In my book Breakable I described the process of developing our adult health through a series of critical periods of childhood development, going on to explain how, in old age, the challenge is to arrest its decay. This remains true, but is too broad a brush: in reality our health is plastic and responsive to change throughout our lives.
Whilst an involuntary change in environment can disturb and change your homeostasis (your default mechanism) for the worse, it is also possible to effortfully affect that change for the better. You can make a vicious cycle into a virtuous one, developing a new, healthier homeostasis, if you manage to take advantage of the opportunities available to you.
First you need the personal agency and autonomy to do it. Blaming those with many fewer choices should be avoided: but similarly consigning them to ill health because of circumstances they cannot control should be strongly resisted. Any healthcare practitioner who works with persistent conditions knows that the best outcomes result from education: finding where the opportunities lie, for the individual, rather than throwing up their hands and telling them there is nothing they can do.
This becomes more difficult as our bodies age and lose their adaptability. The 45 year old billionaire Bryan Johnson (who has become famous in his attempts to regain his youth) makes a good point, though not the one he intended. He showed that although our adaptability declines, we can improve our health at any age. Sadly for Mr Johnson, this does not literally make him younger. His extraordinary efforts only confirm he is ageing: the young just are young: they have reservoirs of adaptability throughout their systems. They can drink, eat unhealthy food, not exercise, stay up all night and turn up for work the next day with few ill effects. Of course if they live well they can be healthier and fitter, and even the young have a point where the load will become intolerable: but it will always be from this base of being in possession of a younger, more tolerant system. Only those beset by illness may feel the persistent malaise so common in those who are older.
Whilst we are undergoing challenging periods in our lives we may not be able to maintain our health, but this does not mean that the acquisition of better health is permanently out of reach. The embarrassment of pubertal breasts will fade, your child will sleep through the night, your perimenopause will end. You’ll get another job, you’ll recover from illness, find a life partner (if that’s what you crave). Yet all too often, people do not recover when their lives change for the better. Their ill health has become as habit forming as their previous good health had been, and they lack the insight, knowledge or opportunity to turn this around.
Unfortunately, the messages we see so often make this worse. As a (just) post menopausal woman, i have been surprised and delighted by my return to health. With all the information out there on just how dreadful the perimenopause is, (and it is, for many) there is much less information about the so called ‘second spring’ when it ends. Too much implication that this is the beginning of the end, that all efforts should go towards slowing your decline, not in recovering your premenopausal fitness.
Women of my age are bombarded with ads targeting our middle age spread with a wide range of restrictive diets that seem destined to remove all the pleasure from life. Stunning, always fit proponents selling an unachievable touched up image eventually wear you down. I even tried some of it: the intermittent fasting, the noom. I also tried what for me had worked before, restrictive diet wise, but it did not work this time. The higher restrictions demanded by my age meant the 20/4 fasting programme or any calorie reduction made me intolerably hungry. I have thrown all of that out, focussing on health, not weight. And that’s when I turned the corner.
In my field, there has been a sea change in thinking about ageing. We know that ageing joints do not mean pain and dysfunction. We know that exercise improves the health of articular cartilage rather than accelerate its deterioration. We know that it’s our metabolic health that determines whether our age related changes are symptomatic or not.
More broadly, we know that investigative findings do not equate to symptoms, more often they equate to risk. And the best way of offsetting risk, any health risk, is to remain as healthy as possible, optimising our metabolic health.
Another unfortunate development in the healthcare sphere is our increasing addiction to diagnosis by preemptive investigation, rather than symptoms leading to clinical diagnosis confirmed by investigation. This ignores our newer knowledge on the effect of metabolic health. Investigative findings mean nothing if the patient has no symptoms. It is not a ‘case’. Their overall health has offset the risk and avoided illness. This risk is a normal finding, not a pathological one.
Without symptoms those who share those investigative findings will not appear in your clinic. On many occasions symptoms will only appear when something else has changed: a period of reduced activity following an unrelated illness, a divorce, a change of job, caring responsibilities. These seemingly unrelated factors drive an adverse change in metabolic health, exposing that underlying risk, resulting in the development of symptoms.
I have seen many people over the years who, on the diagnosis of ‘arthritis’ have stopped being active in order to stop their ‘wear and tear’ becoming worse. But by stopping activity they accelerated their decline rather than preventing it. A repetitively tedious challenge for those of us who work in this area is to try to reverse the nocebo effect this diagnosis has given to patients.
This is also why there is widespread mistrust of some screening programmes amongst healthcare practitioners, for example whole body scans, that purport to troubleshoot any risk as if illness was inevitable: introducing fear and medicalising something a healthy lifestyle could have avoided completely. Of course these will, on occasion, pick up something early that would have presented more severely later on, but how much of the time do they introduce fear, worry and a change in lifestyle that will in itself be more harmful than the usually anomalous finding?
John Mandrola, a US physician, wrote ‘healthy people do not think of health’. This chimes 100% with my experience and my approach as a clinician. Healthy people live a healthy life because it makes them feel fantastic. They look out at the world, not in.
I remember being this way, a long time ago. And now, I refuse to settle for anything less. After my Covid financial losses I need to work an extra 5 years to earn enough to retire on. And I refuse to start my retirement unwell, if I have any choice in the matter.
I kickstarted my own recovery by writing ‘Breakable’, dealing with my mental health, first, to find the bandwidth I knew this would require. By the time my first draft was written, in April 2022, I was able to start looking forwards, but i was in the worst shape of my life. 24lb heavier, constant fatigue, insomnia, pessimism, anxiety: the side effects of my pandemic experience with menopause and depression thrown in for good measure.
In this series of blogs, I will discuss different aspects of recovery, hopefully slaying a few myths along the way. I will make it clear when I am relying on personal experience rather than professional knowledge: many of the principles I will discuss are robust and extensively researched, but are yet to become more common knowledge. I hope you enjoy it.