© 1991-2010 Jerry Emanuelson

Chapter 2


These are the top 15 causes of death in the United States during 2010 according to the United States Centers for Disease Control and Prevention.  (The numbers in parenthesis after the listed cause are the approximate number of deaths in thousands.)

  • 1. Heart Disease (598)

  • 2. Cancer (575)

  • 3. Chronic Lung Disease (138)

  • 4. Stroke (129)

  • 5. Accidents (121)

  • 6. Alzheimer's Disease (83)

  • 7. Diabetes (69)

  • 8. Kidney Disease (50)

  • 9. Pneumonia & Influenza (50)

  • 10. Suicide (38)

  • 11. Septicemia (blood poisoning due to infection) (35)

  • 12. Liver Disease (32)

  • 13. Hypertension (high blood pressure (27)

  • 14. Parkinson's Disease (22)

  • 15. Pneumonitis (lung inflammation) due to solids and liquids (17)

One approach to life extension is to attack the root causes of these major sources of death and disability.  Heart disease remains the biggest killer.  It is also one of the most preventable.  The gap between heart disease and cancer has been narrowing in the past few decades.


Individuals can intervene at six or more levels to prevent heart attack or stroke.

  • (1) Prevent cardiovascular inflammation as measured by markers such as C-reactive protein.

  • (2) Raise HDL levels and reduce LDL levels.

  • (3) Raise antioxidant levels since it is oxidized cholesterol deposited by LDL that forms most of the deposits on artery walls.

  • (4) Keep blood glucose levels between 70 and 90 mg/dl. as often as possible, and keep glycated hemoglobin (HbA1c) below 6 percent.

  • (5) Prevent the clot formation that actually triggers the heart attack.  (The clot formation usually begins because of injury to the artery caused by the oxidized cholesterol from LDL on the artery wall.)  One should be less concerned with total cholesterol levels than with maintaining a low LDL/HDL ratio.  (Total cholesterol levels are probably irrelevant in most people.)

  • (6) Take plenty of folic acid and B vitamins (and other nutrients, if necessary) to prevent the conversion of the amino acid methionine to homocysteine, which may be a significant cause of arterial inflammation and plaque formation.

The main dietary cause of high LDL cholesterol is consumption of certain saturated fats.  In most people, the cholesterol content of food has little to do with serum cholesterol, although most cholesterol-containing foods are also high in long-chain saturated fats.

Poly-unsaturated fats lower LDL cholesterol, but most poly-unsaturated fats should be avoided because they can cause considerable oxidative damage to the body.

Monounsaturated fats and medium chain triglycerides (MCT) are safer types of fats.  MCT can dramatically improve LDL/HDL ratios and can be used as a substitute for ordinary fats in many applications.  MCT is difficult to use in frying, though, because it decomposes (and smokes) at a lower temperature than other fats.  MCT is not often used, except in individuals with special dietary requirements, because of the special considerations that have to be used when cooking with MCT.  Some types of fats, such as the omega-3 fatty acids in fish oil, are very good for most people and are very important substances for life extension.

Niacin is usually very effective at reducing LDL cholesterol and raising HDL, especially if taken in doses of 1 to 3 grams.  Many people avoid niacin because of the flushing reaction that it usually causes when given in doses that are effective on controlling lipid levels.

The niacin flush is an uncomfortable, but generally harmless, redness and feeling of warmth, especially on the face.  Sometimes it can be very uncomfortable, with itching and and tingling effects.  The niacin flush can be reduced by taking aspirin about 30 minutes before taking niacin.  The niacin flush tend to diminish with continued use of niacin.

A more effective form of niacin is timed-release niacin, a form that reduces the flushing problem. Not all brands of timed-release niacin are the same though.  In the past, some brands of time release niacin caused liver problems.  Prescription brands of timed-release niacin have generally proven safe and effective, but they are also very expensive.  A non-prescription brand of timed-release niacin recommended by many doctors is Carlson brand.  In some people, any form of niacin can cause liver problems.  For this reason, anyone starting any form of niacin should get a blood test for liver function within a few weeks of starting niacin.

Although less effective, it may be best to take niacin in the form of inositol hexanicotinate (no-flush niacin) which avoids the uncomfortable flushing reaction (and since inositol is a beneficial nutrient as well).  Inositol hexanicotinate is about 80% niacin and about 20% inositol.  It usually comes in 400 or 500 mg. capsules that should be taken at least three or four times a day.  Larger amounts may need to be taken by those with naturally high LDL levels and low HDL levels.  Inositol hexanicotinate does not work for everyone.  For such a commonly-available nutritional supplement, there is surprisingly little scientific study that has ever been done on inositol hexanicotinate.

