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6 Surprising Causes of Bad Breath and Natural Remedies That Work, clinically…

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• After years of feeling unwell and overweight, Richard and Jill Wendt decided to embark on a weight loss journey together.
• The couple lost a combined 118 pounds by following the Mayo Clinic Diet.
• Today, they both feel physically and mentally healthier.

In 2023, Jill and Richard Wendt decided to take charge of their weight and health. 51-year-old Richard had been taking blood pressure medication since his late 20s and used a CPAP machine for sleep apnea. And 49-year-old Jill reached a weight that made her feel uncomfortable and self-conscious.

“Over the course of time, the weight just kept going up and up. It just kind of happens without you realizing it,” Jill told Healthline. “You just feel down and out about yourself, and you get in the cycle of, well, that sucks. I can’t find pants that fit, might as well go home and have something to eat because what’s the point? I can’t find clothes anyway?”

Realizing that work stress and unhealthy eating habits had taken a toll on their health, the couple wanted to make a change.

“[Knowing] what challenges our parents and grandparents had, if we can do anything to be proactive going into our older years, we wanted to be able to do that,” said Jill. “We might not be able to avoid some of those illnesses, but maybe they won’t be as bad for us.”

They researched weight loss programs and decided to try the Mayo Clinic Diet in June 2023.

Since then, Jill has lost 60 pounds, and Richard has lost 58 pounds. He no longer takes blood pressure medication or uses a CPAP machine.

“I’m a stress eater, so [the diet] kind of brought that to my attention,” said Richard. “When I was in the office, it was easy having a stressful day to get up and walk to the snack machine and grab a bag of M&Ms or [when I’m] working from home, walk up the stairs and grab a bowl of cereal.”

In addition to offering a food plan, he said the Mayo Clinic Diet helped him understand his unhealthy habits and how to practice healthier habits.

What the Mayo Clinic Diet offers

The Mayo Clinic Diet is a digital weight loss program that uses a food groups system to create a whole-health menu program to follow.

“It’s the perfect fit for all the patients who’ve walked into my office and said, ‘Can you please just tell me what to eat?’” Tara Schmidt, lead dietitian for the Mayo Clinic Diet, told Healthline.

People can choose from seven different meal plans, including Simple, Healthy Keto, Mediterranean, and Protein Balance for GLP-1s.

“We have numerous Diet members who are actively taking anti-obesity medications. With this in mind, we created a specific meal plan to address the unique needs of those on these medications, group coaching sessions around frequently asked questions, and continue to update content the more we learn from individuals and research,” said Schmidt.

The program also provides education and behavior change and offers tools like recipes, virtual support, peer support, and a food tracker.

The Wendts chose the Simple plan, which offers quick recipes for breakfast, lunch, and dinner.

“We did some freelancing with it and changed things or ingredients a little bit ourselves but generally tried to follow that,” said Richard. “It never felt like you were dieting, which is one of the things we really enjoyed about it. You were eating healthy, and nothing is off limits.”

One stipulation for finding a program was not feeling deprived of foods they enjoy. For instance, following a program that removed dairy was out of the question.

“[We] both grew up on a farm, and I love my milk. I’m not giving that up, so maybe I don’t drink as much, or if you like your sweets, you can still have them, but maybe you just don’t do it every night…or you find something that substitutes for that sweetness,” said Jill.

Going back to the basics of healthy eating is something that Jill also gained from the program.

“It’s re-learning what you learned as a kid with the food pyramid, the right portion sizes, it’s okay not to eat everything on your plate if you take too much, or if you’re at a restaurant, it’s okay to take the leftovers home,” she said.

Christina Brown, MS, ACSM CPT, a nutrition and weight loss coach, said the majority of weight loss results are due to changing eating habits to ensure that people are not only eating quality calories but also eating in a calorie deficit.

“In order to lose weight, you must eat fewer calories than you are burning,” she told Healthline. “The easiest way to ensure you are doing this is to track everything you are eating so you know exactly how many calories you take in. You cannot out-exercise a bad diet.”

Breaking old habits and making healthier ones

Guidance on habits to add and habits to break is another aspect of the diet that resonated with the couple.

For instance, the habits they added included eating a healthy breakfast, as well as eating more vegetables, fruit, whole grains, and healthy fats.

Some habits they learned to break included watching TV while eating, snacking (except for vegetables and fruit), and consuming sugar and alcohol.

“I review the healthy habits every day before I go to sleep,” said Richard. “[Maybe] I didn’t have whole grains today…you’re not going to meet everything every day but just to keep that general trend of making sure you’re not straying off those healthy habits.”

The couple incorporated the habit of exercising into their program, too, with Jill walking daily and Richard turning walking into running.

“I was never much of a morning person, but now…I try to be out running by 5:30 most mornings. It just became something…I found out I really enjoyed,” he said.

Losing weight together makes it easier

Research shows that people with partners who participate in lifestyle programs are more successful in reducing weight.

“Unfortunately, we can very easily give up on ourselves, but if we have someone else counting on us, we are much less likely to give up,” said Brown.

For example, she said if your partner is sticking to healthy meal planning, you will be more likely to or if you know they are meeting you at the gym for a workout, you will go even if you don’t want to because it is harder to cancel on them than on yourself.

This notion motivated the Wendts to try the Mayo Clinic Diet together. If Jill signed up, she told Richard he also needed to.

“I’m the one that usually prepares the meals, so to do it just for myself and then have to try to make something separate for him…would be difficult, but if we’re in it together, it’s easier,” she said.

In addition to eating the same food, following habits together, like not eating in front of the TV, also helped them stick to it.

Although the couple hit their goals, they plan to stay on the program for a while to maintain their weight and continue to use the program’s resources like its tracker and recipes.

Schmidt said the program is a lifelong health approach and not a program that preaches a certain number of weeks of toughness.

“We’re teaching our members to build new habits and slowly create eating and exercise practices they can continue long term,” she said. “A key predictor of weight loss maintenance is adherence. It’s important for people to find a method they can see themselves practicing for life.”

The benefits the Wendts have experienced are their biggest motivator to carry on healthy habits after they stop the program.

“We were putting up Christmas decorations yesterday and we were like wow a year or two years ago, going through the effort of hauling everything out we would be sweating and winded but this time…it wasn’t a struggle to get the boxes out,” said Jill.

Feeling well together is the most rewarding part of their journey, she added.

“Doing it together has been a fun thing to do…it just brings you closer cause you’re in it together,” said Jill.

• Protein is a vital part of a well-balanced diet, assisting with organ function and muscle growth and maintenance. 
• Protein can also help people lose weight.
• Learning about protein can feel like information overload and lead to common mistakes that can hinder your health and goals.

Generally, it’s a good idea to focus on consuming protein as a critical component of a well-balanced diet.

“Protein is involved in regulating organ systems, maintaining immunity and metabolism, ensuring proper function of hormones and neurotransmitters, and more,” said Maddie Pasquariello, MS, RDN, a registered dietitian. “Protein is also vital for maintaining a healthy body weight and the health of muscles and bones.”

Indeed, a 2020 review suggested that consuming a high protein diet was one safe and effective tool for weight loss, obesity prevention, and lowering the risks of obesity-related illnesses.

