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Show Notes
What is health? What does it mean to be healthy? This is a surprisingly hard question to answer, and in this podcast, we do a little bit of a deep dive and try to answer the question of what health means.
In the health and fitness world, the word health is thrown around a lot. It is one of the three pillars we discuss with clients when discussing their goals (health, performance and body composition being the three pillars).
What is health?
It is actually quite hard to settle on a definition of what health actually is.
- Is health just the absence of disease?
- Is it a certain feeling?
- Is it a certain blood test result?
Take a moment to contemplate what you would actually define as “being healthy”. What are your criteria for health?
Established definitions of health.
- The WHO defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity”
While this is a clear attempt to update previous definitions related to the absence of disease, there are still some holes that need to be patched up before this definition is fit for purpose. Huber et al. (2011) addressed these in the British Medical Journal. They point out that the notion of “complete” well-being in those criteria is problematic, since most of us would then probably be placed in the unhealthy category. If one was to experience some back pain every now and then, would that make one unhealthy? And what if one was to have an argument with a friend?
Huber and colleagues did not just criticise. They also proposed their own definition, which is likely far more useful in the contemporary world where we already have increased life expectancy (and the changes that come with that) and over-medicalisation is omnipotent.
“Health: the ability to adapt and self-manage.”
This definition is not uniquely attributable to the aforementioned authors, as this concept of the ability to adapt and self-manage has been convened upon by panels of experts, and was previously discussed in The Lancet (Health Council of the Netherlands 2010; The Lancet 2009).
Although this definition may seem like it’s a little more open to interpretation, it is certainly more operational. If you experience persistent pain, it would be a shame for you or your healthcare professional to focus solely on the presence of pain as the defining factor of your health (or lack thereof). With this definition, we can move forward by aiming to provide you with / guide you toward the resources necessary to be able to adapt and self-manage the symptom of concern. It is this personal autonomy and ability to continue living that becomes the goal, putting the locus of control back on the individual, as opposed to in the hands of the medical professional.
- What level of analysis?
- Molecular?
- Cell?
- Tissue?
- Organ?
- System?
- Psychological?
- Social?
- Environmental?
We can broadly lump these various levels of analysis into three broad categories:
- Structural/Physiological Health
- Emotional/Psychological Health
- “Environmental” Health
There are some wrinkles we must iron out when we discuss health, however.
Are you maximising “intensity” or “duration”?
- Do you want more life to your years or more years to your life? Are you ok with trade-offs in chasing either, or both at the same time?
- Viewing health via negativa vs via positiva – do we care about the avoidance of pain and suffering, or the pursuit of joy, excellence, actualisation?
Are we trying to be within the average, or are we trying to be extraordinary?
- For some, just being within the normal constitutes good health.
- For others, they want to be at the absolute pinnacle of health.
The term flourishing, used for thousands of years and literally meaning “to grow” or “to prosper,” represents a powerful way to view health in its fullest sense.
So, as an additional layer, I want you to ask yourself what you are doing in your life to flourish?
It may seem esoteric, but do you really care as much about your blood glucose reading as you do about how satisfied you are going to work each day, or the quality time you spend with your family? It doesn’t have to be one of the other, and that’s the beauty of all of this, you needn’t hyper-focus on any single variable.
How we view health.
- Health is resilience to and against insults to your life and well being.
There are a number of determinants of health that are often cited:
- Income and social status
- Social support networks
- Education and literacy
- Employment/working conditions
- Social environments
- Physical environments
- Personal health practices and coping skills
- Healthy childhood development
- Biology and genetics
- Health care services
- Gender
- Culture
As you can see, a lot of these are outside of your control as an individual. However, your lifestyle and health practices are all you really have control over. So rather than losing sleep over the factors that are outside of your control, you should focus on the stuff you have direct control over.
For example, there are a number of causes of death that we can focus on preventing when we try to improve health intensity and duration. We will discuss these in a future episode.
In general, we try to focus on the four pillars of health that we have influence over:
- Sleep
- Nutrition
- Exercise
- Stress management
Then we extend the scope to look at lifestyle practices and their broader alignment to your life mission. Ideally, we want some sort of integration into broader society and the community in general, along with having some sort of spiritual practice (does not have to be religious).
Transcript
This transcript is AI generated, so we apologise for any errors or inconsistencies.
Gary
Welcome to the Triage Method podcast with me, Gary McGowan and of course, Patrick Farrell. As always, this week, guys, it’s our first podcast of 2022, or at least the first that we recorded in 2022. I believe we released one, but this is the first that we’re recording. So Happy New Year. The New Year is off to a fantastic start.
You know, this is a good time for the fitness industry, for those of us that work in the industry, but also those that are trying to, you know, get on the path of their fitness goals. So I hope everything is going well so far. Now, one of our missions for the New Year Attridge, is to be really clear in our communication with our listeners and our followers and those who benefit from our content.
So we’re making a number of changes as a result to the line of communication that we use. One of those is our newsletter and in our newsletter for the purpose of 2022. What we’re going to be doing is just making sure that each week you receive a brand new exclusive piece of content that is you know, a written, useful article or post.
It’s going to be relatively short. It’s going to be just for those who receive the newsletter or the email list or who are on the email list, I should say it’s going to be exclusive. So make sure you subscribed. I’ve got all of the respective emails planned out for the year and I guarantee that if you were to consume nothing else, that will be of great value to you.
Okay, so that’s one thing. The second thing is to make sure that you’re in our fee free Facebook group. That’s the triage method community. Again, we want to foster community as much as we can. So rather than just posting everything out into public social media, we want to make sure that we’re building a community. So that’s going to be helpful too.
If you’re in that group, you’ll see more of us there. If not, make sure that you join us. Okay. And then the final thing is that here on the podcast, what we’re going to be doing is providing more of what we always do, and that is, you know, high quality information and particularly with an emphasis on health. And that’s one of the transitions that I think you’ll see from our content this year, is that we’re going to be placing more and more of an emphasis on the relationship between health and fitness and really trying to bridge that gap between the front line personal training and coaching type of stuff and health care itself, because we feel that that’s an area of great interest to our listeners as we generally have cultivated a fairly health focused audience. So that’s what we’re going to be putting a lot of our attention. And no better topic or way to start off that trend than today’s topic, which Patrick will just introduce for us now.
Paddy
Yeah, So as Gary was saying, we kind of want to move towards discussing a lot more about health, right? And health is something that someone says, I’m just trying to be healthy or I just eat healthily or I’m just know looking after my health. These are just this is just a term that’s thrown around. And while you might have a definition of health or Gary might have a definition of health or I might or whoever you’re discussing this, which might have a definition of health, oftentimes they don’t actually overlap.
Right. And that might seem strange because this is something that should be like, well, surely it’s a defined term. What does House mean? Look it up in the dictionary and you’re like, there, that’s the definition of health. But that’s not really what people mean by health, right? Well, yeah, we will dig in a little bit more into definitions in a second.
Like, are we talking about just being disease free? Right. That’s oftentimes what they used to think about health or had it used to define health as like you have an absence of disease or illness. Right. And you might go, yeah, that’s my definition of health. That’s that’s what I think is healthy. You’re not diseased. It’s either on or off.
It’s a switch. You’re either disease ill or your health, you know your health, right? It’s binary one or the other, right? You know, that might be the definition for you. For other people, it might be a certain feeling. They’re like, Oh, I feel healthy when I’m doing X, Y, or Z. You know, I just feel good. You know, it’s I feel like health, right, Or what health should feel like for them, right.
And it’s a very almost vague this is what it is. Right. And this is something that, like I do a lot of consultations with people. We’ll discuss. And we’re like, okay, well, what are you looking to achieve? And we’re like, I want to improve my health. And then it’s like, okay, well, what does that actually mean? What do we actually aim in towards?
And they might have some definition, they might have some markers, they might have some feeling. They’re like, when I was 18 and I was doing X, Y and Z, I felt really healthy, whatever it is, right? So it’s kind of ill defined and then obviously as well, there is the medicalization of this in terms of are we just looking at specific markers, you know, blood markers, health markers, you know, cerebrospinal fluid markers, whatever it is.
Are there some sort of we call them diagnostic markers that we can be like, okay, once they’re within this range, you are healthy. Now, the avid listener to this will understand that there’s clearly, you know, shades of appropriateness or correctness, if you will, in all of those. Right. And this is why it’s quite hard to actually give you a definitive this is what health means.
Right. So we’re going to try to take it apart during this podcast and really dive into like, what are we actually talking about when we talk about health? And the reason we’re doing this, obviously, is because, you know, myself and Gary, we care about health, we care about our own health, we care about the health of our clients.
