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Penguin Life is part of the Penguin Random House group of companies whose addresses can be found at global.penguinrandomhouse.com.
First published 2018
Copyright © Dr Rangan Chatterjee, 2018
Photography © Susan Bell, 2018
Illustrations © Son of Alan – Folio Art, 2018
The moral right of the author has been asserted
Names and identifying details have been changed.
Any resemblance to actual persons is entirely coincidental.
Cover image © Susan Bell
ISBN: 978-0-241-30356-6
For my Dad, you have influenced me
in more ways than you ever knew.
I wish you were still here.
Introduction
How to Use This Book
RELAX
1. Me-time every day
2. The screen-free Sabbath
3. Keep a gratitude journal
4. Practise stillness daily
5. Reclaim your dining table
EAT
1. De-normalize sugar (and retrain your taste buds)
2. A new definition of ‘five a day’
3. Introduce daily micro-fasts
4. Drink more water
5. Unprocess your diet
MOVE
1. Walk more
2. Become stronger
3. Begin regular high-intensity interval training
4. Movement snacking
5. Wake up your sleepy glutes
SLEEP
1. Create an environment of absolute darkness
2. Embrace morning light
3. Create a bedtime routine
4. Manage your commotion
5. Enjoy your caffeine before noon
FINDING YOUR BALANCE
Sources and Further Reading
Acknowledgements
Follow Penguin
We are very used to the idea that certain lifestyles are bad for us. We know we shouldn’t smoke; we’re aware that sitting at a desk for eight hours per day isn’t a great idea, and that we should avoid eating lots of sugar. Perhaps a less familiar idea is that our lifestyles can actually be medicine. It’s not just that we should avoid bad habits – it’s that the right lifestyle and nutrition can actually improve our well-being, reverse our health problems and even make chronic diseases like type 2 diabetes, obesity and depression disappear.
It took a while for this to come into focus for me. A few years into my job as a GP, I realized that I was probably helping only around one-fifth of the patients walking through my door. I could certainly give them a drug to suppress their symptoms, but I was failing to get to the actual root cause of their problems. The trouble with the way we both think about health and practise medicine is this: we forget that the human body is one big connected system. If a patient presents to us with symptoms of depression, the usual textbook diagnosis is that it’s a psychological condition, caused by a chemical imbalance in the brain. That will almost certainly lead to the prescription of an antidepressant. What I found was that depression, along with many other conditions, could just as easily be driven by poor diet, high stress levels, a lack of physical activity or, even more likely, a combination of all three. Similarly with eczema: the textbook tells us to prescribe a steroid cream for the rash, but the rash is just a symptom. There’s little awareness that the causes of eczema are many, among them an overreactive immune system which in turn may be caused by food intolerance, abnormal gut bacteria or even high stress levels. Why not treat these problems, rather than the rash, and get rid of the eczema for good?
The fact is, the body doesn’t work as the simplistic and reductionist textbook expects it to. It’s a highly evolved biological mechanism that is completely interconnected. This is why I was only managing to treat around 20 per cent of my patients. All too often, a symptom in one domain might actually have a cause in an area of the body that our medical training just doesn’t tell us to look at. This is why I believe that the future of medicine will be about more doctors being super-generalists, rather than super-specialists. Just as our understanding of the human body is evolving, so the practice of medicine will also need to evolve. Good health occurs outside the doctor’s surgery – not inside. Our lifestyles themselves are often the best medicine.
I’ll give you an example of how the current way we view health is tripping us up – with potentially very serious consequences. For years, doctors have struggled to treat a condition called chronic fatigue syndrome. This has led to it being one of the most frustrating conditions that we see, because we don’t seem to be able to help. I think the reason medical researchers are struggling so badly to find an effective treatment is that they’re seeking a single cause and a single cure. But my research into the interconnectedness of the body has convinced me there is no single cause of this condition. I believe that patients who develop chronic fatigue syndrome are usually experiencing multiple problems, and in order to help them we need to address them all.
Our bodies, and the minds that interact with them, are systems of almost unparalleled complexity. I’m heartened to see some research on this basis is now being conducted into ‘incurable’ conditions such as Alzheimer’s. It’s early days yet, and a lot more work needs to be done, but in that area at least it’s beginning to look as if the multipronged approach I endorse could achieve promising outcomes. I call such an approach ‘progressive medicine’. It’s the idea that we need to look at as many factors as possible when examining what creates wellness or illness. Because the body is so connected, with relatively distant parts of it affecting each other, the cause (or causes) of any particular illness might not be immediately obvious.
That this ‘interconnected’ view of health is presenting good outcomes comes as no surprise to me. Back in my surgery in Manchester, it has produced some truly eye-opening results. By taking this view, I find myself prescribing medications that merely address symptoms far less frequently than I used to. Today, I’m much more likely to prescribe a diet high in healthy fats, some meditation and more physical activity than a mood-altering drug for depression. In prescribing small lifestyle adjustments that promote rest and relaxation, encourage better sleep and diet and get people moving, I have managed to reverse type 2 diabetes, get rid of depression, eliminate irritable bowel syndrome, lower blood pressure, reduce menopausal symptoms without the use of hormones, conquer insomnia, help people lose weight, get rid of severe migraines and even reverse autoimmune conditions − all without the use of any medication. We’re all familiar with the idea that lifestyle can be the cause of disease. What’s not common knowledge is that a change in lifestyle can also be the treatment and prevent us from getting sick in the first place.
