough shape to advocate for yourself. (Anyone know if deeply incompetent medical care is as bad a problem in countries which aren’t the US?)

[[deleted]]

Are there any decent vegetarian substitutes for fish?

[RomeoStevens]

No. If you are a vegetarian for moral reasons consider how your personal consumption impacts suffering on the margin and maybe consider at least drinking milk.

[[deleted]]

Is it that we don’t know what makes fish so effective, or we do know and can’t get it any other way?

[ephion]

The main benefits of fish are high protein content and most of the fats are essential omega-3 fatty acids, including the protective EPA and DHA which are mostly unavailable in plant form. The omega-3 fatty acid ALA, which is available in many plans, only gets converted at a rate of 2-10%. If you wanted to get 2g/​day of EPA+DHA, you’d need to consume 20-100g of ALA, or 37-186g of flaxseed oil.

[[deleted]]

What about algae oil?

I’m also looking at krill oil. My vegetarianism is approximately Peter-Singer-When-He-Still-Ate-Mussels (http://​​www.wesleyan.edu/​​wsa/​​warn/​​singer_fish.htm), and I’m pretty sure Krill are simple enough that there’s no disutility in consuming them, but I’m having trouble finding anything definitive.

[RomeoStevens]

I have a general heuristic in my diet of “if you need to process ten thousand of something to get the amount you want to eat, don’t do that.”

[juliawise]

What about yeast? This seems like a silly heuristic.

[RomeoStevens]

I’m not at all confident eating lots of yeast is great for our gut bacteria.

[trist]

Perhaps the reference is to “nutritional yeast”, which are all dead, and won’t impact your gut bacteria aside from being provided with more nutrients.

[juliawise]

I was thinking of bread, actually. Not that bread is the greatest for you, but the problem isn’t the yeast (which are dead, anyway).

[Lumifer]

Replace yeast/​bread with yogurt, then.

[RomeoStevens]

it would be reasonable for, by yourself, to create yogurt. It would not be reasonable for you by yourself to produce canola oil.

[Lumifer]

And how is this relevant to the discussion?

[RomeoStevens]

one is processing 10,000 of something to get an edible amount. One is letting some warm milk sit with a starter culture.

[ephion]

For which respect? Tempeh is a great source of vegetarian protein and micronutrients, as fermentation removes all the nasty stuff from soy. Algae supplements have a good bit of the n-3 fatty acid DHA and EPA, but are extremely expensive with average prices being $60/​mo for the recommended 2g EPA/​DHA per day. Contrast this with $8/​month for fish oil of the same power.

[gimpf]

Very late update: In the meantime products have become available with an EPA/​DHA ratio of ~ ³⁄₂ (prev. it was always ¹⁄₂). Price for monthly dose remained the same.

[James]

On this topic, I’m a bit concerned about the argued support for fish eating. RS writes,

‘Pescetarians live significantly longer than vegans,[4] lending support to fish consumption.’

But this doesn’t follow. Does fish consumption make a difference vs. lacto/​ovo vegetarianism? If not, there’s no support for fish consumption (but perhaps milk/​eggs).

The cited study (from the abstract) seems to rate longevity between each group equally, at least from ischemic heart disease, indicating no effect:

‘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...’

Briefly checking wikipedia and other sites, I can’t find significant support for fish-eating vs lacto/​ovo vegetarianism, but I’d be interested to hear if I’m missing something.

In addition to pure health issues, I’m also concerned that eating fish will have a high disutility, for you get less kg of meat per death. Brian Tomasik has had a stab at crunching the numbers here: http://​​reducing-suffering.org/​​how-much-direct-suffering-is-caused-by-various-animal-foods/​​.

That treats all animal pain as equal, and finds that farmed salmon results in estimated 200x more suffering than beef per kg. You may want to factor in sentience complexity, indirect effects, pain responsiveness, etc. But the intuitive problem is that it would have to be massively less bad to eat fish vs most mammals to conclude that it’s better to eat them, for their relatively lower mass will mean killing many more to achieve the same amount of meat.

Of course, the moral disutility of fish-eating is distinct from its health effects. I only raise it in case people want to consider balancing disutility of production with utility gained from health benefits, if any, from consumption.

[RomeoStevens]

Average is the same for lacto-ovo and for pescatarians but the CI is narrower for pescatarians. The lacto-ovo CI is just barely significant. I’m not covering normative issues in this post as it is a massive topic.

[Vaniver]

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.

[shokwave]

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.

[taryneast]

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. :(

[Adele_L]

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.

[ThoughtSpeed]

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.

[OphilaDros]

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?

[taryneast]

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.

[A1987dM]

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.

[taryneast]

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.

[A1987dM]

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.

[taryneast]

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…

[Prismattic]

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)

[TimFreeman]

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.

[A1987dM]

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.

[TylerJay]

Great article. Lots of really good information. A few questions:

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.

Does anyone have a link to this full study? I’d like to see the full data. The abstract is confusing. It says you would need ” two- and ninefold higher doses of EPA and DHA, respectively, if administered with capsules rather than salmon,” but it’s not clear which numbers you need to multiply by those factors… The amounts in the 100g of salmon or the amounts in the 1 or 3 fish oil caps? If it’s the amount in the 3 caps, then that comes out to 900mg EPA and about 2700mg DHA, which is about 3 and a half grams. That’s achievable in 6 high-quality caps and doesn’t seem like it’s at a level where you’d be in any danger of blood thinning… Do you have a good resource I can read to get more information on the blood thinning effects and when they might be dangerous?

I noticed you didn’t really include anything on the fat content of a diet and its effects on CHD and Lipid Profile. As I understand it, omega-6 fatty acids are harmful in the amounts that most people in Western countries eat, even when not oxidized. On the face of it, this study appears to suggest that in CHD patients, bringing the omega-6 to omega-3 ratio down to 4:1 was associated with a 70% decrease in total mortality. I think it’s likely that the omega-6 : omega-3 ratio is important and that supplementation of omega-3 likely achieves many of its benefits by bringing this ratio back into balance (since people typically have very low omega-3 intake). Reducing intake of omega-6 from seed oils like corn oil, soybean oil, and sesame oil seems likely to have similar beneficial effects.

On that note, really the only thing that jumped out to me about your meal squares is the high PUFA content. If you ate 5 servings to reach 2000 calories, you’d be getting 18g of PUFA, most of which is omega-6 and not much is EPA/​DHA which are likely the only omega-3s your body can actually use effectively. It not being oxidized is definitely an important factor, but omega-6 is inflammatory and (as far as I can tell) negatively affects blood markers even without being oxidized before you eat it. Besides that though, I’m really impressed with it. Good luck.

