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<\/div>\n\u201cEverything Everywhere All at Once\u201d is not only an Oscar-favorite movie. It\u2019s an excellent description of how our personal health works. Sleep reduces stress, which lowers the risk of diabetes. The company we keep affects how much we drink. And vigorous exercise improves nearly every aspect of health. All our activities are interconnected and work together to determine our overall health.<\/p>\n
In the early 2000s, health researchers began recognizing the now-obvious truth that the choices we make and actions we take determine how well and how long we live. A key eye-opener was a study titled simply, \u201cActual Causes of Death in the United States, 2000.\u201d It showed that half of all deaths\u2014including from heart disease, cancer, and strokes\u2014were due to lifestyle choices, especially around diet, exercise, and smoking. Around 2010, the American College of Lifestyle Medicine (ACLM) translated these and other findings into six interconnected pillars that support a healthy body and mind: nutrition, physical activity, restorative sleep, stress management, avoidance of risky substances, and social connection.<\/p>\n
\u201cThe idea is, what can we do with our day-to-day life that can impact our disease, either progression or prevention? And that\u2019s where these six pillars come in,\u201d says Beth Frates, MD who is Director of Lifestyle Medicine and Wellness in the Department of Surgery at Massachusetts General Hospital and President of the ACLM.<\/p>\n
To better understand these six pillars, we spoke with six leading experts in their fields: Layne Norton, Ph.D. (nutrition), Francis Neric, MS, MBA (exercise), Eti Ben Simon, Ph.D. (sleep), Josh Briley, Ph.D. (stress), Professor Ken Leonard, Ph.D. (substances), and Dr. Frates (social connection). They explain the latest science about why we get sick and suggest concrete, achievable actions to become healthier.<\/p>\n
Take Charge of Nutrition<\/h2>\n
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Managing calories is like managing money. As long as you stay within your budget, you have flexibility on how you spend, says nutrition expert Layne Norton, Ph.D., founder of the health and wellness company Biolayne. Norton allows himself a measured amount of ice cream most days. But Norton is a mountain of lean muscle who works out for two to three hours daily. When it comes to losing weight (the most-popular nutrition goal, he says), most of us don\u2019t have a good sense of our budget. \u201cWhen we do studies on nutrition, we find that the majority of people underestimate their calorie intake by about 30 to 50 percent,\u201d he says.<\/p>\n
Tedious as it may sound, it can be very enlightening to do some calorie counting (there are handy apps for that) and even spend a week weighing the food you eat to understand how big the portions really are. \u201cI\u2019ll tell people, the most I ever learned about nutrition was the first week I ever tracked anything,\u201d says Norton,\u00a0 (Calorie counts on labels aren\u2019t terribly accurate, he says, but they give a relative indication of your consumption.)<\/p>\n
While being aware of what you put in your body is important, balance is key. A helpful, healthy habit can quickly turn into an obsession or symptom of disordered eating. So, if you choose to calorie count, do so with care, and be sure to reach out to your doctor if you notice an unusual level of fixation starting to occur.<\/p>\n
There are food choices that not only control calories but also boost overall health. Norton can\u2019t say enough about fiber, and not just because it helps you poop. Fiber also binds to and removes LDL cholesterol\u2014the major risk factor for atherosclerotic cardiovascular disease\u2014as well as carcinogens and other toxins. Plus, fiber is really filling: You\u2019ll feel satiated with fewer calories. Norton recommends consuming at least 15 grams of fiber per 1000 calories you eat. (For reference, a slice of whole wheat bread has about 2 grams, and a cup of broccoli has about 5.)<\/p>\n
Protein is another satiating food\u2014very filling for the number of calories you get. Protein intake, combined with resistance training, is especially important as we age to stave off a loss of skeletal muscle mass and strength called sarcopenia. \u201cAs far as animal sources of proteins go, focus on lean proteins, except for maybe some fatty fish,\u201d says Norton. You can get sufficient protein as a vegetarian or vegan, although it requires more work. \u201cCertainly on a per-calorie, per-gram of protein basis, it\u2019s hard to argue that animal protein is not higher quality in terms of bioavailability, digestibility, and its effects on muscle protein synthesis,\u201d he says. To get enough protein without too many calories, vegetarians or vegans should include protein isolates (extracts from whole foods), such as whey (for vegetarians), soy (a moderate amount won\u2019t affect hormones), or combined pea and corn protein, he says. Norton recommends eating at least 1.6 grams of protein for every kilogram of body weight but says there\u2019s no downside to eating more.<\/p>\n
