The 4 Pillar Plan


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The 4 Pillar Plan

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We are very used to the idea that certain lifestyles are bad for us. We know we

shouldn’t smoke; we’re aware that sitting at a desk for eight hours per day isn’t a

great idea, and that we should avoid eating lots of sugar. Perhaps a less familiar idea

is that our lifestyles can actually be medicine. It’s not just that we should avoid bad

habits – it’s that the right lifestyle and nutrition can actually improve our well-being,

reverse our health problems and even make chronic diseases like type 2 diabetes,

obesity and depression disappear.

It took a while for this to come into focus for me. A few years into my job as a GP, I

realized that I was probably helping only around one-fifth of the patients walking

through my door. I could certainly give them a drug to suppress their symptoms, but I

was failing to get to the actual root cause of their problems. The trouble with the way

we both think about health and practise medicine is this: we forget that the human

body is one big connected system. If a patient presents to us with symptoms of

depression, the usual textbook diagnosis is that it’s a psychological condition,

caused by a chemical imbalance in the brain. That will almost certainly lead to the

prescription of an antidepressant. What I found was that depression, along with

many other conditions, could just as easily be driven by poor diet, high stress levels,

a lack of physical activity or, even more likely, a combination of all three. Similarly

with eczema: the textbook tells us to prescribe a steroid cream for the rash, but the

rash is just a symptom. There’s little awareness that the causes of eczema are

many, among them an overreactive immune system which in turn may be caused by

food intolerance, abnormal gut bacteria or even high stress levels. Why not treat

these problems, rather than the rash, and get rid of the eczema for good?

This is why I believe that the future of medicine will be about more doctors
being super-generalists, rather than super-specialists. Just as our
understanding of the human body is evolving, so the practice of medicine
will also need to evolve.
The fact is, the body doesn’t work as the simplistic and reductionist textbook expects
it to. It’s a highly evolved biological mechanism that is completely interconnected.
This is why I was only managing to treat around 20 per cent of my patients. All too
often, a symptom in one domain might actually have a cause in an area of the body
that our medical training just doesn’t tell us to look at. This is why I believe that the
future of medicine will be about more doctors being super-generalists, rather than
super-specialists. Just as our understanding of the human body is evolving, so the
practice of medicine will also need to evolve. Good health occurs outside the doctor’s
surgery – not inside. Our lifestyles themselves are often the best medicine.
I’ll give you an example of how the current way we view health is tripping us up –
with potentially very serious consequences. For years, doctors have struggled to
treat a condition called chronic fatigue syndrome. This has led to it being one of the
most frustrating conditions that we see, because we don’t seem to be able to help. I
think the reason medical researchers are struggling so badly to find an effective
treatment is that they’re seeking a single cause and a single cure. But my research
into the interconnectedness of the body has convinced me there is no single cause
of this condition. I believe that patients who develop chronic fatigue syndrome are
usually experiencing multiple problems, and in order to help them we need to
address them all.
Our bodies, and the minds that interact with them, are systems of almost
unparalleled complexity. I’m heartened to see some research on this basis is now
being conducted into ‘incurable’ conditions such as Alzheimer’s. It’s early days yet,
and a lot more work needs to be done, but in that area at least it’s beginning to look
as if the multipronged approach I endorse could achieve promising outcomes. I call
such an approach ‘progressive medicine’. It’s the idea that we need to look at as
many factors as possible when examining what creates wellness or illness. Because
the body is so connected, with relatively distant parts of it affecting each other, the
cause (or causes) of any particular illness might not be immediately obvious.
That this ‘interconnected’ view of health is presenting good outcomes comes as no
surprise to me. Back in my surgery in Manchester, it has produced some truly eyeopening results.

 By taking this view, I find myself prescribing medications that merely
address symptoms far less frequently than I used to. Today, I’m much more likely to
prescribe a diet high in healthy fats, some meditation and more physical activity than
a mood-altering drug for depression. In prescribing small lifestyle adjustments that
promote rest and relaxation, encourage better sleep and diet and get people moving,
I have managed to reverse type 2 diabetes, get rid of depression, eliminate irritable
bowel syndrome, lower blood pressure, reduce menopausal symptoms without the
use of hormones, conquer insomnia, help people lose weight, get rid of severe
migraines and even reverse autoimmune conditions - all without the use of any
medication. We’re all familiar with the idea that lifestyle can be the cause of disease.
What’s not common knowledge is that a change in lifestyle can also be the treatment
and prevent us from getting sick in the first place.
The basic idea is simple. Because every of part our body affects, to a greater or
lesser degree, pretty much every other part, we need to take a much more rounded
view of treatment, one that considers every aspect of the patient’s daily life. How well
do they sleep? What do they eat? Are they sedentary at work? Are they constantly
consulting their smartphone or tablet? This is what I call the ‘threshold effect’. The
connected system that is in the human body can deal with multiple insults in various
places – up to a point. And then the system begins to break down. The point at which
it breaks down is our own unique personal threshold. When talking to patients, I liken
it to juggling. Most of us can juggle two balls, even three or four. But when we throw
that fifth one in, all the balls get dropped. We get sick. That sickness might manifest
itself as a skin complaint or a blood-sugar problem or a mood disorder or difficulty
sleeping. These complaints are signals that things – usually more than one – are
going wrong elsewhere in the body. My approach prioritizes the cause over the
The point of this book is to give you a simple, actionable plan to do the same. I want
to go beyond the sort of health advice we’ve all been reading about for so long –
beyond the fad diets and the quick-fix exercise programmes. We have
overcomplicated health – I want to simplify it.

There are four main elements, or pillars, to The Four Pillar Plan. The aim of the book
is to examine and improve the manner in which you Relax, Eat, Move and Sleep. For
each pillar I have set out five ways you might do this, summarized in the table below.
The idea is to create balance across all the pillars – it is not about perfection in each
individual one.
I would much rather you score 2 in every pillar, giving you a total score of 8, rather
than 5 out of 5 in two separate pillars, giving you a higher score of 10. The numerical
score might be smaller but the balance would be greater, and this is the real point of
the book. Achieving balance is what will lead to the biggest improvements and, most
importantly, the sustainable ones. This is designed to be a whole-life plan rather than
a quick-fix gimmick.
For most of my patients, most of the time, scoring 3 in each pillar resulting in a total
score of 12, seems to be about right. It is simply impossible, however, for me to say
what will be the right amount for you. Some of you will need to do more, some can
get away with less.
It is also possible to take each pillar in isolation. You may feel, for example, that your
diet and exercise are already dialled in, whereas your sleep needs more attention. If
so, feel free to go straight to that individual pillar and start there. You do not have to
go through the book in sequential order. I would prefer you to personalize it to suit
your own life.
Give equal priority to every pillar, and proceed at a pace that is comfortable for you.