The continuum of health and disease: why we must not wait until conditions like hypertension or diabetes are confirmed before making the changes that will mean we avoid them
Andy is a gentleman in his 60s who learnt little by little that the adoption of healthy habits now – along with the avoidance of some short-term pleasure – would lead to far more meaningful enjoyment later in life.
Andy underwent major surgery two years ago for aorta dissection, which was complicated by a stroke affecting the left side of his body. High blood pressure was discovered after surgery and treated with multiple pills.
His bladder function was normal, and he opened his bowel every day, very rarely being constipated for 3 to 4 days or losing bowel control. He takes lemon in hot water in the morning, together with flaxseed to help his constipation.
He was prescribed medications for sexual dysfunction in a private clinic. He has suffered from acid reflux for many years. His energy level drops after meals but generally stays around 5 out of 10 most of the day. He smoked ‘roll-ups’ and drank alcohol in the past, but nothing to excess.
With a weight of 82kg and 190cm in height, his BMI was 22.7. His pulse was 47 beats per minute on beta-blocker medication. His blood pressure was high at 168/85 while taking four different blood pressure medications at the maximum dose.
His liver was enlarged below the right ribcage. With a waist of 40.8 inches and a hip of 42, his waist/hip ratio was high at 0.97, indicative of fatty liver and excess body fat in the midsection.
Exercise and a good diet BUT biscuits and beer
He had mild left body weakness and diminished sensation in both feet and lower legs. He was able to walk with a stick and his wife’s support.
Evaluation in the vitality clinic revealed hypertension due to arterial atherosclerosis (cholesterol plaque deposition) with high inflammatory markers and high oxidative stress markers. He also had abnormal bacteria in the gut (dysbiosis), impaired detox pathways and low vitamin D.
He has made good progress over the last 12 months, with his neurological symptoms resolving almost completely, no sensory symptoms, and leg weakness and stiffness resolved. He continues to have symptoms of intermittent claudication (leg pain triggered by walking due to insufficient blood circulation) but has been able to increase his walking from 1.2 km to 3.2 km a day. Initially, he had to stop every 50 to 70 yards due to pain, but now he can complete the distance with few rests.
He recently went on a train trip to the north of England for a few days on his own. He visited friends in two big cities and attended a major sports event without experiencing any difficulty.
Andy made a great commitment to a healthy lifestyle, including anti-inflammatory food, regular physical activity, but he did not bother going to bed early, and his wife noticed him frequently eating junk food such as cake and biscuits and drinking beer, particularly on special family occasions.
On his visit to the Vitality Clinic, he admitted he was finding it difficult to figure out if he should ignore health advice every now and then or stick religiously to it for a bigger gain in the future.
I found that Andy was confused about the possible extent of his recovery and its impact on his quality of life. He found it difficult to work out whether to enjoy himself a little now or to put up with these lifestyle restrictions for a lasting result later.
I recognised that this was a great opportunity to explain health and how to monitor progress and readjust goals and expectations accordingly.
So……..what actually is health?
The definition of health is different from one person to the next due to their experiences. Most people agree that they don’t want to be sick or have pain or need to go to the hospital; most people want to be fully functional and to be able to do their job comfortably. Most people would like to stay independent all their lives.
The World Health Organization’s (WHO) definition of health is physical, mental, social, and spiritual well-being. This definition would indicate a good health status, almost like the person on “Who Wants to Be a Millionaire” does not use their lifelines until they win the prize.
But our definition of health should accommodate people of varied vitality. Vitality is your ability to enjoy life, and it depends on your physical and mental fitness. Vitality increases gradually from birth to a peak between the ages of 20 and 37 before declining due to an accumulation of metabolic damage and the onset of chronic diseases.
During my long medical career, I have met many patients looking for health and vitality in hospitals. I guess these people assume that health is simply the absence of disease. These people want to see the best cardiologist and the best endocrinologist to sort out their hypertension and diabetes, so they can enjoy health and vitality.
Medication will only remove the symptoms
But this is not possible as these diseases are different from others.
If you have pneumonia (chest infection), you can go to the hospital for a course of antibiotics that will usually clear the infection within a few days and get you back to normal as if nothing has happened. But medication will only deal with the symptoms of hypertension and diabetes, while, in the background, these conditions continue to deteriorate and often progress to complications such as heart attack or stroke.