One food type Norton cautions against is saturated fats due to their tendency to increase LDL cholesterol. But Norton doesn\u2019t believe in prohibiting foods outright. Even the occasional donut is OK, he says, going back to the budgeting analogy. \u201c[If] I\u2019m gonna have a donut, I recognize it\u2019s not as satiating, but I\u2019m desiring an experience,\u201d he says. \u201cAnd I understand that means I\u2019m going to have to reallocate funds somewhere else, meaning maybe you\u2019re not gonna get the pasta tonight. Maybe you\u2019re gonna have a salad.\u201d<\/p>\n
Up Your Exercise<\/h2>\n
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Weight loss is also one of the main goals of exercise, but there are limits, says Francis Neric, associate vice president of certification and credentialing at the U.S. Registry of Exercise Professionals. \u201cEighty percent of weight loss is from diet, and 20 percent of the weight loss is from exercise,\u201d he says. \u201cSo, the exercise, what it does is keeps you motivated, and it keeps you accountable.\u201d It also builds muscle mass, which is what the majority of people want. For some, that means bulking up, but it doesn\u2019t have to.<\/p>\n
\u201cFor female clients who do a lot of resistance training [like weightlifting], they aren\u2019t looking like Arnold Schwarzenegger,\u201d says Neric. \u201cThey\u2019re actually becoming much more defined, and they\u2019re able to perform at a high level.\u201d Building strength is key to remaining independent in our later years, giving people stability to avoid falls, and staving off sarcopenia and osteoporosis. (Special gear and exercises can also strengthen proprioception, the awareness of our body\u2019s position and movement.)<\/p>\n
There are many ways to exercise. \u201c[For] somebody who is generally healthy, the biggest bang for your buck is high-intensity interval training,\u201d says Neric. HIIT \u201cgives you a little bit of benefit for aerobic endurance. It also increases your muscle strength.\u201d But you may want to specialize. If strength is your main goal, you should go lighter on the aerobics, he says. If you want to be a great runner, go easy on the resistance training. The minimum requirements are different, too. For aerobics, it\u2019s five times per week, says Neric. For resistance training, it\u2019s at least twice. That said, the American College of Sports Medicine recommends that everyone gets at least\u00a0 5 days per week of moderate-intensity activity or 3 days per week of vigorous activity\u2014for at least 30 minutes in either case.<\/p>\n
While there are sophisticated ways to gauge your performance, such as VO2 max (the volume of oxygen the body absorbs and uses during exercise), there are good ballpark assessments, like the talk test. \u201cWhen you\u2019re working out at a high enough intensity, you can only spurt out a few words together,\u201d says Neric. \u201cIf you can have a full-blown conversation, you\u2019re not exercising hard enough.\u201d For resistance training, he advocates the 2 for 2 rule: You can increase the weight after you can perform two more repetitions in your last set for two weeks in a row.<\/p>\n
You don\u2019t have to figure all this out on your own. Whether working one-on-one or with a group (which is great for solidarity), a professional trainer can guide you through your goals\u2014and make sure you don\u2019t hurt yourself. Selecting a trainer is a lot like finding a therapist, says Neric. \u201cIt\u2019s just like being able to find somebody who understands who you are and is meeting your needs and meets you where you are,\u201d he says. A trainer helps you set realistic goals (you won\u2019t lose 30 pounds in a month), and they won\u2019t overpromise. Also, beware of people who overwhelm you with technical jargon, says Neric.<\/p>\n
He advises taking a close look at education and certifications. \u201cI\u2019m not gonna call out any organizations, but there are somewhere you can just go have an open book test, or you just pay for a credential,\u201d he says. It\u2019s important instead to look for people with credentials from accredited programs\u2014ones that are certified in the U.S. by the National Commission for Certifying Agencies (NCCA) or internationally by meeting the International Standards Organization (ISO) 17024 requirements. (You can look up a trainer\u2019s certifications at usreps.org)<\/p>\n
