02-Do-Not-Die-Slowly.md

2. Don’t die slowly

This section covers just two types of long‑term health risks: those with a big impact on overall mortality and those backed by solid evidence. The items are listed from most cost‑effective to least. A few entries note “randomized trials,” meaning participants were randomly assigned to different groups for comparison — this is the most reliable type of research. All other figures come from observational studies that simply track people over time without any grouping. Such studies produce risk ratios like HR or RR, but they also contain two kinds of confounding factors: participants naturally differ from one another, and some already had health problems before the study began. Therefore these numbers only indicate general trends and approximate magnitudes; they do not guarantee that following these recommendations will produce exactly those results.

1. Quitting smoking, the earlier the better

• Cost: It costs nothing — in fact, it saves money. A pack-a-day habit costs roughly $3–$4, which you’ll no longer spend after quitting. The hard part is getting through the withdrawal period, which usually lasts a few weeks to several months.
• In plain terms: On average, smokers live more than 10 years less than non-smokers. Quitting before age 40 eliminates roughly 90% of the extra death risk caused by continued smoking. The earlier you quit, the more years you gain.
• Benefit: One U.S. study that tracked participants without assigning them to groups found that current smokers have a life expectancy more than 10 years shorter than those who never smoked. Quitting before age 40 removes about 90% of this excess mortality risk. Quitting between ages 25–34 adds roughly 10 years to life expectancy; between 35–44, about 9 years; and between 45–54, about 6 years (as reported in the original source). Similar Chinese research from the 2010s shows that urban male smokers have a 1.65 times higher death risk than non-smokers (RR 1.65), while rural male smokers have a 1.22 times higher risk. After 10 years of sustained abstinence, this smoking-related risk nearly disappears.
• Evidence grade: A
• Sources:Jha P 等 (2013). 21st-century hazards of smoking and benefits of cessation in the United States. NEJM. https://doi.org/10.1056/NEJMsa1211128；Chen Z 等 (2015). Contrasting male and female trends in tobacco-attributed mortality in China: evidence from successive nationwide prospective cohort studies. Lancet. https://doi.org/10.1016/S0140-6736(15)00340-2；Oberg M 等 (2011). Worldwide burden of disease from exposure to second-hand smoke: a retrospective analysis of data from 192 countries. Lancet. https://doi.org/10.1016/S0140-6736(10)61388-8（二手烟那两个数字）
• Notes: Secondhand smoke is deadly too: in 2004, an estimated 603,000 people worldwide died from exposure to it, accounting for roughly 1% of all global deaths that year. Even if you don’t smoke yourself, you must avoid secondhand smoke, especially to protect children. Specific quitting strategies are outlined in the following sections: Section 3 (smoking cessation medications), Section 4 (setting a quit date), Section 5 (visiting a smoking cessation clinic), and Section 6 (e-cigarettes).

2. Don’t smoke at home or in the car, and don’t let guests smoke indoors

• Cost: There is no monetary cost and it takes little time. The challenge is simply having the conversation with family members and guests to keep them from smoking indoors.
• In plain terms: Around 600,000 people worldwide die each year from secondhand smoke exposure; nearly 30% of those are children. Long‑term exposure to secondhand smoke raises the risk of hypertension, heart disease, and stroke by roughly 30% compared to non‑exposed individuals. Smoke inhaled at home is even more harmful than smoke encountered outside.
• Benefit: In 2004, secondhand smoke caused 603,000 deaths globally — about 1.0% of all deaths worldwide, with children accounting for 28% of those fatalities. Pooled data from 57 studies show that people exposed to secondhand smoke have a 1.28‑fold higher chance of developing hypertension, a 1.39‑fold higher risk of heart disease, a 1.50‑fold higher risk of myocardial infarction, and a 1.36‑fold higher risk of stroke compared to non‑exposed individuals. The risk is greater when exposure occurs at home rather than outside.
• Evidence grade: A
• Sources:Öberg M, Jaakkola MS, Woodward A, Peruga A, Prüss-Ustün A (2011). Worldwide burden of disease from exposure to second-hand smoke: a retrospective analysis of data from 192 countries. Lancet：「603,000 deaths were attributable to second-hand smoke in 2004, which was about 1·0% of worldwide mortality. 47% of deaths from second-hand smoke occurred in women, 28% in children, and 26% in men」，「61% of DALYs were in children」. https://doi.org/10.1016/S0140-6736(10)61388-8；(2026). The Associations Between Secondhand Smoke Exposure and Various Cardiovascular Diseases: A Meta-Analysis. Nicotine & Tobacco Research：57 项研究，「hypertension (OR: 1.28, 95% CI: 1.15 to 1.40), heart disease (OR: 1.39, 95% CI: 1.28 to 1.50), myocardial infarction (OR: 1.50, 95% CI: 1.17 to 1.84), stroke (OR: 1.36, 95% CI: 1.18 to 1.54)」「Home exposure has a higher risk of CVD than non-home exposure」. https://doi.org/10.1093/ntr/ntaf111
• Notes: Focus on home environments first, since people spend more time there and pooled research indicates that indoor secondhand smoke is more harmful than outdoor exposure. Children bear 61% of the overall health burden caused by secondhand smoke. For personal smoking cessation, see item 1 in this section.

3. Don’t rely solely on willpower to quit smoking — get medication first: success rates more than double

• Cost: Nicotine patches and gum are over-the-counter products available at any pharmacy. A full course lasts 8–12 weeks and costs anywhere from a few hundred to over a thousand yuan. Varenicline and bupropion, on the other hand, are prescription-only drugs; you’ll need a prescription from a smoking cessation clinic or a pulmonology department. These costs are roughly offset by the money saved from buying fewer cigarettes during the same period.
• In plain terms: Relying on sheer willpower alone rarely works for most smokers. People taking varenicline are more than twice as likely to succeed compared to those taking a placebo. Those using nicotine replacement products also have a 50% higher success rate than non-medication users. Combining patches with gum or lozenges further boosts success rates by roughly 20%.
• Benefit: A pooled analysis of 41 randomized trials involving 17,395 participants shows that varenicline increases smoking cessation rates by 2.32 times compared to placebo (RR 2.32, 95% CI 2.15–2.51; high-certainty evidence). Varenicline also outperforms bupropion (RR 1.36, a 36% relative increase) and single-form nicotine replacement therapy (RR 1.25, a 25% relative increase). Across 133 trials with 64,640 participants, nicotine replacement products raise success rates by about 55% versus no medication at all (RR 1.55, 95% CI 1.49–1.61). Using both a patch and a fast-acting form such as gum or lozenges yields a 27% relative improvement over patch-only use (RR 1.27, 95% CI 1.17–1.37; high-certainty evidence from 16 trials with 12,169 participants).
• Evidence grade: A
• Sources:Livingstone-Banks J, Fanshawe TR, Thomas KH, et al. (2023). Nicotine receptor partial agonists for smoking cessation. Cochrane Database of Systematic Reviews, 5, CD006103. https://doi.org/10.1002/14651858.CD006103.pub8；Hartmann-Boyce J, Chepkin SC, Ye W, Bullen C, Lancaster T (2018). Nicotine replacement therapy versus control for smoking cessation. Cochrane Database of Systematic Reviews, 5, CD000146. https://doi.org/10.1002/14651858.CD000146.pub5；Theodoulou A, Chepkin SC, Ye W, et al. (2023). Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews, 6, CD013308. https://doi.org/10.1002/14651858.CD013308.pub2；上海市卫生健康委员会 (2021). 选对药物，让戒烟轻松一点：「市场上可见的戒烟药物主要有三种，即尼古丁替代疗法药物、安非他酮、伐尼克兰」，「尼古丁替代疗法药物属于非处方药（OTC），可通过药店柜台购买；而安非他酮、伐尼克兰属于处方药，须到医院戒烟门诊或呼吸内科就诊，凭医师处方经药师调配后才能得到」. https://wsjkw.sh.gov.cn/jtyx/20211119/df50681e01ba49f896d54f771d8176ae.html
• Notes: In China, these three types of medications are currently available for smoking cessation; only nicotine replacement products are sold over the counter. Common side effects of varenicline include nausea, vivid dreams, and sleep disturbances; anyone with a psychiatric history should discuss this with their doctor. A typical course of nicotine replacement therapy lasts 8–12 weeks — do not abruptly stop use but taper off gradually under medical guidance. While these medications ease withdrawal symptoms during the first few weeks, they do not eliminate cravings triggered by specific situations, so they should be used alongside the other strategies outlined in this chapter: setting a quit date (Section 4) and seeking professional help at a smoking cessation clinic (Section 5).

4. Pick a quit date and stop smoking on that day — don’t taper gradually

• Cost: No cost at all. Just choose a date on the calendar and let family and coworkers know in advance.
• In plain terms: Many people try to cut back a little each day until they reach zero. Yet after six months, only 15.5% of those who gradually reduced their intake stayed smoke‑free, compared with 22% of people who set a quit date and stopped all at once. So it’s better to pick a date and quit completely on that day.
• Benefit: In the UK, 697 smokers were randomly assigned to two groups. One group quit on a predetermined date; the other cut their cigarette use by 75% during the two weeks before that date. Both groups received nursing support and used nicotine replacement therapy around the quit date. At four weeks, 49.0% (95% CI 43.8–54.2) of the “quit‑on‑date” group remained smoke‑free, versus 39.2% (34.0–44.4) of the “taper‑first” group; the relative risk was 0.80 (0.66–0.93). By six months, 22.0% (18.0–26.6) of the quit‑on‑date group stayed quit, compared with 15.5% (12.0–19.7) of the taper‑first group; the relative risk was 0.71 (0.46–0.91). Even among people who preferred tapering, the quit‑on‑date approach yielded higher success rates at four weeks (52.2% vs. 38.3%).
• Evidence grade: A
• Sources:Lindson-Hawley N, Banting M, West R, Michie S, Shinkins B, Aveyard P (2016). Gradual Versus Abrupt Smoking Cessation: A Randomized, Controlled Noninferiority Trial. Annals of Internal Medicine, 164(9), 585–592. https://doi.org/10.7326/M14-2805；Theodoulou A, Chepkin SC, Ye W, et al. (2023). Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews, 6, CD013308（提前用尼古丁替代品那一段）. https://doi.org/10.1002/14651858.CD013308.pub2
• Notes: This is a somewhat controversial topic. Cochrane previously published a review comparing these two methods; it concluded they performed similarly (RR 0.94, 95% CI 0.79–1.13, based on 10 trials with 3,760 participants). However, that review was withdrawn in 2019 and is no longer updated. The best current evidence comes from the trial described above, which favors quitting on a set date. Both groups in that trial also used nicotine replacement therapy before the quit date, an approach itself backed by evidence: early use raises success rates by roughly 25% (RR 1.25, 95% CI 1.08–1.44, based on 9 trials with 4,395 participants; moderate‑certainty evidence). Therefore, the recommended strategy is to pick a quit date, start nicotine replacement therapy two weeks beforehand, and then quit all at once on that day.

