Healthspanner.org

The healthspan long list

Every practical recommendation on the site, grouped by domain and ordered by how much each one actually moves mortality and healthspan. The complete checklist for a healthy midlife adult.

This is what to actually do. Each item links to the page that justifies it. Groups are ordered roughly by impact in a healthy midlife adult; items inside a group follow the same logic. Nobody reads a checklist front to back — skip around.

A quick orientation:

  • The first three groups — harm avoidance, exercise, sleep — capture the bulk of the achievable mortality reduction. Get these right and everything else is fine-tuning.
  • Nutrition, mind, sensory, hormesis, beverages add measurable but smaller increments.
  • Clinical screening and prescription pharmacology only earn their place when biomarkers or symptoms point at them.
  • Supplements are gap-fillers, not longevity drugs — five clear the bar, almost everything else is hype.

1. Avoid the four biggest harms

These are the largest preventable mortality levers in a midlife adult. The other groups assume you've addressed these first.

  1. Don't smoke; quit at any age. Combustible tobacco is the single largest preventable-mortality lever in modern medicine. Cognitive and cardiovascular trajectories improve regardless of quit age. Non-combustible nicotine carries its own risks — treat it as harm reduction, not a free habit. See Smoking and nicotine.
  2. Drink as little as possible. The "J-curve" cardio-protection has collapsed under Mendelian randomization; cancer risk rises from the first drop. If you currently drink, less is better — Canada's 2023 guidance puts the lower-risk threshold under 2 drinks/week. See Alcohol.
  3. Screen yourself for sleep apnea. Severe untreated OSA roughly doubles all-cause mortality and is dramatically underdiagnosed in midlife. Take the STOP-Bang questionnaire; if you score ≥3 — especially with snoring, hypertension, atrial fibrillation, or BMI ≥30 — get a home sleep study. CPAP at ≥4 h/night cuts cardiovascular events. See Sleep-disordered breathing.
  4. Don't sit through the day. Hours of essentially motionless sitting carry an independent mortality and cognitive risk that one workout doesn't undo — lipoprotein lipase activity collapses within hours of stillness. Break up sitting every 30–60 min (the 20-8-2 rule), defend a daily-step floor near 7,000, and treat NEAT as its own lever. See Sitting.

2. Train: cardio, strength, mobility — and vary it

Cardiorespiratory fitness is the single best clinical predictor of all-cause mortality; resistance training is the only non-pharmacologic intervention that reliably reverses sarcopenia and moves bone density. Both compound.

  1. Lift 2–3 times a week, heavy enough to matter. Compound movements (squat, hinge, press, pull), 2–4 sets × 5–10 reps for strength. A 2019 meta-analysis showed about 21% lower all-cause mortality at just 1–2 sessions/week. The LIFTMOR protocol — twice-weekly compound lifts above 80% 1RM plus jumping drop landings — is the bone-density evidence base, with clinically meaningful gains at the lumbar spine and femoral neck even in already-osteopenic adults. See Resistance training and Bone density.
  2. 150–180 minutes of zone-2 aerobic per week. Conversational pace, spread across 3–6 sessions — walking, cycling, jogging. Builds the mitochondrial and metabolic-flexibility base that VO₂ max work sharpens. See Zone 2.
  3. Add one or two VO₂ max sessions weekly. 4×4 minutes near max with 3-minute rests, or shorter sprint intervals. A 1-MET increase in cardiorespiratory fitness reduces all-cause mortality by roughly 11–17%, with no upper ceiling in the Cleveland Clinic cohort of 122,000 adults. See VO₂ max.
  4. Defend ~7,000 steps a day. The 10,000 figure is 1960s marketing; the empirical optimum plateaus around 7,000. Cumulative cardiometabolic risk reductions track step count up to that point and not much beyond. See Sitting.
  5. Mobility and balance, 10–15 min daily. Single-leg work, hip mobility, thoracic rotation, ankle dorsiflexion, grip strength. Multifactorial balance training cuts falls by ~24% in older adults; falls in midlife are a leading reversible cause of late-life disability. See Mobility and balance.
  6. Vary your modalities. A 2026 BMJ Med analysis of 111,000 adults found about 19% lower mortality at matched volume when exercise was varied across modalities — not just more of the same.
  7. Don't ignore recovery. Protein, sleep, and managing chronic stress are part of training, not separate from it. Excessive chronic high-volume endurance training — sustained over decades — carries a small but real signal for atrial fibrillation and coronary calcification.