We care about the health of society overall. But it is one of the the fundamental foundational three pillars that we discuss with our clients, right? So we kind of have to have an idea of what we’re talking about, not only in terms of being able to influence the stuff, but also in terms of defining what we’re talking about.
Like if you don’t have a defined target, you go back and listen to our podcast we did on goal setting. Like if you don’t have that, this is what we’re talking about. When we’re talking about health, you’re always going to be effectively swimming upstream. You’re going to do stuff that you’re like, Oh, I think this might improve my health, but because you don’t have anything measurable, you don’t have anything that’s concrete, you’re just not going to know how you’re doing, what’s going right, what’s going wrong.
You’re just going to be all over the place. So we need to have some sort of working definition of this stuff. We have to have some sort of target for this stuff or everything’s just going to be a little bit all over the place, right? So before we actually dig into this podcast, pause it here. Well, all is it after I’m done speaking please and of positive and just take a moment and just think, okay, what does health mean to me?
What does being healthy mean to you? What are your criteria for health? Right. So just take a moment. Think about that. Really just kind of go, okay, well, what is that actually what does health define for you? And then come back to the podcast and we’ll talk about our stuff. So Gary, take it away here. We’re talking about health.
Gary
Yeah, so this is a subject of great debate and has been for many years and for good reason, especially because if you look at, let’s say the last hundred years, I suppose in particular there’s been rapid advances in medicine, in surgery and health care more broadly and in medical science in terms of our understanding of health and disease.
And with that, it can often seem like we take the goalposts and kind of move them with us as to what we mean when we talk about health. And for that reason, you will see, you know, various companies that are, you know, selling you blood tests. And, you know, you hear about different markers for cancer and you hear about changing your diet and all of these different things that are very much at the forefront of the public mind, particularly those in the health space.
And it can make you feel like trying to pursue health is actually something that’s just an endless target, You know, that it effectively doesn’t exist because once you get one marker injected, then someone else says, okay, well that health markers and check. But what about, you know, your serum calcium and then what about your own ionized calcium and then what about your magnet and all these different things?
And it can be an endless pursuit if you’re looking at it at that level, because you can always go deeper, you know, you can always go deeper beyond the level of the tissue, beyond the level of the cell to sub cellular and genetic markers and all this sort of stuff that can really complicate our understanding of what it means to be healthy.
And in some cases, that additional understanding at a molecular level, for example, can be really useful. For example, if you’ve got colorectal cancer or breast cancer that has run in your family and you’ve got specific tumor markers, for example, that, you know, increases your risk of a certain type of cancer, then that is something that you wouldn’t have been able to find out before.
And it serves a very clear preventative role. And that’s ultimately what health care tries to do, is to pinpoint these these molecular targets that are maybe a bit more important so that someone can get a piece of knowledge that is actually useful rather than just screening the whole thing. Okay. That was one of the things that kind of emerged in the early 2000 with the the mapping the genome project, where it was kind of thought at the time that once we understand the genome, you know, we all have, you know, solved all of the problems of health, you know, we’ll be able to target all of these things.
We’ll understand all the mechanisms of disease and we’ll be done. You know, and the same thing kind of happened with mapping the the microbiome. And there’s always another kind of level. You see it now with proteomics and other areas in medicine and all that stuff is is really, really valuable. But sometimes people can misinterpret the importance of that stuff by assuming that if we just get access to this information about all this molecular stuff, we can fix it all.
Okay, So in this podcast, what we’d like you to do is to try to zoom out and some of you might need to zoom in, but a lot of people need to zoom out and look at their lives as a whole and ask themselves what are the different parts of one’s life that contribute to health? And in terms of definitions of health, which is where we’re starting, you may have heard of the World Health Organization’s definition of health, which is a state of complete physical, mental and social wellbeing, and not merely the absence of disease and infirmity.
And that’s there’s a lot of stuff that’s really useful in there. And I think the thing that probably stands out is that last part where they really emphasize and not merely the absence of disease. That’s an important point because I guess some people do think of it simply as the absence of disease, you know, and oh, my blood pressure’s fine, my cholesterol is fine.
You know, I’m I’m a healthy guy, you know, But you still might be suffering. You might be struggling in life. You know, you might have physical, mental and social wellbeing. And that’s why it’s important to look beyond just the absence of disease. But even this definition runs into a lot of issues, and that is.
Paddy
To interject there. Like one of the things is like again, like you said earlier on, if you look back through history, we basically only have medicine like what we would consider medicine now since the Victorian era, right? So we’re talking the 1900s, you know, where it’s like, okay, we now have stuff that’s really starting to look like modern medicine.
Of course they had surgery before that and of course they had different herbal remedies and different things and some of them became medicine as well. But if you’re looking at health before, let’s say the turn of the century, not the last from the previous one, in terms of, you know, you’re getting into 1900s, right? So when we’re really in that turn of the century, you basically got, oh, what’s your definition of health?
Oh, well, I didn’t die of fucking diphtheria. I didn’t die of tuberculosis. I didn’t die of any of these diseases. Yeah, cruel. I’m still going to die in my forties, but everyone dies in their forties right at this time. Right? So you’re at that stage, You’re like, What’s your definition of health? That’s much different than our definition of health today, because we come from a different context, because we come from effectively a different culture like the Cultural Revolution that has happened since then is often just like forgotten about.
It’s like, Oh yeah, of course, like living into your eighties. That’s, that’s the norm when in reality, at least from the Industrial revolution, potentially from the agricultural revolution onwards, like living into your eighties is not the norm, right? If you look around the world, it’s really not the norm for societies that aren’t at the level that our kind of Western societies are us, right?
So we have to look at that and go, okay, well what’s happening here? What is our what is change in our cultural lens in terms of how we view health? Because now if I said, oh yeah, you’re healthy, if you didn’t die of tuberculosis or you didn’t get some, you know, chronic pulmonary artery disease or fucking whatever, you’re like, Oh yeah, you’re healthy.
Whereas you actually have psychological issues. You have, you know, I don’t know any number of things. You know, you’re obese, you’ve whatever going on, like back in the day you were healthy as a result of, you know, just not dying. Now, that’s not how we view things.
Gary
Yeah. And I think it’s really interesting to question, you know, in your own head without being aware of the statistics, like what do you feel are the biggest threats to health in the modern day? You know, because often you find the things things can creep in that you might have thought of ever before. Like, for example, one of the things that I think is is actually a massive threat and it’s something that I would think about, but more than most other things related to health, when I consider my definition of health are things like, you know, moral degradation, the loss of of meaning, crisis of meaning, those types of things in the modern world where
you can see that in our Western developed societies, you know, there’s clearly been a loss of common shared understanding, common goals and those types of things. And you see that in in political division and you see it even around the family dinner table sometimes. An example of that would be, you know, I’m sure you’ve seen people sharing stories of them, like disowning family members or being disowned by family members due to, I don’t know, their political affiliation or due to their vaccination status or due to their perspectives on COVID and so on.
And like those that’s that’s actually quite upsetting and is actually a lot more important than you might think, because if you think of how that like firstly that can cause a great deal of suffering. If someone does not feel like they have any sort of of meaning in life and they don’t feel like they have a purpose to go forward with, or they feel maybe isolated from their family or other people because of those that lack of shared understanding, that can cause a great deal of suffering, a lack of direction, etc..
But one of our other one of the other things that that can do is lead to higher, you know, risk of catastrophic events. If you’ve got a society that is heavily fractured, you know, a lot of political division, you obviously have increased risks then of things like violence, for example, And violence can kill in a moment, whereas diabetes will kill over the course of centuries.
And that’s something that’s always worth considering when you’re considering that lens of health. You know, I think that’s something that’s important anyway. And when you move beyond just, you know, that understanding or when you move towards that level of understanding or I should say what you begin to realize is that the World Health Organization’s definition of a state of complete physical, mental and social well-being, it is, I guess, an ideal, you know, you could call it like a platonic ideal that none of us are ever going to reach, but that we strive towards because that word complete actually makes that very, very difficult to attain.
Because for me, there might be moments, but there’s probably never been a day where I felt that I’ve completely physical, mental and social wellbeing where everything is completely well, you know, there’s nothing that you could improve because there’s always something, you know, you’ve got to worry on your mind about work or about politics or about a family member.