5. Visit a smoking cessation clinic or call 12320 to find local services

• Cost: A single clinic visit costs only a few to dozens of yuan. Behavioral support typically involves 4–8 sessions lasting 30–60 minutes each, totaling under 5 hours. Calling the helpline is completely free.
• In plain terms: Medications and regular follow-up support from professionals are two distinct components that work best together. People who take medication while receiving dedicated follow-up have nearly twice the quit rate of those who only receive brief advice. Phone support also helps: those who proactively call the smoking cessation helpline see their success rate rise by 20–30% compared to others.
• Benefit: Across 52 trials involving 19,488 participants, the combination of medication and behavioral support led to a 1.83-fold higher quit rate than standard care or brief advice (RR 1.83, 95% CI 1.68–1.98; high-quality evidence). For the 43 trials conducted in medical settings, this advantage rose to 1.97-fold (95% CI 1.79–2.18). When looking at phone-based support alone: among people who called the helpline themselves, those receiving multiple follow-up calls had a 38% higher quit rate than those who only got informational materials or a single consultation (RR 1.38, 95% CI 1.19–1.61; 14 trials, 32,484 participants). For people who did not call the helpline but received scheduled phone support from researchers, the success rate was 25% higher than those without such support (RR 1.25, 95% CI 1.15–1.35; 65 trials, 41,233 participants). Both findings are supported by evidence of moderate certainty.
• Evidence grade: A
• Sources:Stead LF, Koilpillai P, Fanshawe TR, Lancaster T (2016). Combined pharmacotherapy and behavioural interventions for smoking cessation. Cochrane Database of Systematic Reviews, 3, CD008286. https://doi.org/10.1002/14651858.CD008286.pub3；Matkin W, Ordóñez-Mena JM, Hartmann-Boyce J (2019). Telephone counselling for smoking cessation. Cochrane Database of Systematic Reviews, 5, CD002850. https://doi.org/10.1002/14651858.CD002850.pub4；中国疾病预防控制中心 (2021). 「中国戒烟平台」微信小程序正式上线：「在健康中国行动控烟行动工作组指导下中国疾病预防控制中心和世界卫生组织驻华代表处联合制作了中国权威戒烟资源库『中国戒烟平台』微信小程序。小程序内容主要包括：戒烟热线、戒烟门诊详细信息，以及线上戒烟服务资源等」；同一站点页脚标注「健康咨询电话：12320」. https://www.chinacdc.cn/jkyj/yckz/gzdt/202203/t20220310_296389.html
• Notes: How to find local services in China: Search “China Smoking Cessation Platform” on WeChat to access a list of local smoking cessation clinics and helplines, or call 12320 to ask about nearby options. Most of the above trials were conducted overseas, and the intensity of services at local clinics varies widely; these figures should be viewed as general guidelines only. The recommended medications are listed in Section 3 of this chapter (“Smoking cessation medications”).

6. Only consider e‑cigarettes if you’ve already tried quitting; non‑smokers should avoid them

• Cost: The device plus cartridges cost anywhere from a few dozen to several hundred yuan per month. In China, only tobacco‑flavored e‑cigarettes are legally sold, and only at stores holding a tobacco retail license.
• In plain terms: Switching to nicotine‑containing e‑cigarettes helps roughly 60% more people quit smoking than nicotine patches — this finding is quite reliable. However, e‑cigarettes are not harmless; long‑term safety data remain limited. For people who have never smoked, there is absolutely no benefit to using them.
• Benefit: This up‑to‑date review includes 80 randomized trials involving 29,861 participants. Compared with nicotine replacement therapy, e‑cigarettes raise the quit rate by about 61% (RR 1.61, 95% CI 1.23–2.12; high‑certainty evidence based on 11 trials with 4,114 participants). In absolute terms, that translates to roughly 4 extra quitters per 100 users (range: 1–7). The rate of serious adverse events is similar between groups (risk difference 0.01, 95% CI −0.01–0.02; moderate‑certainty evidence). Compared with behavioral support alone or no support at all, e‑cigarettes improve quit rates by about 75% (RR 1.75, 95% CI 1.39–2.20; low‑certainty evidence).
• Evidence grade: A
• Sources:Lindson N, Livingstone-Banks J, Butler AR, et al. (2026). Electronic cigarettes for smoking cessation. Cochrane Database of Systematic Reviews, 8, CD010216. https://doi.org/10.1002/14651858.CD010216.pub11；国家烟草专卖局 (2022). 电子烟管理办法（国家烟草专卖局公告 2022 年第 1 号，2022 年 5 月 1 日施行）第十八条：从事电子烟零售业务，要向烟草专卖行政主管部门申领烟草专卖零售许可证。第二十二条：「禁止向未成年人出售电子烟产品。」第二十三条第二款：「任何个人、法人或者其他组织不得通过本办法规定的电子烟交易管理平台以外的信息网络销售电子烟产品、雾化物和电子烟用烟碱等。」第二十六条：「禁止销售除烟草口味外的调味电子烟和可自行添加雾化物的电子烟。」. http://www.gov.cn/gongbao/content/2022/content_5697988.htm
• Notes: This topic is controversial. WHO does not recommend e‑cigarettes as a smoking‑cessation tool, citing insufficient long‑term safety data and concerns that they may attract youth to nicotine. The UK, however, includes them in its quit‑smoking services. In China, e‑cigarette sales are not completely banned but are tightly regulated under the “Administrative Measures for E‑Cigarettes.” Only tobacco‑flavored products may be sold, and only at physical stores holding a tobacco retail license; fruit‑flavored e‑cigarettes and refillable devices are prohibited. Sales through any website, online shop, or social‑media platform other than the state‑run e‑cigarette trading platform are illegal, and sales to minors are forbidden. Consequently, fruit‑flavored e‑cigarettes that are still available are sold through illicit channels outside regulatory oversight. This is also how synthetic‑cannabinoid‑laced “high‑effect” e‑cigarettes enter the market; see Section 22, Item 4 (“Do not accept unknown cartridges”). The review examined only legally regulated nicotine‑containing products; unverified e‑liquid mixtures were not included. As a first step, it is advisable to try the medication described in Item 3 of this section, which offers stronger evidence and lower cost.

7. Not drinking sugary drinks — even switching to sugar-free ones doesn’t help

• Cost: There’s no cost involved, nor does it take any extra time. Switching to plain water or sugar-free tea can even save money. The real challenge is breaking the habit of drinking sweet beverages, including sugar-free ones.
• In plain terms: People who drink more than two sugary drinks per day have about a 20% higher chance of dying during the same period compared to those who rarely drink them. Those who consume one to two per day still face a roughly 10% higher risk. Switching to sugar-free versions brings no benefit: individuals drinking two or more sugar-free drinks daily actually have a 25% higher risk of death.
• Benefit: Two large U.S. studies followed large groups of people without any subgroup categorization; together they included around 118,000 participants and documented 36,000 deaths. Those drinking two or more sugary drinks daily had a 21% higher risk of death compared to those consuming less than one per month (HR 1.21). For those drinking one to two per day, the risk rose by about 14% (HR 1.14). The European EPIC study followed 450,000 people across 10 countries under similar conditions; again no subgroups were defined. Compared to those drinking less than one sugary drink per month, daily consumers of two or more sugary drinks faced an 8% higher risk (HR 1.08, 95% CI 1.01–1.16). Those drinking two or more sugar-free drinks daily had a 26% higher risk (HR 1.26, 95% CI 1.16–1.35). When all types of soft drinks were considered together, the risk increase was about 17% (HR 1.17, 95% CI 1.11–1.22).
• Evidence grade: A
• Sources:Malik VS 等 (2019). Long-Term Consumption of Sugar-Sweetened and Artificially Sweetened Beverages and Risk of Mortality in US Adults. Circulation. https://doi.org/10.1161/CIRCULATIONAHA.118.037401；Mullee A, Romaguera D, Pearson-Stuttard J, et al. (2019). Association Between Soft Drink Consumption and Mortality in 10 European Countries. JAMA Internal Medicine, 179(11), 1479-1490. https://doi.org/10.1001/jamainternmed.2019.2478
• Notes: There is ongoing debate regarding sugar-free drinks. The association between sugar-free drinks and health outcomes appears even stronger than that of sugary drinks, which likely reflects reverse causality: individuals who are already overweight or have diabetes tend to switch to sugar-free versions. Therefore, we cannot claim sugar-free drinks are more harmful based on this alone. Nevertheless, this evidence clearly shows that the idea “switching to sugar-free drinks solves the problem” lacks any factual support. The safest choice remains plain water or sugar-free tea. Additionally, these studies rely solely on observational tracking rather than controlled trials; people who consume more sugary drinks often lead less healthy lifestyles overall, which may contribute to the observed higher risk figures.

8. Not chewing betel nut

• Cost: It costs nothing, takes no time, and saves money that would otherwise be spent on betel nut. The hard part is breaking the habit of chewing it.
• In plain terms: People who chew betel nut have roughly a 20% higher chance of dying during the same period compared to non-chewers. Their risk of developing diabetes and metabolic syndrome is nearly 50% higher. Additional risks for oral and esophageal cancer also apply.
• Benefit: Data from 17 Asian studies involving 388,000 participants show that chewing betel nut raises overall mortality risk by about 21% relative to non-chewers (relative risk 1.21, P=0.02). This effect applies to 179,600 of those participants. The risk of diabetes rises by roughly 47% (1.47), while metabolic syndrome risk increases by about 51% (1.51). Betel nut itself is also a known risk factor for oral and esophageal cancer.
• Evidence grade: A
• Sources:Yamada T, Hara K, Kadowaki T (2013). Chewing betel quid and the risk of metabolic disease, cardiovascular disease, and all-cause mortality: a meta-analysis. PLoS One, 8(8), e70679. https://doi.org/10.1371/journal.pone.0070679
• Notes: The longer and more frequently one chews betel nut, the greater the risk of oral cancer becomes. After quitting, this risk gradually declines over time. Betel nut mixed with tobacco poses an even greater danger.

9. Switch household salt to low‑sodium (potassium‑rich) salt

• Cost: One bag costs a few yuan more than regular salt. It’s easy to switch when you shop, adding virtually no extra time. The taste stays almost the same.
• In plain terms: For people who have had a stroke or are over 60 with hypertension, switching to low‑sodium salt can lower their chance of dying within five years by about 12% and the risk of another stroke by roughly 14%.
• Benefit: A randomized trial conducted in rural China enrolled 20,995 participants — all stroke survivors or adults aged 60+ with hypertension — and followed them for 4.74 years. Those using low‑sodium salt had a 12% lower risk of death (RR 0.88), a 14% lower risk of stroke (RR 0.86), and a 13% lower risk of major cardiovascular events (RR 0.87) compared with the regular‑salt group. No statistically significant difference emerged between the groups regarding episodes of excessively high blood potassium levels.
• Evidence grade: A
• Sources:Neal B 等 (2021). Effect of Salt Substitution on Cardiovascular Events and Death. NEJM. https://doi.org/10.1056/NEJMoa2105675；O'Donnell M 等 (2014). Urinary sodium and potassium excretion, mortality, and cardiovascular events. NEJM. https://doi.org/10.1056/NEJMoa1311889（争议方 PURE）
• Notes: This finding is somewhat controversial. The PURE study only recorded long‑term outcomes without random assignment; it reported that individuals excreting less than 3 g of sodium per day faced a roughly 27% higher risk of death or cardiovascular events, while those excreting more than 7 g per day faced a 15% higher risk. According to PURE, both very low and very high sodium intake are detrimental, with moderate intake being optimal. However, the Chinese rural trial only partially replaced regular salt with low‑sodium salt, so sodium levels did not drop to the extremes examined in PURE. Moreover, the trial involved only high‑risk elderly participants; younger, healthier individuals would likely gain far less benefit. People with impaired kidney function or those taking potassium‑sparing medications should consult a physician before making this switch.

