Lifestyle Medicine involves the use of evidence-based lifestyle therapeutic approaches to prevent, treat and, oftentimes, reverse lifestyle-related, chronic diseases like obesity, hypertension, diabetes, depression, heart disease, arthritis, heartburn, lung and kidney diseases, dementia and cancer.
In this episode of HEALTH Yeah!, experts from Stony Brook Medicine discuss the six pillars of lifestyle medicine, including nutrition, physical activity, sleep, stress management, social connections and avoidance of risky substances.
The Experts
- Raja Jaber, MD
- Astha Muttreja, MD, MPH
- Anu Paranandi, MD
- Maryta Marzano, PhD, NP
What You’ll Hear in This Episode
- 00:00 Opening and Introductions
- 2:30 Healthy eating
- 8:18 Food as medicine
- 13:47 Avoiding risky substances
- 18:13 Exercise
- 22:10 Tai Chi and falls prevention
- 28:59 Sleep
- 33:45 Stress reduction and relaxation
- 39:45 Social connection
- 43:44 Closing Remarks
Resources
Full Transcript
00:00 Opening and Introductions
Announcer
Welcome to HEALTH Yeah!, where experts from Stony Brook Medicine come together to discuss topics ranging from the complex inner workings of an infectious disease to tips and tricks for staying safe and healthy all year long.
Raja Jaber, MD
Well, hello and welcome to HEALTH Yeah!, I’m Dr. Raja Jaber. I’m a family physician and lifestyle medicine enthusiast and I’m part of the Department of Family, Population and Preventive Medicine, where we have a small lifestyle medicine division. And today we’re going to be discussing lifestyle medicine and discussing the six evidence-based pillars of lifestyle medicine now and how they can better your health and well-being.
And before we get started, I would love to introduce my fellow experts. So we have here Astha and Anu who will be joining us for the discussion.
Astha Muttreja, MD, MPH
Thanks, Raja. I’m Astha Muttreja. I’m an internal medicine and preventive medicine physician. And I have board certifications in lifestyle medicine and obesity medicine.
Anu Paranandi, MD
Hi and I’m Anu Paranandi. I’m in internal medicine, board certified and I’m getting trained in preventive medicine and then also have a lifestyle medicine board certification, and lifestyle medicine is one of my passions.
Raja Jaber, MD
Okay, great. So maybe you can start by enlightening us about the six pillars of lifestyle medicine, what they are and why they are so important for us?
Astha Muttreja, MD, MPH
Lifestyle medicine is evidence-based behavioral interventions that help prevent, treat and sometimes even reverse chronic disease. It can help us live longer and healthier lives. And it’s based on these six pillars: a whole food plant, predominant eating pattern, avoidance of risky substances, practicing adequate physical activity, getting really good sleep, managing stress and engaging in positive social connection.
Raja Jaber, MD
Wow, that sounds really wonderful. Thank you. And I know that I’ve read that if people actually did practice all these behaviors, which is hard, but if we did, we would live ten years longer without diabetes, without heart disease, without cancer, without any chronic diseases, which is absolutely fabulous. And so I would like to learn more about the first pillar.
2:30 Healthy Eating
Anu, can you talk to us about what is healthy eating? What do we mean by that – it’s so confusing to a lot of people?
Anu Paranandi, MD
Yeah, so nutrition is actually fundamental to good health. And as you mentioned, it prevents chronic diseases, prevents cancer. And really, it’s all about your quality of life so that you don’t have to deal with these diseases and you can live very well and fully.
So in terms of healthy eating, what we mean by that is, you know, getting enough nutrition. So we’re talking about macronutrients, which is basically carbohydrates, fats, proteins and then micronutrients, which are vitamins, minerals, etc.. And to get it in the right proportions in your body so that you can live that good life.
Sso, how do we do that? How do we get the best, most balanced diet is to do a plant predominant diet, which means that it involves a lot of fruits and vegetables. And, you know, by no means do you have to be vegetarian or vegan. That’s not what we’re saying. We’re saying that you just need to include a lot of fruits, vegetables, legumes, nuts, whole grains into your diet so that your body can actually flourish.
And to minimize things like salt, to minimize saturated fats and to minimize the processed foods. So then what do we mean by processed? Right. So we want to get in our bodies food that is at its most natural state. So, for example, a carrot as it is, it’s the raw form and is perfect for your body. Not carrot chips because that is so far removed from what the natural state is.
