Screening for Coronary Disease is not what most people think.

Coronary artery disease is the most common cause of death in the United States and the world. Briefly, when someone has a heart attack, it is due to coronary disease. Cholesterol plaques are deposited in the lining of the coronary arteries, which deliver blood to the heart itself. This causes inflammation and damage to the arteries, and clots can form. When the clot occludes the flow of blood, a heart attack can occur, causing damage to the heart muscle and sometimes dangerous and fatal heart rhythms. Even if complete occlusion doesn’t happen, narrowing of the arteries can cause chest pain and weakness of the muscle, leading to heart failure.

Unfortunately, many people have no idea that they have coronary disease until damage is done. Sometimes, the first sign of the disease is sudden death from a heart attack or arrhythmia. Like most conditions, we would like to diagnose coronary disease early, while there is time to prevent the dangerous signs and symptoms.

Most people do not know what it means to screen for coronary disease. They think that the doctor listens to their heart, checks their cholesterol, and they’re good to go. That is not what I’m talking about. Listening to the heart does not detect early or even late coronary disease in most cases. Checking cholesterol levels is extremely important, but cholesterol levels are a risk factor for heart disease, not heart disease itself. There are many risk factors for coronary disease: cholesterol levels, diet, smoking history, family history, body weight, body fat distribution, and others. Even if you have multiple risk factors, you may never develop the disease, and some people with coronary disease have few if any risk factors.

Sidenote: I have heard people say many things about cholesterol. One is that they don’t understand how they had a heart attack since their cholesterol is fine. A similar statement is that they aren’t going to have a heart attack because they have normal cholesterol levels. Elevated cholesterol is a risk factor for heart disease, and treatment to lower cholesterol lowers the risk of heart disease. (This is definitely true, and anyone who says otherwise is mistaken or lying.) But people can have heart disease without having an elevated cholesterol. Risk factors are just that.

This is true with many conditions. Family history of breast cancer is a risk factor for breast cancer, but most women with breast cancer have no family history. Many people involved in serious car accidents are good drivers with a spotless record and no prior history of accidents. While most cases of lung cancer are in smokers, not all are. During my career in medicine, I saw many, many cases of coronary disease in people who did not expect it.

So, how do we screen? A person’s risk of a disease affects how we screen for it. For example, a teenager has an exceedingly low risk of prostate cancer, so we don’t screen at all. The same is true for breast cancer. Most young women should not be screened for breast cancer. People at very low risk don’t need screening. People who already have proven coronary disease need testing, but not the screening tests that we are going to talk about.

Let’s look at specific types of people. First would be people who are at very low risk and should not get screened. Tests are not perfect. Since a young, healthy person with no risk factors for heart disease (no family history of disease at a young age, and no genetic cholesterol problem) has such a low risk, false positive tests would actually outnumber any positive tests that were real.

We often screen people without symptoms who want to start an exercise program. They or their doctor may want to make sure they are safe to participate. A stress test may be a good choice. The patient walks on a treadmill in a standardized, progressively more difficult protocol, while an ECG is running. Sometimes, an ultrasound (echocardiogram) or nuclear imaging test is also performed. Certain changes on the ECG or imaging would indicate an increased risk of the patient having diseased, narrowed arteries. Further testing, such as a coronary angiogram, would then be performed to determine the extent of disease and whether treatment is indicated.

People with no symptoms but who are at significantly elevated risk may not need screening. They are so likely to have coronary disease that the doctor could just assume that they do have it. For example, they may have a markedly elevated LDL cholesterol and multiple family members with coronary disease. Aggressive risk factor modification would be instituted without further testing. This includes good blood pressure control, cholesterol-lowering medication (typically a statin such as rosuvastatin, which I take), and an exercise program. A stress test might be performed, as mentioned above, to see if they can tolerate such a program.

Perhaps the most common type of patient to screen is one where the risk of disease is intermediate. They may have a family history, but the cholesterol is not markedly elevated. A smoker without a family history may fit in this category. Here, a stress test would not be good enough. Remember, a stress test only detects advanced disease. A routine ECG would be of little help and is not recommended to screen for coronary disease, because there are many false positives and negatives. In this patient, a coronary artery calcium scan may be best, and it was the test I preferred when I was in practice.

