Category Archives: Preventative Health

Preventive Health for Millennials: An Always-Updated Guide



It’s true: you’re invincible. You’re barely 25 years old, you’re in great (ok, good) shape, you eat well (most of the time), and you’ve only ever gotten a clean bill of health at the doctor’s office.

You know you’re supposed to be worried about stuff like retirement and healthcare or <shudder> life insurance, but in the back of your head, you know that with modern medicine improving so fast, you’ll easily live to be 100.

And, if you should happen to catch the sniffles or jam a finger, you’re confident that a quick visit to your primary care physician will fix your problems and let you get back to being productive/socializing/rewatching the second season of Mad Men.

Hey—I get it, I’m 27 and that’s how I feel too.

But, part of you wonders: now that you’ve finally got your school debt under control, your career on a decent track, and a social life that’s moving in the right direction, is there anything you could be doing to protect your health?

That’s the same question I asked, and that’s what this guide is all about.

Too busy to read the whole article? [5800 words, a 25-minute read] Here are the takeaways:

  • I worked with a team of researchers to identify the diseases most likely to cause an early death. They are: cancers, heart disease, lung disease, and diabetes.
  • Next, we tried to find the most effective measures you can take as a young, healthy adult to reduce your long-term risk of the most deadly diseases.
  • We found that the most important actions in order of importance were: (1) don’t smoke (2) collect your family history (3) see the doctor every 1-3 years and (4) exercise. Even though most healthcare professionals would say diet is important too, we found it hard to make specific recommendations about nutrition, as existing research is controversial.
  • The one thing most millennials can do right now that will really make a difference in preventive health is talk to their immediate family members about their medical histories. Scroll to the bottom for some useful resources to help you with this.

Preventive Health and The Pareto Principle

If you’re interested in productivity, you’ve probably heard of the Pareto principle, a simple rule of thumb that goes something like this: “80 percent of outcomes are from 20 percent of causes”

“80 percent of outcomes are from 20 percent of causes”

It applies to all aspects of life: “80 percent of work gets done by 20% of employees” or “80 percent of my sales come from 20% of my clients” or “I can get this presentation to an 80% with only 20% the effort”

So does it apply to health and living longer too? Check out this chart:

causes of death 3

…yup, it applies.

The numbers from the Centers for Disease Control (CDC) show that just 15 causes of death (a tiny minority) are responsible for 80% of all deaths in the United States.

And, when we look even more closely at those top 15 causes, we see the same trend appearing again.

Causes of death 4


For the purposes of this study, we eliminated non-medical causes of death (accidents, homicides, and suicides). That means that just 4 categories of diseases are responsible for 66% of deaths out of the top 15 causes, almost half of all preventable diseases as a whole.


Why are we yammering on about statistics and the Pareto principle? Because when we looked for resources on preventive health, particularly for the millennial demographic, the guidelines were confusing, overwhelming, and at times seemingly arbitrary. So instead, we asked ourselves: “what is the 20% I can do today to give myself 80% of the benefit as I get older?” In the rest of this piece, we explore the top causes of early death* and research the best guidelines for prevention to figure out what behaviors you can start doing today. Do diet and exercise really matter? How much of a role do genetics play? These are the questions we posed. *Why look at figures for deaths before age 75? Don’t most people live longer than that? We looked at causes of death before the age of 751 because statistics on geriatric (old-people) medicine are expected to change considerably in the coming decades as people live longer than ever before.23

We start with the easy stuff.

Lung Disease and Lung Cancer

You could sum this entire section with two simple words: don’t smoke. Here’s why:

  • Lung cancer is the most deadly form of cancer, accounting for about a third of all cancer deaths in people under 75. Between 80% and 90% of all lung cancer deaths are caused by tobacco.4
  • Heart disease is the #2 killer of young people and smoking causes about 20% of heart disease deaths.5
  • Tobacco exposure accounts for 80% of all lower respiratory disease (lung disease) deaths and lung disease is our#3 most deadly disease.6

Oh, and add to these the fact that smoking directly increases risk for many cancers besides lung cancer, and you can conclude that smoking directly causes between 20% and 30% of medically-related deaths under the age of 75. And that’s a conservative estimate.

Of course, it’s not always that easy to quit smoking. It’s very easy to become dependent on or addicted to nicotine. Plus, secondhand smoke has the same negative effects as smoking, if not to quite the same severity.

If you do smoke or are regularly exposed to secondhand smoke, know that you are at significantly higher risk for the most deadly diseases. Be upfront with your doctor about how much you smoke and take special care to follow the other guidelines we’ve summarized for the other deadly diseases, below.

There isn’t much else we can say about prevention for lung disease and lung cancer. Most non-smoking-related cases of chronic respiratory diseases and lung cancer are influenced by genetics. If you have a family history of lung problems or asthmas, you may be at increased risk, especially if you are routinely exposed to smoke. But, even taking family history into account, exposure to smoking is the biggest risk factor here and the best recommendation we can make is: don’t smoke.

Malignant Neoplasms (Cancers)

One in two men and women will be diagnosed with cancer in their lifetimes.

That statistic bears repeating. One in two men and women will be diagnosed with cancer in their lifetimes. It sounds unbelievable but that statistic comes straight from the National Cancer Institute.7

It’s hard to make broad recommendations for avoiding cancer in general because there are so many types and each has its own risk factors. That’s why anytime a product or new study says something like “reduces the risk of cancer” or “helps to prevent cancer” you should be skeptical.

So we started from scratch and looked hard at the published research to find the facts that researchers actually agree on.

Here are the most important takeaways:

  • Smoking greatly increases the risk of multiple types of cancer, not just lung cancer
  • A family history of a particular type of cancer greatly increases your risk of getting it. Depending on the particular type of cancer, and if you know you have a family history genetic testing may be beneficial.
  • Women should definitely get mammograms after age 40.
  • Diet and exercise affect cancer, but causation remains unclear and we can’t make any concrete recommendations.

