Lifestyle choices can become risk factors, but it’s important to remember that they are choices and therefore modifiable.
Unhealthy choices include lack of physical activity, erratic sleep patterns, smoking, excess alcohol intake, poor diet, toxin exposure, and ineffective stress management.
Alone and together, they can contribute to oxidative stress, disrupt physiology, lead to less than optimal metabolic biomarkers, and contribute to chronic disease.
For example, metabolic syndrome is an easily identifiable disorder characterized by modifiable risk factors including:
This cluster of conditions represents a high risk not only for diabetes but for cardiovascular disease and cognitive dysfunction.1 It is not new news that adopting healthy lifestyle habits can not only reduce the risk of many chronic diseases but can actually reverse them.2
Researchers demonstrated that personalized lifestyle care plans facilitated a reduction in biomarkers associated with chronic disease in 90% of a 70-person cohort. Biomarkers that showed significant improvement include:3
A healthy diet that contains an abundance of fresh whole plant-based foods, fruits, vegetables, whole grains, legumes, nuts, seeds, herbs, and spices is the foundation of a healthy lifestyle. The addition of high-quality lean protein (e.g., fish,) and healthy fats (e.g., olive oil and omega-3s) rounds out a dietary pattern that can improve blood chemistry biomarkers and reduce risk of chronic disease.
The traditional Mediterranean diet represents such a pattern.4 Additional contributions include valuable phytochemical5, antioxidant6, and anti-inflammatory compounds that help counteract oxidative stress and support metabolic detoxification.7
Biomarkers of stress can be monitored over time in order to assess allostasis (the process of returning to physiological balance/homeostasis). Along with monitoring blood pressure, heart rate, pulse, BMI and waist-to-hip ratio, several metabolic biomarkers can be monitored:8
Stress can lead to an excess of free radicals that cause oxidative stress. This metabolic stress disrupts normal cell function and contributes to irreversible changes in carbohydrate, protein, and lipid molecules. Immune function can be negative as well.9 Sufficient dietary and endogenous antioxidants are needed to counteract and prevent these metabolic consequences.
Individuals who suffer from perpetual stress in the form of post-traumatic stress syndrome (PTSD) are less likely to maintain a healthy diet and regular physical activity, and more likely to smoke and be obese. A 2018 systemic review and meta-analysis suggests that these unhealthy lifestyle factors are part of the association between PTSD and cardiometabolic disease.10
How one responds to stress may also determine the extent to which stress affects them. Research suggests both an exaggerated and a diminished response to stress can disrupt homeostasis and contribute to poor health.11
Ultimately, whether emotional, physical, or perceived, chronic stress can contribute to central obesity, metabolic syndrome, and elevated catecholamines, cortisol, IL-6, and insulin.12
Stress management is a modifiable lifesaver
Stress is out there… but it doesn’t have to dwell inside.
Being aware of stressors is the first step to modifying stress as a risk factor.
Deep breathing, meditation, stretching, and walking are simple steps in the right direction.
Yoga is an ancient and revered practice that can be a simple and effective tool for managing stress and even reducing oxidative stress and inflammation. A short-term study of 86 patients with chronic inflammatory disease demonstrated significant reductions in cortisol, TNF-alpha, and IL-6, along with significant increases in beta-endorphins by day 10 of the program.13
Additional options for stress management include mindfulness, biofeedback, music therapy, and positive social interaction.
Sleep is more than just a restful state, it is a restorative state. It provides for cellular repair, brain development, learning, and memory processing. Lack of sleep can induce neurohormonal changes that disrupt these processes and contribute to metabolic imbalances such as insulin resistance, diabetes, increased inflammatory markers, decreased leptin, and increased ghrelin and cortisol.14
Research suggests a U-shaped relationship between duration of sleep and cardiovascular risk, indicating 8 hours of sleep per session may be ideal.15 However, this level isn’t confirmed across the board.