In recent years, research has raised questions about whether niacin is actually useful in preventing cardiovascular disease.  Most of the newer research used a combination drug that added a substance called laropiprant that blocks most of the flushing due to niacin.  It is not yet known whether it is the laropiprant or some other factor that is causing the newer studies to show that niacin may be less effective.

Anyone taking more than about 1000 mg. (1 gram) of niacin or inositol hexanicotinate per day should have liver enzymes checked regularly.  This is something that is routinely done for those on cholesterol-lowering drugs, and it should be done for niacin, as well.  Niacin rarely causes a liver problem, but there are significant exceptions in certain individuals.  Large doses of niacin often do cause some mild elevation of liver enzymes.  These liver enzyme tests are part of most routine blood chemistry tests.

The omega-3 fatty acids, such as those present in fish oils, can significantly improve one's cholesterol profile, and they have many other health benefits. Omega-3 fatty acids can also significantly reduce fasting triglycerides, which is a significant risk factor for cardiovascular disease.

DHEA (dehydroepiandrosterone) also often lowers LDL and raises HDL, but this does not work for everyone.

For those with who require a cholesterol-lowering drug, lovastatin, simvastatin and pravastatin are very effective (as are the other "statin" drugs), but it is mandatory to take at least 60 mg. of coenzyme Q-10 daily since all statin drugs lower the liver's production of coenzyme Q-10.  Coenzyme Q-10 is a substance essential for proper muscle functioning, especially functioning of the heart muscle.  The 60 mg. coenzyme Q-10 is a minimum dose:  100 mg. to 120 mg. is a better dose.  (Doses of coenzyme Q-10 larger than 200 mg. should only be taken under medical supervision.)  Simvastatin has become an inexpensive and popular statin medicine since it became available as a generic (although prices vary widely).  Statin drugs probably are much more important for their ability to reduce inflammation (as measured by C-reactive protein) than for their ability to normalize cholesterol.  DNA tests are available that will tell you if you are likely to benefit from statins and, more importantly, if you are likely to experience any serious adverse effects from taking statin medicines.  A SNP (DNA variant) called rs4149056 is especially important in determining serious adverse effects from using statin medications.

Red yeast rice extract is a nutritional supplement that contains several statin compounds, most notably lovastatin (which is often called monacolin-K when it occurs in red yeast rice extract).  The monacolin-K component of red yeast rice extract is identical to the prescription medicine lovastatin.  In addition to lovastatin and other statins, red yeast rice extract contains a number of other compounds that may interact with common medications.  This makes the standardization and quality control of red yeast rice extract extremely difficult because of the number of different substances that must be continuously monitored by the manufacturer.

Many people, myself included, who have no "medical need" for a statin drug take a low dose of simvastatin because of its potential for reducing the risk of cardiovascular disease and certain types of cancer in normal healthy people.  Many healthy physicians also take a statin drug because of its potential benefits in the prevention of cardiovascular disease and many types of cancer.  Anyone considering the use of simvastatin (or one of the other statin drugs) for only preventive use must remember to take a daily coenzyme Q-10 supplement and should strongly consider having a DNA test for the well-known DNA variants that can indicate a high risk of problems with taking statins.  (I knew my relevant DNA variants for more than a year before I started on a very low dose statin.)

Many people taking a cholesterol-lowering drug would find inositol hexanicotinate and pharmaceutical-grade fish oils to be safer and just as effective, but they should not make the switch except under a physician's supervision and with regular blood chemistry tests.  It is prudent to take supplementary coenzyme Q-10.  Like fish oil supplements, statin medicines may have significant health benefits beyond their effects on cardiovascular disease.

An average intake of about one ounce of alcohol per day in men, or 1/4 ounce per day in women, will raise HDL levels.  Even though a little alcohol is good for most people, a little more than this amount can produce very adverse consequences.  The differences between the optimal amount for men and women are more than just a matter of differences in average body weight.  Men and women metabolize alcohol very differently.  For example, the optimal alcohol intake for the average man will substantially increase the breast cancer risk for the average woman.  If the alcohol is consumed in the form of red wine, the polyphenols in the red wine will raise the body's level of natural antioxidants.  Green tea contains similar polyphenols.

