The 4 Pillar Plan

How to Relax, Eat, Move and Sleep Your Way to a Longer, Healthier Life

by Rangan Chatterjee

  • Below you can find my top highlights (not a summary, quotes may be edited for readability)
  • Skim… then slow down on the paragraphs that catch your interest. Reflection requires pause.
  • If it resonates, you can purchase the full book here.

The 4 Pillar Plan: How to Relax, Eat, Move and Sleep Your Way to a Longer, Healthier Life by [Chatterjee, Rangan]

This book takes an “interventions” approach.

Invites you to make changes, see the result, and decide to embrace or discard.

“If you wait for the evidence, you may miss three Olympic cycles” – Charles Poliquin

RELAX

Three criteria for a good stillness/relaxation activity:

  • Firstly, it must be something unashamedly for you and you alone.
  • Secondly, it must not be an activity that involves your smartphone, tablet or computer.
  • Thirdly, you’re not allowed to feel guilty about it.

We’re designed to experience stress in short bursts. When we endure it for a sustained period, it becomes a problem.

People are constantly in fight-or-flight mode. They’re spending their days with their cortisol levels continuously ramped right up, their sympathetic nervous systems activated.

All stress is the same for the body: Whilst there are an infinite number of stressors in our environment, there’s only one main stress response. Your body can’t tell the difference between emotional stress, physical stress and nutritional stress. It can’t tell the difference between the stress of missing a mortgage payment or the stress you feel when someone’s been rude to you on Facebook. To your system, it’s all just a lion flying at your head and it reacts in the same way in every case.

What is inflammation: Your immune system needs to go into a peak state. We call this heightened immune response ‘inflammation’ and, again, we’re not supposed (to stay in it for long periods of time).

Chronic inflammation (in medical parlance, any nasty condition that hangs around for too long is referred to as ‘chronic’) underpins pretty much every single degenerative disease that we have.

On Depression: They showed a remarkable link between inflammation and depression. They found that patients with high degrees of inflammation do not respond to conventional antidepressants. The name of a disease can often tell us very little about the actual cause.

Normalizing cortisol levels – whether through meditation (see here) or from sectioning off some daily me-time, or even from switching to a wholefood diet (which helps reduce the nutritional stress caused by low-quality foods) – very often alleviates menopausal symptoms entirely.

Just by making space for yourself for fifteen minutes per day … you can help normalize your cortisol levels. Your body will be reminded what it’s like not to feel under attack.

Ironically it’s the people who say they don’t have time for these interventions who need to do them the most.

Examples of phone-free me-time you might consider: Having a bath Going for a walk Sitting in a cafe having a drink Sitting on a park bench relaxing, Reading a magazine, Reading a book, Singing, Playing music, Gardening, Cooking with your favourite album playing, or in silence, Painting, Dancing, Fifteen minutes of yoga or Tai Chi, Relaxing at home, with or without music

Phone = drug: Just like many drugs, the more you use your smartphone, the more addicted you become.

Social Media takes advantage of our evolutionary preferences: Just as the company making Mars bars takes advantage of the fact we’ve evolved to love sweetness, so social media takes advantage of the fact we’ve evolved to crave the approval of others.

We used to have the tribe applauding us once every now and then when we did something truly selfless or brave. But we now live in an age when we can have all these things all the time.

We’re overusing all our inbuilt evolutionary mechanisms. And you’d have to be naive to think there aren’t going to be consequences.

We all tend to compare our lives to other people’s and judge ourselves accordingly. These are automatic processes. We can’t help it. In vulnerable adolescents, this can be an easy road to stress and depression. It can be just as harmful in adults.

Taking notifications off your phone is a great place to start. All your apps are still there and functioning, but every time someone likes an Instagram comment you’ve liked, or checks your profile on Linkedin, you don’t get a notification. You could extend this further by turning off the auto-sync on your email inbox. Now you have to physically request your email inbox to refresh.

Locking your phone: You could even try introducing a ‘device box’ at home into which everyone in your household has to drop their phone before meals. (Note from Miguel: consider KitchenSafe).

There’s no down time when you have a smartphone in your pocket. How often do you go for dinner and you’re with your partner or best friend, but you’re really not with them? How many times have you felt a ‘phantom phone buzz’ in your trouser pocket? What’s that about?

