Are You Healthy? Why a Shift in One’s Perspective of Health is Important.
Health is, to be able to function at the maximum efficiency that our bodies can in the time and place we are at in life by identifying and nurturing our intrinsic qualities so that we may handle our extrinsic hurdles.
What is health? Is it a clean bill of health from your physician? Is it a feeling of wellness? Is it being free of any pathological process? If you look for health in the dictionary, you get, “A state free from illness or injury”. The WHO provides a much more comprehensive definition, one I prefer from the rest but still find lacking in regards to perspective, “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”¹. Often, when I ponder over this rather vague question I am reminded of Albert Einstein’s Theory of Relativity. Everything is relative. Including the definition of health. It depends on your individual experiences and priorities.
Let me give you an example. Let’s take 2 women, both 29 years old. One wants to get pregnant, the other wants to run the Boston marathon. The way one would approach health in these individuals would be very different since their goals are very different. If one trains someone to run a marathon the best they can, chances are it will be extremely difficult to sustain a normal pregnancy in such a state. Here’s another one. 2 men. Both 32. One works at a tech company in Silicon Valley and the other is a firefighter. Who do you think is healthier? Most of us would think the firefighter. This is a wonderful juncture for me to discuss two of my viewpoints with you.
- Firstly, this is a situation in which we need to think about our definition of health. Is it the likelihood of survival until the average all-cause mortality age? Or are we looking at the purely intrinsic value of how efficient one’s body functions? In the former, if one would factor in the occupational risk factors (exposure to unsafe environments, chronic smoke inhalation, chronic hot air inhalation) associated in the firefighter’s line of duty (extrinsic factors of health), then in contrast, even just 20 minutes of exercise for 5 days a week would make our techie the more healthy of the two with less chance of injury or illness. However, if we look at only the intrinsic characteristics of fitness and health, it is quite evident the firefighter comes on top. While discussing health, I will be talking about how to understand and try and cultivate these intrinsic qualities.
- Secondly, if everything is relative, does that mean our techie is not healthy since we are comparing his health status to that of the firefighter? What is our benchmark for health? Does that mean he has to strive to be as fit and healthy as a firefighter? He can if he wants to of course. If that’s a priority for him. Or, is it ok for him to not be at that level and yet still be healthy? What I mean to say is that health needs to be taken in the context of the person observing it, it is both temporal as well as spatial. Health depends on the time and place one is at in their life. We should have different targets for when we are 18 vs 80, the same way we should have different targets if we were a techie vs a firefighter vs retired on a beach.
The whole point of this convoluted explanation was to try and explain to anyone reading this, my definition of health is neither an image of a perfectly chiseled body nor is it the ability to run a full marathon or complete any extreme physical feat. These are mere indicators of certain components of health and in no way should be confused as defining health. My definition of health is simply, to be able to function at the maximum efficiency that our bodies can in the time and place we are at in life by identifying and nurturing our intrinsic qualities so that we may handle our extrinsic hurdles. This includes ones mental and emotional fortitude to deal with life’s stressors. To tackle these aspects of health one requires a much more holistic approach to health than is taught in mainstream medical academia.
Approach to Holistic Health
Being healthy is not a grind, it is not difficult. It is just not very well suited for our, “Modern Lifestyles”.
Of course, there is a minimum level of health one should have, that is very absolute. After this threshold, however, there comes a point of diminishing returns and things start to become relative. It is at this point that one should shift their focus on a more holistic approach to health. On creating an effective environment for our mind and body to thrive in. In my opinion, there are 5 broad categories I approach when viewing health(in order of importance):-
- Mindset development
- Stress management
- Sleep and Recovery
- Nutritional adequacy
- Performance-based physical conditioning
The first two points require there own future discussions. For the rest, it is important to understand that our mind and body are wonderfully efficient at adaptation. No matter how efficient though, there comes a point where our bodies just can’t adapt any further or as fast as is required, this is called maladaptation. Most of our modern disease states are a product of these maladaptations. When one has high blood pressure for a long time, our heart adapts by building more cardiac muscle to push blood out with more force. This adaptation works, we can pump out blood more effectively. However, as time progresses and we keep thickening the heart, it starts to require more oxygen to fuel its contraction, in medical terms, it increases the, “Myocardial oxygen demand”. This increase in oxygen demand means our heart tissue is more susceptible to “Ischemia” or the heart being unable to meet its oxygen demand at the present level of oxygen supply. An example of this would be during exercise, where the heart needs to pump more and requires more oxygen to do so, more than that which would be required by a normal heart. This mismatch in demand and supply leads to “Angina” or that crushing chest pain one feels before a heart attack.
