Preventive

Lifestyle - general aspects

 

We all had the experience that some people can do things generally considered unhealthy (no sports, to much food, alcohol, smoking) and still reach extraordinary ages. A famous example for this is Winston Churchill who proved to be virtually indestructible by all the bad habits (not to mention the war, political adversaries etc).

 

However, most of us will pay a price later in life facing preventable diseases (such as type II diabetes or certain forms of induced cardiovascular diseases).This results in severely compromising the quality of life and, ultimately, shortening the life expectancy of the affected. The problem with this development is that such bad consequences develop decades after our misbehavior or after decades of misbehavior. It is basically impossible to tell early on whether anybody would be a Winston-Churchill-type or more like the majority of people who are vulnerable to the consequences of unhealthy behavior. By and large, personalized medicine and molecular diagnostics are not yet far enough developed to give a reliable forecast for everybody early on. Nevertheless, as detailed in the last blog entry (#05) an amazing amount of pertinent information and recommendations can be derived but at a cost currently not sustainable for a general screening. 

 

However, for a subset of diseases or disease predispositions (e.g. inherited) diagnosis can reliably be carried out at young age by targeted diagnostics. Not all such diseases are amenable to the influence of lifestyle (e.g. Huntington’s) but many predispositions can be prevented from progressing into (severe) disease by early lifestyle adjustments. As we all know, even if you were a smoker of more than decade, quitting the habit does improve you general health and your life expectancy. However, in all likelihood not to the extend you would have expected as a lifetime non-smoker. 

 

Lifestyle changes to better and more healthy behavior are always good even if implemented later in life. However, the earlier such changes towards better lifestyle occur the more benefits are possible by this move. Provided they are permanent and followed year after year. Of course, in theory most of us do know that a sedentary lifestyle is not good for us, that obesity is a health risk and that the liver does not really appreciate to be bathed in huge amounts of alcoholic beverages on a daily basis. Despite this more or less common knowledge, surveys show that exactly all these bad things are becoming prevalent especially in the western societies and are manifested at ever younger ages. There are many reasons for that, with the most prominent being the necessities of modern life (work environments, long hours, plenty of tasty food available everywhere and anytime). Last not least comes the indestructible belief that as individuals we are all Winston Churchills and all the bad consequences of our lifestyle will only affect “the others”. Fig. 3 summarizes the major bad habits on the left side in the black bubbles. Please note that the sedentary lifestyle is a combination of moving to little and eating too much more specifically eating too much of the wrong diet.

 

Fig 3: Lifestyle choices

 

Therefore, we all need a little personal extra prodding to realize that we actually are more like the average people and that our lifestyle will have consequences for “us” not “the others”. There is nothing more sobering that a medical checkup that comes back with a list of personal risks forcing us think more serious about taking some action. Personalized medicine with molecular diagnostics can aid this in two ways: Fist it provides a lot more personal information about future risks and second it can monitor the beneficial effects of lifestyle changes and make progress visible in numbers. This is the equivalent of all the fitness watches and devices that do the same thing for physical fitness motivating many people to attend fitness studios, keep on jogging, and trying to get enough sleep (summarized in the green bubbles on the right side of Fig. 3, just add a healthy diet to this). 

 

Personalized medicine and early monitoring is the best way to extend that fitness idea into the molecular realm of our body. Such quantitative monitoring of apparently healthy people and advising them to stay this way has been termed “scientific wellness” (see blog entries # 04 and 05). 

 

In the western world there is a general propensity to reductionism not only in science but also in the general thinking. Problems are dissected into sub-problems which are easier to understand and hopefully also easier to solve. Basically that approach is fine as long as we do not forget that any solution to a sub-problem necessarily is no solution to the whole problem but only to the sub-problem. 

 

Lifestyle and lifestyle changes are especially prone to be victims of the reductionism approach. Changing one aspect of my lifestyle cannot be regarded as a change in lifestyle in general. Let us assume a person lives a rather unhealthy life with lots of stress, sedentary behavior, too much of the wrong food at the wrong times, and maybe combined with job-related disturbances of sleep rhythm. This person decides to squeeze in a hour of exercise in a fitness studio twice a week into the otherwise more or less unchanged weekly routine. This would be an amendment to the lifestyle rather than resemble a change in lifestyle and such a measure most likely will not solve life-style associated problems. But a little is better than nothing…

 

