Lifestyle interventions to increase longevity

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 12070. 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.