Lifestyle: your best medicine

The lifestyle choices we make are the root cause of our physical and emotional problems. They are also the solution to them

woman exercising on the beachOur world is awash in a rising tide of obesity, high blood pressure, heart disease and associated metabolic diseases such as diabetes. These chronic conditions place a heavy emotional toll on individuals and a financial burden on national healthcare systems across the globe. But how did this happen? How did diseases, which were hardly known 200 years ago, come to afflict nearly every family?

Science tells us that human genetics have not significantly changed over the last 200 years, but our 'lifestyles' have.

By lifestyle we mean basic personal behaviours that influence health—diet, exercise, sleeping habits and substance use [including nicotine, alcohol], and our stress-management styles among others. Our personal choices are powerful 'medicine'. To understand how lifestyle can influence our health, let's examine a few common health problems.

Obesity: a gross concern

We start with obesity, since it often precedes other common medical problems.

Fit to fat

Two generations ago, most people were struggling just to get enough food to survive. They burned thousands of calories toiling for long hours in their farms or in physically demanding conditions as miners, loggers. However, the industrialisation of farming and mechanisation of industry has made food plentiful and physical labour less of a daily necessity. Now, we eat more and move less.

As a result, we continue to grow around the waist-line. Over the last 50 years, in America alone, the consumption of sugar has increased by 39 per cent, salt by 100 per cent, meat by 70 per cent, and dairy by 400 per cent for an average of 3,700 more calories per person per week. As a result, the average American is much heavier now then he was in the 1900s. And this phenomenon is not restricted to America alone; more than 1 billion people worldwide are now overweight.

Problem with fat

Now the problem with extra weight or fat is not that it sits and jiggles, but rather that it remains metabolically active. This means that fat cells—in particular belly fat or visceral fat cells—release hormones. These hormones inhibit insulin from doing its job, dramatically increasing one's risk of Type 2 Diabetes.

The same hormones increase the risk of heart disease, strokes, erectile dysfunction and some cancers. In fact, being obese increases a person's risk of a whole list of diseases some of which are: high blood pressure, liver disease, gallstones, acid reflux, hypothyroidism, knee osteoarthritis, gout, and sleep apnoea.

You might think a little fat on your belly can't be that bad. Unfortunately, studies show that being overweight increases your risk of Type 2 Diabetes by 300 per cent and being obese increases your chance by 900 per cent. When it comes to heart disease, liver disease and certain cancers, the story is similar. The poorer our lifestyle habits, the more belly fat we store and the greater our risk of disease, disability and untimely death.

High blood pressure: a hyper worry

When it comes to high blood pressure the story is the same. The food we eat, the exercise we get, the emotions we manage can either elevate or reduce our blood pressure dramatically. For example, eating more than 2000 mg of salt a day has been shown to increase blood pressure, as has persistent stress, lack of exercise and increased body weight.

As you might guess, eating more whole foods rather than processed foods, staying physically active every day, losing around 7-10 per cent of your body weight [if you are overweight], spending time on stress reduction and other simple lifestyle strategies can help most people avoid medications for high blood pressure and reduce the risk of stroke, heart attacks and kidney injury.

The medicine

The threat is the same for all of the metabolic and inflammatory diseases we mentioned: Type 2 Diabetes, high blood pressure, high cholesterol, heart disease, strokes, obesity and all its related complications. Although their pathology is slightly different, they all respond to what we call 'lifestyle medicine'. A healthy lifestyle can prevent, reverse or at the least dramatically improveall of these illnesses.

Health: a way of life

So what exactly is a 'healthy lifestyle'? We believe a healthy lifestyle is a rational, moderate pattern of personal behaviours that promote health and well-being. It is not defined by extremes or expense, but rather by synchrony and purpose.

A healthy lifestyle is not about fad diets, excessive exercise or bizarre cure-alls. Instead, it is characterised by actions that target the key elements of the healthy human in moderation.

These elements include a healthy diet, adequate exercise, emotional/mental poise, good sleep patterns and the avoidance of addictive and/or toxic substances. There are many other sub-categories, which could be addressed, but these are foundational in our model of lifestyle medicine.

The food we eat

Man choosing fruitDiet is a hotly debated lifestyle modality. It's easy to see why. Most of us eat 2 – 10 times per day. And during that time, we make hundreds of choices about our foods including what to eat, how much to eat, when to eat it, when to stop and so on.

