In the presence of major health issues, good enough health may sound… good enough. However, as human beings we strive for optimal wellness, happiness, and self-actualization. We want our best, not our mediocre. Optimal health is more than just the absence of disease, it is us at our best level of being in all aspects of life– mind, body, spirit, social relationships, purpose, and environment. It is our full expression as human beings. Achieving optimal wellness is not a weekend project. It is a lifelong, endeavor.

Addressing our health can be overwhelming, and this article will present an overview of the key areas to consider in the pursuit of wellness.

Conventional medicine can address certain health issues very well. However, there are many health problems for which conventional medicine does not have satisfactory treatments. An integrative approach to treatment gives us a new way to do the detective work required to identify issues that might be roadblocks to optimal health.

In my clinical work with patients I use the comprehensive approaches of integrative and functional medicine to guide my work. Many chronic physical and mental health issues are complex, as is each human being experiencing them. It helps both patient and provider to have a checklist with which to organize thoughts and strategies. If you are dealing with a vague health issue, such as Chronic Fatigue Syndrome or an unexplained problem, then you may need to become a detective yourself in tracking down various factors that contribute to your symptoms.

Becoming your own detective can be an overwhelming pursuit if you or a loved one is suffering from a chronic, vague, or complex health issue. This list is my summary of the key areas to consider based on my clinical practice and study of medicine, psychiatry, and integrative and functional medicine. Perhaps this checklist will serve you in thinking about your health.

Key Areas of Health

Nutrition
Gastrointestinal Health, Absorption, Digestion, Metabolism
Sleep
Exercise
Hormonal Balance
Infections
Immunity and Inflammation
Environment and Detoxification
Work Life Balance and Stress Management
Psychological, Existential and Spiritual Factors

As you can see, health has many key ingredients, and our bodies, brains and lives are complex and dynamic. The key factors of health identified above are not a hierarchy or ladder but rather limbs of a tree. While one can focus on addressing one area at a time, all branches need to be addressed and maintained.

The key areas of health are interconnected. Psychological health in particular affects all the others as well as the commitment to the pursuit of health. We need self-esteem, motivation, coping mechanisms, ability to get organized and stick to a plan, impulse control, flexibility, and a bit of positive thinking to embark on a healthy lifestyle. Biological factors such as sleep and nutrition are the foundations of health, yet mental health is essential to actually being able to enjoy this good health.

The guidelines below are based on my clinical practice and a multitude of sources. Please read the articles on the individual topic for comprehensive explanations, links, and full references. The list and summaries below are intentionally brief.

1. Nutrition

What you eat has a major impact on your health. Food has changed tremendously in the past few decades, and those changes were followed by increases in many chronic health problems. Cleaning up the diet and identifying any nutritional deficiencies or irritants is the first step in addressing overall health and many specific health problems. While each person is biochemically individual and has unique dietary requirements, which calls for appropriate changes to the diet. Here are key general guidelines for what to eat to support optimal wellness:

Plant based foods:

Whole foods, with no more than five (pronounceable) ingredients
Vegetables, mostly leaves and some whole grains and seeds
Vegetarian protein, if tolerated
Whole fruit, not fruit juice, in reasonable quantities
Healthy oils and fats – olive oil, coconut oil, avocado, nuts

Animal based food:

Grass fed, organic dairy in reasonable quantities, if tolerated
Pasture raised eggs
Grass fed, organic meat in reasonable quantities
Wild fish, smaller fish is better
Organic and grass-fed animal fats such as ghee

Since each of us has unique dietary requirements based on our genetics and environment, we all need to become intuitive eaters listening to the signals of our bodies in response to various foods.

Elimination diets provide a way of systematically evaluating the effects of certain foods on the body. Elimination diets involve cutting out common GI irritants one at a time to see if you are sensitive to any of them. The most common irritants are gluten, soy, corn, dairy, and sugar. Completely eliminate one food group or suspected irritant at a time for three weeks to three months and observe yourself and your symptoms.

Choose the best quality foods that are available and select less contaminated foods. If organic, local and pasture raised is available great, otherwise make intelligent choices to limit ingestion of pesticides and chemicals. See the Environmental Working Group for the Dirty Dozen and Clean Fifteen list of most and least contaminated foods.

