Lifestyle Medicine—The Six Pillars of Health

By Dr. Charlie Ross, Oregon

One of the youngest specialties in medicine, Lifestyle Medicine, places emphasis on the root causes of our chronic illnesses.

The Six Pillars of Lifestyle Medicine are:

1. What we eat
2. How we move throughout the day
3. The chemicals we choose to consume
4. How we deal with stress
5. How we sleep  
6. Our social connections

Of all premature deaths, 40% are attributable to these three factors: tobacco use, poor diet, and alcohol consumption

1. Tobacco Use: 18.1% (About one in seven people still smoke.)
2. Poor diet and physical activity: 16.6% (About three out of four people eat too little fruits and vegetables, and about four out of five people do not get enough exercise.)
3. Alcohol consumption: 2.5%

Let’s explore how to focus more attention on the root causes of what brings us health or what leads to disease.

1. What We Eat:  Looking around the world (especially, in the Blue Zones, where people are the healthiest and live the longest) the evidence points to eating a more unprocessed whole plant food diet as the healthiest choice. The healthiest diets incorporate fruits and vegetables, whole grains, legumes, and some nuts and seeds. Fiber in the food that allows our good bacteria (in our microbiome) to produce chemicals like butyrate (which decreases inflammation) and serotonin (that reduces anxiety and depression).

Did you know that FIBER is only found in plant foods? There is no fiber in animal foods. So, increasing the amount of whole plant foods in your diet will add to your overall health. To help you understand better the food choices and how to get a variety of plant foods in your diet, you might want to download the free app “Dr. Greger’s Daily Dozen” on your smartphone. Or you might choose to do the free “21-day Vegan kickstart” program suggested by Physicians Committee for Responsible Medicine, PCRM. (Visit: www.pcrm.org).
The best evidence-based book is How Not To Die, by Michael Greger MD.

2. How We Move Throughout the Day—or the lack of physical activity—is the fourth leading risk factor for global mortality. There are several types of exercises for us to consider:
   • Aerobic/endurance exercise (large muscles movement for sustained period)—lowers risk of all-cause mortality
   • Strength or resistance exercise—muscles contract against an external resistance—with the goal of increasing lean body mass and muscle strength and endurance
   • Flexibility exercise—range of motion that is possible at a joint
   • Balance exercises—static and/or dynamic exercises—decrease in falls and injuries like fractures

Any amount of activity is better than no activity. A physically active person engages in at least 150 minutes per week of moderate to vigorous physical activity. Moderate exercise elevates your heart rate but allows you to comfortably talk whereas vigorous exercise makes it difficult for you to speak more than a few words at a time due to increased breathing effort. Sitting for prolonged periods of time leads to lessening of life expectancy. Keep your sitting times no longer than 50 to 60 minutes without a five-minute movement break. An excellent resource book on the benefits of exercise is: Spark, by John Ratey MD.

3. The Chemicals We Choose to Consume: Tobacco, alcohol, and street drugs continue to take a toll on our health. Prescription drugs, like opioids and side effects from other prescription drugs also exact a toll. Toxins from the not-regulated supplements and even plastic material (endocrine disruptors) found in foods like fish are potentially health damagers. The book Salt, Sugar, Fat: How the Food Giants Hooked Us, by Michael Moss is a good read to help your understanding about why we choose what we choose.
4. How We Deal with Stress: Stress can be helpful (if not overwhelming) or harmful. A stressor is a situation, circumstance, or stimulus that is perceived to be a threat. This threat alters homeostasis in the body.
   Categories of stressors: There are four types of streesors.
   

    Psychological: thoughts, beliefs, or perceptions;
    Physiological: illness, infection, disease, or hunger
    Social: major life changes, personal conflicts, or financial insecurity
    Bio-ecological: weather, pollution, food additives, or chemicals

• Health effects of chronic stress: Impaired immune function, inflammation, decreased bone density, problems with memory, increased appetite, weight gain, abdominal fat deposition, insulin resistance, increased glucose, cholesterol, and triglycerides, increased blood clotting, Impaired wound healing, poor sleep, pain and fatigue, poor mood, adoption of less healthy habits, decreased longevity (telomere shortening), and etiology of many chronic diseases, including hypertension, type 2 diabetes, and heart disease.
• How to Manage the Pathological Stress Response:
• Breathing tools: Lengthening exhale breath, Abdominal breathing
• Movement: Physical fitness, yoga, Tai chi, Qigong
• Meditation
• Connecting with Nature
• Self-expression: Playing a musical instrument, singing, creating art, or dancing
• Community Engagement: Volunteering for meaningful causes, quality time with family and friends, spiritual or religious activities
• Reading self-help books and websites
• Massage
• Listening to music
• Light therapy
• Mental health and Nutrition: Fried foods, refined grains, and sugary products are associated with increased rates of major depression and anxiety disorders, A plant-based dietary pattern with no meat, fish, or eggs in a randomized, controlled trial showed a significant improvement in depression symptoms in just two weeks. Fruit and vegetable consumption has been associated with improvement in depression, anxiety, higher productivity, and higher optimism.
  A wonderful resource book to get started in this area is: The Mayo Clinic Guide to Stress-Free Living, by Amit Sood MD

5. How we sleep: Average sleep is 7 hours a day, but 20% adults sleep less than 6 hours. Short sleep duration has increased in all age groups. 60 million people in U.S. have frequent difficulty sleeping (but only 10% seek professional help)

• Indirect costs of Insomnia: Presenteeism (people at work but not productive), Increased risk of long term disability, Mistakes, errors, and accidents
• There is no recognized objective test for how much sleep a person needs
• Healthy sleep duration and quality as well as circadian physiology promote improved health; Lower cortisol and glucose levels, greater insulin sensitivity, higher daytime leptin and reduced food-seeking behaviors, lower sympathetic tone, greater nighttime peripheral perfusion, increased stamina and faster cardiovascular recovery time.
  A Recommended Resource: Why We Sleep by Matthew Walker, PhD is a very good book resource on this topic.

6. Our Social Connections: A Harvard study concluded that our relationships matter! Our relationships and how happy we are in those relationships has a powerful influence on our health. Taking care of your body is important but tending to your relationships is a form of self-care also. Childhood nurturing plays a significant role in midlife thriving. Marital happiness and social connectedness moderate our health and happiness.

• Social Networks: Being part of a social network improves longevity
• Positive Psychology Interventions
  Counting our blessings everyday (e.g. thinking of three things you are thankful for)
  Expressing gratitude and appreciation (e.g. what challenges did you manage this week?)
  Savoring the pleasant things in life (e.g. taking five minutes a day to savor a particular activity)
  Writing down how we want to be remembered (I want people to remember me for…)
  Connecting and interacting with others regularly in person, not solely or mainly through social media (Belonging to family, social groups, sport groups, spiritual groups, etc.)
  Regularly practicing acts of kindness (how do you feel afterward?)
  Doing activities that feel meaningful (Reflect on what makes this activity meaningful)
  Thinking of one’s happiest days frequently (Look at photos and think about emotions experienced)
  A Recommended Resource: Together by Vivek Murthy MD is one of the best reads on social connection.

If you have an interest in learning more about any of the above these six pillars of health, feel free to connect with me at cataniaross@msn.com. I am retired medical practitioner, and I do not charge to help you along on your journey toward improved health.

Wishing you the very best of health to you in 2025 and beyond,

By Charlie Ross DO, DipABLM. Certified Lifestyle Medicine Physician, Osteopathic Medical Practitioner. Website:  www.livelifestylemedicine.com