A similar maladaptation can be seen with type 2 diabetes. Consistently high blood sugar levels cause consistently high blood insulin levels. Insulin tries to push glucose into cells for metabolic purposes. Over time our cells get used to these high insulin levels and adapt to not be as sensitive to the levels of insulin in our body. This leads to consistently higher blood glucose levels in our blood causing our pancreas to secrete more and more insulin in an attempt to force glucose into cells, this is called insulin insensitivity and with a little inconvenient testing (a 2-hour Oral glucose tolerance test with a 75mg glucose dose with simultaneous insulin levels) and a high degree of clinical suspicion, a physician can catch this and reverse it even up to 10 years before the development of overt diabetes. This after a limit reaches a point where we cannot adapt anymore, the glucose load and insulin insensitivity are just so much that no matter the levels of insulin we cannot control our blood glucose levels and WHAM! You just developed the overt symptoms of diabetes and are now diagnosed as a diabetic with all the long term morbidities associated with that.
It is this same mechanism of adaptation which causes improvements in physical fitness. We put our body through stress and our body adapts to overcome that stress. When we lift weights, we firstly increase blood supply to the muscle. Like our heart, there comes a point with any load (amount of weight in this example) where the demand for oxygen by our muscle exceeds its supply. This leads to something called metabolic stress and stimulates pathways in our muscle to rebuild and upregulate mechanisms to make our muscles more efficient. Second is something called physical stress, where the physical load we put on the body causes micro-tears in our muscle fibers. These micro-tears stimulate regeneration and healing of our muscles. During this healing phase, our body tries to develop fibers which will be able to handle this new level of stress better. The two types of stress in this example can broadly (as well as in an extremely oversimplified manner) be seen as the weight used and the number of reps, sets and rest times. Understand that it gets far more complicated in just this example itself, let alone other components of physical fitness such as cardiovascular fitness, flexibility, mobility or power, let alone other components of health. I will give each of these areas their due with much more detail in future dedicated articles.
So, what then happens if you push your body to lift a load that is just too much for it or not incremental enough for it to adapt. This is when injuries happen during physical training. It is in principle very similar to the mechanism seen in the development of Type 2 Diabetes or Myocardial Hypertrophy. Thus, it is increasingly important to understand the limit to which one must push beyond one’s comfort zone to generate a beneficial stimulus and yet not push so far that our body cannot cope and develops maladaptations(A very insidious process if left unchecked). This is a principle I have noticed even in personal development and growth. There is no growth if we stay in our comfort zone, yet at the same time, we will most likely fail if we push too far out too soon. More about this later as well. What I am trying to say is that it is essential to find this range for each individual so that we can develop at maximum efficiency while minimizing the risks of injury so we can also develop consistently. In my experience, most people often overestimate the amount of strain one needs to stimulate this response, a product of this modern mindset of the constant “Grind”. Being healthy is not a grind, it is not difficult, it is just not very well suited for our, “Modern Lifestyles”.
Performance-based physical conditioning
This is a key step in developing physical fitness. To find our range where it is just the right amount of difficulty to stimulate adaptation but not so much that it hinders with consistency. I like to call this our body’s, “Range of efficient homeostasis” or “REH”. Ideal metrics I like to use to assess this are, 1 Rep Max’s(1RM), Heart Rate Variability, Respiratory Quotient, VO2 max, Blood Lactate and Glucose Levels and Urine Ketones.
This may seem daunting at first but the use of objective data lets us progress with both confidence as well as consistency. To start, the 1RM is an easy and effective metric to start with. It is the load for a particular exercise with which you can complete 1 rep but are unable to complete the second. Based on what you wish to achieve, i.e. strength, size or endurance, we adjust the weight and rep count from this 1RM value. 3–5 reps at 85–90% of your 1RM is ideal for strength development due to its increased focus on increasing physical stress. 8–12 reps at 65–75% of your 1RM is great for increasing muscle size due to the combination of both physical and metabolic stress. 15–30 reps at 30–55% of your 1RM is ideal for developing muscular endurance². Keep in mind, it is not the number of reps that is important but the 1RM weight used to derive these targets which influence developmental goals while at the same time preventing injury.
Sleep and Recovery
Recovery is where the magic happens, it is far more important than the exertion.
