Dr. Sal AbiEzzi, a physician at Palo Alto Medical Foundation, argues that healthspan matters more than lifespan. He outlines four pillars of healthy living: nutrition, activity, sleep, and mindset. Most modern diseases like cancer and diabetes stem from lifestyle, not genetics.
Chapters
Work hard, try to achieve, you know, put everything aside, then you gain the rewards later. So that's a totally unbalanced picture, and that's the world we live in today. It's pushing you to lead an unbalanced life. But the human machine, I call it, wants you to be in balance. And then if you are unbalanced, if you think of healing, if you want to achieve a change, that's what it requires, some sort of a change to achieve healing. So usually my audience doesn't look like this. I've given this talk recently to our physician group. We have at the Palo Alto Medical Foundation now 1,600 physicians. We are one of the top multi-specialty groups in the Bay Area. I've been with that company for 20 years. I run the medical director of the Encina practice, which is a concierge-type retainer practice within that model. Wellness has been my passion for many years. And I've really tried to answer the question with my patients that I see every day, how can I help them achieve better health and wellness? So that's what we'll talk about today. I think Alex alluded to CRISPR and microbiome. And I'm going to save some time at the end. We can talk about all these things. the new technologies. But really, my talk is going to be much more basic and going back to the fundamentals of health. So I have a mantra called the 4 pillars of healthy living. We'll talk about that— nutrition, activity, sleep, and mindset. And then I'm going to delve a little bit into habit because what I've noticed with my patients, we are creatures of habit. And it's been very, very challenging for me to help my patients change some bad habits or have them adopt new habits. So So we'll delve into the science of habit a little bit. And then I'll open up to questions. Palo Alto Medical Foundation is a multi-specialty group that's been in the Bay Area for 90 years. And the concept is that you bring physicians under one roof. And that's the model of the future because you need collaboration. You need to be able to coordinate care at a much higher level than you could do as an individual physician. So the metaphor I like to use, it's always nice to use metaphors. The journey, the health is a journey. And why I like that metaphor is because if you think about it, what happens in a journey? You take one step at a time. You go along a path. Sometimes you don't know what's going to be coming at you. Sometimes you get attacked by a bear or you end up in a firestorm. And so you get hurt or disabled by a disease or an illness. Or an accident. And so you have to pick up the pieces and then go on with that journey. And sometimes having support along with you helps you along that path. So think of it along those lines. So as a physician, this is what I see every day. And it is happening at a younger age to a lot of my patients. And so I've kind of coined the term modern human diseases. These are the diseases that we will encounter at some point in our life. You think of cancer, heart attack, stroke, diabetes. There's autoimmune disorders that are becoming much more prevalent, and then the mental health disorders. This is a lecture that comes from maybe more than 10 years ago that the determinants of health, 40% is attributed to lifestyle and 30% to genetics. And what we're learning more and more now that your lifestyle actually turns on and off your genes. So ultimately, 70% plus of what you do in terms of your lifestyle will impact your health and wellness. What I'll be talking about is not so much about staying alive, lifespan. It's about healthspan. So there are 2 different trajectories I see with my patients, with folks starting at a young age. And then as you go on in this journey is that some people will thrive, will have really an amazing lifespan. healthspan and they will thrive until the end and then something drastic will happen and they'll fall off a cliff. The other trajectory is that you end up with multiple disorders early in life. You start with arthritis, you can't exercise anymore, you get an autoimmune disorder, then you have to take meds and then you end up with a stroke, for example, and then you kind of subsist and then you die. So we're not talking about— We're really good about keeping you alive. We've gotten really good at it. But it's about healthspan and thriving in life. So, you mentioned from the previous talker's speech or lecture that health is balance. So, really think of health as balance. And we live in a totally unbalanced world. I remember my wife, Rola, is in the back. She came to introduce a few of the students. And she actually took a video when you guys were at the swimming pool. I think it was Tim Draper that gave a little lecture, pep talk. Yeah. And he talked about work hard, try to achieve, put everything aside, then you gain the rewards later. So that's a totally unbalanced picture. And that's the world we live in today. It's pushing you to lead an unbalanced life. But the human machine, I call it, wants you to be in balance. So how can you achieve that health? And then if you are unbalanced, if you think of healing, if you want to achieve a change, That's what it requires, some sort of a change to achieve healing. So 200 years ago, we conquered the muscles of the human machine. We used to toil the earth. 50% of us used to just literally toil the earth to generate food. We're in agriculture. And then we invented the steam engine. And now it's less than 5% of us. So that created the Industrial Revolution. Now in the last 10 years since 2007, this is Thomas Friedman. The journalist, he talks about the supernova. He calls it the supernova, which is a smart machine revolution that we are witnessing today. And you are the innovators who are going to carry that forward for us. But that has created a huge dilemma. And I remember reading a book called Get Up: Fight the Machine, Fight the Chairman. And what he basically alludes to is that as the world sped up, we stood still. We stopped. Kind of taking care of our health, stopped moving. And so that's the challenge we're all facing today. How can we interface with this smart machine revolution, the supernova, and yet not sacrifice our health or the health of our families and loved ones around us? So it's a puzzle. It's finding— so I kind of spent 10 years kind of living through that, seeing that supernova affect me, my family, my colleagues. And the world around me. So I've tried to kind of think of the human body as a machine. And what are the determinants of good health if you really want to dissect it down into a machine? I've come up with the 4 pillars. Nutrition— I mean, since day one, since you're born, you have a relationship with food, it turns out. And that relationship can be very complex. And you need it. You need food to survive, obviously. And life is motion. So activity is weaved into life. Sleep. We sleep a third of the time. Imagine, if you think about that in terms of your lifetime, a third of that you spend sleeping. So now we know more, a lot more about sleep than we ever did and the importance of sleep. And then what determines a happy, healthy mindset? So these are the 4 pillars. And if you want to get one slide out of this whole talk, as a machine, if you think of the human machine, what I've realized as a physician that these 4 Interact with each other fundamentally. So when you, for example, exercise, you're going to feel better, so your mindset will be clearer. You'll sleep better at night. You're going to crave the right food. If you have ice cream, sometimes what's going to happen is you're going to have a lull after the ice cream. You're going to fall asleep. I'm going to try to prevent that from happening this afternoon. But then it might actually impact your ability to be energetic and so forth. So So this is really an important way to think of this human-machine.