We looked both at incidence (how often a cancer occurs)8 and mortality rate (how often a patient with a cancer dies from it)9 to identify the cancers you should be most watchful for.*

*Lung cancer, the most deadly type of cancer, is discussed in the previous section.

Colon Cancer (Or why you should be skeptical of all nutrition advice)

Colon cancer is responsible for the majority of cancer deaths after lung cancer. It’s deadly to both men and women.

And the weird thing about colon cancer is this: way more people in developed countries develop colon cancer than do people in less-developed countries. And that’s true regardless of race and socioeconomic factors.

What does that mean? It means that well-off people seem to be making lifestyle choices that increase their risk of colon cancer. What lifestyle choices? Researchers usually single out nutrition as the culprit.

But, here’s why nutrition studies are so hard to believe:

In the early 90’s a group of European nations decided to band together and study the effects of nutrition and lifestyle on the development of cancer.

They developed several key takeaways10 that you’ve probably heard before:

to avoid colon cancer,

  • eat more dairy, fiber, vegetables, and fish, and
  • eat less processed or red meat and drink less alcohol.

While these recommendations might sound reasonable, they don’t tell the full story.

It turns out that the European study, (called the EPIC cohort study), mostly covers ground that had already been addressed by epidemiologists in the past:

  • A 1993 epidemiologic review article on colon cancer concluded that only increased vegetable consumption and leading a non-sedentary lifestyle were supported by the majority of studies.11
  • More recently, professional research service UpToDate concludes that obesity is linked with colon cancer, but that fruit and vegetable consumption have little impact, if any. Fish does seem to reduce risk, but only slightly. No other conclusions could be made because the studies they reviewed were too contradictory.12

Why can’t researchers agree on basic nutrition advice? The answer lies somewhere between research methods, politics, and the adaptability of the human body. We’ll discuss nutrition and nutrition research much more in future articles, but for now, we can’t make any firm recommendations about what to eat and what not to eat based on long-term medical risk factors.

One thing researchers do agree on: people with 1st-degree relatives who had colon cancer are at increased risk.

Breast Cancer

Breast cancer is the most-often occurring cancer in women and is responsible for the most deaths in women after lung cancer.

The most important action you can take to prevent breast cancer is to get routine mammograms every 1-2 years after the age of 40.

Mammogram controversy: In the past few years, there has been some debate around mammograms. The main issue is that the test generates a high rate of false positives (the test says you have breast cancer when you actually don’t), which can result in unnecessary treatment and hardship.1314

The current consensus seems to be that the benefits of getting the mammograms outweigh the downsides; just be aware that your doctor may ask you to come in for a second screening and that a second screening most likely does not mean you have breast cancer—the second screening is used to eliminate those annoying false positives.

And remember, the mammogram recommendation is specifically for women over the age of 40, which isn’t that far off for some millennials. For the rest? You can skip the mammogram for now, unless you know of preexisting factors.

Some women have an elevated risk of breast cancer due to genetics. You’re probably aware of Angelina Jolie’s decision to undergo an elective double mastectomy. The actress made that call because she tested positive for BRCA1, a gene that made her lifetime risk for breast cancer about 87%. Statistically, the presence of either the BRCA1 or BRCA2 genes increases lifetime risk for breast cancer to 65% and 45%, respectively.15

Of course, genetic testing can be expensive and not all women should get tested. The most at-risk women are those of Ashkenazi Jewish descent with relatives who have been diagnosed with breast or ovarian cancer.16

If you are concerned about your risks, the Gail Model pools common genetic factors together with other known contributors to estimate an individual’s risk of getting breast cancer. The best way to use the tool is to try it at home and bring your results in next time you see your doctor to discuss what model says about you.

Prostate Cancer

The prostate is a small gland that is part of the male reproductive system. Prostate cancer is both the most prevalent cancer in men after lung cancer and the number one killer of men after lung cancer.

The risk factors for prostate cancer are pretty straightforward. Prostate cancer rarely occurs in men under 40 and becomes significantly more likely in men older than 60. A family history of prostate cancer increases risk. Diet makes a difference, but exactly how is not clear.17

As most men are probably aware of already, a common way to screen for prostate cancer is the Digital Rectal Exam (DRE), during which a doctor or other healthcare provider to inserts one (gloved and lubricated) finger into the rectum of the patient. From there, they can feel the prostate for lumps or growths—just like a mammogram.

Unfortunately, the DRE is not always effective because (1) many doctors might not know what a diseased prostate feels like and (2) because oftentimes the growth occurs on the side of the prostate toward the interior of the body—where a doctor can’t feel.

There does exist another test. It checks for the marker prostate-specific antigen (PSA) . Unfortunately, some studies have shown that getting your PSA levels checked has no effect on actually reducing mortality.1819 On top of that, PSAs can also be indicative of issues unrelated to prostate cancer, so by screening everybody, you get a lot of false positives and a lot of unnecessary prostate biopsies that may do more harm (complications, infections) than good.

With that being said, many family medicine doctors still do PSA screenings and most insurance companies will still pay for the test, so it appears to remain controversial even between individual primary care providers.

In summary, there simply isn’t a bullet-proof recommendation for prostate screening for most men. What you really need to do is take a look at your family history and bring it up with your doctor if you do have any family history with the disease.

Lymphoma and Leukemia (and Other Cancers of the Blood)

In lymphoma and related cancers, the white blood cells—the very cells normally responsible for fighting infection and disease—become cancerous.

That’s why this family of diseases is often referred to as “hematological neoplasms,”—that’s doctor-speak for “cancers of the blood.”