The scan itself is simple. You lie in a machine for a few minutes. It is not enclosed like an MRI, and I have never heard of anyone becoming claustrophobic. There are no injections and essentially no risk. When cholesterol plaque is deposited, it is soft and uncalcified. Over time, the plaque calcifies, and you can see it on the scan. You will get a numerical score reflecting how much calcium is found in the lining of the arteries. The best is zero. That means that you have no detectable calcification in the coronary arteries. The percentile tells you how you compare to others your age.

A low score when you are young may be in a high percentile. That same score when you are older will put you in a lower percentile. If you are under 50, most people have a zero score. That could be because there is no plaque, but it could also mean that it is there but hasn’t calcified yet. Some specialists would recommend repeating the scan every five years or so until you are 60, giving the plaque time to become visible.

The calcium score scan doesn’t tell you if the arteries are narrowed, though the higher the score, the more likely it is that there is some narrowing. Even without narrowing, plaque can cause a heart attack, but narrowing makes heart attacks more likely. If your doctor suspects narrowing, they may order a stress test or a CT angiogram, a more detailed scan that shows narrowing. The CT angiogram is more expensive than the calcium scoring and requires injection of a contrast agent and more time in the scanner. The CT angiogram is not an appropriate screening tool for most people.

I found the calcium score test to be very helpful. For example, if you are 50, one of your parents had a heart attack in their 50s, but your cholesterol is fine, and you have no other risk factors for heart disease. You might consider a scan. If there is no plaque, your doctor may just repeat the scan in five years. If there is plaque, they may recommend a change in diet and start a statin to slow or prevent further plaque deposition. Statins reduce the risk of a heart attack and save lives.

Everyone wants to have a longer, healthier life, but we all want to live life to the fullest. Many people watch their diet and exercise, but otherwise ignore their risk of the most common cause of death. Talk to your doctor about screening for heart disease. Maybe you haven’t reached the age where any specific screening is needed. If screening is considered, ask if a calcium score is a good idea.

Microplastics are everywhere. We can take some steps to decrease our exposure.

In June of 2025, I wrote a post about microplastics. I discussed that very small particles of plastic are found nearly everywhere: water, food, and the air we breathe. We are constantly exposed to microplastics and smaller particles called nanoplastics. As I said in the earlier post, the risk of microplastics to our health is unclear. A few studies have shown potential harm from microplastics, including stroke, heart attack, and possibly cancer, but there is no good data yet on just how harmful they are. I am not talking about BPA. BPA is an endocrine disruptor and should be avoided.

Regarding microplastics, remember that you can find risk in almost anything, and the level of the actual risk of microplastics is still not known. As you know, plastic is very convenient. It is lightweight, lasts forever (part of the problem), and inexpensive. Giving it up can be a big, expensive commitment.

Since microplastics are found nearly everywhere, in our water, animals, plants, and air, I believe. It will take a massive international effort to eliminate them from the environment. Many companies are working on alternatives to plastic products. Still, even if their efforts are successful, it will be many years before we notice a difference in our levels of exposure.

When I first started reading about microplastics, I was worried. I saw the numbers, which show that we likely consume an average of 100,000 to 200,000 particles a year. Many scientists had theories as to how they could sicken humans. I started cutting out as many sources of microplastics as I could. I threw out kitchen utensils, avoided all plastic containers, and drove my patient wife nearly insane.

But the absolute number of particles we consume shouldn’t bother us until we know more. We are exposed to gazillion waves of ultraviolet a day, and that doesn’t frighten us. Red meat may be harmful if you eat more than other meats. The shockingly high number is scary, but it doesn’t mean it will hurt us. There are gazillions of cosmic rays hitting all of us, and cell phone signals coming from everywhere. No one thinks they are dangerous.

I want to know just how bad microplastics are before I kill myself trying to get rid of all of them. I am not going to wear a special mask, if one even exists, in my house to avoid breathing in microplastics, and I will not avoid drinking tap water. It will take a massive international effort to eliminate these sources of exposure. Still, we can take simple steps to significantly diminish our intake of microplastics. I don’t know whether it will improve our health, but if it’s simple, relatively inexpensive, and cuts my intake substantially, I see no reason not to do so.