Some foods, of course, you’re not going to be able to consume that way, like potatoes, for example. So you do have to process that a little bit. So like steaming it or baking it or whatever. But now if you’re going to deep fry it and it’s fries, that’s really super processed and that’s what you want to stay away from.
Raja Jaber, MD
And also mostly when you buy packaged food, fast food. That’s very highly, highly processed. So anything that you don’t cook yourself essentially is processed food. And then if it’s highly processed is when you look at the ingredients, you don’t recognize any of the ingredients, they’re not rea; foods. So that’s kind of what makes it very highly processed.
Anu Paranandi, MD
Right. And then it has the preservatives in it, etc.. And like you said, you don’t recognize what’s in there.
Raja Jaber, MD
So when I talk to patients, you know, saturated fat is so kind of nebulous. What is saturated fat? I tell them it’s really mostly cheese. So most people eat tons of cheese, that’s why there’s a lot of saturated fats.
And then there’s saturated fat in the beef and the skin of chicken and essentially, if you want to avoid saturated fat completely, then you eat completely plants. So like olive oil, nuts, seeds, beans, lentils, vegetables, that would be like no saturated fat at all.
But except for coconut oil, which has saturated fats. Right. That’s the only one from plants, which we would want to limit. And of course, like you said, processed means sugar as well. A lot of the sweeteners, artificial sweeteners that we put in our food because they change our gut microbiome.
So sugar is bad, but people are replacing it with all these zero sugars. They’re everywhere, right?
Anu Paranandi, MD
Yeah. Which is actually, even though it sounds good, it’s not.
Raja Jaber, MD
It is so sweet, it makes people crave that sweetness because it’s like so much more sweet than regular sugar. Almost addictive, right?
So, if people could change a little bit, like how many meals based on beans would you tell them to do a week? Like, you know, because some people, like you said, are not going to become completely plant-based. It’s hard and sometimes it’s not comfortable. And people want some chicken, want some fish? Fish is good for them.
So how many times a week would you tell them to eat beans or nuts or things like that?
Anu Paranandi, MD
I would say, for beans, I would say 3 to 4 servings. You can start with that and see what you can tolerate. And you know, people can do beans at every single meal. It’s not bad to do that, by no means are you going to have trouble with that.
Astha Muttreja, MD, MPH
So I think, you know, one of the things people are always asking, you know, what kind of diet should I follow? So a whole food plant, predominant eating pattern can really help with reversing disease, preventing disease. And that’s what, you know, we really like to educate our patients about and also practice ourselves, tell our families about and those kinds of things.
8:18 Food as Medicine
Raja Jaber, MD
Yeah, absolutely. I mean, we knew that such a diet would lower your cholesterol, would decrease your heart disease risk, it would decrease diabetes tremendously. I mean, really tremendously, like up to 90 percent – it’s really very powerful if we were to practice all the pillars.
But in particular, the nutrition that you’re talking about, how does it impact other diseases? Does it impact cancer? Do we prevent cancer? Do we prevent cancer recurrence? Can you tell us more about it?
Anu Paranandi, MD
Yeah, absolutely. So food is actually a great medicine for preventing cancer, of course. But also if you are diagnosed with cancer, it helps with your cancer care journey. So it helps, you know, while you’re going through chemotherapy, it helps with just your quality of life during that process.
And then it prevents the recurrence after you’re considered free and clear from the cancer. And so, you know, what is it about food that makes it such a powerful tool against fighting cancer is that there’s a lot of, kind of a technical term, phytochemicals, phytoestrogens, there’s all these components or chemicals within plants.
It’s naturally occurring chemicals that actually fights cancer and can reduce inflammation, reduce the formation of cancer cells. And so having a good diet, having good nutrition, really, it’s a powerful blow against these cancer cells. So it’s important to kind of keep that in mind. In, yes, preventing cancer, but also if you were to be diagnosed and to fight cancer itself and prevent recurrence.
Raja Jaber, MD
Which is wonderful. And yeah, I tell my patients that plants are our ancestors. They develop all these phytochemicals to defend themselves from disease and they are transmitted to us so we can defend ourselves. So plants are wonderful because actually food is information to our body, Right? And the information these phytochemicals we get from plants, they actually change the expression of our genes so they can increase their anti-inflammatory expression, decrease inflammation in our genes and improve our cancer fighting property genetically.
And that is absolutely wonderful. And I’m so glad you mentioned phytoestrogens. These are weak estrogen that are in plants that kind of replace our strong estrogen at the receptor sites. And therefore our cells do not grow as much because the weak estrogens don’t stimulate us as much as our strong estrogen. And that’s really important for women with breast cancer, who are estrogen receptor positive.