You’ve got, you know, an issue with regards to your financial stability. You’ve got some sort of debt, those types of things, or you’ve just got some knee pain. You know, all of those things take you away from that so-called complete state of wellbeing. And for that reason, there’s been a number of challenges from, you know, The Lancet, from the Health Council of the Netherlands, from Hubler and colleagues in 2011 who basically proposed a definition of health being the ability to adapt and self-manage, which is interesting and is more maybe it’s our definition that we’ll come to at the end is probably somewhere between this and the World Health Organization, because I think that the the good thing about this of health being defined is the ability to adapt and self-manage is it actually puts the individual as as the agent of change. You know, that they’re the person who actually has the ability to affect their health, even just through their attitude, you know. So, yeah, I’ve got knee pain, but I can manage that. It’s not a big deal.
I can adapt to that today, you know, whereas someone else, they might have knee pain and they might actually be, you know, really suffering with that. And it’s significantly affecting their psychological and social wellbeing. Clearly the health effect of that symptom is far greater for that individual than it is for the individual who’s well able to manage that.
You know, So that’s something that’s really important to consider is I guess I guess it gets to the point of not just the presence of a symptom or the presence of an abnormality in a blood test or whatever, but also the effect that that has on the person and their entire life, which is something that’s far more in line with how we would typically view health.
You know, because we’ve got a lot of clients who are personal trainers themselves, for example, and have a very good understanding of their health. And sometimes they’ll come to us with very minor complaints saying, Yeah, my shoulder were sore on the bench press this week, but you know, I made a little tweaks to my technique and I just didn’t perform my last set and it’s all good.
Again, that person clearly adapted to that situation. They were resilient and they self-managed. That for me is what health is all about, you know, And so that that for me it makes that definition quite compelling. But, you know, we’ll come back to our own definition later on. But but yeah, Do you have anything to add in there about you.
Paddy
Know, I think you kind of covered that nicely. Like it’s a very hard discussion to have because again, we’re kind of asking to do the role or to do the job of a linguist, right? We’re actually going like, okay, well, what does health mean? Like we need to define us, right? But how do you actually define something that’s isn’t definable?
Because it is kind of the at the essence of what it means to be human. Like, if you knew what it means to be a human, you know what it what it means to be a functional human. You kind of have everything figured x, you know, and well, yeah, you can be like, okay, well, what it means to be a human is this part works and this part works and this part doesn’t work.
But that’s not always the case. You know, for example, like if you think about just even the definition of life, you might go, okay, well, life is a clear definition. You know, it’s like this is living and this is not. But then you come into these weird, like subcategories or you’re like, okay, this fits some of the criteria, right?
But it doesn’t fit all of the criteria. For example, you might be like, is a virus alive? You know, does this myth meet all of the criteria of what it means to be alive? Right? Like you might have a part of the criteria being like, oh, it’s something that reproduces, right? And that might not be something that it does itself.
Like a virus might not reproduce itself. It might need other cells, like human cells, for example, to reproduce. But even if you use a definition of like, oh, it’s able to reproduce, like what if you have a sterile animal or a sterile human? Does that mean that they’re no longer living? You know, we it’s very hard to come up with these definitions and like to be really concrete in terms of what you actually mean when it is something that’s, you know, at the heart of what it means to be a human effectively, both life and health in this context.
So I think you’ve covered everything quite nicely there and as you as you discussed, like again, the Wikipedia page is actually really good for this. I just typed in like health Wikipedia, you know, and the Wikipedia page is actually really quite good at this in terms of giving you an overview of the history of this stuff, what has occurred to get us to this point?
You know, I’m like, Oh, this is what they used to think about, and this is the definitions that have changed throughout time. And and it gives you a good little overview of what has occurred. And as you said, like the WHO kind of defines health as a state of complete physical, mental and social wellbeing and not merely the absence of disease or disease and infirmity.
And that’s actually quite a good definition. Like if you look at that, you look at it subjectively, objectively, you’re going, okay, that kind of does encompass a lot of what we want, right? That that’s kind of good. And then you have Hoover and I believe with some other people, they come up with this health as the ability to adapt and self-manage.
Right now, you might look at that and read that as the definition and go. Is that really all encompassing? Does that really include everything that we want to include? It might not right? So as Gary said, you kind of find yourself somewhere in the middle or at least, you know, people I’ve had discussions with this with or about this wish and also ourselves.
We kind of find ourselves somewhere in between those two. But yeah, I think I think that kind of nicely covers everything. What I want to do now, though, is I want to do a little bit of a thought experiment in terms of what level of analysis are we talking about. Okay, because this is important to understand and hopefully illuminates why it’s so hard to define health, but also in terms of how you could potentially be thinking about it for application stores, because obviously we’re a podcast that talks to you primarily people that are looking to influence their own health right?
So you don’t want to just have this ivory tower discussion of what does health actually mean, you know, Hoover et al. And all those powers sat down and had to write a paper on that, how to actually sit down and be like, what does this mean? Let’s go through the definitions. Let’s do X, Y, and Z. Like, that’s not what you want.
You want to know, how should this influence my life? How should I change my behaviors, my attitudes, what I do, habits, etc. to influence my health positively? Okay, so let’s break this down into like a a level of analysis. So what level of analysis are we starting with?
Gary
Garth Yeah. So the first level of analysis that we could start with would be, you know, the molecular level. Of course we can start at a much lower level on sex and quarks and even lower than that, we start talking about quantum mechanics. And that’s kind of that might seem like like just a total joke. But at the same time, you know, that that’s that’s kind of where it all starts.
Ultimately, it’s physics and we just take it all the way up. But the the importance of of I guess, including that kind of facetious point about quantum mechanics is to realize that understanding things that are deep at a deeper level isn’t necessarily always better. And sometimes the simple higher level and higher levels of resolution are lower levels of resolution technically, but high levels of analysis.
Which are levels of analysis are actually more useful. So like starting at the molecular level, like what are we talking?
Paddy
Just to interject there, I actually love quantum biochemistry. You know, there’s loads of books on it, but when someone goes to me and goes, Oh, let’s define health, I’m not going oh, level analysis of why your biochemistry is out of whack. You know, that’s not what I’m doing. Okay. Like, yeah, we might start at the molecular level, you know that we’ll get on to that.
But even then I’m like, that’s not really answering the question that we want to answer. Right. Sorry for interrupting you.
Gary
Yeah. So, like, if you, if you start to the molecular level, like, that’s often that can be very relevant in specific diseases. And like anyone who has studied biochemistry, I think for any deal of time, even if you just on one module on it, you’ll often see like these diseases that are used as as case studies like maple sirup, urine disease is a classic one or you’ll have galactose in me are different types of that lysosomal storage diseases, field kitchen area, all these specif very specific diseases that are the result of molecular defects essentially, and.
Paddy
Also ones that generally speaking they’re like one gene.
Gary
At just one.
Paddy
One that’s very simple, like one. There’s not a multiple things going on to affect this, you know, it’s like, Oh, you have this one gene mutation and that causes this. And that obviously dovetails nicely in terms of, as Gary said, you know, you got the turn of the twins and you’ve got this like Human genome project coming online.
You’re like, okay, we have this sorted. You know, they have this. This is a little bit incorrect, but people have this theory of like, you know, it’s basically one gene, one protein. That’s how we view genetics. Now, again, that’s not the case, especially not now. And it wasn’t the case then. But, you know, that was the general soundbite, one gene, one protein.
And that just was not the case when we had all of this stuff fixed. You know, it was like, okay, there’s lots of stuff in here that redundancy back and forth and whatever else, right? And but they do always use these case studies of this is the one gene, one protein at a place or one structure at a place or whatever, because they’re very simple to understand.
Gary
Yeah. And I think I got a good kind of case study for that which, which is relevant and a bit more, I guess understandable than just those bio bio or chemical ones would be probably like cystic fibrosis. I think cystic fibrosis is a good case because it’s effectively related to a molecular defect, which is the cystic fibrosis transmembrane conductor or something.
It basically the CFT gene which encodes for a a membrane protein that’s involved in the chloride channels. And this is you’re starting the molecular level laboratory, you’re looking at the CFT gene, then you’re moving to the level of the cell where you’re looking at the effect that they are the, the absence of chloride channels and then the effect that that has on cellular function.
Then you’re moving to the level of different tissues where, for example, in the lungs you can get excess mucus, for example, as a result of the absence of those toy channels or defective chloride channels. If you look to the pancreas, you know, you’ve got exocrine dysfunction, which effectively means that your pancreas just isn’t really secreting the stuff that it should normally it gets blocked off a little bit because of the defects in those three channels and you’re at the levels of tissues and organs then and then system wise, you think of.