It is not my place to tell you how to consume your digital media. That is up to you. My hope is for you to question your current usage; how much of it is what you have chosen and how much of it chose you. Just because smartphones have the functionality of emails, does that mean you have to use it? What happens if you don’t?

If your email says you are unavailable, you are unavailable. He realized that by turning them off when he was away, he was controlling his time and stress levels far better, raher than being controlled by his device

You don’t think you are addicted to your phone? If you find yourself thinking that smartphone dependency is not a problem in your life, why not try doing without it? See if you can manage it, just for one day per week. Will you find an excuse?

Ten minutes before bed writing down three things that went well, no matter how large or small, and also – in order to force you to further ‘reflect on and immerse yourself in the good event’ – the reason why that thing went well. You start making this a regular practice, you’ll be ‘less depressed, happier, and addicted to this exercise six months from now’.

On reflecting on positive experiences: Writing about a positive experience for twenty minutes on three consecutive days.

On gratitude: People who had more feelings of gratitude not only slept better but also had more energy and increased focus.

Religious laws are time-tested heuristics: Much of what makes up religious laws are the learned life-lessons in how to live well or maintain some sort of order within populations of people.

It seems to me that Christians probably found a dose of gratitude at the end of every day increased the quality of their sleep and their state of mind, and that this had plenty of genuinely positive effects on their health and mental well-being.

Get a journal: A simple tip is to buy a really nice journal or diary and keep it by your bed. Own it. Love it. Treasure it.

Bad meditation sessions still work: Even though, during some sessions, I couldn’t switch my mind off at all and was sure the meditation had been a complete waste of time, it didn’t seem to matter. The effect remained.

Human life is meant to be mostly calm: Our daily lives would probably have consisted of lengthy episodes of calmness punctuated by peak moments of stress. This is what our brains and bodies have evolved to expect, but the modern environment just doesn’t allow for it.

How to activate your relaxation mode: when your out-breath is longer than your in-breath, you activate the parasympathetic nervous system, which you can think of as your relaxation mode.

3-4-5 breathing: I’ve come up with a simple exercise called 3–4–5 breathing. It couldn’t be easier. Just breathe in for three seconds, hold for four and then breathe out for five. It’s easy to remember and even easier to do.

Start meditating small but daily: Having felt the benefits, those few minutes became longer and longer, and now he does fifteen minutes every day. Brian started small and built up big. You can too. The important thing is just to start.

2 minutes of daily conscious breathing: Even two minutes per day will have benefits. Not got two minutes? Really? Do you manage to brush your teeth morning and night? I suspect you do. Why? Because it has been prioritized since childhood and that priority has now become a routine. Perhaps it is time to create a new routine: two minutes of conscious breathing per day. Try to do this at the same time every day – it is much more likely to become a habit if you do.

Stillness practice takes gradual training: ‘If I asked you to run the London marathon, would you try to run twenty-six miles two or three times and then say “I can’t do it”, or would you build up gradually?’ Most people understand that, to complete a marathon, you have to train your body to do it. In the same way, you have to train your mind to get used to practising stillness.

Kids are natural single taskers: Many of our natural capacities for stillness are lost as we grow into adults, and all the pressures and responsibilities of real life kick in. That’s why it can be instructive to look at kids. They don’t multitask; they focus on what they’re doing.

When was the last time you were fully immersed in something you loved? What gives you that flow? Is it gardening? Reading? Cooking? Painting? Tinkering with engines? Whatever it is, seize it. Own it. Guard it. Practise it. Use it as your way of gaining stillness.

EAT

Eat one meal a day at the table, in company (if possible), without your devices.

What we lost was that feeling of us all sitting around together, gossiping, laughing, bickering and doing all the things a family should be doing when they get together. What we lost was connection.

Firelight talk: When the sun goes down, all that changes. Around the campfire, more than 81 per cent of their conversation time is spent telling each other stories. The researchers call this ‘firelight talk’. It’s a time of calmness, reflection and – perhaps most importantly – connection.

You digest food properly when you’re in relaxation mode. When you’re in fight-or-flight, you don’t.