[RomeoStevens]

We’re going to be replacing our current sunflower seeds with high oleic acid versions which will bring us down to under 5% of calories from PUFA.

Do you have a jailbroken version of that study anywhere? That’s a really large effect, and the best evidence against PUFA yet if true.

[Mqrius]

The maximum total energy from PUFA has been a discussion point with DIY Soylent makers as well. The final consensus was that it should definitely be below 10%, and possibly below 4%. The 4% figure comes from The perfect health diet, which uses this as a source:

Angela Liou Y, Innis SM. Dietary linoleic acid has no effect on arachidonic acid, but increases n-6 eicosadienoic acid, and lowers dihomo-gamma-linolenic and eicosapentaenoic acid in plasma of adult men. Prostaglandins, Leukotrienes and Essential Fatty Acids 2009 Apr;80(4):201–6, http://​​pmid.us/​​19356914.

I’ve also got a copy hosted at http://​​forecast.student.utwente.nl/​​Lesswrong/​​ but only download that if your university or company legally gives you access to Elsevier content.

For the discussion and links to other relevant papers, see http://​​discourse.soylent.me/​​t/​​optimal-micronutrient-ratios/​​5049/​​52 and further posts

For my Soylent, I ended up getting most fats from macadamia oil (mostly Omega-9 aka MUFA) and MCT oil (Medium-chain saturated fat), since they don’t have any negative effects associated with them. Correct me if I’m wrong.

[Mqrius]

My university has access to the paper. I’ve got it hosted on my server, but you’re only allowed to download it if you have legal access through your university as well. If you have legal access, feel free to click this link:

http://​​forecast.student.utwente.nl/​​Lesswrong/​​The%20importance%20of%20the%20ratio%20of%20omega-6%20omega-3%20essential%20fatty%20acids.pdf

[TylerJay]

I don’t, unfortunately. I thought it looked really high as well. The wording of the abstract seems to indicate that it was an observational/​epidemiological study, not an RCT, but you can never really tell from the abstracts.

[erratio]

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.

[Eliezer Yudkowsky]

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.

[CCC]

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.

[scav]

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.

[iarwain1]

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.

[oge]

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)?

[iarwain1]

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.

[timujin]

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?

[RomeoStevens]

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

[timujin]

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

[RomeoStevens]

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

[octopocta]

I’m very surprised that there is no mention of a low-dose aspirin regime here. Low dose aspirin can greatly reduce chances of stroke, heart attack, and cancer. The main caveat is that there is increased chance of bleeding or stomach ulcer, the latter of which can be avoided by taking with food.

[RomeoStevens]

I looked into the numbers and it’s a wash for people under 45. The risks are greater than often presented, likely because the marketing is targeted at people at heightened risk who really do need to be convinced to take it.

[gwern]

I looked into the numbers and it’s a wash for people under 45.

Link? (Perhaps you didn’t take into account the roughly 5 year lag before the reductions start becoming visible?) My own reading of the meta-analyses is the opposite: that while not studied very much, the cost-benefit is probably even more positive than for older people since the all-cause mortality reduction does not seem to vary by age, the benefits seem to be cumulative/​have that lag (so you want to start before the cancer/​death risks start going up), younger people have far more DALYs to lose, and the risk of bleeding increase substantially in the 70s and higher. No one seems to show any increase in risk or reduction in effect extrapolating from the ~50yo cutoff in most studies, and at least some people like Rothwell are raising the question of suggesting baby aspirin use for the middle-aged.

[RomeoStevens]

My impression was that when looking at subgroups the low risk groups didn’t show any significant risk reduction, and that the higher your risk profile goes the more you reduce risk[1]. So I guess a 5 year lag implies it would be reasonable to start taking it at 40. But an individual has access to better predictors than population wide analysis of age cohorts. The problem is that there is no easy way to judge the balance of risks as you age. Mortality from GI bleeding is low, but not that low[2]. I would hazard a guess that someone who gets regular blood panels and finds themselves leaving the very low risk cluster of parameters (ApoA:ApoB, CRP, high BP) it is probably on net worth it.

1. http://​​www.nejm.org/​​doi/​​full/​​10.1056/​​nejm199704033361401

2. http://​​www.ncbi.nlm.nih.gov/​​pmc/​​articles/​​PMC3309903/​​ (table 4)

[curiousepic]

Is it worth it to carry around aspirin to take if you even worry you might be having a heart attack, for people under 45?

[RomeoStevens]

carrying a small first aid kit in your day bag is pretty reasonable.

[Nornagest]

I’m not a doctor, but my understanding is that aspirin won’t do anything for a heart attack once it starts—the possible benefits are prophylactic, not curative, and come from low doses over time.

[Lumifer]

If you worry about having a heart attack, there are better things than aspirin to carry with you.

[Vaniver]

there are better things than aspirin to carry with you.

This post would be much more helpful if you had listed those things. The only thing I’m seeing suggested besides aspirin is nitrates of some form, which appear to be prescription.

[Lumifer]

This post would be much more helpful if you had listed those things.

I am not a doctor and I don’t want to give medical advice to unknown people over the ’net.

If curiousepic has a medical condition that causes him to have a well-founded fear of a heart attack, he really should ask his doctor—who, among other things, will know what that condition is and can write prescriptions.

[Vaniver]

I am not a doctor and I don’t want to give medical advice to unknown people over the ’net.

Wouldn’t it be better to say something like “ask your doctor, who can give you answers tailored to your medical history,” then?

[Lumifer]

No. It is a condescending answer which provides no information. My answer points out that things better than aspirin exist but leaves open the question of what would actually be appropriate for the OP. Essentially, it tells him to explore the matter further.

[Vaniver]

It is a condescending answer which provides no information.

Why do you think it’s condescending?

My answer points out that things better than aspirin exist

But is that true? As far as I can tell, the other things that are available are recommended to people who cannot take aspirin for whatever reason, and so to call them “better” seems not quite right.

Essentially, it tells him to explore the matter further.

But saying “explore the matter further” in response to someone saying “is X worth it?” seems profoundly unhelpful, especially when you don’t actually say that, compared to saying “explore the matter further by talking to your doctor” or “explore the matter further by looking into miracle drug X.”

[James_Miller]

Examine.com is much less positive about CoQ10 writing “all the noticeable effects (more vitality) could potentially be placebo. It is very much a faith buy and the costs if you take it in the wrong manner (without a fatty transport) could be quite high financially.”

