The Wellness Primer

The Wellness Primer By Emeran Mayer, MD Wellness and the related state of optimal health are lofty goals for millions of Americans. Unfortunately, it is estimated that only about 5% of the US population fall into this category, while about 45% live in a suboptimal health/pre-disease state (without even being aware of it), 50% already live in a chronic disease state, dependent on multiple medications and interventions of our disease care system (an expression that in my opinion best characterizes our modern healthcare system). An overwhelming amount of epidemiological and scientific evidence supports the idea that the transition from optimal health to predisease and ultimately disease is caused in large parts by the increasing stress our brains and bodies are experiencing during a lifetime, often starting in childhood. While acute, transient stress improves our performance by increasing arousal, excitement and focus on a particular challenge, severe chronic stress engages maladaptive responses of the nervous and immune systems which are damaging to our health. With stress, I’m not only referring to the chronic psychological stresses that we are increasingly exposed to in our modern world; the current pandemic is an excellent example of this challenge. But I also include the chronic metabolic stress that millions of Americans are exposed to without knowing it: the stresses on the gut microbial ecosystem and the closely linked gut health caused by the unhealthy Standard American Diet. The combined influence of these growing psychosocial and dietary perturbations of the normal state of health (also referred to as allostatic load) that has become the new normal in the US population is stretching the resilience of our organism to its limits and is making more and more people dependent on the modern disease care system. In this short video clip above, I provide a brief explanation of the relentless transition that has been occurring in the US and increasingly in developing countries from a state of optimal health and the associated subjective feeling of wellness to the current epidemic of chronic non-infectious diseases. I also provide an understanding of how both psychosocial and dietary stresses interact to result in a maladaptive engagement of the immune system ultimately leading to organ dysfunction and disease. I will follow up in two weeks with the second part of this story, focusing on the preventive and therapeutic strategies supported by scientific evidence that are available to counteract this unhealthy development. If…

Managing Our Mental Health in the Midst of the Pandemic

Managing Our Mental Health in the Midst of the Pandemic By Ariel Suazo-Maler Over the last year, we have collectively gone through a reeducation process surrounding best ways to ‘take care’. While the pandemic caused us to immediately focus on how to support our physical well-being, we quickly understood that ‘health’ included taking care of our mental wellness. “Bringing awareness to best practices and understanding mental health as physical health is a great place to start.” Fluctuating statistics, novel discoveries, and an everchanging narrative contributed to an increase in individual stress levels to the point where stress management became an essential aspect of Covid-care and prevention. Moreover, prolonged isolation, and chronic fear triggered a simultaneous crisis in the psychiatric space, resulting in self-imposed loss of life. Now, while there is no single best solution to supporting mental health, and the path to emotional wellness is specific to the individual, bringing awareness to best practices and understanding mental health as physical health is a great place to start. “We thought it vital to go for an annual check-up, but taboo to see a therapist” Before the pandemic, while conversations surrounding mental health were beginning to be more commonplace, many of us still understood emotional and physical health as two separate entities. We thought it vital to go for an annual check-up, but taboo to see a therapist. Now, more attention has been placed on speaking openly about the link between our mental state and overall health status. Science has shown that chronic stress and anxiety can manifest as a delayed immune response to viruses and bacteria as well as contribute to negative gastrointestinal symptoms and poor cardiovascular health. So, how can we mitigate this when the contributors to our poor mental health status seem to be out of our control? For starters, learning to control our thoughts is a hugely healthful practice. Recognizing what influences where our mind goes, and realizing when it’s time to take back control is one of the most empowering things we can do for our health. “Empowering yourself to turn down the volume on sources of extra noise can be liberating”. A relatable example of how to do this involves the news. Many of us are afraid of not being up to date on the latest facts and figures when in reality, much of what is broadcasted is a repetition of the gravest statistics. Trusting that…

Is Long COVID the New Chronic Fatigue Syndrome?

Is Long COVID the New Chronic Fatigue Syndrome? By Emeran Mayer, MD Subtitle “COVID-19 infection has also taken a serious toll on the nervous system.” By now the COVID-19 pandemic has claimed as many American lives as World War I, the Vietnam War, and the Korean War combined, and despite the impressive reduction in infection and death rates in the US since the beginning of the year, this ravaging diseases is far from over. While most of the COVID related deaths are due to the well-known pulmonary complications of the coronavirus, the infection has also taken a serious toll on the nervous system. In addition to the acute, severe, but generally transient neurological manifestations ranging from encephalitis and cognitive impairment to stroke, milder persistent symptoms are reported by many survivors, causing pervasive yet subtle cognitive, behavioral, and psychological problems. “50% to 80% of patients continue to have bothersome symptoms three months after the onset of COVID-19.” Although many people who have recovered from COVID-19 can resume their daily lives without difficulty — even if they have some deficits in attention — there are a number of patients who may experience difficulties in meeting their regular responsibilities at home or at work. Published studies (see here and here) and surveys conducted by patient groups indicate that 50% to 80% of patients continue to have bothersome symptoms three months after the onset of COVID-19 — even after tests no longer detect virus in their body. The most common symptoms are fatigue, body aches, shortness of breath, difficulty concentrating, brain fog, inability to exercise, headache, and difficulty sleeping. Since COVID-19 is a new disease that first appeared in December 2019, we have no information on long-term recovery rates. Tens of thousands of people in the United States are reporting lingering symptoms following COVID-19. In medical jargon, such patients are called post-COVID “long haulers” and the condition they are suffering from is referred to as “long COVID,” although other names are being proposed. “Long COVID is likely the same or very similar to Chronic Fatigue Syndrome.” Long before the COVID pandemic, I have seen many patients complaining of identical symptoms which at the time were referred to as Chronic Fatigue Syndrome, a challenging medical problem for which no effective treatment exists. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, has speculated that long COVID likely is the same as…