Exercise only works in conjunction with nutrition, says Neric. \u201cWhen [you] were in high school, you could eat whatever you wanted as long as you exercise. As you get older, especially when you hit 30 and 40, that\u2019s not the same,\u201d says Neric. \u201cYou can\u2019t outwork a bad diet.\u201d<\/p>\n
Optimize Your Sleep<\/h2>\n
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While your body needs a good workout, it also needs a good lie-down. But sleep isn\u2019t passive. \u201cIt\u2019s during sleep, and especially during deep sleep, when hundreds of thousands of brain cells all of a sudden decide to sing together in this amazing feat of coordination,\u201d says Matt Walker, founder of the UC Berkeley Center for Human Sleep Science and author of the book Why We Sleep, in his eponymous podcast. If you don\u2019t allow your brain sufficient sleep (seven to nine hours for a young, healthy adult, and up to 11 for teens), things deteriorate quickly, says Walker\u2019s colleague, research scientist Eti Ben Simon. The effects are clear when people sleep for just six hours, then perform tests of vigilance and alertness. \u201cThey would report not feeling sleepy,\u201d she says. \u201cBut then when you look at their performance, they\u2019re still doing worse relative to themselves on seven hours of sleep.\u201d To test yourself, try a brief online Psychomotor Vigilance Test (PVT)\u2014like one hosted by Sleep Disorders Center Florida.<\/p>\n
Research by Ben Simon and Walker shows that poor sleep also impairs our ability to regulate emotions, increasing the risk of stress, irritability, and depression. After just one sleepless night, \u201cyou see that the region of the brain that is in charge of processing emotions, the amygdala, can be up to 60 percent more active,\u201d says Ben Simon. If you pull an all-nighter, go easy on yourself\u2014and others\u2014the next day. Conversely, anxiety hurts sleep by keeping the body in fight-or-flight mode, causing frequent awakenings and diminished deep sleep (the most important stage for regulating emotions).<\/p>\n
Sleeping better requires paying attention to substances. Ben Simon advises cutting caffeine off by noon. Even then, up to a quarter of it still sloshes about your bloodstream at midnight. Alcohol blocks REM, the main dreaming stage of sleep, which helps us process emotions and consolidate memories. Ben Simon suggests ending drinking at least six hours before sleep. In lieu of that, taking a nap the next day can provide some REM-catchup. (She\u2019s generally a proponent of naps but cautions that ones lasting more than 20 minutes are followed by 10-15 minutes of grogginess.) THC, the psychoactive component of cannabis, also disrupts REM sleep. Low doses of CBD, the other key ingredient in pot, rev you up. But higher doses (over 50mg) may help sleep, though there isn\u2019t enough data to prove that.<\/p>\n
Sleeping pills such as Zolpidem (Ambien) or benzodiazepines like Clonazepam (Klonopin), simply sedate the mind (as does alcohol). \u201cThere is a lot of\u2026electrical dance that\u2019s happening during sleep, and that\u2019s not always mimicked by sleeping pills,\u201d says Ben Simon. Supplements of melatonin, a hormone that initiates the sleep process, can help people over 60, whose natural melatonin levels can drop by up to 50 percent. (She recommends a gradual-release version, such as the melatonin-mimicking drug Ramelteon.) But studies don\u2019t show benefits in younger people. Learning new behaviors through psychological treatment, especially cognitive behavioral therapy, is the best remedy for long-term sleep problems such as insomnia.<\/p>\n
A good bedtime routine helps everyone. Start by turning the lights down about an hour before bedtime, as darkness triggers melatonin release. Screens aren\u2019t necessarily bad if you filter out the melatonin-blocking blue light component by shifting them to a warm tone, enabling dark mode (white text on black), or wearing blue light-blocking glasses. Otherwise, screens are OK, \u201cas long as you\u2019re not reading anything too suspenseful or arousing,\u201d she says, such as aggravating social media. Ben Simon also advocates relaxing activities, such as meditating, stretching, or journaling. Light exercise like yoga is fine if doesn\u2019t warm you up. (The body needs to cool about two to three degrees Fahrenheit before sleep.) Eating can also warm you up, but a snack to stave off hunger is fine. \u201cIt\u2019s kind of the Goldilocks region of not too hot and not too cold, not too full and not too hungry,\u201d she says.<\/p>\n
Reduce Stress<\/h2>\n