[RomeoStevens]

mean decrease in systolic pressure over 8 studies of 16mm Hg kicks the crap out of a lot of interventions, including some prescription ones.

[PeterDonis]

Are there any theories about the mechanism involved here? I’ve done a fair bit of Googling about this but haven’t found any discussion of underlying mechanisms, only the statistics. I know that CoQ10 is critical in the metabolic cycle that produces ATP, and therefore is involved in energy production everywhere in the body; but I’m not sure how to get from that to the specific result of lowering blood pressure (rather than something more general like “feel more energetic”).

[RomeoStevens]

The fact that blood pressure is an independent predictor of mortality would imply it affects, and is most likely affected by, a lot of metabolic processes.

[CellBioGuy]

From my own looking around I would recommend adding CoQ10 if you are on statin anti-cholesterol medications. They interfere with its recycling within your body, and while there’s a reason that the active part of CoQ10 is called ‘ubiquinone’ (its in EVERYTHING that was once alive) its plausible that levels might drop enough to mess with higher metabolic levels if you are on these drugs. Source: anecdotal evidence and a recent study that seemed to show that statin drugs cause people to stop getting cardiovascular benefits from aerobic exercise.

[brazil84]

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.

[Lumifer]

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.

[khafra]

Those of us disqualified from donating blood should probably try to get into some form of exercise that involves a lot of blood loss; like skateboarding over sharp rocks, fencing with un-foiled blades, or taunting apex predators in their natural habitat. A new Ev-psych explanation for why men engage in this sort of activity more than women!

[Nornagest]

Huh, a plausible longevity argument for Mensur fencing. Never thought I’d see that in the wild.

(Snark aside, I imagine it’d be rather difficult to find a hobby that reliably takes a pint of blood a year and doesn’t kill or seriously injure you.)

[Lumifer]

I imagine it’d be rather difficult to find a hobby that reliably takes a pint of blood a year and doesn’t kill or seriously injure you.

Pet leeches :-P

[maia]

Hmm. Do the studies account for this?

Also, that would mean women on medication that stops their period also might have this problem.

[Vaniver]

Also, that would mean women on medication that stops their period also might have this problem.

Indeed; also post-menopausal women.

[CellBioGuy]

Wouldn’t necessarily call it iron overload, but definitely higher levels.

Hmmm… as someone who is a carrier for hemochromatosis (thanks 23andme!) perhaps I should consider this more than the average person...

[Lumifer]

Wouldn’t necessarily call it iron overload

I thought it was a pretty standard term.

[CellBioGuy]

Yes it is, but generally for rather more clinically significant levels. The difference between men and women exists but is much much smaller than the difference you get from, say, hereditary hemochromatosis. Ordinarily I hate nomenclature quibbles but labelling the normal state of half the population as a pathology seems out of place.

[Lumifer]

Well, nobody claims all males suffer from iron overload.

On the other hand, the correlation between blood donation and mortality seems to suggest that there is a nontrivial amount of people (very likely males) with “clinically significant levels” who are probably not aware of that fact.

[G0W51]

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

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

[RomeoStevens]

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.

[G0W51]

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

[RomeoStevens]

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

[G0W51]

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

[RomeoStevens]

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.

[G0W51]

Keep in that one of blood donation’s supposed mechanisms is to prevent iron overload, but only ~0.5% of the population has iron overload to begin with. See ChrisT’s comment.

[Lumifer]

My post mentions a specific reason—iron overload—which is bad for you. Blood donation fixes that problem if it exists.

That particular argument does not rely on correlations at all.

[G0W51]

Your post also mentioned that males tend to have iron overload. I find this to be suspect, as if males tended to have iron overload, the study would have probably found that blood donation decreases mortality.

That said, for those who do have iron overload, blood donation likely does fix that.

[Lumifer]

I don’t know how prevalent iron overload is. It might well be rare enough so that its effects are lost in the noise. I wasn’t claiming that donating blood is necessarily healthy, my point was rather that mechanisms (not correlations) by which blood donation could be useful for health exist.

[G0W51]

If you don’t know how prevalent iron overload is, then you can’t know that men tend to have it, so I suggest editing you comment to say “some men have iron overload” instead of “men tend to have iron overload.”

[ChrisT]

Iron overload /​ haemochromatosis occurs in approx 0.5% of the population of Northern European origin (and less in other ethnicities). Undiagnosed and untreated the iron will build up in the liver and other organs and cause a variety of unpleasant side effects. Venesection is the standard treatment, though I suggest that less than 0.5% of the population is not significant enough to explain the other studies.

Source: http://​​www.haemochromatosis.org.uk/​​index.html

[D_Malik]

Also relevant to longevity are supplements for reducing the cognitive decline that comes with aging, such as piracetam.

[AlexSchell]

I can’t donate blood where I live. Perhaps I should look into good old-fashioned bloodletting.

[michael_b]

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?

[Anders_H]

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”

[michael_b]

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”

[ChristianKl]

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).

[michael_b]

Fair point.

[RomeoStevens]

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

[RomeoStevens]

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?

[michael_b]

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?

[RomeoStevens]

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.

[IlyaShpitser]

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

---

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

[IlyaShpitser]

Heh, do you know who Anders_H is?

[John_Maxwell]

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.

[John_Maxwell]

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.

[Xodarap]

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”.)

[RomeoStevens]

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.

[A1987dM]

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.

[RomeoStevens]

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.

[Xodarap]

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.”

[RomeoStevens]

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.

[Xodarap]

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.

[RomeoStevens]

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.

[orthonormal]

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

[RomeoStevens]

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

[orthonormal]

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?

[RomeoStevens]

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.

[Qiaochu_Yuan]

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.

[Wei Dai]

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?

[RomeoStevens]

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.

[Pablo]

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.

[RomeoStevens]

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.

[Pablo]

Do you mean that the CR evidence is bad, or that it’s bad that the evidence for methionine restriction is weaker?

[RomeoStevens]

“CR works in humans” evidence is bad. “CR works in primates” is bad. “CR works in mice” is shakier than it has been presented.

[Pablo]

“CR works in humans” evidence is bad. “CR works in primates” is bad. “CR works in mice” is shakier than it has been presented.

I don’t think this is an accurate characterization of the state of the evidence. See here for a rigorous examination of the relevant issues.

Also, it seems inconsistent to dismiss the evidence for CR in humans as “bad” and yet praise intermittent fasting (IF), given that (1) IF has been studied much less extensively than CR, (2) IF hasn’t generally shown health benefits comparable to those of CR, and (3) it is generally believed that the benefits that IF does confer are explained by its ability to mimic CR.

