Medicines are a mainstay of American life and the healthcare system not only because they are perceived to work by the individual taking them, but also because their benefit may be shown by the objective assessment of scientific study. Clinical research trials have shown that some of the medicines of Western science may reduce the risk of heart attacks, strokes and cardiovascular death while others may reduce certain types of cancer.
In the first 58 installments of the Non-Medicated Life, informed diet and lifestyle have been shown to accomplish naturally for the majority of individuals, many, if not most of the benefits of medications in the treatment of chronic medical conditions. Moreover, informed diet and lifestyle as a medical intervention may accomplish such benefits at lower risk for side effects and at a lower cost. Underlying many of the specific recommendations on diet and exercise, however, is a guiding principle: true health is achieved through the practice of balance, moderation, and the avoidance of extremes.
The choice of what food to consume and the amount should be varied and balanced with the choice of appropriate activity and exercise. Moreover, this balance should be cultivated in and with our emotional and spiritual lives as well, because feelings and beliefs influence such choices. Without such a balance evidenced-based recommendations of diet and exercise become simply a series of dos and dont's, and may not become incorporated into daily habits as a true lifestyle, which determines long-term success.
Western society has largely succeeded in providing enough food and material goods to its population to avoid widespread starvation, and material hardship. In large part this has been accomplished through assembly-line industrialization, modern agricultural methods, and free market economies that are based on products. Unfortunately, the replacement of scarcity with availability and even excess does nothing to help self-regulate or balance the consumption of food or the use of services or products. For example, in the age of scarcity of food, there was a survival benefit for our ancestors to eat until full and indeed to overeat. However, with scarcity no longer regulating the intake of calories and no natural biological break on appetite, it is much easier to overeat and throw out of balance caloric intake and expenditure.
This imbalance fuels obesity that in turn leads to diabetes and heart disease. In another example, in an age of scarcity before the mining of salt, it was natural for humans to be salt avid and seek out what little salt existed in the natural world. However, once salt became available and was placed in a myriad of products, it became easy to over-consume sodium leading to an imbalance of sodium and electrolytes in the body. This imbalance encourages the development of hypertension that in turn leads to heart disease, heart failure and stroke.
While this may seem logical and even commonsensical, it begs the question of how to achieve balance in our physical, behavioral and spiritual health – with so many conditions and forces contributing to imbalance. I would suggest that a structure for balance begins with conscious choices in our schedules and how we apportion the minutes of our day. I would further suggest that the minutes of our day must be apportioned to the physical, the emotional and the spiritual, to have any hope of sustainability. Thus the person who has no time for exercise cannot achieve balance in the physical realm and will not be able to sustain a lifestyle contributing to physical health.
I will suggest additionally that such an individual will have greater difficulty in achieving fulfillment in the emotional and spiritual realms as well. For example, the average person sitting in a chair consumes 1,700-1,800 calories per day. If this individual were to eat a normal 2,000 calorie per day diet, they would need to burn 300 calories per day to be in energy balance, and not gain weight. Exercise therefore needs to be a daily lifestyle choice – if you eat each day, you must exercise each day, usually around 30-60 minutes to maintain balance. To those who say they do not have the time I suggest that the 30-60 minutes do not need to be contiguous and one may exercise 15 minutes three to four times a day. Finding a spare 15 minutes in our schedule two to three times a day is critical to establishing and balancing a sustainable diet.
Another potential aid in establishing balance is to view any choice from another perspective. Because balance in our physical health involves conscious choices in what we eat, seeing the spiritual implications of our choices may help inform and balance those choices. For example, if we’re able to think of our body in spiritual terms as if a temple of the gift of life, then as a temple our body needs to be cared for with reverence and thankfulness. If you hope to make conscious choices consistent with this representation, you have to know what it is you are bringing into the temple and consuming.
Viewed in this way, it may be easier to read labels and see a dietitian to know what is in a product, and that the ingredients are consistent with spiritual and physical health. If you are going to a restaurant, it may be easier to inquire about fat grams and sodium content. If you are cooking, then a mindfulness of the circle of life, and awareness that our existence is a result of the “sacrifice” of an animal or plant, may help bring a spiritual aspect to meal preparation that is lost when we pick out a cellophane-wrapped sirloin steak at the market. Such a spiritual perspective may moderate and balance our consumption of meat. Even the process of giving thanks with a prayer at the dinner table may help us moderate our choices.
Another potential aid in establishing balance in our choice of diet and exercise involves cultivating and moderating behaviors and emotional interactions with others. We are barraged on a daily basis with negativity from rudeness, lack of respect, and lack of common civility. We are barraged with media and advertising intent on convincing us that our fulfillment and happiness is a consequence of what we have bought and own rather than who we are and what we believe. Achieving balance means objectively identifying negativity from others and consciously choosing not to respond in kind. It means avoiding media and advertisers attempts to convince us that they have what we need for health and happiness, when in truth we already have everything we need to achieve both. Achieving balance additionally means establishing and cultivating a structure of family and friends to help support our spiritual and physical choices for health.
In summary, health is achieved through a balance of the physical, emotional and spiritual choices we make. Achieving balance may be helped by establishing a schedule, viewing our choices from another perspective, and establishing a structure of family and friends who encourage healthy choices. It is not achieved from medications, it is not achieved from medical procedures, and it is not achieved by consuming the latest, greatest product that some unscrupulous entrepreneur tries to sell.
Paul E. Lemanski, MD, MS, FACP is a board certified internist with a master’s degree in human nutrition. He is director of the Center for Preventive Medicine. Paul is an assistant clinical professor of medicine at Albany Medical College and a fellow of the American College of Physicians.