American Journal of Internal Medicine

2021; 9(4): 166-170

http://www.sciencepublishinggroup.com/j/ajim
doi: 10.11648/j.ajim.20210904.12
ISSN: 2330-4316 (Print); ISSN: 2330-4324 (Online)

Beyond “Normal”: Optimal Levels of Medical Parameters

for Assessing Positive Health
Abhaya Indrayan1, *, Gayatri Vishwakarma2, Sanjeev Sarmukaddam3, Saumya Verma1
1
Department of Clinical Research, Max Healthcare, New Delhi, India
2
Department of Biostatistics, Indian Spinal Injuries Centre, New Delhi, India
3
Department of Biostatistics, BJ Medical College, Pune, India

Email address:
*
Corresponding author

To cite this article:

Abhaya Indrayan, Gayatri Vishwakarma, Sanjeev Sarmukaddam, Saumya Verma. Beyond “Normal”: Optimal Levels of Medical Parameters
for Assessing Positive Health. American Journal of Internal Medicine. Vol. 9, No. 4, 2021, pp. 166-170. doi: 10.11648/j.ajim.20210904.12

Received: June 13, 2021; Accepted: June 26, 2021; Published: June 30, 2021

Abstract: Background: Whereas the concept of normal levels of various parameters is extensively used in medical practice,
the concept of optimal levels has not received much attention. We propose that it is time to pay attention to the optimal levels
so that positive health can be measured. Objective: The objective is to define optimal levels of medical parameters as that
combination which prevents the occurrence of ailments or gives strength to fight these ailments if they occur. Methods: A large
number of articles and other literature was reviewed in search of medical parameters and their levels that could be considered
to indicate optimal levels. Result: The optimal combination of medical parameters that prevents occurrence of ailments and
gives strength to fight if an ailment occurs, is conceptually beyond the ‘normal’ levels that we use in everyday clinical practice
and can be considered to indicate positive health. This is illustrated with the help of several examples after dividing the concept
of positive health into five domains on the pattern of quality-of-life assessment. Conclusion: A concept of positive health has
been proposed and its link to the optimal level of medical parameters is described. We plead that more efforts be made to
identify the positive parameters of health, and their optimal levels that measure positive health be delineated.
Keywords: Beyond Normal, Normal Levels, Optimal Levels, Positive Health

measures taken to put the body systems back on track when a

1. Introduction derailment occurs. Thus, medical science is mostly oriented
The oft quoted and perhaps the most widely accepted to relieving suffering and restoring health to its normal state.
definition of health is “a state of complete physical, mental The steps for prevention of ailments and promotion of health
and social well-being and not merely the absence of disease are separate from this conventional view of medicine
or infirmity”. [1] However, this is utopian and an although the terms such as preventive medicine and
unattainable ideal. [2] On the ground, health can be defined promotive medicine are also common in medical parlance.
as that state of dynamic equilibrium of body, mind, and soul, The aim of the present communication is to present the
when homeostasis is going on well and the person is able to concept of positive health as beyond ‘normal’ that signifies
carry out the routines of life without inhibition. This may be that the body systems are working at optimal level to prevent
the most direct definition of “normal” health, although there ailments and their adverse consequences if they occur.
is no consensus on what is normal in health and medicine. [3]
Health abnormality occurs when an ailment strikes that 2. Positive Health
disrupts the equilibrium and impedes the routine of life in
any manner. Diseases, injuries, impairments, and Some people fall sick frequently and die early while some
psychological disturbances are examples of such ailments. rarely fall sick and die late. Positive health can be considered
Conventional medicine can be understood as the remedial as a state when the person is not just healthy but has
167 Abhaya Indrayan et al.: Beyond “Normal”: Optimal Levels of Medical Parameters for Assessing Positive Health

