Dietary patterns that damage microvasculature are likely to impact the delicate inner ear microvasculature in a way that’s similar to retinopathy (JAMA Otolaryngol Head Neck Surg. 2020;146:152-159). Foremost recommendations for treating laryngopharyngeal reflux rely heavily on dietary modifications (JAMA Otolaryngol Head Neck Surg. 2017;142:1023-1029; Laryngoscope. 2022;132:1916-1923; Am J Otolaryngol Head Neck Med and Surg. 2018;39:50-55). Large observational studies also suggest the protective role of fruits and vegetables in upper aerodigestive cancer risk reduction (Int J Cancer. 2009;124:2671-2676).
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October 2022Pillar 2: Physical Activity
A review of the benefits of physical activity turns up repeated studies that show that any amount of physical activity is beneficial, with optimal health benefits achieved at 150 minutes per week of moderate activity (CMAJ. 2006;174:801-809). Sedentary behavior has been linked to an increase in all-cause mortality, cardiovascular disease, diabetes, and Alzheimer’s disease (Korean J Fam Med. 2020;41:365-373).
In the latter half of our lives, sedentary behavior is likely responsible for the disequilibrium many of our patients describe, and treatment focuses on increasing movement and adding strength training and balance exercises. There is also evidence that physical activity improves allergy and asthma symptoms, decreases rates of cancer recurrence, and improves sleep quality (J. Clin. Med. 2020;9:706; Front. Aging. 2022;3:852643; Eur J Epidemiol. 2011;26:619-628; J Behav Med. 2015;38:427-449; Sleep Med. Rev. 2018;39:52-68).
Pillar 3: Sleep
An underappreciated health contributor is adequate, high-quality sleep. The American Academy of Sleep guidelines encourage seven to eight hours nightly, but in our fast-paced world many people boast about being able to function on much less than that. The restoration that occurs while we sleep is irreplaceable—even the best nutrition and exercise routine cannot overcome its absence.
Obstructive sleep apnea is something we tend to feel very comfortable discussing and treating, but how much do we discuss insomnia or “social jet lag” (defined as the delay in the natural sleep cycle of the body that happens when you stay up late on Friday and Saturday to socialize and then sleep in the next morning to catch up—and why so many of us feel tired on Monday morning)? Many patients treat their insomnia with pills as a first-line treatment when sleep hygiene, daily outdoor activity, and cognitive behavioral therapy are better recommended.
Pillar 4: Stress Management
An estimated 70% of primary care visits are related to stress in its various manifestations (Health Policy Q. 1981;1:159- 175). In a field of headaches, neck pain, dysphagia, and increased susceptibility to recurrent respiratory infections, I would suggest that the numbers for our patients are similar.