A prospective study of 82,969 women in the Nurses’ Health Study suggests that those who slept 6-7 hours per session had the lowest mortality risk, suggesting that too much sleep can be detrimental as well. Adjustments were made for age, alcohol, cancer history, cardiovascular disease history, depression, exercise, obesity, smoking, and snoring.16
Sleep duration - relative mortality risk after adjustment
The National Health and Nutrition Examination Survey (NHANES) data from 2005-2006 indicates that those who slept for 7 hours had the lowest homocysteine at 8.28 umol/L compared to those who slept 5 hours or less, 6 hours, 8 hours, or 9 or more hours per session. Those who slept 7 hours also had the lowest CRP and the lowest fasting glucose.17
Meta-analysis suggests that the risk of coronary heart disease increases 20-50% for each 5 umol/L rise in homocysteine level.18
Research in mice revealed that sleep deprivation was associated with multi-organ damage characterized by increased serum levels of alpha-amylase, BUN, CKMB, CPK, GOT/AST, GPT/ALT, LDH, and total bilirubin.19 Researchers note that past studies in humans indicate that disruption of sleep can negatively affect immune cells and antibody titers; increase inflammatory markers CRP, IL-6, and TNF-alpha; and shift immunity toward Th2 activity. These negative consequences may be seen in night-shift workers or travelers experiencing disruption of sleep patterns.
Lifestyle habits translate into indicators of health and disease. It is the fundamental responsibility of a healthcare provider to provide lifestyle guidance, not disease care rhetoric.
1. Juster, Robert-Paul, Bruce S. McEwen, and Sonia J. Lupien. "Allostatic load biomarkers of chronic stress and impact on health and cognition." Neuroscience & Biobehavioral Reviews 35.1 (2010): 2-16.
2. Roberts, Christian K, and R James Barnard. “Effects of exercise and diet on chronic disease.” Journal of applied physiology (Bethesda, Md. : 1985) vol. 98,1 (2005): 3-30. doi:10.1152/japplphysiol.00852.2004
3. Lewis, Thomas J et al. “Reduction in Chronic Disease Risk and Burden in a 70-Individual Cohort Through Modification of Health Behaviors.” Cureus vol. 12,8 e10039. 26 Aug. 2020, doi:10.7759/cureus.10039 This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
4. Ahmad, Shafqat et al. “Assessment of Risk Factors and Biomarkers Associated With Risk of Cardiovascular Disease Among Women Consuming a Mediterranean Diet.” JAMA network open vol. 1,8 e185708. 7 Dec. 2018, doi:10.1001/jamanetworkopen.2018.5708
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8. Juster, Robert-Paul, Bruce S. McEwen, and Sonia J. Lupien. "Allostatic load biomarkers of chronic stress and impact on health and cognition." Neuroscience & Biobehavioral Reviews 35.1 (2010): 2-16.
9. Sharifi-Rad, Mehdi et al. “Lifestyle, Oxidative Stress, and Antioxidants: Back and Forth in the Pathophysiology of Chronic Diseases.” Frontiers in physiology vol. 11 694. 2 Jul. 2020, doi:10.3389/fphys.2020.00694
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12. Pervanidou, Panagiota, and George P Chrousos. “Metabolic consequences of stress during childhood and adolescence.” Metabolism: clinical and experimental vol. 61,5 (2012): 611-9. doi:10.1016/j.metabol.2011.10.005
13. Yadav, Raj Kumar et al. “Efficacy of a short-term yoga-based lifestyle intervention in reducing stress and inflammation: preliminary results.” Journal of alternative and complementary medicine (New York, N.Y.) vol. 18,7 (2012): 662-7. doi:10.1089/acm.2011.0265
14. Aldabal, Laila, and Ahmed S Bahammam. “Metabolic, endocrine, and immune consequences of sleep deprivation.” The open respiratory medicine journal vol. 5 (2011): 31-43. doi:10.2174/1874306401105010031
15. Yu, Edward et al. “Diet, Lifestyle, Biomarkers, Genetic Factors, and Risk of Cardiovascular Disease in the Nurses' Health Studies.” American journal of public health vol. 106,9 (2016): 1616-23. doi:10.2105/AJPH.2016.303316
16. Patel, Sanjay R et al. “A prospective study of sleep duration and mortality risk in women.” Sleep vol. 27,3 (2004): 440-4. doi:10.1093/sleep/27.3.440
17. Chen, Tien-Yu et al. “Short Sleep Duration Is Associated With Increased Serum Homocysteine: Insights From a National Survey.” Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine vol. 15,1 139-148. 15 Jan. 2019, doi:10.5664/jcsm.7588
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19. Periasamy, Srinivasan et al. “Sleep deprivation-induced multi-organ injury: role of oxidative stress and inflammation.” EXCLI journal vol. 14 672-83. 18 May. 2015, doi:10.17179/excli2015-245