Another from 2024 indicated that physicians prescribing antiobesity medications should counsel people on nutrient intake, specifically protein.

But how much should you consume, and what types and when? These are all excellent questions.

“Many people make mistakes when it comes to their protein intake,” said Andrea Soares, MS, RDN, CSSD, a registered dietitian with Top Nutrition Coaching. “From not eating enough to ignoring plant-based options, these errors can affect health goals.”

According to registered dietitians, the following are six of the most common mistakes people make when changing their protein intake to reach new health goals and how you can best avoid them.

Consuming too little protein

Protein needs are personal and based on factors like weight, height, and lifestyle (i.e., activity level).

“Expert guidance suggests multiplying your body weight in pounds by anywhere from 0.55 to 0.72 to calculate the grams of protein you need daily,” Pasquariello said. “If you’re hoping to build muscle, or if you’re an older adult, something on the higher range of this scale is typically recommended. And if you are looking to lose substantial weight, you may want to go a bit lower than this range.”

But you won’t want to go too low.

“If you don’t get enough protein, your body can’t function properly — nearly all reactions in our body require protein,” Pasquariello said.

Pasquariello said common signs you’re not getting enough protein include:

• Snacking more throughout the day 
• Constant cravings
• Weakness
• Lethargy
• Difficulties with mood and cognitive function
• Getting sick more frequently 
• Brittle hair and nails

Maria Karalis, RDN, a registered dietitian nutritionist with Fay, said simple ways to add more protein to your diet include:

• Adding eggs, tuna, leftover meat, grated cheese, canned beans, or tofu to noodles, rice, salads, sandwiches, soups, casseroles, pasta, and other mixed dishes.
• Eating cottage cheese or Greek yogurt with fruit as a snack or dessert.
• Spreading peanut or other nut butter on toast or using it as a dip for bananas or celery sticks.

Consuming too much protein

Pasquariello said that high protein diets are usually safe if they work for you, you enjoy them, and you are still getting enough of other vital nutrients.

However, it’s possible to go overboard, and some people may be dissuaded from following a high protein diet, regardless of weight goals.

While a 2023 study didn’t find that high protein diets specifically triggered kidney stones or other diseases, authors did call for longer-term data. 

Karalis said signs you’re consuming too much protein include:

• Constipation (due to lack of fiber)
• Dehydration
• Kidney strain, especially if you have kidney problems already
• Bad breath
• Weight gain

Consulting with your doctor or a registered dietitian can help you determine whether a high protein diet is correct for you (and what a high protein diet means for you). Karalis said you’ll also want to ensure you’re consuming a well-balanced diet, which includes the following:

• Fruits
• Whole grains
• Healthy fats 
• Vegetables

Not spacing out protein intake 

While adequate protein is essential, registered dietitians suggest playing small ball instead of hero and attempting to swing for the fences. In other words, eat protein with each meal and snack instead of trying to get your entire day’s worth at once.

“Spreading protein intake across the day helps keep a constant flow of amino acids to your muscles,” said Christopher Mohr, PhD, RDN, a registered dietitian and fitness and nutrition advisor for BarBend. “It also helps with muscle repair and growth, controls hunger, and keeps your energy levels steady.”

Feeling satisfied and energized makes you less likely to consume excess calories. 

“Try to have about 20 to 30 grams of protein per meal,” Mohr said. “This is a good rule for most adults to keep you full and support muscle synthesis. The amount of protein needed may vary based on activity level, goals, and health conditions.”

Some of Mohr’s favorite on-the-go snacks include pistachios and seasoned tuna packets. Karalis loves edamame.  

Forgetting protein quality counts

While no foods are completely off the table, registered dietitians say it’s essential to be mindful of the types of protein you consider a part of your regular rotation.

Marjorie Nolan Cohn, MS, RD, LDN, CED-S, the clinical director of Berry Street, said quality proteins are:

• Lean meats
• Seafood
• Dairy
• Plant-based protein

A few common (and loved) protein sources that are not on the above list are processed/red meat and processed proteins like bars, shakes, and powders.

Cohn said processed and red meats are a protein source but often have added sodium and other ingredients that can outweigh the benefits.

“Red and processed meats are higher in saturated fat and have been linked to cancer development and may not be the best primary source of protein in the diet,” Cohn said.

A 2021 review suggested that red and processed meat consumption was linked with a higher risk of numerous cancers, including breast, lung, and colon.

Cohn and Pasquariello say shakes, bars, and high quality powders are convenient and can have their place, especially if you’re struggling to meet your needs, but would treat them more as a supplement than a primary source.

“I also recommend looking out for added sugar and total fat, as those things can add up if you’re consuming these regularly,” Pasquariello said. “Generally, whole food sources of protein are going to give you the most bang for your buck without unnecessarily increasing calories or added sugar intake.”

Ignoring plant proteins

Animal proteins are often the default, but Soares said that plant-based proteins like legumes and tofu are rich in fiber, vitamins, and minerals.

Soares noted that a “variety of plant proteins in your diet can improve heart health, support digestive function, and provide a more sustainable food source.”

People can also go entirely plant-based and consume a vegan or vegetarian diet, but they should be mindful of their protein intake.

However, Soares noted that “while it’s entirely possible to meet protein needs on a plant-based diet, vegetarians and vegans should ensure they’re consuming a variety of protein sources to get all essential amino acids.”

She added that it’s important to also monitor vitamin B12 and iron intake, as these nutrients can be more challenging to obtain from plant foods alone.

Eating the same protein every day

Loving a protein so much that you eat it daily isn’t necessarily bad. But if chicken breast is the bee’s knees for you, consider having them once and varying the rest of your menu.

“Protein sources contain amino acids, the building blocks of life, which make up the protein,” Cohn said. “Every single amino acid works differently in our body. Some are essential to get from the diet because our bodies cannot produce them, and others are non-essential because our bodies can reconfigure other amino acids to make them.”

Experiment and play in the kitchen to find new favorites, like putting kidney beans in chili or adding fatty, omega-3-rich fish like salmon to a salad. 

“Focus on what’s enjoyable and accessible,” Pasquariello said. 

Takeaway

Protein is vital to our physical and cognitive functioning, supporting organs, hair and nail strength, muscles, and focus.

High-protein diets might also assist with weight loss and maintenance. Registered dietitians say it’s important to be mindful and strategic about protein consumption, as people can make common mistakes when they make changes to their daily protein intake to help lose weight or build muscle mass.

Protein needs vary based on factors like lifestyle, weight, and height. Consuming too much may prompt unintended weight gain.

Space out protein throughout the day and consume various plant-based sources like beans and tofu.

Depiroitizing red and processed meats might help you reduce your risk of health issues, including several cancers.

A registered dietitian can help you meet your needs with foods you love.

As holiday festivities fade into the rearview, these lesser-known tips can help you navigate the winter blues and seasonal depression.

The holidays are over, which, for some people, may come as a relief. For others, going back to work or school or the daily grind of the routine may seem like a downer, especially during the darker days of winter.

During the winter season, when the days are shorter and colder in the northern hemisphere, the body’s internal clock may become disrupted due to a lack of exposure to sunlight. This may take a toll on mental health, leading to seasonal depression or seasonal affective disorder (SAD).

Whether you’re experiencing post-holiday or January blues or seasonal depression, a little self-care can go a long way.