The largest sources of microplastics are:

• Indoor air (usually thousands of particles a day): Fibers are shed from furniture, carpet, and household products
• Drinking water: Tap water has microplastics, and bottled water, as you would expect, usually contains much more
• Food: Many foods, especially seafood and sea salt, often contain microplastics in the food itself. Some are contaminated by the equipment and processing. Relatively small amounts are found in canned fish (in the hundreds of particles per can.
• Plastic containers: Plastic releases far more microparticles when heated. This occurs whether you heat the plastic container with liquids already in it or whether you add hot liquid to the container. When possible, I use ceramic and glass products to store food, especially liquids, and I never heat food in a plastic container.
• Plastic teabags release tens of thousands of particles per cup of hot tea. Earlier studies found much more, but they may have been in error.
• Pouring hot tea or coffee into a disposable coffee cup can release tens of thousands of particles. Most disposable paper cups and coffee shops are lined with plastic to keep them waterproof. I will discuss below how to avoid this source of microplastics.
• Plastic coffee pods, such as those used in Keurig machines, likely release thousands of particles, but there haven’t been major studies published that I could find. Plastic food containers can release thousands of particles into your food.
• Using plastic tools for cooking can release microplastics
• Teflon-coated nonstick pans release more microplastics than non-Teflon pans. Cracked and damaged Teflon pans release far more. Using cracked and scratched Teflon pans and heating at high temperatures can also release harmful chemicals, and Teflon pans are now banned from sale in Minnesota.

We cannot meaningfully decrease our exposure to the plastics in the air or what is contained in the food we eat. Fruits, vegetables, and seafood contain plastics, but avoiding them would have undesirable health effects, so I am putting that out of my mind. I intend to work at limiting my exposure to plastics in the following ways:

• When possible, I will avoid drinking water from plastic bottles. Even canned drinks have microplastics, so I have another incentive not to drink Diet soda. We are fortunate to have reverse osmosis in our home. RO removes most microplastic particles from the water, and if you own a home, I would consider installing it.
• When I prepare food, I use bamboo or wood cutting boards, rather than plastic. I do eat canned fish because other than salmon, I am allergic to fresh fish and want the health benefits. Otherwise, I try to minimize my exposure to cans, at least until there are cans without the plastic lining.
• Tea: It is easy to avoid the massive amount of microplastics found in tea. Use loose-leaf tea. I use this infuser, but there are many options. You can cut and empty teabags that have plastic, but I drink tea made by companies that don’t use plastic. There are certainly other companies, but I like Bigelow, Twinings, and my new favorite, Stash. Each of these teas has multiple choices of teas, and their sites state they don’t use plastic in their teabags.
• Coffee: I never use Keurig or other pod systems when the pods have plastic, and wrote a post on the beauty of the pourover. I no longer use a plastic pourover dripper. I use a ceramic one (or this one) at home and the Hario metal dripper when I travel, because it is lighter. Regular #2 coffee filters don’t fit right for the Hario, so I use these.
  • In restaurants and coffee shops, it is difficult to avoid coffee made in machines that contain plastic. Our home Hamilton Beach coffee maker is great for the price. Hot water doesn’t sit long in plastic parts, so I expect the overall microplastic exposure is low, but I prefer pour over anyway. In-home fully automatic coffee machines, such as those made by Kitchenaid, De’Longhi, and Jura, hot water comes in contact with plastic. Again, I have no idea how important this is. (Drip coffee may be healthier for another reason. Using paper filters removes nearly all of the diterpenes from coffee. Diterpenes may increase the risk of heart dise
• Coffee Shops: As I mentioned, disposable paper cups shed lots of microplastics. Some studies show tens of thousands of particles released per cup. Fortunately, this is easy to avoid. Most coffee shops will serve you in a ceramic, “for here” cup. Even better, you can bring your own travel mug. Coffee shops, gas stations, and convenience stores will usually fill your mug rather than use a disposable cup. Some will even give you a discount. The good news is that many companies are developing cups without plastic, and I expect they will become the norm soon.

