Diminishing Returns are defined by Webster as “benefits that, beyond a certain point, fail to increase in proportion to extended efforts.”

Diminishing returns, sometimes called the Law of Diminishing Returns, often refer to businesses. For example, as a company increases the number of employees (labor), its productivity increases. After a while, the increase in benefits slows down—adding new employees doesn’t help as much as it used to. Eventually, the company will lose money if it continues to increase labor costs above a certain amount. I apply this law to health.

Look at this chart:

Along the bottom is the effort you put into a healthy habit. Let’s say aerobic exercise. On the left, going vertically, is the impact that exercise has on your health: on weight loss, heart attack risk, and a multitude of other issues. If you are at zero effort, meaning you don’t exercise at all, there is no impact, of course. As you put in more effort exercising and move along the curve to the right, the impact increases and your health gets better. When your effort reaches five or so on my chart, but every healthy habit is different for every individual, the increase in benefit diminishes. To clarify further, for each increase in exercise, you get less of an improvement in your health. It still improves, just not as much.

Here is a real-world example. As I said in a prior post, a key to good health is to concentrate on the big things first. Exercise is a big thing. Say you never exercise at all, and you start walking a mile, three days a week. As you increase to 7 days a week, your cardiovascular health improves significantly. You are on the left part of the curve, which we call the steep part of the curve. If you get in better shape and switch to running a few days a week, your health improves further, at a good rate. If after a year of working out, you’re running six days a week for three miles, you are probably at five or six on the graph, and the curve starts to flatten. If you increase how much you run, the benefits you see will not increase as much or as fast as when you started. That is the law of diminishing returns. Eventually, even with more effort, the benefits may not increase at all. This is called a plateau. Running six miles a day, six days a week is not much better than five miles a day. See my book for more details on the benefits of exercise.

The same law applies to the weight loss that follows as you improve your diet by cutting calories, cutting carbs, or, in my recommendation, getting rid of the bad carbs that hinder weight loss. When you cut back on enough calories or bad carbs, you lose weight. As you cut back more and more, you lose weight faster. Eventually, you may reach a level of cutting where the rate of weight loss slows down. You may still be losing weight, but not as fast. This happens more with cutting calories than bad carbs, but it can happen with any diet, even the new GLP-1 medications and bariatric surgery. If you use the diet I recommend, The Three Rules to Lose Weight and Keep It Off Forever, it usually doesn’t reach the plateau where weight loss stops until you reach your goal.

Sometimes, if you keep increasing whatever you are doing, you may start to make something worse. You know this intuitively because it’s true for many things. Sometimes, after the plateau, negatives occur. Adding salt to food is an obvious example. If there isn’t enough salt, adding salt makes it taste better. But too much salt will ruin the dish. This is the best portrayal I have seen.

This happens with many healthy habits. Cutting calories too much leads to malnutrition, and running too much can be dangerous. Most vitamins and supplements have diminishing returns at a fairly low level, and a plateau is quickly reached. After the plateau, if you keep increasing, even some vitamins can become toxic, including vitamins D and A. As you know, this often happens with medications, and the toxic dose varies for different medications. I am on a relatively low dose of a blood pressure medication. If I doubled the dose, I would probably have side effects. With medications and supplements, the problem is easily avoided by reading labels and checking with your doctor.

An important problem with diminishing returns is that you think you’re helping things by increasing efforts with one healthy habit, ignoring others where you could improve and make a difference. Many weightlifters keep increasing their efforts and ignore diet and cardiovascular exercise. Others take every supplement ever invented and don’t eat healthy or exercise. You can spend a lot of money eliminating more and more plastics from your diet and forget about losing weight. Some will read every label to eat only organic and non-GMOA and not work on their weight. You have to be aware of where your efforts fall on the curve above, and that may require consulting a medical source.

