In our traditional healthcare system, we tend to think of personal health as follows:
If we have a non-serious medical issue, we go to our primary care physician (resulting in perhaps a prescription for medication or a referral to a physical therapist or others).
If we have a chronic condition, we get referred to an -ologist (heart–cardiologist; GI tract— gastroenterologist; joints—rheumatologist; and so on).
If we have an urgent complaint, we go to urgent care.
If we have a serious condition, we head to the ER.
But what if we want to stay healthy and actually prevent the majority of these conditions from visiting us in the first place?
Or, what if we want to feel our best every day, with energy to overcome every challenge and live our best life? Well then, we need a different way to think about our health. Consider our options as more like a pyramid:
It's like the fabled food pyramid, but for your health—on the bottom are your foundations, the things you need the most of. On top are things to use only sparingly.
A nod to Dr. Andrew Huberman, who described something similar to this on a recent podcast episode, Huberman Lab.
Let's start at the most foundational.
Behaviors
The base of the pyramid is made up of the behaviors we tackle every day. From the moment we wake up in the morning to the time when we lay our pillow on our bed at night, our life is a series of decisions/choices we make.
When we get up in the morning do we scroll through Instagram, or worse check email? Or, do we take the first 5-10 minutes of being awake to set our intentions for the day? That may be taking the time to meditate, do breath work, or pray? Do we stop outside and get some morning sunshine on our face to reset our internal clock? Whatever it is, these decisions will help to determine how our day unfolds.
During the day, do we structure it to take advantage of our energy? For some that means tackling the hardest task soon after arising. For others that means waiting until our energy level ramps ups later in the morning.
When we are feeling stressed, how do we handle it? A few clearing breaths or a moment of gratitude? Or, do we let our mind focus on the negative and get lost in an ever-deepening cycle of anger and sadness? If that happens, how do we reset? Going outside to change your location or taking a quick walk around the house or office can be a way to physically and mentally reset.
Are we taking intentional actions during our days to build that network of friends and strengthen our tribe? Do we have a way to wind down and make sure that to get enough rest for our body and our mind? Are we gearing down for sleep by turning lights down after 9pm and minimizing screen time, reading a book, or journaling to allow our natural sleep regulator, melatonin, to be released?
The above suggestions are a partial list of what would be considered behaviors that can impact the quality of our day, the energy we must have to tackle challenges, and the ability to ensure appropriate sleep to recover and re-energize.
Nutrition
After our overall behaviors, there is nothing that will impact health more than the decisions we make about the 2,000 calories (give or take) we place in our mouths every single day. Are they whole foods with a variety of plants that will provide energy for our body and brains, lower inflammation, and contribute to resilience? Or, are they based on ultra-processed foods high in sugar leading to higher inflammation, fatigue, and metabolic syndrome (elevated blood glucose, high blood pressure, high lipids, and obesity)?
How about the timing of our meals? Do we practice intermittent fasting? Do we refrain from eating after dinner, and give our metabolism time to rest and focus on cellular repair? We can do this by eating all our meals within a 12-hour window during the day. This has also been shown to help control calorie intake.
Hand in hand with our nutrition is paying attention to gut health. Our microbiome is home to some 40 trillion bacteria and viruses which live primarily in our large intestine. This collection of creatures helps to maintain the critical lining of our intestines, provides essential nutrients, and makes sure our immune system’s first line of defense in and around our gastrointestinal tract is functioning at its optimal level. The idea is to allow molecules that are critical to our health to pass through while stopping hostile bacteria and toxins from entering our body.
It is common for many people to have food sensitivities that impact gut and overall health. The most common ones are those of dairy and gluten. A simple process called an elimination diet done over a few weeks can help to determine if you have specific food sensitivities that may be causing issues such as fatigue, joint pain, or brain fog.