I expect that we will soon know more about the risks of microplastics in our environment, and especially in our food. It may turn out that some of us are overreacting to the risks. If microplastics turn out to be dangerous, research will be able to tell us what levels in food and water are important. For now, you may want to consider what you can easily do to decrease your own risk.

Note: If you want references for any of the data I presented, send me an email at harold@haroldoster.com.

Are Vaccines Still Important?

Early in 2025, I wrote a post about vaccines, stressing how important many vaccines are. Recently, I’ve had discussions with friends and family about vaccines and was surprised by how many people were against vaccines in general and objected to specific vaccines that are uncontroversial in the scientific community. I listened and tried to understand their concerns. It can be unnerving to have foreign material injected into our bodies. People feel different about an injection than they do about consuming something orally or inhaling it. Some of the same people who avoid all vaccines are perfectly willing to consume hallucinogens, tobacco products, and alcohol, which are more dangerous than any vaccine. They can eat bad carbs without concern, yet refuse to get a vaccine, which is proven to save lives with minimal risk of harm.

It can be even scarier to allow our children to get shots. Knowing the history of the vaccines might alleviate some of the concerns. Before vaccines, parents lived in fear that their children would get measles, diphtheria, polio, and other infections. Every year, thousands of adults and children died of diseases that vaccines now prevent. During the frequent outbreaks, parents were afraid to let their children leave the home.

Vaccines changed everything. I was an Infectious Diseases specialist and internist, and I saw one case of measles, a few cases of rubella (German measles), and no cases of smallpox, diphtheria, or acute polio. If you lived before the measles vaccine came out, virtually everyone got measles, and you likely knew someone who had polio.

We don’t see the infections much at all now and haven’t for years. People who didn’t live during those times don’t understand what it took to eliminate smallpox and virtually eliminate the other infections I just mentioned. They don’t know that all of these infections (except smallpox) are still common in parts of the world. Globally, there are over 60,000 rabies cases per year, all fatal. Over 99% of these are caused by dog bites. What would happen if we stopped vaccinating dogs? We would see cases again. Now, we have very few cases in the United States, nearly all from exposure to bats or raccoons, and virtually all in people who didn’t get the vaccine after exposure.

If you study the history of these infections, you can’t fail to understand that we no longer have them because of the vaccines. Vaccines have risks. Everything does. That is not the point. The point is whether the benefits outweigh the risks.

One argument some people have against vaccines is that the person in question is not likely to benefit much because they aren’t likely to become ill with the disease, anyway. That is true enough, but that is the whole point of all safety measures. Do something that will protect you in the uncommon but serious event that it happens. That is why we buy smoke alarms. Most people will never experience a fire in their home, but I don’t want to die from one. Same with homeowners’ insurance, seatbelts, car seats for babies, bicycle helmets, carbon monoxide detectors, life jackets, and back-up parachutes. The list goes on forever. I am 57 and have never been in a serious car accident. I probably never will, but if I do, I want to minimize my odds of dying. I take 15 seconds a few times a day to put on a seatbelt, knowing that it is unlikely ever to help me. I take a smoke alarm and a carbon monoxide detector on every trip. In the slight chance the hotel or rental home owner doesn’t maintain working alarms, my family and I are protected.

In addition to the individual, vaccines clearly benefit society. Here are links to individual data on Human Papillomavirus (New England Journal, Cochrane Review), Smallpox, TDaP (tetanus, diphtheria, and pertussis), and MMR (measles, mumps, rubella). Special note to pregnant women and those who may become pregnant. The MMR article I just linked discusses the horrible birth defects associated with rubella in pregnant women. This is called the congenital rubella syndrome. In the 1964 and 1965 epidemic, over 20,000 babies contracted this syndrome. These articles discuss the overwhelming benefits of the vaccines, and most of the articles also discuss their safety.

Below is from UpToDate. It is a chart of the Effectiveness of routine childhood vaccines.

As with everything, vaccines have risks. The benefits of vaccines significantly outweigh these risks, and serious adverse effects from vaccines are uncommon. The most common side effects are pain at the injection site, fatigue, and fever. Neurologic reactions such as Guillain-Barré Syndrome are much, much less common. People often talk about severe reactions they had to a vaccine. Some of the stories are real, but many are coincidental and not related to the shot itself. Remember, people who have bad reactions to vaccines, real or not, often talk about it, but the millions who get vaccines with minimal or no difficulty don’t.

