This a book review of The Four Pillar Plan, by the book industry’s prestigious flagship publication, The Bookseller, first published on the bookseller website December 19, 2017
The Four Pillar Plan
In keeping with the advice in his first book, The 4 Pillar Plan: How to Relax, Eat, Move and Sleep Your Way to a Longer, Healthier Life, Dr Rangan Chatterjee and I turn down coffee (it’s after midday) and sip sparkling water instead. We also ignore a large plate of biscuits that has been thoughtfully provided in the Penguin HQ boardroom where we sit.
But I don’t believe he’d frown if I did snaffle a shortbread. With over 16 years as a GP under his belt, Chatterjee is a down-to-earth realist, and an immensely engaging presence to boot. You sense that only the most intractable patient would remain resistant to his likeable gusto. Halfway through our chat, he stands up to his full six-foot six-inch height to make a point as he spells out his determination to tackle the chronic health conditions from which 15 million people in the UK are now thought to suffer. “Every single day I see patients with skin problems, gut problems, headaches, diabetes, Alzheimer’s. This book has come from seeing tens of thousands of patients and thinking, hang on. Is the answer always to medicate these symptoms? I’ve always been open-minded as a doctor and, if you listen, your patients teach you everything.”
Realising that he was only helping around a fifth of those who came to see him, Chatterjee changed tack, and is now seeing the dramatically improved results of having adopted a more progressive approach with his patients. “We all want a quick, magic pill, but good health is a combination of factors. I’ve never used so little medication. I’m not anti-medication. But we’re overusing it for lifestyle problems.”
Chatterjee, who has also fronted two series of BBC1’s “Doctor in the House” alongside his work as a GP, has distilled his progressive methods into The 4 Pillar Plan. Readable and straightforward, it divides his lifestyle prescription into four pillars: Relax, Eat, Move and Sleep. Each pillar is sub-divided into five interventions, each designed to provide a small and realistic step towards better health. While integrated health plans are nothing new, and neither is much of the advice that The 4 Pillar Plan contains, whether it be eating more vegetables or turning off all screens well before bedtime, Chatterjee has succeeded in synthesising it all into a compelling but non-preachy health guide that will encourage almost anyone to make simple, all-around improvements to the way they live.
Nowhere in The 4 Pillar Plan do we sense a doctor’s wagging finger, warning us how little alcohol we should be drinking, or to cut out the chocolate bars. This is deliberate. “I don’t feel it’s my job to tell people what to do,” says Chatterjee. “I’ve never told a patient to give up smoking. My job, if they ask me, is to tell them what smoking is doing to them. The way we’re living our modern lifestyles is causing us a lot of problems: stress is the biggest health issue we face today. But this is not about blaming anyone. I think many of us are unwittingly doing things on a daily basis without realising the impact it’s having on our health. What I’m trying to do with the book is to give people the information they need to make choices based on knowledge. I want people to understand that, by and large, they are the architects of their own health.” With our highly stressed lives in mind, the book purposely begins with the Relax chapter. “I live and breathe this stuff but, as I freely admit in the book, although I exercise and eat really well, the Relax pillar is my weak spot,” says Chatterjee.
A Reader’s Digest
While Chatterjee deliberately doesn’t overload The 4 Pillar Plan with research (although there are robust references in the back, should you wish to find out more), it includes some compelling findings. I tell him how astonished I was to read just how significant lifestyle is now believed to be. “Absolutely. In the past five to 10 years, research about this has just exploded. We thought that sequencing the human genome was going to give us all the answers. But we’ve realised that genetics only account for 10% of our health outcomes; 90% of what happens to us is determined by our environment, our lifestyles and our behaviour. I think that’s empowering. So let’s give people this information!”
There are two poignant personal stories behind Chatterjee’s missionary zeal. His father, who died four years ago, was also a doctor, a consultant at Manchester Royal Infirmary who came to the UK from India in the 1960s when the government was recruiting Asian doctors to fill a gap in the domestic workforce. Eventually, however, he was forced to give up work due to a chronic health condition, and for years Chatterjee acted as his father’s main carer. “As a first-generation immigrant, Dad worked and worked and worked to give me and my brother the life we now have. He did night shifts all the time and worked weekends. But I think there was a consequence for his health”.
The second story concerns the author’s son, now aged seven, who fell desperately ill as a baby when the family was on holiday in France. The cause turned out to be an easily rectified vitamin deficiency, but Chatterjee was racked with guilt. “He’s a happy, thriving kid now, but why did I, his father, a doctor, know nothing about this?” The incident made him question everything: the way he practised, and also what they didn’t teach him at medical school. “Our training is brilliant for acute disease. And 30 years ago, that’s what GPs were mostly seeing. The problem is that the health landscape of this country has changed, and the conditions we’re seeing now are, in my opinion, largely the result of modern lifestyles.” In the cause of changing wider practice, Chatterjee has created a course for the Royal College of General Practitioners, which has just been accredited. Entitled Prescribing Lifestyle Medicine, Chatterjee’s goal is for 1,000 doctors to have taken it by the end of 2018.
Saving the National Health Service
While The 4 Pillar Plan is a guide tailored to individuals, you can’t help wondering how the highly stressed National Health Service would be affected by all of us making small lifestyle improvements. Chatterjee is evangelical on this point too. “I believe the NHS is unsustainable unless we take the weight of lifestyle-driven illness off it. It doesn’t matter which political party comes in, or who pledges this million or that billion, the reality is that the NHS is creaking. And the reason is that modern society is driving ill-health.
“My own view is, yes, personal responsibility is important, of course it’s important, but we also have to try and create a society which makes it easier to make healthier choices. How many people these days are waking up in the morning and jumping out of bed, ready to go? And yet I believe that is our default birth right as human beings!”, Chatterjee exclaims, whacking his hand with his fist for emphasis.
The last author I interviewed with this degree of passion for a cause was Joe Wicks. Indeed with The 4 Pillar Plan, Penguin Life believes that Chatterjee will “do for health what Joe Wicks has done for dieting”. I feel so invigorated after my consultation with the good doctor that I, for one, wouldn’t bet against it.
The basic idea is simple. Because every part of 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 prioritises the cause over the symptoms.
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.