Right, the respiratory system, you can say right this long isn’t working properly because of these defects in these channels. And as a result, this is leading to compromised oxygenation. We’re not getting enough oxygen. This is affecting all the other systems. Then psychologically, what what might that do to a person? It might make them and, you know, feel kind of social dysfunction when it comes to partaking in sport.
That might be a challenge for them. And it might mean that they have to make various dietary changes because the pancreatic dysfunction at the social level, then because of the psychological distress of distress, it might mean that they don’t partake in sports and as a result don’t make those friendships that other people might, you know, So you keep keep taking it up levels from that low level of analysis to the higher level of analysis.
And each one of them matters, you know, and and which one you look at depends on the problem you’re trying to solve. Like in cystic fibrosis. It’s a good example because over the last couple of decades, there’s actually been great progress in terms of specific medications that have been developed and stuff like that. And you actually have to be looking at the molecular and cellular level in order to solve those types of problems.
However, if you’re maybe thinking about, for example, whether or not you should prescribe exercise for someone with cystic fibrosis, you actually might be more concerned that the kind of organ and system level. Okay, because what are we trying to do? We’re trying to maybe improve some of those categories, arbitrary fitness. And it’s not necessarily that we need to solve the problem, the chloride channels, but we might need to maybe make the heart work a bit better, maybe effect some parameters in the lungs and impact the muscles, which overall has a positive system wide effect for someone with cystic fibrosis.
So that’s an example of where you have two different levels of analysis. And then if you have someone maybe who has cystic fibrosis who has been having a real difficult time at school because of not being able to partake in sports, etc., or a psychologist or a counselor or someone in the school might actually be the best person to deal with those problems.
And that person might be looking at the psychological and social level of analysis of that person’s health. So overall, you can see how taking it from those different levels, molecular cell tissue, organ systems, psychological, social and environmental, how that can actually give you a much better understanding of how different professionals might intervene at different levels of someone’s health and how someone might understand their health overall.
Because ultimately, if you think about it, for the individual, you you actually don’t care or are aware of the molecular and cellular are that even the tissue levels like for the most part not really aware of what’s going on. Like you’re not really aware, you can’t necessarily feel that what you feel the effects of it. And it’s the respiratory distress that leads to you, for example, being a bit anxious or psychologically distressed or an activity, etc..
So, so so it’s important to have your level of analysis right before you move on to try to to solve particular problem.
Paddy
I think and this is important to understand for multiple reasons, but to I’m going to note here is because depending on who you talk to, they’re going to have a different view on this. They’re going to be like, say, you come to a biochemists are going to be like, let’s look at this molecular or cellular level. Let’s go.
Let’s see what’s going on here. That’s what they really care about. And this is you oftentimes see this or someone who is a scientist, you know, that’s their their job. They will talk about health related topics and they won’t actually be that. They’ll be talking about mechanisms. They’ll be talking about like almost like we call it mechanistic, hypothesizing.
They’re like, oh, we see this mechanism in the body. It goes X, Y, Z. That’s really beneficial. So we want to encourage that and it completely ignores everything else. You know, it’s like all you’re focused on is the cellular or molecular level stuff, and it’s not necessarily improving the rest of the stuff. Well, yeah, it might improve the tissue or even the organ, but that doesn’t necessarily mean that it’s contributing to your health.
For example, you might see someone, a scientist, say this supplement, you should be taking this supplement and it’s really going to improve your health. Like, for example, in the health, the longevity around people talk about MMN or and or, you know, like take these supplements, they interact with sirtuins and they interact through these two different pathways and they potentially lead to better health.
We’re just say better, longer health, right? Those supplements especially and or really expensive. Okay. So first of all, you might be like, okay, I really want this benefit that these guys are hypothesizing about that is shown in like animal cells or animal models or whatever. You know, like I want those benefits right? But the cost of this could actually have a much bigger influence on your life because now you’re like, okay, well, I’m shelling out, even if it’s just whatever, £100 per month on this stuff, that’s still like 1200, about 1300, depending on how you count a month pounds per year.
Right. So that’s now money that you’re not able to contribute to potentially your pension could potentially contribute to your house. But then she contribute to your children or other tasks. Right. What are the things that you’re like, Oh, I want to do that. You can go on holiday this year because you just spent a grand and a half on a supplement that might not even work, right?
So first of all, we have to look at that. Okay. Who is giving this information? Are they are they actually dealing with the media consequences? Are they actually dealing with people that are seeing benefits from this stuff or are we just not this kind of tissue, molecular or cellular level where we’re like, yeah, we can see some stuff when we put some stuff on some cells in a petri dish, right?
So that’s the first thing we have to be aware of who we’re talking to. Okay. And then also, it’s really important to understand because some of this stuff, we have impact over some of this stuff. We can be like, okay, this is within my individual purview to look after some of this stuff. It’s in my purview to look after.
But unfortunately I’ve just been dealt a shit card, right? Like you could have a genetic mutation unless we have some sort of gene therapy that can change that. Unfortunately, you just have to deal with that. Right? But either way, you are still able to change your habits, change your lifestyle, change whatever to lead to better health. Right. But we have to still go back to that and go, well, what does better health mean?
Right. Again, it goes back to what does better health mean for an individual that doesn’t have whatever mutation it is or whatever gene de fact or whatever, and versus what health means for someone that is not doesn’t have this this gene de facto gene mutation. Right. Again, we go back to that cystic fibrosis. What health means for someone that has cystic fibrosis might be completely different than what someone means by mouth when they don’t have cystic fibrosis and they’re just like, Oh, yeah, Like health means I’m able to, you know, go out and play football with the lads twice a week or whatever it is and person with cystic fibrosis means.
Yeah, my definition of health is not dying this year, you know like completely different sides of a perspective. So we have to be aware of that. So both from an individual perspective, what are we looking at when we do this level of analysis? But then also when we’re consuming information, we have to think of, okay, well, what is this person that’s giving this information?
What level of analysis are they looking at and what ramifications does that have downstream from upstream? Depending on how you want to look at it, You know, check.
Gary
And I think one other thing to to add here, which is actually quite useful, is I guess looking beyond the looking beyond the neutral definitions of health, because I suppose if you look at the neutral definitions of health, like, for example, the World Health Organization, we’ve got a state of wellbeing, I guess that’s positive. And then you’ve got health, the ability to adapt and self-manage, Then you’ve got one that I think is is really interesting to ponder, and that is basically the idea of flourishing.
And there’s a good paper on this by Vanderbilt in 2019 and other authors. But effectively what what they propose is this understanding of health in terms of flourishing and that that being again, that ideal that we’re looking for and the term flourishing used for thousands of years and literally meaning to grow or to prosper represents a powerful way to view health in its fullest sense.
That’s what they claim. Okay, but what do they actually mean? So what they try to do is, you know, put together a number of different domains and they’ve got questions or statements that are flourish there. It’s affected their following measure, a flourishing measure. And I’m just going to read out a couple of them because I think it’s worth at least pondering these when you’re questioning your own health, because it doesn’t it doesn’t necessarily always come into how we think about health.
So the first domain is happiness. Okay. And the question is, overall, how satisfied are you with your life as a whole these days Then in general, how happy or unhappy do you usually feel then, mental and physical health in general? How would you rate your physical health? Now? One thing I suppose to interject on there is that the really important thing here is that sometimes when you get into these domains of understanding health in terms of flourishing, you could actually be overlooking things that are actually detrimental to your health because, for example, in general, how do you rate your physical health like, it’s not so clear how to reconcile that with the understanding that most
of the diseases that are a burden on the health care at the moment are chronic long term diseases, that you don’t feel something’s really important because you could have high blood pressure and just not know, okay. And it could be a significant threat to your health. And if you just race how you feel or how you rate your physical health, you might be like, Yeah, it’s fantastic.
I’ve never had any issues, but that 160 over a hundred blood pressure could be pumping away in the back ground and putting you at high risk of stroke. Okay. So that’s that’s something that I would just interject on there. Now, the other things that they mentioned are.
Paddy
This as well. To really put that in context, like if you’ve never been quote unquote healthy, how the fuck are you supposed to know what that feels like? Yeah, you know, like if you’ve just always been say you have a potential for a ten out of ten health and you’ve just always been out of three, right? How do you know what being healthier feels like?
Three for you? You’re like, Great. I feel fantastic here because, you know, I’m not falling apart, right? That’s your best ever. You’re most well rested, etc. Is a three out of ten, right? You’re dehydrated, you’ve never exercise, you’ve done whatever. But it’s still the best health that you’ve ever been in, you know? So you’re like, yeah, I’m in my best health, right?