Johns Hopkins has an excellent site on vaccine safety. Among many other topics, it outlines the data supporting vaccine use. Many people, including some in the government, complain that vaccines haven’t been adequately studied with regard to risks. This site should help assuage them. Also, here is an excellent article showing how much study goes into vaccines and their safety.

When our son was young, I sometimes worried about all the vaccinations he received. Was it safe to give him so many shots at the same time? The coadministration of vaccines has been studied extensively. There is a small added risk of fever and even febrile seizures if multiple vaccines are given together. As scary as that sounds, the risk is small, and fever-related seizures are usually benign. On the other hand, dividing up all the shots causes significant problems. It is difficult to take children to the doctor multiple times in the first two years, and many children would miss out on the vaccines that can save their lives.

When deciding whether to get a vaccine for yourself or your children, please keep in mind the benefits and the risks. It is easy to focus on one or the other. Doctors sometimes focus only on the benefits of vaccines, and if you haven’t personally seen the dangers of the infections themselves, it is easy to focus on the risks. In recent days, we have seen a resurgence in vaccine-preventable infections, most notably measles. If we are not careful, it could soon get much worse.

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.

What do I mean by Thanksgiving perspective? As everyone knows, Thanksgiving is a day when we show gratitude and thanks for what we have, especially family and friends, though it was originally a religious holiday.

However, even on Thanksgiving Day, we sometimes spend much of our time feeling rushed and stressed. For several days leading up to Thanksgiving, I often see people complaining and worrying about all they have to do for the big party. I admit that I have sometimes been one of the complainers. I’ve gone to Costco twice this week and my beloved Lunds and Byerlys grocery store three times. At both stores, people were stressed and upset. A man in front of me at the Costco liquor store complained about how long the lines were at Costco. He had a cart full of food and was buying several bottles of wine, yet he couldn’t wait a few minutes longer than usual to buy them without complaining.

I overheard several other people complaining about the cost of food. Yes, I know that we have had an increase in some food prices. The cost of beef, coffee, soda, and other items has gone up dramatically in the last year or two. But Costco had a fresh turkey for $1.09. I just checked online, and Target has fresh turkeys for $0.79 a pound. A spiral ham is $1.49, and green beans are about $3 a pound. And if you spend $50, you get ten dollars back. You could feed ten people for under fifty dollars. I don’t think the cost of food was something worth complaining about. Yes, the price of a standing rib roast was over a hundred dollars, so we’re having turkey.

Rather than complaining about the hassles around the holiday dinner, we should be thankful that we live in this country, where we have easy access to food. In fact, few Americans need to worry about finding food. One look around will tell you that the majority of people have more food than they need.

In America, we have much to be thankful for. In addition to access to food, we have clean water, shelter, cars, television, streaming services, mobile phones, computers, and many other things our grandparents didn’t even dream of.

More important than anything I’ve mentioned is that we should be thankful for being alive.

Being born was not your only good fortune. You had to survive until today. We all know how many times our lives could have ended before now. And it was much worse a hundred years ago. In 1925, our life expectancy was about 58, and it was even lower in 1900. Now, we consider someone young when they die at 70. That’s in the United States. In several countries in Africa, the life expectancy is under 60.

It took extremely good fortune for any of us to be alive right now. My parents had to get together at the perfect time for me to be born. The same had to happen with their parents, their parents’ parents, and so on for millions, literally millions of generations. Had any of my ancestors died without children, I wouldn’t be here at all, and no one would have known the difference. The same is true for everyone in the world today.

One of the things that bothered me in my practice was when a patient in their 80s or even 90s complained about getting old. Really? There are only two things that can happen to a person: get old or die young. Which would you prefer? Yet, many people don’t do much to try to live into old age. Read about my book, The Six Rules for a Longer, Healthier Life, if you want to increase your chances. Just a few days ago, I complained about pain in my arthritic left thumb while I was playing piano. How silly. First, I should be thankful I have a piano. More importantly, I should be thankful I have lived long enough to develop age-related arthritis. That is one of countless things I’ve complained about that I shouldn’t have. Enough complaining.