Ignoring the law of diminishing returns sometimes distracts us from things we could do for our happiness and well-being. Taking reasonable protection against infections is wise, but isolating yourself from others leads to loneliness and depression. Instead of exercising so much, I could spend more time with my family. I could also practice meditation or develop other habits that would help my mental health. Despite what some people say, butter and red meat have health risks. Working hard and cutting red meat and butter to twice a month can be helpful, especially if you’re at increased risk of heart disease. Cutting further to zero has no proven benefit. I like eating red meat and foods with butter in them, and will not eliminate them from my diet for no benefit.

I strongly recommend working on healthy habits and concentrating on the part of the curve that is to the left of the diminishing returns zone. A good guide is my book, The Six Rules for a Longer, Healthier Life. Now, there is one more thing I want to mention.

Keep in mind a very important concept: The Threshold Effect.

The threshold effect is when you attain little or no benefit until you reach a level of effort or change. This is extremely important if you are on a low-glycemic diet, such as The Three Rules to Lose Weight and Keep It Off Forever, or a low-carb diet like the Atkins Diet (similar to Keto), but it’s seen to some degree on a low-calorie diet. As you start to cut back on bad carbs or calories, you may not initially notice substantial weight loss, though some do. As you increase your efforts, the amount you lose on a weekly basis will increase rapidly. If you give up all bad carbs, as I usually recommend, you will definitely have crossed the threshold and will lose a substantial amount of weight every week. Eventually, you may eventually reach a plateau, usually when you’re at the weight level you want to be.

See the graph. You may not notice much, if any, weight loss until you reach the threshold. In my graph, I arbitrarily started the weight loss at about 2.5 units of effort. That might be eliminating 90% of bad carbs or cutting calories by a few hundred a day.

When you reach 2.5, you lose weight faster and faster until you get diminishing returns. You lose weight, but each time you cut calories or bad carbs, the weight loss diminishes. Eventually, you may reach a plateau.

A common mistake is to forget the Threshold Effect if you cut back on your efforts. You may expect to have continued success when you slack off a bit, because you are eating fewer bad carbs than when you started. Perhaps you started eating one or two cookies a day or a few pieces of bread a week. However, if you slack off enough, you will reach the threshold in reverse, and you are likely to stop losing weight and even gain weight. I have made that mistake too many times to count.

The threshold for weight loss can be very high for some people. To lose weight, some need to get below 1200 calories a day. On keto, they need to be below 20 grams of carbs a day, and on a low-glycemic diet, you may need to give up all or nearly all bad carbs. Fortunately, you can otherwise eat what you want and should never be hungry.

Cutting calories has an additional problem—tolerance. Your body becomes accustomed to the lower calorie intake. If you start at 2000 calories, your threshold for weight loss might be 1600 calories a day. But, if you eat that amount, you will see diminishing returns quickly, so that you lose none or virtually none after a month. You’ve reset the threshold. Now, if you go back to 2000 calories, you will gain weight when before you had been stable at that level.

Keep in mind where you are on the curves above. Push hard enough to cross a threshold, and be especially careful not to cross that threshold in reverse if you back off on your efforts. Additionally, if you have reached the level of diminishing returns, don’t continue to increase your efforts at the expense of another healthy habit you could work on.

Default to No is the first step to quitting a habit or something that could become a habit.

Just like my last post, Default to Yes, Default to No seems simple. Nancy Reagan proposed that when you’re approached with drugs, you just say no. It makes perfect sense, but that doesn’t mean it’s easy. I use the term default in the same way they do with computers. According to Webster, to default is “to make a selection automatically in the absence of a choice made by the user.” I mean the same thing. When you default to no, you don’t make a choice; you just do it. Soon, it becomes second nature. Defaulting to no removes any bargaining you might otherwise make, such as “Just one Drink,” or “It’s a small cookie.”