10. Brush teeth thoroughly and floss daily; replace missing teeth promptly

• Cost: Dental floss or interdental brushes cost just a few dozen yuan per year, while professional cleanings run about 100–200 yuan each. It takes only two to three extra minutes per day. The real challenge is making flossing a daily habit.
• In plain terms: People who floss daily have roughly a 10% lower chance of dying over the same period. For elderly individuals with no natural teeth, the risk of death is about 90% higher. Those with fewer than 20 natural teeth face roughly double the risk.
• Benefit: A Japanese study followed 9,676 participants for six years. Those who used interdental cleaning tools saw their mortality risk drop by about 11% (hazard ratio 0.89). Those who used tongue cleaners saw a 23% reduction (HR 0.77). When multiple studies of community-dwelling seniors are combined, people with no natural teeth have roughly 1.87 times the risk of death (95% CI 1.35–2.59). Those with fewer than 20 natural teeth face about 2.04 times the risk (95% CI 1.67–2.49).
• Evidence grade: B
• Sources:Wang K, Matsuyama Y, Kiuchi S, et al. (2026). Routine oral health practices and all-cause mortality. Journal of Dentistry. https://doi.org/10.1016/j.jdent.2026.106789；Ko MJ, Seo S, So JS, et al. (2026). Deteriorated oral health and function as risk factors for physical disability and mortality in community-dwelling older adults: a systematic review and meta-analysis. European Geriatric Medicine. https://doi.org/10.1007/s41999-025-01319-4
• Notes: This topic remains debated. These studies are purely observational; individuals with poor dental health often also have poorer overall health and lower socioeconomic status. It is unclear whether poor dental health harms overall health or whether poor health leads to poor dental health. Regardless, the cost of proper dental care is very low, and periodontal disease and missing teeth do directly affect eating ability.

11. Walking 7,000–8,000 steps per day

• Cost: It costs nothing. You can spread 60–90 minutes of walking throughout your commute and daily errands. The hard part is doing it every single day.
• In plain terms: People who walk 5,800 steps daily have roughly a 40% lower chance of dying during the same period compared to those who walk only 3,500 steps. When they reach 7,800 steps, that risk drops by about 45%. Going beyond that still lowers the risk a bit, but only up to a certain point. For adults over 60, 6,000–8,000 steps per day is sufficient.
• Benefit: Fifteen studies tracking large groups of people were combined for analysis without separating participants into subgroups. These studies included 47,471 participants and 3,013 deaths. Participants were divided into four groups based on daily step count; the lowest group had a median of 3,553 steps per day. The other three groups had medians of 5,801, 7,842, and 10,901 steps per day. Compared to the lowest group, death risk in these three groups was reduced by roughly 40%, 45%, and 53% respectively (HR values: 0.60, 0.55, 0.47). For people over 60, benefits level off after reaching 6,000–8,000 steps; for younger adults, benefits level off after 8,000–10,000 steps. Another analysis of multiple studies showed benefits start at around 3,867 steps per day; beyond that point, each additional 1,000 steps per day lowers death risk by about 15%.
• Evidence grade: A
• Sources:Paluch AE 等 (2022). Daily steps and all-cause mortality: a meta-analysis of 15 international cohorts. Lancet Public Health. https://doi.org/10.1016/S2468-2667(21)00302-9；Banach M 等 (2023). The association between daily step count and all-cause and cardiovascular mortality: a meta-analysis. European Journal of Preventive Cardiology. https://doi.org/10.1093/eurjpc/zwad229
• Notes: The range from 4,000 to 7,000 steps offers the best value; you don’t have to hit 10,000 steps to see benefits. Keep in mind these studies are purely observational: the group with the fewest steps includes people who were already ill and unable to walk much. Their low step count reflects poor health, not the other way around, so the calculated risk differences tend to be somewhat exaggerated. Still, the clear trend of better outcomes with more walking remains. This recommendation aligns with Recommendation 14 (150–300 minutes per week of moderate-intensity exercise); they describe the same health benefit, just expressed differently. Meeting either target is sufficient.

12. People with hypertension and high cholesterol should take their medication regularly as prescribed; never stop on their own.

• Cost: Generic hypertension drugs and statins cost only a few to several dozen yuan per month. They’re taken once daily, so they don’t require much time or effort. The real challenge is sticking to them long-term — once people feel better, they often stop taking them.
• In plain terms: For every 10 mmHg drop in blood pressure, mortality decreases by roughly 13%, while stroke risk drops by about 27%. Each 1.0 mmol/L reduction in LDL cholesterol achieved by statins lowers mortality by roughly 10%. Those who take their medication as directed have a 30% to 45% lower risk of death compared to those who frequently miss doses.
• Benefit: Pooled data from multiple randomized controlled trials show that a 10 mmHg reduction in systolic blood pressure (the “high” number in a blood pressure reading) lowers mortality by about 13% (RR 0.87) and major cardiovascular events by roughly 20% (RR 0.80). Stroke risk drops by around 27% (RR 0.73), while heart failure risk decreases by about 28% (RR 0.72). Statins also reduce LDL cholesterol; each 1.0 mmol/L drop lowers mortality by roughly 10% (RR 0.90) and major vascular events by about 22% (RR 0.78). Observational studies further indicate that patients who adhere to prescribed treatment regimens (≥80% compliance) enjoy significantly lower mortality rates: statin adherence reduces risk by about 45% (RR 0.55), while adherence to antihypertensive therapy lowers risk by roughly 29% (RR 0.71).
• Evidence grade: A
• Sources:Ettehad D 等 (2016). Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. https://doi.org/10.1016/S0140-6736(15)01225-8；Cholesterol Treatment Trialists' (CTT) Collaboration (2010). Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170 000 participants in 26 randomised trials. Lancet. https://doi.org/10.1016/S0140-6736(10)61350-5；Chowdhury R 等 (2013). Adherence to cardiovascular therapy: a meta-analysis of prevalence and clinical consequences. European Heart Journal. https://doi.org/10.1093/eurheartj/eht295
• Notes: Only individuals deemed by doctors to need medication should follow this advice; healthy people do not require it. The figures regarding “consistent medication use” stem from observational data; those who stick to treatment tend to be more disciplined overall, which may inflate perceived benefits. The mortality reductions linked to blood pressure control and statins are more firmly supported by randomized trials than any potential benefits of tighter blood glucose control.

13. Getting roughly 7 hours of sleep each night and keeping a regular schedule

• Cost: No cost involved. You simply need to set aside time for sleep — most people achieve this by cutting back on phone usage. The real challenge is maintaining consistent bedtime and wake-up times.
• In plain terms: People who regularly get less than 7 hours of sleep have a roughly 10% higher risk of dying over the same period. The more irregular their sleep schedule, the greater this risk becomes. Those with the most consistent routines have a 20–50% lower mortality risk compared to those with the least regular schedules. In other words, how consistent your sleep pattern is matters more than the total number of hours you sleep when it comes to predicting death risk.
• Benefit: A pooled analysis of 16 longitudinal studies — which simply recorded data without grouping participants — included 1.38 million people and 113,000 deaths. People who slept less than 7 hours had a 12% higher mortality risk (RR 1.12), while those who slept more had a 30% higher risk (RR 1.30). Another pooled study that grouped participants by sleep duration found the lowest risk among those getting exactly 7 hours of sleep. For every hour slept under 7 hours, risk rose by 6% (RR 1.06); for every hour over 7 hours, risk rose by 13% (RR 1.13). Data from the UK Biobank, which tracked over 61,000 participants using wrist-worn monitors, also showed that when people were divided into 5 groups based on sleep regularity, the four groups with more consistent schedules had a 20–48% lower mortality risk than the least regular group. This confirms that sleep regularity is a stronger predictor of death risk than total sleep duration. A further UK Biobank study that tracked sleep timing for 51,562 participants found 3,853 new cases of cardiovascular disease over the study period. Social jetlag — the difference between average weekday and weekend bedtime — also plays a role: people with a social jetlag of 2 hours or more had a 30% higher risk of cardiovascular disease (HR 1.30, 95% CI 1.11–1.54). This link remained evident even among people getting a normal amount of sleep.
• Evidence grade: A
• Sources:Cappuccio FP 等 (2010). Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies. Sleep. https://doi.org/10.1093/sleep/33.5.585；Yin J 等 (2017). Relationship of Sleep Duration With All-Cause Mortality and Cardiovascular Events: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies. JAHA. https://doi.org/10.1161/JAHA.117.005947；Windred DP 等 (2024). Sleep regularity is a stronger predictor of mortality risk than sleep duration: A prospective cohort study. Sleep. https://doi.org/10.1093/sleep/zsad253；Kumar N, Krishnamurthy S (2026). Social jet lag is associated with incident cardiovascular disease independent of sleep duration and cardiac genetic risk. Journal of Internal Medicine. https://doi.org/10.1111/joim.70133
• Notes: The main issues to address are getting too little sleep and having an irregular schedule; there is no need to deliberately cut back on total sleep time. The higher risk seen in people who sleep more is likely due to reverse causation: depression, chronic illnesses, and sleep apnea all tend to lead to longer sleep duration. Currently, only two longitudinal studies support the link between sleep regularity and lower mortality risk; both simply recorded data without grouping participants, so this evidence is classified as grade B on its own. For guidance on how to catch up on sleep after staying up late, see Section 39 of this chapter.

14. A total of 150–300 minutes of moderate-intensity exercise per week, such as brisk walking, is sufficient.

• Cost: It costs nothing. You only need 20–45 minutes each day. The real challenge is sticking with it over the long term.
• In plain terms: People who walk briskly for 150–300 minutes each week have a mortality risk roughly 30% lower than those who don’t exercise at all. Even if they fall short of that amount, their risk is still about 20% lower. When they reach 3–5 times that volume, the risk drops to its minimum level — about 40% lower. Exceeding that amount further won’t lower the risk any more, but it certainly won’t hurt either.
• Benefit: When multiple observational studies are pooled together (without subgroup analysis), individuals whose activity levels reached 1–2 times the recommended minimum had a mortality risk roughly 31% lower than non-exercisers (HR 0.69). This amount corresponds to 7.5–15 MET·hours per week, or about 150–300 minutes of brisk walking weekly. Those who failed to meet the minimum still saw a 20% reduction in risk (HR 0.80). For those whose activity levels reached 3–5 times the minimum, the risk dropped to its peak level — about 39% lower (HR 0.61). Any further increase did not yield additional benefit, though it remained harmless (at 10 times the minimum, HR was still 0.69). Another pooled analysis based on accelerometer measurements found that the top quarter of participants with the highest levels of moderate-to-vigorous activity had a mortality risk roughly 48% lower than the bottom quarter (HR 0.52). Accelerometers are wearable devices used to measure actual physical activity levels.
• Evidence grade: A
• Sources:Arem H 等 (2015). Leisure time physical activity and mortality: a detailed pooled analysis of the dose-response relationship. JAMA Internal Medicine. https://doi.org/10.1001/jamainternmed.2015.0533；Ekelund U 等 (2019). Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis. BMJ. https://doi.org/10.1136/bmj.l4570
• Notes: You can choose either this recommendation or Recommendation 11 (which suggests walking 7,000–8,000 steps daily). Keep in mind that these studies are purely observational in nature. The studies relying on accelerometer measurements have relatively short follow-up periods and include a higher proportion of older participants; they also contain some bias related to reverse causality — i.e., individuals who were already ill may have become less active. Therefore, the real benefit is somewhat smaller than the apparent reduction of mortality risk to 0.52 times the baseline level.