Most people know that eating a healthy, balanced diet and engaging in plenty of heart-pumping physical activity are effective strategies for alleviating depression and boosting mood.

But for some, diet and exercise may not be enough. That’s why we asked several experts to share some lesser-known science-backed tips for beating the winter blues. If you’re feeling low, these surprising tips may help lift your spirits.

1. Take a brief psychological holiday

Mayra Mendez, PhD, a licensed psychotherapist and program coordinator for intellectual and developmental disabilities and mental health services at Providence Saint John’s Child and Family Development Center in Santa Monica, CA, told Healthline it’s OK to feel overwhelmed and even irritated with life sometimes.

But if you’re feeling depressed, Mendez said it doesn’t serve you “to close the door to that which is going well.”

“When feeling down, consider doing a task that takes you away from the overwhelming and toward a happier place, even if only for a few minutes,” she said.

“This might include doing a craft, reading a book on your wish list, going to see a movie, cooking your favorite meal or treat, looking up a new recipe, or listening to an inspirational message. Doing something that is of interest and maybe even a little special offers the opportunity to feel in control and take care of yourself,” she explained.

2. Commune with nature

Mendez noted the natural world has “tremendous healing powers,” especially animals.

“Take a little time to touch, play with, or chat with your animal if you have one. If you do not have an animal, there are endless ways of communing with animals in nature,” she said.

Take a calm walk around the neighborhood, she suggested, and listen “for the tweeting birds, the lizard that scuttled by, the pups walking with their owners, the kitty grooming at the side of a house, or the squirrels playfully chasing each other in the trees.”

According to Mendez, this simple, brief exercise can help to “relax the mind and shift negative thoughts.”  

3. Take a break from the routine

Mendez recommended taking a break “from the conventional, predictable and expected routines.”

“Take a trip; take yourself to that museum you have been wanting to visit for the last year,” she suggested.

“This allows for stepping out of the melodrama taking place in your mind and provides an opportunity for interaction that might otherwise have been neglected or avoided.”

4. Make a small change

Mendez suggested to “embrace making simple and easy-to-manage life changes.”

“For example, change the furniture in the home, repurpose something that seems no longer meaningful, declutter your life from the physical space to the mental space,” she said.

“This strategy activates creative juices and increases the chances that small changes may bring a greater sense of purpose and value to life in the moment. This may be particularly helpful to someone who feels stuck in the drudgery of life and opens the way for new perspectives or attitudes,” she noted.

5. Consider volunteering

Volunteering for a good cause you’re interested in can boost mental well-being.

Mendez suggested the following ideas for volunteering:

• Meals on Wheels
• serving food at homeless shelters
• wrapping, delivering, and donating gifts to Toys for Tots
• giving back to your community (i.e., helping with a local gathering or parade or working events at churches, synagogues, or schools)

“These activities help to reduce isolation, increase engagement in purposeful and meaningful activities, and provide opportunities to positively impact others’ lives,” Mendez said.

6. Wear your favorite outfit

It sounds too simple to work, but popping on your “special” clothes might give you the push you need to break free from the winter blues. 

“Don’t save that special shirt for an unplanned future event that may or may not occur,” Mendez said. “Wear it with confidence now. It might lift your spirits and self-esteem.”  

7. Try ‘tapping’

Caitlyn McClure, PhD, vice president of Clinical Services at Northern Illinois Recovery Center in Crystal Lake suggested tapping — also known as the emotional freedom technique (EFT).

“EFT is a method that uses tapping on acupressure points to help manage emotions, reduce stress, and ease anxiety,” she told Healthline.

“EFT is based on a variety of theories, including acupuncture, neurolinguistic programming, and cognitive behavioral therapy. It’s considered an ‘evidence-based’ practice for treating anxiety, depression, phobias, and post-traumatic stress disorder (PTSD),” McClure explained.

8. Strategic caffeinated ‘power naps’

McClure recommended strategic naps to help improve mood since many people lose sleep during the festive period of the holidays and don’t allow themselves time to catch up.

“Have caffeine mid-afternoon and take a 20-minute power nap,” she suggested. “The caffeine will absorb during the nap and kick in afterward.” This helps you recoup sleep without the grogginess that follows a standard afternoon sleep.

However, if you’re sensitive to caffeine, consumption later in the day could disrupt your bedtime. Ask your healthcare team for more guidance, or skip the caffeine and just nap instead.

9. Take an ‘awe walk’

“While walking, in general, can often be helpful for one’s physical and mental well-being, an ‘awe walk’ takes this idea up a notch,” explained Ilana Lane, PhD, a licensed psychologist and owner of Wellness Lane Psychological Services in Raleigh, NC. 

“An awe walk is a walk where you mindfully experience your surroundings and are intentional about seeking things in your surroundings that give you a sense of awe or wonder versus going through the motions of walking without taking the time to notice or appreciate your surroundings.”

Lane shared a 2022 study demonstrating that taking even just one 15-minute awe walk each week can significantly improve emotional well-being and enhance positive emotions such as compassion and gratitude.

10. Gratitude practice with a twist

“Many of us have heard about the benefits of engaging in a gratitude practice,” Lane told Healthline. “But there is one particular practice derived from the field of positive psychology that is a bit different.”

“The ‘gratitude visit,’” she explained, “involves calling to mind someone who did something that you are grateful for, writing a letter of gratitude to that person about what they did for you, and then physically visiting that person — or calling them up if a physical visit is not possible — to read them the letter out loud.” 

“The really beautiful part of this practice,” she continued, “is that it tends to have a very positive impact on all parties involved — the letter writer and the letter recipient.”

“Research has demonstrated that for the letter writer, the gratitude visit tends to lead to increased happiness and decreased depressive symptoms that last up to a month after the visit.”

11. Create anticipation

“The letdown of anticipation is one of the reasons people can feel down after the holidays,” Eileen Anderson, MD, director of Education, Bioethics, and Medical Humanities at the School of Medicine at Case Western Reserve University, OH, told Healthline.

“To brighten our moods, we can think about what to do to create anticipation again. While having something positive to look forward to — such as a spring vacation — can provide a similar lift, there are more immediate (and less expensive) ways to create the kinds of excitement that support our wellbeing.”

Anderson explained how learning something new can help the brain in long-term ways, including reducing the risk of dementia. 

“Why not look forward to a new learning adventure or experience? Taking introductory courses to new activities — whether it’s a cooking class at your favorite store, a learn-to-curl session at a community ice rink, or a meditation workshop.”

She noted this produces an “anticipatory positive feeling” while providing a little dose of excitement.

For people with social anxiety, she suggested “investigating online options that both allow a new experience but also the psychological safety of home.”

“Either way, having a structured, new experience to look forward to can help you beat the post-holiday blues. And maybe you’ll even find a new hobby you love,” she said.

12. Find opportunities for laughter

As the old saying goes, laughter is often the best medicine.

Watching humorous videos is another simple but effective strategy, according to Jay Serle, PhD, a clinical psychologist at The Ohana Luxury Rehab, HI.

“Research shows that laughter can help reduce stress and anxiety. Watching funny videos or TV shows can help whether you have the post-holiday blues or have just had a bad day at work.”

Similarly, Sophia Spencer, a specialist social psychology and mental health psychotherapist at Socially Fearless, suggested creating more opportunities for social laughter.