Now, the most important thing.

If you have a single person in your life whom you love, be thankful. I am fortunate to have several such people. How my wife puts up with me is beyond my comprehension. Yet, as much as I love them and am thankful to have them, I have not always shown my gratitude. I have sometimes been short-tempered and have complained when they’ve done something that wasn’t ideal for me.

That is what I mean by Thanksgiving Perspective, showing your gratitude for what you have, especially your loved ones, on Thanksgiving and every day. Try to be thankful for all the good things, and accept that we will have things that don’t seem good when they are happening. In retrospect, what bothers us in the moment is usually not a big deal. (Keep a copy of Don’t Sweat the Small Stuff on your desk.)

I hereby make a Thanksgiving resolution.

I will work as hard as I can to keep the Thanksgiving Perspective, showing my gratitude for everything good in my life, and avoiding complaining about anything that is not perfect. Please consider joining me in a resolution to keep the Thanksgiving Perspective.

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.

Default to yes for things that you want to accomplish

This is another of the tricks to help you accomplish something meaningful. I primarily use it when I want to improve in some way. It sounds very simple, and it is easier said than done, but it’s much more effective than “winging it.” As I say often, you must act with intent. It is up to each of us to decide what is important. What about ourselves do we want to improve?

It is tempting to choose something very simple and vague. I don’t want you to say, “I want to eat better.” Anyone can eat better without putting in any effort. If you eat two large McDonald’s fries a day, you can eat better by throwing two fries into the garbage before you sit down. That’s an improvement, but not much of one. You can do better than that. You can say, “I won’t eat fast food or bad carbs.” For this tool, be as precise as possible. Instead of, “I want to exercise more,” say, ” I will work out hard every Sunday, Tuesday, Thursday, and Friday.”

So, what does it mean to default to “yes?” If you want to work out those days, then on Sunday morning, you say to yourself, “Should I work out today?” The answer is always yes, unless there is a compelling reason to override it. It is ridiculous to evade the default to Yes by saying, “I don’t want to,” or that you need to meet someone for drinks. Don’t do it. However, if there is a compelling, urgent reason not to work out that day, of course, override the default, but think through it very carefully. As I say in my other book, cheating on a diet or exercise routine is really cheating yourself.

My wife’s goal is to exercise every day she’s not working. She was off yesterday, and we had plans for the day. She asked, “Should I run before we go?” I immediately answered, “Yes.” That is the trick. No wiggle room. She could have said that she’d run at the end of the day. But something could have come up. She could have been tired, had a drink, whatever. She defaulted to yes and ran the best she had in a long time. With this tool, you won’t be perfect, but if your default is to say yes, you will do well.

I no longer need to think about this tool to get myself to exercise, because the habit of nearly daily exercise is so ingrained in my life. I have recently been using it for social events with loved ones. I am by nature a homebody. I don’t like parties or crowds. I like my routine and generally don’t want to vary from it. But when my wife or son asks me to do something (as long as it doesn’t involve strenuous work outside), I want to do it. Unless I have something planned that I can’t miss, which is uncommon now that I’m retired, I default to yes and do it.

Once a habit is ingrained, as I said, you won’t need to pay attention to this trick. An example that comes to mind is wearing a seatbelt. You definitely should default to putting on your seatbelt when you get in the car. In a few weeks, you don’t even think about it. You always wear a seatbelt. If you aren’t strict, defaulting to yes, or opting in, as some people call it, you will debate yourself. “I’m just driving to the corner, or the roads are empty, so I don’t need to wear it.” If your goal is always to wear a seatbelt, wear it every time, and soon, it’s a habit.

That is what you do with every important goal. Get out of bed, exercise certain days of the week, don’t eat bad carbs, read something worthwhile every day—whatever is meaningful to you.

The importance of water is obvious, yet most of us take the availability of clean water for granted.

I have been working with a start-up company, The Joseph Project. The mission of the company is to help people prepare for emergencies, large and small. The official launch is scheduled for the spring of 2026, but the website is up and running, and a few products are being sold.