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stress had a 21 percent increased risk of death from all causes, with a 22 percent higher risk for cardiovascular disease and a 9 percent higher risk for cancer. (And none of these 68,222 people suffered from a diagnosed mental illness like anxiety or depression.) This is just one of many studies showing that stress can kill you.<\/p>\n
When stress is high, you go into fight or flight mode as if in mortal danger. \u201cYour body pumps more resources to the extremities than to the torso, so digestion is affected, heart rate goes up, cortisone production is increased because your body needs those sugars to escape the bear that\u2019s trying to kill you,\u201d says clinical psychologist Josh Briley<\/a>, a spokesman for the American Institute of Stress<\/strong><\/a>. Blood vessels constrict, raising blood pressure, and the extra glucose in your system raises the risk of developing diabetes. The recognized symptoms of stress hint at how widespread the damage to the body is. In addition to blushing, sweating, or grinding teeth, the unpleasantries may include muscle pain and spasms, frequent colds, and other infections, seeming allergic reactions, constipation, and excessive farting. People under stress also tend to wreck other components of health by smoking, eating poorly, and not exercising.<\/p>\n Stress isn\u2019t always bad, though. \u201cStress can improve your performance,\u201d says Briley. \u201c[It] can help you think more clearly.\u201d It\u2019s natural, for instance, to feel stressed before you speak in front of a crowd, and that stress can focus the mind. But it\u2019s unhealthy to feel stressed afterward, he says, especially if you criticize yourself with worries that you didn\u2019t speak well, that you were boring, that people didn\u2019t like you.<\/p>\n Such negative thinking prolongs and exacerbates stress and can lead to anxiety disorder and depression. Signs of danger, says Briley, include snapping at your partner or children, pulling away from friends and family, constantly griping or venting around others, and having poor sleep and diet. \u201cThat\u2019s when it\u2019s time to seek professional help,\u201d he says. Briley doesn\u2019t advocate a particular type of therapy. \u201cMore important than trying to find a cognitive behavioral therapist, or somebody who\u2019s trained in EMDR or something like that, is finding somebody that you feel comfortable opening up to,\u201d he says.<\/p>\n But some of the best treatments are DIY, and things you should be doing already for optimal health. \u201cOne of the best ways to deal with pent-up energy from stress is to exercise,\u201d says Briley. An intense cardio workout is best if your body can handle it. Briley used to run three to five miles a day. \u201cI just poured all of it into that workout, and I was exhausted. But I wasn\u2019t keyed up and stressed anymore,\u201d he says. If that\u2019s too much for you, though, the key thing is to get some regular exercise, says Briley, such as walking. In addition, \u201csleep is very restorative to your mind and body,\u201d he says. \u201cAnd so that increases your resilience to handle stress and all those situations.\u201d<\/p>\n Maintaining solid relationships helps you gain others\u2019 perspectives to appreciate if you are overreacting and understand that you are not alone. \u201cIf you\u2019re stressed out about something, and you think, \u2018Man, I\u2019m the only one worried about this,\u2019 you run the risk of crossing from stress into anxiety,\u201d says Briley. A changed mindset allows you to focus on how to solve a problem rather than magnifying it into a catastrophe or blaming yourself. \u201cYou can say that was a stupid thing to do; you can say, I screwed that up,\u201d he says.\u00a0 \u201cBut don\u2019t personalize it and make it a trait about yourself.\u201d<\/p>\n There are many addictive and harmful substances, but the harm and potential for abuse vary wildly. There\u2019s no case for smoking a drug\u2014be it tobacco, cannabis, or anything else. \u201cThe substance that causes the most deaths and the most expensive in our society is tobacco\u2014hands down,\u201d says Professor Ken Leonard, director of the University at Buffalo Clinical and Research Institute on Addictions. He means smoking tobacco, which the CDC estimates causes more than 480,000 deaths (or about one in five) in the U.S. each year. But the second-greatest cause of harm (killing 140,000 people) is alcohol\u2014something that most of us can use safely, with moderation. So substances fall into two groups: Those you might be able to use safely and those that are never a good idea. The latter includes some drugs that doctors prescribe. \u201cThe people who research pain suggest that opiates do not have real good effectiveness in the long term,\u201d says Leonard. \u201cBut [patients] continue to need opiates\u2026and doctors are reluctant to take them off.