[RomeoStevens]

My praise for IF can not be based on longevity considerations because the evidence simply isn’t there. It is based on shorter term considerations regarding blood markers that should lead to better health outcomes, as well as quality of life considerations.

I read the linked examination of various CR studies, if anything I am even more dubious than before. There are simply way too many free parameters in the studies that have been done so far for me to feel confident in their results. CR requires an extraordinary lifestyle change that induces some changes that seem quite bad (hormonal and immune system), it would take excellent evidence of benefit to be worth these downsides. The methionine evidence seems even more preliminary, and I’m not going to get rid of nutrient dense food items in my diet based on it until there is stronger evidence.

I’d specifically point to the “Diminishing returns hypothesis” section of the paper as representative of my impression across all studies so far.

[Pablo]

It is based on shorter term considerations regarding blood markers that should lead to better health outcomes, as well as quality of life considerations.

We observe even better blood markers (and other biomarkers) on people doing CR. My point is that there is no relevant line of evidence that provides stronger support for IF than for CR. So it’s hard to square your claim that the evidence for CR is bad with your praise for IF.

Upon reading your second paragraph, it now seems to me that you are actually using different evidential standards to assess these two dietary interventions, on the grounds that one (but presumably not the other) “requires an extraordinary lifestyle change”. I think however that it’s much clear to keep the evidential question (“does CR work?”) separate from the practical question (“should I try CR?”), and use consistent evidential standards across the board. Once you reach a position about the degree to which the existing evidence supports the claim that CR has various health benefits, you can then proceed to tackle the issue of whether the benefits are worth the costs. And note that methionine restriction doesn’t require anything remotely like the sacrifices required by CR, so we should clearly keep the two questions separate in this case.

[RomeoStevens]

We observe even better blood markers (and other biomarkers) on people doing CR.

No we don’t, we see immunosupression, elevation of some stress markers, and sex hormones crashing. The stronger support for IF is that you can lead a normal life and meet all the usual criteria we use for assessing health. With CR we improve some markers for health at the cost of others and hope we have chosen the correct ones to downgrade in our estimation of effectiveness for longevity.

If I based lifestyle changes on studies with similar levels of evidence to methionine restriction, I would be pulling a Ray Kurzweil and taking dozens of supplements. Rat/​mouse models should NOT inform lifestyle changes. Their purpose is to explore hypothesis space cheaply.

[Pablo]

Rat/​mouse models should NOT inform lifestyle changes. Their purpose is to explore hypothesis space cheaply.

Your epistemology seems flawed. We have multiple lines of evidence and a proper Bayesian agent will take these all into account. This is especially the case when certain types of evidence will only be available after a period of several decades or even several generations. In such cases, we need to rely on the limited evidence we have at present.

In any case, your original point was that the evidence for methionine restriction was worse that the evidence for CR, which you claimed was “pretty bad”. Yet your grounds for concluding that the evidence for CR was “pretty bad” were partly based on practical considerations which do not apply to methionine restriction, so that argument doesn’t really work.

[RomeoStevens]

Let’s drop CR for now then and focus on Methionine. The hypothesis here is that I should be dropping foods with known health benefits like salmon[1] and whey[2] from my diet based on a rodent model. I can’t find any studies on human methionine restriction, do you have any pointers? Also, is there any reason I couldn’t achieve the same effect with a methionine inhibitor like SAMe? Another plausible idea is that methionine is not a problem itself but is merely a symptom of a different issue, such as glycine deficiency (we don’t eat connective tissue much anymore).

[1] http://​​circ.ahajournals.org/​​content/​​109/​​22/​​2705.short

[2] http://​​www.ncbi.nlm.nih.gov/​​pubmed/​​21338538

[Pablo]

The dairy meta-analysis you provide was supported by the “Dairy Innovation Australia Limited”, which makes me skeptical of their findings, given the multiple ways in which data can be aggregated to yield specific conclusions, and the evidence documenting the degree to which financial incentives can affect scientific findings. I haven’t looked at the other study, but I’m happy to accept that the evidence for the health benefits of fish is strong.

I haven’t researched the literature on methionine restriction extensively, but here’s a paper I found after a quick Google Scholar search.

More generally, I think having answers to questions of the following sort would be very helpful in these discussions: “To what degree do hypotheses confirmed by non-human animal models are later vindicated by experimental studies?” and “To what degree do hypotheses confirmed by correlational human studies are later vindicated by experimental studies?”

[IlyaShpitser]

“To what degree do hypotheses confirmed by correlational human studies are later vindicated by experimental studies?”

That depends on what you mean by a ‘correlational study.’ People who analyze observational data with causality in mind spend a lot of time thinking about potential confounding and what to do about it. For example, here’s an analysis of a very large longitudinal dataset with the aim of determining a causal effect:

http://​​www.hsph.harvard.edu/​​wp-content/​​uploads/​​sites/​​1138/​​2012/​​09/​​ije_2009.pdf

which does very sensible things. If you look at sensible analyses of observational data, then ‘the vindication rate’ will be related to how often the needed assumptions actually hold. If you look at non-sensible analyses (e.g. that aren’t adjusting for confounder bias, and so on), then it’s just garbage, no reason to expect better than chance then.

[RomeoStevens]

“To what degree do hypotheses confirmed by non-human animal models are later vindicated by experimental studies?”

Not sure of actual base-rate but I know it is very poor, which is why most researchers don’t take animal models very seriously.

“To what degree do hypotheses confirmed by correlational human studies are later vindicated by experimental studies?”

Not sure, I think also very poor, but having a measure of this would be very valuable.

[orthonormal]

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.)

[RomeoStevens]

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

[RomeoStevens]

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

[Xodarap]

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?

[RomeoStevens]

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.

[Lumifer]

this meta analysis is the best data we have

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

[RomeoStevens]

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.

[Lumifer]

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

Random example thought not meta.

[RomeoStevens]

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.

[Xodarap]

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.

At last, we have reached convergence! I disagree slightly (the most recent article you linked again does not find significant differences between vegans and vegetarians as far as I can tell) but I’m fine calling that “slight evidence”. The problem was that the OP said:

Ovo-lacto vegetarians live significantly longer than vegans

Which doesn’t sound like it’s true in either the statistical nor the colloquial sense of the word. Right? So can we just remove that sentence pretty please?

[RomeoStevens]

Sure, seems reasonable.

[waveman]

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

[Jiro]

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?