People have a very personal connection to food on many levels including nutritional, emotional and cultural. We believe that a healthy diet can have several variations but the central theme is the same.

A large percentage of our daily calories should come from whole grains, nuts, beans, fruits and vegetables and a smaller proportion from refined flour, sugar and animal products. Studies across the globe have shown that individuals, who consume such a diet, reduce their burden of disease and improve their quality of life.

How well we sleep

Woman sleepingDisordered sleep can play havoc with your health. During a healthy sleep cycle, our body releases hormones to accelerate healing. These include melatonin, certain steroid hormones and growth hormone. Our body also reduces inflammation, and oxidation at the cellular level while double checking any and all new cells formed during that time. The chemical and cellular shift, which occurs at night, is crucial to keeping our cells healthy.

During rest, the body is able to focus its energy on healing damaged tissue and compensating for the wear and tear of daily life. In fact, recent studies report that insufficient sleep increases the risk of several common cancers including breast cancer. So to stay healthy, a restful night of sleep is imperative.

The exercise we get

Physical activity is another key component of a healthy lifestyle. Research shows that moving our bodies regularly has all kinds of benefits; from lowering the risk of diabetes and heart disease to improving mood and enhancing libido.

Check with your doctors before starting an exercise routine. Once cleared, we recommend that you try to get 150 minutes per week of moderate intensity physical activity [such as a brisk walk] and add a couple of sessions of resistance strength training.

No one is the same, and while some people love running, going to the gym or yoga, others hate it. In recognition of the social, cultural and personal norms of each person, we encourage you to find something you enjoy doing that is feasible in your life. We believe a little activity is better than none and daily is better than weekly. It is also never too late to "get off the couch and into the game" as we say in America. Exercise has dramatic benefits for the teenager, the busy executive and the mature grandparent equally.

The stress we take

Man stressedDo you feel stressed? Perhaps we should re-state that …who doesn't feel stressed? Stress is an age-old response to perceived threat. It is tightly linked to our sympathetic nervous system, which helps trigger appropriate fear in 'fight or flight' situations. In the past, if a tiger was about to pounce on you, the increased heart rate, wide open eyes, chill of fear down your back, helped you move faster and possibly survive. Unfortunately, we have a similar fight or flight response to daily stress in our families, our jobs, on the roads, or in many other common experiences.

This leaves us in a chronically stimulated and stressed state, which in turn slows down digestion, disturbs metabolism, increases fat storage, promotes hyperacidity, accelerates ageing, increases cancer risk and leads to other unwanted disease patterns.

Since our world doesn't show signs of becoming less stressed, it's up to us to develop strategies to cope and balance the stress. Spending time developing supportive relationships, engaging in calming behaviours, and developing healthy responses and resilience to stress is key. For example, if you know you might have a long work day, you can schedule short meditation breaks instead of coffee breaks; schedule a mid-day walk, or perhaps a few minutes of laughter yoga with friends around the lunch hour. Perhaps you can learn some breathing exercises to complete at your desk, or if traffic always stresses you, can you choose a different time or route to travel? Simple, thoughtful changes can help reduce stress and promote health. Start today.

The emotions we feel

A very happy womanEffectively managing your stress levels is key to promoting healthy emotions. In fact, the elements of a healthy lifestyle we have discussed either support or undermine our emotional health. In turn, our emotions can influence our personal behaviours. Let's look at some examples. When we are feeling depressed or anxious, we are more likely to reach for 'comfort foods' with lots of fats, sugars and excess calories.

These foods increase the release of the 'happy hormone,' dopamine in the brain for a short time, which encourages us to eat more unhealthy foods. If we don't break the cycle quickly, our unhealthy habits make us feel fatigued and unhealthy. We have less energy, put on more weight and then we reach for more unhealthy foods because we feel depressed or anxious. And so the cycle continues.

Likewise, when we are emotionally unbalanced we are less likely to exercise. Yet, exercise is exactly what we need. Exercise has been shown to be as effective as anti-depressants for mild depression and anxiety, with even longer-lasting effects. Our diet is also powerful. Eating a diet rich in micronutrients, and healthy proteins provides our cells with the building blocks to make plenty of neurotransmitters including dopamine, serotonin and norepinephrine, which help keep us balanced and happy.