The first step to defaulting to no is choosing what is important to you—what you want to stop doing. Start with only one or a few. In the Six Rules book, I discuss the risks of drinking alcohol. If you’re a habitual alcohol drinker, I strongly recommend you stop drinking. Make this your first default to no habit. At a minimum, do it for a month and see how you feel. Virtually everyone feels better after abstaining from alcohol for one month, and no one wakes up in the morning regretting that they didn’t drink the night before.. If you have several things you want to eliminate, quit drinking alcohol first, since alcohol makes it more difficult to quit anything else. When someone offers you a drink, don’t think about it. “No,” or “no, thanks.” (Once a friend knows that you don’t want to drink alcohol, I hope they don’t ask you if you want one. If they do, I see no reason to thank them.) Do it every time, and soon, you are a nondrinker. You will feel better and likely live longer. There will be hard days, but if you default to no and never override the default, soon, you won’t think about it.

If you have no issues with alcohol, choose the most important habit that you want to break. If you smoke, that would be the habit I would work on. No habit kills more people than tobacco. Mind-altering chemicals would be just above or just behind smoking, in my opinion. Since what distinguishes us from lesser animals is our mind, it would be a shame to damage it. That is not to mention the medical harms of most drugs, even cannabis. If you don’t smoke or do drugs, work on processed food and sugar. Default to no. If you have no unhealthy habits, be more productive by avoiding social media and mindless web surfing. If you have no undesirable habits, you’re better than almost everyone else in this world, and just keep doing what you’re doing.

If you’ve read my book, The Three Rules to Lose Weight and Keep It Off Forever, then you know I am all or none. I never significantly break a rule, and it’s second nature after many years on the plan. But, in the beginning, I had to have a default. I avoided even looking at the dessert menu. I said “No,” and I tried not to think about it. Now it is simple, and I can read dessert and drink menus without much risk of losing my resolve.

I haven’t had alcohol in more than eight years, and I still use the default, because in certain circumstances, I am tempted. If anyone asks if I want a drink, I say, “No, thanks.” There is no need to explain. In fact, as Benjamin Disraeli said, “Never complain. Never explain.” If you explain your actions too much, it invites questioning and negotiation. Your friend offering a dessert may tell you that it’s low-calorie, or one won’t hurt you, or a million other excuses people use when they eat things they wouldn’t otherwise eat. Many alcohol abusers have relapsed after having just one drink. So, it is best to say no, or “No, thanks,” and leave it at that.

Another habit where the default helps is having multiple servings at a meal, or eating repeatedly from a bag of snacks. I call this “eating from the trough.” If you have a weight problem, it is best handled by always saying no. Never have seconds. You can’t be that hungry that you must have a second serving of cheesecake. Another helpful tool to avoid seconds is to do it preemptively. Serve everyone at the table and put any remaining food into the fridge, or even better, the garbage. Similarly, if you want to give up alcohol, dump it all down the sink. Then you’re not even tempted by alcohol or seconds because it is gone.

Quitting habits and making new, healthy ones are difficult. Most people never do it. Use every tool at your disposal to accomplish your goals. Define the most important habit you want to break. Start saying no every time the temptation arises. Don’t allow yourself to think about it. Don’t bargain with yourself or let anyone else bargain either. Default to no, and you are much more likely to succeed.

My new book is available on Amazon in Kindle and paperback formats.

We all want to be healthy and live longer, and there is no shortage of theories on how to do it. In my book, I explain what science really says about your health. The book outlines what you can do to make yourself healthier and what isn’t worth doing. Following the six rules will reduce your risk of the most common diseases and improve your quality of life. None of the rules are complex, but like any goal, becoming healthy requires effort. There are no guarantees—there will always be factors we can’t control. The Six Rules give you the best chance for a longer, healthier life. 

The Three Rules to Lose Weight and Keep It Off Forever is still available on Amazon.

Big things make the most difference in your health and life.

If you want to improve anything in your life, work on the big things first. The big things are often harder, so we usually put them off. Students will spend hours deciding on a font for their term paper rather than starting to write the paper. If a kid is failing math, he’ll do anything before he starts working on his math homework. When trying to learn a complex piano piece, I usually play the easy parts many times before I even get to the difficult sections. We all want to do the easy things first.

With health, we do the same. Everyone wants to make easy changes, but most cannot or will not do what it takes to get healthy. If you’ve read my book, The Three Rules to Lose Weight and Keep It Off Forever, I talk about this. To lose weight, you have to cut out the bad carbs. That means all of them. If you want to lose weight, you can’t eat the bun and the fries in the photo above.