So plants have very interesting properties. And of course, most of the phytoestrogen comes from soy and beans, and a little bit of soy is okay – people used to say it wasn’t. Yeah, and these have very amazing properties. And the thing that can increase growth, and you want to avoid growth of cancer, is mostly these animal proteins.
So a lot of animal protein, people who eat tons of animal protein will promote growth. And we don’t want to do that in cancer. We want to lower growth. And these plant phytochemicals actually have properties to stop growth, inappropriate growth. So it’s a wonderful balance that we can achieve by eating more and more plants.
Especially if you are going through the cancer care journey and you are fighting Or you have a strong family history, you want to prevent it. Now, you do have a program, right, that you’re developing, right?
Anu Paranandi, MD
That’s right. So we have a program that we’re piloting and it’s in our clinic and it’s basically lifestyle medicine and breast cancer care. So it’s women who’ve been diagnosed with breast cancer anywhere in their journey. So it could be that, you know, they were just diagnosed versus they’ve gone through chemotherapy, surgery, etc., and now they’re just trying to prevent recurrence.
So either, you know, in any stage we see these women and we kind of formulate a lifestyle medicine plan, taking into account all of the six pillars so that they can live the best life possible. And, you know, and part of that, obviously, is the nutrition.
Raja Jaber, MD
And this is like a group program or individual program?
Anu Paranandi, MD
So we are seeing patients individually at the moment. But we are planning to expand it into seeing patients in the group.
Raja Jaber, MD
That’s great. That’s wonderful. Thank you, Anu, that’s so informative.
Astha Muttreja, MD, MPH
And you know what’s so powerful about something like this as it gives patients something to do that’s in their control, you know, and that’s really what’s so lovely about lifestyle medicine is that there is very little risk in trying this. And the benefits are just, you know, they can be so impactful in helping you feel better and in helping your disease. And it’s something that can be just life altering as well.
Raja Jaber, MD
And thank you for mentioning that because taking over control is so important. In the past, people would finish treatment and would be actually scared about what’s going to happen next. But now when they adopt a lifestyle program they are actually doing something for things not to happen, which is actually empowering.
13:47 Avoiding Risky Substances
So really, thank you for all of this. And I would like to see something about breast cancer and we’re going to move to the next pillar, which is avoiding risky substances, which is one of the pillars. And how does it relate to cancer and overall, and then in general, why is it so important in life sign medicine?
Anu Paranandi, MD
Yeah. So generally for risky substances, what we’re really focused on is tobacco. So smoking or any sort of use of tobacco products and then alcohol use. So those are the two kinds of things that we concentrate on.
It’s well known that smoking or tobacco can lead to lung cancer, but it really is linked to numerous other cancers, head and neck cancers, bladder, etc., etc.. So really it is a carcinogen and something to definitely be avoided. And I think it’s been getting out there. More and more people know about it.
But what I wanted to concentrate on is our alcohol use. So alcohol really is a carcinogen. And I know it’s, you know, having a glass of wine with dinner, etc. that’s actually fine to do. And I’m not trying to, you know, put that message that it’s all bad out there or anything like that. But it is just to be mindful of the benefits versus the risks of it, especially with cancer, especially with breast cancer, because even moderate use of alcohol. So, you know, moderate can be defined as for women one drink a night or seven drinks in the week that would amount to. So even that is too much for breast cancer, for example.
There is a link. So the more consumption of alcohol there is, there’s a higher chance of actually having breast cancer. So you know, just to think about that, just to be mindful, again, I’m not saying to stop drinking…
Raja Jaber, MD
People can stop, that’s fine to say.
Anu Paranandi, MD
Absolutely. I just don’t want to, you know, I’m not trying to make it about fear. It’s just about being very careful about your habits, really.
Raja Jaber, MD
The worst is smoking. Like you said, everybody should stop smoking. There’s no moderation in that one. Of course, all the other substances that, you know, other drugs, strains of drugs that are linked to all kinds of overdoses, but we’re not going to expand on that in this particular panel, but there’s a lot of risky substances out there that kill people in their midlife.
Anu Paranandi, MD
Yeah and alcohol of course has other health effects not just for cancer, you know, heart disease, cholesterol, a number of others – liver failure, Cirrhosis…
Raja Jaber, MD
And colon cancer, very much linked to colon cancer as well. Excessive alcohol consumption.