Movement:
Movement and exercise sit in the center of the pyramid for good reason. Consistent daily movement is essential to maintain metabolic health and stave off chronic disease like cancer and dementia. It also provides energy and vitality for you to tackle the challenges of life. The health benefits of regular physical activity include:
improved sleep
reduced stress
increased energy
increased mental alertness
weight loss
reduced cholesterol levels
improved cardiovascular and respiratory fitness
improved mood
increased libido
improved bone and muscle strength
The combination of lower-level activities combined with high intensity and strength building exercises is the perfect balance. The easiest thing for anyone to do is to start walking for 20-30 minutes a day. Easier still is to get up and move for five minute exercise "snacks" six times a day in order to get in your 30 minutes. There is good data that shows going from no regular activity to 30 minutes a day of something will bring 50% of overall health benefits meaning lowering your risk of cardiovascular disease, cancer and dementia. That seems like an incredibly positive trade off:
Ideally getting 45 minutes of "Zone 2" activity (where you move to the edge of still being able to carry on a conversation) twice per week helps to maximize mitochondrial function, maintain insulin sensitivity, and build aerobic capacity. Maintaining and building strength as we age is critical and has been shown to help control blood sugar as well as lower the risk of dementia and other neurocognitive disorders.
Finally, high intensity activity has been shown to maximize cardiovascular function as well as lower risk of dementia. Doing this at least twice weekly for short periods of time (10-15 minutes) builds cardiovascular fitness and contributes to improvement in rates of dementia for most people.
Supplements
Supplements are undergoing a change in our society. While some call out supplements as unnecessary, others are realizing due to changes in nutritional value of food and the rise of ultra-processed food as part of our normal diet that there is a need for targeted supplementation for optimal health. While we could fill a novel discussing supplements, I want to focus on four specific situations:
Vitamins and minerals essential for healthy metabolic functioning
Targeting "optimal" levels of essential nutrients
Use of specific supplements for specific needs
Genetic variants or nutritional regimens requiring specific supplementation
Under the first category are a broad array of essential vitamins and minerals which your body requires to process nutrients, create energy and build proteins. There is clear evidence there has been a decrease in the nutritional value of common foods. the reduction in these values suggests a broad-based multivitamin/mineral combination may be indicated especially as we age and our ability to extract nutrients from our food declines.
The second category, targeting optimal levels of essential nutrients, includes looking at essential compounds like Vitamin D or Omega 3 fats. Over 40% of Americans have low Vitamin D levels, or below 20 ng/ml. That does not mean that as soon as you are above that level all is well. There is a difference between an optimal level of a nutrient and a level which does not make you deficient. Think of the corollary to sleep. While consistently getting less than five hours of sleep will not kill you, your ability to function at peak performance is very different than if you are getting over seven hours of rest daily.
The unfortunate fact is there is great controversy, and not a tremendous amount of data, regarding optimal level of nutrients. So, we are left with bits of information here and there to piece together that optimal level.
Using supplements for specific needs includes those desiring to use plant biology to achieve certain goals or treat certain conditions. It is well known that the use of creatinine to maintain and build muscle mass has been a tried-and-true method for decades. The field of plant-based compounds includes a whole category called adaptogens which have subtle but persistent effects on mood and energy levels when taken either short or long term. One of the most common in this area is ashwaganda, used for centuries to provide energy and relax mood in those people who are ‘wired and tired’.
The final category is one that, surprisingly, impacts a large number of people. There are genetic variations that are quite common and impact certain essential pathways. One of the most common is that due to MTHFR, a genetic variant affecting how your body utilizes folate, an essential B vitamin, that can effect 10-25% of ethnic groups in the US. People with this genetic variant can build up more inflammatory compound and increase risk for heart disease, or the inability for a woman to carry a child to term if not given a methylated form of folate routinely.
Another example is those following certain dietary regimens like veganism where there is a challenge getting enough iron, B12, vitamin D, zinc and Omega 3 fats unless supplemented.
It is a rare medical doctor that has taken the time to familiarize themselves with the value of supplements as listed above as none of us have been taught this in medical school.
Drugs
Finally, there are drugs. Pharmaceutical medications have saved countless lives over time. Yet there is also a clear acknowledgement that pharmaceutical interventions are greatly overused, from overuse of antibiotics leading to drug resistant infections to medication side effects leading to millions of injuries and deaths in the US alone every year. That is not taking into account the over 100,000 deaths due to drug overdose per year which often start with a simple narcotic prescription for a short-term painful condition leading to addiction.
These are just some of the reasons why pharmaceuticals should be a small percentage of a longevity plan. They should be the last thing we reach for or are prescribed as opposed to the "I have a problem and I need a pill" habit we have fallen into, especially in the U.S.
The challenge, as many of us know, is structuring these habits to become the norm—just the way we live over time. Yes, it is hard work that will pay off in improved health and longevity, more energy to tackle each day and a happier outlook on life. The choice is yours.