Ok, so we are safely loading our muscles to develop a controlled stressor. Our muscles will now require the proper building blocks and environment for efficient recovery. The more efficiently you recover the faster you adapt. This is the area where doping athletes try to use anabolic steroids. Steroids don’t increase muscle mass, they increase recovery rates so you can increase the stressor on the muscle faster, albeit with a slew of dangerous and life-altering side effects. Recovery is where the magic happens, it is far more important than the exertion. So how do we recover faster?
The most important time for muscle recovery is during the first half of the night.
Recovery is predominantly a metabolic and hormonal function. We can improve recovery by targeting these 2 areas. The most important time for muscle recovery is during the first half of the night, during Stage 3 of Non-REM sleep. This stage sees a large surge in Growth Hormone levels which is vital for efficient muscle repair. Cortisol, a stress hormone is highest in the morning and slowly falls till about 8–10 pm. This fall in conjunction with an increase in melatonin secretion when blue light levels fall at night is a major factor in inducing sleep³. If one stays awake past this, cortisol starts to rise again till about 2 am. This disrupts Stage 3 of NREM sleep and thus impairs efficient muscle recovery.
Nutritional adequacy
Apart from sleep, providing the right building blocks for muscle synthesis is another key area. I like to think of nutrition under three headings:-
- How Much You Eat — This point is pretty straight forward. The more you eat the more you gain. The less you eat the more you lose. There are numerous online TDEE(Total Daily Energy Expenditure) calculators. I find all of these to have quite poor resolution and quite a large standard deviation. In my opinion, it is useful to use these calculators to generate a ballpark approximation and then titrate calorie levels based on daily calorie tracking and weekly weight measurements. The consensus is that an excess or deficit of 3500 kcal causes a gain or loss 1 lb of body weight. This value can be used to cross-reference and titrate ones TDEE. Ideally, according to multiple studies, a mild calorie deficit (5–15% of TDEE) is effective in the reduction of long term morbidity and chronic disease onset⁴. Too much of a calorie deficit and one starts to catabolize ones on muscle mass which leads to a vicious cycle of reduced muscle mass as well as a reduced basal metabolic rate(BMR). In my experience a mild-moderate calorie deficit with sufficient physical stimulus to muscles is sufficient to maintain muscle mass and BMR.
- What You Eat — This is an area which has some wiggle room based on which method works best for you. There are many protocols people follow like Ketosis, Paleo, the Mediterranean diet, Atkins, etc. In my experience there are a couple of core principles one should follow, the rest can be based on personal circumstances and priorities. First is to reduce all forms of sugar and processed carbohydrates. Our bodies were never meant to deal with such high volumes of glucose in our body. Think Sugar, Think Toxic. Second, if you are calorie restricting and exercising, ensure adequate protein intake. The daily RDA is 0.8g/kg body weight(approx50–60g/day). I don’t agree with this recommendation. Especially if someone is exercising and calorie restricting. Barring any underlying kidney disease, one should have at least 1.2g/kg body weight⁵ going up to 1.8g/kg body weight to ensure ample amino acid building blocks for proper muscle repair. Apart from these 2 factors, the break up of macros is broadly up to you. 1g of protein is 4kcal, for a 75 kg male, that’s (1.2 x 75 x 4) to (1.8 x 75 x 4) which comes out to 360–540 kcal worth of protein per day. For an average 75 kg man, let’s assume a TDEE of 2200, maintaining a 15% deficit, leaves us with 1870 kcal, out of which 540 kcal(~35%) is for protein leaving us with 1330 kcal to be divided amongst carbohydrates(4kcal/gram) and fats(9kcal/gram). The way I titrate these two is based on my day and exercise routine. For feeling satiated longer I prefer having a higher fat percentage. If I have a very intense training session I’ll increase my carbohydrate percentage to replenish my glycogen stores for more quick-release energy.
- When You Eat — My favorite area in nutrition management. Numerous studies have been published regarding the benefits of time-restricted eating. I broadly observe these as 2 categories of time restriction, the shorter/daily intermittent fasting(IF) and the longer, less frequent periodic fasting(PF). IF, recently popularized, is an eating protocol involving a shorter daily eating window and a longer fasting window, i.e. one can start to eat at noon and finish eating by 8 pm for a 16:8 fasting protocol(all kinds of protocols exist, 16:8 and 14:10 showing the most benefit). One can have no calories while fasting, ideally only water, however black coffee or green tea without any sweetener or creamer is also acceptable. IF is very effective for muscle development as it stabilizes the cyclical release of Growth Hormone and Insulin-like Growth Factor-1, assisting in anabolism while also improving insulin sensitivity. At the same time IF promotes reduced caloric intake due to the sheer dearth of time to eat. However, the more interesting fasting protocol from a health perspective, in my opinion, is the long water-only fast lasting from between 48–72 hours every 2–3 months. I don’t advise these to the uninitiated, however, the possible health benefits are truly quite impressive. I will not go into cyclical mTOR inhibition(The underlying process) and its effect on delaying the onset of chronic disease and increasing longevity⁶. I will say this though, if the animal studies on mTOR inhibition are to be believed then these fasting cycles could prolong the onset of chronic disease states as well as longevity by up to 30% through the process of autophagy, a process which helps clear damaged cells with far more efficiency. *
Mindset development & Stress Management
If there is one thing you take out of this article, I truly hope it is that you start a meditation practice. I believe it is the keystone for a healthy mind and in turn a healthy body.