Stress level, sleep rhythm, average duration of sleep, nutrition, daily routines, exercise in daily life and/or sports together with relaxation times and the personal rating of the quality of life all that resembles our lifestyle. Any change in lifestyle meant to alleviate or prevent disease necessarily has to affect all of the above - which is where things are getting complicated on a personal level. Many people have jobs that are simply not compatible with a really healthy lifestyle. Changing lifestyle would mean literally changing the whole life which is often impossible due to constraints such as a family. This situation forces a lot of compromises in what can be realized without radical changes in the socio-economic context of a person. As a consequence many approaches propagated for lifestyle changes end up delivering no more than sub-optimal results. This is not because lifestyle changes would be not effective but because partial changes necessarily are also only partially effective. Of course, the industry has found a way to cash in on the bad feeling about making bad compromises by offering myriads of (expensive) Nutritional supplements (NS). They are are complexes of nutrients with variant activity that may bring a reversal to nutrient depletion. From the safety/ quality point of view NS lack harmonization and sovereign laws/ institutional controls on the market, while due to their wide commercialization may possibly lead to risks to public health (Kioukia-Fougia et al, 2016). Anyhow, these are no magic bullets to correct more or less effortless the consequences of a bad lifestyle.

 

The limitations on what can be realized in a “normal” life is a general and inevitable problem of our society. Fortunately, personalized medicine in its preventive and predictive capacities, can help in tackling this problem, at least partially. We all react to individual aspects of lifestyle changes differently. For example, some people can get rid of obesity by taking up and maintaining even rather moderate physical activities while others can work out as hard as they like and still barely manage to shed a few pounds in the long run. Assessment of the genetic and metabolic status of a person can pinpoint which interventions would be most promising for an individual (often enough this starts with dietary changes - least favorite for many). People could focus their efforts on those sub-problems where lifestyle interventions would have the most pronounced effect for them personally. Can’t get it all but at least the most bang for the buck (i.e. effort).

 

So what can be done in general to prevent / alleviate such risks in our lifestyle? One of the foremost important facts are robust sleep/wake rhythms. They are important for health and cognitive function. If the eating behavior and the sleep time do no harmonize this results in problems with the circadian clock, or better circadian clocks. We have two of them. One is in the suprachiasmatic nucleus (SCN) of the brain and is a robust master pacemaker, while the molecular clock in the hippocampus (another part of the brain) is synchronized by the timing of food availability. When the two clocks are forced out of synchrony by inappropriate eating times deficits in hippocampal-dependent learning and memory may be the result (Loh et al, 2015). 

 

However, eating at the wrong times is not the only way to upset your circadian clock work. A cup of coffee may be shifting your circadian clock. Caffeine inserts a delay into the ~24-hour metabolic rhythm that keeps your body running in time with the world. Having some real coffee before bedtime can delay your internal clock by 40 min, a shift about half as long as bright light, a stimulus known to robustly lengthen the circadian phase (Burke et al., 2015). 

 

The bottom line to all of this in very general terms comes down to misalignments between your mind, your body and the environment. Let’s take the example of the much touted “work-life balance”. This is meant to provide a healthy distribution between your job-life and your personal life. While the idea is good, the notion itself creates a conflict by putting up “work” and “life” as opposing forces competing for your time. In my mind this only shows another form of fundamental misalignment. Work is simply a part of our life not something extra. Unless work and life are seen as one the internal conflict is programmed.  That is why you read in the bubble in Fig. 3 mental balance the terms “activities” and “reflection” as both apply to “work” AND “life”. When you manage to experience your work as integral part of your whole life there is no conflict in your life - which encompasses everything you experience. 

 

What I mean to say here is that apart from all “actionable” changes a change in mind set might be the very first step to reduce inner conflicts and stress before changing anything lese. Unless we change our inner view of life any lifestyle changes we impose on ourselves will be short-lived. In case of body weight this is known as the Jo-jo effect.

 

 

References

 

3.    Burke, T. M. et al. Effects of caffeine on the human circadian clock in vivo and in vitro. Sci Transl Med 7,

       305ra146, doi:10.1126/scitranslmed.aac5125 (2015).

4.    Loh, D. H. et al. Misaligned feeding impairs memories. Elife 4, doi:10.7554/eLife.09460 (2015).

5.    Kioukia-Fougia, N. et al. Synthetic and natural nutritional supplements: health "allies" or risk to public health?

       Recent Pat Inflamm Allergy Drug Discov (2016).

 

 

What’s coming up next?

 

Next week I will illustrate a few examples of common lifestyle factors of major diseases where we have scientific evidence for the influence of lifestyle on wellness and health.

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