Most people will do anything but what it takes. They will cut back on carbs, eat a little more protein, go for a walk in the afternoon, take off the top bun of a burger, or a host of other things. They won’t do the important thing: giving up all the bad carbs.

People want to be healthy, but often ignore their most important health problems. Someone with a drinking problem talks about their evening walks. A walk may help your health, but heavy drinking causes cancer, heart disease, liver disease, stroke, and cognitive decline. I have seen many smokers who believe, or at least say they believe, that a glass of wine at night helps their heart. A glass of wine might help a little (I doubt it), but smoking is the worst thing you can do for your heart and your general health.

I support veganism for ethical reasons and environmental benefits. Being a vegan is healthy if you take the vitamins you’re missing and avoid bad carbohydrates. However, the small health benefits of veganism don’t negate smoking, drinking too much, a lack of exercise, or obesity.

What about organic and non-GMO (genetically modified) foods? There may be a small benefit to eating only organic food. I am unaware of any substantive data showing a significant risk of consuming GMOs. If there is a benefit to eating organic and avoiding GMOs, it is small. Yet, people eat organic, at a significant financial cost, and don’t accomplish the important things, like losing weight. The reason is simple. Eating organic is easy—pay a few dollars more. Giving up your favorite bad carb foods is hard. Working out five days a week is hard.

I like the financial analogy of credit cards. Clipping coupons can save you money—several dollars a week. But, if you have a credit card debt with 19% interest, that is the important thing to work on. Keep clipping coupons, but work on your credit card debt right now.

As Franklin said, “There are no gains without pains.” If you want to get healthy, it takes hard work. Ten percent of Americans smoke. That is their biggest health problem. Over forty percent are obese. If they don’t smoke, then obesity is their biggest health problem. Lack of exercise is likely the third biggest health problem in the United States. It takes hard work to do the important things and correct these problems.

Do it anyway. The best day to start doing the work and getting healthy is today. Start with the biggest thing.

I am not talking about people who are physically unable to exercise, though there are few such people. I also am not suggesting you run ten miles or lift weights three hours a day. Overwork is detrimental, as Ryan Holiday puts it. In his book Discipline is Destiny, he teaches to “manage the load.“ Holiday is right, and I have hurt myself running too much.

As always, talk to your doctor before you start an exercise program or make a major change in your lifestyle.

For most people, overwork is not a concern because they don‘t exercise at all. We rate our health as one of the most important things in our lives, yet we don’t do enough exercise. Exercise lowers overall mortality and benefits us in nearly every aspect of health that has been tested. I will not list everything it does, but one of the main reasons I work out is to benefit my mental health.

Fine, most people know that exercise has health benefits, but why do I recommend you exercise every day? Again, for me, it is the mental health. This morning, I lifted weights and ran three miles. I have a sense of accomplishment. I already did something worthwhile today. Also, I am often worried about my health, (too often if you ask my wonderful wife and son). Being able to run three miles makes it unlikely that I have a serious medical illness. That is far more comforting than my wife saying, “Don‘t worry.“

I don’t do the same exercise every day, or I would burn out. Tomorrow, I plan to skip the weights and use a rowing machine. The next day, I might walk outside if the weather is nice. Yesterday, it was cold and windy, so I used an aerobic platform for 45 minutes. It was boring, so I listened to an audiobook. I can always find an exercise to do.

If you avoid ‘bad carbs,‘ you can lose weight and keep it off without exercise. But as I say in my book, exercise has a significant weight-loss benefit, though it doesn‘t negate a bad diet. Sometimes, if you are watching your bad carbs and exercise a lot, you may lose too much weight. No big deal—it is easily remedied.