15. Playing racket sports three times a week for 45 minutes each session

• Cost: The cost of court fees is typically several dozen yuan per session. This amounts to roughly 2 hours of activity per week. The main challenge is arranging enough participants and securing a court, plus maintaining a regular weekly schedule.
• In plain terms: People who regularly play tennis, badminton, or table tennis have roughly half the risk of dying during the same period compared to non-players. Their risk of cardiovascular death is about 56% lower. For swimmers, the reduction is roughly 28%. No significant difference was observed between runners and football players in these statistics.
• Benefit: A UK-based longitudinal study involving 80,300 participants compared individuals who engaged in specific sports with those who did not. Those who played racket sports had a 47% lower risk of death overall (hazard ratio 0.53, 95% CI 0.40–0.69). Their risk of cardiovascular death was reduced by about 56% (hazard ratio 0.44, 95% CI 0.24–0.83). Racket sports include tennis, badminton, and table tennis. For swimmers, these figures were 0.72 and 0.59 respectively; for aerobic exercise they were 0.73 and 0.64, and for cycling 0.85. No statistically significant differences were found between runners and football players.
• Evidence grade: A
• Sources:Oja P, Kelly P, Pedisic Z, et al. (2017). Associations of specific types of sports and exercise with all-cause and cardiovascular-disease mortality: a cohort study of 80 306 British adults. British Journal of Sports Medicine, 51(10), 812-817. https://doi.org/10.1136/bjsports-2016-096822
• Notes: This finding is somewhat controversial. Such studies merely track participants over time; people who play sports tend to be healthier and more socially active overall. The lack of difference seen among runners also suggests that individual characteristics may influence which sports people choose. This does not mean running is ineffective — separate entries in this section consider total weekly exercise volume.

16. Accumulating brief bouts of strenuous activity like stair-climbing and brisk walking to total four to five minutes per day

• Cost: There is no cost involved, nor is any extra workout time required. The difficulty lies in remembering to climb stairs and walk briskly instead of taking shortcuts.
• In plain terms: For people who normally do no exercise at all, simply engaging in three brief bouts of strenuous activity lasting one to two minutes each per day reduces their overall risk of death by roughly 40% compared to those who do none at all. Their risk of cardiovascular death also drops by nearly half. Such strenuous activities include stair-climbing, brisk walking, and similar efforts.
• Benefit: A study conducted by the UK Biobank involved 25,200 participants who did not regularly exercise. After an average follow-up period of 6.9 years, 852 participants passed away. Those who performed three short bursts of intense activity daily, each lasting 1–2 minutes, saw their overall mortality risk and cancer-related death risk drop by 38%–40% relative to those who did no such activity. Their risk of cardiovascular death decreased by 48%–49%. Even individuals who accumulated just 4.4 minutes of such activity daily experienced a 26%–30% reduction in mortality and cancer death risks, as well as a 32%–34% drop in cardiovascular death risk.
• Evidence grade: A
• Sources:Stamatakis E, Ahmadi MN, Gill JMR, et al. (2022). Association of wearable device-measured vigorous intermittent lifestyle physical activity with mortality. Nature Medicine, 28, 2521-2529. https://doi.org/10.1038/s41591-022-02100-x
• Notes: This finding is somewhat controversial. While this study utilized wearable devices to accurately measure activity levels, making it more reliable than self-reported questionnaire data, it still relied solely on observational tracking rather than controlled randomized trials, and the follow-up period was only 6.9 years. Moreover, these results apply only to individuals who currently do not engage in regular exercise; they are not applicable to those already following a consistent exercise routine.

17. Doing 30–60 minutes of strength training per week

• Cost: Bodyweight squats and push-ups cost nothing. Aim for 1–2 sessions per week, each lasting 20–30 minutes. The real challenge is fitting this into your weekly schedule.
• In plain terms: People who perform 30–60 minutes of strength training each week have a 10–20% lower risk of dying during that period compared to those who don’t train. Training beyond this amount won’t bring any extra benefit. Combining strength and aerobic exercise yields the best results.
• Benefit: When multiple longitudinal studies are pooled together (without subgroup analysis), individuals who engage in strength training show a 10%–17% reduction in mortality risk relative to non‑trainers. The greatest drop — roughly 10%–20% — occurs at around 30–60 minutes of weekly training; more time does not further lower risk. Those who also do aerobic exercise enjoy an even lower mortality rate than those who do neither type of activity.
• Evidence grade: A
• Sources:Momma H 等 (2022). Muscle-strengthening activities are associated with lower risk and mortality in major non-communicable diseases: a systematic review and meta-analysis of cohort studies. British Journal of Sports Medicine. https://doi.org/10.1136/bjsports-2021-105061
• Notes: These studies merely track participants over time, and the reported exercise amounts are self‑reported. The evidence supporting the claim that “excessive training can be detrimental” is very weak, so there’s no need to cap training volume for that reason. For older adults, strength training also helps prevent falls and preserve muscle mass; those benefits are discussed in Section 1.

18. Don’t sit for too long at a time — get up and move every now and then

• Cost: It costs nothing; getting up a few times doesn’t take much time at all. The hard part is that once you sit down, you tend to lose track of time, so you’ll need a reminder.
• In plain terms: People who sit the longest have a 2.6 times higher risk of dying during the same period compared to those who sit the least. Sitting continuously for long stretches also adds extra risk. However, if you get 60–75 minutes of moderate-intensity activity each day, this extra risk from prolonged sitting is largely offset.
• Benefit: A U.S. observational study used accelerometers to measure activity levels without grouping participants. It divided people into four groups based on total daily sitting time; those in the group with the most sitting had a 2.63 times higher mortality risk than the group with the least (HR 2.63). When grouped by duration of each continuous sitting session, the group with the longest sessions had a 1.96 times higher risk than the group with the shortest sessions (HR 1.96). This shows that both total daily sitting time and duration of each session are independently linked to risk. Another meta-analysis of millions of participants also found that people who sat for over 8 hours daily and did little to no exercise had a 1.59 times higher mortality risk compared to those who sat for under 4 hours and were most active (HR 1.59). Even among the most active group, those who sat over 8 hours daily still had an HR of only 1.04, showing no statistically significant difference.
• Evidence grade: A
• Sources:Diaz KM 等 (2017). Patterns of Sedentary Behavior and Mortality in U.S. Middle-Aged and Older Adults: A National Cohort Study. Annals of Internal Medicine. https://doi.org/10.7326/M17-0212；Ekelund U 等 (2016). Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women. Lancet. https://doi.org/10.1016/S0140-6736(16)30370-1
• Notes: The key takeaway is that how much you move matters more than how long you sit; sufficient physical activity essentially eliminates the extra risk from prolonged sitting. Keep in mind that these studies are purely observational, so many of the people who sat the most were already unwell — the “2.63 times higher risk” partly reflects this pre-existing health condition. Additionally, the same meta-analysis found that watching TV for over 3 hours daily increased risk across all activity levels; for the most active group, this threshold rose to 5 hours.

19. Eat less processed meat (ham, bacon, sausages, luncheon meat)

• Cost: It costs nothing — in fact, it saves money — and takes no extra time. The hard part is simply eating less of a food you enjoy.
• In plain terms: People who eat the most ham, bacon, and sausages have a roughly 20% higher chance of dying during the same period than those who eat the least. For every extra serving of processed meat consumed daily, that risk rises by another 20%.
• Benefit: When multiple long‑term studies are pooled together (without separating participants into groups), the group eating the most processed meat faces about a 23% higher death risk compared to the group eating the least (RR 1.23). For all red meat combined, the increase is about 29% (RR 1.29). Unprocessed red meat raises the risk by roughly 10% (RR 1.10), though this difference does not reach statistical significance. Another synthesis looks at daily intake: each extra daily serving of processed meat adds about a 23% higher death risk (RR 1.23), while each extra serving of red meat adds about 10% (RR 1.10).
• Evidence grade: A
• Sources:Larsson SC, Orsini N (2014). Red meat and processed meat consumption and all-cause mortality: a meta-analysis. American Journal of Epidemiology. https://doi.org/10.1093/aje/kwt261；Schwingshackl L 等 (2017). Food groups and risk of all-cause mortality: a systematic review and meta-analysis of prospective studies. American Journal of Clinical Nutrition. https://doi.org/10.3945/ajcn.117.153148；Johnston BC 等 (2019). Unprocessed Red Meat and Processed Meat Consumption: Dietary Guideline Recommendations From the NutriRECS Consortium. Annals of Internal Medicine. https://doi.org/10.7326/M19-1621（争议方 NutriRECS 指南）
• Notes: This is a contentious topic. The NutriRECS guidelines apply the standard GRADE evidence‑rating system and deem these studies “moderately reliable.” They offer only a very weak recommendation: “continue eating as you currently do.” The debate centers on whether the evidence is strong enough, not on the overall direction of the findings. No studies have shown any benefit from eating processed meat, and the effect of unprocessed red meat appears minimal and statistically insignificant. The focus should be on cutting back on processed meat.

20. Drink less or no alcohol

• Cost: There is no cost at all — it saves money and time. The only difficulty is handling social pressure to drink in gatherings.
• In plain terms: After consuming 100 g of pure alcohol per week (roughly 2.5 L of beer), the more you drink, the earlier you are likely to die. For people aged 40, those drinking 100–200 g per week lose about half a year of life expectancy; those drinking 200–350 g lose 1–2 years; and those drinking over 350 g lose 4–5 years. Overall, the healthiest choice is to abstain completely. A total of 64 drinkers were included in these analyses.
• Benefit: A pooled analysis of 83 longitudinal studies involving 600,000 drinkers shows that the lowest mortality risk occurs at a weekly intake of no more than 100 g of pure alcohol — equivalent to about 2.5 L of beer or 300 mL of 40% alcohol. At this level, 40-year-olds lose roughly 6 months of life expectancy; higher intakes lead to greater losses. The Global Burden of Disease Study 2016 also identifies zero alcohol consumption as the safest level. One adjusted analysis found that daily intake of 1.3–24 g of alcohol is linked to a 7% lower mortality risk (RR 0.93), while intakes above 65 g per day increase risk by 35% (RR 1.35).
• Evidence grade: A
• Sources:Wood AM 等 (2018). Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies. Lancet. https://doi.org/10.1016/S0140-6736(18)30134-X；GBD 2016 Alcohol Collaborators (2018). Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. https://doi.org/10.1016/S0140-6736(18)31310-2；Zhao J 等 (2023). Association Between Daily Alcohol Intake and Risk of All-Cause Mortality: A Systematic Review and Meta-analyses. JAMA Network Open. https://doi.org/10.1001/jamanetworkopen.2023.6185；Di Castelnuovo A 等 (2006). Alcohol dosing and total mortality in men and women: an updated meta-analysis of 34 prospective studies. Archives of Internal Medicine. https://doi.org/10.1001/archinte.166.22.2437（争议方）
• Notes: This topic remains debated. One major review of 34 long-term studies suggests that moderate drinking can reduce overall mortality by up to 17–18% for men drinking up to 4 drinks per day and women up to 2. Critics argue that non-drinkers in such studies often include people who quit drinking due to illness or who were already in poor health; when these factors are accounted for, any protective effect disappears. The safest interpretation is that moderate drinking offers little benefit, while excessive drinking clearly harms longevity. There is no evidence to support starting to drink for health reasons. For tips on cutting back, see Section 22; those already drinking daily should not attempt to quit abruptly — see Section 21 for guidance.