But it’s not the best you could potentially be. And this is also further confounding and we didn’t dig too much into we might go back in a second. And in terms of your environment as well plays into this because again, if you’re up three out of ten, right, and everyone else around you is also three out of ten or potentially a two out of ten, right?
There are two at a ten. You’re going to be like, Wow, I’m in fucking fantastic shape. You know, I’m in the best health of my life because your context for your environment for that is set up in such a way that you’re like, Oh, these other people have far worse off than me. But that doesn’t necessarily mean that you have good health.
Gary
Yeah, absolutely. And I think a lot these questions do get at some messy areas. And the next one is just how would you rate your your overall mental health, you know similar similar issues there. The next is meaning and purpose, which is something that’s interesting and kind of goes back to what I said previously. And the questions that they ask are overall, to what extent do you feel the things you do in your life are worthwhile?
And then a statement they make that you agree or disagree with or to a certain degree is, I understand my purpose in life. Okay, Again, like really difficult. Okay, Really difficult to try to pin those things down. Character. I always act to promote good in all circumstances, even in difficult and challenging situations. Again, so difficult because have to then answer what does it mean to to promote good?
You know, is it just a personal moral conscience? And is that something that you like to be influenced by others, by your society.
Paddy
Who taught you morals?
Gary
Absolutely. So that that’s that’s such a difficult one. But but I actually think that I like I’m saying it’s difficult as in it’s challenging. I’m not saying that these shouldn’t be considered within the framework of health because I absolutely think they should. And I think that as as health care professionals or as people who are concerned about our health, I actually think it’s really important to consider that stuff, which is why I mentioned previously that questions around your meaning and purpose in life.
And, you know, shared understanding with others and seeing not dehumanizing people and stuff. I think that all of that is incredibly important for health and I think that it should be discussed. So that there are other points, then I’ll just play through them. I’m always able to give up some happiness now for greater happiness later. Really difficult thing to do, but definitely a marker of maturity, I think.
And total social relationships. I’m content with my friendships and relationships or relationships are satisfying as I would want them to be. And then finally, financial stability. How often do you worry about being able to meet normal monthly living expenses, and how often do you worry about safety, food or housing? Again, interesting questions, but you have to ask yourself there.
You know, are they the only things I worry about? Is it just safety, food or housing? You know, does that vary by the country that you live in? Are they are they the only needs that you’re trying to meet? Because many people would say that, you know, safety, food or housing are are very basic needs. And for many people in the West, if they could only meet that, they still might have a lot of anxiety about their financial stability and everything.
Whereas if you were to ask if you were just give someone in a very undeveloped, underdeveloped nation, safety, food and housing, they’d be, you know, totally content. That’s what they’re fighting for. Okay. So again, social context matters. As you can see, these questions, if you were to go through them, I think they should be used as sort of like a life analysis type of thing where you basically review where you’re at what you need to work on rather than trying to come up with some number out the other end saying, you know, I’m 70% healthy or whatever, but look at that table.
We will include all this in the podcast notes so that you can review it anyway.
Paddy
Yeah. Just also you have a question there as well at the end with flourishing self-care. So I ask you.
Gary
Which is what? Where’s my question? Oh yes, yes. So yeah, as I said so Oh wait, no. Is this the. It may seem esoteric. Yeah. Yeah. And so may seem esoteric, but do you really care as much about your blood glucose reading as you do about how satisfied you’re going, how satisfied you are going to work each day, or the quality time that you spend with your family?
Okay. That’s something that, again, really important to ponder, because very often what we do, especially those of us who are, you know, in the fitness industry, working in the fitness industry, will start to measure all these different things, like our blood glucose, heart rate, variability, resting, heart rate, etc.. And we have all of this idea of what’s going on in our blood, but we don’t know what’s going on in our heart or in the hearts of our family members, you know.
And what I mean by that is, you know, like, do you really do all of the things that that that bring you joy and that bring you that kind of that lasting sense of purpose and meaning? You know, are you are you really nourishing those things? Because sometimes what we can do when we get so hyper focused on on micromanaging our health is that we forget about the more macro things.
And we can spend so much time trying to measure our blood glucose that we don’t spend time with family and that we don’t share our meals. And an example of that, it’s obviously it’s such an obvious one that I’ve seen so much and that is where someone just prepares all their meals, eats all their meals alone and misses out on something so simple as just sharing a meal with your family, which can just be so incredibly valuable.
And to be honest, in your early twenties or early in your training career, like some people get into training in their thirties and go through that obsessive phase, it can be very easy to to focus on all that stuff. I think most people, they do come out the other end and realize that maybe some things are more important and they need to find some balance between their very strict diet and, you know, living a more normal lifestyle, eating with their kids or passing on good food practices.
The classic example we always talk about in the podcast is, you know, if you if you’re fasting until like 4 p.m. in the day or 6 p.m. in the day or whatever, like it’s not something you pass on to your kids. Do you want them to see that like not eating standard meals is, is, is a good thing.
Is that normal? Like, do you want to pass that on? I’m not so sure like not many people would. And that’s just something that we begin to ponder, I think, as we get a bit older. And in my old age now, I’ve begun to realize that at a very worn out 26 years of age. But yeah, look, it’s it is what it is.
Paddy
That’s very harsh. So basically what we’re saying at this point is, okay, we can categorize, we can lump things together and we can look at it in terms like what kind of structural or physiological health. And you can be like chase these different markers, right? Maybe you even go a little bit beyond that and go, okay, that’s just emotional or what we call a psychological.
All right. Okay. We’ll lay it on. Right. We can also look at it in terms of environmental health. And what I mean by this is not just like environmental toxins, for example, but I mean, like how is your environment set up to actually support your health, community, society, you know, your social situation, all of that stuff as well.
And obviously there’s a lot of components to environmental. We’re not going to get into all of them because, again, like we could be talking about this from a policy perspective, you could might maybe want fantastic health, but the policies that are set up in your country or whatever are not conducive to good health. But either way, that is a component to all of this stuff.
But there are a few wrinkles that we need to kind of iron age when we’re discussing this stuff. And we kind of were just touching on it there. And the flourishing concept really helps you kind of cut through a lot of the noise. Now, I don’t think it answers all the questions we would necessarily want it to answer, but it helps you really start analyzing this a little bit deeper.
Right? For example, there is something that we would call now maybe. Well, we’ll put it in these terms. When you’re looking at your health, a lot of people will look through it in terms or look through it to from the lens, I suppose, of I want to maximize the duration of my life. I want to live to 100.
Now that’s what I want, but that’s not necessarily what you want. If it means that you don’t feel great, you don’t have a great connection with people around you. You don’t have your environment set up correctly, you don’t have all of these other things and you’re just barely hanging on to 100 years old because you’re like, That was the goal.
That’s what I see. Is health a long life, right? Other people will be like, I want to maximize the intensity of my life, right? And they want to maybe they don’t care about trading off a couple of years at the end because they’re like, I want to really just get the most out of my health, my body, whatever.
At this time, for example, you might see people to give those to camps. You might see people in their twenties go on a lot of like steroids, a lot of different drugs, because they’re like, I want to, you know, literally be as big as I want or do all these things sporting whatever, all of that. And they’re like, Right.
The intensity of my life, the amount that I’m packing into a single day, a single week, a single year, whatever you’re like, I’m really maximizing that, right? It’s hard to say whether which one of those is healthier, whether maximizing the intensity. And you’re like, this person lives the most vibrant, really full on life, you know, versus the other person.
That’s like, I want to really maximize the duration. And you often see this in the the healthy longevity world where people are like, Oh, I fast for weeks, you know, I fast for days, I take different drugs, metformin, myosin, and they take all these different drugs and you’re like looking at them like they have literally this gray skin.
They look terrible. They look like, you know, they hate life. They’re just cold all the time because their metabolic rate is so low because it like a higher metabolism. You know, you don’t want that for a long life. And they’re doing all these things to extend their life. But the intensity, you know, it’s just not there. It’s just not they’re not living vibrantly.
Right. So we have to look at this in terms of we actually be pretty clear in terms of our definitions of what we’re actually looking to achieve. And it’s really hard because there’s so many levels of analysis for this stuff. Right. Are we looking to add years to our life or are we adding more life to our years?
Right. And again, a classic example of this is you definitely have met know someone or vaguely know someone or heard of someone that you know. They’ve basically been surviving on a life support machine for the last ten years of their life, you know, And it’s like their their quality of life is just not there. They literally lay in a bed for ten years.
You know, it’s just like they they really didn’t see their family. They didn’t enjoy it. They couldn’t move. They couldn’t do X, Y and Z. And for some people they might argue and say, Oh, well, that person just had a terrible life, right? They just you know, there’s no quality to that life. But the thing about it is it’s very hard to say whether that person is healthy or not.