“In one of the first studies investigating the neuroscience of shared laugher, researchers discovered that social laughter leads to endorphin release in specific brain regions,” she told Healthline. “Endorphins alleviate pain, lower stress, and boost mood.” 

Spencer explained that social laughter can play an important role in supporting mood, but it also reinforces and maintains relationships, “which buffers against stress and low mood. So, pro-actively create opportunities for laughter can help boost your January mood and ward off the January blues.”

13. Plan in advance

Kim Baron, PhD, a clinical psychologist in Philadelphia, PA, recommended preempting the blues and fending them off in advance.

She suggested “proactively planning to engage with people and activities.” 

“We spend so much time planning for the holidays that we often neglect to plan activities for after the holidays,” she told Healthline. “December is the perfect time to put things on the calendar for January and February.” 

“Make plans with family, friends, and co-workers, and focus on people and activities that make you laugh. Laughter will naturally boost your mood.”

14. Write thank-you cards

Our final tip comes from Courtney Morgan, a licensed counselor and founder of Counseling Unconditionally, a mental health therapy practice in Louisville, KY. 

“One way to beat the post-holiday blues is by writing thank-you cards,” she suggested. “Whether you’re expressing gratitude for a gift, for hosting, or for being a listening ear, sharing appreciation with people we care about can help mitigate the post-holiday blues.” 

“It’s a great way to stay connected with our loved ones, a gratitude practice, and an opportunity to further reflect on the holiday season,” she continued.

“This approach is attainable and relatively low-effort, which is important when considering that we may have less energy after a busy holiday season.”

“Many studies have found that people who regularly express gratitude often have higher life satisfaction, less stress, and anxiety, and tolerate uncertainty more effectively, all of which help us combat the emotional holiday hangover.”

Takeaway

There are many proactive ways to navigate feelings of seasonal depression, especially during the winter months.

If you’re feeling down, remember that it will eventually pass — spring is just around the corner. In the meantime, be sure to exercise, eat well, and get plenty of rest.

Try reaching out to friends and family, watching something funny, enjoying nature, petting a dog, planning something exciting, or taking a power nap — whatever works best to help you cope.

Remember that you have the tools whenever you need to use them.

• Human longevity is affected by a complex number of factors, including lifestyle.
• Through modifiable lifestyle behaviors, including diet, exercise, and limiting sedentary behavior, you can improve longevity and quality of life during aging.
• As with any resolution, sustainability is key, so find ways to integrate healthy habits that will keep you engaged and happy.

The science behind longevity — extending human life span — continues to improve year after year.

Though we have yet to discover a veritable fountain of youth, research indicates that lifestyle choices, particularly diet and exercise, play an outsized role in determining whether or not we live long, healthy lives. That’s good news because it means that you are likely in better control of the factors that influence longevity than you think. 

While we still can’t change our genes, science indicates that genetic makeup is just one part of the complex puzzle of life span. Today, there is also more emphasis on healthy aging rather than just life extension.

“The question we really should be asking and focusing on is what is healthy aging and healthspan, not life span,” Amanda Boyce, PhD., Health Scientist Administrator in the Division of Aging Biology, NIH’s National Institute on Aging, told Healthline.

Healthline spoke with various experts in health and medicine to find the best, most actionable recommendations for living longer and aging gracefully in the new year.

5 science-backed ways to improve longevity in 2025

Give your diet a Mediterranean or Japanese boost

The science is very consistent: when it comes to diets that improve longevity and prevent disease, the Mediterranean diet and the Japanese/Okinawan diet are the best.

While they might seem worlds apart in terms of culture and geography, both emphasize similar dietary patterns. They are heavy on fish as a source of protein, which is rich in brain-boosting and heart-healthy fats. They also include plenty of whole vegetables (fresh or fermented) and limit heavily processed foods and sugar.

“As we approach the new year, know that no one “quick fix diet” will be impactful. When we think about longevity, we must consider dietary patterns and changes that will provide long-lasting impact and, most importantly, are sustainable!” said Alyssa Kwan, MS, RD, Clinical Dietitian in Cardiology, Stanford Medicine.

If you want to start changing your diet to better align with these practices but aren’t sure where to start, here are some simple tips. 

“Focus on one component at a time and make sure it’s something that fits within your personal, religious, and/or cultural preferences. For example, if you enjoy lentils, use them instead of white rice in veggie bowls. But if you dislike fish, then focus on other sources of protein,” said Kristin Kirkpatrick, MS, RD, a nutritionist at the Cleveland Clinic, and co-author of Regenerative Health.

Shed those excess pounds

Obesity is linked to numerous chronic illnesses, including cardiovascular disease and diabetes, and yes, even a shorter lifespan. For many adult Americans, shedding a few excess pounds can be tremendously beneficial to longevity and overall health. 

But rather than just trying to lose weight, learn about the ideal body weight for your age, sex, and height. Losing even 5% of your body weight can significantly impact everything from blood sugar to blood pressure.

“Maintaining a healthy weight across life stages is critical for healthy aging and for improving both lifespan and healthspan,” said Frank B. Hu, MD, PhD, professor and chair of the Department of Nutrition, Harvard T.H. Chan School of Public Health.

“Clinical trials have shown that weight loss achieved through lifestyle changes, medications such as GLP-1 agonists, or weight loss surgeries is associated with a reduced risk of chronic diseases, including diabetes, cardiovascular disease (CVD), and certain cancers, and premature death,” said Hu.

Cut down on sitting

There’s a good chance that you are sitting far more than is good for your health. That’s likely no fault of your own: you sit when you use a computer, watch TV, or meet friends at a coffee shop. But as our lives have become more sedentary, science has homed in on the negative effects that can have on longevity and disease risk. 

“Sedentary behavior, such as prolonged TV watching, has been associated with an increased risk of chronic diseases, including diabetes, cardiovascular disease (CVD), and premature death. This heightened risk is primarily attributed to increased obesity and the displacement of physical activity,” said Hu.

Even if you exercise regularly, sedentary behavior has serious health risks associated with it. So don’t just think about trying to offset lazy days with a hard gym session. Think about ways to increase physical activity throughout the day, even if it just means taking a walk around your house or office, even if you are still exercising regularly.

Exercise — the more, the better

Regular exercise is one of the best things you can do for your health. And it’s not just about your body either. The benefits extend to brain health and cognition, too.

New research published in December 2024 found that among older adults, cardiorespiratory fitness was an excellent indicator of brain health across multiple domains of cognition, including memory.

Finding ways to increase physical activity and cut down on sedentary time in a manner that is enjoyable is key to making the habit sustainable. 

As a starting point, the CDC recommends that adults get a minimum of 150 minutes per week of moderate-intensity physical activity.

“The two things in older adults that we see as a result of aging that lead to decreases in their quality of life are changes in cognition, and functionality, staying up on your feet. Exercise is far and away the thing that impacts both of them,” Katherine T. Ward, MD, clinical section chief of geriatrics at Stanford Medicine, told Healthline.

Boyce adds that establishing habits that can reduce sedentary behaviors and increase activity at the same time is a great place to start.

“You can also build physical activity into your everyday life. For instance, get off the train one stop early and walk or bundle behaviors like only watching TV while you’re exercising,” she said.

