Health is in the big picture, not the details!
Part 1: What does it mean to own your own health?
Self-Empowerment, Self-Efficacy, Self-Awareness, Self-Determination
Self-empowerment
In psychology and philosophy, the debate between “nature” and “nurture” is a long-standing tradition. Are behavioral characteristics inherited from our parents or learned as we grow up? Over the last 20 years, this debate has expanded to include medicine and the other physical sciences.
Nature is what we think of as “pre-wiring” and is influenced by genetic inheritance.
Nurture is understood as the influence of external environmental and lifestyle factors after we have received our genetic pre-wiring.
DNA takes the form of the double helix we are familiar with thanks to James Watson, Francis Crick, and Rosalind Franklin. They first theorized the specific structure of DNA and subsequently identified and photographed it, presenting in the journal Nature in 1953.
The Human Genome Project mapped the entire human gene sequence identifying individual genes that are responsible for physical traits like hair and eye color, but it also identified genes that are responsible for specific cancers, weight, and other physical traits with direct health implications. At the completion of the project in April 2003, for the first time, we had nature’s complete genetic blueprint for building a human being in our hands.
I started my lifestyle modification journey on June 23, 2003, right in the middle of an explosion of new genetic discoveries. This was a time when some doctors and scientists were saying that certain individuals had a “genetic predisposition” to heart disease, diabetes, hypertension, obesity, addiction, and a whole list of chronic illnesses. This has very personal implications for an individual that is deciding how to handle a recent heart episode. The news that there could be a predisposition to heart disease sounded hopeless and made me wonder what real options for mediating heart disease were available to me.
As scientists took the new genetic predisposition information to heart, there seemed to be an understanding that genetics alone could explain how gene expression works. There was at first a big “I told you so” moment from those on the nature side of the nature vs. nurture debate, but it didn’t last long.
Even before the Human Genome Project was complete, there were some very interesting studies of twins that were starting to show that there was something different at work too; the epigenome. Around 2005-2008 there was another explosion of genetic information, and the science of epigenetics came into its own.
All cells have the same underlying genetic code or sentencing, but it is how the genes or genetic sentences are read that determine how a specific gene will function or not. This is referred to as gene expression. Although a gene may carry the information to code for a certain cancer, that gene may either be expressed, resulting in cancer, or not expressed, resulting in cancer-free cells. What controls gene expression is the epigenome. Epigenetics is characterized by a change in gene expression not caused by changes in the DNA sequence.
DNA is packaged into compact structures called chromosomes, which act as extremely efficient storage units. Strands of DNA are wrapped tightly around proteins called “histones” and chemical tags such as methyl and acetyl groups that together make up the epigenome or a layer of molecules “on” or “above” the genome; hence epi-genome. These chemical markers shape the physical structure of the genome, acting to either constrict the strand of DNA so tightly around the histone molecule that the genes cannot be read or expressed or to dilate or relax the strand of DNA so that its genes can be easily read or expressed. Relaxed genes are active, and constricted genes are inactive.
Epigenetic tags react to influences from the outside world like diet and food availability, physical activity, exposure to toxins, and stress. It is these environmental and lifestyle variables, not the genome, that determine gene expression. The epigenome represents a subconscious physiological connection to our rapidly changing environment.
Remember that this five-part series of healthy eating tips on looking at the big picture rather the details, so let’s pull our head up and see what we can derive from this.
The basic actionable implication for those of us with genetic predispositions is pretty simple and extremely empowering! Even if you have the gene for diabetes, it doesn’t have to mean that you will get diabetes. It depends on your lifestyle! Further, there is a body of evidence developing showing that some conditions like heart disease and diabetes may be able to be reversed. At this very moment, your doctor will urge you to change your lifestyle to reverse obesity or hypertension, and even now, doctors will readily agree that lifestyle changes can mediate heart disease and diabetes. The only question is what people will be able to make those lifestyle changes? Is one of them you or not?
Self-efficacy
The American Psychological Association defines self-efficacy as “an individual’s belief in his or her capacity to execute behaviors necessary to produce specific performance attainments.” Your self-efficacy is a reflection of your confidence in your ability to control your motivation, behavior, and responses to your environment.
People with high self-efficacy approach obstacles in life as challenges they can master, instead of situations to be avoided. They set challenging goals for themselves, are committed to those goals, and work very hard to achieve them, even in the face of failure. If they are unable to achieve their initial goal, they recognize this as a lack of skills or knowledge, which they can acquire, and then they try again. This approach to life challenges increases personal growth and decreases negative emotions associated with failure.
On the other hand, people with low self-efficacy view life obstacles as threats, and instead of focusing on how to overcome them, they will focus on their deficiencies, how difficult it will be to achieve success and all the possible negative outcomes of failure. They rarely set goals for themselves, and when they do, they do not remain committed to them. When they face difficult situations, they give up quickly and attribute failure to their deficiencies and are easily overcome by stress, anxiety, and depression as a result.
Self-efficacy is all about getting your head in the right place and setting yourself up for success. Remember that your lifestyle modification starts with commitment, which needs to be well anchored and never changes. The details of your plan change based on your current willingness to change and resources on hand at the present.
Self-awareness
A paraphrased step four of a twelve-step program for addiction recovery is to make a searching and fearless inventory of ourselves, noting strengths and shortcomings. The same step is required in lifestyle modification.