Therefore, it is sensible to start thinking about health and disease as a continuum. You start healthy and gradually develop certain symptoms that are not enough to diagnose as a disease. For example, you may feel tired or exhausted, have brain fog, light-headedness, anxiety, or a low mood; your blood pressure or blood sugar may start to rise but not enough to diagnose hypertension or diabetes.
This gap between complete health and obvious disease is the ideal time to spot cases and stop the slide towards actual disease.
But it is not logical to use this gap just to monitor the patients until their disease status is confirmed, and then we start medication or plan surgery.
Monitor your metabolic markers
A patient of mine recently attended the Vitality Clinic with very mild urological symptoms and a borderline PSA (prostate marker.) I advised a simple dietary change and a natural agent to enhance detoxification. Their PSA plummeted back to normal, and the symptoms resolved. This is the beauty of acting on chronic disease at an early stage. At this point, I could educate the patient on a healthy lifestyle to prevent disease and avoid them taking medication for the rest of their life.
Since the most frequent issues prior to the onset of chronic disease are metabolic, it would be sensible to monitor a variety of markers such as body weight, BMI, waist/hip ratio, pulse, blood pressure, blood sugar, cholesterol, and triglycerides.
My discussion with Andy focused on how to convert his new knowledge into lifestyle habits. I advised him not to try to adopt more than three habits at the same time. You need to define your goals timeline – short- and long-term goals linked together.
Andy quite liked his little treats, such as chocolate cake or a glass of wine. But he learnt to focus on long-term goals such as playing with his grandchildren and dancing at his granddaughter’s wedding. In this way, he is starting to give more weight to the long-term goals and expressed some willingness to give up some short-term enjoyment.
A habit is something we do every day without thinking about it
To start a new habit, anchor it to one that is already well-established and matches the frequency of the habit you want to acquire. For example, if you want to adopt intermittent fasting 16/8, you could push your morning run to a little bit later, returning home at 10, which is the right time to break your daily fast.
This allows you to link two positive lifestyle habits together and effectively make them one.
Of course, you will need to monitor the new habit to see if anything is stopping you from practising it. In this case, you may need to analyse and remove these obstacles and readjust the sequence.
I have also found that a goal that you discover for yourself is usually healthier and more motivating than the one you copy from other people.
“What you conceive and believe you can achieve.”
People currently live long lives and would be sensible to set their goals for 30 years’ time at least. Habit is an intended action repeated with purpose until it becomes a standard behaviour.
However, you can’t be what you can’t see. Napoleon Hill says, “What you conceive and believe you can achieve.”
Andy initially found it hard to visualise his long-term desire to play with his grandchildren, who were not yet born. But when he did start to do this, he became more flexible and willing to give up small pleasures now to have more enjoyment in the future.
If you keep the habit acquisition simple and you have a vision of where it is going to take you, this will help you to make it happen. Your habit needs to be simple and doable. It is sensible to start small and to build up gradually. Tap into your vision for the motivation to keep you on track.
If you share what you are doing with others, this will not only increase your commitment and give you more motivation but also teach other people about good lifestyle habits.
Reflect on your learning and continuously adjust and redesign it until you make it happen. Embrace failure as an important part of your continuous learning process. Allow time for these obstacles in your goal planning.
I myself have adopted a different learning style. I always look for the worst example of anything I would like to learn. I explore why they failed or did it badly. Then I focus on how I can correct that to come up with a good result. This approach always helps me to come up with great, original ideas. I love them because they’re mine. Hence, I can push very hard to make them happen.
Small changes can add up to big results
You may have heard about SMART objectives – goals that are specific or simple, measurable, achievable, results-orientated, or relevant to you, and have a timeframe. These are good tests of your new habit goals.
Your health is hugely important, and any change in it is naturally very important to you. In order to change it for the better, you need to break your big change down into smaller, manageable units; otherwise, you can feel overwhelmed and unable to complete it.
So, my friends, do remember that you can achieve any goal you really set your mind to. The first thing is to create a personal definition of success – what are you trying to achieve, and how will this impact your life?
- This “big picture” will give you the motivation to start.
- The “baby steps” will provide the process to keep you moving forward.
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