Stop smoking

Yes, you’ve heard it before, but the science is as firm as ever: stop smoking, and you will live longer. Period. 

In a study led by Frank Hu and published in 2018, researchers found that “never” smoking was one of five key factors for prolonging life expectancy. The others were:

• maintaining a healthy weight
• regular physical activity
• healthy diet
• only consuming a moderate amount of alcohol

Cigarette smoking is associated with roughly one of every five deaths in the United States each year, amounting to more than 480,000 deaths annually.

Why is smoking so deadly? It is linked to everything from cancer and heart disease to diabetes and COPD. Stopping smoking not only lowers your risk of all these diseases but can add as much as ten years to life expectancy.

Expert recommendations for longevity in 2025

Healthline asked the experts to give their top recommendation for longevity in 2025, and here’s what they said:

“Maintaining a healthy body weight through diet and exercise is something that I have continually strived for,” said Hu.

Ward told Healthline, “Whatever you’re doing for physical activity, add 30 more minutes to it.”

“Move your body. Take a walk after dinner, have a family dance party, or try a new sport. Not only will it improve your health, hopefully, it will bring more joy into your life,” said Boyce.

When it comes to eating healthy, think holistically about other behaviors, including exercise and sleep.

Kirkpatrick emphasized, “Match your dietary pattern (not diet) to your why. If your ‘why’ is ‘I don’t want to get dementia like my mother did,’ for example, then pay attention to relevant supplements, adequate exercise, and a nutrient-specific pattern (along with enhancements in stress management and sleep).”

“Overall, to improve longevity, think about sustainability. Consider other factors such as maximizing sleep, minimizing stress levels, and engaging in an active lifestyle ~150 minutes of physical activity weekly,” added Kwan.

The bottom line

Rather than looking for a quick fix, the science behind longevity suggests that healthy lifestyle habits, including diet and exercise, are most important.

Getting active, losing weight, stopping smoking, eating a Mediterranean diet, and limiting sedentary behavior are keys to not only lengthening your life span but also increasing your quality of life or health span.

Take small, sustainable steps across different aspects of your life to build habits that will last beyond 2025.

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• Jimmy Carter, the 39th U.S. president, died at age 100 in his hometown in Plains, Georgia.
• The former president left a long legacy working in public health.
• In recent years, Carter has had multiple health issues, including being diagnosed with metastatic melanoma and a fractured pelvis.

Former United States President Jimmy Carter died on December 29 at age 100 in his hometown of Plains, Georgia. Carter was the 39th president and the only former president to reach centenarian status. He leaves a long legacy in global health and infectious disease that has changed the world for the better.

In a statement issued by the White House, President Joe Biden called Carter a “dear friend’ who was “a man of great character and courage, hope and optimism.”

“With his compassion and moral clarity, he worked to eradicate disease, forge peace, advance civil rights and human rights, promote free and fair elections, house the homeless, and always advocate for the least among us.” President Biden said. “He saved, lifted, and changed the lives of people all across the globe.”

Carter has been in in-home hospice since February 2023, following a series of hospitalizations.

Health issues have plagued Carter in the past decade. In 2015, he was diagnosed with metastatic melanoma that had spread to his liver and brain. But he subsequently beat the diagnosis and was declared cancer-free.

In 2019, Carter suffered a series of falls around the time of his birthday in October, with one resulting in a black eye, stitches, and a fractured pelvis. He again went on to make a full recovery.

Carter’s wife of 77 years, Rosalynn Carter, died in November 2023, at age 96. The Carters were the longest-married presidential couple in the U.S. history.

Jimmy Carter’s public health legacy

The former President’s charitable work since his defeat by Reagan in 1980 was legendary. He worked with organizations, including Habitat for Humanity and his namesake, the Carter Center.

Throughout the past decades, Carter has also worked diligently in global health to work toward the eradication of devastating diseases around the world. He has become a patron in the world of neglected tropical diseases, a group of conditions with far-reaching health and economic outcomes. However, because they are found predominantly in impoverished areas, these diseases, which include Chagas, dengue, guinea-worm disease, and river blindness (onchocerciasis), were often not well studied.

Peter J. Hotez, MD, PhD, Co-director of the Texas Children’s Hospital Center for Vaccine Development and dean of the National School of Tropical Medicine at Baylor College of Medicine, has worked with Carter over the years. In 2006, the two worked on a panel that helped to introduce the term “neglected tropical diseases” into the global health lexicon.

“To have him be out in front, talking about the importance of diseases that previously most people didn’t care about was a tremendous boost to our whole field of neglected tropical diseases,” he told Healthline.

William Schaffner, MD, a professor of infectious diseases at Vanderbilt University Medical School, echoed those sentiments, saying that Carter Center cast a light on “the forgotten problems of forgotten people.”

“These tropical diseases are outside of our daily purview, outside of our daily experience here in the developed world, but they cause untold misery for people around the world,” he told Healthline.

Fight against neglected tropical diseases

Today, the Carter Center continues its fight against neglected tropical diseases with the ultimate goal of eradication in mind. The six at the top of the center’s list are:

• Guinea worm disease
• River blindness (onchocerciasis)
• Trachoma
• Lymphatic filariasis (elephantiasis)
• Schistosomiasis
• Malaria

Neglected tropical diseases are historically hard to treat for many reasons. They most often occur in impoverished regions and countries, often in remote areas. They also tend to be debilitating but not deadly, which can put them lower on the list when it comes to money and resources for treatment, according to Hotez.

“When you’re trying to compete for resources with people who study certain diseases like AIDS or tuberculosis, getting people to care about these chronic and debilitating infections is not always easy,” he said.

River blindness (onchocerciasis) is caused by a parasitic worm that is transmitted to humans through the repeated bites of infected blackflies. The worm larvae migrate within the body to the skin, eyes, and organs, leading to inflammation, lesions, and blindness.

“You can see pictures of a village where there’s a tiny little child, a 5-year-old with a long stick, and the stick is extended behind him, and the other end is held by an adult, and he is leading that adult around the village because the adult cannot see,” said Schaffner.

Schistosomiasis is caused when a parasitic blood fluke infects humans. Freshwater snails serve as an intermediary host for the larvae before releasing them into bodies of water; from there, the larvae are capable of penetrating human skin.

“It is the second most important parasitic disease in the world in terms of its extent and its morbidity,” Ronald Blanton, MD, Chair of Tropical Medicine at Tulane University’s School of Public Health and Tropical Medicine, told Healthline.

Schistosomiasis causes liver and intestinal damage, resulting in bloody urine and stool, among other serious health problems.

Carter’s tireless effort to eradicate Guinea worm disease

Of all the neglected tropical diseases that he has worked to eradicate, the one that Carter’s name is most closely associated with is guinea worm disease. Caused by larvae of the parasite Dracunculus medinensis, most often from drinking from a contaminated water source.

Inside the body, a female larvae will grow, sometimes up to over three feet in length, before emerging through a blister in the skin to expel its own larvae into water.

Carter worked tirelessly to eradicate the disease. In the mid-1980s, the estimated number of guinea worm disease cases stood at 3.5 million. By 1989, that number fell to under one million. According to the most recent reports by the WHO and CDC from 2022, there were only 13 known cases in the world.