Regular exercise and maintenance of normal body weight is very important to maintaining low LDL/HDL ratios.  Vigorous aerobic exercise (especially running) is the best method of increasing HDL levels.

In some people, supplements of L-carnitine or acetyl-L-carnitine (about 1000 to 2000 mg. per day) will significantly increase HDL levels.  This is more likely to be true in vegetarians, since meats are the primary natural source of dietary L-carnitine.  Supplementary carnitine can also aid in weight loss.

Supplementary chromium polynicotinate can improve LDL/HDL ratios in some people.  This is probably due to the beneficial effects of chromium on insulin resistance.  A diet that maintains blood sugar levels at a moderately-low and stable level will also improve LDL/HDL ratios.

To prevent the buildup of plaque on the artery walls, it is important to minimize the levels of homocysteine in the bloodstream.  Homocysteine is a toxic byproduct of normal human metabolism.  It is not known if homocysteine is a cause, or just an indicator, of cardiovascular risk.  To convert homocysteine to harmless (or even useful) amino acids, the body requires folic acid, vitamin B-6 and vitamin B-12.  It is important to get at least 800 micrograms of folic acid, 25 milligrams of vitamin B-6 and 100 micrograms of vitamin B-12 every day.  Although a good broad spectrum vitamin supplement will probably supply the necessary B-6 and B-12, it is usually necessary to take a separate folic acid supplement to get adequate folic acid to minimize homocysteine formation.  Folic acid has many important benefits at high doses.  Although 800 micrograms is the largest folic acid dose generally available in the United States without a prescription, 5000 microgram (5 mg.) folic acid tablets are available in many other countries.

It is important to have one's homocysteine levels measured occasionally.  Many people with an adequate intake of folic acid and vitamins B-6 and B-12 still have high homocysteine levels.  Those individuals need to take enough trimethyglycine (TMG) to keep their homocysteine levels low.  TMG is a readily-available nutritional supplement.  S-adenosylmethionine (SAM-e) can also reduce homocysteine levels.  Creatine (the supplement often used for muscle building) has also been shown to significantly reduce homocysteine levels.

Recent studies have sometimes not shown any benefit of lowering homocysteine levels with respect to improving heart disease risk.  Homocysteine remains somewhat of a medical mystery, but high levels of homocysteine continue to be found to correlate with a wide range of chronic diseases.  Homocysteine is correlated with a number of genetic variants (DNA polymorphisms).  It may be that these genetic variants that cause high homocysteine levels also cause other problems.  Whatever medical studies eventually conclude about homocysteine, it is clear that homocysteine is a indicator of potential health problems, and that homocysteine levels can be dramatically reduced with nutrients that are quite inexpensive and have excellent safety records.

To reduce oxidation of cholesterol from LDL, you need at least 100 units of vitamin E, 5,000 units of beta carotene (and/or 5 mg. lycopene), and 500 mg. of vitamin C per day, along with other dietary antioxidants.  Alpha lipoic acid or R-lipoic acid may be an even more important antioxidant.  Lipoic acid, when taken throughout the day, can lower blood sugar levels significantly.  This can cause a significant beneficial increase in HDL.  It is important to get a broad spectrum of fat-soluble and water-soluble antioxidants.  Many single antioxidants, taken alone, will actually generate free radicals that must be de-activated by other antioxidants.

A very important antioxidant in preventing heart disease and many cancers is lycopene, which is very similar to beta carotene, but which has finally become commonly available in pure form as a nutritional supplement.  The best food sources of lycopene are canned tomato juice, or juices such as V8 that are high in tomato juice.

A low carbohydrate diet can also raise HDL by reducing insulin requirements.

In case all of the above fail, it is important for many people to take 1/4 aspirin tablet (81 mg.) per day.  Low dose aspirin is the simplest and least expensive method of heart attack prevention, although it is definitely not for everyone.  Low dose aspirin, by itself, can reduce the risk of heart attack by at least 40 percent in many people.  Low dose aspirin will also reduce the risk of colon cancer, one of the deadliest and most common forms of cancer, by at least 40 percent.

There are dangers of aspirin, even at very low doses.  Aspirin can cause some bleeding in the digestive tract, and, more importantly, can impair somewhat the absorption of some important nutrients.  For most people, though, the benefits of low-dose aspirin are so remarkable that they far outweigh the dangers.