For more information read Grain Brain by David Perlmutter, The Ultra Brain Solution by Mark Hyman, Omnivores Dilemma by Michael Pollan, and Fat Chance by Robert Lustig, and visit blogs such as Green Med Info, Mind Body Green, Kelly Brogan MD, Whole 9, and Food and Healing.

2. Gastrointestinal Health, Absorption, Digestion, Metabolism

What you eat will influence the health of your digestive tract, which will influence your ability to extract nutrients from the food you eat. Metabolism determines our energy stores as well as energy deposits in the form of fat. Sorting out GI issues may involve some detective work and specialized testing.

Don’t be surprised if changing your diet brings up emotional reactions. We all have very personal relationships to food. Whatever your reaction, you are not alone. Find the support you need. For more information visit Dr. Mark Hyman’s website or http://nutritionfacts.org.

Use an elimination diet to discover your individual food sensitivities
Consider specialized testing for nutritional deficiencies, food sensitivities, gluten sensitivity, parasites, and other problems with digestion or absorption
Keep your metabolism strong, eat breakfast, and avoid toxins
Consider nutritional supplements – food provides the basis of nutrition, add supplements in an intelligent manner. Specialized laboratory testing for nutritional deficiencies and genetic polymorphism can identify individual needs for extra nutrients.

3. Sleep

Sleep is one of body’s built in healing and repair mechanisms. In fact, our bodies do the bulk of the recovery work while we sleep. Poor sleep can cause fatigue, poor concentration, low mood, irritability, food cravings and weight gain, and can contribute to a variety of other physical health issues.

Some key suggestions for better sleep:

Allow your body to fall into a circadian rhythm by going to bed and waking up at roughly the same time every day.
To get enough sleep most people need about 8 hours. Staying in bed more than 9 hours dilutes sleep quality.
Caffeine and other stimulants can interfere with sleep.
Intensive exercise close to bedtime can interfere with sleep.
Bed is for sleeping and sex. To protect the association of bed with sleep, if you can’t sleep for more than 20 min, get out of bed, and read something calming then return to bed.
The blue light from television, phone, computer and other screens suppresses melatonin and makes it harder to sleep. To reduce the suppression of melatonin, dim the lights, put the devices away at least an hour before bed, or wear amber colored lenses to cut out the blue light.
If you snore, you may need to rule out sleep apnea by seeing a sleep specialist.
Are there any other factors you can identify that are interfering with sleep? Are you taking a medication that could cause insomnia, or sleeping in room that is too hot, bright or noisy?
If you still can’t sleep then see a specialist to address any physical and psychological conditions that may be causing the sleep problem.

For more information, visit the American Sleep Association or American Academy of Sleep Medicine. For more informal articles about sleep see Doctor Oz’s website.

4. Exercise

Exercise heals. It stimulates blood flow, delivering nutrients and removing toxins from tissues, maintains muscle mass and fitness, stimulates regeneration of tissues, increases energy reserves and is great for the brain.

Doing some exercise every day, even if it is 15 minutes of walking, allows for developing a habit of activity.
With exercise more is better and more intense is better, yet do whatever exercise is sustainable for you. Doing some form of exercise that elevates heart rate and mobilizes multiple muscle groups, even if it is in short 2 minute bursts, gives best effects. The American Heart Association recommends at least 150 minutes per week of moderate exercise or 75 minutes per week of vigorous exercise (or a combination of moderate and vigorous activity).
Thirty minutes a day, five times a week is an easy goal to remember. You will also experience benefits even if you divide your time into two or three segments of 10 to 15 minutes per day.
Weight bearing exercise helps with developing and maintaining muscle mass.
To help yourself get into exercise, visualize yourself as someone who exercises and give yourself a positive affirmation about exercise, such as “I am fit and enjoy exercising every day.” If you see yourself as an active and fit person your behavior will follow.
Finding enjoyable physical activity that works for your body and lifestyle will make exercising fun.

For more information about the links between exercise and the brain read Spark by John Ratey or visit the website.

5. Hormonal Balance

The endocrine system orchestrates a multitude of body functions and cycles. A hormonal imbalance can have an effect on the function of the whole body. Thyroid abnormalities are common and can cause fatigue, metabolic issues, weight gain, depression and a multitude of other problems.

If you are symptomatic, get tested for hormonal abnormalities under the guidance of a knowledgeable physician.