In 1995, during the Second Sudanese Civil War, Carter helped to broker the longest humanitarian cease-fire in history to combat the disease. The six-month “guinea worm ceasefire,” as it came to be known, gave health workers the opportunity to distribute some 200,000 water filters capable of filtering out guinea worm larvae and provide treatment and education about the disease.

“I would like to see Guinea worm completely eradicated before I die,” Carter said at a press conference in 2015, “I’d like for the last Guinea worm to die before I do.”

Jimmy Carter’s global health legacy

Carter’s legacy continues to live on.

“The infectious disease world, and particularly those who are interested in global medicine and tropical diseases think of Jimmy Carter in a very, and I mean this seriously, reverential fashion,” said Schaffner.

Hotez told Healthline that Carter’s work and legacy are those of “a life well lived.” 

Hotez prefers, however, to remember Carter as an American who was humble and forever in touch with his roots:

“Before I lived in the South, when we were standing in the breakfast buffet line together, I didn’t know what cheesy grits were, so he gave me a lesson in how to make cheesy grits. I don’t think of President Carter, I think of cheesy grits.”

• Weekend warriors get their exercise in over a couple of days (like the weekend) rather than throughout the week.
• Studies have shown this exercise pattern results in significant health benefits, similar to a more traditional exercise schedule.
• An exercise routine that works is one that works for you and your schedule. Being a weekend warrior can provide flexibility in how and when you get your exercise.

Don’t have time to get enough exercise during the week? Becoming a weekend warrior could help jumpstart your exercise routine.

According to the Centers for Disease Control and Prevention (CDC), adults should get at least 150 minutes of moderate-intensity physical activity weekly. For many people, it makes sense to tackle that throughout the workweek: 30 minutes daily, Monday through Friday, for example. 

For others who may be stretched thin juggling work, family, commuting, school, and countless other obligations, exercising five days per week might not be feasible. Thus, the rise of the weekend warrior: individuals who cram all their physical activity into just a couple of days.

Whether you like to hike, play in amateur sports leagues, or go for an extended gym session, the weekend can be the perfect time to have fun and still get your recommended dose of exercise. 

Health benefits of weekend warrior physical activity

Studies have shown that weekend warriors reap many of the same health benefits as people who exercise regularly throughout the week.

“Getting at least 150 minutes of physical activity per week is broadly associated with improved health and lower risk of disease. So the key question is: Do concentrated activity patterns result in similar benefits as that activity spread out more regularly?” said Shaan Khurshid, MD, MPH, a cardiac electrophysiologist at Massachusetts General Hospital who has published research on weekend warriors.

“We found that consistent with older studies, both weekend warrior activity and regular activity were associated with substantial reductions in risk of cardiovascular disease. Most recently, we found that both weekend warrior and regular activity were associated with lower risk of over 200 diseases and very similar benefits for all of those diseases across the spectrum,” he told Healthline.

The benefits of being a weekend warrior aren’t limited to cardiovascular disease alone. A study published in the British Journal of Sports Medicine in October 2024 found that weekend warriors also experienced benefits to brain health.

In that study, which included more than 75,000 participants, weekend warriors had a significantly lower risk for dementia, Parkinson’s disease, depression, and anxiety compared to those who exercised less than 150 minutes per week. 

The bottom line: get your physical activity in however and whenever you can.

“The data suggests that it’s the overall volume of physical activity rather than the pattern that matters,” said Khurshid.

5 tips to get started with weekend warrior workouts

Being a weekend warrior isn’t about any particular kind of exercise or trend, but rather finding the time in your unique life and schedule to engage in physical activity.

No matter how you get your physical activity in, here are five tips to jumpstart your fitness goals.

1. Create an exercise routine that works for you

Brad Donohue, PhD, a professor of psychology and Creator of The Optimum Performance Program in Sports (TOPPS) at the University of Nevada Las Vegas, told Healthline that being a weekend warrior is “about getting out and exercising to the best of your ability in a manner that is fun and exciting.”

Donohue, who works with UFC fighters, Cirque du Soleil acrobats, and athletes of all levels through his TOPPS program, emphasized that a routine that works is the one that works best for you.

This means if you don’t have time to exercise during the week but enjoy playing sports on the weekend, then lean into that. Don’t get hung up on what works for other people.

“Get out there and just do the best you can for your own situation,” Donohue said.

2. Listen to your body

Being a weekend warrior doesn’t mean you have to be an elite athlete, but it does mean you are putting more strain on your body in a shorter period of time. So, that’s something worth considering based on your own fitness level and medical history.

Khurshid noted he didn’t find any association between weekend warriors and an increased risk of musculoskeletal injury in their research. Nonetheless, some caution is in order.

“It makes sense to listen to your body and follow common sense. I don’t recommend that you necessarily go out and try to exercise 150 minutes on Saturday all at once. I think it makes sense to ramp up your activity gradually and in a manner where you’re listening to your body,” he said.

3. Get friends or family involved

Donohue encourages anyone undertaking a new routine to get friends and family involved as well.

“How do you motivate someone to get out there and do some physical exercise? The key is to bring in family and other people [who] love them to get them to do shared activities and make it fun. We found that the more family members we involved, the greater their engagement, and participation, and also the better the outcomes,” he said.

Bringing together friends or family for group workout classes or weekend sports leagues could be the perfect opportunity to bond, have fun, and, of course, get some exercise.

4. Don’t focus on outcomes

As you start your new routine, focusing on a specific outcome, like a goal weight, could feel natural. But, according to Donohue, that kind of thinking can lead to problematic thinking and, ultimately, burnout.

“With our athletes, anxiety was really associated with outcome thinking, such as focusing on winning, or losing a certain amount of pounds… And if you don’t meet those expectations, then people have a tendency to quit,” he said.

Instead, he suggests, focus on thinking about your physical activity in a positive way: have fun and celebrate your own accomplishments, even the small ones.

“If you can just get out there and walk as much as you can and be happy with that, it’s going to be a lot more fulfilling and sustainable in the long run,” Donohue told Healthline.

5. Limit sedentary activity

Even if you exercise regularly, you should still be mindful of how much time you spend doing sedentary activity.

Too much sitting — whether working at a computer, watching TV, or just relaxing — limits the calories you burn and is associated with many deleterious health outcomes, including early death.

In a November 2024 study that Khurshid co-authored, researchers found that sedentary behavior was still associated with elevated risk of certain cardiovascular diseases, even among those who were physically active.

“Minimizing sedentary time is still important for people, even if they get the recommended levels of physical activity,” he told said.

Takeaway

Weekend warriors are individuals who get their recommended 150 minutes per week of exercise over the course of a few days (such as a weekend), rather spread out through the week.

Numerous studies have concluded that weekend warriors reap many of the same health benefits as those who follow traditional exercise patterns.

Weekend warrior exercise can be a flexible alternative for those with schedules that make it difficult to find time to exercise during the week.

• New research reports that people with chronic kidney disease have an elevated cardiovascular disease risk eight years earlier than people without the disease.
• Researchers add that people with type 2 diabetes have the elevated cardiovascular risk about a decade earlier.
• People with both conditions can have that higher risk as much as 28 years earlier than people without those diseases, researchers say.
• Experts say you can maintain good heart health by eating a healthy diet, exercising regularly, and managing stress levels.

