Understanding Allostasis: 6 Keys to Unlocking Better Health
Our health depends on our ability to anticipate and adapt to change.
Posted Jan 01, 2020
Part 1 of 3.
It’s another holiday season with temptations of rich foods, binge-watching, overspending, and complaining about family, wishfully offset by resolutions to be better in all of the above. Seeking better is never a bad thing, but it can be frustrating if things don’t seem to change fast enough or change too quickly, never staying just right for long.
The solution to these difficulties is often presented as a matter of self-control and discipline. Yet this mindset is rarely adequate for addressing problems shaped by myriad factors, including past experiences, deeply ingrained habits, and a world containing intense stressors and nearly limitless temptations, many of which are specifically engineered to take advantage of our biological and psychological makeup.
But what if there is another way?
Changing our approach to change might help us more easily adjust to a stressful season, a new year, new challenges, or old problems in a new way. Allostasis, a term that describes this new paradigm of change, calls into question existing ideas about health that are based on the concept of homeostasis, or balance. The homeostatic understanding of health suggests that we have default set-points for various health indicators, such as blood pressure, weight, happiness, or even how much stuff accumulates in our closet. Within this paradigm, health results from our body’s ability to maintain those set points, even in the face of significant changes to our external environment.
In contrast, allostasis,1 which means stability through change, identifies anticipatory change as the primary means by which our brain-body (as one unit constantly communicating with all parts) maintains stable health. In other words, our brain-body is in constant conversation with the internal and external environments and our health is determined by our brain-body’s ability to proactively adapt to as wide a range of changing environments as possible.
Allostasis says we can understand ourselves in our context as social creatures whose brain-body anticipates future needs based on past experiences. Allostasis is complex and nuanced, but this new paradigm of change can lead to a more holistic and practical understanding of health that may enable healthier responses to the challenges of daily life.
Here are six keys, drawn from Sung Lee’s "Paradigm of Allostastic Orchestration" (2019)2, that can unlock greater capacity for health:
- Change is the norm, not the exception.
- The brain controls the brain-body system and good communication is key.
- Our brain-body system anticipates needs, not just reacts to demands.
- Flexibility is better than rigidity.
- Health and disease are on a continuum versus distinct categories.
- Context. Context. Context.
1. Change is the norm, rather than the exception.
Many of us are taught to think in steady states about health, find good health and then maintain it: find a diet that works and keep it, a sleeping position, a workout, a TV show, or a belief system and stick to it forevermore. Yet allostasis informs us that it is precisely the ability to adapt to an ever-changing environment, rather than sticking to the same rigid practice, that defines good health and makes us resilient.
As dynamic, not constant beings, our brain-body loves rhythm, like a flexible pattern that can adapt and change as demands in our surroundings change, as they always do.
Take a minute to observe moment to moment changes in your own body (such as breathing or heart rate), personal health status changes over months or years (such as high blood pressure or diabetes), and individual and societal behavior changes (such as Americans eating more processed food each decade). A set-point, whether it be blood pressure, weight, or mood, is determined, entrenched by habits, and altered by daily stress or life events. This is our system adapting to new demands; yet to feel well, we want our systems to be able to change to a healthier set point once the stress has passed. (Part 2 will be about changing our set-points).
2. Brain-body is a whole system and the brain is in charge of communicating across all systems.
For ancient Egyptians, the heart was the “seat of intelligence,” but the brain claims that status in modern Western culture. It was also previously believed that the brain stops changing in young adulthood; recent research says neuroplasticity is the new rule. The brain changes and grows new pathways throughout the lifespan. Good communication between the brain and all organ systems allows us to adjust and adapt with great resiliency.
Blood pressure, for example, is an obvious function of the heart and blood vessels but also includes the kidneys, lungs, adrenal glands, liver, sensors in specific arteries, and related hormones, with the brain orchestrating signals to all about what to do next. Returning to a previous baseline of lower blood pressure is complicated because the entire system is involved.
