How Gen Zers approach health and health care

Host Amber Smith: Upstate Medical University in Syracuse, New York, invites you to be The Informed Patient, with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith.

Doctors of family medicine treat patients of all ages, but today I am focusing on young adults in their 20s, who've graduated from pediatric care and are out on their own.

I'm talking about Gen Z patients, born between 1997 and 2012, with Dr. Kaushal Nanavati. He's a doctor of family medicine at Upstate and also the director of integrative medicine, and he has some observations about this patient population.

Welcome back to "The Informed Patient," Dr. Nanavati.

Kaushal Nanavati, MD: Thank you, Amber. Great to be back.

Host Amber Smith: This is going to be very general, understanding that people are individuals, but there are sometimes trends that you can see in certain patient populations.

Are these young adults more or less health-minded than their parents, do you think?

Kaushal Nanavati, MD: It's a fascinating topic. In general, they're more health-minded, they're more health-conscious. They're looking to make choices that are healthier.

And at the same time, we also know that in some ways, physical activity-wise, and even in terms of weight, overweight, et cetera, diabetes, some of these chronic conditions, we're also seeing some more of these conditions in this generation, including some cancers, in this generation compared to others.

So it's kind of a mixed data set, but, in general, the trend is that they're making decisions to try to promote their health proactively better than generations that have come before them.

I think millennials have kind of paved the way for Gen Z in some ways, as well.

Host Amber Smith: So they're trying to do right with their health, but you do see some things that they're not doing, they're not getting right.

Kaushal Nanavati, MD: Right. And again, that has to do with generational shifts. That has to do with the way in which we engage with the world, lifestyles and focus as well.

Host Amber Smith: So how do you talk with this patient about diet and nutrition?

Kaushal Nanavati, MD: So the thing is, they're actually more inclined to make health-conscious choices in terms of nutrition. Things like plant-based eating, aren't an unknown enigma to them. They understand what that means.

The choices they make in terms of what they do to take care of their own nutrition, they have more insight and are more amenable to making some changes. And again, some of this, obviously it's a broad population that we're talking about, so there are more with more knowledge, and making some better decisions, and that enables us in a health system to then be able to support that much more easily.

I can tell you that even at our own medical school, students coming in from class year to class year, over time, we can see that interest in nutrition, that interest in plant-based eating. In fact, we have students right now who are working with our health system to continue to improve the nutritional offerings for our employees and our staff and those who visit our system as well as for patients, which I find to be fascinating, especially having been in health care for a time frame that I've been in.

Host Amber Smith: Are the Gen Z patients, are they apt to take vitamins and supplements?

Kaushal Nanavati, MD: I think there's curiosity. I think there are people who sometimes will do more. They feel like there's more information that's accessible to them online and content. and I'm always very cautious about this because frankly, "let food be thy medicine" should still be the principle for all of us.

So when you think about nutrients, when you think about nutrition, think about where you get your vitamin base, primarily it should be from whole foods and how we pair them. Understanding fiber and healthy fat and healthy protein, things like pickled vegetables versus raw versus cooked. This is all the information that's important to be shared.

I think "pillification," whether it's supplements or medications, it still becomes a formulary. And when people start using supplements in bulk or beyond recommended levels, we have to be very careful of the impact on the body, the liver, the kidneys, the organs of the body, and sometimes these supplements can interfere and/or interact or enhance the effect of medications they may be taking, which could lead to potential toxicity or blunting the effect of something that may be vital for their body and their health.

Host Amber Smith: What's their general feeling about alcohol use?

Kaushal Nanavati, MD: In general, they're using it less, marijuana less, and that's what some of the data bears out. At the same time, there are pockets where you may find that it's different. And I think with the current transition, the things that we have to help people be more aware of is that there are different ways of utilizing different things. So when it comes to marijuana, there are multiple factors and components, CBD, THC, et cetera, and some things in certain forms, like the essential oil versus smoking, have a different effect, different impact on the body, may have different health consequences as well.