When I was in practice, patients told me they exercised three days a week. Maybe so, and that is better than most people. I would ask, “Why not every day?“ Usually, they stared at me like I had just asked if they wanted to clean the clinic‘s toilets, but I truly wanted to know the answer. We do so many things every day. We brush our teeth, take a shower, sleep, check the news, watch TV, comb our hair (I don‘t do that), and surf the net. Some have an alcoholic drink, and most have caffeine. Some of the daily activities help us, some are a waste of time, and some are harmful. What makes exercise so different that we don‘t even consider doing it every day?

I believe the reason is that animals, including humans, evolved to minimize energy expenditure. It is difficult to get enough calories to survive in the wild, and wasted energy loss can kill. Modern humans, at leas in the United States, rarely have the problem of getting enough food, which is one reason we have such an obesity probem. It is hard work to exercise, and we don’t like doing it. Do it anyway. Find a way to enjoy or at least tolerate it. I listen to audiobooks during cardio. My wife watches shows. Some people listen to music. Outside, I look at nature and think. Find a way. Enjoy the knowledge that you are healthier after you exercise. My wife says she enjoys the burn. I cannot say that I enjoy the burn of running, but I definitely am happy having completed a run.

There will be days you cannot exercise—illness, travel, or a family crisis. On the other days, exercise. Do something physical. Exercise every day. You will be better for it.

Hypertension, or high blood pressure, is a leading cause of stroke and heart disease. See my recent post on the importance of checking your blood pressure at home. This is the machine I use. Hypertension or prehypertension (elevated blood pressure not reaching the level of hypertension) affects more than half of Americans. The reasons are obvious: We are overweight and out of shape, and we eat a huge amount of salt.

Many, if not most, people will need medical treatment to control their blood pressure. Some, though, can make a real difference on their own. The two best ways are to eat less salt and to exercise.

In medical school, we learned that eating salt affects blood pressure. In nature, animals get little salt, and humans were no exception. Now, salt is in all prepared foods, and restaurants load the salt into the food. We love the taste of salt. That is why we eat it. It’s the same reason we eat sugar. We evolved to love salt because it was scarce thousands of years ago. We needed as much as we could find, presumably to keep our blood pressure up if we bled or became ill or dehydrated. If we started with low blood pressure, we would die sooner.

Now, we eat way too much. There are tribes in South America that survive on a few hundred milligrams of sodium a day. Last night, my wife and I had ham, and my serving had 1800 mg of sodium. Soups are nearly as bad. Few people know that a serving of cottage cheese has 500mg of sodium. We love salt.

Experts have debated the importance of lowering your salt intake, but now it is clear that it helps. An elegant study published a few months ago showed that switching from a high-sodium diet to a low-sodium diet may lower your blood pressure by eight points. That is impressive. If you go slowly, you will hardly notice the change in taste. Some of you will not want to cut your salt intake that much. Fine, cutting it less still makes a difference.

How can you cut your salt intake? Start with never adding salt to anything. Then, decrease your reliance on packaged foods and restaurants. Especially avoid prepared foods with liquids. The reason soup has so much sodium, compared to salted nuts, is that the salt has to dissolve in all that liquid to allow you to taste it. On nuts or even pretzels, you taste it right away. You can also try low-sodium salt. I have tried no-sodium salt but found it tasted like metal. I like Morton’s 50% sodium salt. The taste is fine. You should talk to your doctor if you want to try it. There is potassium in it, which also lowers blood pressure. However, potassium supplements can pose a risk in some medical conditions.

The other way to lower your blood pressure is exercise. Regular exercise lowers blood pressure. It also helps in many other ways. It doesn’t even take brutal workouts to lower your blood pressure. In a recent study, the authors showed the already-known benefits of aerobic and resistance training on blood pressure. Surprising to me was the benefit of isometric exercise, which is when you work your muscles without moving, such as when doing planks. Tai chi may also be beneficial for your blood pressure. You can lower your blood pressure by several points with virtually any form of exercise. Do it regularly.

Again, many people with prehypertension and hypertension will require medications. But if you cut your salt and exercise, you may not. At the least, you will likely not need as much medication. Accomplishing something on your own is its own reward.

Two downsides of weight loss drugs are rarely mentioned.