21. People who drink daily and experience tremors and palpitations when they stop should not try to quit on their own

• Cost: Seeing a psychiatrist or addiction specialist costs just a few to several dozen dollars. In severe cases, a short hospital stay may be required.
• In plain terms: Individuals who consume large amounts of alcohol every day can suffer from withdrawal symptoms if they suddenly stop. Mild cases involve tremors, sweating, palpitations, and insomnia; severe cases may lead to seizures or delirium tremens — a life-threatening emergency. A Norwegian study of over 30,000 participants found that 8% of those who had experienced delirium tremens died each year thereafter. Anyone wanting to quit should first consult a doctor and clearly describe their daily alcohol intake.
• Benefit: A 2026 clinical review confirms that chronic heavy drinkers often develop withdrawal syndrome after abruptly cutting back or stopping entirely. Symptoms include tremors, autonomic hyperactivity, anxiety, insomnia, perceptual disturbances, seizures, and delirium tremens — conditions that are both common and potentially fatal in general medical practice. Norway’s national registry included 36,287 individuals diagnosed with alcohol dependence, withdrawal states, or delirium tremens between 2009 and 2015. The annual mortality rate was 8.0% among those with delirium tremens, 5.0% among those in withdrawal states, and 3.6% among those with alcohol dependence. The standardized mortality ratio for the delirium tremens group was 9.8 (95% CI 8.9–10.7), meaning their risk of death was roughly 9.8 times higher than that of age-matched peers in the general population.
• Evidence grade: B
• Sources:Caputo F, Lungaro L, Costanzini A, De Giorgio R, Addolorato G (2026). Alcohol withdrawal syndrome in hospitalized patients: a practical review. European Journal of Internal Medicine, 107103. https://doi.org/10.1016/j.ejim.2026.107103；Bramness JG, Heiberg IH, Høye A, Rossow I (2023). Mortality and alcohol-related morbidity in patients with delirium tremens, alcohol withdrawal state or alcohol dependence in Norway: A register-based prospective cohort study. Addiction, 118(12), 2352–2359. https://doi.org/10.1111/add.16297
• Notes: How to tell if you’re at risk: If you drink almost every day, experience tremors, sweating, palpitations, or insomnia when you skip a day, or feel better after having a drink in the morning, you should not attempt to quit on your own. Standard medical treatment involves using benzodiazepines to manage the initial withdrawal period while also supplementing thiamine (vitamin B1). This evidence is rated B because the Norwegian cohort data describe outcomes among people who had already suffered delirium tremens rather than directly testing the effects of self-directed abstinence. Quitting alcohol remains essential; the safer approach is to seek professional medical help. For guidance on what constitutes “frequent” drinking, see section 20; strategies for reducing intake are outlined in section 22.

22. To drink less, first tally how much you drink each week, then chat briefly with a doctor

• Cost: No cost at all. Simply count the number of drinks each day and jot it down. Asking your doctor about it during a routine visit costs nothing extra.
• In plain terms: A doctor can spend a few minutes reviewing your drinking habits, explaining the risks, and helping you set a goal. After a year, people following this approach typically cut their weekly alcohol intake by about 20 grams of pure alcohol — roughly half a liter of beer. Longer consultations don’t bring any added benefit. For those already struggling to quit, two medications have proven effective abroad: for every 12 patients treated, roughly one additional person manages to avoid heavy drinking.
• Benefit: Data from 34 randomized trials involving 15,197 participants show that individuals receiving brief interventions ended up drinking 20 grams less pure alcohol per week after a year compared to those receiving minimal or no intervention (95% CI: 12–28 grams; moderate-quality evidence). The average baseline consumption in these studies was 244 grams per week. “Brief interventions” here refer to no more than five sessions totaling under 60 minutes of advice or lifestyle counseling; longer sessions provide no further advantage. Regarding medications, 122 trials with 22,803 participants indicate that acamprosate helps one additional person per 12 treated avoid any alcohol use altogether (95% CI: 8–26). Oral naltrexone at 50 mg daily similarly yields one additional non-heavy drinker per 12 patients (95% CI: 8–26).
• Evidence grade: A
• Sources:Kaner EF, Beyer FR, Muirhead C, et al. (2018). Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database of Systematic Reviews, 2, CD004148. https://doi.org/10.1002/14651858.CD004148.pub4；Jonas DE, Amick HR, Feltner C, et al. (2014). Pharmacotherapy for adults with alcohol use disorders in outpatient settings: a systematic review and meta-analysis. JAMA, 311(18), 1889–1900. https://doi.org/10.1001/jama.2014.3628
• Notes: The benefit is classified as “small” because both sets of data track alcohol consumption rather than mortality; per our guidelines, outcomes based on surrogate endpoints receive this rating. The medication trials were conducted primarily abroad, with most participants meeting criteria for alcohol dependence and receiving psychosocial support alongside drug therapy; the figures represent extra benefits achieved on top of those standard treatments. Availability and prescription of these drugs in China depend on individual doctors and official labeling — do not purchase them online without medical guidance. Anyone experiencing withdrawal symptoms should refer to section 21; do not attempt to quit abruptly on your own.

23. Eating a small handful of nuts daily

• Cost: Consuming 28 grams per day costs roughly 200–300 yuan annually. It’s easy to fit into your routine without taking extra time.
• In plain terms: People who regularly eat nuts have about 20% lower mortality risk compared to those who don’t. Even eating nuts just once a week yields a roughly 10% reduction in risk. The greatest benefit is seen when nuts are consumed daily.
• Benefit: Two large U.S. studies tracked over 119,000 participants for several years, totaling more than 3 million person-years. Compared to non-nut eaters: individuals consuming nuts less than once a week saw a 7% lower risk of death (hazard ratio 0.93, 95% CI 0.90–0.96). Those eating nuts once a week had a 11% lower risk (0.89, 0.86–0.93). For consumption of 2–4 times weekly, the reduction was 13% (0.87, 0.83–0.90). Those eating nuts 5–6 times weekly saw a 15% drop (0.85, 0.79–0.91), while daily consumption resulted in a 20% lower risk (0.80, 0.73–0.86).
• Evidence grade: A
• Sources:Bao Y, Han J, Hu FB, et al. (2013). Association of nut consumption with total and cause-specific mortality. New England Journal of Medicine, 369(21), 2001-2011. https://doi.org/10.1056/NEJMoa1307352
• Notes: Choose plain, unsalted nuts. Although nutritious, nuts are calorie-dense, so avoid eating them in excess as snacks. Keep in mind these studies only track long-term trends; nut eaters generally maintain healthier lifestyles overall, so these figures should be interpreted with some caution.

24. Swapping some red meat for fish and poultry

• Cost: There’s no extra cost or time involved. You’re simply replacing one type of meat with another, not buying more. The real challenge is adjusting your taste preferences.
• In plain terms: Eating two extra servings of processed or red meat each week raises the risk of death by roughly 3% compared to eating the same amount of fish or poultry. This effect is relatively small within this section, so it’s an easy swap to make without much effort.
• Benefit: This conclusion comes from combining data from six U.S. studies involving nearly 30,000 participants. Consuming two extra servings of processed meat weekly increases mortality risk by about 3% (hazard ratio 1.03, 95% CI 1.02–1.05). The same increase applies to unprocessed red meat (1.03, 1.01–1.05). However, switching to poultry or fish shows no significant change: hazard ratios of 0.99 (0.97–1.02) and 0.99 (0.97–1.01) respectively.
• Evidence grade: A
• Sources:Zhong VW, Van Horn L, Greenland P, et al. (2020). Associations of Processed Meat, Unprocessed Red Meat, Poultry, or Fish Intake With Incident Cardiovascular Disease and All-Cause Mortality. JAMA Internal Medicine, 180(4), 503-512. https://doi.org/10.1001/jamainternmed.2019.6969
• Notes: The impact of swapping two weekly servings of meat is minimal, so don’t expect a major lifespan boost from this change. If you’re already spending money on meat, fish and poultry are the better choices.

25. Swap some refined rice and flour for whole grains

• Cost: Whole grain options like brown rice, oats, and whole wheat flour cost slightly more than refined varieties and require no extra prep time. The main challenge is adjusting to their different taste and texture.
• In plain terms: People who eat an extra 90 g of whole grains daily have a roughly 17% lower risk of dying over the same period. That amount equals about three servings. The risk continues to drop when intake rises to around 200 g per day.
• Benefit: Pooled data from multiple observational studies (no participant grouping used) shows that adding 90 g of whole grains daily cuts mortality risk by roughly 17% (RR 0.83). This effect holds true up to 210–225 g per day. Another pooled analysis found an 8% lower risk per extra daily serving (RR 0.92).
• Evidence grade: A
• Sources:Aune D 等 (2016). Whole grain consumption and risk of cardiovascular disease, cancer, and all cause and cause specific mortality: systematic review and dose-response meta-analysis of prospective studies. BMJ. https://doi.org/10.1136/bmj.i2716；Schwingshackl L 等 (2017). Food groups and risk of all-cause mortality: a systematic review and meta-analysis of prospective studies. American Journal of Clinical Nutrition. https://doi.org/10.3945/ajcn.117.153148
• Notes: You do not need to replace all refined grains with whole grains — swapping just half delivers the bulk of these benefits. Keep in mind these studies are observational, so participants eating more whole grains tend to be healthier overall, which may inflate the reported effect sizes. Results across individual studies also vary widely (I² 83%, a high value indicating substantial inconsistency between study conclusions).

26. Drinking tea three or more times per week

• Cost: It costs just a few dozen to a few hundred yuan per year. Brewing a cup takes only a few minutes, so it doesn’t take up much time at all.
• In plain terms: People who regularly drink tea have a roughly 15% lower risk of dying over the same period. Starting at age 50, they can expect to live 1.26 extra years on average, and 1.41 extra years without suffering from any atherosclerotic cardiovascular diseases.
• Benefit: One large study in China, called China-PAR, involved over 100,900 participants, with half of them followed for 7.3 years. Those with a regular tea-drinking habit had a 15% lower risk of death (hazard ratio 0.85, 95% CI 0.79–0.90, which is a reliable range). Starting at age 50, these individuals gain 1.41 extra years free from atherosclerotic cardiovascular diseases, and 1.26 extra years of total life expectancy.
• Evidence grade: A
• Sources:Wang X, Liu F, Li J, et al. (2020). Tea consumption and the risk of atherosclerotic cardiovascular disease and all-cause mortality: The China-PAR project. European Journal of Preventive Cardiology, 27(18), 1956-1963. https://doi.org/10.1177/2047487319894685；茶叶霉菌毒素：Cui P 等 (2020). Quantitative analysis and dietary risk assessment of aflatoxins in Chinese post-fermented dark tea. Food and Chemical Toxicology. https://doi.org/10.1016/j.fct.2020.111830；Zhou H 等 (2022). Mycotoxins in Tea (Camellia sinensis (L.) Kuntze): Contamination and Dietary Exposure Profiling in the Chinese Population. Toxins. https://doi.org/10.3390/toxins14070452；绿茶提取物与肝损伤：Hu J 等 (2018). The safety of green tea and green tea extract consumption in adults - Results of a systematic review. Regulatory Toxicology and Pharmacology. https://doi.org/10.1016/j.yrtph.2018.03.019
• Notes: There are some caveats to keep in mind: this type of study is purely observational, and Chinese men who drink tea tend to smoke and drink more than average. The researchers have accounted for some of these factors, but not all. Also, never drink tea that is piping hot — please refer to the section on hot drink temperatures for more details. Some people worry about mycotoxins in tea; a test of 158 batches of dark tea found aflatoxin in just 2 of them, and the amount consumed via normal tea intake stays well under internationally accepted limits. Another study examined 352 tea samples for 16 different mycotoxins, and only ochratoxin A in dark tea exceeded the legal limit on average. Even accounting for typical Chinese tea consumption levels, neither study found any dietary risk. Always store tea in a dry place, and discard any batches that have become damp or moldy. Tea extract capsules are a different story: taking large doses of concentrated catechins at one time can damage the liver, but this is not a risk when drinking brewed tea. Therefore, all the benefits mentioned here apply only to brewed tea — do not replace regular tea with extract supplements.

