How not to die
Longevity: much more than you wanted to know
Why should you prevent your death? Because there's too much beauty and pleasure to be experienced in your lifetime. Because what if you die one month before scientists find the cure for aging? Or one day before your mind is uploaded to a global server? I'm sure you don't want to miss that. And even if you do, you would prefer to be healthy as long as possible rather than spending the final years of your life in misery.
So, today, we're going to talk about how not to die. Not how to never die, because I, unfortunately, don't have the answer, but how to die as late as possible.
I will spare you the usual "be born to parents with good genes in a rich country" and instead focus on things you have more power over.
I'll assume you're between 20 and 50 in a first-world country and haven't got any medical predisposition. If that's not your case, maybe don't take my advice.
How do people die?
Before thinking about how not to die, we have to look at how people actually die. A quick search on Our World In Data for death causes in the UK in 2017 returns this:
As you can see, cancers and cardiovascular diseases combined killed more people than everything else. All else equal, you will probably die of one of these two things. Your efforts, then, should primarily be focused on preventing these diseases. Luckily, these interventions will likely overlap with other death causes. For example, not smoking reduces chances of cancer and CVD, but also dementia, respiratory diseases, Parkinson's, neonatal disorders, and so on.
Determining the risk factors for cancer and CVD is an arduous task, for which even experts don't have an extensive answer. Luckily, Our World in Data also has a good report on the number of deaths by risk factors, which will support the rest of this post.
What to do?
I will list interventions in order of how important they seem to be and how much evidence supports them.
Don't smoke
Looking at the previous graph, this seems like the most effective lifestyle change and the most actionable one (not saying the easiest.)
I want to highlight a 2013 study from Pirie et al. that features this incredible line:
Among UK women, two-thirds of all deaths of smokers in their 50s, 60s, and 70s are caused by smoking.
If you don't smoke, congrats! If you do, you should probably think about quitting.
It looks like switching to e-cigarettes might be the best intervention possible for your health. E-cigarettes are likely to be harmful but certainly less than regular cigarettes.
I also found this graph on Wikipedia, titled "Percent increase of success for six months over unaided attempts for each type of quitting (chart from West & Shiffman based on Cochrane review data)." It looks like varenicline combined with some sort of support is the most effective way to quit.
Exercise
Exercise is great. As well as preventing diseases and increasing longevity, it also improves shorter-term physical and mental health. That means you don't need to wait until you're old to see the benefits!
There is just so much evidence in favor of exercise for aging that I will throw random studies at you; feel free to explore them further.
Woods et al. "Exercise, inflammation and aging." (2012).
Gremeaux et al. "Exercise and longevity" (2012).
Arsenis et al. “Physical activity and telomere length: Impact of aging and potential mechanisms of action.” (2017).
Pinckard et al. “Effects of Exercise to Improve Cardiovascular Health.” (2019).
Hupin et al. “Even a low-dose of moderate-to-vigorous physical activity reduces mortality by 22% in adults aged ≥60 years: a systematic review and meta-analysis.” (2015)
Rebelo-Marques “Aging Hallmarks: The Benefits of Physical Exercise.” (2018)
But the next question is: how to exercise to improve longevity? Wikipedia:
The majority of the benefits from exercise are achieved with around 3500 metabolic equivalent (MET) minutes per week. For example, climbing stairs 10 minutes, vacuuming 15 minutes, gardening 20 minutes, running 20 minutes, and walking or bicycling for 25 minutes on a daily basis would together achieve about 3000 MET minutes a week.
That's quite a lot, but you didn't think you would be off the hook so easily, did you? Barbell Medicine, one of my favorite sources for exercise and nutrition science, also give this recommendation:
150 to 300 minutes per week of moderate-intensity aerobic physical activity, or;
75 to 150 minutes per week of vigorous-intensity aerobic physical activity, and;
Resistance training of moderate or greater intensity involving all major muscle groups on 2 or more days per week.
Aerobic (often referred to as "cardio") exercise is better for longevity, but resistance ("strength") also helps with a ton of stuff (insulin resistance, resting metabolic rate, glucose metabolism, blood pressure, hormone balance, joint health, organ reserve, depression...). A combination of both seems to be the optimal strategy.
Also remember, there is no minimum amount of exercise that's effective for health. Even working out for 1 minute is better than nothing. Please take every opportunity to be active!
Keep a balanced body composition
Maintaining a healthy body composition is critical to longevity. According to the European Association for the Study of Obesity, "44% of the diabetes burden, 23% of the ischaemic heart disease burden and between 7% and 41% of certain cancer burdens are attributable to overweight and obesity." Furthermore, they argue that "obesity is preventable."
Obesity is often defined by a Body Mass Index of over 25-30 (calculate yours here). If this applies to you, make losing weight your priority.
Calories In, Calories Out is an oversimplification of nutrition science, but it's a good place to start. In short, if you consume more calories than you burn throughout the day, you will gain weight. If you consume fewer calories than you burn, you will lose weight. Begin by figuring out your daily energy expenditure, then adjust the number of calories you consume. Apps like MyFitnessPal or MacroFactor can help you track these.
