The Four Pillars of Health

Every day new studies about diet, lifestyle, and health pop up. Keeping up with the latest findings can be overwhelming, especially when new studies contradict the old. Is coffee good or bad for you? Will a glass of red wine at night protect your heart, or increase your risk of cancer?[1],[2] Exercise is great for you—but how much is optimal?[3]

In reality, achieving good health works best if you simplify your approach and ignore all the noise. What I’ve learned, both in medicine and in life, is that health isn’t complicated. That focusing on four basic foundational aspects of health reliably creates well-being, increased energy, and joy. My four pillars of health are proper diet, a healthy active lifestyle, quality sleep, and connection to others. These four pillars are the foundation for becoming as healthy, vibrant, and energetic as you can be.

Each pillar is equally important. You cannot exercise away a poor diet or connect joyously with others when you’re exhausted and sleep-deprived. I can testify to the power of these four pillars because I’m in better shape and happier in my fifties than I was in my twenties or thirties. But we’re all human. Focusing equally on all four of the pillars of health all the time isn’t realistic for most people.

Thankfully, it doesn’t matter which pillar you start with. Research shows that people who create healthy habits in one area of their life end up creating healthy habits in other areas, too. People have an easier time sticking to their goals when they have planned ahead, so plan ahead.[4] Start with the pillar that motivates you the most, make concrete goals, and consistently take action.

I can’t think of a single chronic disease that isn’t powerfully affected by diet. In some cases, dietary strategies can completely reverse diseases.[5] The foods you eat are the basis of long-term health. And the way to eat healthy for life is to emphasize plants and healthy proteins. That includes whole grains, fruits, vegetables, legumes (such as beans), nuts, and healthy oils like extra virgin olive oil or avocado oil.

Two famous diets that follow these guidelines include the Mediterranean diet and the DASH diet.[6],[7] Both diets are rich in fiber, vitamins, and minerals that help maintain healthy blood pressure and lipids, lower the risk of diabetes and heart disease, and maintain healthy weight and energy. Moreover, these kinds of plant-based diets emphasize fruits and vegetables and are loaded with health-promoting flavonoids, antioxidants, and polyphenols that have a profound effect on health. For instance, one review of 16 different studies that encompassed over 460,000 adults found that flavonoid intake significantly protected against cardiovascular disease and mortality.[8]

Healthy fats are a key part of such diets and include Omega-3 fatty acids from fish like sardines and salmon, from nuts like walnuts and almonds, and from oils like extra-virgin olive oil and avocado oil, among others.[9],[10],[11]

The good news about plant-centric diets is that they tend to be alkaline. An alkaline diet emphasizes vegetables, fruits, and drinking lots of water while reducing refined carbohydrates, alcohol, meat, and highly processed food. They are known to improve overall health, help reduce weight and improve longevity.[12]

For step-by-step instructions and handouts to help you learn to eat healthily, read my blog, Dr. Neustadt’s 3-Steps to Eating Healthy for Life.

Our bodies were born to move. It’s well known that a sedentary lifestyle is a risk factor for a wide range of chronic ailments, including heart disease, diabetes, high blood pressure, obesity, depression, osteoporosis, and osteoarthritis. In fact, increased levels of physical activity and fitness are correlated with a lower risk of mortality from any cause.[13]

But don’t think you have to be a Type A overachiever to reap all the health benefits. Moderate exercise also helps. If you are moderately physically active at least three hours per week, you can lower your risk of dying by 27%.[14] The most recent guidelines, published by the US Department of Health and Human Services (HHS) in 2018 states that the ideal amount of activity is 150 to 300 minutes of moderate-intensity aerobic activity per week. This activity can be continuous or in short bursts.[15] Ten minutes a couple of times a day or 30 minutes five days a week will get you to that 150 minutes per week threshold.

Moderate activity means you’re exercising hard enough to raise your heart rate and break a sweat. Examples include brisk walking, bicycling, gardening, dancing, water aerobics, canoeing, or even golf as long as you’re doing them vigorously enough. You can also wear a pedometer, with a goal of walking 10,000 steps a day. Moderate intensity on a pedometer is 3,900 steps within 30 minutes.[16]

Exercise impacts your other pillars. For instance, physical activity helps you sleep better, and improves your mood.[17],[18] And, just to give you an idea of how powerful physical activity is, a 2008 study in the prestigious journal The Lancet, found that not moving enough can be as hazardous to health as smoking.[19] Physical inactivity leads to 5.3 million deaths a year around the world, and smoking causes about 5 million deaths.

For tips on working exercise into your daily life, read the blog, 5 Simple Ways to Work Exercise into Your Life.

We all know that sleep is essential for survival and that sleep is a time when the body and brain repair. During sleep, your brain sends waste and toxins out of the cells and brings in nutrients, which then replenish the cells.[20]  In fact, while sleeping your brain cleanses itself up to ten times faster than when awake.[21]  Poor sleep increases your risk of stroke, heart attack, excess weight, and weak bones.[22] Poor sleep also is associated with a lower cortisol awakening response (CAR), which leads you tired and can increase inflammation. That is the spike in the secretion of cortisol, an important hormone that helps prepare your body for the demands of the day.[23]

Quality sleep is on the decline, however. We sleep 25% less than humans did a hundred years ago.[24],[25] One out of five adults sleeps less than 6.5 hours a night.[26] The optimal amount of sleep for most people is about 8 hours a night. Those who regularly sleep less than 6 hours or more than 9 hours are not as healthy.10

To sleep well, try to turn off the ‘bright blue’ screens two hours before bedtime. They can disrupt melatonin cycles.[27] Don’t snack late at night. Adaptogenic and calming herbs might also help. Try a peaceful meditation app or music.[28] Take a relaxing hot bath. Even weighted blankets have been shown to improve sleep.[29]

For more tips on improving sleep, read the blog, Your Checklist to Beat Insomnia.

Last but not least, stay connected to others, from colleagues to friends to family. We are a social species, and connection nourishes our minds and souls. Connection helps us shift into a parasympathetic “calm and connect” mode, a mode where we also rest, repair, and digest.[30]

And make sure to connect with yourself. That can mean taking time for things you love. Meditating. Doing self-care like treating yourself to getting your hands and feet done. And since too many people struggle with maintaining healthy boundaries and suffer the consequences, making sure you’re not overcommitted is crucial. Because when you’re frazzled by being pulled in too many directions, you can’t take care of yourself. You end up feeling overextended, overwhelmed, and resentful.

If you’re not sure whether or not you’ve got healthy boundaries, ask yourself this question. Do you feel sucked dry by all your commitments? Then you’re suffering from what I call “Yes syndrome” and it’s time to make some changes.

Yes Syndrome is the inclination to say yes too often and to too many things. Yes Syndrome is often the result of wanting to be a people pleaser. Of feeling that other’s needs are more important than your own. Yes Syndrome is a sure way to experience burnout.

But don’t fret, because the cure to Yes Syndrome is simple. Say No. Say No to those things that don’t serve you. Say No when you hear your inner voice say, “I should say yes, but I really don’t want to.”

What I’ve found in my work with thousands of people is that too often people are suffering Yes Syndrome because they don’t believe they’re worthy of getting what they want. They’re not worthy of more. That they don’t deserve more. But you do deserve more.

And instead, connect with others in healthy ways. This can include making healthy changes fun by doing it with a friend or volunteering in your community.

To learn more about how connecting with others can help you, read my blog, Do This One Thing to Be Happier and Live Longer.


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