Since blood travels everywhere in the body, the tumors associated with hematological neoplasms can appear in many places at once, such as in the lymph nodes, bone marrow, or spleen. And since these tumors can be spread all over the body, they’re harder to treat, which means mortality rates are high.

The two main types of hematological neoplasms are leukemia and lymphoma:

Leukemia affects the bone marrow and disrupts production of white blood cells. Children usually develop acute leukemia, while adults are equally susceptible to both chronic and acute forms of leukemia. Only 56% of patients will survive leukemia after 5 years.20

Lymphoma affects lymphocyte production (lymphocytes are a type of white blood cell) . Both types of lymphocytes—bursa-derived (B-cells) and thymus (T-cells)—are affected.

There are two main types of lymphoma. Hodgkin’s lymphoma is characterized by the orderly spread of the disease from lymph node to lymph node, whereas non-Hodgkin’s lymphoma is characterized by the non-systematic spread of the disease. Non-Hodgkin’s lymphoma is more deadly with a five-year survival rate of 69%, compared to Hodgkin’s lymphoma’s survival rate of 85%.21

Unlike other cancers, hematological neoplasms do not appear to be caused by genetics.22 And that means that environmental exposure to chemicals appears to be the primary cause of lymphomas and leukemias.

We’ve done some pretty extensive research on this subject, but frankly there are a great many conflicting opinions about what factors are most dangerous. We’ll follow up here with more information as we get it. For now, it appears that researchers agree that the following exposure can increase your risk of cancer.

  • Exposure to diesel fumes
  • Exposure to ionizing radiation
  • Exposure to hair dyes
  • Exposure to pesticides, specifically:
    • Dichlorodiphenyltrichlorethane (DDT)
    • cis-nonachlor
    • Oxychlordane

References: 2324

Keep in mind that when we talk about “exposure” what we mean is being in contact with these chemicals over the course of 20 years can increase your risk of developing cancer by about 50%. So there’s probably no need to worry if you accidentally get sprayed once with DDT; but, if you use that particular chemical every day for an extended period, you may want to take a look at your risk factors.

Pancreatic, Ovarian/Uterus, Urinary, and Skin Cancers

These other cancers are less deadly and prevalent than the other cancers we’ve discussed, but we felt like they were worth mentioning here.

Although rarely deadly, skin cancer is the most common form of cancer in the U.S. In fact, one in five Americans will develop skin cancer in their lifetime.25 Basal cell carcinoma is the most common form, followed by squamous cell carcinoma. 90% of nonmelanoma skin cancers are associated with UV exposure from the sun.26

Melanomas are more rare but also more serious: 1 in 50 men and women will be diagnosed with melanoma during their lifetimes and the overall 5-year mortality rate is 10%.27 Melanoma is also associated with UV exposure. In a recent study, researchers at Yale found that people who tanned indoors were 69% more likely to develop melanoma.28 The findings were so conclusive that a law in Connecticut banned indoor tanning only months after the findings were reported.

BUT, although the above study stands as a pretty significant condemnation of intentional tanning, don’t think that scientists are saying you have to hide from the sun. The truth is, most Americans don’t get enough sunlight. To avoid skin cancers, simply use sunscreen if you anticipate being outside for an extended period of time.

Pancreatic cancer: though the lifetime risk for men and women is only 1 in 67, the five-year survival rate for pancreatic cancer is a dismal 6%.29 Smoking accounts for 20% of pancreatic cancer cases. Also, people with the BRCA1 mutation (see breast cancer, above) carry about a 116% increased risk of getting the disease.30

There’s also a protein-based screen for pancreatic cancer developed by a 15-year-old that looks promising, but we don’t know when it will be available to the general public.

Ovarian cancer is only the 10th most common cancer among women, but it’s the 5th most deadly. Genetics play the most significant role in predicting ovarian cancer. BRCA1 increases lifetime risk to 39% and BRCA2 increases it to 11%.31 Women with a family history of the disease may want to consider getting tested for these genes.

Uterine cancer affects 1 in 37 women and has an overall 5-year survival rate of 81.5%.32 Like ovarian cancer, there is no known screen; the disease is largely genetic. Oral contraceptives reduce the risk for both ovarian and uterine cancer.33

Bladder cancer is a less common cancer, but it can be dangerous, with an overall 5-year survival rate of 77.9%.34 About 50% of all bladder cancers are attributed to smoking.35 The rest of cases are usually attributed to genetics. If you think you are at high risk (you’re a smoker or have a family history), there are some simple screens you can do. A urinalysis is the simplest method, but you’ll have to ask specifically for a bladder cancer screen, as that test does not come standard. More specific tests exist, such as UroVysion, bladder tumor-associated antigen, immunocyt, and NMP22 bladder check.36 Once again, these tests are only recommended if you know you have a family history of the disease or you’re a smoker.

Conclusions about Cancer

Despite huge strides in medical research and technology, cancer remains a poorly-understood disease. Or rather, a poorly understood family of very different diseases.

Here are the most important takeaways:

  • Smoking greatly increases the risk of multiple types of cancer, not just lung cancer
  • A family history of a particular type of cancer greatly increases your risk of getting it. Depending on the particular type of cancer, and if you know you have a family history genetic testing may be beneficial.
  • Women should definitely get mammograms after age 40.
  • Diet and exercise affect cancer, but causation remains unclear and we can’t make any concrete recommendations.

Heart Disease

Heart disease is most often known for being the most deadly disease in the developed world. The reason it falls behind cancers in our analysis is because we looked only at causes of death in persons aged 75 years or younger.