They obviously they’re on a life support machine. You could argue that they’re probably not in a health household per position, but that person might just fucking love doing mental arithmetic. You know, they’re literally just sitting there doing the most fascinating complex in their maths and they’re just like, they’re loving life, you know, you don’t know. So you cannot make a judgment on that without the full picture.
And unfortunately, none of us will ever have the full picture because we didn’t create life, you know, we didn’t make this stuff, you know, But then also and you were you were talking about this before the podcast, that you can view health through this kind of via negativa versus via a positive lens like take it Away. You can you can probably dive into a little bit deeper.
Gary
Yeah. So I mean, like I kind of use that, that terminology and in a couple of different senses and I initially got it from, from the scene to lab, the way he talks about DNA via Negativa. But effectively, you know, you could look at the negative, the real positive lens in terms of what you take away addition or addition through subtraction and then via positive addition through addition.
Okay. So for example, via positive interventions might be things like am adding in loads of additional drugs to prolong your life. Like you said, you know, metformin, rapamycin, you know, making hypotheses that if you target these specific pathways that it’s going to enhance your life. So you’re adding in.
Paddy
Going back to that analysis, we’re like looking at this cellular molecular stuff and going, Here’s a drug, let’s take this.
Gary
Yeah. And I saw it’s about adding new things. And that’s something that you see as I think at that crossover between health care slash functional medicine and especially that kind of new tech Silicon Valley type of space, that’s where you see a lot this start to creep in, where it’s all about doing more like for example, wearing a continuous glucose monitor to try to hack that, you know, the whole biohacking space.
It’s all about what we can add, what we can do, what we can change to try to become healthy. And to some degree that works. Clearly, we have to add some things in order to be healthy. An easy example of that would be something like I’m polyphenol content in the diet, you know, through olive oil or dark chocolate or blueberries, for example.
Paddy
Or even exercise. You might be not exercising out in an exercise boom.
Gary
100% and adding these things and to your adding adding poly polyphenols, for example, or adding exercise to your life, they have benefits above and beyond if you had lived without them. So, for example, polyphenols in the diet would be considered nonessential. Okay? They’re not part of the essential nutrients. They’re not necessary for life, but they have a positive effect when consumed.
Okay, So they’re adding something else. Same with exercise, You know, and an easy example is weight training. It’s adding muscle mass above and beyond strength, above and beyond what you’d expect the average person to have if they were to live a normal life. Now, clearly, there’s a very, very strong argument for adding things in for the purpose of health.
Now, the other side of things is actually simpler and often what we try to target with our clients because Via Negativa is actually asking yourself what’s harming me and how can I practice harm reduction? Okay, for example, I live in an area I don’t, by the way, but let’s say someone lives in an area with very poor air quality.
If they were to move or the air quality was to be fixed tomorrow, that would be have a massive impact on their health. They didn’t have to spend extra money unless they bought a new house. They didn’t have to add any supplements, add any drugs. They just had to remove something that was harming their life, giving up smoking, giving up alcohol or drinking alcohol less, giving up the overconsumption of food.
Obviously all these.
Paddy
Things function of social media.
Gary
Yeah, 100%. The overconsumption of social media. You know, if you if you get up in the morning and you’re scrolling Twitter and you follow all political pages, like that’s not good for your health regardless of your political beliefs, because it’s no one that is like into politics at the moment is like getting joy from political content unless it’s just memes, in which case, please continue.
But you know, for the most part, if you’re scrolling social media for hours and hours per day and just consuming, that’s generally something that’s that’s detracting from your health. So if you were to take that away, your health improves via negativa and not only that, but a lot of the removal of certain harms, like, for example, time spent on harmful activities leads to you being able to allocate that time to something else that’s potentially more helpful, which is just fantastic for your health.
And the other thing you know, might be you might be in a position in your life where you’ve been working for 20 years already and you actually just crushed yourself in your twenties. You saved loads of money, you worked 80 hours a week and you might be in a position now if you were to reduce your working hours to, I don’t know, 25 hours a week, you know, and you start reading more in your spare time or take up baking or crochet or whatever that, that actually be a net positive for your health because you’re financially stable.
You don’t need the money anymore. You’re just kind of been it’s been a path dependent life. You know, you worked really hard. You got the position and now you’re just keeping the position, but you have the option to step down. And if you were to do that, that might give you better health long term because you’re reducing your stress, you’re potentially going to sleep more, etc..
I’m sure you can think of countless other examples, but very often it’s actually those via negativa interventions where you’re adding something to your health by subtracting something that’s harmful that are the most powerful because you don’t you generally don’t have to go spending more or adding loads of into your routine. The place I talk about this most, I think with clients is when they’re talking about stress management, because some people make stress management just stressful.
Like, Right, I need you to wake up in the morning and meditate for half an hour. How am I going to find time to meditate for half an hour? You know, and all that’s happening is you’re just running through heading and everything’s more stressful. Okay. Or other types of interventions. You know, a lot of these people with elaborate two hour morning routines for stress management, when for most people in the real world, that’s just not going to cut it.
Okay? Whereas if they were to apply to be a negative approach, maybe they might be having a wind down routine at night by not staying up watching Netflix or something like that, or it might be taking a few hours off work on a Friday so they can do something meaningful, whatever it happens to be. That tends to be more powerful.
Paddy
Yeah, 100%. And look, there’s not lot. We’re going to come away from this podcast and be like, Here’s everything we covered. Absolutely everything. You know. And what it does, it was they’re thinking about for you as an individual in terms of what are you aiming for with your health, right? And then how are you actually going about achieving that?
Are you just thinking of it? What can I add to this? What can I do? What can I do to do more? Do more here? Add in here. That might be you kind of missing the forest for the trees. It’s like, okay, let’s do this analysis of your life and know these things are clearly distracting for them from your goals, from what you want to achieve as a result of that, you’re more stressed, you’re not sleeping as much.
You don’t have as deep, meaningful connections with people because you’re never really present. You’re always on your phone, for example, like these different things is like, okay, you potentially would benefit from just taking away a lot of these things and you would have a much higher quality of life then as well, right? So that’s not necessarily going to be shown on a blog panel.
So we have to look beyond that, right? We also have to consider that some individuals, they’re not necessarily looking to be average some individuals are looking to be the pinnacle of health. Right. And there’s going to be shades within that. So potentially for an individual just to get into the we’ll call it the reference ranges for health, although again, I don’t think markers are necessarily the be all and end all.
But let’s just say this general reference range is for health. They’re based on averages, right? So if you just want to get into them, yeah, you’re in a healthy position. But there’s other individuals that want to be like, I am at the best position within those markers. So for them simply removing certain things, maybe it’s not going to call it that.
You know, maybe they’ve already got rid of all of the things that are detracting from their life and they already have their life set up in a way that is, you know, relatively on point for them, then, yeah, you probably are going to have to add something in, you know, put the thing about it is you kind of have to get the fundamentals done first before you can upgrade to the bonus features, you know, because yeah, you can go get the bonus features now, but if you get a fantastic stereo system in your car, that’s cool.
You’ve bought the stereo but you don’t have a car, you know, like you have to do, you have to get the car first. You have to do the fundamentals. You can’t skip ahead of this stuff. You know. So look, there’s a few other things that we want to cover in this. I am aware that it’s, you know, getting on and the first thing I want to cover is, well, effectively what our view of health is.
So where do we stand with this Gary?
Gary
Yeah. So before we get to our definition, what I want to mention quickly is the fact that health doesn’t have to be number one, okay? It doesn’t have to be your first priority. There’s very valid cases for not prioritizing your health. Okay. And I put that out there as someone who is obsessed with all things health, my whole life is effectively around surrounds, is surrounded by things that are related to health, whether it be my medical studies, triage, our work, my own personal exercise, nutrition.
Clearly I care about a lot, but someone throws a grenade into the kitchen while me and my family are having dinner. I’m going to dive on that shit and be blown to a million pieces of skinny guys all over the kitchen. Okay? Because clearly there’s things that are more important. Okay? If if we’re on the London Underground at the weekend and there’s a suicide bomber standing next to Paddy and he’s about to get blown up, he’s probably going to do it first.
But I’m going to I’m going to hug him or her pull and get absolutely blown to pieces all over the lot.
Obliterated. Okay. So carry this things that are more important than health, whether that be your own personal idea of honor or sacrifice or maybe you’re a very religious person who would, you know. Absolutely be burned at the stake before denying your god or something along those lines. Those types of things can absolutely be put ahead of your health.
