"Sleep is that golden chain that ties health and our bodies together"
From the time that we were very young, people, starting with our mothers, have been telling us about the importance of sleep.
I am going to do the same...
Like all of the Wellness Garage core behaviors, failing at sleep will negatively impact all other behaviors and will independently and collectively worsen your health.
The impact of lack of sleep is both obvious and insidious; obvious to the extent that our performance is clearly impaired; insidious in the way chronic sleep deprivation increases our risk for chronic disease.
So what to do...
Go to bed and get up at the same time, every day.
Aim for 7-8 hours per night.
Build your night-time routine
As part of all Wellness Garage programs we will assess your sleep and help you build the right behaviors that optimize your health.
Beyond the basics for insomnia
While I am a definite proponent of the food first paradigm for health, exercise is a very close second.
The Wellness Garage exercise principles are simple to understand, easy to do and evidence based:
Research consistently shows the importance of cardiorespiratory fitness (CRF) as an independent predictor of mortality. A recent study found that low cardiovascular fitness accounts for 16% of all deaths and was in fact the leading mortality predictor ahead of high blood pressure, smoking, obesity, high cholesterol and diabetes.
Studies have shown that running, mainly through it’s improvement in cardiorespiratory fitness can reduce risk for heart disease and stroke by 45-70% and cancer by 30-50%.
A recent study postulated that if all non-runners became runners 16% of all-cause and 25% of cardiovascular disease mortality would be prevented, and that every hour of running increased longevity by up to 7 hours! This effect was of course not infinite and caps out at about 3 years of additional life expectancy.
High levels of CRF are associated with normal insulin function and improved insulin sensitivity, improved blood pressure, improved cholesterol profiles, less inflammation and less oxidative stress. In fact when looking at running specifically there are many benefits:
From Progress in Cardiovascular Diseases 2017 60, 45-55DOI: (10.1016/j.pcad.2017.03.005)
These benefits are not isolated to those associated with mortality as higher levels of CRF are associated with lower levels of depression, cognitive impairment and overall disability later in life. In other words, high levels of CRF lead to vital longevity.
The World Health Organization recommends 150 minutes per week of moderate intensity aerobic exercise.
Bottom Line – improved cardiovascular fitness from regular activity is essential for vital longevity.
Similarly, but independently, to cardiorespiratory fitness, muscle strength has been shown to be inversely associated with death from all causes and cancer, especially in men.
Human ageing is associated with a loss of muscle, a decrease in strength and gradual impairment in ability to perform activities of daily living.
These changes start in middle age, around 40, and progressively deteriorate.
Bottom Line – maintaining muscle and strength is essential for vital longevity.
In addition to cardiorespiratory fitness and muscle strength, the ability to maintain normal functional movement is essential for long term health and independent living.
Functional training trains muscles and the nervous system in a coordinated, multiplanar movement patterns, incorporating multiple joints, dynamic tasks and consistent alterations in the base of support for the purpose of improving function.
Functional training has been shown to improve the ability to remain active and live independently.
Bottom Line – maintaining functional movement is essential for vital longevity.
It is clear that exercise improves health, prevents disease and leads to vital longevity and that a well designed exercise behavior would incorporate activities that improve cardiorespiratory fitness, muscle strength and functional movement.
The Wellness Garage exercise principles are simple to understand, easy to do, and evidence based:
Many of you will recognize "eat real food, not too much and mostly plants" comes from Michael Pollan.
I highly recommend any and all of his books, but would especially encourage you to check out "In Defense of Food".
Let's start with the first principle: Eat Real Food
Avoid packaged foods
Real food is food that your great grandmother would recognize. Packaged foods are a problem. Many (most) contain ingredients that have nothing to do with nutrition: preservatives, taste and texture enhancers. A good rule of thumb is to avoid anything with more than 5 ingredients or with any ingredient that you don't recognize as food. Another helpful hint is that real food is mostly found around the perimeter. Packaged foods are also high in refined processed carbohydrates which will spike insulin levels, cause chronic low grade inflammation and lead to weight gain.