Astha Muttreja, MD, MPH
And we know it’s a toxin because as soon as we ingest it, our body starts trying to get rid of it. It’s not really giving us nutrients. And so minimizing, you know, those things that our body doesn’t need is really the goal here.
And it is a process, you know, sort of changing those habits.
Raja Jaber, MD
And no doubt we are all creatures of habit. So sometimes people feel singled out when they have “bad habits.” But we all have bad habits, right? Some of us don’t go to sleep all night, some of us watch too much TV, some people eat too much. Some people drink too much.
It’s all a question of habit and developing healthier habits, letting go of the habits that are hurting us and developing better habits. And that’s where all the science of behavior change comes. And we’ll talk about that later.
Well, thank you so much for this very interesting discussion about lifestyle and nutrition and risky behaviors. And now we’re going to be talking about exercise. So thank you both. And we’ll be right back to talk about exercise.
18:13 Exercise
Well, welcome back. And we are going to move now to our next pillar, which is exercise. And we have our exercise expert here. So I would like to introduce Maryta.
Maryta, please introduce myself.
Maryta Marzano, PhD, NP
So I’m Maryta Marzano, I’m a family nurse practitioner. I am board certified in lifestyle medicine and I am finishing up a Ph.D. in lifestyle as well.
Raja Jaber, MD
Yay! We are all excited. So tell us more about that.
Maryta Marzano, PhD, NP
So physical activity is one of the lifestyle medicine pillars that is very important. It mostly revolves around exercise, right? So we have physical activity, which is any activity that keeps you moving around – house chores, gardening, those kinds of things. And then we have exercise, which is a formal form of activity that is set out with an intention to exercise and do things that get our heart rate elevated.
We have a lot of guidelines on physical activity, so the guidelines generally recommend 150 minutes of moderate intensity exercise. So moderate intensity is usually judged by talking but not singing. So you can talk in short sentences, but you cannot sing because you’re that out of breath. That also recommends strength training.
Raja Jaber, MD
So examples of this moderate exercise would be walking really fast, or…?
Maryta Marzano, PhD, NP
It usually would probably require walking on an incline if it’s going to be walking. Or it could be a light jog, running, it could be cycling, swimming, you know, anything that gets our heart rate up and makes us a little out of breath.
Astha Muttreja, MD, MPH
That’s why I like the talk test, because for some people that is walking on a flat surface. Or if they just don’t really exercise as much and they’re just starting out. But it’s such a good gauge because as you get more efficient, you’re going to have to move up the intensity, right?
Maryta Marzano, PhD, NP
Yeah, You will have to increase the intensity as you go.
Raja Jaber, MD
I just want to highlight because we didn’t really mention it in the discussion on cancer, exercise is such a great modality to help prevent cancer and prevent recurrences of cancer as well. So I just wanted to highlight that before I let you go and proceed.
Maryta Marzano, PhD, NP
Yeah. So exercise in general prevents a lot of things. It keeps our heart healthy and strong, right? Our heart is a muscle. So every time we exercise and our heart rate goes faster, it’s getting stronger.
So exercise fixes a lot of things. It helps prevent heart disease. It actually is better at fixing depression and anxiety than some of the medications that we use. So it helps with a lot of things. Also cancer.
But back to what kind of physical activity is required. In addition to 150 minutes of moderate intensity, they also like a portion of that to be strength training. So anything that helps build our muscles and that is often done with bodyweight exercises, but is sometimes done with dumbbells and lifting heavy things.
A lot of people think that we need to stop doing that as we get older, but that’s not true. We need to keep exercising and keep strength training as we get older. It’s what keeps us independent as we move into our older age. A lot of what helps us to stay out of requiring assistance when we get older and out of facilities is our independence, is our ability to walk to the bathroom and get ourselves on and off the toilet.
So things that keep us doing those things like functional movements, that stuff like squatting is a very functional movement and all of these things can be modified. So we’re not expecting everybody to just get down and get back up again. We can modify these things using chairs and other modalities that make it easier and more accessible for everybody.
22:10 Tai Chi and Falls Prevention
Raja Jaber, MD
I know in Stony Brook, talking about all these things as we get older, we have some excellent programs. We have a Tai Chi program, which is available to everyone everywhere. It’s free. It’s on Zoom. It’s a wonderful program and helps a lot with balance. And so people actually when they do Tai Chi and they get older, they don’t fall as much.