Nowadays, some homes don’t even contain a dining table. Twenty years ago it was common for families to eat their evening meals together. Nearly every house – even smaller ones – had a space reserved for doing exactly that. 

I simply refuse to believe there’s One True Diet that’s optimal for everyone. Remember, humans have always been opportunistic omnivores. All through history our diets have been dictated by geography and climate. We ate whatever food was available. This means the evolved human machine is capable of thriving on a whole range of diets.

On dairy & gluten: Misguided commentators in the media have portrayed the avoidance of gluten, and dairy, as some sort of dietary fad, as if they are somehow essential food groups. They are not. There are several populations around the world who consume little to no dairy, such as the Chinese, and do just fine.

On greens & children: One of the most troubling trends I’ve seen over my sixteen years of practice as a doctor is an increasing number of children who refuse to eat fruit or vegetables at all.

On sugar: overconsumption of sugar seems to alter our taste buds. As they become used to it, our bodies crave more and more. Reducing your intake of sugar changes your sense of taste. We’re wired to crave sugar in order to store it as energy in the form of fat.

SYMPTOMS THAT MAY INDICATE OVERRELIANCE ON SUGAR:

  • Feeling the need to eat every two hours
  • Concentration dropping mid-morning
  • Experiencing an afternoon slump 

If you start the day with foods that are high in sugar or are converted in your body to sugar (foods like white bread and breakfast cereal), your blood sugar soars and you go into a buzzy high. Two to three hours later, however, it crashes. Then you’re craving sugar again.

Periods of fasting can be very helpful in reducing insulin and sugar levels.

Go ‘cold turkey’ and cut out all sugar for fourteen days. This can be an excellent way to retrain your taste buds quickly, but will often lead to withdrawal symptoms such as headaches, irritability and insomnia, especially between days 3 and 6. However, once past ten days, patients often report many benefits, including improved sleep, mood and energy.

Keep healthy snacks readily available at home, at work, and even in the car – carrots and hummus, celery and nut butter, a piece of fruit or some olives.

Protein keeps you feeling full for longer, which helps avoid sugar cravings.

Strategies when craving sugar: Drink two large glasses of water (some find sparkling water especially helpful), Do some deep breathing (such as 3–4–5 breathing, see here), Distract yourself with a complex task that focuses your attention elsewhere, Have a piece of fruit, Eat a handful of nuts, If you are really struggling, have a small portion of 90 per cent (ideally 100 per cent) dark chocolate.

I came to think of that evening craving for food as having a kind of ‘itchy mouth’. That’s become the way we talk about it in my house now. Am I really hungry? Or do I just have an itchy mouth?

If you take a bunch of human liver cells and put them in a test tube, they start operating by daily rhythms?’

Don’t be disheartened if you miss a day, or even two. It really doesn’t matter. When you feel ready, try again and see how you get on.

Aim to drink eight small glasses of water per day (approximately 1.2 litres).

Evidence vs Sensible: What should I do as a practising doctor? Wait for the evidence to come from academia that frankly may never arrive? Or should I make a sensible recommendation that I’ve seen help thousands of patients? I choose to help patients now.

This is the big difference between researchers and clinicians. Researchers assess evidence but it can be a long time before such evidence gets translated into mainstream clinical practice – some say about thirty years! In addition, some concepts never get properly examined, sometimes because they’re hard to study, but often because there’s simply no financial imperative to do so.

Try to avoid food products that contain more than five ingredients. (Then) you will very probably be following an anti-inflammatory diet.

The major problem is not that we’re simply eating too much food; it’s actually that we’re eating the wrong type of food.

Challenge yourself to go for two weeks eating ONLY fresh, unprocessed food. Every patient of mine who has done this has always felt a difference.

The muffins or burgers get digested, but there’s a price to pay.

By making sure that you don’t consume any food product that contains more than five ingredients, you will very probably be following an anti-inflammatory diet.

MOVE

(High Intensity Interval Training could be) ‘the most time saving invention since the microwave’ – A. A. Gill

Like most things, exercise has its ideal dose. Are you overdosing?

We should stop talking about ‘exercise’ altogether and start thinking, instead, about ‘movement’. We simply need to move more during the day.

We need to design our lives around movement.

We simply can’t undo the damage that prolonged sitting does to us by going to a spinning or gym class for forty-five minutes after work.