More simple kind of normal example without having two pictures of being blown up might be, you know, if a family member became sick and you had to become you to take on the responsibility of caregiving, for example, and that you knew that was going to be a trade off in health because you might enough time to train and you’re not going to sleep well.
You’ve to be looking after them. You’re willing to accept that trade off because health for you are feeling good every day is not necessarily more of a priority than looking after those that you love obviously parents know this, okay, day of day sight make massive sacrifices to their own health for the purpose of their children. So clearly, it’s not just about taking health and making your whole life about your own health, because that can sometimes have the opposite effect long term.
If you’ve become too selfish long term to self-centered, you might miss out on some things that are protective later in life. So that’s just the first thing. I’m sure you agree, huh? Yeah. So with regards to how we think about health, clearly we’ve made a lot of this fairly explicit so far, but I’m just looking for your your little definition that you wrote out of your body.
Oh, yeah. How we view health. So this is effectively a very simple way that you can see is influenced by the previous definitions. But health is resilience to and against insults to your life and wellbeing. I love that because the resilience element, it goes back to the previous definition from Hooper and colleagues, which was the ability to adapt and self managed and the resilience to and against insults to your life and wellbeing, those insults potentially being psychological, potentially being and your your lipid profile or your blood pressure, etc. It’s that your resilience to and against those insults.
So resilience doesn’t necessarily like resilience sometimes is the connotation of just grinning and bearing it. You know, and just being tough and not dealing with it, But being resilient to a health insult might also be right. I’m going to get myself to the hospital. I’m going to get this wound dressed and get this fracture, you know, set in place and cast it.
And I’m good. I’m resilient. I’m ready to go again. You know, it’s not about you never getting any sort of illness or any sort of injury. It’s that you’re resilient to it. And I think that the important thing there long term is that if you’ve developed, I guess, what you might call a reserve of resilience through physical activity, strength training, good nutrition over the years, then you’ve got that capacity that if you do get, let’s say, a chest infection and you’re hospitalized for two weeks and you’re bedbound, you come out of that better off than someone else who hadn’t trained and eaten like you did for for all those years, because you’ve effectively got that reserve. Okay? If you lose 10% of your muscle mass, it’s not a big hit. So you’re resilient to that insult because of those healthy practices over all of those years. You know, there’s many other examples, I’m sure that that you could think of, for example, that fact that let’s say it doesn’t even have to be muscle mass specific, because one of the things that you do see as well is that as people get quite old, like in their, for example, like being frail, it’s probably more of a problem than being obese.
Okay. It’s not always the case. But if you go to the hospital and you’ve actually got some spare body fat, that actually gives you resilience to losing body weight rather than becoming severely malnourished. So again, that’s an example of how one might be resilient and how your idea of health might actually need to vary across the lifespan as well.
You know, I think that that’s something that the layperson often identifies. You know, my parents will often say, you know, he he doesn’t look well for a man of his age, like the classic one is like a man in his fifties or sixties. My parents will make a judgment that they at it’s like my mom in particular. If a man in his fifties or 60 is just like real frail and gaunt, that doesn’t have the same positive connotation as someone who’s maybe in their twenties and thirties and really lean, it’s kind of a bit different.
And that’s partially true from a health perspective because that person’s pushing into that stage of their life where they’re already naturally movement losing muscle mass. If they had a bit bit of extra body fat, it might actually be beneficial for them because they have the potential to lose weight as they age. So, you know, my mom might say, Oh, you know, it’d be nice if he’d have a fuller face on it, you know, a bit of a bit of strength to him.
You know, she might necessarily know what exactly she means in terms of like the health statistics and stuff, but there’s truth there. And that’s why we don’t want people getting too frail when they get older. And so, yeah, that gives you resilience. I’m sure there’s other examples.
Paddy
Yeah, like we resilience, I always think of it as well, and this is why I chose those words carefully for this. I always think of it in terms of, first of all, there’s an inherent building quality to resilience. You know, like you’re resilient to future insults, you know, like what you’re accomplishing now is helping you build towards being more resilient in the future.
So I really like the word resilience, but obviously, again, like words shift over time and, you know, people have different, you know, context for the word, right. But I also feel with the word resilience, the way we phrase it there in terms of resilience to and against insults to your life and wellbeing like this could be, again, like, as you said, physical, psychological or social whatever.
But if you had someone that approached a problem would have resilient mindset. In my mind, at least that means they’re approaching that with first of all, a level head, but also a lack of fear. And I don’t mean just like a complete lack of fear, no regard for their own health or their own safety or whatever. But what I mean is like they are coming to this going, okay, well, whatever happens, I will deal with this.
You know, I’m resilient to what’s happening. For example, like you’ve seen this all the time with the last two years of COVID. People will be extremely scared of COVID and other people will be extremely scared of the vaccine, you know, whereas a resilient person will be like, I’m not necessarily scared of COVID because I exercise, I eat well, I’m yong fit, etc. and I’m not necessarily scared of the vaccine because, you know, I don’t think Big Pharma is going to inject me with a whatever, Right.
Or, you know, I don’t think the vaccine is going to kill me. Like I got COVID and I got the vaccine. And neither we’re an issue right? So I’m coming from the context of having both. So you know what I mean? So it’s like, that’s a resilient person. Now, the thing about the resilience is it is an attitude as much as it is an actual expression.
And what I mean by that is, look, you could get COVID using that same analogy. I was just using you could get COVID and have a fucking awful time of it, you know, like it kills people, right? You could also get the vaccine and have a vaccine injury. You know, like I know a guy who had a stroke directly after the vaccine, you know, So it’s like these things happen, right?
But the guy coming into that with the resilient mindset goes, okay, I’m going to deal with this whatever comes my way, and then I’m going to build for the future off of that, right? So I really like, again, the word resilience, and I think it fits in nicely with that overall definition in terms of health is resilience to and against insults to your life and wellbeing.
And again, with that kind of insults to your life and wellbeing, this is important to understand. And we’re going to finish the podcast here, just talking about some of the determinants of health, but this is also relevance to future discussions when we talk about the different things that kill people, right? Because people have a very hard time understanding that this is more important to focus on because maybe it doesn’t kill them straight away, but also that means that some things do kill you straight away.
For example, as we discussed a couple episodes ago, I believe, and for debt statistics in your twenties and thirties, one of the highest things that can kill you is like interpersonal violence, right? So if you’re going to be resilient to and against insults to your life, we’re not just looking at diseases. We’re not just looking at this, you know virus that in and yeah, or the water or whatever we’re going okay well other humans could kill you, right?
Or cars could kill you. Right. So how do we how do we deal with that? How do we become more resilient to that? How do you protect yourself from that in the future? You know, so it kind of is nicely all encompassing. Now, obviously, look, I’m an idiot. Gary is an idiot. I just came up with this definition.
I think it fits nicely. Gary likes it, but I’m sure someone out there could pick that apart, be like, No, this is not. This is not you miss this, blah, blah, blah. Right. But that’s not the point of it. We have to actually deal with clients. We have to deal with people in front of us. And we talk about these kind of three pillars that we often talk about with all this health and fitness stuff.
We’ve got health, we’ve got performance, we’ve got body composition, right? So if this is one of the three pillars here that I’m talking about with clients, every time I feel secure client pretty much like we have to have some sort of working definition for that that allows us to look at what we’re doing and how we should go about achieving the overall goals.
Right. And I’m trying to add on to that.
Gary
No, no, that’s all good.
Paddy
Fantastic, right? So I just want to finish this on just a quick overview of the the few different determinants of health that are often cited. We’ve gone through quite a lot of them already in terms of the different stuff that we’ve covered, and we will definitely be covering these again in the future, right? But there’s a few that are often cited and I’m going to go through these purely because you’ll see a lot of this stuff is within your control, but you’ll often also see that a lot of this stuff is outside of your control.
Right? And it does all impact on your actual health at the end of it, right? So the first thing is income and social status. Right now, parts of that are inside your control. A lot of it is outside your control as well. So we have to be aware of that, that it influences your health 100%. Those right social support networks, again, some of that is inside your control.
Some of it’s not, you know, like if people just don’t like you for whatever reason, like your I don’t know, an untouchable in Indian society or something, it’s like, know you don’t even exactly have this great social support network. Right. And your education and literacy like that literally can directly kill you. You can have poor reading comprehension skills, read something wrong, take too many pills and die on the spot, you know?
So that kind of stuff is important, you know, or road work ahead and you just blast out into traffic because you can’t reach, you know, employment, working conditions. Again, they impact on your health. This is obviously relevant, but you definitely will see this throughout your career in medicine as well. Very. You know, it’s like your employment, working conditions.