For more information visit http://www.hormonesmatter.com or The Hormone Health Network.

6. Infections

Hidden infections or overgrowth of harmful strains of bacteria or yeast can cause a variety of symptoms. Some integrative physicians dig deep to uncover systemic yeast, chronic Lyme disease, small bowel overgrowth, or excessive clostridia in the gut and treat these problems with long courses of antifungal and antibacterial medications. The evidence base remains limited for such long antibiotic courses and antibiotic treatment may disturb the beneficial bacteria in the gut. Maintaining healthy gut bacteria is key to protecting from harmful bacteria.

Eat probiotic foods, such as fermented vegetables or yogurt, if your body tolerates it.
Take a probiotic supplement. Select high quality probiotics with a variety of strains and consider rotating brands or types of probiotics you take.
Eat a healthy diet to promote healthy and happy gut flora.
Discuss with a specialist testing for hidden infections such as Lyme, mononucleosis, Epstein Barr virus, or hepatitis.
Be cautious with the use of antibiotics.

To learn more about yeast read Dr. Hyman’s article.

To read more about Lyme disease visit http://lymedisease.org.

To learn more about small bowel overgrowth visit Mind Body Green

7. Immunity and Inflammation

Disruptions of immune function manifest as susceptibility to infections, autoimmune disease, allergies and a variety of inflammation related chronic health problems.

The immune system is interconnected with many systems of the body, including the nervous system. Sorting out immune issues may involve addressing a broad range physical health issues, as well as lifestyle factors.

Allergies to foods and environmental factors may be related to the toxic strain on the body, and improving the overall health of the body and the digestive system, may alleviate many allergies.

The evidence for the role of chronic inflammation in various health problems, including depression and schizophrenia and is mounting.

Reducing inflammation through diet and lifestyle changes can alleviate a variety of health problems. Mind-body practices can also aid in reducing inflammation.

Diet, sleep, exercise, and stress reduction are essential for healthy immune function.
Reduce inflammation in the brain by eating an anti-inflammatory diet.
Consider allergy testing when appropriate.
In case of food sensitivities, which may increase inflammation, consider an elimination diet and improve the overall health of the gut and gut bacteria.

Read more about inflammation and mental health.

8. Environment and Detoxification

We are exposed to numerous chemicals and pollutants in our diet and environment. Our bodies have built in detoxification mechanisms and we can support these clean up efforts of our bodies by reducing our toxic load through healthy diet and lifestyle.

Improved the quality of air and water through filtration
Minimize exposure to chemicals and pesticides in the food
Support the body detoxification systems through healthy diet, exercise, sleep and a healthy non-smoking lifestyle

Read more about simple ways to detoxify.

9. Work Life Balance and Stress Management

Stress affects every system of the body and has deleterious effects on health. Sorting out stress triggers and learning stress reduction methods takes time, commitment and self-study.

What is causing stress in your life? Are there any factors you can reduce or eliminate?
Do you have balance in your work and life?
Are you living your life according to your values and priorities?
What works for you to reduce stress and create relaxation?
Our body’s most basic built in stress-reduction method is our breath. Learning a few breathing techniques that promote relaxation and using them every day is a great first step towards relaxation. Initially practicing a breathing technique twice a day for 10-20 minutes will allow for the body to absorb the new breathing pattern. Taking long, slow, deep breaths into the belly with longer exhalation than inhalation promotes the activation of parasympathetic nervous system and relaxation of the body and mind.
A variety of mind-body techniques promote stress-reduction: mindfulness, guided imagery, self-hypnosis, body-scan, progressive muscle relaxation, and yoga are just a few.
Exercise and dance reduce stress and allow for release of tension from the body.
Consider psychotherapy to identify negative thought patterns and core beliefs that may be increasing stress and to gain insight and skills for coping with the challenges of life. Psychotherapy may also help with sorting out life priorities and values and aligning your life and activities with your authentic self.

10. Psychological & Existential/Spiritual Factors

Ego Functions – Ego functions are the ways we cope with the world, for example how we regulate our emotions, deal with frustration, or interact with other people.

Meaning, Purpose and Spirituality – There is a growing body of research literature on the health benefits of spirituality. Physical health provides a foundation on which we can build lives of meaning and purpose. If you are climbing a professional or social ladder make sure that it is leaning against the right wall (do it for you, not because you think you are “supposed to”).