sufficient reserves to fight the illness if and when that strikes domain of immunity includes items such as the optimal level
and is able to carry out the routines of life in a normal of immunoglobulins, lymphocytes (B-cells and T-cells),
manner in adverse situations. This implies the availability of macrophages, neutrophils, and dendritic cells.
mechanisms in the body to thwart the ailments and to The next most important domain perhaps is the optimal
minimize their adverse effect if they strike. The implication combination of nutritional elements in the body. This
of positive health is living long in good health. includes items such as the levels of various vitamins,
The earliest reference we could locate to the concept of minerals, fatty acids, and probiotics that have a salutary role
positive health is the sense we present in this communication in protection from several diseases, besides protein,
is in a 2001 book where positive health is described as the carbohydrates, and other elements. For example. National
ability to cope with biological, psychological, and social Research Council Committee on Diet and Health [12] has
stress, with parameters such as pain-bearing capacity and extensively discussed how nutritional elements can help in
vital capacity as its indicators. [4] Seligman in 2008 provided preventing some chronic diseases, although the data are
another version and operationalized it by a combination of incomplete. Nevertheless, it is known that an appropriate
excellent status on biological, subjective, and functional combination of vitamins and minerals can protect from
measures. [5] He included factors such as optimism, stable cancer. [13] Different vitamins help in making antibodies that
marriage, and lower blood pressure level. [6] fight disease, [14] build bone health, [15] and help fight
Our focus is on body elements and functions that harness infections and protect from damage to body cells, [16] and
the body’s capacity to fight any adversity and be able to serve as antioxidants to protect from various diseases as we
maintain homeostasis at an adequate level in adverse age. [17] The role of trace elements in the maintenance of
situations, in addition to maintaining normal health. Distal immune functions is being increasingly recognized. [18] Zinc
factors such as genes, diet, exercise, sleep, and social lowers oxidative stress, [19] probiotics can cut the number of
interaction are indeed relevant and appealing, but we do not respiratory infections, [20] and electrolytes help the body to
consider them in our framework because these are mostly maintain fluid and blood volume for it to function normally.
subjective, highly volatile, and defy measurement. Instead, [21] Convincing evidence exists that antioxidants and
we restrict to proximal parameters of the body’s internal essential minerals are indispensable for a healthy mind and
mechanisms, particularly those that are measurable and body. [22]
relatively more stable, so that an objective assessment of the The third domain comprises items such as hormones,
level of positive health can be made. There is a plenty of endorphins, enzymes, amino acids, and such other
evidence that these distals modulate various medical substances. Schwartz and Holtorf [23] have discussed the
parameters such as immunity level and hormonal balance that role of hormones in wellness and disease prevention. For
shield from ailments. For example, genes are involved in example, melatonin is widely reported to exhibit protective
hormonal signaling, [7] exercise reduces the level of stress effect in various diseases[24] besides controlling the sleep
hormones such as adrenaline and cortisol and stimulates the and wake cycle, [25] oxytocin helps with lactation and
production of endorphins, [8] nutrition modulates immune childbirth, [26] parathyroid hormone controls calcium levels
functions, [9] and sleep influences the cardiovascular in bones and blood, [27] testosterone contributes to sex drive
endocrine and thermoregulatory system. [10] and body density, [28] and serotonin regulates anxiety,
Although the normal level of various parameters is happiness, mood, sleep, appetite, memory, and learning
important for positive health, our emphasis is on the optimal ability[29] and regulates biological process including
level of parameters and markers that protect from disease. cardiovascular functions, metabolic rate, and temperature
We realize that disentangling of physiological and control. [30] Endorphins control the perception of pain and
neurological pathways that lead to positive health would be a fight stress, [31] and enzymes support, maintain, and repair
challenging task but at least a beginning can be made. the body and its functions. [32] Amino acids stimulate
muscle synthesis. [33] An optimal combination of these and
3. Domains of Positive Health such other parameters may be effective in warding off many
ailments or in controlling adverse effects of some ailments
The concept of positive health may be easier to when they occur.
comprehend when divided into domains and items on the The set of neurological parameters is the fourth domain of
pattern of quality of life. As in the case of quality of life, positive health. Besides preventing neurological diseases
these domains do not work in isolation. They affect one such as Alzheimer’s, dementia, anxiety, vertigo, aneurism,
another, and the overlap is substantial. For items within each and epilepsy, these parameters control physiological
domain, we restrict to objectively measurable parameters processes required for normal brain functions and neuronal
instead of images and invasive investigations. support while working with other parameters. [34] The
The most prominent domain of positive health is the nervous system controls brain growth and development,
adequate level of immunity that helps battle the infection and sensations, perception, emotions, memory, response to stress,
protects us from several ailments. The immune system and several others, including pain tolerance. [35]
identifies and destroys foreign elements such as microbes, Neurological parameters may be among the most difficult to
[11] which can disturb homeostasis and produce disease. The identify and measure and may have considerable overlap
 American Journal of Internal Medicine 2021; 9(4): 166-170 168

with hormones and other parameters. Whereas neurological 5. Limitations

assessment is mostly done through sensory and cerebellar
investigations, search is on for substances in the blood that We realize that we may have just scratched the surface and
would indicate cognitive functions. [36] Among others, not gone into sufficient details. Our review of the literature
neural tissue markers such as microtubule-associated protein- may be selective yet suggests that not much is known about
2 (MAP-2), S100B protein, [37] neuron-specific enolase the optimal combination of the levels of various parameters
(NSE), and tumor necrosis factor (TNF) can also help in that is enough to protect health. We may not have been
determining the level of positive health on neurological comprehensive in our description of even the known factors
parameters. P300 is considered an important maker of and some crucial aspects that affect health may have been
cognitive function [38]. missed. The purpose of this communication is to propose an
The fifth and the last domain of positive health in our idea and show that it is useful and feasible although we agree
framework is the whole gamut of physiological and that much work is required to make it operational in the
biochemical parameters. Most of the routine laboratory-based actual setup.
investigations fall in this domain. This includes parameters
that protect from diseases of various organs, those that 6. Conclusion
measure the adequacy of reproductive functions, and those
that indicate the status of spine, bones, and muscles. This A feasible idea of positive health of individuals has been
domain also includes parameters such as body mass index proposed that goes beyond ‘normal’. We contend that the
(BMI) and handgrip strength. The emphasis here also would optimal level of some major proximal factors could be
not be on their normal levels but on optimal levels that adequate to proceed ahead with the idea of positive health
provide a buffer against ailments. This may include low and leave the complexities for future workers. The proposal
levels of substances such as bilirubin, total cholesterol, may help in identifying the data gaps that can be used to
aspartate aminotransferase (AST), alanine aminotransferase inform policies for improving the health of the people so that
(ALT), very low-density lipoprotein, troponin, prostate- they develop the ability to thwart ailments and live long in
specific antigen, rheumatoid factor, and high levels of good health. The proposal can also later lead to a scale that
parameters such as omega-3 fatty acids, bone mineral density can be used to quantitatively measure positive health of
(BMD), lung functions, and handgrip strength. Elevated individuals on an objective basis. In course of time, the
levels of C-reactive protein (CRP), D-dimer, interleukin-6 concept can be extended to include parameters that promote
(IL-6), and such other cytokines are associated with all-cause health where promotion is enhancing the functionality level
mortality [39], implying that their low level may help in of the individuals.
avoiding mortality. Low levels of these markers may also
help preserve brain health and support successful aging. [40]
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