Takeaways about heart disease:

  • There are all sorts of factors that contribute to your risk of developing heart disease, but the most important markers to track are blood pressure, cholesterol/triglycerides, and bodyfat.
  • You get your blood pressure checked every time you visit the doctor’s office. You can help your doctor out by tracking your own blood pressure over time.
  • Cholesterol/triglyceride numbers should be checked every five years for adults over the age of 20. A high ratio of omega-3 fatty acids to other types of fat can improve your numbers.
  • Bodyfat is usually tracked using something called “Body Mass Index,” but the Body Mass Index was never designed to be used for assessing bodyfat. There are better methods that we discuss.
  • The most important takeaway about heart disease? Make sure to visit your doctor every 1-3 years in your 20s and 30s. They will make sure you get the right tests and can develop an accurate picture of your risk factors.

Most people know heart disease as heart attack—the malfunction and subsequent stopping of the heart that can cause sudden death. In the medical world, heart attacks are separated into categories based on what portions of the heart are failing and how that failure was caused. The term heart disease also covers blood clots that can cause death at the brain or lungs, as well as abnormal heart rhythms (ventricular tachycardia and ventricular fibrillation).

But, regardless of the particular type of heart disease in question, the risk factors are largely the same. You can start taking a look at your risk factors using this online Reynolds Risk Score calculator. Most of the numbers you’ll need you can find on a standard lab test. (For the hs-CRP box, put “2” for middle of the average if you don’t have it available. Bump it up to 3 or higher to see how your risk changes.) Just keep in mind that the calculator only assesses data for people older than 45. This is an educational exercise only.

For a simpler calculator, check out the 10-year CVD risk calculator based on the Framingham Heart Study.

While these calculators can give you a rough idea of where you stand, remember that they are based on epidemiological data and each person’s situation is different. Bring your results in to the doctor’s office if you have concerns about what your numbers say.

Looking at the calculators, it’s pretty clear that there are established markers for assessing risk for heart disease. The major culprits are blood pressure, cholesterol, triglycerides, and body mass index (BMI).* We’ll discuss these more next.

*Note that these levels (BP, cholesterol, triglycerides) are associated with a number of a chronic illnesses in addition to cardiovascular disease. Diabetes, for example, is strongly associated with lower HDL levels, high triglycerides and high blood pressure. So if you are older than 50, have a family history of cardiovascular disease or diabetes, or are overweight, pay very close attention to these measures.

Heart Disease Marker #1: Blood pressure (BP)

Blood pressure refers to the amount of pressure needed to move blood through your veins and arteries. If you have high blood pressure it means your heart is working too hard, and that can contribute to a number of health problems, including heart disease.

The American Heart Association maintains resources for blood pressure monitoring at home. Levels below 120/90 are considered healthy. Blood pressure is a good indicator across many types of people—that is, athletes with a blood pressure of 140/100 carry the same cardiovascular disease risks as non-athletes.

But, more than just looking at the numbers by themselves, it’s important to monitor blood pressure over time. An increase in blood pressure over time could be indicative of development of a chronic disease. And your doctor might not catch the trend, especially if she doesn’t have access to robust electronic medical records. It’s up to you to stay aware of trends in your key markers. If you’ve recently switched primary care providers, try to make your new care provider aware of your historical blood pressure readings.

If you’ve recently switched primary care providers, try to make your new care provider aware of your historical blood pressure readings.

Heart Disease Marker #2: Cholesterol and Triglycerides

Cholesterol is a fat-like substance that serves as an important building block in the body. It is found in all cells of the body and is a precursor to many hormones, as well as vitamin D. It does travel through the bloodstream, but cannot flow freely because it is not water soluble. Instead, it travels in “packages” called high-density lipoproteins (HDL) and low-density lipoproteins (LDL).

A triglyceride is just a fancy way of saying “a fat molecule.” They flow freely through the bloodstream and play an important role in providing energy to the body. However, these molecules can aggregate in the blood vessels and, in conjunction with cholesterol, cause a blockage.

There’s some confusion about which of these indicators (HDL, LDL, triglycerides, or total cholesterol) should be used to assess health and indicate possible disease. In November 2013, the American Heart Association released several new guidelines for measuring cholesterol/triglyceride levels as an indicator for heart attack and stroke as well as the management of lifestyle and diet to manage risk.373839 The full text documents are a bit cumbersome, but the highlights are worth skimming. Note: the AHA itself makes clear that the lifestyle guidelines are “designed for people who need to lower cholesterol and blood pressure,” so although they make specific nutrition statements, we wouldn’t necessarily say they apply to a healthy young adult. See [above] for more thoughts on nutrition research.

Here’s what does matter for our generation: the AHA recommends that all adults over the age of 20 get a fasting lipoprotein test every five years. This blood draw measures HDL, LDL, and triglycerides. Total cholesterol can then be calculated from those numbers.

When you do get this test, your doctor will apply the AHA’s guidelines for calculating risk. Since you can’t really test your own cholesterol, we’ll skip discussing the equations here and simply recommend that you remember to get your cholesterol checked at least every five years.

Heart Disease Marker #3: Body Mass Index (BMI)

BMI is the most commonly used measure for assessing body fat distribution and is calculated like this:

BMI = weight (kg) / height2 (m2). 40

Here’s how physicians use BMI:

underweight <18.5
healthy weight 18.5-24.9
overweight 25-29.9
obese >30

There are two very good reasons why doctors use BMI to estimate body fat: it’s easy and it’s free. But that doesn’t mean it’s effective.

Unfortunately, BMI is a pretty terrible metric when used incorrectly. And for a metric that’s considered the gold standard in obesity research it’s used incorrectly an awful lot.

In fact, the metric was originally developed for population studies and never meant for individual diagnoses. Unfortunately, it’s such an easy metric that doctors started adopting it nonetheless.