A gym session is not the antidote to sitting …‘Breaking sitting with standing and light-intensity walking effectively improved twenty-four-hour glucose levels and improved insulin sensitivity in individuals with type 2 diabetes to a greater extent than structured exercise.’ The answer is to sit less and spend more time fidgeting and moving. Design your day around it.

Regular walking is also one of the best things you can do to prevent Alzheimer’s.

The benefits of getting your 10,000 steps per day are profound.

1,000 steps is only about ten minutes on your feet.

Walking, like breathing, is such a fundamental process that it’s one of the core activities that the brain does without the need for conscious control.

Make it a rule that you never sit down for more than one hour at a time.

Saving time to harm your health isn’t a good deal for me.

When you start seeing the whole world as your gym, you start seeing all the opportunities you have to make moving a simple and achievable part of your daily life.

Do some form of strength training twice a week.

Find a form of HIIT (High Intensity Interval Training) that works for you and do two ten- to fifteen-minute sessions each week.

An eleven-minute HIIT workout gives as much benefit as one hour of continuous activity. One minute of intense working out, pushing yourself as hard as you possibly can in three twenty-second bursts of intense cycling spread out over ten minutes, showed equivalent improvement to forty-five minutes of moderate-intensity cycling.

Simple sample exercise: doing ten burpees, ten star jumps and ten side lunges sequentially in your living room for forty seconds … then spend the next eighty seconds walking around slowly and then repeat five times.

Make a habit of doing three or four ‘movement snacks’ five days a week.

Primal Play Tag. You need two people and the aim is simply to try to touch your opponent between the knee and the hip. So you’re both simultaneously trying to avoid and trying to tag. This is three-dimensional movement. You can do it pretty much anywhere, and it’s so much fun that you just don’t feel like you’re exercising.

A lot of back pain is actually caused by having sleepy backsides (glutes).

It’s not by accident that men and women tend to, consciously or unconsciously, judge the quality of a potential mate partly on the shape of their butt.

It was in Gary’s brilliant book What the Foot? and on his training courses that I first learned about the importance of glutes, and how we must reawaken them in order to combat the effects of our flexed, hunched-over lifestyles.

We can’t simply consciously ‘decide’ to use our glutes and therefore extend properly. Our brains make these decisions for us, unconsciously. Therefore, we need exercises that remind the brain how to trigger the correct muscles. And this is exactly what Gary has designed.

My recommendation is that you do at least one of these four movements every single day… (The book has sets of exercise explained in detail, I recommend buying the book if interested.)

SLEEP

‘If sleep does not serve an absolutely vital function, then it is the biggest mistake the evolutionary process ever made.’ – Dr Allan Rechtschaffen

The longest any human has managed to stay awake is a mere eleven days. The fact that we spend a third of our entire lives asleep just hints at how critical it is for both our mental and physical well-being.

There is no tissue within the body and no process within the brain that is not enhanced by sleep, or demonstrably impaired when you don’t get enough.

When you sleep well, it’s much easier to make better choices the following day. You crave less sugary food and feel more energetic, which, in turn, means you’re inclined to be more physically active on the one hand and to engage in relaxation practices such as meditation

The majority of sleep problems are lifestyle related.

Spend at least twenty minutes outside every morning (without sunglasses).

Those who exercise outdoors on a regular basis have higher levels of serotonin, which is a hormone thought to be involved in happier moods. It also helps reduce fatigue.

Start your evening wind-down with a ‘No-Tech 90’ as part of a set ritual.

Sleeping in at the weekend, for example, is a well-known trigger for migraine sufferers.

Make your alarm a signal that the wind-down for bed must begin and set it for ninety minutes before lights out. And as soon as it sounds, that’s when your No-Tech 90 begins. This is when you turn off all your e-devices, including computers. No exceptions.

Ensure that any caffeine you do choose to consume is taken before lunchtime.

By designing our home environment we’re controlling what can be controlled and maximizing our chances of success. Remember, about 90 per cent of your health is determined by your environment, not your genes.’

When it comes to well-being, maintaining long-term health and quality of life, the best medicine for you is you.

One of the basic tenets of our craft is the Hippocratic oath, primum non nocere – first, do no harm.

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