Anyone at risk for a heart attack should also carry at least two regular aspirin tablets with them at all times.  The two tablets should be chewed up and swallowed at the first sign of a heart attack.  The tablets you carry with you should be regular Bayer or other easily chewable aspirin.  The aspirin can stop much of the damage inflicted by a heart attack even after it has started.  Replace the aspirin tablets every four to six months, or whenever the aspirin tablets begin to smell like vinegar.


Cancer is the most difficult of the major causes of death to prevent, but regular consumption of a broad range of antioxidants, a low-dose aspirin regimen, along with a program to keep the immune system strong, can cut one's cancer risk at least in half.  There is good preliminary evidence that melatonin can reduce the risk of breast cancer and that sterols extracted from the saw palmetto berry can reduce the risk of prostate cancer.  The evidence about the benefits of saw palmetto has been contradicted by some studies, but the combination of the proper extracts of saw palmetto, pygeum and stinging nettles seems to be much more beneficial than saw palmetto extract alone.

Dehydroepiandrosterone (DHEA) and melatonin can also cut the risk of breast cancer, and many other types of cancer.  The polyphenols in green tea and red wine also have been shown to substantially cut cancer risks.  (Melatonin, DHEA, and green tea polyphenols are discussed later in this manual.)  Green tea is one of the most effective, and well-studied, natural anti-cancer agents.

There is evidence that coenzyme Q-10 may be an important nutrient for breast cancer prevention, especially in larger doses.

Lycopene, an antioxidant found in tomatoes and other foods, is a potent inhibitor of cancer.

The prescription medicine metformin dramatically reduces the incidence of pancreatic cancer (which is one of the most dangerous cancers) and may significantly reduce the incidence of several other kinds of cancer, including breast cancer.  Evidence is mounting that metformin may be the most potent cancer preventive agent available today.

Regular checkups to detect cancer early are important.  Early detection not only makes cancer easier to cure by conventional means; it also gives the individual time to research and seek out alternative therapies.

Also see Appendix B, Notes about Breast Cancer and Prostate Cancer.


Blockage of a blood vessel is the cause of a great majority of strokes.  These strokes can be prevented in the same manner as heart disease is prevented.  The other kind of stroke is the hemorrhage, which is best prevented by keeping blood pressure low.  Many low-cost and easy-to-use devices for measuring one's own blood pressure are now available.


The best way to prevent all kinds of respiratory diseases is to maintain a strong immune system.  In order for the immune system to work properly against respiratory disease, the membranes of the respiratory system must be kept moist.  Failure to keep the respiratory membranes moist is the most neglected aspect of respiratory health.  In many parts of the country, the humidity of heated indoor air is less than 10 percent during most of the winter.  The process of heating the air, no matter what heating method is used, lowers the indoor relative humidity quite dramatically.  This low humidity is devastating to the respiratory system.  In dry or cold climates, indoor humidifiers are necessary to maintain the relative humidity at 30 percent to 50 percent.  (Artificially humidified buildings which maintain humidities much above 50 percent may promote the growth of molds and other allergens and irritants.)

Digital relative humidity meters are available for about $20, and are very useful for educating yourself about the humidity problem.  Many of these devices only register relative humidities of 20 percent or more.  Many people are surprised to learn that in many locations, for several months out of the year, there is not enough humidity in their homes to even register on these meters.

One can also maintain a moist respiratory system by drinking plenty of water and using a mucolytic agent such as N-Acetyl-Cysteine (500-1500 mg. daily) or guaifenesin (500-1500 mg. daily), or both.  N-Acetyl-Cysteine is available at health food stores and from many mail-order suppliers.  Guaifenesin is a component in many over-the-counter cold medicines and can also be obtained by itself in both immediate release and time-release forms.  (If you buy an over-the-counter form of guaifenesin, be very careful about what else is in it.  Many of the over-the-counter forms of guaifenesin also contain things that one normally shouldn't take on a regular basis.)  People with chronic sinus problems may require up to 2400 mg. of guaifenesin daily.

The use of the some of the antihistamines that are available over-the-counter in the United States damage the respiratory system by drying out the respiratory membranes.  The antihistamines loratadine (Claritin), and Allegra are relatively free of drying effects.  (It can be very dangerous to drive after using any of the sedating antihistamines currently available in the United States.  These anti-cholinergic antihistamines impair memory, judgement and reaction time.)