3. The brain-body system anticipates rather than reacts.
Allostasis argues that our system is not just reactionary to our circumstances changing but anticipates and prepares like any good emergency first responder. It looks ahead and learns from what has already happened in an attempt to prepare resources for continued action. Our brain-body anticipates and adjusts based on what the system has required before.
To continue using blood pressure as an example, perhaps it increased during or after a difficult year (such as illness or death of loved one, divorce, moving) and may have stayed at a new, elevated set-point even after the difficult time passed. It did this in anticipation that you would need this increased pressure to continue as you were. Other physiological changes likely occurred as well, such as thickening of artery walls and hormonal recalibration to adjust to this increased system demand.
4. Flexibility is better than rigidity.
The allostatic paradigm maintains that physical, biological, emotional, and mental agility are signs of health. Thus, practices that support increased flexibility will improve your capacity to anticipate and adapt to an ever-changing world.
Biologically: Our brain-body system (blood pressure, heart rate, breathing, digestion, muscle tension) adjusts moment by moment in anticipation of what the system will need. It could not meet the brain-body’s demands to perform a given task if it stayed the same all the time, which is why blood pressure is often higher at work and lower during sleep.
Physically: Stretching and many other types of physical activity improve balance, strength, blood flow, and reduce the chances of injury.
Emotionally: It may be tempting to deny difficult emotions or avoid them as they arrive, but being able to surf highs (triumph, excitement) and lows (anger, sadness) and recover from intense emotions (disappointment, rage) keeps us stable.
Mentally: Being able to grow our gray matter by new learning at any age, challenge and change our minds, and improve focus (achieved ironically by not multi-tasking) all keep us mentally agile. Allostasis aims to empower more insights, not fewer, and encourages us to change our paradigm of change.
5. Health and illness are on a continuum versus distinct categories.
Diagnostic categories are currently used in psychology and medicine to be able to recognize and treat something with a specific set of tools. Acute conditions may be handled well this way (appendicitis or psychosis), but this approach is less helpful for chronic conditions (hypertension or depression) that are ailing more people than ever. Allostasis offers a solution by placing such chronic conditions on a spectrum of health and disease with varying dimensions.
Viewing our health on a continuum enables us to make adjustments that more effectively move us toward wellness. Recognizing health and disease as a continuum also prevents us from over-identifying with any particular diagnosis or getting caught in the trap of an illness becoming a personal identity.
Some diseases now have acknowledgment lower on the health-disease continuum, such as pre-diabetes and pre-hypertension. Along with a list of symptoms, mental health evaluations include assessment of daily function, background, and context, which brings us to #6.
6. Context. Context. Context.
Lab tests may reveal some information about what makes you tick but likely not as much as viewing you in the context of your family, life experiences, work, and environmental surroundings. Vincent Felitti recognized decades ago that adverse childhood events (ACEs) predict health throughout the lifespan and this has led to the recent integration of trauma-informed care into the mainstream of mental and physical healthcare.
Trying to understand ourselves without the benefit of context may lead to false conclusions or shed light on only a part of who we are. Allostasis suggests, for example, that social disruption (such as divorce, loss of social status, loss of community to a natural disaster, displacement of war) are primary causes of many ailments that lead to poor health.
By incorporating cultural context in our assessment of health, allostasis helps us understand that the more disconnected we feel, the more dis-eased we will be individually and as a collection of humans. This awareness also demonstrates that the opposite is true; actions that increase our connection to ourselves, others, and the natural world will increase our health potential.
Part 2 of this series explores 12 specific health practices that arise from an allostatic approach to health to change our personal set-points.
1. Sterling, Peter (2004). "Chapter 1. Principles of Allostasis". In Schulkin, Jay (ed.). Allostasis, homeostasis, and the costs of physiological adaptation. New York, NY: Cambridge University Press. ISBN 9780521811415. OCLC 53331074.
2. Lee S. W. (2019). A Copernican Approach to Brain Advancement: The Paradigm of Allostatic Orchestration. Frontiers in human neuroscience, 13, 129. doi:10.3389/fnhum.2019.00129.