People with type 2 diabetes have an elevated risk of developing cardiovascular disease earlier than someone who doesn’t have the condition. The same goes for those with chronic kidney disease.

For people with both conditions, however, the risk may be much higher, according to new research being presented November 16–18 at the American Heart Association’s Scientific Sessions 2024 in Chicago.

The study has not yet been peer-reviewed or published in a scientific journal, but the researchers said their report provides valuable information.

“Our findings help to interpret the combination of risk factors that will lead to a high predicted [cardiovascular disease] risk and at what age they have an impact on risk,” Vaishnavi Krishnan, lead study author and researcher at Northwestern University in Chicago, and medical student at Boston University School of Medicine, said in a statement.

“For example, if someone has borderline-elevated levels of blood pressure, glucose and/or impaired kidney function, but they don’t yet have hypertension or diabetes or chronic kidney disease, their risk may not be recognized. Understanding how age interacts with risk factor levels is important to optimize [cardiovascular-kidney-metabolic] health,” Krishnan continued.

How age may affect cardiovascular disease risk

In October 2023, the American Heart Association identified a new condition called cardiovascular-kidney-metabolic syndrome.

CKM syndrome makes the connections between cardiovascular disease, kidney disease, obesity, and diabetes. Its risk factors have four stages.

In May 2024, experts reported that 90% of adults in the United States may have CKM syndrome.

In the new research being presented this week, researchers report females with CKM syndrome can expect to reach an elevated risk for cardiovascular disease at age 68. For males with the condition, the age of increased cardiovascular disease risk is 63.

The researchers said that for females with type 2 diabetes, the predicted 10-year cardiovascular disease risk was elevated at age 59. For males, it was 52. That is 9 years earlier for females and 11 years earlier than males compared to those without the condition.

They also reported that for females with stage 3 chronic kidney disease, the predicted cardiovascular risk was elevated at age 60, while for males, it was 55. Both are 8 years earlier than people without the disease.

For people with both type 2 disease and kidney disease, the researchers said the 10-year risk for females was elevated at age 42 while for males it was 35. That’s 26 years earlier for females and 28 years earlier for males compared to people without CKM syndrome.

Experts say the findings are startling.

“Surprising to see such a significant impact on health and quality of life with disease developing nearly three decades sooner (28 years). That is really jaw dropping,” Jayne Morgan, MD, a cardiologist and vice president of medical affairs for Hello Heart, told Healthline.

“Even astute clinicians will likely be surprised by the sobering prediction that the co-existence of these two problems radically increases the risk of early myocardial infarction and stroke,” added Richard Wright, MD, a cardiologist at Providence Saint John’s Health Center in Santa Monica, California.

New research is a ‘simulated’ study

It should be noted that this research was a simulated study as opposed to using information from medical records of patients.

For this study, the researchers used data from the National and Nutritional Examination Survey 2011-2020.

The researchers utilized this information to create risk profiles to simulate men and women for chronic kidney disease and/or type 2 diabetes at each age from 30 to 79 years.

They then used the American Heart Association Predicting Risk of cardiovascular disease EVENTS (PREVENT) calculator to try to determine at what age someone with each risk profile could be expected to have a higher risk of cardiovascular disease.

Experts said the simulated study does have its merits.

“This interesting and provocative analysis is only a simulation and is not based on actual clinical data, but nevertheless, dramatically points out the potential ‘more-than-additive’ risk these conditions possess in predicting future cardiovascular events,” Wright told Healthline.

“Although not as scientifically sound as an actual prospective population study, the current assessment is based on valid science and should not be ignored,” he added.

“To gauge risk, one can use multiple methods, including retrospective review, a prospective study, or what the authors did — a simulated risk in a simulated population (i.e. not actual patients),” Marilyn Tan, MD, the chief of the Stanford Endocrine Clinic in California, told Healthline. 

“With a simulated risk, the goal is to use various models to identify how different medical factors impact risk,” she noted.

How diabetes and kidney disease affect heart health

Cardiovascular disease (CVD) is an umbrella term that includes heart disease, heart attack, and stroke that may cause serious health issues.

Atherosclerosis is a condition where plaque builds up in the walls of the arteries. This narrows the arteries, making it more difficult for blood to follow and potentially leading to a heart attack or stroke.

Heart failure is also a form of CVD, which occurs when the body isn’t pumping blood as well as it should.

Heart valve problems may also develop with CVD, as well as arrhythmia, which is when the heart beats irregularly. The most common form of arrhythmia is atrial fibrillation (AFib).

The American Heart Association reports that nearly half of all adults in the U.S. are living with some form of cardiovascular disease. Around 1 in 3 has at least three risk factors that contribute to cardiovascular-kidney-metabolic syndrome.

Experts say conditions such as kidney disease and diabetes have a direct effect on heart health.

“Type 2 diabetes leads to high blood sugar levels, which damage the blood vessels in our body. This then results in atherosclerosis which can then lead to conditions such as heart attack and stroke,” explained Cheng-Han Chen, MD, an interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in California.

“Similarly, chronic kidney disease can have effects such as increased blood pressure, atherosclerosis, and inflammation, all of which can then increase the risk of cardiovascular disease,” Chen told Healthline.

“Unhealthy kidneys cannot regulate blood pressure, leading to hypertension,” Morgan added. “Hypertension damages blood vessels and the heart. Sodium retention increases as the kidneys fail, further increasing blood pressure and the workload of the heart, which could lead to heart failure.”

“High blood glucose damages blood vessels and nerves both within the heart and supplying blood to the heart,” she noted. “This leads to early plaque buildup and atherosclerosis, further increasing the risk of heart attacks.”

How to improve your heart health

The American Heart Association has launched a four-year Cardiovascular-Kidney-Metabolic (CKM) Health Initiative.

The initiative will help assess gaps in clinical care as well as identify areas for future research. It will also implement guidelines and screening recommendations.

There are myriad steps you can take to improve your heart health, such as:

• Follow a heart-healthy diet low in sodium and saturated fats with high amounts of fruits and vegetables.
• Stay active and exercise regularly.
• Don’t smoke and avoid second-hand smoke.
• Manage your stress levels.

Experts had praise for the AHA’s new health initiative.

“This is a great initiative to really understand the interplay of these disease processes on the heart, the body, and on healthy aging,” Morgan said.

“It’s great that the AHA is working on guidelines and educating other healthcare providers (including nephrologists and endocrinologists) to promote best practices for reducing cardiovascular risk in the setting of kidney and metabolic disease,” added Tan.

“This is truly a call to action, to both identify those at such risk and to begin more aggressive treatment, earlier than we have traditionally felt necessary,” said Wright. 

“Fortunately, it is known that aggressive lifestyle changes, weight loss, hypertension control, and use of modern pharmacologic therapies can interrupt the vicious CKM spiral and can bend the risk curve in the desired fashion. The American Heart Association should be commended for starting their CKM Initiative and placing a spotlight on this issue. We can only hope that the medical community pays attention,” Wright added.

Takeaway

Researchers say conditions associated with cardiovascular-kidney-metabolic syndrome can elevate a person’s risk of cardiovascular disease at an earlier age.

They report that people with chronic kidney disease can reach that elevated risk eight years earlier than people without the disease.