There are many risks of Wegovy (called Ozempic when used for diabetes) and other weight loss drugs. They are expensive and usually not covered by insurance. There are many possible side effects, including nausea and other gastrointestinal symptoms. These symptoms are very common. Sometimes, they are more serious, including pancreatitis and gastroparesis, a weakness of the muscle of the stomach. The long-term risks are not known yet. Before you go on such a medication, you should talk to your doctor about the medical risks.

I want to mention two downsides of weight loss drugs that you may not have heard of or considered. They may not be deal-breakers for you, and you should discuss them with your doctor. I am asking you to consider these downsides.

If you start Wegovy or one of the similar medications called GLP-1 agonists, you are likely to lose 15% to 20% of your body weight. If you weigh 300 pounds, you may expect to lose 45 to 60 pounds or more, if you don’t stop the medication because of side effects. If you stop the medication, you are likely to regain 2/3 of the weight you had lost. Read the study here. Before I retired, many patients requested medication for weight loss. They wanted to use it to jump-start their weight loss. I told them they were likely to regain most of their weight when they stopped, and they answered that they would be careful. I always wondered how they would manage to be careful when they hadn’t been able to be careful before.

Do you want to use an expensive medication with significant side effects for the rest of your life? Putting the potential medical risks aside, you will be reminded of your weight problem every week when you inject yourself. The shot is virtually painless, but the constant reminder that you need a shot to maintain weight loss may be unpleasant.

Another downside of weight loss drugs is that you will not have lost weight on your own. There are many medical conditions that require medication, conditions that you cannot manage on your own. I have high cholesterol, but with rosuvastatin, it is in superb control. Despite daily exercise and a healthy diet, I still require the medication. Nothing I can do about it, and I am thrilled to have the medication. There are many conditions like this, including hypertension, which affects more than a third of Americans.

But, if you can manage your medical condition on your own, you will have a sense of accomplishment. As Ryan Holiday says in The Obstacle Is the Way, overcoming obstacles makes you better. Yes, some obstacles require the help of others to overcome, and perhaps obesity is one of these obstacles for you. But most people will be successful if they devote all their energy to a carbohydrate-based diet such as The Three Rules to Lose Weight and Keep It Off Forever, Second Edition. If you lose weight with a drug, you will miss out on this benefit, not to mention the other benefits of a healthy diet and exercise regimen. (That is a third downside of weight loss drugs that is rarely mentioned.

An analogy I like to use illustrating the benefit of doing it on your own is your kid’s homework. You can help your child do their homework. You can give them some or all of the answers. But if you want them to learn something and become a better student, it is better if they do the work themselves. Losing weight on your own will teach you that you can do it. If you slip up and regain the weight, you know you can do it again. Overcoming the obstacle of losing weight will make you better equipped to overcome other challenges.

I recommend you think about these downsides of weight loss drugs. Talk them over with your loved ones and your doctor, and choose what is right for you.

Begin With the End in Mind

Everyone should read The 7 Habits of Highly Effective People. Habit two is “Begin with the end in mind.” It is a simple yet powerful habit, and I consider it the most important one. It is critically important for success in anything you do. You have to define what success actually is. You must define your goal.

When I was in practice, hundreds of patients told me they were trying to lose weight. When I asked what they were doing to lose weight, they often said they were eating better. Great. I’m glad they were eating better, but does eating better make you lose weight?

Begin with the end in mind. In this case, it’s to lose weight. Figure out how to do it. The Three Rules to Lose Weight and Keep It Off Forever, Second Edition is the best way, but many diet plans work. If you want to lose weight, get my book or any of the dozen other good ones. You can even read some medical studies yourself. You will never see anyone recommend eating better as the solution to being overweight. It is poorly defined and doesn’t work. If you eat six Big Macs a day and cut to five, you’re eating better, but you won’t lose weight. Skipping a snack here and there will not do it. Winging it without a plan won’t work. It takes a dramatic change.