This generation, more than others, is more open to learning this type of thing and has access to more information, which I think, because they're young, we still have to wait to see health consequences over time.

So we don't know what the impact will be fully yet, but the trend seems to be that, in general, they're making decisions that promote their health moreso than generations in the past have, and maybe because they have more access to better information.

Host Amber Smith: So, is this generation more into integrative medicine like yoga or massage therapy?

Are they likely to try some of these things that are on kind of the fringes of medicine?

Kaushal Nanavati, MD: So I think in terms of the complimentary approaches, in general, they have more access. But again, there are factors, in terms of who's utilizing. Historically it's been women more than men. Historically it's been people with higher education. So even in this generation, some of those trends seem to be bearing out, and so access, I think, is still an important factor, but knowledge is more readily available. And then, I think they're wiser about asking questions. So I know in our practice, they tend to be more proactive with asking questions about things when they do come in.

I will say that this is also a generation that access is really important to them, so they tend to be more readily utilizing urgent cares and things like that, which, again, compared to two decades ago, there are more urgent cares around. And so what they sometimes don't recognize is the value of the continuity that you can get in a primary care setting, where somebody knows you over time and knows both the ups and downs, but also your history individually and in the context of your relations, generational history, which can influence and impact decision making, for the good of the person when the provider is aware of that. And so they tend to use urgent cares more, which is something that we'll have to see how that bears out in terms of the quality of health over time.

Host Amber Smith: This is Upstate's The Informed Patient" podcast. I'm your host, Amber Smith. I'm talking with Dr. Kaushal Nanavati about Gen Z health practices. He's a doctor of family medicine and the director of integrative medicine at Upstate.

So let's talk about the chronic health conditions that you're seeing in this group: diabetes, heart disease, obesity? What else are you seeing sometimes?

Kaushal Nanavati, MD: There's data with certain types of cancers where the younger generations seem to be having a higher percentage, relatively speaking. And, you think, is it because we have better testing? Is it because we have better tools to detect? Are we screening more consistently, because they're accessing health care more consistently, whether it be primary care, urgent care, as we spoke about earlier? And the answer is, we don't know yet because they're young. What we do know, though, is that diabetes and even overweight seems to be more prevalent in this population.

And that's something that is of concern because on the one hand, they do engage in physical activity, they do engage in, even are more amenable to, mind/body therapies, mindfulness therapies, those types of things. In terms of complementary approaches, as you mentioned, yoga, but is that across the spectrum of the population?

And generally people in their 20s and even 30s, and in this population, aren't necessarily as consistent with accessing health care, and that may be the issue. We know with colorectal cancer, there's a trend showing an increase. And so, there are many, many, national bodies looking at the "why," and whether it comes back to nutrition, whether it comes back to processed foods and those types of things. What's been accessible to them in school systems? For people who don't have access to healthy foods, what's accessible to them in their proximity, in their community? Now, all of these things are factors amongst many others, that make a big difference in what we're seeing.

So, while they're intending to be healthier, we're also finding more chronic conditions showing up earlier. And for that we have to be proactive, not only as a health system, but socially, politically, to have the right policies in place that improve access to healthy nutrition, that engender people having access to more physical activity opportunities and the education that goes along with that.

And stress plays a big role in a lot of this as well. And especially with what we've had and experiencing over, from 2019 onwards and a lot of the stresses in the world now. There's a lot of stress, some of which people can't control, but it's in their lives, and that can have an impact as well.

Host Amber Smith: So, do they come to the doctor's office with concerns about cancer or diabetes? Do they have a fear of something that they're trying to ask you to help them keep away?

Kaushal Nanavati, MD: Some do. I would say that the trend has been that they come in wanting to be proactive. So there's the "fear of," right? So when you're trying to prevent a problem, you're concerned about the potential of the problem.

