The Triangle of Health | Part 1:
Getting “Unstuck”
3 Obstacles (and 3 Solutions) to Unleash Your Body’s Ability to Heal.
Dr. Aaron Hartman
September 5, 2023
Editor’s Note: This article was originally published as a four-part series. The content has been edited to make it easier to find and read.
Stuck...
Your body was designed to heal itself.
That is amazing and it is beautiful. But perhaps that doesn’t feel like your reality.
“I’ve tried all the things … why isn’t my body healing?”
“I’ve tried so many diets, supplements, and programs.”
“I eat well and exercise. Why am I still stuck?”
First of all: you are not alone. That is so important to hear. I’ve heard these questions over and over in the last 10 years in my practice. It’s common to get stuck. It’s also common to get unstuck. I have the privilege of witnessing that truth every day. Others have gotten unstuck, and you can too.
The Bad News: We can sabotage our body’s amazing ability to heal itself.
The Good News: The diagnosis isn’t overwhelming and neither is the prescription.
In my experience with over 100,000 patients in five countries on four continents, this is what I've learned: There are three major places where people get stuck in their health. When I see patients who have been to other clinics and seen other practitioners, I have noticed that these are the main things that are keeping them from making progress. These are the humps they can't seem to get over.
Gut • Stress • Sleep
That’s it. Focus on the three corners of the Triangle of Health, and you can too can “unstuck” your body’s ability to heal itself.
Why Gut, Stress, & Sleep?
You may be asking yourself, “Why those three?”
Perhaps you’ve seen lists from other doctors. At RIFM, we often refer to the 5 Foundations of Functional Medicine. So, why do I focus on these three, in particular? Why do gut, stress, and sleep make the difference? What is the magic in this formula?
To answer that question, I first need to walk you through two other “lists.” I arrived at the Triangle of Health after working with two important systems:
The Blue Zones
In his book The Blue Zones, Dan Buettner surveys areas of the world containing the most long-lived individuals. He uncovers seven underlying factors, “blue zones,” common to those living in these areas.
For those familiar with Functional Medicine, these seven principles of health and resilience may sound familiar. The “Blue Zones” underpin the Foundations of Functional Medicine.
Which is our next list.
The Foundations of Functional Medicine
The Institute for Functional Medicine developed its foundation model for the delivery of health care, and it closely mirrors Dan Buettner’s research and what ancient cultures have already taught us. But unlike Buettner’s seven-point model, the Foundations of Functional Medicine focuses on five essential leverage points in people's health.
Too Much...
Both the Blue Zones and the Foundations of Functional Medicine illustrate the interconnected nature of our health and lifestyle. I call this Connected Health. Both can be helpful resources.
But let’s be honest with one another: managing seven blue zones in your life is too much. Managing five foundations is better, but that’s still too much. If you are starting from a place of health, you might be able to manage five foundations. But as I have walked alongside people fatigued and in pain, I realized managing seven blue zones or five foundations is too much of an added burden.
But there is a simpler way.
If you focus your attention on your gut, stress, and sleep, you will experience dramatic progress in your health. Gut, Stress, and Sleep are the primary obstacles preventing your body from healing itself. And if you focus on these three things, the rest of the interconnected nature of your health will come along for the ride.
The Triangle of Health
01. Gut
All Disease Starts in the Gut
This is a common phrase many of us have heard, which dates back to the fifth century BC with the father of medicine, Hippocrates. However, only recently — in the last 10 years or so — has scientific research caught up with his insights from over 2,500 years ago.
Only 20 years ago, the idea of ‘leaky gut’ emerged … and was ridiculed by most mainstream medical organizations. Now everybody has heard about leaky gut.
But what’s so important about the gut? Why is our gut the beginning and end of healing?
Consider What the Gut Accomplishes
We can start by realizing that just to digest what you eat and turn it into something that your body can use is a miracle in and of itself.
Just to digest what you eat and turn it into something that your body can use is a miracle in and of itself.
The lining of the GI tract is only one cell thick. On top of that is a thin layer of mucus that protects it from all the bacteria and toxins we drop into the toilet on a daily basis. Somehow, enzymes from your mouth, acid from your stomach, pancreatic enzymes from your pancreas, bile from your gallbladder, and enzymes secreted by your intestinal lining are able to take what you see on your plate and turn it into a liquid substance that can then be absorbed by your body and transferred to every part for healing. At the same time, lymphatic tissue around your GI tract secretes toxins that come from your blood and eventually work their way to the end of the colon.