Microbiome and Aging

Microbiome and Aging By E. Dylan Mayer Subtitle I recently came across an article in the NYTimes titled, A Changing Gut Microbiome May Predict How Well You Age. The article talks about the gut microbiome and its role in healthy aging. The author quotes a new study published in the February issue of the journal Nature Metabolism which found it may be possible to predict the likelihood of living a longer, healthier life by analyzing your gut microbiome. “The gut microbiome goes through different developmental phases.” It has been known for some time, that the gut microbiome goes through different developmental phases, starting with fairly dramatic changes during the first 1000 days of life, followed by a relatively stable period throughout adolescence and adulthood, and ultimately by a relative decline in certain health promoting microbes (such as Faecalibacterium, Roseburia, Eubacterium), as well as a decrease in microbial diversity in the elderly. These changes in the elderly have been associated with clinical measures of frailty and cognitive decline. “The gut microbiome becomes increasingly unique to the individual with age.” The authors studied gut microbiome parameters in 3 independent cohorts, comprising over 9,000 individuals ranging in age from 18-101 years. They demonstrated that the gut microbiome in healthy individuals changes as we get older, and this change is a sign of healthy aging. The researchers found that beginning in mid-to-late adulthood, the gut microbiome becomes increasingly unique to the individual with age, with a relative decrease in the abundance of certain bacterial taxa (mainly of the genus Bacterioides), and this uniqueness was positively associated with known microbial metabolic markers – primarily tryptophan and phenylalanine/tyrosine metabolites - previously implicated in immune regulation, inflammation, ageing and longevity. “Retention of high relative Bacteroides abundance and a low gut microbiome uniqueness measure were both associated with significantly decreased survival.” In the later decades of human lifespan, healthy individuals continued to show an increasingly unique gut microbial compositional state (associated with a decline in Bacterioides but not Prevotella taxa with age, whereas this pattern was absent in those in worse health. In individuals approaching extreme age (85+ years), retention of high relative Bacteroides abundance and a low gut microbiome uniqueness measure were both associated with significantly decreased survival in the course of a 4-year follow-up. Interestingly, the age-related gut microbial changes were not found to be related to differences in diet or medication use, both of which…

The Wisdom Within Adventure

The Wisdom Within Adventure From Paul Bell My previous two articles on excitement and learning have a very powerful element in common; adventure is a way to experience both of these and may be very close to the core of excitement and a stimulus to learning. Adventure is much more than just being entertained. It involves risk. It can be physically, psychologically and financially challenging. There is no certainty of outcome. If you view life with an adventurous spirit, the possibilities for excitement are endless. Writing a book, starting a business, falling in love, battling with an unexpected storm, giving birth, climbing an unknown peak, taking a meditation retreat - throwing fear to the wind and jumping feet first. If you view life’s experiences as adventurous, they will be. If you are in control of the adventure, there are many possible life-enhancing benefits. Your decisions and actions are affecting the outcome. This will create the feeling of ownership and empowerment which can give you a more confident, decisive, self-aware character. It can give you a wonderful sense of freedom. A freedom from the careful, balanced, predictable world you have left behind. It can make you feel very alive, present, focused just on the moment, on the now. This level of emotional involvement will give you powerful lasting memories, for you to relive or to tell as stories. Adventurous exploits and stories have raised the bar for humanity. The mythical stories of the past are filled with adventure and civilizations have grown with these stories supporting their cultural beliefs. The human capacity for adventure has created the world we know. Much of our history and progress is that of adventurous discovery. Humankind has a natural, innate adventurous spirit. It is not just environmental or competitive pressure that drives us forward, but a curiosity leading to discovery, the exciting possibility of gaining new information and awareness. Most of us cannot resist just peeping around that next corner. We were not just pushed out of Africa or across the Bering Sea; we did not have to go to the moon. For an adventure to succeed rather than become a misadventure there are some clear guiding principles. Don’t construct an expected world and deny the contrary evidence. Accept things that are not what you want them to be. Keep an independent mind and spirit and be open to all possibilities. Remember that an adventure…