At the very least, you can target your own BMI more effectively by factoring in race:

Race Overweight BMI
White 25.0
“American Black” 26.3
Chinese 23.1
Thai 22.1
Ethiopian 20.4
Indonesian 21.8
Polynesian 29.5

Reference: 41

Though, even between same races, BMI can be different depending on what country you came from. Try googling for your particular background if you really want to calculate BMI, but remember that it’s really not a great metric of health.

Better methods to measure bodyfat

Here’s the obvious, but underpublicized truth: BMI is simply a poor estimate for body fat. If you’re any sort of athlete, you probably know what I’m talking about. Every year at the doctor’s office, your doctor inevitably blushes when he tells you that “according to his measurements” you fall in the overweight BMI category—you know, despite your 6-pack and the fact that your blood markers are all perfect.

There are many better ways to measure body fat, and if it’s not practical to do it in the doctor’s office, you can always do it yourself and bring in your results. Personally, I use a combination of the U.S. Navy taping method and the Jackson skin caliper algorithm. Simply looking at comparison photos of people at various body fat levels can also provide a quick guess. A recent study found that skinfold thickness was 10% more accurate than BMI in assessing body fat. 42


Diabetes may not be a leading cause of death, but it does have significant impacts on quality of life, on everything from energy levels, to being able to eat certain foods, to possibly losing a limb due to poor blood flow.

Once again, regular light exercise and having a healthy body weight can drastically reduce your risk for diabetes. With that being said, causation remains uncertain. 434445

But whereas we normally find it difficult to make specific recommendations about diet, with diabetes, we can safely say that excess sugar consumption likely contributes to poor insulin regulation. The worst culprits are processed sweets, such as sodas, fruit juices, and candy. Next comes highly processed grains like pre-cooked white rice, white bread, and corn-derived processed foods. Finally, even some less processed starches, like pasta and potatoes could make an impact, but the buffering effects of fiber might also mitigate the insulin response.

Besides diet and exercise, diabetes is marked by a resistance to insulin and the best marker for insulin, is blood glucose levels. Here is a sense of scale for glucose levels:

  • Normal: <100 mg/dl
  • Pre-diabetes: 100-126 mg/dl
  • Diabetes: ≥126 mg/dl

Source: 46

You can get your blood glucose levels checked through a standard blood draw at the doctor’s office. We would not recommend monitoring blood glucose at home unless you are pre-diabetes or already have diabetes and must monitor glucose on orders from your doctor.

Although high BMI, high blood pressure, and high triglyceride levels all increase your risk for developing diabetes, the best thing you can do today watch your simple sugar intake and commit to regular light exercise.

Conclusions and Next Actions

Let’s review. In this article, we started off by asking the question: what preventive health actions can millennials take today to improve their lives for the long term? Remember: the tagline of this blog is “teaching 25-year-olds to survive the next 75 years.”

Our approach was to identify the diseases most likely to cause an early death and identify the specific actions we can take today to reduce our risk factors for those diseases.
Here’s what we found out about the actions we can take:

Smoking. Smoking drastically increases your risk of both lung cancer and lung disease. On top of that, smoking increases your risk of developing several of the most deadly cancers, heart disease, and diabetes. Taking all that into account, smoking can be directly correlated to 20-30% of all preventable early deaths.

Family History. In our research, we repeatedly found that a family history of a disease increased your own risk of disease. Since the other preventive often talked about didn’t pan out as cut and dry as we expected (see below), we want to emphasize here the importance of collecting a thorough family history. Skip below for resources and help on this.

Tests given at the doctor’s office. Healthy young adults should visit a primary care provider once every 1 to 3 years. The doctor will check your blood pressure during every visit and will get you a cholesterol test once every 5 years. These will help assess your risk for heart disease. If you’re concerned about diabetes, you can ask for a glucose test as well. Mammograms are recommended for women over 40 and men can have their prostates checked, though the effectiveness of known prostate cancer screening techniques are currently in question.

Exercise. Exercise has clearly been shown to reduce the risk of heart disease and may be correlated to other major diseases as well. Specifically, researchers recommend about 40 minutes of light exercise (defined as a minimum of brisk walking) 3 to 4 times a week for optimal benefits. At this point, we can’t make recommendations about other exercise regimens for preventive health, such as weightlifting or more intense exercise.

Genetics. The vast majority of healthy young adults probably don’t need a genetic test. The one exception are women of Ashkenazi Jewish decent. If you have a significant family history of a disesase, genetic testing may also be useful, but you should start with collecting a family history, then ask your doctor about genetics.

Nutrition. Nutrition is the most divisive topic we researched for this article. The research on nutrition mostly deals with colon cancer, heart disease, and diabetes. The only two recommendations we can make are to (1) increase the ratio of omega-3 fatty acids to other types of dietary fat, this improves triglyceride levels, which are related to heart disease; it also reduces the risk of colon cancer. (Fatty acids can also help maximize your performance in the gym.) And, (2) limit the intake of simple sugars such as candy and soda (this helps prevent diabetes). We looked at all sorts of other nutrition studies and there simply weren’t other specific recommendations we could make for young, healthy adults.

Your next action: collect your family history

  • Of all the preventive measures you can take, the most important action you can take right now in terms of both simplicity and effectiveness is to get in touch with your immediate family and get them to answer a few questions about family history.
  • We found two pretty simple resources to help you gather a family history. The Surgeon General of the United States created a Family Health History Initiative that allows users to store and track family health information online.

Travis Whitfill, Jennifer Petrea, Stefanie S., and Neliswa Nhlbatsi contributed research to this article.

Travis is a graduate student at Yale University studying chronic disease epidemiology. Jennifer is a registered nurse (BSN) and currently as the Health & Fitness Outreach Coordinator at Vitality Medical Wellness Institute. Stefanie is a PhD Candidate in Molecular Biology. Neli is an MSc(Med) student at the University of the Witwatersrand in Johannesburg, South Africa.