The basic idea is simple. Because every of part our body affects, to a greater or lesser degree, pretty much every other part, we need to take a much more rounded view of treatment, one that considers every aspect of the patient’s daily life. How well do they sleep? What do they eat? Are they sedentary at work? Are they constantly consulting their smartphone or tablet? This is what I call the ‘threshold effect’. The connected system that is in the human body can deal with multiple insults in various places – up to a point. And then the system begins to break down. The point at which it breaks down is our own unique personal threshold. When talking to patients, I liken it to juggling. Most of us can juggle two balls, even three or four. But when we throw that fifth one in, all the balls get dropped. We get sick. That sickness might manifest itself as a skin complaint or a blood-sugar problem or a mood disorder or difficulty sleeping. These complaints are signals that things – usually more than one – are going wrong elsewhere in the body. My approach prioritizes the cause over the symptoms.
The point of this book is to give you a simple, actionable plan to do the same. I want to go beyond the sort of health advice we’ve all been reading about for so long – beyond the fad diets and the quick-fix exercise programmes. We have overcomplicated health – I want to simplify it.
There are four main elements, or pillars, to The Four Pillar Plan. The aim of the book is to examine and improve the manner in which you Relax, Eat, Move and Sleep. For each pillar I have set out five ways you might do this, summarized in the table below. The idea is to create balance across all the pillars – it is not about perfection in each individual one.
I would much rather you score 2 in every pillar, giving you a total score of 8, rather than 5 out of 5 in two separate pillars, giving you a higher score of 10. The numerical score might be smaller but the balance would be greater, and this is the real point of the book. Achieving balance is what will lead to the biggest improvements and, most importantly, the sustainable ones. This is designed to be a whole-life plan rather than a quick-fix gimmick.
For most of my patients, most of the time, scoring 3 in each pillar resulting in a total score of 12, seems to be about right. It is simply impossible, however, for me to say what will be the right amount for you. Some of you will need to do more, some can get away with less.
It is also possible to take each pillar in isolation. You may feel, for example, that your diet and exercise are already dialled in, whereas your sleep needs more attention. If so, feel free to go straight to that individual pillar and start there. You do not have to go through the book in sequential order. I would prefer you to personalize it to suit your own life.
Give equal priority to every pillar, and proceed at a pace that is comfortable for you.
What I’m about to say probably sounds far-fetched, but here it is. The health problems of the majority of patients I see – yes, the majority – are driven entirely by their lifestyle. It’s not cuts or bruises or bacteria or a fungus or a virus or some tumour or hereditary disorder that’s the source of their pain, but the way they’re choosing to live. Their conditions are very often exacerbated by the fact that they’re super busy. They wake up fully stressed, rush to get the kids ready, do the school run, come back, try to juggle their jobs and their home life. On top of that, they might have other family members who require care and attention. From the moment they open their eyes, it’s all go, go, go. Then, when their kids are finally in bed, they’re straight into their emails or social media. At no point in the day are they just chilling out, or even alone. Everything they do is for someone else. When I mention this in surgery, they roll their eyes, telling me, ‘But I just don’t have time for me.’ To which I reply, ‘Well that, right there, is your problem.’
I never thought that, as a doctor, I’d have to give anyone permission to do anything. I see my patients as adults who can make their own decisions. But daily experience has taught me that, when it comes to relaxation, a surprising number of people don’t get any. So here I am, giving you doctor’s orders: I want you to give daily relaxation as high a priority as food, movement and sleep. I think our lack of routine switch-off time is one of the most pressing issues in modern society. For your health, it could hardly be more critical.
In this Relax pillar, as in the other three, you’ll find five different interventions. Whilst you are reading through them, start to think about which ones resonate the most, and which ones you might be able to introduce into your life right away. I would love you to adopt at least three, but if that seems too daunting, build up to it by taking on one at a time. I’m the type who’s always desperate to jump in and attempt the lot, but we’re all different, and it’s really important that you find your own pace. It really doesn’t matter how you get there, as long as you get there.
The Relax pillar is the one I struggle with the most. However, despite many challenges along the way, I’ve seen the benefits in my own life. I’ve also seen it in my practice. Potential gains include:
There is a reason why I’ve started this book with the Relax pillar. It’s the one that most often gets ignored, both by the public and also by the plethora of quick-fix health books that are out there. Which intervention should you start with? I genuinely don’t believe there’s much between them but, if you made me choose, the two I would prioritize are the first – carving out some me-time every single day – and the fourth – a daily practice of stillness. The benefits are not only immense but also can be rapid, which will help you engage with the others.