Maryta Marzano, PhD, NP
Right. I’m so glad you brought up Tai Chi because balance is another important aspect of physical activity. Tai Chi is great for that. Yoga is also really great for balance. People don’t realize what makes older people more at risk for falling is the fact that they can’t catch themselves when they slip, when they trip over the rug, or when they miss a step.
A lot of younger people are able to catch themselves because they have good balance. But as we get older, we lose that and we aren’t able to catch ourselves. So doing things like yoga and Tai Chi a few times a week really helps us to stay safe and healthier as we grow into our older age.
Astha Muttreja, MD, MPH
Yeah, and your discussion about strength training I think was so important too, especially because some people are just never told to lift weights, you know, especially young women. And when we’re young, that’s when we’re building our bone health. And that’s so important as we get older, though, we don’t really get that guidance, you know, in our teens and our 20s.
Maryta Marzano, PhD, NP
Women lifting weights is getting better but it wasn’t always a very strong recommendation. But we know now because of osteoporosis and the risk that it poses how important strength training is because it helps prevent osteoporosis and even build bone density.
We actually have a program that does that. We have an osteoporosis group visit where we sit down with a few patients in a setting and we talk all about osteoporosis, how to prevent it, the nutrition and activity that goes along with it. And a lot of it is strength training and it’s getting people that are post-menopausal to lift heavy things.
Raja Jaber, MD
And of course, you have to go slowly, right? You have to go slowly. That can’t jump into these heavyweights. And that’s why we have a program with our physical therapy department to kind of transit people to that heavy weight lifting so they can actually then maybe find somebody to help them with heavier weights.
Maryta Marzano, PhD, NP
Right. So we do usually recommend for people that are doing this for the first time to do it with a professional and a physical therapist is a great option.
Raja Jaber, MD
Right. And there’s programs online for that. And we’ll talk about our lifestyle medicine website at the end because it has a lot of resources in it.
Maryta Marzano, PhD, NP
It’ll have community resources and virtual resources, people that we think are competent leading other people in exercise virtually. And because a lot of people have to do the virtual option for financial reasons and transportation reasons, when I tell people that have to do the virtual option, I usually recommend they do it with a mirror, right? So I usually have them have the virtual video in front of them and also a mirror so that they can look at the video and then look at themselves because they need to make sure that they have good form when they’re doing it so that we don’t injure ourselves.
Raja Jaber, MD
That’s wonderful. And all of these exercises not only prevent diseases like heart disease, strokes, hypertension, cancer, osteoporosis, but they also keep people fit.
So like with knee arthritis, like older people are handicapped because of knee arthritis. As we get older, if we keep our muscles strong, our glutes and our quadriceps, we’re less likely to develop knee arthritis. Our muscles keep our joints in place and we lose muscle as we get older, right? So our muscles get weaker as we get older and that’s more important to fight with good nutrition and exercise.
Maryta Marzano, PhD, NP
And I wanted to say, because I know the recommendations, the guidelines say 150 minutes but any exercise is good exercise, even if it’s just 10 minutes a day. And there are studies that show 10 minutes is better than zero.
So any exercise is good exercise. And we don’t always have to meet all of the guidelines. Lifestyle is not about being perfect or doing everything. It’s about doing a little bit of everything
Raja Jaber, MD
Right. And sometimes people don’t want to walk half an hour and I say, walk 10 minutes after breakfast, 10 minutes after lunch, 10 minutes after dinner.
So we can modify it for people so they can fit their needs.
Maryta Marzano, PhD, NP
Well, I love the modification. I always tell people even when they’re injured and stuff, to not get out of the habit of doing it. Go and do your exercise, but do it modified and how you can do it. Getting out of the habit is what gets us into trouble sometimes.
Raja Jaber, MD
Yeah, right. And I do want to mention the resistance bands because some people don’t have weight, but they can get resistance bands and you can get a lot out of it.
Maryta Marzano, PhD, NP
There are a lot of modifications we can use. A lot of very inexpensive props to help us achieve the mobility and independence and strength that we’re looking for.
Astha Muttreja, MD, MPH
And you can find so many workouts just online. So that just makes it so much easier.
Maryta Marzano, PhD, NP
There’s apps, too, and a lot of the apps you can plug in what equipment you have and it will spit out what exercises you should do and your level. So if you’re a beginner, you know, I always tell people to start at the beginning and then slowly work their way up.
Raja Jaber, MD
And we have a lot of these apps on our website. One thing I want to say, you know, people are trying to exercise for weight loss and I just wanted to clarify that because it’s great at maintaining weight loss. It helps you jumpstart for weight loss if you’re going to exercise a lot, you have to do like at least an hour a day if you’re going to use exercise to help you lose weight.
