The Connection Between Stress, Allostatic Load, and Inflammation in Public Health Outcomes

Unlocking wellness and reshaping healthcare involves the profound bridge between Lifestyle Medicine and the Social Determinants of Health, a blueprint found in the wisdom of the Blue Zones. Blue Zones are regions of the world where people are known to live longer, healthier lives compared to the global average, often to 100 years of age. These areas have gained attention from researchers and health enthusiasts because they provide valuable insights into the factors that contribute to longevity and well-being.  Researchers have reverse-engineered longevity to find the common denominators and found that these Blue Zones are all places where people enjoy a diet rich in plant-based foods, regular physical activity, strong social connections and community support, and a sense of purpose or meaning in life. Given these lifestyle factors that contribute to the remarkable longevity and well-being of the people in these Blue Zones, we need to find a way to replicate them in our uniquely American society, which is often limited by modern fast-paced living, processed foods, and social structures that de-prioritize these essential elements of health and well-being. If population health success is at the intersection of Blue Zones and Lifestyle Medicine, how can drive the necessary realignment of financial incentives for value-based care?

In this enlightening episode of Race to Value, we dive deep into the world of healthcare transformation with Dr. Dexter Shurney, President of the Blue Zones Well-being Institute. He is responsible for creating innovative health and well-being solutions that have broad impact. The Blue Zones Institute is a “Living Lab” to create, study, and codify best practice, including a whole-person approach to care, that can be replicated across regions and communities, including those of greatest need. In this episode, we explore the potential for wellness through the lens of Blue Zones research, discuss the impact that chronic disease has on declining U.S. life expectancy, uncover the profound connection between stress-induced inflammation and chronic disease, and address the impact of both racism and SDOH variables on health equity.  Additionally, we go deep into the tenets of lifestyle medicine and how it aligns with the broader movement value-based care. Tune in for a thought-provoking conversation that unveils the pathway to healthier lives, stronger communities, and a brighter future in healthcare!

Episode Bookmarks:

01:30 Introduction to Dr. Dexter Shurney and the wellness potential of applying Blue Zones research.

03:30 After peaking in 2014, US life expectancy has declined each subsequent year, trending far worse than peer countries.

04:00 Chronic diseases remain our nation’s greatest killer, erasing more than double the years of life as all overdoses, homicides, suicides, and car accidents combined.

04:30 The death rate gap between the rich and poor has grown almost 15x faster than the income gap since 1980.

05:30 We have the answers to address declining life expectancy…but haven’t put in place the right policies to solve the problem.

06:00 Referencing the new Netflix docuseries, “Live to 100:  Secrets of the Blue Zones”

06:30 People living in Blue Zones often live to be 100 and do not suffer from high rates of chronic disease.

07:00 “Blue Zones countries spend far less than the U.S. on healthcare, and their good health is driven by things others than genetics.”

07:45 “Drug overdoses, homicides, and suicides with our youth are all deaths of despair. It touches back to people being lonely and not connected to friends, family, and society.”

09:00 The common denominators of long life expectancy (plant-based diet, regular physical activity, strong social connections and community support, and a sense of purpose or meaning in life).

09:30 Finding ways to replicate Blue Zones in our uniquely American society, which is often limited by modern fast-paced living, processed foods, and social structures that de-prioritize health and well-being.

10:00 There are 75+ Blue Zones projects in the U.S. showing transformation by reverse engineering research from the original Blue Zones.

10:30 Singapore is an example of an emerging Blue Zone that has put in place the right policies to ensure continued health improvement.

11:00 Applying Blue Zones principles in underserved and marginalized communities has proven successful.

11:30 Healthcare systems are not the only player in a Blue Zone transformation. You must form community-based partnerships!

12:00 Making the connection between stress-induced inflammation and chronic disease.

12:30 The release of stress hormones and inflammatory agents that affect the immune system (e.g. cortisone, norepinephrine, cytokines).

13:00 A chronic burden of stress leads to allostatic load, which refers to the cumulative physiological wear and tear on the body that occurs in response to chronic stressors.

15:00 “The common path to disease is inflammation, and stress is the common denominator.” (stress can come from lack of sleep, poor diet, or even stress itself)

16:00 Referencing the work of Arlene Geronimus: “Weathering: The Extraordinary Stress of Ordinary Life in an Unjust Society”

16:30 The acute and chronic stressors of living in an underserved community.

17:00 Lifestyle medicine reduces stress levels in patients to improve overall health and wellbeing.

17:30 Addressing “Weathering” and “Allostatic Load” at a community-level.  Delivering Lifestyle Medicine at an individual level.

18:30 Over half of all Medicare beneficiaries are treated for five or more chronic conditions which account for over 75% of Medicare spending.

19:00 The alarming statistics of health disparities in racial and ethnic minority communities.

20:30 Eliminating the root cause of inflammation through Lifestyle Medicine will reduce the prevalence of chronic disease.

22:30 Genetics are not the prime determinant of chronic disease (e.g. identical twins growing up in separate environments)

23:30 Black women with a college degree have higher rates of maternal mortality than white women without a high school education.

24:00 Addressing socioeconomic status doesn’t always solve the problem of health disparities due to institutional racism.

25:30 Don’t be too quick to blame the patient for poor compliance; lack of trust and poor living environments determine behavioral choices.

27:00 The example of how lack of good employment options (due to discrimination) leads to chronic stress and poor health.

31:00 In talking about value-based care, we must ask ourselves “value for whom”?

32:00 Why many employers may not see “value” in VBC.

32:30 Not a single HEDIS measure exists for the reversal (elimination) of chronic disease!

33:30 Changing quality metrics to realign incentives for lifestyle medicine.

35:00 Referencing prior Race to Value episode (Ep 87 – The Future of Value: Lifestyle Medicine and the Reversal of Chronic Disease, with Dr. Dean Ornish)

35:30 The concept of Food as Medicine (“When diet is wrong, medicine is of no use. When diet is correct, medicine is of no need.”)

37:00 Referencing Geisinger Fresh Food Farmacy and prior Race to Value episode (Ep 70 – The Geisinger Value Journey, with Dr. Jaewon Ryu)

38:00 The success of a Food as Medicine strategy is ensuring that the food tastes good!

39:30 Finding ways to pay for Food as Medicine initiatives (think of it just like you would a prescription for a drug on a formulary).

41:30 The cost vs. benefit investment decision in food prescriptions for chronically ill patients.

42:30 Unlike drug prescriptions, food prescriptions will not have an adverse reaction.

42:45 50% of patients will no longer need their food prescriptions after 12 months.

44:00 Large employers will spend over $10 million a year on wellness programs that are largely ineffective.

45:45 “Half of Americans receive their healthcare through an employer. It is a great place to start with wellness, and the incentives there are more pure.”

46:30 Employers that focus on workforce wellness perform better overall at a financial level.

47:30 EAP employee participation is in the single digits, despite employees dealing with overwhelming amounts of stress.  We must remove the stigma!

51:00 Transformation at the Venn Diagram intersection of Blue Zones and Lifestyle Medicine.