27. Drinking three to four cups of coffee daily, without sugar or cream

• Cost: Making coffee at home costs just one or two yuan per day. It takes only a few minutes to brew each cup, so it doesn’t take much time at all.
• In plain terms: People who drink three to four cups of coffee each day have a roughly 17% lower risk of dying during the same period compared to those who don’t drink coffee.
• Benefit: One review combined results from 201 separate studies. All of these original studies simply recorded outcomes without grouping participants. The overall finding was that drinking 3–4 cups of coffee daily lowered mortality risk by 17% compared to non‑drinkers (relative risk 0.83, 95% CI 0.79–0.88; this is a reliable range).
• Evidence grade: A
• Sources:Poole R, Kennedy OJ, Roderick P, et al. (2017). Coffee consumption and health: umbrella review of meta-analyses of multiple health outcomes. BMJ, 359, j5024. https://doi.org/10.1136/bmj.j5024
• Notes: There is some debate here: the authors note that almost all evidence comes from observational tracking studies and state that “reliable randomized controlled trials are needed to confirm a causal relationship.” In other words, participants must be randomly assigned to groups for a true cause‑and‑effect conclusion. For this benefit to apply, coffee should be consumed black; adding sugar or cream cancels out these advantages. This recommendation does not apply to pregnant women or people with arrhythmia, anxiety, or insomnia.

28. Eating 5 servings (about 400 g) of fruits and vegetables daily

• Cost: It costs only a few to a dozen yuan per day. You’ll also need some time each day to wash and cut them. The real challenge is making sure to buy and eat the required amount every single day.
• In plain terms: Consuming an extra 200 g of fruits and vegetables each day lowers the overall risk of death by roughly 10% over time. People who eat 5 servings daily have a 13% lower risk of death compared to those who eat just 2 servings. Eating more than 5 servings does not bring any further risk reduction.
• Benefit: When pooling data from multiple observational studies (without subgroup analysis), an extra 200 g of fruits and vegetables daily reduces mortality risk by about 10% (RR 0.90). This protective effect remains consistent up to 800 g per day. A combined analysis of two large US cohort studies and 26 other studies shows that those eating 5 servings daily have a 13% lower mortality risk than those eating only 2 servings (HR 0.87). The optimal combination is 2 servings of fruit and 3 servings of vegetables; any extra servings beyond that do not provide additional benefit.
• Evidence grade: A
• Sources:Aune D 等 (2017). Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality: a systematic review and dose-response meta-analysis of prospective studies. International Journal of Epidemiology. https://doi.org/10.1093/ije/dyw319；Wang DD 等 (2021). Fruit and Vegetable Intake and Mortality: Results From 2 Prospective Cohort Studies of US Men and Women and a Meta-Analysis of 26 Cohort Studies. Circulation. https://doi.org/10.1161/CIRCULATIONAHA.120.048996
• Notes: It is sufficient to eat 5 servings daily — there is no need to reach 10 servings, as both studies agree on this point. Keep in mind that these studies are purely observational, so they are prone to confounding factors: people who eat more fruits and vegetables tend to have higher incomes, better education levels, and engage in more physical activity. Therefore, the reported 10% risk reduction represents an upper limit estimate.

29. Eat fewer ultra-processed foods (chips, instant noodles, pastries, ready meals)

• Cost: There’s no direct cost involved, though you’ll need to spend time either preparing meals yourself or selecting minimally processed ingredients each day. The real challenge is overcoming the long-standing habit of opting for convenience over health.
• In plain terms: People who consume the most ultra-processed foods have roughly a 20% higher risk of dying during the same period compared to those who eat the least, and a 50% higher risk of dying from cardiovascular disease. However, this evidence is rated as fairly uncertain, so these figures should be treated as rough estimates.
• Benefit: One review combined multiple existing studies into a single analysis, using raw data without any subgroup categorization. The results showed that individuals consuming higher amounts of ultra-processed foods had a 21% greater risk of death (RR 1.21) and a 50% greater risk of cardiovascular death (RR 1.50) compared to those eating less of these foods. These findings were classified as “highly suggestive” and “convincing” respectively. Yet when assessed using standard GRADE criteria, the overall certainty of the evidence is rated as low or very low.
• Evidence grade: A
• Sources:Lane MM 等 (2024). Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses. BMJ. https://doi.org/10.1136/bmj-2023-077310
• Notes: There are three main points of contention here. First, the NOVA classification system groups foods with vastly different nutritional profiles into the same category. Second, ultra-processed foods overlap heavily with sugary drinks and processed meats (discussed in items 7 and 19), making it hard to isolate which factor is having the actual effect. Third, GRADE ratings for this evidence also remain low. Consequently, it’s hard to predict exactly how much additional benefit this recommendation will provide after following items 7 and 19. The opposing evidence comes solely from the low GRADE rating given in this same review; no original studies have yet produced contradictory results. For now, it’s best to first adhere to items 7 and 19 — avoiding sugary drinks and limiting processed meat intake — before focusing on this recommendation.

30. Switching from coal and wood to electricity or gas for cooking and heating

• Cost: Rural households need to replace their stoves and also pay higher fuel costs; this adds up to several hundred to over a thousand yuan per year. The switch is a one-time effort and doesn’t require ongoing time investment. In cities, most households already use electricity or gas.
• In plain terms: People who cook using coal or wood face roughly a 10% higher chance of dying over the same period compared to others; those who heat their homes this way have a roughly 14% higher risk. Those who have already switched to electricity or gas have a 13%–33% lower mortality risk than those still relying on coal and wood.
• Benefit: One Chinese study followed 271,000 adults without cardiovascular disease, recording their health outcomes without grouping them by lifestyle. People who cooked using solid fuels such as coal or wood had an 11% higher risk of death compared to those using electricity or gas (HR 1.11). Those who used solid fuels for heating faced a 14% higher risk (HR 1.14). Among people who had switched from solid fuels to cleaner alternatives, the risk dropped by 13% for cooking (HR 0.87) and by 33% for heating (HR 0.67). Separate data also show that for every 10 µg/m³ increase in long-term exposure to outdoor PM2.5, the risk of death from natural causes rises by about 8% (RR 1.08). In total, 104 studies were analyzed for this conclusion. Natural causes refer to deaths not caused by accidents.
• Evidence grade: A
• Sources:Yu K 等 (2018). Association of Solid Fuel Use With Risk of Cardiovascular and All-Cause Mortality in Rural China. JAMA. https://doi.org/10.1001/jama.2018.2151；Chen J, Hoek G (2020). Long-term exposure to PM and all-cause and cause-specific mortality: A systematic review and meta-analysis. Environment International. https://doi.org/10.1016/j.envint.2020.105974
• Notes: These studies merely track health outcomes over time. Households that switch to cleaner fuels are often wealthier, so part of the observed 0.67-fold reduction in risk is likely linked to socioeconomic factors. Regarding outdoor PM2.5, individuals have limited options — moving to a cleaner area, wearing masks, or using air purifiers. There are no studies evaluating air purifiers based on mortality rates, so no specific figures are provided here.

31. Let hot drinks cool down a bit before drinking; avoid tea, soup, and coffee that are piping hot

• Cost: No money is required; you just need to wait two to three extra minutes each time. The hard part is resisting the urge to drink when you’re craving a hot beverage.
• In plain terms: Drinking tea that is very hot raises your risk of esophageal cancer by 8 times compared to drinking lukewarm tea. Even tea that is just “hot” doubles the risk. If you drink tea less than two minutes after pouring it, your risk is 5 times higher than if you wait at least four minutes to drink it.
• Benefit: In a high-risk region for esophageal cancer in northern Iran, researchers compared 300 patients with esophageal cancer to 571 healthy individuals. All results below are compared against people who drank lukewarm tea. Those who drank “hot” tea had roughly 2.07 times the risk of developing squamous cell carcinoma of the esophagus (95% CI: 1.28–3.35). For people who drank “very hot” tea, the risk was about 8.16 times higher (95% CI: 3.93–16.9). Those who drank tea less than two minutes after pouring it had 5.41 times the risk of developing the disease compared to people who waited at least four minutes to drink it (95% CI: 2.63–11.1).
• Evidence grade: A
• Sources:Islami F, Pourshams A, Nasrollahzadeh D, et al. (2009). Tea drinking habits and oesophageal cancer in a high risk area in northern Iran: population based case-control study. BMJ, 338, b929. https://doi.org/10.1136/bmj.b929；Loomis D, Guyton KZ, Grosse Y, et al. (2016). Carcinogenicity of drinking coffee, mate, and very hot beverages. Lancet Oncology, 17(7), 877-878. https://doi.org/10.1016/S1470-2045(16)30239-X
• Notes: The International Agency for Research on Cancer classifies hot drinks above 65°C as Group 2A carcinogens, meaning they are “probably carcinogenic to humans.” The same assessment also confirms that coffee itself is not carcinogenic. In China, high rates of esophageal cancer in regions like Chaoshan and the Taihang Mountains are strongly linked to the habit of drinking beverages while they are still very hot.

32. Getting some sun during the day — don’t stay out of the light all the time

• Cost: No cost at all. Just a few minutes each day — on your commute or during lunch breaks is enough.
• In plain terms: Women who deliberately avoid sunlight can expect to live 0.6 to 2.1 years less than those who get the most sun exposure. Even non-smokers who avoid the sun tend to have a life expectancy similar to smokers who get plenty of sun.
• Benefit: A Swedish study followed 29,500 women for 20 years. Compared to the group getting the most sun, those who avoided it ended up living 0.6 to 2.1 years less. The authors noted that “non-smoking women who avoid sunlight have a life expectancy comparable to smokers who get the most sun exposure.”
• Evidence grade: B
• Sources:Lindqvist PG, Epstein E, Nielsen K, et al. (2016). Avoidance of sun exposure as a risk factor for major causes of death: a competing risk analysis of the Melanoma in Southern Sweden cohort. Journal of Internal Medicine, 280(4), 375-387. https://doi.org/10.1111/joim.12496
• Notes: There are some caveats: Sweden’s high latitude and limited sunlight mean these findings may not directly apply to China. It’s also possible that people avoiding sun tend to be less physically active or prefer staying indoors. Also, avoid sunburn — use protection under strong midday sun, since excessive exposure raises skin cancer risk.

33. Keep BMI between 20–25; lose weight if you’re overweight

• Cost: No monetary cost. However, diet and exercise require daily time and effort. This is the toughest guideline in the whole chapter: maintaining weight loss is harder than losing it in the first place.
• In plain terms: Mortality is lowest when BMI falls within 20–25. At BMI 27.5–30, risk rises by roughly 20%; at 30–35, it climbs by about 45%; at 35–40, it nearly doubles. East Asians are especially sensitive to excess weight — for every 5‑unit increase in BMI, risk rises by roughly 40%.
• Benefit: Data from 239 longitudinal studies were pooled and analyzed (no subgrouping was performed). Only three groups remained in the final analysis: non‑smokers, individuals without chronic disease at enrollment, and those who survived at least five years after joining the study. Results showed that mortality risk was lowest at BMI 20–25. Between 25–27.5, risk increased by about 7% (HR 1.07); at 27.5–30, by roughly 20% (HR 1.20); at 30–35, by about 45% (HR 1.45); at 35–40, by nearly 94% (HR 1.94); and at 40–60, it was 2.76 times higher (HR 2.76). For East Asians, each additional 5 kg/m² of BMI raised risk by about 39% (HR 1.39).
• Evidence grade: A
• Sources:Global BMI Mortality Collaboration (2016). Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents. Lancet. https://doi.org/10.1016/S0140-6736(16)30175-1；Flegal KM 等 (2013). Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA. https://doi.org/10.1001/jama.2012.113905（争议方）
• Notes: This topic remains controversial. Some researchers argue that being slightly overweight actually extends lifespan; their pooled data show a roughly 6% lower mortality risk for overweight individuals and a 5% reduction for those with mild obesity. The main disagreement centers on whether to exclude three types of data: smokers, patients already suffering from disease, and participants in the first few years after enrollment. Those groups are excluded because severely ill patients tend to lose weight first. After removing these three categories from the analysis of 239 studies, the elevated mortality risk associated with excess weight reappears. It is also important to note that no randomized trials have proven that weight loss itself lowers overall mortality. The benefits described above result from comparing people of different weights, not from a guarantee that losing weight will produce those exact reductions. Those aiming to lose weight need not obsess over meal timing; neither breakfast nor the 16:8 intermittent fasting regimen offers any extra advantage — see Section 6, Item 26 for details.