Respiratory diseases are a major cause of disability and death.  One recent study in France showed that bronchitis alone was the ultimate cause of 5 percent of all deaths.  Many elderly people, or others with weak immune systems, are hospitalized for an accidental injury or other illness, but die of pneumonia or bronchitis.

A French pharmaceutical company, Roussel Uclaf, developed an immune stimulant that has successfully been used for years to prevent respiratory infections.  The immune stimulant is sold under the trade name BIOSTIM, and is useful in enhancing the immune system against a wide variety of viral, bacterial and fungal infections.  Biostim is also useful as a vaccine amplifier.  It increases the number of antibodies the human immune system produces in response to a vaccine.  Biostim is especially useful in preventing viral respiratory infections.  Biostim has an extraordinary safety record, but is not available in the U.S. and it has become very difficult to obtain at all in recent years.

Biostim can be legally imported from Europe for personal use.  Usual dosage is two tablets per day for 8 days, then wait 3 weeks and take one tablet per day for 8 days, then wait another 3 weeks and take one tablet a day for 8 days.  This sequence can be repeated once a year.

Vitamin D is necessary for a healthy immune system.  The current recommended daily allowances of vitamin D in the United States will result in a severe vitamin D deficiency in most people.  Most people will benefit by taking 2000 international units of vitamin D every day.  A dosage of 5000 units per day of vitamin D per day is safe and beneficial for most people.  The levels of vitamin D recommended by medical officials for the past several decades have resulted in countless millions of premature deaths due to vitamin D deficiency.


Eating a diet rich in low carbohydrate, low-glycemic-load foods, getting moderate exercise and avoiding obesity are important factors in preventing or reversing diabetes.  Carbohydrates with a low glycemic index are those which produce the lowest levels of insulin release per gram of carbohydrate.  What is really important is glycemic load, which is the glycemic index multiplied by the number of grams of carbohydrate in the food.  Keep in mind that the published tables of glycemic index and glycemic load are only averages in test populations.  The only way to determine the glycemic load of a food in your body is by testing yourself using a glucose meter.

The prescription medicine metformin is very useful for preventing diabetes.  The United States Department of Health and Human Services has held two news conferences urging physicians to consider the use of metformin for any of their non-diabetic patients who have higher than normal blood glucose levels.  Metformin has shown many benefits as a preventive medicine in healthy people.  Unfortunately, in the United States, medical insurance companies have long had the practice of permanently labeling users of metformin as diabetics.

Also see the Chromium chapter in this manual.  Adequate levels of chromium are necessary for maintaining normal blood glucose levels.

Timed-release alpha lipoic acid (or R-lipoic acid) is also an very important nutrient for the prevention and treatment of diabetes. 

One of the most important things a person can do for preventing diabetes is to monitor one's glucose levels.  Most people on serious life extension programs take about 1000 mg. of metformin (Glucophage) daily if their fasting glucose level is less than ideal.  If you want to live a very long and healthy life, your fasting blood glucose level should be between 70 and 90 mg/dl.  If you take metformin, dealing with insurance companies can be a real problem (because they insist that you must surely be a diabetic), but this is better than getting diabetes or pre-diabetes.


Taking care of one's brain can reduce the risk of these causes of death.  For more on this subject, see the books on "smart drugs" and "brain boosters" listed the recommended reading section. Although it may seem strange to suggest that "smart pills" or "brain boosters" could prevent homicide, a significant percentage of homicides can be avoided if the potential victim maintains good enough judgment to avoid or escape a dangerous situation.

[An interesting sidelight to this:  In animal studies done on fluoxetine (Prozac) before it was released in the U.S., animals became less prone to violence.  In one study, in monkeys that normally exhibit a notable dominant/submissive social structure, the dominant monkeys given Prozac became less dominant; and the submissive monkeys given Prozac became less submissive.  In a study with another antidepressant, minaprine, a species of rat that routinely kills mice for no apparent reason, was no longer interested in killing mice after being given minaprine.]


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Exogenous CoQ10 supplementation prevents plasma ubiquinone reduction induced by HMG-CoA reductase inhibitors.
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Mol Aspects Med. 1994;15 Suppl:S187-S193.

Lovastatin decreases coenzyme Q levels in humans.
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Health implications of creatine: can oral creatine supplementation protect against neurological and atherosclerotic disease?
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Arch Intern Med. 2001 Jun 11;161(11):1455-1456.

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