Additionally, I strongly recommend this guide by Stronger By Science. It is the most up-to-date and exhaustive guide I know for setting up a diet (including calculating your energy expenditure and caloric needs).
If you still struggle to lose weight, consider bariatric surgery or medication.
Adopt a healthy diet
Nutrition science is a mess. There is so much contradictory information and so many potential confounders that it's hard to be sure of anything. However, some claims are backed by more evidence than others.
Here, I will give you the most basic advice possible. If you want to learn more about the specifics, I would again strongly suggest the aforementioned guide.
Eat lots of:
Fruits and vegetables (1)
Avoid:
Sugar (mostly added sugar, don't worry about fruits) (1, 2, 3, 4)
Trans fatty acids (found in fried food, margarine, cookies...) (1, 2, 3)
No specific diet is better than another, as long as it contains enough of the things mentioned in the first list and little of the things mentioned in the second. The Mediterranean diet is often cited as the "healthiest" because it checks these two boxes — but that doesn't mean it's the only viable one!
Avoid air pollution
Cities are great. They allow communities to live closer together and partake in economic activities. But there's one major disadvantage caused by this activity: air pollution. It's sometimes less visible than other risk factors but still deadly. Our World in Data estimates that between 3 and 9 million people die from it every year.
Avoiding air pollution is not always actionable, as you might not be able to move freely because of personal reasons (money, work, relationships).
But, if you can, consider moving to a place with better air quality.
If you can't, buy and use an air purifier for your home and HEPA cabin air filter for your car. You can also wear a mask outside.
Dynomight goes over these topics and a lot more in his great practical guide called "Better air quality is the easiest way not to die."
Avoid alcohol and drugs
Along with more immediate risks like overdoses, car crashes, or falling asleep with the stove on, alcohol and most hard drugs also have long term negative effects.
If you struggle with quitting, there are many useful resources out there. The alcohol treatment navigator is a good place to start.
The "one glass of wine per day is good" claim is very controversial, and I'll probably look into it at some point. For now, I would recommend avoiding alcohol at all costs.
Sleep just the right amount of time
Sleep has an impact on mortality. People who sleep less than 5 hours per night increase their risk of cardiovascular disease by 50% (Ferrie et al., 2007).
But, as counter-intuitive as it may seem and despite what "experts" may tell you, longer sleep duration is also harmful. Study after study shows this (1, 2, 3, 4).
There is a U-shaped relation between sleep quantity and health effects. Even if there could be some confounders for the longer sleep times, such as depression, disease, or unemployment, people who sleep about 7 hours per night have the lowest mortality risk.
Avoid stress
This is somewhat harder to study as the number of confounders here is high. However, we have some good evidence that stress is in itself a risk factor for many diseases.
Paragraph from Wikipedia:
Avoidance of chronic stress (as opposed to acute stress) is associated with a slower loss of telomeres in most but not all studies, and with decreased cortisol levels. A chronically high cortisol level compromises the immune system, causes cardiac damage/arterosclerosis and is associated with facial ageing, and the latter in turn is a marker for increased morbidity and mortality. A meta-analysis shows that loneliness carries a higher mortality risk than smoking. Stress can be countered by social connection, spirituality, and (for men more clearly than for women) married life, all of which are associated with longevity.
Stress also increases inflammation and deregulates your immune system.
But how the hell do you "avoid stress"?
Developing strong relationships with others seems to be the most important intervention for mental well-being. Plus, it gets even more critical with age (Berkman & Syme, 1979). Books like How to win friends and influence people are a good place to understand and practice your social skills.
Also, remember exercise? Well, it's a hell of a drug. It can decrease cortisol levels and is often cited as one of the most effective antidepressants.
Finally, mindfulness, gratitude, spending time in a flow state, and pursuing hobbies are all proven strategies to deal with stress and anxiety.
What else?
Okay, we're done with the main lifestyle interventions. If you stick to these, you should be able to enjoy many years of good health. You can even start experimenting with longevity tactics to increase your lifespan even more, such as fasting, protein restriction, metformin... But these are outside the scope of this article.
However, things can still go wrong while you're young. Look at the causes of death for 15-49 years old in the UK.
Suicide is in third place. I didn't go in depth about depression. Still, you can read Scott Alexander's (a clinical psychiatrist) advice for depression if you think that can benefit you.
If you don't have any genetic or medical precondition in your 20/30s, road accidents are one of your most likely causes of death. A LessWrong user posted an extensive guide on how to avoid dying in a car crash.
Finally, one thing I haven't seen cited before, but which is commonly thought of as a high risk factor, is medical error. It has sometimes been referred to as one of the leading causes of death. McGill University offers a good rebuttal, called Medical Error Is Not the Third Leading Cause of Death. This piece made me update my beliefs considerably. However, it still states that "It is not easy to determine if a particular case of patient harm was preventable or not." With this uncertainty in mind, I strongly recommend staying away from the hospital if you can (e.g., by following the advice given in this article) and marking your body before any big procedure.
Wrap up
Don't smoke.
Be active for at least an hour every day.
Eat fruits, vegetables, fish, nuts, olive oil, and whole grain.
Avoid processed meats, added sugar, and fried food.
Buy an air filter.
Don't drink.
Sleep about 7 hours per day.
See and talk to people.