3. Sleep: duration, regularity, environment

Short, fragmented, or misaligned sleep predicts cardiovascular disease, dementia, metabolic disease, and all-cause mortality. The dose-response is U-shaped: 7–8 hours on a regular schedule is the optimum.

  1. Anchor your wake time. Same time every day, weekends included. The CNS adapts to consistent waking, not to consistent sleep onset. Sleep regularity outperformed duration as a mortality predictor in the 2023 Windred Sleep analysis. See Circadian rhythms.
  2. Get morning light within an hour of waking. 10–30 minutes outdoors is the strongest zeitgeber there is.
  3. Aim for 7–8 hours. The U-shape is real on both ends — short and long sleep both raise mortality.
  4. Dim the evening; cool the bedroom. Reduce screens and overhead light 1–2 hours before bed; sleep at 18–20°C with blackout curtains and no glowing electronics. The natural core-temperature drop is what initiates sleep.
  5. No caffeine 10–12 hours before bed. Half-life is 5–6 h; varies meaningfully by genotype. See Coffee.
  6. No alcohol within 3 hours of bed. It hastens sleep onset but fragments architecture and suppresses REM.
  7. For chronic insomnia, start with CBT-I, not pills. Digital programmes (Sleepio, Somryst) have RCT support and outperform drugs in head-to-head trials. Z-drugs and benzodiazepines — especially after age 50 — raise falls, fractures, cognitive impairment, and dementia risk. See Treating chronic insomnia.
  8. Avoid OTC antihistamines as sleep aids. Diphenhydramine (Benadryl, ZzzQuil) is anticholinergic; chronic use is associated with cognitive impairment.
  9. A 20-minute power nap is fine; an obligatory 90-minute nap is a warning. A daily long nap in midlife is an independent signal for cardiovascular disease, dementia, and earlier death — usually pointing at underlying poor nighttime sleep or undiagnosed OSA. See Daytime naps.

4. Eat the pattern, hit protein, limit the harms

Dietary pattern outperforms any individual macro or "superfood." Mediterranean, MIND, and DASH agree on the core: lots of plants and fish, minimal ultra-processed food.

