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The Four Pillars of Health

Article at-a-glance:

  • Health isn’t complicated, but too often people get overwhelmed when they think about improving their health.
  • Simplify your approach and you’ll find it much easier to achieve results
  • There are four basic pillars to good health: proper diet, a healthy lifestyle, quality sleep and connection to others
  • But don’t stress about focusing all of them at the same time, because increasing healthy habits in one area makes it easier to strengthen the other pillars too.
Caution Sign

Every day new studies about diet, lifestyle, and health pop up. Keeping up with the latest findings can be overwhelming, especially when new studies contradict the old. Is coffee good or bad for you? Will a glass of red wine at night protect your heart, or increase your risk of cancer?1,2 Exercise is great for you—but how much do you really need?3

In reality, achieving good health works best if you simplify your approach and ignore all the noise. What I’ve learned, both in medicine and in life, is that health isn’t complicated. That focusing on four basic foundational aspects of health reliably creates well-being, increased energy, and joy. My four pillars of health are proper diet, a healthy active lifestyle, quality sleep, and connection to others. These four pillars are the foundation for becoming as healthy, vibrant, and energetic as you can be. In fact, they’re so important that they’re part of the holistic approach I teach in my book, Fracture-Proof Your Bones: A Comprehensive Guide to Osteoporosis.

Each pillar is equally important. You cannot exercise away a poor diet or connect joyously with others when you’re exhausted and sleep-deprived. I can testify to the power of these four pillars because I’m in better shape and happier in my fifties than I was in my twenties or thirties. But we’re all human. Focusing equally on all four of the pillars of health all the time isn’t realistic for most people.

Thankfully, it doesn’t matter which pillar you start with. Research shows that people who create healthy habits in one area of their life end up creating healthy habits in other areas, too. People have an easier time sticking to their goals when they have planned ahead, so plan ahead.4 Start with the pillar that motivates you the most, make concrete goals, and consistently take action.

Pillar One: Healthy Food

I can’t think of a single chronic disease that isn’t powerfully affected by diet. In some cases, dietary strategies can completely reverse diseases.5 The foods you eat are the basis of long-term health. And the way to eat healthy for life is to emphasize plants and healthy proteins. That includes whole grains, fruits, vegetables, legumes (such as beans), nuts, and healthy oils like extra virgin olive oil or avocado oil.

Two famous diets that follow these guidelines include the Mediterranean diet and the DASH diet.6,7 Both diets are rich in fiber, vitamins, and minerals that help maintain healthy blood pressure and lipids, lower the risk of diabetes and heart disease, and maintain healthy weight and energy. Moreover, these kinds of plant-based diets emphasize fruits and vegetables and are loaded with health-promoting flavonoids, antioxidants, and polyphenols that have a profound effect on health. For instance, one review of 16 different studies that encompassed over 460,000 adults found that flavonoid intake significantly protected against cardiovascular disease and mortality.8

Healthy fats are a key part of such diets and include Omega-3 fatty acids from fish like anchovies, sardines and salmon, from nuts like walnuts and almonds, and from oils like extra-virgin olive oil and avocado oil, among others.9,10,11

The good news about plant-centric diets is that they tend to be alkaline. An alkaline diet emphasizes vegetables, fruits, and drinking lots of water while reducing refined carbohydrates, alcohol, meat, and highly processed food. They are known to improve overall health, help reduce weight and improve longevity.12

For step-by-step instructions and handouts to help you learn to eat healthily, read my blog, Dr. Neustadt’s 3-Steps to Eating Healthy for Life.

Pillar Two: Movement

Our bodies were born to move. It’s well known that a sedentary lifestyle is a risk factor for a wide range of chronic ailments, including heart disease, diabetes, high blood pressure, obesity, depression, osteoporosis, and osteoarthritis. In fact, increased levels of physical activity and fitness are correlated with a lower risk of mortality from any cause.13

But don’t think you have to be a Type A overachiever to reap all the health benefits. Moderate exercise also helps. If you are moderately physically active at least three hours per week, you can lower your risk of dying by 27%.14 The most recent guidelines, published by the US Department of Health and Human Services (HHS) in 2018 states that the ideal amount of activity is 150 to 300 minutes of moderate-intensity aerobic activity per week. This activity can be continuous or in short bursts.15 Ten minutes a couple of times a day or 30 minutes five days a week will get you to that 150 minutes per week threshold.