[Top image: Tuna Akçay]


  1. Preliminary Mortality File – CDC
  2. The 2030 Problem: Caring for Aging Baby Boomers, Health Services Research
  3. Geriatrics for the 3rd millennium, Wien Klin Wochenschr
  4. Smoking – National Cancer Institute
  5. Smoking and Heart Disease – WebMD
  6. Chronic lower respiratory disease – West Virginia Health Statistics Center
  7. Cancer of All Sites – Surveillance, Epidemiology, and End Results Program, National Cancer Institute
  8. CDC’s data on cancer incidence
  9. CDC’s data on cancer mortality.[and here’s the pdf]
  10. Key Findings – EPIC Project
  11. Potter, J., et al, Colon Cancer: A Review of the Epidemiology, Epidemiologic Reviews 15(2).
  12. UpToDate is a paid subscription service that reviews recent medical journals to provide physicians and other subscribers with concise, useful research.
  13. Mammogram Fact Sheet from NIH’s National Cancer Institute
  14. Free PubMed Article: Mammography screening. Benefits, Harms, and Informed Choice.
  15. Hereditary Breast Ovarian Cancer Syndrome (BRCA1/BRCA2) – Stanford Cancer Institute
  16. ABC News Health Blog: Should You Get BRCA Testing?
  17. Prostate Cancer – Causes, Incidence, and Risk Factors – National Library of Medicine
  18. Mortality results from a randomized prostate-cancer screening trial – New England Journal of Medicine
  19. Prostate-Specific Antigen (PSA) Test – National Cancer Institute
  20. Lymphoma Incidence and Mortality – Surveillance Epidemiology and End Results, National Cancer Institute
  21. Lymphoma Incidence and Mortality – Surveillance Epidemiology and End Results, National Cancer Institute
  22. Bhatia, S. and Robison, L., Epidemiology of leukemia and lymphoma, Current Opinion in Hematology, 1999
  23. Occupational exposures and non-Hodgkin’s lymphoma: Canadian case-control study, Environmental Health, 2008.
  24. A Prospective Study of Organochlorines in Adipose Tissue and Risk of Non-Hodgkin Lymphoma, Environmental Health Perspectives, 2012
  25. Sun exposure, sun protection, and vitamin D. JAMA
  26. Prevention and early detection strategies for melanoma and skin cancer. Current status. Arch Dermatol, 1996.
  27. SEER Fact sheets: Melanoma of the Skin – Surveillance, Epidemiology, and End Results Program, National Cancer Institute.
  28. Some Melanoma Survivors Still Use Tanning Beds, Skip Sunscreen – American Association for Cancer Research
  29. Cancer of the Pancreas – Surveillance, Epidemiology, and End Results Program, National Cancer Institute
  30. Cancer Incidence in BRCA1 Mutation Carriers, Journal of the National Cancer Institute
  31. Hereditary Breast Ovarian Cancer Syndrome (BRCA1 / BRCA2) – Stanford Cancer Institute
  32. Cancer of the Corpus and Uterus – Surveillance, Epidemiology, and End Results Program, National Cancer Institute
  33. Uterine Cancer Prevention– Centers for Disease Control
  34. SEER Stat Fact Sheets: Bladder Cancer – Surveillance, Epidemiology, and End Results Program, National Cancer Institute
  35. Cigarette smoking implicated in half of bladder cancers in women – National Cancer Institute
  36. Can bladder cancer be found early? – American Cancer Society
  37. 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults
  38. 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk
  39. 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk
  40. for those of us not used to metric calculations, use BMI = (4.89) weight (lbs) / height2 (feet2) or BMI = (704.55) weight (lbs) / height2 (inches2)
  41. Body mass index and percent body fat: a meta analysis among different ethnic groups, Int J Obes Relat Metab Disord, 1998
  42. Can weight-related health risk be more accurately assessed by BMI, or by gender specific calculations of Percentage Body Fatness?, Medical Hypotheses, 2012
  43. Diagnosing Diabetes and Learning About Prediabetes – American Diabetes Association
  44. Prevent Diabetes – Centers for Disease Control
  45. Overweight and obesity and weight change in middle aged men: impact on cardiovascular disease and diabetes, Journal of Epidemiology and Community Health, 2005
  46. Diagnosing Diabetes and Learning About Prediabetes – American Diabetes Association



Does Your Daily Multivitamin do More Harm than Good?


We originally wanted to write an article about which multivitamins are best for healthy young people. But as we dug deeper into the topic, our research showed that a daily multivitamin is almost never beneficial and might even be harmful.

Too busy to read the whole article? [2000 words, a 9-minute read] Here are the takeaways:

  • The medical community agrees that healthy people do not need multivitamins.
  • Studies of multivitamin supplementation show increased risk of some diseases in those who take them.
  • The Medical literature has documented specific downsides to supplementing with Vitamins A and E, and calcium.
  • You probably don’t need a multivitamin; if you have symptoms related to malnutrition, consult a doctor.

If you’re anything like me, taking vitamins was a part of your daily childhood routine. Though, in truth, I cared more about which flavor Flintstone chewable I got than about what that mystery Barney/Fred/Wilma actually had in it.

As I outgrew my beloved Flintstones chewies, my vitamin usage dwindled and stopped through high school and college. But, by the time I made it into graduate school, I started getting paranoid about my health and wondered if I should begin taking vitamin supplements again.

As a Ph.D student in Molecular Biology, I’m no stranger to doing in-depth research, so I started researching vitamin supplements to determine which ones were worth prying open my (very) tight wallet for.

I was surprised by what I found. You see, nutrition research can often be a contentious field, with experts and researchers going back and forth on what’s really “good for you.” Which is why I was so surprised that peer-reviewed, placebo-controlled scientific studies have consistently shown that vitamin supplements are not only unable to prevent disease, but in fact may increase your risk of cardiovascular disease, cancer, and mortality.