  1. Default to a Mediterranean pattern. Vegetables, legumes, fish, nuts, olive oil, whole grains, fruit; optional moderate dairy (yogurt, cheese); modest poultry. PREDIMED cut major cardiovascular events by ~30%; pooled cohorts show ~2–3 years of life-expectancy gain in top-quintile adherence. See Dietary patterns.
  2. Eat fish 2+ times a week. Fatty fish — salmon, sardines, mackerel, herring — gives EPA+DHA at a dose that obviates the supplement.
  3. Hit protein targets. 1.2–1.6 g/kg/day for active midlife adults; the upper end past 65. Per meal aim for ~0.4 g/kg, rising to 30–40 g past 65 because older muscle responds less to a given dose. The 0.8 g/kg RDA is inadequate for healthy aging. See Protein.
  4. Cut ultra-processed food. Every 10% of daily calories from UPF associates with ~10% higher all-cause mortality. The 2025 UCL crossover trial confirmed the harm persists even when fat, sugar, salt, protein, fibre, and produce intake are matched. See Ultra-processed food.
  5. Limit added sugar to under ~25 g/day. WHO sets 10% of calories as the upper limit; added sugar dose-responsively accelerates validated biological-age clocks. Sugar-sweetened beverages are the worst single delivery vehicle. See Sweeteners.
  6. Limit red meat; minimize processed meat. Cap unprocessed red meat near ~3 servings/week (the WCRF upper bound, roughly 350–500 g cooked); treat processed meat (bacon, sausage, ham, deli, hot dogs) as occasional, not weekly — there's no established safe threshold and the dementia, CVD, and colorectal cancer signals all align. Each 100 g/day of unprocessed red meat raises CHD ~17% and T2D ~27%; each 50 g/day of processed meat raises colorectal cancer ~16–18% and incident dementia ~13%. Replace with fish, poultry, legumes, nuts, or eggs — not refined carbs. If you grill, marinate and don't char; co-consume with fibre. See Red and processed meat and Foods to limit.
  7. Get the fat type right. Eliminate industrial trans fats (check for "partially hydrogenated oil"; mostly already gone in regulated markets). Anchor cooking on extra-virgin olive oil. Replace saturated fat with PUFA or MUFA, not refined carbohydrates — the substitution effect dominates (PUFA replacement cuts CVD ~30%; refined-carb replacement does nothing). Don't fear linoleic acid in a home kitchen; the "seed oils are toxic" framing fails 150 cohort meta-analyses. The full lipid picture, including the omega-6:omega-3 ratio, is under Dietary fats.
  8. Eggs are fine for most adults. Whole eggs at up to one a day / 5–7 per week are compatible with cardiovascular health for healthy adults. The geographic paradox (US/Western cohorts mildly elevated, Asian cohorts neutral-to-protective) reflects the companion foods, not the egg. Eggs are also the densest dietary source of phosphatidylcholine, with ~4× the bioavailability of synthetic choline. Diabetics warrant a more conservative cap. See Dietary fats.
  9. Eat 25–35 g of fibre a day. Strongest single nutrient signal for cardiovascular and colorectal cancer prevention. Also blunts the TMAO spike if you do eat red meat.
  10. Front-load eating. Larger breakfast and lunch, lighter dinner, last meal 2–3 hours before bed. Early time-restricted eating improves fasting insulin and body composition versus matched-calorie late eating. See Fasting.
  11. Include fermented dairy. Habitual yogurt, kefir, and traditionally aged cheese track with lower all-cause, cardiovascular, and cancer mortality across pooled cohorts. The food matrix matters more than live CFU counts. See Fermented foods.
  12. Eat carbs last; choose sourdough; add vinegar. Sequencing vegetables and protein before starches flattens postprandial glucose without cutting carbohydrates. Individual "glucotypes" vary enormously even on the same foods. See Glycemic index.
  13. Skip the keto/carnivore experiment for general longevity. Short-term metabolic improvements in some populations, but no long-term outcome data and an unfavorable 2026 mouse-lifespan signal for low-carb high-protein. The pattern with the data is Mediterranean.
  14. Forget "detoxes." No clinical evidence; the liver and kidneys handle this.
  15. For a concrete weekly menu that hits the protein, fibre, fish, legume, fermented-food, and meal-sequencing targets simultaneously, see a sample longevity week.

5. Look after the mind, mood, and meaning

The Hallmarks-of-Health framework adds psychosocial adaptation as a ninth dimension of biological aging. Loneliness, chronic stress, and lack of purpose deregulate the immune system and move epigenetic clocks at effect sizes comparable to obesity or smoking.

  1. Stay socially connected. Strong relationships carry a survival hazard comparable to or larger than smoking cessation. The single most robust behavioral predictor in cohort data.
  2. Defend purpose, especially between ages ~63 and 70. Wisconsin 28-year data identify this as the critical psychosocial window. Sense of purpose is one of the strongest non-pharmacological mortality and dementia levers known. See Purpose.
  3. Slow-paced breathing, ~10 min a day. About 6 breaths per minute is the highest-leverage 10-minute autonomic intervention; sustained practice raises HRV and lowers resting sympathetic tone. See Stress.
  4. Mindfulness, if you'll do it consistently. MBSR/MBCT show effect sizes of g ≈ 0.97 for anxiety and ≈ 0.95 for mood — uncommonly large in psychological interventions.
  5. Engage cognitively — productively. Novel skill acquisition builds cognitive reserve in a way passive consumption does not. The ACTIVE trial's speed-of-processing arm cut 20-year dementia incidence by 25%; analog crosswords beat commercial brain-training apps head-to-head; bilingualism delays functional dementia onset by up to 5 years. See Cognitive engagement.
  6. Treat depression, regardless of when. Depression is both a risk factor for and a prodrome of dementia, and one of the Lancet Commission's 14 modifiable factors.