But the most important thing of exercise is that it makes us lose our belly fat. And belly fat is what creates a lot of the inflammation. And exercise is probably even better than nutrition to make us lose that belly fat, which is so important to prevent diabetes and heart disease and all.
Astha Muttreja, MD, MPH
Yeah. It improves our overall body composition and, you know, a lot of people are just so focused on the number on the scale. But it’s really about your ratios and how much muscle you have. Like we said, we love our muscle. We want to maintain our muscle. We don’t always need to be thin, but we want to be strong.
28:59 Sleep
Raja Jaber, MD
Okay. Well, thank you so much, Maryta. I think we should move and talk about sleep, which is another pillar, right?
And one thing that I want to translate is that exercise helps people sleep. A lot of people tell us that they sleep much better when they exercise.
Maryta Marzano, PhD, NP
And people will say, I can’t exercise, I’m too tired. But it actually does give you energy and makes you sleep better.
Astha Muttreja, MD, MPH
But I think the energy part is what so many people struggle with. I mean, I think every day I think most of us see patients who complain about being tired. And my first question when you’re complaining about being tired is how much are you sleeping? And oftentimes people are not sleeping enough or they’re not getting restful sleep. They’re waking up a lot in the middle of the night for various reasons.
And so, you know, I tell people that sleep is so important to get at least 7 to 9 hours of sleep each night to make sure that when you’re waking up, you’re feeling well rested. We know that we need sleep because we know when we don’t sleep, we’re tired, irritable or more hungry. You know, it affects our mood, our stress, maybe cognition or memory.
So we spent quite a time in our lifestyle medicine appointments talking to patients about their sleep.
Raja Jaber, MD
Yeah. And so what can people do to improve their sleep? Like, I think a third of our population have problems sleeping so it’s so common. Because between falling asleep, not staying asleep, people who have sleep apnea, which is a big kind of epidemic because unfortunately we are quite overweight as a population and that’s kind of linked to sleep apnea, but not all the time.
Astha Muttreja, MD, MPH
So I think, you know, step one is just assessing what you’re doing before bed. You know, that may not be helping you sleep, just like we have a routine when we get up in the morning and go to work. We need a routine when we go to bed. And you got to kind of treat it like your job.
You know, you make your coffee in the morning, you brush your teeth, you get out, you know, you make breakfast, lunch, go. You need to do the same wind down procedure. And so talking about sleep hygiene is really important.
Some people still struggle and they’ve been struggling for a long time with insomnia. So that’s where we can employ strategies and programs like cognitive behavioral therapy for insomnia, which we’re so lucky to have a program here at Stony Brook that does that.
And then evaluating for sleep disorders like sleep apnea or upper airway resistance syndrome.
Raja Jaber, MD
Yeah, we have a great program. Dr. O’Brien at Stony Brook has cognitive behavioral therapy for insomnia, which is actually the most effective for chronic insomnia. So learning how to approach sleep, so many people are so worried about not sleeping, right? So going to bed to have all these worried thoughts, they’re constantly thinking, I’m not going to sleep, I’m going to be tired tomorrow and It’s actually preventing them from sleeping.
So there’s a great program to help them approach that differently. And really for a lot of our patients its through Dr. O’Brien.
And sleep is very important for our health, right? It’s important for cardiovascular disease. Can you tell us more about why it is so important?
Astha Muttreja, MD, MPH
Yeah. So, you know, we have so many important functions that are linked to adequate sleep. When we don’t get that rest at night, our body never relaxes and never comes down, you know. So that’s where sleep apnea has been linked to high blood pressure and arrhythmias. And so that is why screening for that and treating that, if we do find that is so important when we don’t get restful sleep, our immune system, you know, doesn’t work as well.
And then lack of restorative sleep, which is that slow wave sleep which activates our lymphatic system, which cleans out some of the waste in our brains that has been linked to poor cognition and even dementia.
Raja Jaber, MD
Right. This is like a new system they discovered, it kind of drains all the toxins from your brain. It’s like this lymphatic system that gets activated when we sleep deeply and cleans all the toxins, this tau protein, which is specifically associated with Alzheimer’s. So it it’s very important for our cognition and for our brain health to get all of our sleep cycles. We have to reach all of our sleep now.
So even like, lack of sleep is linked to diabetes, right? So every disease is kind of influenced by whether we sleep well or not. And one of the things that improves slow wave sleep, that deep sleep, is actually exercise.