[Lumifer]

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.

[[deleted]]

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.

[Creutzer]

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

[[deleted]]

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.

[Lumifer]

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.

[[deleted]]

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.

[Lumifer]

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.

[brazil84]

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?

[ephion]

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).

[RomeoStevens]

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?

[ephion]

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.

[brazil84]

Would you mind posting a self-pic?

[RomeoStevens]

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

[waveman]

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.

[brazil84]

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.

[brazil84]

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.”

[brazil84]

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.

[Eliezer Yudkowsky]

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.

[RomeoStevens]

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.

[John_Maxwell]

Some mouthwashes may be risky

[Dorikka]

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).

[zedzed]

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.

[Anders_H]

I don’t know anything about whether this product causes heart attacks, but any mouthwash containing cetylpyridinium chloride may cause horrible stains on your teeth. Check out the customer reviews on Amazon, where this mouthwash has a one star average rating. I can testify from personal experience that this phenomenon is real, and not some negative marketing campaign instigated by their competitors: I used this mouthwash for less than a month, and it took my dental hygienist almost an hour to remove the stains.

[Anders_H]

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.

[gwern]

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)...

[Anders_H]

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.

[IlyaShpitser]

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.

[John_Maxwell]

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

[brazil84]

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.

[RomeoStevens]

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

[brazil84]

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.

[RomeoStevens]

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

[A1987dM]

The ToC makes it looks like “blood donations” and “exercise” are among “things that will eventually kill you”...

[Gunnar_Zarncke]

Changing bed cloth once a week.

This recommendation is not in the list and I heard about it the first time just now:

Huffington Post: This Is What Happens If You Don’t Change Your Bed Sheets (And how often the average person actually does it.)

I can’t vouch for it but the potentially long list of benefits—and the long time you spend in bed—same as the arguments for mattresses—make this a potentially high-value intervention.

[ChristianKl]

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

[RomeoStevens]

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).

[Gunnar_Zarncke]

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?

[RomeoStevens]

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

[ChrisHallquist]

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.)

[RomeoStevens]

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.

[[deleted]]

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.

[Pablo]

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:

[ephion]

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.”

[Pablo]

• 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).

[fubarobfusco]

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.

[Pablo]

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.

[shokwave]

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.

[Pablo]

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.

[Jiro]

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.

[A1987dM]

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

[Jiro]

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.

[Nornagest]

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.

[A1987dM]

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

Who eats 30 grams of spinach and then stops?

[Jiro]

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.

[RomeoStevens]

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.

[Lumifer]

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.

[RomeoStevens]

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.

[CurtisSerVaas]

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.

[Lumifer]

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.

[Nornagest]

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.

[Lumifer]

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.

[Nornagest]

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.

[Pablo]

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.

[Lumifer]

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.

[Pablo]

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.

[Lumifer]

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.

[Pablo]

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.

[Lumifer]

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?

[Vaniver]

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

According to Linnaeus…

[Pablo]

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.

[Lumifer]

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?

[Jonathan_Graehl]

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.

[Pablo]

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.

[Shmi]

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

[ephion]

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.

[framsey]

What do you think of the health effects of too much sitting? That seems to be a hot topic recently. http://​​www.mayoclinic.org/​​sitting/​​expert-answers/​​faq-20058005

[RomeoStevens]

Breaking up long sitting periods with stretching and walking around is a safe bet, but the studies are actually less clear than the editorials on them would lead you to believe.

[CurtisSerVaas]

I’d love links to some of the studies!

[Gunnar_Zarncke]

I missed a section on sugar (even if it just says that this is not covered or e.g. link to http://​​lesswrong.com/​​lw/​​je5/​​critiquing_gary_taubes_part_3_did_the_us/​​ )

ADDED: And a sentance about caffeine.

[RomeoStevens]

While average sugar consumption is certainly too high, a lot of nutrition concerns seem to be overblown for how large their actual effect size is. Of course, hopefully increased fruit consumption is having a substitution effect on other sugars in the diet.

[waveman]

Downvoted so I should say why.

1. Citation required.

2. When I saw Professor Lustig’s talk (http://​​www.youtube.com/​​watch?v=dBnniua6-oM) and followed up the literature I personally cut my sugar intake from average (almost all from fruit by the way) to low. Consistent with his claims, my cholesterol (particularly LDL), triglycerides, and inflammatory markers fell dramatically, to the point that my doctor told me this is good but we don’t want cholesterol any lower.

The authorities recommend limiting sugar intake. One issue is that modern processed foods are full of sugars, in part to make “low fat” foods tolerably palatable, so you are probably getting more than you think. Even some canned sardines I bought the other day has added sugar. Also be aware of the various euphemisms for sugar (HFCS, fructose, sucrose, etc).

inb4 I have no citation.

[Lumifer]

I personally cut my sugar intake from average (almost all from fruit by the way) to low. Consistent with his claims, my cholesterol (particularly LDL), triglycerides, and inflammatory markers fell dramatically

It is pretty clear there is WIDE individual variation in response to low carbs.

Low-carb and paleo forums are full of people who eat none or very little sugar and their lipid panels horrify mainstream doctors. See e.g. this or this.

[RomeoStevens]

My physical and mental performance improved when I went from VLC to a more moderate 150ish grams a day. My HDL, Triglyceride, and c-reactive protein numbers are great, and my total cholesterol is 220, which is right in the middle of the lowest risk group. We see pretty much every hunter gatherer group using tubers extensively, along with some fruit, as a carb base.

[Lumifer]

As far as I know going VLC will (typically) push both your LDL and HDL numbers up and will drastically lower your trigs. CRP is an inflammation measure, not part of the lipid panel.

We see pretty much every hunter gatherer group

You mean “We see pretty much every tropical hunter gatherer group”. The Inuit/​Eskimos obviously don’t.

[RomeoStevens]

The Inuit are a fairly large outlier in dietary makeup.

[Richard_Kennaway]

Then it is all the more important to see how well or badly they do on their diet.

[waveman]

My experience also. I formed the view, based on how I felt, that if I stayed on very low carb for much longer I would die, and a little bit of clean starch really made all the difference.

[waveman]

Low-carb and paleo forums are full of people who eat none or very little sugar and their lipid panels horrify mainstream doctors.

Indeed. Healthy nutrition is not a matter of making a single choice, and individuals vary greatly in their responses to foods and drugs. (As one example: Green tea puts my blood pressure -up-, quite a lot, up to 12 hours later).