Moderate activity means you’re exercising hard enough to raise your heart rate and break a sweat. Examples include brisk walking, bicycling, gardening, dancing, water aerobics, canoeing, or even golf as long as you’re doing them vigorously enough. You can also wear a pedometer, with a goal of walking 10,000 steps a day. Moderate intensity on a pedometer is 3,900 steps within 30 minutes.[16]

Exercise impacts your other pillars. For instance, physical activity helps you sleep better, and improves your mood.17,18 And, just to give you an idea of how powerful physical activity is, a 2008 study in the prestigious journal The Lancet, found that not moving enough can be as hazardous to health as smoking.19 Physical inactivity leads to 5.3 million deaths a year around the world, and smoking causes about 5 million deaths.

And if you’re one who prefers walking, studies show that all you need are 7000-7500 steps per day to decrease the risk fo dying by 50-70%.

Pillar Three: Sleep

We all know that sleep is essential for survival and that sleep is a time when the body and brain repair. During sleep, your brain sends waste and toxins out of the cells and brings in nutrients, which then replenish the cells.20 In fact, while sleeping your brain cleanses itself up to ten times faster than when awake.21 Poor sleep increases your risk of stroke, heart attack, excess weight, and weak bones.22 Poor sleep also is associated with a lower cortisol awakening response (CAR), which leads you tired and can increase inflammation. That is the spike in the secretion of cortisol, an important hormone that helps prepare your body for the demands of the day.23

Quality sleep is on the decline, however. We sleep 25% less than humans did a hundred years ago.24,25 One out of five adults sleeps less than 6.5 hours a night.[26] The optimal amount of sleep for most people is about 8 hours a night. Those who regularly sleep less than 6 hours or more than 9 hours are not as healthy.10

To sleep well, try to turn off the ‘bright blue’ screens two hours before bedtime. They can disrupt melatonin cycles.27 Don’t snack late at night. Try a peaceful meditation app or music.28 Take a relaxing hot bath. Even weighted blankets have been shown to improve sleep.29

For more tips on improving sleep, read the blog, Your Checklist for Better Sleep.

Pillar Four: Connection

Last but not least, stay connected to others, from colleagues to friends to family. We are a social species, and connection nourishes our minds and souls. Connection helps us shift into a parasympathetic “calm and connect” mode, a mode where we also rest, repair, and digest.30

And make sure to connect with yourself. That can mean taking time for things you love. Meditating. Doing self-care like treating yourself to getting your hands and feet done. And since too many people struggle with maintaining healthy boundaries and suffer the consequences, making sure you’re not overcommitted is crucial. Because when you’re frazzled by being pulled in too many directions, you can’t take care of yourself. You end up feeling overextended, overwhelmed, and resentful.

If you’re not sure whether or not you’ve got healthy boundaries, ask yourself this question. Do you feel sucked dry by all your commitments? Then you’re suffering from what I call “Yes syndrome” and it’s time to make some changes.

Yes Syndrome is the inclination to say yes too often and to too many things. Yes Syndrome is often the result of wanting to be a people pleaser. Of feeling that other’s needs are more important than your own. Yes Syndrome is a sure way to experience burnout.

But don’t fret, because the cure to Yes Syndrome is simple. Say No. Say No to those things that don’t serve you. Say No when you hear your inner voice say, “I should say yes, but I really don’t want to.”

What I’ve found in my work with thousands of people is that too often people are suffering Yes Syndrome because they don’t believe they’re worthy of getting what they want. They’re not worthy of more. That they don’t deserve more. But you do deserve more.

And instead, connect with others in healthy ways. This can include making healthy changes fun by doing it with a friend or volunteering in your community.

To learn more about how connecting with others can help you, read my blog, Do This One Thing to Be Happier and Live Longer.