Avoid refined carbohydrates
Refined carbohydrates have become a mainstay in Western diets and their increased consumption is thought to be at the core of the diabetes and chronic disease epidemic in our society. Refined carbohydrates are forms of sugars and starches that do not exist in nature. They have been processed, extracted, concentrated, purified or transformed enzymatically from natural whole foods. Refined sugars make packaged goods sweeter. Over the past 30 years, the low fat diet trend has resulted in foods where fat has been removed and substituted with added refined sugars. Refined grains are whole grains that have been broken down to some extent through grinding, polishing, high-heat treatment and extrusion puffing. The extent of processing can vary from minimal (cracked and stone-ground grains) all the way to fine powders, flours and starches. With processing the outer bran coating is lost and with it fibre and many nutrients. The net result is that refined grains are easily and rapidly digested, converted into sugars and absorbed into the blood stream and resulting in the release of insulin to maintain controlled blood sugar levels. The more sugars absorbed the more insulin is released, and high levels of insulin over time result in increased inflammation, weight gain, and insulin resistance, eventually (potentially) descending into type II diabetes and metabolic syndrome.
A good rule of thumb is to balance your fats:
From a practical stand-point this means getting a mix of fats from whole, unprocessed, high quality foods - nuts, seeds, fish, pasture raised, grass fed animals, eggs, butter, olives avocado and coconut.
One of the reasons many people overeat is that they eat too quickly. The reason this happens your body needs time to send signals to your brain that you are full and to give you a feeling of satiation. There is a complex web of signals that send information from your stomach and intestine via stretch receptors and hormones like cholecystokinin and leptin, to your brain where the release of dopamine signals pleasure after eating. In addition to helping avoid overeating, eating slowly improves your digestion. More time chewing your food allows amylase in your saliva more time to break down starches into simple sugars, the sugars make the food taste sweeter and richer which leads towards satiation. The more salivary amylase released the higher the pre-absorptive insulin response which seems to smooth out the overall insulin response to carbohydrates.
Eat to 80% full
This rule again probably works because of the lag between food passing through the stomach and small intestine and the brain's signalling satiation. Put another way, when eating, your brain is probably 15 to 20 minutes behind your stomach, so when you feel 80% full you have probably eaten enough. Eat to 100% and you have probably overeaten. Okinawans are renowned for longevity call this "Hara Hachi Bu" which seems to be one of their keys to staying lean and healthy into advanced ages.
Fasting, Intermittent Fasting or Time Restricted Eating
Whether is is prolonged fasting (nothing but water for >1-5 days), intermittent fasting (18-24 hours) or time restricted eating (consuming all calories within an 8 to 12 hour per day window) there is increasing evidence that the body responds well to time without nutrients.
All of these strategies have been shown to improve multiple risk factors for diabetes, metabolic syndrome, heart disease, cancer and neurodegenerative disease (Mattson et al., 2014). Although the mechanisms of action are not completely understood, fasting appears to promote coordinated positive effects on the aging process. I will spend more time on this in a future blog post, but the point here is that building a regular fasting period into your weekly or daily eating patterns can have profoundly positive health effects.
For some this will be the hardest principle to accept, so I am going to focus mainly on why plants are healthy and more of them is always good before concluding with some of the evidence regarding a pure plant-based diets.
Simply put, eating a variety of fruits and vegetables (>5 portions per day) is the best way to get all the micronutrients that your body needs.
In addition to being rich sources for vitamins and minerals, plants also contain anti-oxidants and many other beneficial compounds that we are only now beginning to appreciate the importance of. For vegans, there are considerations around supplementing Vitamin B12, Vitamin D and Omega 3 fatty acids.
Dietary fibre is found mainly in fruits, vegetables, whole grains and legumes and is probably thought of most in connection with preventing constipation, but fibre has many other benefits to good health.
Fibre comes from the roughage of plant foods - the bulk that your body cannot digest or absorb.
There are two types of fibre - soluble fibre that dissolves in water and has been shown to lower blood glucose and cholesterol; and insoluble fibre that increases the bulk and promotes the movement of stool through the bowels.
Fibre also promotes diversity in the microbiome that has been associated with reduced inflammation, chronic disease and optimal weight.
Researchers have shown that a more plant-based diet may help prevent, treat, or reverse some of our leading causes of death, including heart disease, type 2 diabetes, and high blood pressure.
Evidence of the benefits of plant-based diets by category (The Plantrician Project)
An update of the evidence relating to plant-based diets and cardiovascular disease, type 2 diabetes and overweight
Not all plant-based diets are created equal
That's it 6 core behaviors, 21 principles - follow these and your life will be better.