The Gut’s Role in Brain Health
75% of all of your brain’s neurotransmitters are made in your GI tract. That includes 90% of serotonin and 50% of dopamine.
So now we know that, if you want to have good brain health, you must have good gut health.
The Home of Your Immune System
Your GI tract is also home to 90% of your immune system. This means that illness, allergies, asthma, respiratory tract issues, cancers, chronic infections, or anything else that has to do with your immune system, begins in the gut. Research is now showing that the bacterial content of your GI tract can actually increase your risk for things like multiple myeloma and certain kinds of leukemias.
The One-Cell-Thick Barrier Between You and the Outside World
Another interesting concept is that the lining of your GI tract is the primary interface between your body’s chemistry and the outside world. Anything you breathe in or swallow works its way from your mouth to the gut. We take in bacteria, viruses, environmental proteins, and other things that your immune system then learns about. When functioning properly, your body learns to ignore them, not to activate your immune system, and they are passed through the body and from the colon.
When the Barrier is Compromised
If this system doesn't work just right, we can develop allergies, asthma, autoimmune diseases, and immune dysregulation in the form of cancers, malnutrition, and a whole host of other health conditions.
As you can see, health does truly begin in the gut, but addressing your gut health must be holistic. While buying organic, whole food and removing seed oils is a good start, there is much more to consider. Gut health is impacted by environmental aspects of how we eat and includes sitting down, having family meals, eating slowly, and chewing our food thoroughly. And it includes much, much more.
02. Stress
“I’m stressed”
I’ve heard it. You’ve heard it. We’ve all heard it. Because we’ve all said it.
“It’s been a stressful day … or week … or year … or season of life.”
What does that even mean? What is stress? Is it just getting stuck in traffic? Or is it something deeper, affecting every aspect of your health?
Stress is Actually a Good Thing
First and foremost, stress by itself is not actually a bad thing. Stressors are a natural part of our lives and work within in our bodies to help us learn and grow. When you go to the gym and lift weights, you’re stressing your body. You are stressing your muscles and tearing them slightly. Your body’s response is inflammation and — ultimately — healing. Similarly, when you study for a test and stress your mind, you are making new connections and learning new things.
Low-level stress resulting in positive change is an effect called hormesis. Hormesis also allows micro-stressors to regulate our immune system. Turmeric and cinnamon are just two examples of herbs and spices that work through this mild hormetic stressor effect, which turn on different gene systems and self-regulatory systems in our bodies.
Stress isn’t inherently bad, but let it run amuck and stress causes … well, just about any chronic health issue.
Too Much of a Good Thing…
Recent research has shown, for example, that for women following a divorce, it is common to see an uptick in breast cancer about two years after that stressful life event.
There are childhood events called ACEs or Adverse Childhood Events. These are traumatic life events that occur in childhood are associated with diseases in adulthood (e.g. immune issues, mood disorders, and even certain types of cancers).
Returning to the gut, low-grade stress can induce leaky gut, which will affect your entire digestive system. And by affecting your hormones, stress can affect your sleep, which is the third part of the Triangle of Health.
Yes, But Why?
Why has stress become such an issue in our modern culture?
Why is it destroying our kids’ mental health?
Why does everybody seem to have some kind of mood or anxiety disorder?
And why is it getting worse?
Part of the answer is our Western response to stress. We don’t really do any kind of self-regulation or self-healing practices. When we “rest,” we’re not really resting; we’re activated in front of a screen. When we take time off to heal, we don't actually do it; we go on ridiculously stressful vacations that we need to take a vacation for. Have you ever wanted to take a vacation from your vacation? I certainly have. Every family vacation I come back from, I need a break from my break. And this is the norm in our culture. On top of that, we feel a deep need to be super productive. Our culture emphasizes productivity over self-healing and self-awareness. It’s a perfect toxic soup for low-grade stressors, and it's killing us.
Ever heard of Chinese water torture? The idea is that you’re immobilized while a drop of water repeatedly drips onto your forehead … drip, drip, drip. Initially, it doesn’t seem particularly harsh, but after several hours, it can drive the individual insane. That’s essentially what a low-grade drip, drip, drip of stress does to our bodies over time.
And then there’s cortisol...
I’ve previously published a blog series on hormones, including two articles on cortisol, the king of all hormones. If we live a chronically stressed life – whether it’s physical stress, emotional stress, or environmental stress – over time, this drains the brain’s ability to respond and results in low cortisol. In other words, elevated cortisol over time results in insufficient cortisol … and a cascading series of negative symptoms and diseases.