In fact, the evidence is so concrete that in a public statement, the National Institutes of Health (NIH)1 said, “present evidence is insufficient to recommend either for or against the use of [multivitamins/minerals] by the American public to prevent chronic disease”.

 “present evidence is insufficient to recommend either for or against the use of [multivitamins/minerals] by the American public to prevent chronic disease”.

Regan Bailey—a nutritional epidemiologist in the Office of Dietary Supplements at the NIH—futher elaborated, “people have very strong beliefs about these products and I don’t know where they are getting their information… It’s not from the doctors. The majority of scientific data available do not support the role of dietary supplements for improving health or preventing of disease”.2

And yet, half of Americans take vitamin supplements today. Half. Besides the obvious role of marketing, why do so many of us allow ourselves to believe that vitamins are good for us with zero proof? Have we become a society that believes we can correct an unhealthy lifestyle with a daily pill?

Why we need vitamins and the downside of getting too much

We’re using the term “vitamin” here to refer to the organic compounds needed for your body’s proper function. For example, “vitamin A” is actually a group of organic fat-soluble compounds used in the eyes to maintain good vision. But we’re really also talking about minerals and inorganic compounds like calcium or potassium that serve similar necessary functions in the body.

There’s no denying that prolonged deficiency of certain vitamins can lead to illness and disease. The real question, though, is whether vitamin supplements are necessary for healthy individuals.

In the United States, if you eat a diet full of fruits, vegetables, and whole grains, you are most likely getting your full daily value of essential vitamins and minerals. And even if you eat a terrible diet, many types of processed foods are fortified with vitamins and minerals.

If you are taking a vitamin supplement in addition to eating well and consuming some fortified foods, you may be ingesting multiple fold over your recommended daily value (DV) of certain vitamins.

Multivitamins as a drug: an analogy

To visualize the downside of overdosing on vitamins, let’s consider an analogy.

Would you take a powerful antibiotic every day “just in case”?

Well, sure you would, if you lived in an area infested with malaria. In such a situation, you might take a daily dose of the anti-malarial antibiotic doxycycline. But, would you want to take doxycycline in a malaria-free region? Probably not, unless you’re a fan of daily nausea, headaches, and let’s just say…digestive discomfort.

What happens when you apply that same benefit vs. side effects analysis to your daily multivitamin?

If you knew you were at risk for a vitamin deficiency due to a poor diet or a preexisting medical condition, then you would perhaps consider supplementing to address that deficiency. But, if you were otherwise healthy and didn’t suspect a vitamin deficiency? The downsides of multivitamins could easily outweigh the benefits.

Multivitamins often contain 100% or more of your daily recommended value of Vitamin A, Vitamin C, iron, and calcium. Unless you aren’t consuming any nutritional food at all, you simply don’t need these supplements.

The downsides of supplementing with multivitamins

A very popular 2004 meta-analysis study from the University of Copenhagen examined the ability for antioxidant supplements (Vitamins A, C, E, and beta-carotene) to prevent gastrointestinal cancer in over 170,000 individuals. Their results found that these supplements were not only unable to prevent cancer, but actually significantly increased overall mortality by 6 percent.3

Another study by the same authors three years later found that in over 232,000 patients treated with another antioxidant supplement (Vitamins A, E, and beta-carotene) mortality rates were again significantly higher than in patients who received no supplement.4

Lastly, a 2011 study of over 38,000 older women found that women who used multivitamin supplements had increased mortality rates compared to women who did not use them.5 The fact that three separate studies with over 440,000 total participants show there is a significant increase in mortality associated with multivitamin supplement use should concern anyone who pops these pills daily.

Additionally, a 2007 study showed that multivitamin supplements (Vitamin C, E, beta-carotene, selenium, and zinc) increased the risk of skin cancer in women.6

Learn how we interpret and evaluate studies, and how you can too.

While it appears that multivitamin supplements may have alarming effects, can single vitamin supplements have deleterious effects, as well?

The downsides of supplementing with Vitamin A/beta-carotene

Vitamin A is a fat soluble nutrient that can be obtained either through animal sources or through fruit and vegetable sources as “pro-Vitamin A” (most commonly beta-carotene). The body then converts pro-Vitain A into Vitamin A through digestion. They’re basically the same thing from a practical standpoint.

Vitamin A is found in bright yellow and orange fruit and vegetable sources such as sweet potatoes (1 cup = 380% DV), butternut squash (1 cup = 300% DV) and carrots (1 medium = 200% DV). It can also be found in dark leafy vegetables such as kale (1 cup = 130% DV), spinach (1 cup = 50% DV) and broccoli (1 cup = 10% DV). Fortified sources, like most breakfast cereals, contain ~10% DV.

Unfortunately, beta-carotene (pro-Vitamin A) has been shown to increase the incidence of lung cancer in two separate studies. In a 1994 study, it was found that beta-carotene supplementation increased the incidence of lung cancer in male smokers by 18 percent.7 In 1996 the Beta-Carotene and Retinol Efficacy Trial (CARET) tested the combination of supplemental beta-carotene and Vitamin A in men and women who were at high risk of developing lung cancer due to asbestos exposure or an extensive smoking history, respectively. This study found that with supplementation there 28 percent more lung cancers developed and 17 percent more deaths occurred than those in the control. In fact, that study was discontinued 21 months early due to the obvious danger of this supplement combination in this patient demographic.8

The downsides of supplementing with Vitamin E

Vitamin E is a fat-soluble nutrient that can be found in wheat germ (1 tbsp = 100% DV), various nuts and seeds (1 serving = ~35% DV), as well as dark leafy vegetables and seed/vegetable oils. You can also obtain this vitamin through fortified sources like cereals (1 serving = ~40% DV). While it appears there are more limited sources of Vitamin E, studies with its supplementation have been shown to be concerning.

