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Four pillars of health

5 Sep, 2023 | Emotional Health, Exercise, Nutrition, Sleep

All the medicine in the world will make no difference if we aren’t taking care of these four pillars of health first: sleep, movement, nutrition, and emotional wellbeing[1]. It’s difficult to put them in any kind of hierarchy, as this will change depending on your circumstances, and at different times throughout your life (we hear you, moms of new-born babies!). But what remains consistent is to always bring your health goals back to these four pillars and ask yourself: what it is that needs the most attention. Based on these goals, we can devise a plan, involving lifestyle interventions and supplements where needed, to maximise your potential.


We all know what sleep deprivation feels like – and we’re talking about more than just those spicy rings under your eyes and increased need for caffeine … Studies have shown that disrupted sleep has far reaching consequences: from being more accident prone and suffering from low mood to more deleterious health effects such as increased incidence of obesity, type II diabetes, hypertension, cardiovascular disease and even certain cancers[2]. Inconsistent sleep has further been shown to increase systemic inflammation, with an increase in c-reactive protein (CRP), interleukin 6 (IL-6) and fibrinogen [3]. And by now most of our readers know that inflammation is at the heart of many, many disease processes. For once you don’t need to work hard to reap the benefits … just get a good night’s sleep:-)

So, what is good sleep – and here it differs less from person to person than any of the other pillars. Research is relatively clear: we should all be aiming for a solid 7 to 9 hours a night, with proper cycling between the phases of sleep. According to neuroscientists Matthew Walker, impairments in brain activity can be measured as soon as you clock a few nights under 7 hours. Therefor every effort should be made to develop a good sleep hygiene routine … EVERY night. This means having your last meal ideally 3 hours before you go to bed (easy on the snacking), no screens for one hour before (rediscover a love for books or enjoy some connection time with your partner, so many options!), aim to be in bed at the same time every night, keep it really dark, and nice and cool. Repeat. You will be astounded at how much more energy you have and how much clearer you can think, with just a good night’s rest!


This can mean so many different things to different people. But as a species we were not made to sit behind desks for hours on end. Your flavour of movement can be anything from a gentle stroll all the way to powerlifting, and anything in between. How you approach this will depend on your health goals, not just for the immediate future but also in old age. Dr Peter Attia speaks to this eloquently when discussing what he calls the Centenarian Decathlon[4], what you will be capable of physically in your marginal decade (the last 10 years of your life). When you consider this, you can plan how to train now, whether you are in your 20’s or in your 70’s. It’s undeniable that how fit we are plays a pivotal role in how we age [5]. It’s all too common for doctors (and patients alike) to rely on chronic medication when in fact getting moving and changing our diets can solve the problem equally well, or often better. Areas in the movement sphere that need attention can be broken into VO2Max, zone 2 training, stability, and strength. We will write tons more about this, as the positive effect of movement cannot be understated.


Never, since the advent of politics and religion, has a subject been more divisive. We believe in this case that saying less is more. And none have done a better job at that than Michael Pollan when he said, “Eat food. Not too much. Mostly plants.” We can already hear the vegans crying at ‘mostly’ and the carnivores are just about hopping, but for the most part this covers just about every kind of healthy eating devised by man. And yes, it will vary from person to person and no, there is no ‘perfect’ way to eat. This will not be a treatise on healthy eating, but we can leave you with some nuggets. Processed food is bad, the vegan kind too. Lots of fresh veg is good, so too are healthy fats (avo, nuts, olive oil and such), and making sure you have adequate protein with every meal. For the rest of it, it will depend on you – your genes, your level of activity, your religion, your culture, your preferences and all the other little quirks you have. And then an often-overlooked aspect of eating … enjoy it!

Emotional wellbeing

This can be divided into ‘stress management’ and ‘social relationships’ according to the folks at Stanford. If, like us, you live in Johannesburg, stress management is something we need in the drinking water (you can keep the cholera, thanks). Fortunately, we have numerous tools we can employ to help in our efforts to remain equanimous, or at the very least not spontaneously combust. One of the most effective tools is simple breathing [6] – it’s one superpower we carry with us all the time, whether we need to get ourselves out of a stress induced coma or require calming down from near boiling point. We’ll write about breathwork (several times) in more detail in blog posts to come. The other, of course, is meditation and mindfulness practices. These practices have been shown in numerous studies to have positive outcomes on the physical, psychosomatic, and psychological effects of stress [7].

In his book, Lost connections, Johann Hari speaks to the importance of social connections, and how the absence of true and meaningful connection can have grave consequences on one’s health. The social isolation experienced world-wide during the COVID pandemic had far reaching consequences on the mental and physical well-being of many, and highlighted the loneliness experienced so often in our ageing population [8]. For many it was a reminder of how important it is to maintain (and appreciate) social connection, and for those working in healthcare, a reminder that well-being cannot exist without those connections.

As the research community redirects more attention to these fundamentals of health, we will keep you posted and give you our spin on what we find works for our patients. If there are any aspects of these topics that you would like to know more about, please drop us a message and let us know.


[1] (n.d.). PILLARS – Stanford Center on Longevity. Retrieved August 10, 2023, from PILLARS – Stanford Center on Longevity

[2] (2017, May 19). Short- and long-term health consequences of sleep disruption – PMC. Retrieved August 10, 2023, from Short- and long-term health consequences of sleep disruption – PMC

[3] Sleep Inconsistency and Markers of Inflammation – Frontiers. Retrieved August 10, 2023, from Sleep Inconsistency and Markers of Inflammation

[4] “#261 ‒ Training for The Centenarian Decathlon: zone 2, VO2 max ….” 10 Jul. 2023, 261 ‒ Training for The Centenarian Decathlon: zone 2, VO2 max, stability, and strength | Peter Attia, M.D.. Accessed 11 Aug. 2023.

[5] “Exercise Attenuates the Major Hallmarks of Aging – PMC – NCBI.” Exercise Attenuates the Major Hallmarks of Aging – PMC. Accessed 11 Aug. 2023.

[6] “How Breath-Control Can Change Your Life: A Systematic Review on ….” 7 Sept. 2018, How Breath-Control Can Change Your Life: A Systematic Review on Psycho-Physiological Correlates of Slow Breathing – PMC. Accessed 10 Aug. 2023.

[7] “Mindfulness-based stress reduction and health benefits: A meta ….” Mindfulness-based stress reduction and health benefits: A meta-analysis – ScienceDirect. Accessed 10 Aug. 2023.

[8] “Loneliness and social isolation during the COVID-19 pandemic – NCBI.” Loneliness and social isolation during the COVID-19 pandemic – PMC. Accessed 10 Aug. 2023.

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