Lustig is making two main points I think:

1. Carbs aint carbs. Fructose in its various forms is more like a saturated fat metabolically than a carb.

2. The safe dose of fructose is pretty low for most people.

I haven’t heard him advocate VLC.

The most important point is that carbs aint carbs.

[Lumifer]

Carbs aint carbs

True, but then fats ain’t fats as well -- different fatty acids have rather different effect on humans. Which is also true of different amino acids...

[RomeoStevens]

Very low LDL is predictive of greater mortality, not less.

[waveman]

I was not clear; the inflammatory markers were super-low but LDL wasn’t. Just low enough.

I had had exteremely low LDL in the past and I did not want to feel that way again eg tendency to depression, low tesosterone etc.

[waveman]

To be clear I did not go very low carb. I continued to eat ~2 apples a day or equivalent, and several small potatoes or equivalent.

[Gunnar_Zarncke]

Very good post.

How I plan to act on it:

• reduce processed meat further (but not unprocessed meat)

• consider adding some restance training to my exercise (once I figure out which fits best and needs no weights etc.; probably http://​​en.wikipedia.org/​​wiki/​​Bodyweight_exercise )

• check my blood measures with you info in mind

• consider yearly blood donation

• More exposure to sun

I already ordered an e-cig to give to an acquaintance.

[[deleted]]

OP said that you shouldn’t publicly commit to your plan because it makes you less likely to do it. Can I ask why you decided to do so anyway?

[Gunnar_Zarncke]

because it makes you less likely to do it.

Why do you think so? From procrastication and other advice I took it that publicly committing to a plan makes you more likely because or social pressure. What did I get wrong?

[[deleted]]

Why do you think so?

It’s slightly counterintuitive, but studies say that this is what happens. I’ll just paste a few paragraphs from the article linked by OP:

Tests done since 1933 show that people who talk about their intentions are less likely to make them happen.

Announcing your plans to others satisfies your self-identity just enough that you’re less motivated to do the hard work needed.

In 1933, W. Mahler found that if a person announced the solution to a problem, and was acknowledged by others, it was now in the brain as a “social reality”, even if the solution hadn’t actually been achieved.

NYU psychology professor Peter Gollwitzer has been studying this since his 1982 book “Symbolic Self-Completion” (pdf article here) - and recently published results of new tests in a research article, “When Intentions Go Public: Does Social Reality Widen the Intention-Behavior Gap?”

Four different tests of 63 people found that those who kept their intentions private were more likely to achieve them than those who made them public and were acknowledged by others.

Once you’ve told people of your intentions, it gives you a “premature sense of completeness.”

You have “identity symbols” in your brain that make your self-image. Since both actions and talk create symbols in your brain, talking satisfies the brain enough that it “neglects the pursuit of further symbols.”

A related test found that success on one sub-goal (eating healthy meals) reduced efforts on other important sub-goals (going to the gym) for the same reason.

[A1987dM]

TED talk: Derek Sivers: Keep your goals to yourself

[TylerJay]

I’m confused here too… Commitment and Consistency pressure are well-researched and documented phenomena...

[[deleted]]

Derek Sivers has argued that “announcing your plans to others satisfies your self-identity just enough that you’re less motivated to do the hard work needed”.

The page includes links to studies, but I haven’t read them yet

[Gunnar_Zarncke]

Update

• I reduced processed meat

• I did donate blood today and created a yearly schedule.

• I forgot about sun exposure :-(

[ephion]

Why avoid weights? They’re the most efficient and effective way to do strength training. Bodyweight exercises are OK but they fairly quickly top out on any benefits, unless you get rings and other gymnastic equipment.

You can get a barbell and 300lbs of weights for under $300 used, with which you can do deadlifts, overhead press, and barbell rows. That’s a complete, full body routine of scalable difficulty which will last you for quite some time and requires no other equipment.

[Gunnar_Zarncke]

Why avoid weights?

Because they take space, are no fun, cannot be combined with useful activity and often encourage too simple movement patterns.

The only weights I’d consider are those to be worn on arms and thighs and can be continuously worn and are combined with all movements.

[ephion]

You appear to possess some misconceptions about weight training.

they take space,

A stack of plates with the barbell stored vertically takes 0.2m^2 (~2sqft). Here’s a picture of a 330lb set for demonstration; wine bottle and keyboard for scale. I have a lot more equipment than just the barbell, but that’s because I do powerlifting and it’s a hobby.

are no fun

This is a matter of perspective and preference. I find weight lifting to be extremely fun, especially the sport of powerlifting. Furthermore, it has no bearing on the fact that weight training is the most effective and efficient means of getting stronger.

cannot be combined with useful activity and often encourage too simple movement patterns.

The deadlift, overhead press, and row are three of the most fundamental movements a person can do. In sports science terms, these are highly general movements, which means that increasing strength in these movements will have positive carry over to every other physical pursuit that uses similar movements. Runners use the deadlift to improve their running speed, for example, and throwers use the overhead press to improve their throwing distance. Your assertion that they can’t be combined with useful activity is incorrect, as they are useful activity. And they don’t encourage too simple movement patterns, as they increase the strength of all movement patterns.

I would agree that weight training can be an ineffective choice, if you limit your exercises to machines and single-joint isolations and use too many sets/​reps with too little resistance. If you deadlift, overhead press, and barbell row for 3 sets of 3-5 reps 3 times per week and progressively add weight, then you’ll get strong much faster and with less time spent exercising than on any no-equipment routine.

[waveman]

I would agree with this. I have found weightlifting (“Starting Strength” program is a good place to start) tremendously beneficial in real life applications. Eg helping my brother dig trenches at his house, lifting things into the car, my back problems have gone away, I am a lot more flexible and agile etc. Also my blood pressure is a lot better (117/​77 this morning).

Key points:

1. Full body compound exercises. Not “curlbro” isolation exercises.

2. Weights not machines (I tried machines and found that specific muscles got big but I did not gain real world strength).

3. Progressive increase in load.

4. Sufficient rest days. For health purposes 1-2 workouts a week is quite sufficient. It will not get you “toned for summer” in minimum time but you will get good benefits.

5. Good form—do the lifts properly. And allied to this, do not rush. Newbie gains are good for 6-8 months and then you will slow down no matter what you do. If you take your time you will avoid injury. Lifting weights is one of the safest forms of exercise statistically.

6. Sufficient nutrition—a nutrient rich diet with sufficient protein and other nutrients.

Unfortunately most personal trainers have minimal training and often give bad advice. You need to do some research.