Studies show that diets such as mine, where you minimize or eliminate the sugar and other carbohydrates that raise your sugar, cause weight loss. Cutting calories below 1200 a day works. Eating better doesn’t. Dieters without a real plan don’t really have weight loss as their end, though they may think they do. Their end is to eat better. If their goal were truly to lose weight, they would figure out what it takes and do it.

If you choose the calorie-counting plan, which I don’t recommend, your goal is not just to cut calories—the goal is to lose weight by cutting calories. (I know it sounds obvious, but keep your final goal in mind.) For most people, it takes a cut to less than 1200 calories per day. When I asked patients how many calories they were taking in, they often said, “less than 1200.” I asked if they measured, weighed, and counted everything they ate or drank. Very few ever did. If your goal is to lose weight, you should know whether you are on the path to success. Half-measures don’t work.

The same is true with exercise. If you want to get in shape, that should be the end in mind. If you do what most people do and walk more, what will you have accomplished? Not getting in shape. It takes more than that. Walking may be better than nothing, but if you walk a mile or two a day, you will not get in shape. (You won’t lose weight either.) There are many exercise programs to get in shape. There must be hundreds of websites and books on training programs. Find one that appeals to you and do exactly what it says.

Beginning with the end in mind doesn’t guarantee success, but it is necessary for nearly everything important. If you want a good job, you can’t simply go to college and expect employers to come to you. Figure out what it takes to get the type of job you want and do it.  

Whatever your goals are, decide what you want to accomplish and figure out how to get there. The rest is hard work and follow-through. 

Is Everything Unhealthy? In a sense, yes. Everything we do has a risk.

Over many years as a physician, I have been asked this question hundreds of times. Few patients ask if smoking is unhealthy because everyone knows smoking cigarettes carries substantial risks of cancer, heart disease, and stroke. What about electronic cigarettes and oral nicotine pouches, such as Zyn? Any form of nicotine can cause headaches, nausea, anxiety, and a rapid heart rate, but it is the tobacco, especially burning tobacco, that causes the greatest harm. Some people, even most physicians, believe that the main harm of cigarettes is in the nicotine. Not true. 

The biggest risk is tobacco, which contains chemicals far more dangerous than nicotine. I tell people that for their health, avoiding all tobacco and nicotine is the best, but if they can’t give up nicotine, do it with the least risk, which would be oral nicotine pouches. However, it’s up to them to decide if the benefits of smoking outweigh the negatives to their health. Who am I to say?

Why do government groups and politicians regulate certain foods and products and not others? I don’t know of any product, food or otherwise, that doesn’t have a risk. We have all seen warning labels on cigarette boxes. Fine, cigarettes kill millions. There are age limits to e-cigarettes and chewing tobacco. Chewing tobacco causes cancer, but the risks of e-cigarettes are small.

If e-cigarettes have warning labels, why aren’t there warning labels on Coke and Mountain Dew? It’s well-known that drinking sugar-sweetened beverages increases the chance of obesity—people who drink a soda a day gain an average of a quarter of a pound per year. Politicians say that oral nicotine pouches and vaping may lead to cigarette use. Maybe. But we know sodas lead to diabetes, and yet there is no restriction on selling sodas to minors.

Oral nicotine pouches have not been shown to cause serious harm, yet they have warning labels and can’t be sold to minors. The labels say that nicotine is addictive and scientists say nicotine can affect brain development in adolescents. Caffeine also is addictive and affects brain development in adolescents. Why are there no regulations on energy drinks and caffeine when the harms are well known? One-third of teens use energy drinks, which cause significant neurological and behavioral problems. Why aren’t they banned or even regulated?

Alcohol ads are everywhere, and 140,000 Americans die from alcohol yearly. Should kids be exposed to that? Should parents be allowed to drink in front of their kids? Juul was punished for marketing e-cigs to minors and not proving that their products are safe. So what? Beer commercials during football games are marketing to minors. What about Coke and other soda companies? Why aren’t they punished? Maybe cookie ads should be banned.

I’ve pointed out large inconsistencies in regulations, but that isn’t the point. Everyone knows the government and its rules are inconsistent.

So, is everything unhealthy?