You’re basically sacrificing some of your health as a doctor to benefit others, you know, So again, you might not be thinking of it in terms of like you work in a coal mine. Obviously your working conditions are not going to be conducive to health, but It’s also in every other career as well. You could be a pilot and you’ve got this circadian shifting all over the place.
You know, you’re also exposed to radiation up there because, you know, there’s less ozone. Ozone, what am I saying? There’s less air basically up there, you know, less protective stuff between you and the sun, you know, So different things like that we have to be aware of. Right? Your social environment’s like, do you socialize? You might just be someone that’s a very common thing.
Like, I live in London, so I see this all the time. People will literally go to work and nowadays it’s a lot of work from home. And then all they do is watch TV afterwards. You know, it’s like that. You didn’t socialize with another human that entire day. You know, your physical environments, what are they like? Obviously that’s important for your health, personal health practices and coping skills.
And that’s a lot. The stuff that we focus on with our coaching in terms of like, let’s get your personal health practices in a good place, coping skills that kind of goes along with the coaching process. A lot of that is also outside of our scope in terms of you might need psychological support and healthy childhood development. Again, you’re kind of all conscious that if you just had a poor childhood development, like a lot of that is just completely out of your control, that you were just born into a certain circumstance, you know, your biology, your genetics.
And again, we talk about that. You might have it like a single point mutation and then all of a tick. All of a sudden you have this inborn error of metabolism that completely changes your whole life. Like, again, like we said, briefly touched on about fetal senile to an area like you might have that and then you’re not able to have any fetal right And you might be like, Oh, that’s fine.
But that never influences a whole host of other things in your life. Okay, yeah, you can get it under control, but now you’re never able to have like a Coca-Cola. You know, you have to look at the different food sources that you have. You probably need a lower protein diet, so maybe you’re not able to build the muscle mass.
You want to maybe you don’t reach higher levels of growth in childhood because protein intake is very highly correlated with childhood growth. So all these other things, you know, and that’s just a single point mutation, right? Health care services, what are they like in your area? What are they like in your country? Right. You’re gender based off those influence.
Your health is a determinant of your health for a variety of reasons. Again, we’ll talk about them in future. Your culture itself, right. Again, you might come from this real macho culture that goes, I’m never going to go to a doctor. I’m not going to go see a doctor about whatever health issue. And I was a result of that.
You have poor health outcomes because you never actually got and tested. You know, you never actually interacted, even though you should have. You’re like, oh, this mole on my arm, you know, it’s looking a bit all over the place. It’s been growing and it has no defined edges. You’re like now not, you know, like someone that cares about their health would go to a doctor, right?
That’s right. So a lot of those practices, as you can see, they’re a sign of your control as an individual. But there are also a huge amount of things that are inside your control as an individual. Right. And we will this is become really apparent and really obvious when we do go through the different things that humans die of.
Right. Because that really brings this home in terms of, oh, there are some things that are really protective that we can do and, you know, are relatively free. A lot of times that will really profoundly influence our health. Right. And this is why we generally like focus on sleep, nutrition, exercise and stress management as our foundational. Like these are the things that we care about, Right?
And if you go through the last like two years or whatever of the podcast, that’s what you’ll see us talk about the sleep nutrition, exercise, stress management. We constantly come back to them and we’re going to keep coming back to them for the next ten years as well, right, Because they’re so foundational for your health. And again, you can get really esoteric and look at these different things, this molecular pathway or whatever.
But if you don’t have those like four foundational pillars, we’ll call them sorted, it’s kind of irrelevant. You know, you need to get those lifestyle practices in place, right? And they kind of need to be in place first. That’s not necessarily true before you can really start encompassing all the other stuff in terms of your relationships with others.
Right. And I’ve said this before, but if you’re starving, you’re literally hungry, you’re cranky, you probably don’t have the best relationship with other people. As a result of that. So that’s impacted by our nutrition, but it’s also impacted by our sleep. If you’re just under slept chronically, you’re not giving the most to those different like social events socially, using your friendships, your potential, love, interest, whatever it is, right?
So it comes back to looking after yourself so that you can really start to get all the other determinants of health in place. And you can really start to get a broader view of the analysis because it’s like on a plane, if you have a child with you, they always say put on your mask first. The reason is because, yeah, you can be fondling way, putting on your child’s mask, not get it on and two of you die because you’re not breathing, they’re not breathing.
They didn’t get their mask on properly. You weren’t able to secure their mask when they ripped it off because they’re looking child and that’s what children do. And so you need to get your mask sorted first. And it’s the same with this. Once you get yourself sorted, you get these fundamental pillars sleep, nutrition, exercise, stress management, you get them sorted, and now you’re able to tackle all of the other stuff, all of the other determinants of health and also all of the different levels of analysis we can go through.
Right. So do you mind add to that, Gary, and if not wrap this up?
Gary
No, I think that just about covers it all. And as you said, we’ll be back again with further discussions, specifically those related to, you know, what health conditions and diseases you should be concerned about and I guess more specific practices or protective factors there. So as we said at the beginning of the podcast, guys, make sure that you’re subscribed to our email list and also part of the free Facebook group.
Again, it’s free no catches free information, beneficial information. If you care about your health, you’re likely to benefit. We do also put out free information on social media, so make sure that you follow us on Instagram triage method. You can also follow the triage method, YouTube channel. You’ll see excerpts from the podcast on our YouTube channel, which is really helpful.
Some people don’t have enough time to watch full episodes or listen to full episodes, so we’ve gotten great feedback on some of the snippets that we’ve been putting out that have, you know, allowed people to on the things they want to get from the podcast a bit more. So that’s useful, of course, if you’d like more specific guidance.
We do have coaching spaces available. We’ve got a full team, excellent coaches, all of whom have spaces available at the moment. So if you’d like full nutrition coaching, full training and nutrition coaching, you’d like to focus on training in the presence of pain or injury, any of those types of problems. We help clients through that so you can get in touch.
The information will be in the description box below. And also one final thing is that on Spotify now Spotify do ratings just they just out of them recently. So if you would be so kind because I know a lot of people listen on on Spotify, what you could do is leave a five star review. That’d be fantastic. Okay.
That’s what we want to see that five star and I that 4.2 or 4.3 or something like that. I want to see that those five stars. So give us a review there. That is fantastic. And we promise a lot very, very valuable content on the podcast in 2022.
Paddy
All right, Enjoy yourself, guys.
References and Further Reading
https://en.m.wikipedia.org/wiki/Health
Brüssow H. What is health?. Microb Biotechnol. 2013;6(4):341-348. doi:10.1111/1751-7915.12063 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3917469/
https://www.hsph.harvard.edu/nutritionsource/disease-prevention/
Cohen, R., Bavishi, C. and Rozanski, A. (2016). Purpose in Life and Its Relationship to All-Cause Mortality and Cardiovascular Events. Psychosomatic Medicine, 78(2), pp.122-133.
Health Council of the Netherlands. Publication A10/04.www.gezondheidsraad.nl/sites/default/files/bijlage%20A1004_1.pdf.
Huber, M., Knottnerus, J., Green, L., Horst, H., Jadad, A., Kromhout, D., Leonard, B., Lorig, K., Loureiro, M., Meer, J., Schnabel, P., Smith, R., Weel, C. and Smid, H. (2011). How should we define health?. BMJ, 343(jul26 2), pp.d4163-d4163.
Martín-María, N., Miret, M., Caballero, F., Rico-Uribe, L., Steptoe, A., Chatterji, S. and Ayuso-Mateos, J. (2017). The Impact of Subjective Well-being on Mortality. Psychosomatic Medicine, 79(5), pp.565-575. https://pubmed.ncbi.nlm.nih.gov/28033196/
Sturmberg, J., Picard, M., Aron, D., Bennett, J., Bircher, J., deHaven, M., Gijzel, S., Heng, H., Marcum, J., Martin, C., Miles, A., Peterson, C., Rohleder, N., Walker, C., Olde Rikkert, M. and Melis, R. (2019). Health and Disease— Emergent States Resulting From Adaptive Social and Biological Network Interactions. Frontiers in Medicine, 6. https://pubmed.ncbi.nlm.nih.gov/30984762/
VanderWeele, T., McNeely, E. and Koh, H. (2019). Reimagining Health—Flourishing. JAMA, 321(17), p.1667. https://pubmed.ncbi.nlm.nih.gov/30933213/
WHO. Constitution of the World Health Organization. 2006. www.who.int/governance/eb/who_constitution_en.pdf.
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