Life is a Journey, Find your Path
The genesis of Wellness Garage came several years ago when I was working at a local clinic.
Linda, a 58 year old woman with Type II Diabetes came in to review her lab results and get a prescription refill. In the ten minutes that I had to spend with her, I was confronted with many of the challenges of our current healthcare system. Linda was struggling, she had diagnoses for Diabetes, Heart Disease, high blood pressure, high cholesterol and osteoarthritis. She was on 12 medications, carefully taking them all at various times of the day. She was measuring her blood sugars 2-3 times per day and recording them in a diary that she had me review. The results were not encouraging, her blood sugars were increasing, and I could see from her lab results that this was a definite trend. Linda was doing all that we asked from her as a patient – she was taking her pills and doing her blood work. As her doctor, in our health system, I was about to do my job – increase her meds and order more blood work. This did not feel right. I asked Linda about diet, a major factor in diabetes control. She told me that she was not doing anything different than what she had always done. She had seen the Diabetic Nutritionist but what she was told did not make sense to her, she did not know how to make the changes she was being asked to do, so she did what she knew. When I asked about exercise, another behavior that has been shown to positively influence the trajectory of diabetes independent of diet, Linda pointed to her knee and told me that the pain she gets limits her ability to do anything, so she was not exercising, in fact she was sedentary much of the time. I offered to refer her for physiotherapy but she declined as she had tried that before to no avail. And so as our ten minutes was coming to a close, I increased Linda’s medications and asked her to get more blood work. I left the room, discouraged with myself and the system, knowing that we would be there when Linda had a heart attack, went into renal failure or had a stroke, but we were not going to be there for her today, we were not going to help her prevent these horrible, potential outcomes of her disease.
While I am sure that my ten minutes with Linda had little impact on her life, her situation has had a profound effect on mine. Leaving that exam room I began to think more and more about where the health problems that are affecting our society come from. I did not have to dig very far to realize that chronic diseases are the primary driver of cost for our healthcare system, and that many chronic diseases such as Type II Diabetes, heart disease, high blood pressure, stroke, obesity, osteoporosis and many types of cancer were lifestyle related, and can be prevented, treated and in many cases reversed using evidence-based lifestyle approaches such as a predominantly whole food, plant-based diet, exercise, sleep, and stress management. The extent and effect of chronic disease on our society cannot be overstated:
There are a lot of Linda’s out there and the importance of lifestyle factors is irrefutable, yet our current approach is not working. So it did not take long for me to understand where “bad health” comes from, but to understand the right way to address this massive problem, I needed to understand where “good health” comes from.
Fortunately, many have already answered this question, and by investigating the determinants of health, many very precise estimates have been made. By immersing myself in this body of work, I came to understand the roots of my frustration after my encounter with Linda. As a physician it is isn’t easy to accept that clinical medicine contributes a small fraction to health outcomes. In fact when analyzed across multiple studies clinical medicine only determines 11% of health outcomes. Social circumstances determine 23% of health outcomes, the environment 7%, genetics 23% and behaviors 38%! Given the extent of chronic disease and the role of lifestyle behaviors in their etiology, this made sense, but there is something more profound at play here.
When you look at the inter-relationships between various determinants of health a case can be made to think about health in three domains:
This interplay of environment, behaviors and genetics drives 68% of health outcomes and it is clearly upstream from our current healthcare system, in that health approaches here offer the potential of prevention and even reversal of disease.
The determinant of health approach should have us rethink our approach to healthcare – clearly we underinvest in Population and Personal health while pouring ever increasing amounts of resources into clinical medicine to treat diseases that could have been prevented in the first place.
Once I made the realization that Personal Health is the future of healthcare, I became very motivated to work upstream from disease and create a practice that is dedicated to preventing and reversing disease.
Wellness Garage is founded with the belief that optimizing one’s environment and behaviors while understanding one’s unique genetic and biological system risks is the key to good health.
Wellness Garage focuses on six core behaviors:
After each tune-up, we reassess make adjustments and start over.
We believe that wellness is a process, requiring an ongoing practice; it is not a goal, a destination or an outcome.
We believe that we are all responsible for our own individual health; at Wellness Garage we are here to help you find your own way, not to prescribe medications or one size fits all recommendations.
We believe we all need Wellness Practices – a set of habits and behaviors that make us feel better physically, mentally and socially.
Finally we believe that wellness is fun!
Dr. Brendan Byrne