[Lumifer]

A stack of plates with the barbell stored vertically takes 0.2m^2 (~2sqft)

Storage isn’t the real problem. You need, for example, a floor which will survive 300+ lbs of steel dropped onto it from more than six feet. Lifting weights without a spotter or a rack is risky, especially for beginners.

The deadlift, overhead press, and row are three of the most fundamental movements a person can do.

Weightlifters keep on saying that, but I see no sense in this. Why in the world, say, an overhead press is a “fundamental movement”?

If asked about highly general fundamental movements, I’d probably say run, climb, swim.

[ephion]

Storage isn’t the real problem. You need, for example, a floor which will survive 300+ lbs of steel dropped onto it from more than six feet.

Unless you’re doing olympic weightlifting (at which point you’d be using rubber bumper plates), you’ll need to drop weights from hip height at most. Any weight you can overhead press, you can safely lower slowly to the ground. A 300lb deadlift will have two 150lb contacts with the floor—if your floor isn’t built to withstand 150lbs of force (an average person jumping), then it’s not fit to live on.

Lifting weights without a spotter or a rack is risky, especially for beginners.

For the bench press or squat, yes. For the deadlift, overhead press, and row, no. In the deadlift and row, the weight is never over you, and in the event of failure, dropping it is simple and easy. For the overhead press, a failed weight is still light compared to a person’s ability to control it to the ground. Furthermore, you should almost never be training to the point of failure if your goal is strength.

Weightlifters keep on saying that, but I see no sense in this. Why in the world, say, an overhead press is a “fundamental movement”?

In an overhead press, you 1) use your shoulders and triceps to move the weight up, 2) use your abs and back to stabilize your torso, 3) use your legs to balance yourself and stay in line, 4) brace your entire body to transmit force from the floor to your hands. Increasing the weight used increases the demand placed upon the entire body to develop strength.

How can that not be a fundamental movement? And how could improving these four points not have carry over to other tasks and movements?

If asked about highly general fundamental movements, I’d probably say run, climb, swim.

These are actually fairly specific movement patterns, even though they’re rather common. If you only trained running, you would not improve your squat much—but if you trained squatting, you’d improve your running, jumping, kicking, and any other motion that involves leg or hip extension. If you train climbing, you won’t help your swimming much—but if you train rows or chinups, you’ll improve both.

Someone runs across a field—using leg and hip extension trained in the deadlift and maintaining good posture also developed by the deadlift. They swim across a river—using pulling muscles developed by the row and pushing muscles developed by the overhead press. They climb up a cliff—using pulling muscles developed by the row, and push themselves over the ledge using muscles developed by the overhead press.

Sports scientists have very good ideas about what has broad carry over (ie general exercises/​movement patterns) and what has limited carry over (ie sport specific movements). The idea is termed specificity. Strength training is very general, which means that it has very broad carry over to other activities. Elite weightlifters have very impressive vertical jump and sprint speeds, despite never training for these events.

[Lumifer]

Any weight you can overhead press, you can safely lower slowly to the ground.

In theory. In practice (especially with beginners) you lose your balance or you get a sudden pain or something else happens—and you would just throw the barbell on the floor.

if your floor isn’t built to withstand 150lbs of force

Force isn’t measured in pounds. What matters is momentum and contact surface. Drop your 300 lbs barbell even from hip height onto a wooden floor and it will leave dents.

How can that not be a fundamental movement?

Maybe we have a different idea of what “fundamental” means :-)

I am not arguing that weightlifting doesn’t develop muscles or that muscle strength isn’t useful. I just don’t see why, say, climbing a tree is less “fundamental” than taking, essentially, a very heavy stick and raising it over your head.

[A1987dM]

A stack of plates with the barbell stored vertically takes 0.2m^2 (~2sqft).

What about the bench?

[ephion]

You don’t need a bench. Overhead pressing (and push pressing for intermediate trainees) is sufficient to develop pushing power, and is a better movement for balanced shoulder strength and posture. If you really want to develop the chest muscles, then you can do floor press for most of the same benefits without purchasing a bench.

[brazil84]

Why avoid weights?

For what it may be worth, I avoid weights because I want something I can do every day, any time, anywhere. Because I know that if I miss one day, there’s a good chance I will fizzle out.

So I do pushups, crunches, and pullups. I have a pullup bar at work which fits into the door frame and the same thing at home. But sometimes I do pullups on the subway or on one of the many scaffoldings in NYC.

Using weights might very well be superior in some respects but for me the main thing is consistency.

[Gunnar_Zarncke]

The section “How to actually form new habits” is small and doesn’t fit in well. I recommend removing it or making it into a separate post or add it as a comment. There are some posts on this topic already that might be referenced roughly falling into the How To Actually Change Your Mind category.

[Velizar]

The linked study for processed meat is a dead link, but it’s on archive.org or alternatively this is a working link: https://​​pubmed.ncbi.nlm.nih.gov/​​20479151/​​

There is a problem with it, though. This is from the abstract:
> Conversely, processed meat intake was associated with 42% higher risk of CHD (n=5; relative risk per 50-g serving per day=1.42; 95% confidence interval, 1.07 to 1.89; P=0.04)

P=0.04 is way too high and my subjective probability for it replicating is somewhere below 50%.

[qbolec]

Why do you think exercise improves health? Is it just an educated guess (if so, then what is the reasoning behind it), or is there actually some study establishing causality? I found https://​​bjsm.bmj.com/​​content/​​52/​​14/​​890 which says:
> As presented by Kujala, RCTs, the gold standard in epidemiology for inferring causality, have failed to provide conclusive evidence in this context (eg, Lifestyle Interventions and Independence for Elders,⁸ Look Action for Health in Diabetes,⁹ Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training¹⁰ and other large-scale meta-analyses).

OTOH I’ve found https://​​www.fightaging.org/​​archives/​​2018/​​04/​​finding-a-causal-relationship-between-exercise-and-longevity-in-human-data-is-more-challenging-than-one-might-imagine/​​ claiming that
> It is straightforward enough to prove that exercise extends healthy (but not average or overall) life span in studies of mice. (...). It is felt that these correlations likely reflect causation because of the extensive animal studies and the essential similarities of biochemistry between the mammalian species involved, but that isn’t the same thing as a rigorous determination.

[ancientcampus]

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.

[John_Maxwell]

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.)

[brazil84]

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.”

[soreff]

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

[RomeoStevens]

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.

[brazil84]

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

[Oscar_Cunningham]

Could you use the standard font and fontsize please?

[John_Maxwell]

I standardized a bunch of the formatting. Will try to do more visual polish in the next few days.