Solutions
So what can you do about stress?
You don’t need to hop out of your life and go away to a desert island. But you do need to discover and implement a daily strategy to help your body self regulate and heal so you can get back to 100% the next day.
You can (and should) find a self-regulatory practice — something that resonates with you, where you get away and learn to be at peace with yourself and the world around you. That probably sounds like I’m advocating Yoga. Yoga is one such strategy, but there are many other ways to accomplish the goals of self-regulation that will resonate with you, personally. it took me years to understand why a massive subset of men are always fishing and hunting and generally out in the woods. Candidly, I used to think it was a personal deficit; they didn’t work hard enough. I now realize they are getting away into nature and letting nature heal them; they are relaxing and allowing their cortisol levels to come down. My own perspective has changed in this field in the last 10 years.
What are some self-regulatory practices you can do? I published another article series, Lifestyle Medicine for Stress, which delves deeper into specific strategies for regulating stress, including: Yoga, Exercise, Mindfulness & Breathing, Creativity, Nature, and Relationships.
There are many strategies for regulating stress. Don’t let all the options overwhelm you. Select one meaningful strategy that resonates and work on integrating that into your life. Build on that one success and work towards small next steps.
03. Sleep
“I’ll sleep when I’m dead.”
I used to say this myself. I was wrong. Not sleeping actually speeds up the process to being dead.
During my medical school and residency, I didn’t have much of a choice. I generally worked a minimum of 80 hours a week, and 100 – 120 hours was normal. A typical “workday” was a 30 – 36 consecutive hours. My longest workday during my internship was a 42 hours. By the third year of my residency, I managed to achieve working 60–70 hours per week. I was in heaven. It felt like a part-time job compared to what I was used to.
But it’s what I had to do, right? I just had to do what I had to do; I had to learn what I had to learn. It’s what all doctors have to do.
But this isn’t just common in medical school. It’s becoming the new normal in high school. High school students are staying up late to study; then waking up early to get to get to school. The average American sleeps six and a half hours a day. If the average is six and a half, that means you have people like me sleeping eight, and you have people balancing me that are sleeping 4–5 hours a night. That’s literally killing us.
In the mid 1800s, the average American slept eight and a half hours a night. What’s going on? Is that two hours we’re losing everyday important. Is it affecting our health? Should we do anything about it?
The answers are yes, yes, and yes.
Why Sleep Matters
It’s worth acknowledging that we are only just beginning to understand why we need to sleep. We still don’t actually know what occurs during sleep. But we know what happens when you don’t get it. Your cortisol levels are elevated. Your memory is affected. Your hormones are dysregulated and your mental health becomes a mess.
Not sleeping (or not getting adequate sleep) affects our body systems, our mind’s sensibility and leads to all kinds of sicknesses. It’s the three S's of not getting enough sleep.
Tragically, it’s become a badge of honor for many of us. It was for me. I bragged about how much I slept in college (8–8.5 hours a night). Then, I bragged about how little I slept in medical school and residency (3–6 hours a night). The corporate world isn’t any better. And mothers often feel the need to one-up each other with their tales of sleeplessness. Now, there may be times and seasons when sleep deprivation is necessary, but isn’t it odd that mistreating our bodies becomes a badge of honor?
But why is this important? Why should you make sleep a priority?
Because sleep affects everything. Sure, that’s a sweeping claim. How? Sleep affects our ability to handle stress. If you don't have adequate sleep, your body’s ability to handle stress greatly diminishes. That, in turn, affects your gut … which is the beginning of both health and illness.
You can see the Triangle of Health at play, here.
During sleep, our immune systems re-regulate; our memories become cemented in our brain. And most of our primary brain and liver detoxifying events occur while we sleep.
So, if you’re someone who wants to optimize your health to lower your risk of heart disease, lower your risk of cancer, help your diabetes, help your sugar and insulin resistance, manage your weight, or just to live as long and healthy as possible … sleep is vital for all of these.
Solutions
10 Tips for Better Sleep
The most important step is simply to prioritize sleep. It’s a bigger deal than any of us have given it credit. Assuming you want to sleep but have difficulty getting enough quality sleep (at least 8 hours), here are 10 tips to help you sleep better.
Focus on the three corners of the Triangle of Health, and you can too can “unstuck” your body’s ability to heal.
If you found this article helpful and would like to take a deeper dive into the healing benefits of The Triangle of Health, I encourage you to enroll in the first of my three signature pathways: Connected Health: Gut.
Connected Health: Gut
A Six-Week Guided Journey to a Restored Gut
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