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[2]Snopek L, Mlcek J, Sochorova L et al. Contribution of red wine consumption to human health protection. Molecules. 2018 Jul; 23(7): 1684. [Article]

[3]Warburton DR, Nicol CW, Bredin SD. Health benefits of physical activity: the evidence. CMAJ. 2006 Mar 14; 174(6): 801–809. [Article]

[4]Milne S, Orbell S, Sheeran P.  Combining motivational and volitional interventions to promote exercise participation: motivation theory and implementation intentions. British Journal of Health Psychology May 2002 (7) 163–184. [Article]

[5]Wedge, M. Reversing disease with food. Psychology Today, February 2019. [Report]

[6]Martínez-González MA, Salas-Salvadó J, Estruch R et al. Benefits of the Mediterranean Diet: Insights from the PREDIMED Study. Prog Cardiovasc Dis. 2015 Jul-Aug;58(1):50-60. [Article]

[7]Mayo Clinic Staff. DASH diet: Healthy eating to lower your blood pressure. May 2019 [Report]

[8]Mazidi M, Katsiki N, Banach M. A Greater Flavonoid Intake Is Associated with Lower Total and Cause-Specific Mortality: A Meta-Analysis of Cohort Studies. Nutrients. 2020 Aug 6;12(8):2350 [Article]

[9]Fernández del Río L, Gutiérrez-Casado E, Varela-López A et al. Olive Oil and the Hallmarks of Aging. Molecules. 2016 Jan 29;21(2):163. [Article]

[10]Yasgur BW. Higher Omega-3 levels linked to healthier aging. Medscape. October 2018 [Report]

[11]Howley EK. Avocado oil vs .olive oil: what is the difference? US News. March 2020 [Report]

[12]Blackburn KB. The alkaline diet: what you need to know. MD Anderson. Setpember 2018 [Report]

[13]Warburton DE, Nicol CW, Bredin SS. Health benefits of physical activity: the evidence. CMAJ. 2006 Mar 14;174(6):801-9. [Article]

[14]Leitzmann MF, Park Y, Blair A, et al. Physical Activity Recommendations and Decreased Risk of Mortality. Arch Intern Med. 2007;167(22):2453–2460 [Article]

[15]Haskell W. Physical activity, decreased risk for all-cause mortality and cardiovascular disease: No longer any doubt and short bouts count. American College of Sports Medicine. July 2019 [Report]

[16]Marshall SJ, Levy SS, Tudor-Locke CE et al. Translating physical activity recommendations into a pedometer-based step goal: 3000 steps in 30 minutes. Am J Prev Med. 2009 May;36(5):410-5 [Article]

[17]Johns Hopkins Medicine. Exercising for better sleep. [Report]

[18]Berger BG, Moti RW. Exercise and mood: a selective review and synthesis of research employing the profile of mood states. Journa of Applied Sport Physiciology January 1998: 69-82 [Article]

[19]Lee IM, Shiroma EJ, Lobelo F. Lancet Physical Activity Series Working Group. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet. 2012 Jul 21;380(9838):219-29 [Article]

[20]Iliff JJ, Wang M, Liao Y et al. A paravascular pathway facilitates CSF flow through the brain parenchyma and the clearance of interstitial solutes, including amyloid β. Sci Transl Med. 2012 Aug 15;4(147):147ra111.  [Article]

[21]Xie L, Kang H, Xu Q, et al. Sleep drives metabolite clearance from the adult brain. Science. 2013 Oct 18;342(6156):373-7.  [Article]

[22]He Q, Zhang P, Li G et al. The association between insomnia symptoms and risk of cardio-cerebral vascular events: A meta-analysis of prospective cohort studies. Eur J Prev Cardiol. 2017 Jan 1:2047487317702043.  [Article]

[23]Hek K, Direk N, Newson RS, et al. Anxiety disorders and salivary cortisol levels in older adults: a population-based study. Psychoneuroendocrinology. 2013;38(2):300–305 [Article]

[24]Doghramji PP. Detection of insomnia in primary care. J Clin Psychiatry. 2001;62 Suppl 10:18-26. [Article]

[25]Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. In: Colton H, Altevogt B, eds: The National Academies Press; 2006:424

[26]Banks S, Dinges DF. Behavioral and physiological consequences of sleep restriction. J Clin Sleep Med. 2007;3(5):519-528. [Article]

[27]Ostrin LA. Ocular and systemic melatonin and the influence of light exposure.Clin Exp Optom. 2019 Mar;102(2):99-108. [Article]

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