6. The sensory and dental levers nobody mentions

Three of the largest underrated dementia and CVD modifiers are sensory and dental: hearing, vision, oral health. Each is cheap, well-evidenced, and unevenly addressed.

  1. Get audiometry between 40 and 50; use hearing aids if prescribed. Hearing loss is the largest single modifiable midlife dementia risk factor in the Lancet Commission 2024 update. The ASPREE 2026 target-trial emulation found hearing-aid users had a 7-year dementia risk of 5.0% vs 7.5% without (RR 0.67). If you struggle in noisy rooms despite a "normal" audiogram, ask for extended high-frequency (EHF) audiometry — it captures about 64% of age-related variance in real-world speech understanding versus ~16% for the standard test. See Hearing.
  2. Get a comprehensive dilated eye exam at midlife. Treat any correctable loss promptly — cataract surgery, glasses, low-vision rehabilitation, AMD management. Visual impairment was added to the Lancet 2024 list. Ask about OCT and OCT-angiography; the Retinal Age Gap is a validated cardiovascular and dementia biomarker. See Vision.
  3. Eat the macula. Leafy greens daily for lutein and zeaxanthin. Macular pigment density tracks cognitive performance independently of dementia status.
  4. Brush twice daily, floss or interdental-brush once, see a hygienist every 6–12 months. Top-quintile oral hygiene associates with HR ≈ 0.25 for cardiovascular mortality; periodontal therapy lowers hs-CRP comparably to a statin. Periodontitis is a chronic low-grade systemic inflammatory state, and P. gingivalis is a documented Alzheimer's-brain inhabitant. See Oral health.
  5. Don't routinely use chlorhexidine mouthwash. It kills the tongue bacteria that produce most of the body's nitric oxide after midlife; daily use raises blood pressure measurably. Reserve for short-course or post-surgical use.

7. Hormesis: sauna yes, sun yes, cold maybe

Mild controlled stressors that trigger adaptive responses — hormesis — is the framework that ties together sauna, sun, cold, fasting, and exercise itself. The evidence is sharply different across them.

  1. Sauna 2–4× a week, ideally 4+. ≥19 min at ≥80°C captures most of the Finnish cohort benefit (4–7 sessions/week associates with ~40% lower CVD and ~33% lower all-cause mortality versus 1×). The strongest mortality cohort data of any wellness intervention. Hydrate; cool down before driving. Avoid with aortic stenosis, unstable CV disease, pregnancy, or alcohol. See Sauna.
  2. Brief, sub-burning sun on most days. Strict avoidance roughly doubles all-cause mortality versus high-exposure groups in the Melanoma in Southern Sweden cohort. About 10–20 min midday with arms and legs uncovered is enough for vitamin D and the UV-driven nitric-oxide release that lowers blood pressure. Past that window, broad-spectrum sunscreen and UV-blocking sunglasses. Never burn; never use tanning beds. Hard contraindications: melanoma history, dense dysplastic nevi, immunosuppression, photosensitising drugs — manage vitamin D orally instead. See Sun exposure.
  3. Cold plunging is optional. Reliable acute physiology (catecholamines, parasympathetic rebound, mood lift), modest hormetic adaptations, no longevity outcome data. 11–15°C for 10–15 min for recovery; 1–5 min at 10–14°C for mood and alertness. Avoid immediately after resistance training if hypertrophy is the goal — post-RT cold blunts adaptation. Hard contraindications: cardiac arrhythmia, severe Raynaud's, pregnancy; never breath-hold immersion. See Cold exposure.