They add that people with type 2 diabetes can see an elevated risk a decade earlier than those without the condition.

They stress that people with both these diseases, known as cardiovascular-kidney-metabolic syndrome, can see an elevated cardiovascular disease risk as much as 28 years sooner than people without this condition.

• Smoking rates in the U.S. are declining overall, but vaping remains more popular than ever, especially among young people.
• A new study found nearly half of young adults successfully quit vaping at 3 months with a quitline-based intervention.
• Overall, quit rates were higher than expected based on previous studies on smoking cessation among young adults, researchers say. 
• The quitline intervention that included nicotine replacement therapy (NRT) seemed most promising for quitting vaping. This is the first randomized trial testing NRT for vaping cessation.
• Participants also reported satisfaction with coaching calls, which researchers say likely contributed to the higher-than-expected quit rates.

Quitlines are free telephone services for people who smoke and use tobacco that provide support to help them quit. 

In the United States, more than 10 million people have reached out to a quitline to help them quit smoking, a promising intervention for successful smoking cessation, according to the Centers for Disease Control and Prevention (CDC). 

Research on the effectiveness of quitlines has grown in recent decades. 

Now, a new study from the RVO Health Center for Wellbeing Research found that a quitline-based intervention successfully helped young adults quit vaping. E-cigarettes are the most commonly used tobacco product among young people.

The research, funded by the American Heart Association, was published in the American Journal of Preventative Medicine on December 11.

The quitline intervention used in this study provided all participants with some form of treatment. The intervention yielded higher-than-expected quit rates, with nearly half (45%) of participants abstinent after three months. It’s the first large randomized trial examining the impact of a quitline-based intervention with nicotine replacement therapy (NRT).

“These findings suggest that NRT is a promising intervention and needs further examination in future research trials,” said Katrina Vickerman, PhD, director of the Center for Wellbeing Research at RVO Health, a health information and services company that includes platforms like Healthline.

“We were excited to see the success of young adults in this study with overcoming their addiction to the high levels of nicotine that many vaping devices can deliver,” Vickerman said.

Quitline intervention led to successful vaping cessation

While overall smoking rates in the U.S. have declined in recent years, vaping continues to be popular, especially among young people. In 2018, former U.S. Surgeon General Jerome M. Adams, MD, declared a vaping epidemic among youth and young adults. 

The long-term effects of vaping are not fully understood, but emerging evidence cites cardiovascular disease and chronic obstructive pulmonary disease (COPD) as possible health risks. 

Despite the prevalence of vaping and its possible consequences for human health, only a handful of large studies have tested effective vaping cessation strategies. 

“When we initiated this study, there were no published vaping cessation trials to base our estimates on,” Vickerman told Healthline. 

“Smoking cessation interventions for youth and young adults have historically achieved lower quit rates in randomized trials, which may reflect challenges engaging these groups in treatment studies. In this study, we provided everyone with treatment,” she explained. 

“At the time we designed this study, there was very little information about dosing NRT for individuals who vape. We wanted everyone to speak to a quitline coach to allow for an assessment of their nicotine addiction, NRT dosing for those randomized to receive NRT through the study, and education on why and how to use NRT,” she said.

For the study, Vickerman and co-leader Liz Klein, PhD, MPH of The Ohio State University College of Public Health, examined the effects of a two-call coaching protocol, mailed NRT, and a mobile health “mHealth” technology program. The mHealth program was delivered via text message and included links to quit resources like videos, podcasts, and online education content. The control group was a two-call coaching program only.

From July 2021 through September 2022, researchers recruited young adults in the U.S. ages 18–24 who exclusively used e-cigarettes through ads on Facebook, Instagram, and social websites like Reddit.

A total of 981 participants were eligible and randomized into four groups with a 2×2 design. After completing the first coaching call, 508 were fully enrolled. Participants who were enrolled vaped regularly, which researchers defined as 20 or more days in the last month.

The four groups were broken down as follows:

• coaching calls (with no NRT or mHealth)
• coaching calls with mHealth (no NRT)
• coaching calls with NRT (no mHealth)
• coaching calls with mHealth and NRT

The coaching calls were an important part of the study intervention. Vickerman said they follow quitline intervention protocols, which are based on social cognitive theory and current clinical practice guidelines for tobacco cessation. 

The calls begin with a series of questions to understand a person’s tobacco use history, triggers for use, barriers to quitting, and strengths that can help with quitting. Vickerman noted the impact of these calls exceeded the researchers’ expectations.

George Chaux, MD, board certified interventional pulmonologist and medical director of Interventional Pulmonary at Providence Saint John’s Health Center in Santa Monica, told Healthline he found the effectiveness of the coaching calls as the control intervention compelling. Chaux wasn’t involved in the study.

“This study, although limited, suggests that coaching calls are sufficient alone,” Chaux told Healthline, adding that combined forms of NRT may be even more effective for vaping cessation.

Why are quitlines so effective?

Quitlines are confidential services that offer guidance, counseling, and self-help resources, with some providing free medications like NRT.

They are available in every state in the U.S. and have the infrastructure to provide large-scale, effective, and cost-effective interventions for smoking cessation.  

“[Quitlines] are effective in people who are motivated to quit smoking or vaping and simply need support to overcome the cravings of nicotine,” Chaux said.

Vickerman noted that young adults in the study seemed more aware of NRT and more open to using it than anticipated.

“In fact, 28% reported previous use of NRT before the start of the study, and a quarter of participants who were not provided NRT in the study sought out NRT on their own,” she said.

While the 7% improvement in quit rates with mailed NRT was not statistically significant, Vickerman said the findings suggest that NRT is a promising intervention and needs further examination in larger trials. 

“Our study was underpowered to detect a difference of this size; this would be a clinically important difference if it held up in a future, larger study,” she said.

“Given that NRT appeared to be safe (with no unusual side effects) and acceptable for young adults in this study, we would feel comfortable dosing and mailing NRT without coach interaction in future studies. The mHealth intervention had a smaller effect but still warrants further investigation in future trials as mHealth interventions are easily scalable and can reach more individuals in need of help at a lower cost,” she continued.

Vickerman added they would like to better understand which components of the quitline-based intervention are most effective for helping young adults successfully quit.

“It may be that all of the intervention components are not needed, or that one component, like mHealth, is more successful in reaching and engaging participants, but some individuals who vape may need a higher level of support to be successful, like one-on-one coaching,” Vickerman said.

“Understanding the impact of the individual components can inform how best to use public health resources and offer vaping cessation interventions through state quitlines. In future trials, we plan to expand who is eligible to individuals who both vape and use other tobacco products,” she concluded.

Takeaway

Vaping is widespread among young people despite the possible health risks.

A new randomized trial used a quitline-based intervention to help young adults quit smoking and found nearly half of the participants successfully abstained at 3 months.

Researchers were surprised by higher-than-expected quit rates and how well the coaching calls resonated with the young adult participants who often prefer digital engagement.

The quitline intervention that included nicotine replacement therapy (NRT) seemed most promising for vaping cessation.  

Quitlines are free resources available in every state in the U.S., offering support and medications like NRT to help you quit for good. For more information, call 1-800-QUIT-NOW or visit Live Vape Free.

RVO Health provides tobacco cessation services and is a vendor for numerous state quitlines in the U.S.