34. Eating chili peppers more than four times a week

• Cost: There is no cost and it doesn’t take any extra time.
• In plain terms: People who eat chili peppers more than four times a week have a roughly 23% lower chance of dying during the same period compared to those who rarely eat them; their risk of dying from cardiovascular causes is about one-third lower.
• Benefit: One Italian study followed 22,800 people for an average of 8.2 years; 1,236 participants died over that time. Those who ate chili peppers four or more times a week had a 23% lower risk of death than those who rarely ate them (hazard ratio 0.77, 95% CI 0.66–0.90). Their risk of cardiovascular death was also about 34% lower (HR 0.66, 95% CI 0.50–0.86).
• Evidence grade: B
• Sources:Bonaccio M, Di Castelnuovo A, Costanzo S, et al. (2019). Chili Pepper Consumption and Mortality in Italian Adults. Journal of the American College of Cardiology, 74(25), 3139-3149. https://doi.org/10.1016/j.jacc.2019.09.068
• Notes: There is some debate: this research was conducted within the context of a Mediterranean diet, so chili eaters may simply follow a diet that aligns more closely with local traditional eating habits. Additionally, people with gastroesophageal reflux, hemorrhoids, or irritable bowel syndrome may experience worsened symptoms from eating chili peppers; they don’t need to force themselves to eat it.

35. Drinking one or two servings of milk or yogurt daily

• Cost: Only a few yuan per day; requires no extra time.
• In plain terms: People who consume two or more servings of milk or yogurt daily have a roughly 17% lower chance of dying during the same period compared to those who don’t drink any.
• Benefit: The PURE study followed 136,000 participants across 21 countries for an average of 9.1 years; 6,796 of them passed away. Those who ate two or more servings of dairy products daily faced a 17% lower mortality risk than non-consumers (hazard ratio 0.83, 95% CI 0.72–0.96). The statistical significance of this trend is confirmed by a P-value of 0.0052.
• Evidence grade: B
• Sources:Dehghan M, Mente A, Rangarajan S, et al. (2018). Association of dairy intake with cardiovascular disease and mortality in 21 countries from five continents (PURE): a prospective cohort study. Lancet, 392(10161), 2288-2297. https://doi.org/10.1016/S0140-6736(18)31812-9
• Notes: There are some concerns: the PURE study included many participants from low- and middle-income countries, where regular milk consumption often reflects better household financial status, making it hard to rule out this confounding factor. Additionally, people with lactose intolerance can safely switch to yogurt or low-lactose milk instead of forcing themselves to drink regular milk.

36. Eggs don’t need to be avoided, but don’t eat three or four daily

• Cost: No cost and no extra time required.
• In plain terms: Eating an extra half whole egg each day raises the overall mortality risk by roughly 7%. Swapping that half egg for egg whites, fish, poultry, or nuts actually lowers the risk of death across all categories. There’s no need to cut eggs out of your diet; just avoid consuming three or four daily.
• Benefit: A U.S. study tracking 521,000 people found that 129,000 participants died over time. Those eating an extra half whole egg daily had a 7% higher mortality risk (hazard ratio 1.07; 95% CI 1.06–1.08). Replacing that half egg with an equal amount of egg whites, poultry, fish, dairy, or nuts and legumes further reduced mortality risk, including risks related to cardiovascular disease, cancer, and respiratory conditions.
• Evidence grade: B
• Sources:Zhuang P, Wu F, Mao L, et al. (2021). Egg and cholesterol consumption and mortality from cardiovascular and different causes in the United States: A population-based cohort study. PLoS Medicine, 18(2), e1003508. https://doi.org/10.1371/journal.pmed.1003508
• Notes: This topic remains controversial: other large-scale long-term studies and meta-analyses have found no link between egg consumption and mortality. The U.S. Dietary Guidelines have also removed the previous daily cholesterol limit. The key takeaway is to avoid eating three or four eggs daily; one egg per day poses no significant concern.

37. Take baths when you can — don’t limit yourself to showers

• Cost: It costs more in water and electricity; each bath takes about half an hour.
• In plain terms: People who bathe almost daily have a roughly 28% lower risk of cardiovascular events and a roughly 46% lower risk of brain hemorrhage compared to those who bathe fewer than twice a week.
• Benefit: A Japanese study involving 30,000 participants followed for 19 years recorded 2,097 cardiovascular events. Those who bathed almost daily had about 28% lower risk of cardiovascular events than those who bathed no more than twice a week (hazard ratio 0.72, 95% CI 0.62–0.84). Their risk of coronary heart disease was about 35% lower (0.65, 0.45–0.94), risk of stroke about 26% lower (0.74, 0.62–0.87), and risk of brain hemorrhage about 46% lower (0.54, 0.40–0.73).
• Evidence grade: B
• Sources:Ukai T, Iso H, Yamagishi K, et al. (2020). Habitual tub bathing and risks of incident coronary heart disease and stroke. Heart, 106(10), 732-737. https://doi.org/10.1136/heartjnl-2019-315752
• Notes: These results apply to the Japanese population and its bath culture; most Chinese households lack the conditions for daily baths. Also, water should not be too hot and baths should not last too long. For older adults and those with cardiovascular or cerebrovascular diseases, excessively hot water and prolonged bathing can actually be dangerous — Japan sees many elderly deaths in bathtubs each year.

38. Keep naps under 30 minutes — no longer than an hour. If you need a full hour or more to feel functional, it’s time to get checked out.

• Cost: It costs nothing. Just set an alarm before you nap; it requires almost no willpower at all.
• In plain terms: People who nap for less than an hour show no increase in mortality or chronic disease risk, and their mental clarity actually improves. Those who nap longer than an hour face roughly a 30% higher risk of coronary heart disease, and about a 20% higher risk of diabetes and obesity. So set that alarm and wake up after half an hour. If you regularly need a full hour or more to get through the day, that’s a clear sign you should have a medical checkup.
• Benefit: One umbrella meta-analysis pooled data from 16 separate meta-analyses covering 244 health outcomes. The bottom line: people who nap fewer than 60 minutes experience no rise in overall mortality or chronic disease risk, and see the greatest gains in cognitive function (SMD 0.69, 95% CI 0.37–1.00 — a reliable range). Naps lasting 20–30 minutes produce the biggest improvements in physical performance (SMD 0.99, 95% CI 0.67–1.31). In contrast, naps exceeding 60 minutes raise coronary heart disease risk by roughly 30%, and diabetes and obesity risk by about 20%. Another study used wrist-worn monitors to track actual nap duration in 1,338 adults aged 56 and older, rather than relying on self-reported surveys. After up to 19 years of follow-up, 926 participants died. For every extra hour of napping, mortality risk rose by about 13% (HR 1.13, 95% CI 1.04–1.23). Each additional daily nap added roughly 7% to that risk (HR 1.07, 95% CI 1.02–1.13). Naps taken in the morning carried a roughly 30% higher risk compared to those taken earlier in the afternoon (HR 1.30, 95% CI 1.03–1.64).
• Evidence grade: B
• Sources:Du P, Li J, Hua Z, 等 (2026). Multiple Health Outcomes of Daytime Napping: A Comprehensive Umbrella Review. Public Health Reviews. https://doi.org/10.3389/phrs.2026.1609013；Gao C, Cai R, Zheng X, 等 (2026). Objectively Measured Daytime Napping Patterns and All-Cause Mortality in Older Adults. JAMA Network Open. https://doi.org/10.1001/jamanetworkopen.2026.7938；Dashti HS 等 (2021). Genetic determinants of daytime napping and effects on cardiometabolic health. Nature Communications. https://doi.org/10.1038/s41467-020-20585-3
• Notes: This topic remains controversial. Both of the major studies mentioned above merely recorded nap duration without stratifying participants by health status. People who habitually nap longer are more likely to suffer from sleep apnea, anemia, hypothyroidism, depression, or other chronic conditions; therefore it’s hard to isolate exactly how much of the observed mortality increase is directly attributable to napping itself. Mendelian randomization studies involving 453,000 and 541,000 participants respectively found only one consistent link: the more frequently someone naps, the slightly higher their blood pressure and waist circumference become. No causal effect on coronary heart disease or diabetes was identified. Consequently, “shortening naps” shouldn’t be promoted as a standalone strategy for lowering mortality. The recommendation to “get checked out” is an author‑suggested precaution; it falls under a lower‑grade evidence tier. If daytime fatigue forces you to nap for extended periods, first evaluate nighttime sleep quality — check for snoring or breathing pauses that might indicate sleep apnea — and then arrange routine blood tests and thyroid screening. For quick, effective energy boosts, see Section 3, Item 11 (a 10‑minute afternoon nap works best). Optimal nighttime sleep duration is discussed in Section 13 of this chapter (aim for 7 hours per night).

39. Catch up on sleep the night after a sleepless night — don’t wait until the weekend

• Cost: No cost at all. Those extra hours of sleep you make up are exactly what you’d have wanted to get anyway.
• In plain terms: People who lose sleep one night and fail to make it up the following night have a roughly 15% higher risk of death compared to those with regular sleep patterns. For those who lose far more sleep and still don’t catch up, the risk rises by about 42%. No such increased risk is seen in people who do make up the lost sleep. So if you stay up late, go to bed early the next night.
• Benefit: This study used data from 85,618 UK Biobank participants, with an average age of 61.8 years. Wrist-worn monitors tracked their daily sleep, and they were followed for a median of 8 years. The researchers first identified each person’s individual sleep needs, then defined “sleep deficit nights” as nights when they got at least 2.5 hours less sleep than required. The first night after such a deficit was called a “catch-up night”, and if they got more sleep than needed that night, they were counted as having made up the deficit. Five distinct sleep patterns were identified based on this framework. Compared to people with regular sleep schedules, those who lost sleep and did not catch up had a 15% higher risk of all-cause death (HR 1.15, 95% CI 1.01–1.31, a reliable range). For those with a cumulative sleep deficit of over 3.5 hours who also failed to catch up, the risk rose by around 42% (HR 1.42, 1.24–1.63). No significant risk increases were found in the two groups who did make up their sleep deficit; for those who lost sleep but caught up, the HR was 1.12 (0.98–1.28). Among people who naturally get less sleep, those who lost sleep and did not make it up had a 19% higher risk (HR 1.19, 1.01–1.40), while those with a severe sleep deficit and no catch-up showed a 38% higher risk (HR 1.38, 1.17–1.63). These findings were replicated in a separate US health survey of 4,586 participants.
• Evidence grade: B
• Sources:Li X, Zhang M, Li Z, 等 (2026). Acute sleep rebound following sleep restriction is associated with reduced mortality risk. Nature Communications. https://doi.org/10.1038/s41467-026-72461-1
• Notes: This is an observational study with no formal grouping of participants. People who cannot make up lost sleep may simply be busier or in poorer health, and this factor cannot be fully ruled out. The fact that no risk increase was detected in the two groups who caught up only means no statistically significant difference was found; their point estimates remain above 1, so catching up does not completely eliminate risk. Therefore, if you lose sleep, you should make it up as soon as possible — but this does not give you a free pass to stay up late regularly. The “catch-up sleep” referenced here means getting extra sleep on the very first night after a deficit, not saving up multiple nights of sleep to make up all at once over the weekend. The practice of staying up on weekdays and sleeping in on weekends, which creates “social jetlag”, is linked to cardiovascular disease — see Section 13 (aim for around 7 hours of sleep per night with consistent schedules). The advice to wake up at the same time every day, including on weekends (Section 3, point 2), does not conflict with this tip: this recommendation only asks you to go to bed early the night after a sleepless night, not to sleep in until noon the next day.