33:45 Stress Reduction and Relaxation
And actually our next pillar that I would like you to talk about, which is stress reduction, relaxation, because that also improves our slow wave sleep rate because most people don’t sleep because they’re stressed out.
Maryta Marzano, PhD, NP
Right. So yeah, turn off that inner dialogue. That’s often times when I talk to my patients and they say I can’t sleep. I say is it because you’re not tired or is it because you can’t turn off that inner dialogue that’s running in your brain? And most often it’s because they can’t turn that off.
Astha Muttreja, MD, MPH
And stress and lifestyle are so closely linked, right? When we’re stressed, we’re not thinking about practicing healthy behaviors or health habits. And so it kind of is this vicious cycle that we wind up in. And so employing stress management strategies is important for sleep, it’s important for reducing diseases that are linked to high levels of stress, like cardiovascular disease, like high blood pressure. And all of the diseases.
Yeah, because increased stress, you know, is linked to increased inflammation. Stress is not a bad thing. But what we’re struggling with, you know, it protects us. Our stress response is supposed to be protective. It’s supposed to get us out of danger. But when we have chronic stress that doesn’t go away, that’s when it can harm us.
That’s when we’re not able to adapt to that stress. So everybody has stress, but it’s about learning how to not get stressed by the stress. So I often tell my patients that. And so we have so many things, you know, on our website to help with stress management. And it can be a mindfulness based practice where you’re meditating or praying, using prayer, exercise, spending time with loved ones.
All of that can help with stress management and figuring out what works for you before you enter a highly stressful state. I think it is so important because you have to practice that muscle.
Raja Jaber, MD
Absolutely. So they’ve done a lot of research on that, right? So the stress response produces a lot of cortisol, increases inflammation, increases adrenaline, and then if we learn to develop the relaxation response, which is the opposite of the stress response, then we simulate the vagus nerve, we lower our adrenaline, we lower our cortisol with lower inflammation.
And that has been found in research. And even like that relaxation response changes our gene expression. Again, the same genes that produce inflammation are shut down and we become healthier. So it’s so important.
Astha Muttreja, MD, MPH
And that mindfulness based really showed that our telomeres are longer, you know, when you only practice mindfulness and we have less stress. So it’s been shown, it’s been proven it works and working on that and incorporating that as part of your healthy lifestyle is so important.
Raja Jaber, MD
Yeah. And as I mentioned, we have so many resources, but I find that truly that’s the hardest thing for people to develop amongst all the lifestyle pillars. I find that’s the hardest thing.
Maryta Marzano, PhD, NP
Well, I think sometimes when people think of a mindfulness practice, they think that the purpose of it is to turn that inner dialogue off when the purpose of it is actually to just recognize that it’s happening and to pivot to something else instead. So it’s training your brain to turn off that inner dialogue.
And it’s an exercise, it’s a practice. So every time we recognize that the inner dialogue is taking over and we pivot to whatever else it is that we’re concentrating on, we’re doing a rep of that and that’s making that practice stronger and it’s going to make us more able to turn off that inner dialogue when we need to, when in times of sleep and that sort of thing.
Astha Muttreja, MD, MPH
Yeah, decreasing how we react to it and knowing that we don’t always have to react.
Raja Jaber, MD
Yeah right. And this is so important. I teach this to medical students and they all are surprised by the fact that it’s okay not to shut your mind off because nobody can shut their mind off. But to get that presence right, it was really talking about noticing.
It’s like a presence, right? But it’s a non-judgmental presence because people sometimes say, my God, I’m thinking again. So they know this, but they’re angry, right? So the idea is to notice with kindness, to notice and smile. And to let it go. And to do something else, like wash the dishes or brush your teeth or smile to yourself. Right? And then the thoughts come back, and then we notice and we smile.
This non-judgmental moment to moment awareness is so key and so beautiful. Yeah. So this is great.
So we’re moving on. So think about stress, right? We can’t avoid stress. So things happen to us apart from our own perceived stress, right? Catastrophic things happen in life, right?
Maryta Marzano, PhD, NP
And it builds resilience, right? So resilience is also important. So stress is not always a negative thing. It helps us to build resilience, to be able to recover from traumatic events that are inevitable because life is full of that. You’re never going to be able to avoid that. Right?
39:45 Social Connection
Raja Jaber, MD
And that resilience is beautiful and we can cultivate that. Some of us genetically have more resilience than others, and that’s really true. But at the same time, it can be cultivated. And I mean, mindfulness is one thing. But also what helps a lot in resilience is your support system, right?