It is of vital importance to understand that none of this information is useful without consistency. Through personal experience and multiple failed attempts over the past 6 years, I have learned that the most important foundational factors are your mindset and correct goal setting. Developing a growth mindset and learning to enjoy the fruits of hard work while steering clear of instant gratification has by far made consistency something I am proud about and something I enjoy to strive for. The understanding we have developed regarding the neuroanatomy and biochemical pathways related to happiness, contentment and will power is truly very impressive. It deserves a dedicated article or even multiple articles to truly do justice to the advancements in understanding and navigating human psychology. Mindfulness meditation has by far been the most groundbreaking intervention I have applied to my life. Apart from the esoteric benefits of meditation, numerous studies have demonstrated significant physiologic changes in the minds of practitioners on both neuroimaging and biochemical marker assays. These have shown changes is neuronal connections(plasticity) and activation of different parts of the brain causing increased self-awareness, attention, emotional stability⁸, etc. If there is one thing you take out of this article, I truly hope it is that you start a meditation practice. I believe it is the keystone for a healthy mind and in turn a healthy body.
There is a lot more information regarding each of the sections I mentioned above. Things like practices to help shift and maintain one’s mindset, various areas of fitness such as cardiovascular endurance, power, mobility, flexibility, strength, mind-muscle connections, understanding neuronal fatigue and proper recovery, micronutrients, supplements, nutrition for mental health and function, neurophysiology of emotions, sleep hygiene and practices to improve sleep to name a few. Most of these areas have objective metrics we can use to assess our current state as well as progress. With technology improving rapidly in the healthcare sector, more and more of these metrics and tests are becoming available for consumers at home. I hope to publish more articles about these topics and their associated metrics individually. If you are interested, stay tuned for these in the future. I hope this provided you with some insight into some of the broader concepts to help identify and nurture your intrinsic qualities so you may handle your extrinsic hurdles in the most efficient way possible.
*If anyone tries fasting, it is important to stay hydrated and to replenish electrolytes frequently as our kidneys flush water and electrolytes more during fasted states. Some rock salt with apple cider vinegar and a squeeze of half a lime in about 500 mL of water first thing in the morning works well for me.
**Disclaimer: This article is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information in this article is at the user’s own risk. The content of this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard, or delay in obtaining, medical advice for any medical condition they may have, and should seek the assistance of their health care professionals for any such conditions.**
References
- https://www.who.int/about/who-we-are/constitution
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- Gnocchi D, Bruscalupi G. Circadian Rhythms and Hormonal Homeostasis: Pathophysiological Implications. Biology (Basel). 2017;6(1):10. Published 2017 Feb 4. doi:10.3390/biology6010010
- Willcox, D. C., Willcox, B. J., Todoriki, H., Curb, J. D., & Suzuki, M. (2006). Caloric restriction and human longevity: what can we learn from the Okinawans?. Biogerontology, 7(3), 173–177.
- Deutz, N. E., Bauer, J. M., Barazzoni, R., Biolo, G., Boirie, Y., Bosy-Westphal, A., … & Singer, P. (2014). Protein intake and exercise for optimal muscle function with aging: recommendations from the ESPEN Expert Group. Clinical nutrition, 33(6), 929–936.
- Longo, V. D., & Mattson, M. P. (2014). Fasting: molecular mechanisms and clinical applications. Cell metabolism, 19(2), 181–192.
- Bordone, L., Guarente, L. Calorie restriction, SIRT1 and metabolism: understanding longevity. Nat Rev Mol Cell Biol 6, 298–305 (2005). https://doi.org/10.1038/nrm1616
- Tang, Y. Y., Hölzel, B. K., & Posner, M. I. (2015). The neuroscience of mindfulness meditation. Nature Reviews Neuroscience, 16(4), 213–225.