A 2005 study found that Vitamin E supplements had no effect on preventing cancer or cardiovascular disease, but actually increased the risk of heart failure.9 A separate study that same year found that in over 135,000 patients, supplemental Vitamin E was significantly correlated to increased mortality rates. The authors even went as far as to conclude that Vitamin E supplementation should be avoided.10 Lastly, a 2011 study in over 35,000 men reported that Vitamin E supplementation significantly increased the risk of prostate cancer.11

The downsides of supplementing with Calcium

Nearly every multivitamin supplement contains calcium and calcium supplements are highly recommended to women. The CDC has reported that 10% of women over 50 are afflicted with osteoporosis of the hip and so increasing calcium intake has become a concern for many women as they age. Great natural sources of calcium include yogurt (1 cup = 20-45% DV), dairy milk (1 cup = 30% DV) and tofu (1/2 cup = 45% DV). Some types of fish and various vegetables also contain calcium. Fortified sources such as soy or almond milk (1 cup = 50% DV) and cereals (1 serving = 25-100% DV) are easy ways to increase your intake.

Calcium supplements can be found not only in tablet form, but in tasty chocolate and caramel chewable form, as well. So can these supplements help protect your bones as you age? Not only have some studies shown that increased calcium intake does not protect you from bone loss, but can also increase your risk of cardiovascular disease. A 2007 study found that not only were calcium supplements unable to protect women or men from hip fracture, but that they actually put patients at increased risk for fracture.12 Results from four separate studies looking at the relationship between calcium supplementation and cardiovascular disease (CVD) indicate that calcium supplements are associated with higher CVD-related deaths.13,14,15,16

Conclusion: Treat vitamins and supplements with the same care you would treat any other drug

It’s just so easy to think of vitamins as a “nutritional insurance plan” and so many people take them that everyone thinks they must do something good, or at least do no harm. But, would you take a tylenol every day just because it didn’t make you feel worse?

Doctors are catching on to the research and starting to advise against vitamin supplementation.

With that being said, remember that I specifically researched the effects of vitamin supplementation on healthy adults, aged 25-35. Although I didn’t see any studies in the course of my research that specifically said children or seniors benefit from a daily multivitamin, I also didn’t look at those age groups in depth.

Also, just like any drug, vitamins can and should be prescribed for special cases. If you’re pregnant, your obstetrician/gynecologist will probably advise you to supplement with folic acid and if your doctor suspects you have a vitamin deficiency due to poor diet or a particular physiological problem, she might also advise you to supplement.

But for the rest of us? I simply could not find any real benefits to taking vitamins and there appear to be some pretty significant risks to healthy individuals or to those at risk for cancer or heart disease.

Your next action: stop taking multivitamins

  • As long as you are eating a diverse and healthy diet, it appears the “necessity” for vitamin supplements is unfounded. If you believe you are deficient in certain vitamins, increasing your consumption of natural sources is unarguably the best way to resolve the issue.
  • If you have more serious symptoms, consult a doctor. If they think you may have a deficiency, they may recommend a blood draw for nutritional screening or refer you to a licensed nutritionist or registered dietitian.


  3. Bjelakovic, et al. (2004) “Antioxidant supplements for prevention of gastrointestinal cancers: a systematic review and meta-analysis.” Lancet: 364(9441), 1219-28.
  4. Bjelakovic, et al. (2007) “Mortality in randomized trials of antioxidant supplements for primary and secondary prevention: systematic review and meta-analysis.” JAMA: 297(8), 842-57.
  5. Mursu, et al. (2011) “Dietary supplements and mortality rate in older women: the Iowa Women’s Health Study.” Arch Intern Med: 171(18), 1625-33.
  6. Hercberg, et al. (2007) “Antioxidant supplementation increases the risk of skin cancers in women but not in men.” J Nutr: 137(9), 2098-105
  7. [No authors listed]. (1994) “The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. The Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group.” N Engl J Med: 330(15), 1029-35.
  8. Omenn, et al. (1996) “Risk Factors for Lung Cancer and for Intervention Effects in CARET, the Beta-Carotene and Retinol Efficacy Trial” JNCI J Natl Cancer Inst: 88(21), 1550-1559
  9. Lonn, et al. (2005) “Effects of long-term vitamin E supplementation on cardiovascular events and cancer: a randomized controlled trial.” JAMA: 293(11), 1338-47.
  10. Miller, et al. (2005) “Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality.” Ann Intern Med: 142(1), 37-46.
  11. Klein, et al. (2011) “Vitamin E and the Risk of Prostate Cancer: The Selenium and Vitamin E Cancer Prevention Trial (SELECT).” JAMA: 306(14), 1549-1556.
  12. Bischoff-Ferrari, et al. (2007) “Calcium intake and hip fracture risk in men and women: a meta-analysis of prospective cohort studies and randomized controlled trials.” Am J Clin Nutr: 86(6), 1780-1790.
  13. Michaëlsson, et al. (2013) “Long term calcium intake and rates of all cause and cardiovascular mortality: community based prospective longitudinal cohort study.” BMJ: 346, f228
  14. Xiao, et al. (2013) “Dietary and Supplemental Calcium Intake and Cardiovascular Disease MortalityThe National Institutes of Health–AARP Diet and Health Study.” JAMA Intern Med.: 173(8), 639-646.
  15. Bolland, et al. (2010) “Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis.” BMJ: 341, c3691
  16. Kuanrong, et al. (2012) “Associations of dietary calcium intake and calcium supplementation with myocardial infarction and stroke risk and overall cardiovascular mortality in the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition study (EPIC-Heidelberg)” Heart: 98, 920-925.