8. Beverages

  1. 2–4 cups of filtered coffee a day. Lowest all-cause mortality (HR ~0.83–0.85) clusters at 2–4 cups; benefits across diabetes, Parkinson's, liver disease, and several cancers; both caffeinated and decaf show signal. Watch evening timing; skip the added sugar. EFSA/FDA: up to 400 mg caffeine/day safe for healthy adults, 200 mg in pregnancy. See Coffee.
  2. 1–3 cups of tea if you enjoy it. Modest mortality and cardiovascular signal, plus an 18% lower dementia risk at 1–2 cups/day in the 2026 JAMA Nurses' / Health Professionals analysis. Avoid concentrated green-tea extract supplements (rare hepatotoxicity). See Tea.
  3. Drink water steadily, not in boluses. Roughly 2.0–3.0 L/day total fluids for most adults; pale-yellow urine and rare thirst are the real biomarkers. Sip metered (~75% capture) beats chugging (~55%). Serum sodium chronically >142 mmol/L tracks with up to 50% higher odds of being biologically older than chronological age in the ARIC cohort of 15,752 adults. See Water.
  4. Filter for PFAS and microplastics. Reverse osmosis with remineralization is the protocol of choice for most modern municipal supplies; mineralized water carries an ischemic-stroke advantage that demineralised water erases.
  5. Skip "structured" / alkaline / marine-plasma waters. No clinical evidence; physicochemical pseudoscience. Hydrogen water is the one functional-water exception with preliminary biology — small effect.
  6. Skip "bulletproof" / butter coffee. Calorie-dense, no benefit over plain coffee, meaningful saturated-fat load.

9. Numbers and labs

The annual untargeted physical doesn't move all-cause mortality, but a short, evidence-anchored midlife panel does change clinical decisions and lets you track interventions over time.

  1. Run the annual midlife panel. apoB, fasting insulin + HbA1c, hs-CRP, ferritin, uric acid, CBC, CMP. Once-in-a-lifetime: Lp(a). Symptom-driven: TSH, two morning total testosterone draws, estradiol/FSH. See Midlife labs.
  2. Skip the low-yield tests. Untargeted NMR lipoprofiles when apoB is available, IgG food panels, salivary "adrenal stress" panels, routine IGF-1 in healthy adults, provoked heavy-metal challenges. These add cost and overdiagnosis, not signal.
  3. Treat hypertension aggressively in midlife. Systolic <130 if tolerated. SPRINT cut major CV events by 25% and all-cause mortality by 27%; SPRINT-MIND cut mild cognitive impairment by 19%. Home-based monitoring beats one-off clinic readings; isometric wall squats lower systolic by ~8 mmHg comparable to a first-line drug; bedtime dosing is not superior to morning (TIME and BedMed both negative). See Blood pressure.
  4. Treat apoB to risk, with cumulative-exposure framing. Atherosclerosis biology is a dose × time integral; Mendelian randomization shows up to 3× greater benefit per unit of LDL lowered when intervention starts earlier. apoB outperforms LDL-C — about 25% of adults are discordant. Statins, ezetimibe, bempedoic acid, and PCSK9 inhibitors all work by the same mechanism; ~90% of statin "side effects" were nocebo in SAMSON. See Lipid management.
  5. Test Lp(a) once. Inherited, monotonic-causal coronary risk factor; you only need to know it once; the HORIZON trial of pelacarsen reads out in 2026.
  6. Run the high-value cancer screens. Biennial mammography from 40; colorectal screening from 45; primary HPV every 5 years 30–65; low-dose CT in 50–80 with 20+ pack-year history; one-time HCV antibody 18–79; one-time AAA ultrasound for men 65–75 who ever smoked. Mean life-extension across the six common screens is measured in days not years — the value is in the tail. See Cancer screening cadence.
  7. Don't chase "subclinical" findings. Subclinical hypothyroidism in older adults rarely warrants levothyroxine (TRUST trial); ~58% of mild persistent cases revert spontaneously within 3 years. Up to ~94% of US papillary thyroid cancer diagnoses 1991–2019 were overdiagnoses driven by neck ultrasound. See Thyroid management.
  8. Get adequate iodine — but don't megadose. The 150 µg/day RDA via iodized salt and seafood is the dose with the cohort data; kelp/Lugol's megadoses go the other way (U-curve).
  9. Optionally, a third-generation epigenetic clock. DunedinPACE measures the rate of biological aging and is uniquely sensitive to short-term lifestyle change — useful for tracking your own interventions, not yet routine.