The relationships we build

Two woman friendsNow, very few of us can sustain great habits on our own. For this reason, surrounding ourselves with friends and family members who support our healthy behaviours is important. Healthy relationships in which we feel loved, supported, respected and appreciated are integral to our health. Get out of bad relationships and avoid negativity whenever possible. The 'happy heart' complements and inspires the healthy body.

We have more power in being happy than we realise. How you set up your day, negotiate your relationships, develop your habits and perceive your existence—all influence your emotions. We recommend you start by engaging your life, enabling yourself to be healthy through a framework of health-engendering behaviours.

Start slow, and don't let the stress of change and the challenge of breaking old habits hold you back.

The 'stuff' we cling to

Finally, the non-food substances we eat, smoke or inject can have very powerful effect on our body and mind.

Nicotine is a potent vaso-constrictor, which means it makes blood vessels small and reduces blood flow to the skin and other important organs. By doing so, it slows healing and accelerates aging.

Most commercial nicotine products also have toxic chemicals added during processing, which cause problems of their own. Other addictive drugs such as cocaine, marijuana and heroin are even worse for your body and mind on many levels. Some drug-like substances such as alcohol and caffeine can have both good and bad effects depending on how much you use. We encourage limiting their consumption to small amounts and only occasionally, as they can easily lead to abuse anddependence.

Putting the pieces together

A plateful of fruitSo how do you put all the pieces of a healthy lifestyle together? First ask yourself: Am I happy with my health today? Am I creating good health for the future? Are there ways I could be healthier? Next go through the list. Are you eating: nutrient dense/fibre-rich foods or processed, high calorie, low nutrient foods? Are you getting regular physical activity? Do you get sufficient sleep and awaken rested and restored? Do you let stress run your life or are you able to manage your stressors? Do you use any toxic substances like: nicotine, betel nuts, heroin, marijuana, cocaine, or use excess alcohol or caffeine?

Once you have determined where you can improve, then it's time to set goals and make a plan. We encourage you to make SMART goals.

SMART stands for goals that are specific, measurable, attainable, realistic and timely. This means your goal shouldn't be, "I will get more exercise." Instead, it should be "I am going to walk for 30 minutes during lunch with my co-worker on Mondays, Wednesdays and Fridays." With the second approach you know exactly what you are going to do, so you can monitor your progress and change your plan if it is not effective. Use the SMART approach when planning all your lifestyle changes.

You can do it!

The best part about lifestyle medicine is that anyone can apply it to his/her life, anytime and anywhere. No matter how old or how young you are, where you live or what work you do, simple intentional changes can have a dramatic effect on your health today and in the years to come. So we invite you to embrace change, advance your health, experience a healthier, happier tomorrow and lead a vibrant life!

Our tummy loves balance

To promote well-being, our body strives for balance at every level—on the large scale of bones and muscles, down to the cellular level and biochemistry. A major threat to this balance occurs when we develop excess acidity, or alkaline body states.

Our cells work best at very specific acid levels. Too much or too little acidity can alter normal cell function and may increase our risk of disease. Some common causes of increased acidity, esophageal reflux are directly linked to the lifestyle choices we make—having spicy, highly processed foods and foods of animal origin; smoking, consuming excess caffeine, alcohol and large meal sizes, lack of activity and excessive emotional stress among others.

In turn, a more plant-based diet, and improved mental/emotional poise, aid digestion, promote cellular health and reduce excess acid buid-up.

By living a moderate life, we can eliminate many of the associated health risks. There are also many treatments both medical and ayurvedic, which can help if simple changes are insufficient.

Listen to your body and make a plan to be your best!

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Edward Phillips
Edward Phillips, MD, is Director of the Institute of Lifestyle Medicine, founded by the Spaulding Rehabilitation Hospital and the Harvard Medical School. He is also the Assistant Professor of Physical Medicine and Rehabilitation at Harvard Medical School in Boston, Massachusetts.
Stephan Esser
Stephan Esser, MD, is a resident in Physical Medicine and Rehabilitation at Harvard Medical School and Spaulding Rehabilitation Hospital in Boston, MA, where he works closely with the Institute of Lifestyle Medicine.

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