[CAE_Jones]

I am considering writing a program that will launch this page in my web browser every few hours.

(While most of these interventions are things with a surprisingly high cost in terms of stress, the one I like the least but am least stressed about is the recommendation to eat more fish. I am not a fan (nor much of an enemy) of fish. I will gladly save any recommended recipes that manage to include fish and all its benefits without making it overly obvious that I’m eating fish. I could always try and self-modify so that I no longer treat fish as pretty far down the preferred meat hierarchy, but using it in something more desirable in general sounds way more fun. Bonus points if it’s something well balanced.)

[ephion]

Have you had a seared tuna steak? Cooked properly, it’s one of the tastiest things I’ve ever eaten.

[Alejandro1]

Here is a very simple recipe for fish that doesn’t feel like fish. I made it yesterday :). In addition to being simple, it is easily tweak able/​optimizable for your tastes and dietary needs. All quantities are rough approximations:

Throw in a pot 1 onion (chopped), 4 celery sticks (chopped), 1 potato (diced), 2 cod fillets, and 2-3 cups of watered tomato sauce. (The one I use is a super-simple homemade one: 2 tablespoons tomato paste, 2 tablespoons olive oil, 2 cups water, 1 tablespoon sugar, and salt and pepper to the taste). Bring to the boil and simmer until cooked. (I do it in a pressure cooker, where it takes 20-25 minutes. In a normal pot it would take longer and you probably need to use more water). And there you have it. The defining taste is the celery in tomato sauce; the fish (which breaks down) and the potato are just white chunks in it giving the feelings of protein and starch without changing the taste. Makes 3-4 servings.

[RomeoStevens]

You can get sashimi delivered to your house frozen for around $25 a pound.

[atorm]

That seems really expensive.

[roystgnr]

If you refer to “fish” rather than a particular species (or at least to “red fish” vs “white fish”?) then I have to wonder which varieties you’ve tried. There are significant enough differences between tuna, cod, salmon, and tilapia, for instance, that I would not be surprised to find a person whose liked/​disliked any combination of the four.

[A1987dM]

If you refer to “fish” rather than a particular species (or at least to “red fish” vs “white fish”?) then I have to wonder which varieties you’ve tried. There are significant enough differences between tuna, cod, salmon, and tilapia, for instance, that I would not be surprised to find a person whose liked/​disliked any combination of the four.

Do all kinds of fish have the same health effects, BTW? What about molluscs and crustaceans?

[juliawise]

Chart

[Alicorn]

I like to drown my slab-in-the-oven type fish in hollandaise sauce, or garlic, or both. Ceviche is surprisingly easy and can be full of non-fish flavors, especially if you use a mild (sushi-grade) fish and plenty of avocado and onion and put it on nice crackers.

[NancyLebovitz]

What do you want concealed about fish?

Would small bits of fish cooked in a strong-flavored sauce be enough to make the experience less fishy?

[[deleted]]

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.

[RomeoStevens]

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.

[John_Maxwell]

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.

[Vaniver]

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.

[[deleted]]

Are you planning to do a post on nutrition later?

Are waterpiks as good as flossing?

[RomeoStevens]

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.

[iarwain1]

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.

[CronoDAS]

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

[arundelo]

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.

[CronoDAS]

I mostly have problems with #1.

[EHeller]

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.

[RomeoStevens]

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.

[CronoDAS]

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

[iarwain1]

Listerine doesn’t work vs gingivitis for me.

[RomeoStevens]

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#

[CronoDAS]

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.)

[[deleted]]

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.

[Jonathan_Graehl]

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.

[RomeoStevens]

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.

[Vaniver]

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.

[G0W51]

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.”

[Vaniver]

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.

[G0W51]

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.

[ChristianKl]

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.

[CronoDAS]

A word of warning about eating fish: lots of kinds of fish are contaminated by mercury. My psychiatrist ate sushi regularly and he ended up with mercury poisoning. :(

[Error]

Melatonin pills work for many, but make sure you start with 75mcg (cut these into fourths), rather than the 3mg most pills come in.

Why is it important to use the lower dose? (I started using 3mg pills after reading recommendations here, and they work excellently)

Don’t publicly commit to your plan in the comments, this makes you less likely to do it

This one surprised me. It’s the exact opposite of advice I’ve seen elsewhere here on social precommitments.

[mare-of-night]

I remember seeing another LW member comment that over-the-counter drugs tend to get sold in too-high dosages because people who don’t know how to dose (most customers) assume the strongest is best, and the stores stock the versions that are selling best, leading to doses that are too high for the typical user being the most commonly sold ones. I don’t remember where the original comment was, unfortunately.

[Error]

That makes sense but doesn’t actually answer my question. The phrasing implied (to me) that either the smaller dose works better or that the larger has more side effects, without specifying which. I’ve tried 1mg pills and they didn’t seem to work as well, but I’m not sure if that was placebo talking or not.

[RomeoStevens]

For many smaller doses do work better than larger doses, though I don’t have the cite handy. Better to start too small and work up than the other way around IMO. When I took large doses I had negative side effects.

[fubarobfusco]

This is a press release, but might be a pointer in the direction of the study.

[witzvo]

this is the insomnia study for that press release

[Douglas_Knight]

Does the word “cite” mean that you have seen a controlled study claiming that smaller doses are more effective than large doses, and not just anecdotes?

[RomeoStevens]

Yes. or at the very least there were issues with side effects and tolerance building.

[mare-of-night]

This makes sense. I don’t know the answer, though.

[RolfAndreassen]

the highest plurality

Excellent post, so naturally I nitpick the language… anyway, ‘plurality’ means “largest fraction but not a majority”. So “highest plurality” is redundant.

On the subject of exercise: What intensity are we talking about for the endurance? Is it sufficient to bicycle, or do you need to work up a lot of sweat?

[RomeoStevens]

I have a whole post on optimizing exercise parameters, it will probably go up friday.

[advil]

Coenzyme Q10 is a mitochondrial energizer that has shown remarkable effects against common heart ailments and neurological disorders. In just the past year, scientists have uncovered specific mechanisms indicating that CoQ10 may have a role in fighting certain cancers. Most surprising, however, are new studies that show how CoQ10 guards against a wide array of common age-related disorders. In this article, we summarize recent discoveries that significantly broaden the clinical utility of CoQ10.

[Lumifer]

SPAMMITY SPAM SPAM WITH SPAM ON TOP

[Ixiel]

Out of baked beans?

[Lumifer]

Nope, green eggs :-P