\u201d<\/p>\n The possibly safe group is pretty tiny, including alcohol, perhaps cannabis (if you don\u2019t smoke it), and maybe hallucinogens like magic mushrooms\u2014at least in a clinical setting to treat ailments like depression. For cannabis that you eat, \u201cI don\u2019t think we\u2019re near understanding what\u2019s a safe level,\u201d says Leonard, including the risks of THC vs CBD. Research on mushrooms is also scant, he says, but notes that people tend only to take them occasionally, \u201cand that would seem to mitigate a lot of the potential health problems, as long as they\u2019re taking them in a protected environment,\u201d he says. \u201cI don\u2019t think I\u2019d want to walk around New York City after taking some mushrooms.\u201d<\/p>\n Alcohol is much better understood. The National Institute on Alcohol Abuse and Alcoholism has some straightforward measures for excessive use. For women: more than three drinks on any day or more than seven drinks per week. For men, it\u2019s four and 14 drinks. But alcoholism is more than a numbers game. The AUDIT test, which you can take online at auditscreen.org, asks about other factors, including whether you can ever stop drinking, if you drink in the morning, or if you have felt guilt or remorse after drinking. \u201cYou begin to think that there\u2019s a problem when it begins to be an organizing principle in people\u2019s life,\u201d says Leonard. Are you really looking forward to that next drink? Are you drinking every day? Do you need a drink to prepare yourself before you go out? The same questions could hold true for cannabis, as well.<\/p>\n Some people may need professional help to curb addiction. The most effective therapies are motivational interviewing and cognitive behavioral therapy (including a version called relapse prevention). Opiate addictions, however, always require the medication buprenorphine (aka naloxone or Suboxone). There are also some medications for severe alcoholism: disulfiram (Antabuse), acamprosate (Campral), and naltrexone (Revia).<\/p>\n Luckily, many people can deal with substance abuse on their own, says Leonard. Mindfulness practices like meditation, self-help tools, like the book Sober for Good, and (as in so many other cases) exercise are all excellent remedies. \u201cI think moderate to high intensity is probably better at generating that positive feeling,\u201d says Leonard. But if all you are up for is a walk, that still helps. Your relationships also play a key role. \u201cTake a good hard look at your friends,\u201d he says. \u201cAnd if they\u2019re just drinking buddies, and that\u2019s all you do with them, then you need to expand your friend network and find friends that you can do interesting and joyful things with that don\u2019t involve alcohol or cannabis or other drugs.\u201d<\/p>\n Companionship shores up the other pillars of health. It provides solidarity and encouragement in exercise groups. It provides a reality check and understanding for people with runaway anxiety, and it can provide healthy activities as alternatives to getting drunk or high. \u201cThe Connection Prescription,\u201d a 2017 summary of research studies, pulled together oodles of findings on the possible health benefits of social connection. One study indicated that low social interaction was as harmful as smoking 15 cigarettes per day. Another showed that people with diabetes in a peer support group had better blood glucose control. And another found that social connection may increase the lifespan of women with breast cancer. \u201cWe knew that there was something protective about being connected to people,\u201d says Dr. Beth Pegg Frates, who was one of the authors, noting that such research dates back to the 1970s. How can socializing potentially affect so many aspects of our health? Some studies found that support groups for people with illnesses help them manage fears and develop strategies to feel better.<\/p>\n But one physiological mechanism may be the \u201clove hormone\u201d oxytocin. It\u2019s central to childbirth\u2014stimulating labor, milk production, and bonding between mother and child. But oxytocin is produced by all types of intimacy, from lovemaking to petting your dog. And it\u2019s an essential product of social interaction. Oxytocin lights up several parts of the brain, improving mood and memory. It has sedating and anti-anxiety effects that can lower heart rate, blood pressure, and levels of cortisol (the primary stress hormone), dampening the amygdala response that revs up emotions. Some research indicates that it can lower blood glucose levels, too.<\/p>\nEliminate or Minimize Harmful Substances<\/h2>\n
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<\/p>\nFoster Social Connections<\/h2>\n
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