10. Prescription pharmacology, when indicated

Most levers on this site are behavioral, but a small set of prescription interventions delivers effect sizes lifestyle can't match — in the populations where they actually matter. Wilder's Law of Initial Value applies across the group: benefit is roughly proportional to baseline drift.

  1. GLP-1 receptor agonists in overweight/obesity with cardiovascular risk. SELECT cut major CV events by 20% in non-diabetic adults with overweight and established CVD; semaglutide is the first drug class to measurably slow GrimAge in an RCT. The catch: 25–40% of weight lost is fat-free mass and hip BMD drops ~2.6% at 52 weeks. Without 1.6–2.2 g/kg protein and 2–4 resistance sessions per week, you arrive at sarcopenic obesity. See GLP-1 receptor agonists.
  2. Testosterone replacement in symptomatic, biochemically confirmed deficiency. TRAVERSE (2023, n=5,204) settled the CV fear — MI/stroke/CV-death rates were equal to placebo, plus 22.5% lower progression to type 2 diabetes. About 25% of men start TRT without a baseline workup, the most common avoidable mistake. Optimize sleep, OSA, alcohol, exercise, and endocrine-disrupting-chemical exposure first. Monitor hematocrit >54% as the most consistent adverse effect. See Testosterone therapy.
  3. Menopausal hormone therapy, within the 10-year window. Estrogen initiated within 10 years of menopause preserves endothelial function and associates with ~30–50% lower CHD incidence and RR ≈ 0.70 all-cause mortality (KEEPS, ELITE). Initiated >10 years out, the CV signal flips. Transdermal beats oral for thrombotic safety; micronized progesterone beats MPA/norethisterone for breast safety. See Menopausal hormone therapy.
  4. Treat type 2 diabetes hard. Well-controlled diabetes is not uncontrolled diabetes for cognitive, cardiovascular, or kidney outcomes. Metformin remains first-line; GLP-1s and SGLT-2 inhibitors deliver hard cardio-renal endpoints.
  5. Target the middle of the range, not the top. Mendelian-randomization data on lifelong genetically predicted higher testosterone show ~17% higher coronary risk in men, mediated by blood pressure — compatible with TRAVERSE because late-life restoration is different from cumulative lifelong exposure, but a strong argument against "optimization" toward 25-year-old levels in healthy adults.
  6. Avoid compounded GLP-1s and compounded female testosterone. Both bypass FDA oversight on dose accuracy, sterility, and salt formulation. Global consensus discourages compounded female testosterone specifically.
  7. Don't microdose GLP-1 "for longevity" if you're healthy. Mechanistically plausible; zero RCT evidence; compounded supply chain. Speculative.

11. Supplements: a short useful list, a longer pointless list

No supplement on the market has been shown to extend life, prevent disease, or slow biological aging in healthy middle-aged adults at the magnitude of basic lifestyle interventions. Five clear a usable bar; almost everything else is gap-specific or hype; a few actively cause harm. Test before you supplement anything fat-soluble, mineral, or chronically dosed.

