🧠 From Chronic Disease to Chronic Health — But Are We Asking the Right Questions?

A recent spotlight in the European Heart Journal made a strong case for changing how we approach chronic illness. Rather than treating diseases like heart attacks, diabetes, and stroke after they occur, the authors advocate for a shift in focus—from “chronic disease” to “chronic health” [Cassidy et al., 2022]. They present compelling evidence: even modest lifestyle changes—eating better, moving more, sleeping well—can reverse or prevent many cardiometabolic conditions. Personalized interventions, powered by apps, wearables, and new imaging tools, are now more scalable than ever.

This is good news. And yet, something’s missing.

While the paper brilliantly showcases how we can improve health, it never truly asks the deeper question:

🔍 Why do we get sick in the first place?

💥 Disease Doesn’t Just Happen — It’s the Cost of Adaptation

What if illness isn’t just the result of “bad habits,” but a long, invisible process of physiological trade-offs?

That’s the question at the heart of the Exposure-Related Malnutrition (ERM) framework—a new way of understanding chronic disease that doesn’t begin when symptoms appear, but years earlier, during our body’s hidden struggle to adapt to stressors.

From this perspective:

• A child under chronic psychological stress may shift nutrients away from growth or brain development to fuel immune vigilance.

• A woman eating a seemingly adequate diet may still experience fatigue or cognitive fog if key nutrients are being redirected toward cellular repair or inflammation.

• A man recovering from viral infections may develop metabolic syndrome—not because he “let himself go”—but because his system never got the chance to fully resolve the bioenergetic cost of that immune battle.

In each of these cases, the body adapts. But adaptation has a cost.

⚖️ ERM: When Energy Isn’t the Problem—It’s the Prioritization

The authors of the paper rightly point out that today's lifestyle—sedentary, sleep-deprived, ultra-processed—is undermining our health. But they don’t dive into how this lifestyle forces the body into constant triage: choosing which systems to prioritize and which to sacrifice, based on limited metabolic and nutrient resources.

That’s the missing piece.

The ERM model helps us understand:

• Why two people with similar diets can have very different health outcomes.

• Why recovery takes longer for some, even with good nutrition and care.

• Why subclinical changes in blood markers may signal the beginning of breakdown long before any diagnosis appears.

📱 Technology Can Help—But Only If We Track the Right Things

The featured study introduced the LIVEPLUS app, which delivers a pescovegetarian diet, physical activity, and stress-reduction program, paired with imaging and omics data to monitor improvement. It’s a promising model.

But what if we also used these tools to:

• Track bioenergetic reserve and resilience capacity?

• Detect patterns of chronic adaptation, not just disease endpoints?

• Flag early warning signs of hidden malnutrition, even in people with normal weight and labs?

🧭 Toward a Deeper Model of Health

If we really want to change the conversation, we need to ask:

Not just “How can we fix disease?” But “Why does the body lose its ability to adapt?”

That’s where the ERM and stress adaptation model offers hope. By seeing health as a dynamic balance of allocation and recovery, not a binary of sick vs. well, we can build systems that:

• Detect risk earlier

• Intervene more precisely

• And empower individuals not just to live longer—but to stay resilient.

Because in the end, health isn’t just the absence of disease.

It’s the sustained ability to adapt.

🔗 Reference:

Cassidy, S., Hunyor, I., Wilcox, I., & Fontana, L. (2022). Changing the conversation from ‘chronic disease’ to ‘chronic health’. European Heart Journal, 43(8), 708–711. https://doi.org/10.1093/eurheartj/ehab633

#ChronicHealth, #StressAdaptation, #ExposureRelatedMalnutrition, #ResilienceNotResistance, #PersonalizedPrevention