After you commit to lifestyle modification, it is imperative that you honestly assess your ability and willingness to change and update that assessment regularly. You use this information to choose a place on the healthy diet spectrum that is comfortable to you and a place where you can be successful. You also need to select an exercise regime that will yield results that you want but is not so aggressive that you fail to meet goals. Setting smaller goals at the start wouldn’t be a bad idea because being brutally honest with yourself when creating self-awareness is essential! Remember that success tends to breed success, and failure tends to breed failure.
Self-determination
As a society, Americans place a tremendously unfair burden on our doctors and other healthcare professionals when we expect them to have all the answers to our health concerns on the tips on their tongue. Responsibility for our health is not something we can rely on any other person for. I didn’t use to think that was the case, but after going to school at age 45 and seeing first hand some of what future doctors go through, I know it is so.
I used to get angry with doctors when they did not present the plant-based whole foods diet as an alternative to every newly diagnosed heart disease patient they saw. The reality of our healthcare system is that docs get a very small amount of time with each patient. During that time, they have to do much of what we are talking about here. All patients ask, “what do I do now, doc?” To answer that question, doctors have to guess what your commitment level is, assess your willingness and ability to change and then select an appropriate diet and exercise regime for you. That’s just not a realistic expectation and given what we in the healthcare industry know about the very low percentage of people that are both willing and have the ability to be successful with a plant-based whole foods diety. It is also not responsible on a doctor’s part to even waste valuable patient contact time suggesting it. For most people, medication and medical procedures are just a better alternative. If that is not the case with you, then you need to step up and say so!
In medicine, self-determination is called “patient autonomy.” That’s a phrase that makes some healthcare professional cringe. Patient autonomy doesn’t mean that you just have a right to know about treatment options and can deny certain treatments. It means that you and your doctor or healthcare provider are partners and need to collaborate and come up with a treatment plan that best fits you. That’s what owning your health is all about! With you as an active partner, your healthcare provider is an invaluable resource!
Putting it all together; own your own health!
“Absorb what is useful,
discard what is useless,
and add what is specifically your own.”
― Bruce Lee
Nobody else is responsible for your health! You need to take control and not allow anything, anyone or any situation to derail your lifestyle modification plan. I mentioned last week that when I was just starting my personal lifestyle modification journey, one of the things that confused and frustrated me was all the controversy surrounding the details of nutrition. Some doctors and scientists thought one thing and argued with others that thought something different. Some of those doctors had suggestions that were great for me, and others didn’t. Not anyone of them provided a lifestyle modification blueprint that was 100% right for me, and you will probably not find anybody to provide you with a lifestyle modification blueprint that is 100% right for you so like Bruce suggests; take what you can use, discard what you can’t and add your own ideas. Make it your own and OWN it!
There is an education component to lifestyle modification, and the next two weeks deal with important topics we need to explore. Next week we’ll look into how did we got in this mess to start with, and the following week we will learn about why it is difficult sometimes. Until next week work on making yourself empowered, aware, and determined! Make yourself into your own hero and start with a theme song; every respectable hero needs a good theme song!
Here are the references for today’s Healthy Eating Tip:
National Institutes of Health: National Human Genome Research Institute: The Human Genome Project https://www.genome.gov/human-genome-project. Accessed 6/26/2020.
Lichtenstein P., Holm N.V., Verkasalo P.K., Iliadou A., Kaprio J., Koskenvuo M., Pukkala E., Skytthe A., Hemminki K. “Environmental and heritable factors in the causation of cancer–analyses of cohorts of twins from Sweden, Denmark and Finland.” New England Journal Medicine, July 13, 2000:343, 78-85.
Youngson NA, Whitelaw E. Transgenerational epigenetic effects. Annu Rev Genomics Hum Genet. 2008:9:233-57.
McGowan PO, Meaney MJ, Szyf M. Diet and the epigenetic (re)programming of phenotypic differences in behavior. Brain Research. 2008:1237:12-24.
Wong AH, Gottesman I, Petronis A. Phenotypic differences in genetically identical organisms: the epigenetic perspective. Human Molecular Genetics. 2005:14:1:R11-18.
McGowan PO, Meaney MJ, Szyf M. Diet and the epigenetic (re)programming of phenotypic differences in behavior. Brain Research. 2008:1237:12-24.
Stover PJ, Caudill MA. Genetic and epigenetic contributions to human nutrition and health: managing genome–diet interactions. Journal of the American Dietetic Association. 2008:108:1480-87.
Kaati G, Bygren LO, Pembrey M, Sjostrom J. Transgenerational response to nutrition, early life circumstances and longevity. European Journal of Human Genetics. 2007:15: 784-90.
American Psychological Association: Public Interest Directorate: Education Resources: Teaching Tip Sheet: Self-Efficacy. https://www.apa.org/pi/aids/resources/education/self-efficacy. Accessed 6/26/2020.
Bandura, A. Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 1977: 84(2) 191-215.
Bandura, A. “Social foundations of thought and action: A social cognitive theory.” Englewood Cliffs, NJ: Prentice-Hall, 1985.
Bandura, A. “Self-Efficacy: The exercise of control.” New York, NY: W. H. Freeman, 1997.