The five that earn their place

  1. Vitamin D3, if 25(OH)D is low. Target 75–125 nmol/L (30–50 ng/mL). 1000–2000 IU/day usually does it; up to 4000 IU/day for severe deficiency. Take with a fat-containing meal. Don't routinely megadose — hypercalcemia above 4000 IU/day without monitoring is rare but real. See Vitamin D.
  2. EPA+DHA omega-3, 1–2 g/day, if you don't eat fish. Two-plus servings of fatty fish per week makes the supplement unnecessary. DO-HEALTH is so far the only supplement in everyday use to have slowed DNA-methylation aging clocks in a randomized trial, at 1 g/day. Stay under ~2 g/day unless you have a triglyceride or CV indication. Refrigerate after opening; look for IFOS or Labdoor marks. Algae oil is non-inferior for vegans. See Omega-3.
  3. Magnesium, 200–400 mg/day. Glycinate or threonate in the evening for sleep; citrate any time. About half of adults don't meet the RDA from food; supplemental magnesium lowers blood pressure ~3/2 mmHg in healthy adults and ~8/3 mmHg in those treated for hypertension. Be cautious in chronic kidney disease; separate doses from quinolones, tetracyclines, and bisphosphonates. See Magnesium.
  4. Vitamin B12 in specific groups. Vegetarians and vegans; anyone on metformin or chronic acid-suppressing drugs; adults past about 50 with documented absorption decline. 25–250 µg/day for prevention; 1000 µg/day for confirmed deficiency. Don't trust serum B12 alone — confirm with methylmalonic acid or holotranscobalamin.
  5. Creatine monohydrate, 3–5 g/day. Strong for muscle and strength (685+ trials in over 12,800 participants); moderate for cognition under metabolic stress and in older adults; one of the strongest safety profiles in nutrition. Stick with monohydrate — HCl, nitrate, ethyl ester cost more and don't outperform. ~10 g/day for brain effects. See Creatine.

Situational add-ons (case-by-case, not universal)

  1. Multivitamin, no iron. A small cancer/cognition signal in COSMOS and PHS II. Cheap insurance, small effect.
  2. Vitamin K2 (MK-7), 90–180 µg/day paired with D3 for bone density — directs calcium to bone, not artery.
  3. Folic acid 400 µg/day for women capable of pregnancy.
  4. CoQ10 100–200 mg/day — adjunct in heart failure; mixed evidence for statin muscle pain. No mortality benefit in healthy adults.
  5. Iron only with documented deficiency (ferritin <30 µg/L in premenopausal women; men over 50 sometimes need less, not more).

Things to skip or be careful with

  1. Most "longevity molecules" — NMN, resveratrol, urolithin A, spermidine, lithium orotate — currently rest on animal data, surrogate biomarkers, or short-term industry-funded trials. No hard outcomes in healthy adults. See Geroprotectors.
  2. OTC melatonin in the US ranges from 83% to 478% of label dose. Use prolonged-release prescription melatonin (Circadin 2 mg in Europe) for sleep, only short-term, and primarily in adults over 55 where the evidence is strongest.
  3. OTC antihistamine sleep aids, benzodiazepines, and Z-drugs after age 50. Falls, fractures, cognitive impairment, dementia signal.
  4. Megadose single nutrients. Beta-carotene in smokers (cancer increase, CARET/ATBC); high-dose vitamin E (mortality increase in pooled meta-analyses); chronic high-dose zinc (copper depletion); high-dose B6 (peripheral neuropathy). See Supplements to avoid.
  5. Cheap multivitamins that use the least bioavailable forms. Look for USP Verified, NSF Certified for Sport, or Informed Sport on the bottle.

12. Reduce the exposome

The non-genetic share of lifespan variance is 75–85%. Lifestyle is one half of that; the exposome — air, water, household chemicals, psychosocial stress — is the other. Specific chemicals (cadmium, lead, phthalates, bisphenols, PFAS) measurably move epigenetic-aging clocks at population scale, and substitution interventions drop urinary biomarkers within days.

  1. Filter indoor air if you live near major roads. Chronic PM2.5 exposure raises dementia incidence; HEPA filtration is a small but plausible win. See Environmental toxins.
  2. Get plastic out of food contact. Glass, stainless steel, ceramics. Don't microwave plastic; don't drink hot liquids from plastic-lined cups.
  3. Skip synthetic fragrance. Phthalates and other endocrine disruptors track measurably with urinary biomarkers; substitution interventions drop those biomarkers within days.
  4. Wear seatbelts and helmets; avoid repeated head impacts. Contact sports and motorcycling without a helmet carry a real TBI-mediated dementia signal.

That covers most of the practical landscape. Each pillar page on this site goes deeper on its own group; each topic article holds the trial-level evidence behind the headline numbers.

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