So people can be exposed to the same amount of stress and if they have no support system, they really get diseases, they get very ill. People who have the same amount of stress, but they’re surrounded by loved ones have a great support system and they do better. And now we know that from research, even people who have a good relationship with their doctor do better because it’s a kind of a support system.
So tell us more about social connection and why this is another important pillar of lifestyle medicine.
Maryta Marzano, PhD, NP
So loneliness, specifically, is actually associated with disease processes, so it has been shown to be an equal negative predictor as smoking, as obesity, as hypertension. So we need to move away from loneliness and build really strong social connections in our lives.
Another good point is that the research has shown, right? We’ve done some research with the Harvard Happiness Study and the blue zone studies and what we know is that things and money don’t make people happy. People make people happy. The relationships in our lives are what makes people happy. It’s what makes life worth living. So we need to invest in those things.
We need to invest in those people and our relationships in our lives are never always smooth sailing, right? They are sometimes full of events and stress and ups and downs, and the research actually shows that that’s okay. But what has to be there is mutual respect. So you can go through these ups and downs where you have disagreements and when those come, as long as you treat each other with mutual respect and you attack what’s happening as a problem that you’re trying to solve together instead of the other person, that is what builds nurturing, strong relationships and that’s what keeps us healthful.
Raja Jaber, MD
It’s wonderful you mentioned the blue zones because the blue zones is like this research which looked at people who lived the longest in life and most of these people ate together, right? And talked together and spent time together and socialized. And so what can people do?
Maryta Marzano, PhD, NP
Right now there’s a big disconnect. All of those things are decreasing, right? So I think it was the Gallup poll that showed that the amount of families that are getting together to eat dinner at night is decreasing. The amount of clubs and social gatherings that people are doing are decreasing. And this is a problem because that’s our social connectedness.
So what can we do to fix those things?
We want to show the people that love us and we love that we love them. We want to nurture those relationships, right? Remember to tell them. We want to remember to tell them. The greatest gift we can give people is our undivided attention. And so we have a lot of things in today’s society that is distracting us and we’re not giving our loved ones our undivided attention.
So doing things like phone-free time, making sure that we’re having family dinners and putting the phones away so that we’re giving the people that we love our undivided attention is really important.
Raja Jaber, MD
That’s also true. And I just want to add that people who don’t have a lot of very strong, close ties, there are support systems in the community that they can join. There are senior centers, there’s programs in the libraries that we always encourage our patients to attend. There are support groups for people who have chronic illness, support groups for people with Parkinson’s, for the families of people with Parkinson’s. And these are so helpful. People really get that – there are bereavement groups, there are volunteering opportunities.
Maryta Marzano, PhD, NP
So actually giving and being able to be of service to other people is another thing that makes people feel connected and happy.
So when people volunteer and give to others, then it makes them feel more fulfilled, right? It gives them purpose. When we have purpose, we live longer because we think that we’re needed. And on our website, again, there are lots of resources for finding volunteer opportunities. And there’s actually a website that will show a list of volunteer opportunities so that you can pick and choose which one is better for you.
43:44 Closing Remarks
Raja Jaber, MD
This conversation is amazing, but we have to end. And yes, if you Google Stony Brook Medicine, lifestyle medicine, you’ll find our website is filled with a lot of treasures.
And that’s all the time we have for today. Thank you to all our experts, for everything you added and informed us with, and thank you for our listeners.
I would like it to remember the important takeaways from today’s discussion. Eat mostly unprocessed food, things that you can cook yourself. Cooking is also movement, so you will cook and clean the dishes and eat maybe more plants, both more vegetables and a bit more beans and lentils, a bit more nuts and seeds. Move a lot. Move a lot in your home. Try to move all the time between work and home.
But exercise. Do something to increase your heart rate, to strengthen your muscles, and deepen your sleep. Smiles – smile to yourself, smile to the world, take a deep breath. Let’s go and have great conversation and great social connections and feel better and live longer. And thank you.
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Stony Brook Medicine is Long Island’s premier academic medical center. We transform lives through scientific discovery, education and care, and we bring together innovative research, advanced education and extraordinary health care expertise to set the standard for how healthy communities thrive. For more information, visit Stony Brook Medicine or follow us on social media.
*DISCLAIMER: The information provided in this podcast is for educational and informational purposes only and is not intended as a substitute for professional medical advice, diagnosis or treatment. If you think you may have a medical emergency, call your doctor or emergency services immediately.