40. The longer you work night shifts, the higher your cardiovascular risk — switch jobs if you can

• Cost: Switching jobs or changing roles may mean a lower salary and the loss of night-shift allowances. Job hunting takes time and requires a firm decision. If you factor this cost in when choosing a job, it effectively becomes zero.
• In plain terms: People who work night shifts develop cardiovascular disease about 13% more often than those who don’t, and cardiovascular-related deaths are about 27% higher. The longer you work nights, the worse it gets: for every additional five night shifts, cardiovascular disease risk rises by roughly 7%. So, when you calculate this over years, it makes sense to switch jobs early on. As for cancer and night shifts, the evidence is far weaker than commonly believed. A meta-analysis of 12 studies involving 12,132 breast cancer cases found only a 5% higher risk among night-shift workers (RR 1.05, 95% CI 0.96–1.14). For those who worked night shifts for 20 years, the risk rose to 25% (RR 1.25, 1.01–1.55), but after correcting for publication bias this figure became non-significant and essentially close to 1; the authors concluded this link “is far from established.” Another long-term study of Chinese men followed for 16.1 years found no overall link between night shifts and cancer; only pancreatic cancer risk rose about 59% (HR 1.59, 1.09–2.31) among those who worked night shifts for 11–20 years. The absolute number of pancreatic cancer cases in this group was 8,202. Therefore, this discussion focuses on cardiovascular risk, not cancer.
• Benefit: A pooled analysis of 23 studies — all observational, no subgrouping — shows that night-shift workers face a roughly 13% higher risk of cardiovascular events (RR 1.13, 95% CI 1.10–1.16). Cardiovascular-related deaths are about 27% higher (RR 1.27, 1.18–1.36). Over time, each extra five night shifts adds roughly 7% to cardiovascular disease risk (RR 1.07, 1.04–1.09) and about 5% to cardiovascular deaths (RR 1.05, 1.03–1.06). Specific conditions show similar trends: coronary heart disease incidence rises about 22% (RR 1.22, 1.16–1.28), as does coronary death risk (1.22, 1.10–1.36). Ischemic heart disease death risk climbs about 39% (1.39, 1.06–1.84), while stroke death risk increases about 49% (1.49, 1.04–2.12). Stroke incidence, however, shows no significant change (RR 1.06, 0.95–1.18).
• Evidence grade: A
• Sources:Xi J, Ma W, Tao Y, 等 (2025). Association between night shift work and cardiovascular disease: a systematic review and dose-response meta-analysis. Frontiers in Public Health. https://doi.org/10.3389/fpubh.2025.1668848；Esposito G, Bravi F, Santucci C, 等 (2025). Night shift work and breast cancer risk in healthcare workers: a systematic review and meta-analysis. Occupational Medicine. https://doi.org/10.1093/occmed/kqaf040；Shen QM, Li ZY, Tan YT, 等 (2026). Night shift work and risk of total and site-specific cancer: results from a prospective cohort study among Chinese men. Scandinavian Journal of Work, Environment & Health. https://doi.org/10.5271/sjweh.4290；Czeisler CA, Johnson MP, Duffy JF, 等 (1990). Exposure to bright light and darkness to treat physiologic maladaptation to night work. New England Journal of Medicine, 322(18), 1253-1259. https://doi.org/10.1056/NEJM199005033221801
• Notes: All these studies are purely observational and do not adjust for key factors like smoking, weight, or income — differences that naturally exist between night-shift workers and others. Cancer and night shifts: the evidence is much weaker than popular belief suggests. A meta-analysis of 12 studies involving 12,132 breast cancer cases found only a 5% higher risk among night-shift workers (RR 1.05, 95% CI 0.96–1.14). For those who worked night shifts for 20 years, the risk rose to 25% (RR 1.25, 1.01–1.55), but after correcting for publication bias this figure became non-significant and essentially close to 1; the authors concluded this link “is far from established.” Another long-term study of Chinese men followed for 16.1 years found no overall link between night shifts and cancer; only pancreatic cancer risk rose about 59% (HR 1.59, 1.09–2.31) among those who worked night shifts for 11–20 years. The absolute number of pancreatic cancer cases in this group was 8,202. Therefore, this discussion focuses on cardiovascular risk, not cancer. Not everyone must quit night shifts — you should weigh the yearly cost-benefit yourself. For those already working nights, several steps can help: quit smoking (see Section 1), control blood pressure and cholesterol (Section 12), and make up lost sleep properly (Section 39). Two additional strategies are worth trying: eat mainly during daytime hours and use bright light during shifts while strictly avoiding light at night to reset your circadian rhythm. The latter is the only proven method to shift circadian timing; ordinary indoor lighting leaves the rhythm unchanged even after six night shifts, but exposure to 7,000–12,000 lux during shifts plus near-total darkness by day can reset it in just four days. Crucially, bright nighttime light, strict daytime darkness, and wearing sunglasses on the way home are all essential — missing any one of them negates the effect. Neither strategy has been shown to lower cardiovascular risk; returning to a daytime routine on days off also resets the rhythm. Full details on exact figures, sources, and how the body tracks time can be found in docs/生物钟和夜班.md.

41. Buy pre-packaged cooking oil with an SC number, not bulk homemade peanut oil from small workshops

• Cost: Switching to such oil costs about the same. Just check whether the packaging shows a food production license number starting with “SC”. The real challenge is convincing older relatives who are used to buying homemade oil.
• In plain terms: When peanuts get damp and moldy, they produce aflatoxin — a known human carcinogen that mainly harms the liver. After Guangzhou tightened regulations on small workshops, the rate of abnormal liver function among local residents who regularly consumed homemade oil dropped by roughly 35%. In Guangxi, pregnant women who ate homemade peanut oil had nearly a 90% higher risk of giving birth to low‑birth‑weight babies and an 80% higher risk of premature delivery.
• Benefit: Aflatoxin is classified as a Group 1 carcinogen by the International Agency for Research on Cancer, meaning it definitely causes cancer — primarily liver cancer. A Guangzhou study measured aflatoxin B1 levels in homemade peanut oil from small workshops between 2010 and 2022; the median concentration was 1.29 μg/kg, with half of all samples falling between 0.12 and 6.58 μg/kg. After local regulations took effect, toxin levels fell by 2.865 μg/kg and continued to drop by 2.593 μg/kg each year thereafter. Consequently, the proportion of local residents with abnormal liver function fell by about 35% (PR 0.650, 95% CI 0.469–0.902). Another study in Guangxi followed 1,611 pregnant women; 81.7% of them consumed homemade peanut oil. Those women faced roughly a 90% higher risk of having low‑birth‑weight infants (aOR 1.9, 95% CI 1.1–3.2) and an 80% higher risk of premature delivery (aOR 1.8, 95% CI 1.1–3.0).
• Evidence grade: B
• Sources:Lei J, Li Y, Wang Y, 等 (2024). The impact of small food workshops management regulations on aflatoxin B1 in home-made peanut oil and the liver function of high-consumption area residents: an interrupted time series study in Guangzhou, China. Frontiers in Public Health, 12. https://doi.org/10.3389/fpubh.2024.1484414；Zhong Y, Lu H, Jiang Y, 等 (2024). Effect of homemade peanut oil consumption during pregnancy on low birth weight and preterm birth outcomes: a cohort study in Southwestern China. Global Health Action, 17. https://doi.org/10.1080/16549716.2024.2336312；IARC (2012). Chemical Agents and Related Occupations. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Vol 100F. https://publications.iarc.fr/123；国家卫生计生委、国家食品药品监督管理总局 (2017). 食品安全国家标准 食品中真菌毒素限量（GB 2761-2017）
• Notes: Both studies were observational in nature and lacked a control group. The Guangzhou study used liver‑function test results as its endpoint rather than incidence of liver cancer or mortality. The median aflatoxin level in homemade oil actually stayed below China’s legal limit of 20 μg/kg for peanut oil; the risk arises from long‑term consumption and occasional batches with higher concentrations. The legal limit applies to all peanut oil, but pre‑packaged oil must meet production‑license and factory‑inspection standards, while small workshops are subject to far fewer inspections under regional regulations. The main beneficiaries of this advice are you and your family members who eat the same meals.

42. Replacing lard and butter with vegetable oils for cooking: you don’t need to constantly switch oils for health reasons, nor should you expect flaxseed oil to protect your heart.

• Cost: It doesn’t cost much extra. Vegetable oils are already the main cooking oils in most households. The real challenge is breaking the habit of using lard or butter for stir-frying and flavoring meals.
• In plain terms: Cutting back on saturated fats like lard and butter and switching to vegetable oils reduces the risk of heart disease and stroke by roughly 17%. However, there’s no measurable change in overall mortality. Switching between soybean oil, corn oil, and canola oil shows no clear health benefits either. Consuming large amounts of flaxseed oil also doesn’t lower heart disease risk.
• Benefit: A Cochrane review analyzed 15 randomized trials involving 56,675 participants, each followed for at least two years. Reducing saturated fat intake lowered the combined rate of cardiovascular events by about 17% (RR 0.83, 0.70–0.98). Overall mortality remained virtually unchanged (RR 0.96, 0.90–1.03), as did cardiovascular-related deaths (RR 0.95, 0.80–1.12). No significant difference was found between replacing saturated fats with polyunsaturated fats (the main component of soybean and corn oils) or with carbohydrates. Data on replacing them with monounsaturated fats (found in canola and olive oils) was too limited to draw conclusions. Another Cochrane review of 19 trials with 6,461 participants found that higher omega-6 intake (linoleic acid) had no effect on overall mortality (RR 1.00, 0.88–1.12) or cardiovascular events (RR 0.97, 0.81–1.15). A third review of 86 trials with 162,796 participants showed that increasing plant-based omega-3 intake (primarily from flaxseed and perilla oils) had virtually no impact on overall mortality (RR 1.01, 0.84–1.20) or coronary heart disease events (RR 1.00, 0.82–1.22).
• Evidence grade: A
• Sources:Hooper L, Martin N, Jimoh OF, 等 (2020). Reduction in saturated fat for cardiovascular disease. Cochrane Database of Systematic Reviews, (5), CD011737. https://doi.org/10.1002/14651858.CD011737.pub3；Hooper L, Al-Khudairy L, Abdelhamid AS, 等 (2018). Omega-6 fats for the primary and secondary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews, (11), CD011094. https://doi.org/10.1002/14651858.CD011094.pub4；Abdelhamid AS, Brown TJ, Brainard JS, 等 (2020). Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews, (3), CD003177. https://doi.org/10.1002/14651858.CD003177.pub5；中国营养学会 (2022). 中国居民膳食指南（2022）. 人民卫生出版社
• Notes: Controversy: Some argue that high levels of omega-6 in soybean and corn oils promote inflammation, so these oils should be limited or replaced. However, the aforementioned studies on omega-6 showed no harmful effects, and the authors rated the evidence quality as low. The 17% reduction in cardiovascular events is considered a moderate benefit, while overall mortality shows no change. Regardless of the oil type, portion control is essential; dietary guidelines recommend 25–30 grams of cooking oil per person per day.