I am the medical director of The Joseph Project, and one of my responsibilities is education. My first article/ blog post is on the website. I discuss the importance of water, how much we need, and how to prepare for the temporary lack of access to clean water. Even a few days without clean city water is a problem. If you have a well, you will need a backup plan to have water for yourself and your family.

Check out my article and the company if you are interested.

Go back to HaroldOster.com

I hope that most people want to improve some aspect of their lives. If your life is already perfect, I am happy for you, and you have no reason to read the rest of this post. If there is something in your life you want to improve, there are three tools I find effective. I will discuss the first, “Do What’s Important First,” in this post. People I know say that I have willpower and discipline. Maybe so, but I use a lot of tools and tricks. This is one of my favorites.

The tool, Do What’s Important First, applies to anything you want to accomplish. I use it for habits I want to develop, getting in shape, and choosing which trip to take next. It also works well for less important choices, such as which hike to take on a trip in the mountains. The concept sounds obvious, but most people don’t do the important thing first. They procrastinate. Kids work on their pencil drawer and the text’s font before they start writing the term paper. Many people plan to start a diet and exercise program on January 1, rather than today. Write the paper first, and start eating better right now. This concept is critical in starting habits because they are so difficult to develop.

Years ago, I read several studies showing how good pushups are for your health. This study in JAMA shows the link between the capacity to do pushups and the risk of a future heart attack. (This is not one of the studies that got me started on this habit, but it is impressive.) I do pushups virtually every day. I have only missed days when I was ill or getting a colonoscopy.

People often can’t believe that I have done pushups every morning for years, but it’s true. This morning, I did three sets of 55 pushups about 30 minutes apart. How do I do it? It is important to me to do pushups daily, so I do it first. I get up, I do a set, then another, then another. That’s it. It took me years to build up to this level—I could only do a few when I started, and my form was terrible.

If I didn’t do pushups first thing every morning, or if I waited until later in the day, something would have always come up. I could be tired, hungry, busy—whatever. By 6:00 a.m., I have already done one of the things that is important to me. Other things are important, and I do them early also. Since I don’t enjoy doing pushups, it is especially important that I do them first. Ryan Holiday talks about doing the hardest thing first. It’s called swallowing the toad. I feel that way about pushups. On the other hand, I want to write something, anything, every day, but I enjoy it much more than pushups, so I can do my writing second, and so on. I talk more about wasting time here.

I wanted to get in shape in general, so I work out almost every day. Read about the benefits of exercise in my book, The Six Rules For a Healthier, Longer Life. I have trouble exercising before eating, so I exercise first thing after eating, usually when my wife leaves for work. If she’s home, we try to work out together. I will talk about spending time with others when I discuss another tool I use.

How does “Do What’s Important First” apply to choosing trips to take? Several years ago, my wonderful wife and I were debating what trip to take. We hadn’t been to Michigan for many years, so that was on our list. There were five or six other trips we had planned, including Yosemite and Oregon, where we had never been together. We chose Michigan because our dear friends, Jack and Suzanne, lived there. I have known them since I was about two, longer than any other non-relative. You never know what is going to happen, so we chose to go to Michigan. We had a wonderful trip, seeing the Upper Peninsula, Mackinac Island, and spending time with our friends. Less than two years later, Jack passed away. Had we gone somewhere else, we may never have seen him again.

This tool, to do what’s important first, helps when choosing less important things, like which hike to take. My wife and I love trips where we can hike all day long. I do the legwork—booking flights, arranging a rental car, and finding a hotel or VRBO, while she considers the hikes and chooses which ones we should do. Most of the time, I agree with her choices. In fact, I have never once been disappointed in her plan. In Oregon last month, we went on beautiful trails in places that didn’t sound all that great to me, but her choices were gold. For example, I was blown away by Smith Rock State Park near Bend.

My wife always asks me whether I agree with her plan for a day of hiking. My usual question is “What is the best hike here?” Whatever she answers, I respond with, “Let’s do that hike first.” If we save the best hike for later, we could be disappointed. It could storm, they could close the trail for a bear sighting, or I could sprain an ankle and not be able to hike. (If she sprains an ankle or even breaks a toe, it doesn’t stop her.)