Defense Mechanisms These are ways in which we react to demands and stresses of life in more or less beneficial manner. For example defense mechanisms that may bring more trouble are denial, acting out, projection or passive aggressive behavior, while more mature and helpful defense mechanisms include humor, or sublimation. For more information read Anna Freud’s original book on the topic The Ego and the Mechanisms of Defense.

Emotional and Social Intelligence – Our EQ, or emotional intelligence quotient, may be more predictive of our chances for happy, healthy and successful life than the conventional IQ. Read The Social Animal by David Brooks or Daniel Coleman’s Emotional Intelligence for more in depth discussion.

Social Skills and Communication Skills – We all continue to refine our communication skills throughout our lives. For an excellent introduction read Non-Violent Communication, A Language of Life by Marshall B. Rosenberg or visit The Center for Nonviolent Communication’s website.

Resilience, Adaptability and Flexibility – While human beings crave stability, control and predictability, the only thing we can really count on is change. Being able to adapt to new demands and circumstances is essential to our health.

Resolving Traumas – The major and minor traumas of our life can affect both physical and mental health. The key approaches to the treatment of trauma involve exposure therapies such as Trauma Focused CBT and mind-body approaches such as Eye Movement Desensitization and Reprocessing (EMDR) and Somatic Experiencing.

Strengths and Goals – The new movements of life and executive coaching bring attention to the importance of recognizing our strengths and setting goals for our wellbeing and success in life. Setting Specific Measurable Attainable Realistic and Timely or SMART goals and writing them down is a key practice of coaching. Visit the Institute of Coaching website for additional information and resources.

Thought Patterns and Core Beliefs – Self-study through personal reflection, mindfulness and psychotherapy allows for identification of thought patterns, which may be causing problems. Negative thought patterns such as black and white thinking, catastrophizing, mind-reading, or focusing on the negative contribute to anxiety and depression. Cognitive Behavioral Therapy is the key approach to learning how to identify and alter negative thought patterns.

Cognitive Function and Attention – Our brains need exercise as much as our bodies do. Cognitive function and focus can be sharpened by physical and mental exercises. In certain situations neurofeedback training can help to address a specific dysfunction of the brain. Visit EEGinfo for more information on neurofeedback.

Optimism and Positive Psychology – Optimists live longer (and probably have more fun doing it). Optimism can be learned. Read Learned Optimism: How to Change Your Mind and Your Life by Martin Seligman for more information, or visit Psychology Today’s website for additional resources and articles.

Mindfulness – Mindfulness or nonjudgmental attention to the thoughts, feeling and sensations in the present moment has been a focus of much clinical research. Meditation has been shown in research studies to affect neurotransmitters, such as increasing dopamine, GABA, melatonin and serotonin, and decreasing serum cortisol and norepinephrine. Meditation increases inhibitory GABA neurons, therefore reducing anxiety and depression. Visit Mindful Magazine’s website for more information or Palouse Mindfulness for a free online course in Mindfulness Based Stress Reduction. In person mindfulness training courses are available in many locations. In New York City consider New York Insight Meditation Center, Kadampa Meditation Center or Mindfulness Meditation New York Collaborative.

Motivation – The key to change is motivation. If you want to improve your health and change your lifestyle or diet, the first step is to look at your motivation. Are you ambivalent about making a change? Motivational Interviewing is a therapy for increasing motivation to achieve personal goals. See Psychology Today’s website for additional resources and articles and visit http://www.motivationalinterview.org/ for information about Motivational Interviewing.

Cultural Factors and Gender/Social Roles – We live within a cultural a specific culture and environment and our stress level is connected closely to how we feel in that context and to our social status. Read The Status Syndrome by Michael Marmot for more information about the impact of social status and inequalities on health.

Integrative Medicine, Functional Medicine and Integrative Psychiatry offer a new way of approaching health. Instead of waiting for problems to develop and then scrambling for treatments we can invest in preventing health issues and optimizing health. Mental health factors are essential for overall wellbeing and cannot be ignored in the pursuit of optimal health. We are all unique and biologically individual and the diet and lifestyle approach needs to match our individual needs and temperaments. This overview article provides introductions to the many key areas of health, and I encourage you to keep reading and learning about the many topics summarized here.