It depends how you define unhealthy. Virtually everything has a risk. Over 40,000 Americans die in a year in motor vehicle accidents; grapes are a leading cause of choking in small children; and hundreds of people die in bicycle accidents a year. Exercise can lead to injuries; you can slip and fall in church; you can catch a cold visiting your grandkids and die from pneumonia.

It is up to each of us to live our lives. I take the risk of driving a car and riding a bike because I believe the benefits outweigh the risks. I don’t ride a motorcycle or ski. I would rather my son use Zyn once in a while than drink two Mountain Dews with sugar every day. Everything has a risk.And we all have different ideas of which risks are worth it. 

Animals in the wild assess their risks all the time. Should they drink water from a pond when there are predators lurking? How is that different from eating a food that may cause heart disease? Yes, everything has a risk. The government picks and chooses what they feel is too much of a risk for us. They make us wear seatbelts, yet we can ride motorcycles. We can drink soda at 12 but not use nicotine at 20. Just remember, everything we do has upsides and downsides.

Decide for yourself.

How to create a habit. Make it the default.

I exercise nearly every day. I eat within The Three Rules to Lose Weight virtually 100% of the time. I do push-ups every morning. How do I do that? Some say I am disciplined. I suppose that’s true, but I started the habits by making them the default, just like brushing my teeth. By default, I eat within the Rules. If someone gives me food against the Rules, say Godiva truffles, my default is to get rid of it and not eat it. Same thing with push-ups. If I’m lazy one morning, it doesn’t matter. I need a good reason to break with my default and skip push-ups. 

By nature, I’m a homebody. Even before Covid, when my wonderful wife wanted to do something with our wonderful son or with friends, I found a way to see them at our house or get out of it entirely. It would take convincing for me to go out. When I did go, I was almost always happy that I had gone, but the next time, I still chose to stay in.

My son said something that changed my way of thinking. He said that you should default to yes for the things you want to do. If you want to go out with friends more, say “yes” when they ask. Don’t think about it. That is what I do now. When my wife says someone invited us out, I say yes unless I have a good reason not to, and I rarely do. I go out much more now.  

Sometimes, something important comes up. An injury or illness will get me out of my default of exercising every day. I had to break the Three Rules for a double-prep colonoscopy because I couldn’t survive the two-day clear liquid diet unless I drank sugar-sweetened Powerade and ate green jello. 

Defaulting to something you want to do adds an extra step if you’re tempted to avoid it. This has been proven to work with organ donation and 401ks. Countries that have a system where everyone is an organ donor unless they opt out have a much higher rate of organ donation than countries where no one is an organ donor unless they opt in. In the United States, the default is that you are not an organ donor. If the United States wanted to make it a habit to be an organ donor, the government could make the default be that we are all organ donors.

The SECURE 2.0 Act in the United States will make it the default that employees enroll in a 401k. If you don’t want to contribute to your retirement plan, you will have to opt out. Undoubtedly, people will save more for retirement.

This is true with creating your own habits. If you want to work out every day, make it the default. Don’t agree to anything that interferes with working out unless there is a very good reason. When my wonderful wife and I plan a trip, we make sure we’ll be able to exercise every day. Some days, something will come up, but then we will have to opt out of exercising. If we went on a trip without a plan, without the default to exercise, we would only exercise when we had nothing else to do. 

We are visiting our good friends in Peoria in April and plan to have dinner with them every evening. Patrick knows I follow The Three Rules to Lose Weight. (He has lost a lot of weight on the same plan.) The default is that I won’t go to any restaurant where I can’t eat on the Rules. A few days ago, he sent me a list of some restaurants to consider. You can be sure they all look great, and there are several choices for me. But if there weren’t, I would tell him to look for another restaurant.

Choose what you want to make a habit and make that the default. Opting out should rarely happen, and only with good reason. In a short time, it will be a habit you don’t have to think about. I exercise daily, eat within the Three Rules, avoid alcohol, and spend time with friends and family. They are habits now. But, if you ask me which on this list was the most difficult, I will refuse to say.