If you want to make sure you get it done, then do it first. This also holds true in life’s big choices. If you really want to have kids, try early in your marriage. If you wait, you could become unable to have kids later. It happens more often than you may think. If you want a particular career, get started right away. Most kids who drop out, even those who say they plan to go back, don’t get a degree within eight years. So, if you want a career that requires a college degree, start early and work hard. Finish the degree first. Gap years may not have the same negative effect on attaining a college degree. Still, the ones who succeed after a gap year usually do something during that year to further their career and gain clarity about their career path.

Doing the important thing first is intuitive. Of course, you shouldn’t put off homework until you get home from a party. You shouldn’t go for a beer after work, planning on going to the gym right after. Still, it helps to actually focus on the concept. Many people never take the time to think it through. They believe they will have the time and motivation to go to the gym after a drink with friends. They believe they will feel like doing pushups and yoga after a big breakfast. More often than not, they won’t feel up to it. They will have completed the less important tasks (which may even be harmful) and ignore the important ones.

Should you consider quitting social media?

With the recent murder of Charlie Kirk, the harms of social media have again become apparent. I don’t believe his murder had much to do with social media, but after something horrible happens that is apparently linked to their political or religious views, there are reports of what people said on social media. Sometimes, a professor will get fired for a post on X, or a celebrity loses their job because of their views on violence against someone with opposing ideas.

What we see on social media then becomes news, with commentators on multiple networks sharing their views on how the post on X.com matters. Social media is not news. Social media is where people can say anything they want, good or bad, to a large number of other people. The social media platform enables and emboldens people to say what they feel, no matter how vile it is. Before social media and the internet, you would have to write a letter to the editor of a newspaper to have your views published. The editor would rarely publish a letter stating that someone deserved the violence perpetrated against them. If you wanted to be heard, you could also stand up on a soapbox (I had to do that in a speech class in school) and shout your views. Most of the time, you would be ignored.

Now, you can write what you believe, and in thirty seconds, it’s available for the world to see. Your words, good or bad, can be fed to my screen without anyone screening them first. There is no way to avoid these words and ideas if you use social media platforms. It takes extreme effort not to be affected negatively by these negative comments. Yes, positive comments and ideas sometimes can have positive effects, but the negative ideas overpower them. I believe people should have the right to write and say anything they want. But I don’t have to read it or listen to it.

Even when there isn’t terrible news spreading on Twitter or Bluesky, much of social media is unhelpful. If you click on a video in X or Facebook, you’re destined to weeks of similar videos on your screen. Every time you click, you waste minutes of your day, minutes of your life. As Ben Franklin said, “Dost thou love life? Then do not squander Time; for that’s the Stuff Life is made of.”

If you know me or have read my books (The Three Rules to Lose Weight and Keep It Off Forever, and The Six Rules for a Longer, Healthier Life), then you know I have never had success cutting back on anything and have only had success with completely quitting. All or None. That’s why I quit bad carbs and alcohol. A week ago, I decided to quit social media. Even if I don’t entirely avoid negative ideas, I will at least save time by not watching videos that don’t help me in any way.

Cal Newport, who wrote the superb books Digital Minimalism and Deep Work, wrote a post on this topic. I recommend you read it to see a similar take on the subject. I mention Newport in my post on killing time.

If you decide to quit, delete any social media apps from your phone and vow to never check X, Bluesky, Instagram, or Facebook on your computer. Post on these sites that your friends can reach you by phone or email. I don’t like texts, but if you do, then, of course, use texts. Our son often contacts us with FaceTime. It’s far superior to text and even a phone call, and I believe that FaceTime is the most important use of a smartphone. However, GPS, Spotify, and Audible are also invaluable.

If you have considered quitting social media but are hesitant, consider a break first. I often recommend this with alcohol. Start today and decide in 30 days whether you’re better or worse. If you’re better, then quit forever. If you’re worse off without social media, then I was wrong, but at least you made an informed decision. However, I expect you will be better. I have never met anyone who felt worse having abstained from alcohol for 30 days, and I doubt many people have regretted abstaining from social media.

Note: I wrote this several days ago and am only posting it on September 18, 2025. I just read on the news that Jimmy Kimmel’s show was suspended because of something he said about the Charlie Kirk murder. I am glad I will not be checking X.com to see what everyone is saying about that.