And then there's the promotion of health, where you're proactively seeking to be healthier. And the mindset shift is, one is a proactive, and one is avoiding, fear-averse kind of a mindset. And so we're seeing more people coming in with a proactive mindset, which is, "What can I do to stay healthy?" versus "What can I do to avoid this problem?"

And that mindset engenders better health overall, mentally, emotionally, spiritually, physically, right, nutritionally, and so you embrace the journey with joy versus looking over your shoulder in case something's going to show up.

Host Amber Smith: So do you know what the projected lifespan is for someone, we're talking people that are from 12 to 27 at this point? Do you know what their projected lifespan is and if it's shorter or longer than their parents'?

Kaushal Nanavati, MD: So compared to baby boomers and even Gen X, Gen Zers have a higher life expectancy and even Generation Alpha. So, in general, we used to say baby boomers had a life expectancy around 70 or in their 70s, whereas Gen Z, the life expectancy is going to be over 85, potentially, and even higher, potentially. And, this is a fun statement, but it's also a fact, the longer you live, the longer you're projected to live. So, when you get to 65, the potential that you get to 75 is greater.

When you get to 75, the potential that you get to 80 is greater. And part of that is how you maintain health over time. And the healthier you age, the healthier you will age, right? And these statements, even, I'm chuckling when I say it, but it's good science, which is to say, "Build it well now. You're always building your foundation for the future." And this generation has a potential due to both advances in science, as well as improvements in knowledge and access to knowledge, that they can actually have a quality of life that extends well into their 60s, 70s, 80s as a generation.

And then we have pockets, and we have areas and people and subgroups that still struggle with getting access to good health care, to good nutrition, healthy nutrition and to be able to engage in self-care in a consistent manner. And socially, we had to continue to work on putting a spotlight on these subgroups, so that we can benefit them, so that overall, as a society, we advanced as a whole group.

Host Amber Smith: So, Generation Alpha, those are the people born after 2012, right?

Kaushal Nanavati, MD: Correct.

Host Amber Smith: And I should let listeners know, baby boomers are born between 1945 and 1964,Gen X from 1965 to 1980, and then the millennials were '81 to '96.

Looking into the future, what is the best advice you'd like to give your Gen Z patients, regarding their health?

Kaushal Nanavati, MD: In general terms, if you want to get very, very fundamental, but kind of the big rocks in place, you've heard me talk about what I call the "core four," optimizing nutrition, plant-based whole-food eating, thinking about fiber, healthy fat and healthy protein as being consistent parts of our nutrition.

Physical activity and what the data shows regarding aiming to get up to seven hours of moderate/intense physical activity.

Stress, focusing on things that you can do something about and continue to work on those things.

And then this idea that contentment and peace are dynamic in our lives.

But really, if we recognize that those are the ultimate goals in life, then we tend to reassess that periodically. Are we content, and are we at peace? And if we are, that's a great starting point to continue to build better, make today better than yesterday, and you'll look back on a life well lived. Save for tomorrow what you can do today, and you're going to look back on life unfulfilled,

Even more simply, living by "the sevens." Seven servings of vegetables a day. Seven hours of exercise a week. Seven hours of sleep a night; sleep is a very vital part, and when people are in an age range where they're trying to still build their life, oftentimes sleep becomes an afterthought.

In medicine, when we talk about our trainees, our students, our residents, but in the world of finance and investment banking and consulting, people that work shift work and nursing, there are life metrics that do truly make a difference, both in the quality and the potential quantity, moving forward. And so we have to recognize stress points in our life, be able to step back and focus on the fundamentals.

Host Amber Smith: Well, Dr. Nanavati, thank you so much for making time to tell us about this.

Kaushal Nanavati, MD: My pleasure. I really appreciate you having me on.

Host Amber Smith: My guest has been Dr. Kaushal Nanavati. He's a doctor of family medicine and the director of integrative medicine at Upstate.

"The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe, with sound engineering by Bill Broeckel and graphic design by Dan Cameron.

Find our archive of previous episodes at upstate.edu/informed.

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