The Wellness Pyramid: A Holistic Approach To Health

Almost every conversation I have with a customer eventually involves a slight perspective change. Most understand the supplement industry isn’t regulated, but it isn’t until I bring up multiple examples of the deception do people really start to pivot their mindset into the “Oh man, I have to really be careful what I buy.”  

Everyone knows that diet and exercise are crucial. It isn’t until I use the analogy I am going to put forth here that it really clicks and the perspective truly shifts.

If you’re reading this, you probably believe a holistic approach – approaching the body as a whole, not unrelated parts with individual pathologies – is the way to fly. You are 100% right, and this article will teach you once and for all how to shift your mindset to truly live by this ethos.

View the wellness journey as a pyramid: 

The bottom are the things you can control most directly:  diet, stress, exercise, sleep and more. The middle are all the things you can buy without restriction:  supplements, vitamins, and over-the-counter medicines. The top is medical related intervention: prescriptions, doctor advice, testing, and procedures.

Changing your perspective in this way will guarantee greater success achieved faster. It sets the stage for a truly optimized holistic life.

First, A Few Scenarios 

I’ll have you try on my worn out, beat up, kinda stinky size 12 shoes for a moment. Let’s look at a few questions I get asked on a pretty regular basis:

Scenario 1:  What can I take for sleep?

We have herb and supplement combinations that can calm you or put you in a coma. Your choice. But what if you drink a pot of coffee before bed? What if you have obstructive airway disease and you are waking up because you don’t even know you have it? Will the supplement help?

Scenario 2:  My allergies are really bad, what natural options do I have?

We have some unique allergy support formulas that have herbs like nettles, some quercetin, and more. What if the dust underneath your bed has grown legs and is tickling your nose every night? Will the supplement help?

Scenario 3:  I can’t focus/I feel like my mind isn’t sharp. Help!

People are worried about early onset dementia. We have things that support brain health and herbs that can support energy in a healthy way. What if your brain doesn’t have enough fuel to run (aka food!)? Will the supplement help? 

With each of these common scenarios, we offer a non-supplement or medicine option FIRST.

The question I ask here today is a simple one: How do you know the problem you are suffering from is TRULY a medical concern? Could it be that choices we make directly cause or contribute to our problem? Spoiler alert:  yes, it’s probably your fault 🙂

Foundations for Great Health

It’s important to note that this discussion is primarily for specific problems, but the advice carries into the preventative minded among us. 

Before we can know our current issue is truly a medical concern, we must do everything we can in our power to eliminate any variables within our control that can contribute to our troubles.

As a pharmacist, I’m quick to tell someone when NOT to call a doctor. Imagine you have allergy symptoms for the first time in your life. You look to do the right thing – you call your doctor and schedule an appointment. After 2 hours of waiting, they say “try over the counter antihistamines.” If they are really good, they talk about using a pillow and mattress cover, cleaning under your bed, and using a humidifier. They send you home and you feel short-changed. “I could have done that myself.”  My point is that you should do all of these things first when you can.

The truth is, we can’t bring out the big guns until we sweat the small stuff.

To simplify this, we approach this in a step-wise manner that builds on each step.  Our wellness pyramid (again, because we think our MS Paint skills are awesome):

The Wellness Pyramid

At the bottom, we have all of the non-pill steps we take. Lifestyle changes. Diet. Exercise. Sleep. Stress management.

At the middle tier, we have the self-care “pill” options. The supplements. The OTC medicines. Anything we can’t get from the first step of the pyramid that we can get without really consulting any medical experts. Readers of this blog know they SHOULD consult a TRUE expert, especially around supplements and advice.

At the top of the pyramid we have the true medical problems. If you’ve done everything you can, including trying some stuff we’ve picked up at the store, we can now presume that the issue we are facing is a result of some medical concern. Here, we consult with a doctor.

The pyramid doesn’t always apply, of course. Some conditions shoot you straight up to the medical side. If you are an 11 year old with a pancreas that decides to sit out the next 80 years, you go straight to the top of the pyramid. No smoothie will touch that problem. But as Americans have heard in the media enough, many diseases and problems we face are preventable and are a result of lifestyle choices. An important thing to remember: even if you don’t need a scooter to get around, the bottom step of your pyramid probably could use some tweaks.

The Bottom of the Pyramid

What can we do to make sure we are doing everything we possibly can? Just you wait baby birds, I’m gonna tell ya!

Lifestyle changes

This is kind of broad topic. To many, lifestyle modifications means anything from diet, stress, and sleep. This is true, but I separate it out a bit. I consider lifestyle changes to be the non-you things done to help reduce preventable diseases. These are the things we can do, typically tied to environment or behaviors.

A few examples: Your allergies can flare up at night if there’s a 6 foot hole in your bedroom wall allowing pollen and junk to come in undisturbed. If your spouse loudly listens to death metal to fall asleep, I can guess why you don’t feel energetic all day. You have acne, but you are applying butter and mineral oil as sunscreen three times daily.

The point of the dramatic examples is to say, sometimes it’s the simple things that matter most. Don’t blow off advice like “remove the TV from your bedroom” – it actually matters!


Most people don’t make their campfires, and therefore aren’t providing enough macronutrients at the right time to maintain energy levels. Remember, your brain especially needs lots of energy continuously, so the 6 hour gap between the granola bar and Big Mac isn’t helping. There are many diet choices we make that make things worse; there are many really unhealthy foods filling up the shelves of grocery stores and our pantries.

Besides our wellness consults to beat up your diet, we have plenty of tips on healthy eating. Eating to fuel you fire provides the macronutrients to fuel the body systems on a consistent basis, stabilizing energy, metabolism, and blood glucose. By varying the components of the campfire, we get exposed to lots of healthy micronutrients – vitamins, minerals, antioxidants, and more.

Here’s some advice that usually accompanies all of the health concerns we address:

  • Reduce simple carbs/sweeteners/sugar intake
  • Stop eating processed or prepackaged foods
  • Reduce/limit artificial food coloring, dyes, flavors, and preservatives
  • Avoid inflammatory oils: no vegetable oils, fake butter
  • Eat more good fats – avocado, olive oil, real butter, eggs
  • Eat lots of dark, leafy greens
  • Limit alcohol consumption
  • Avoid caffeine
  • Drink lots of water – half your body weight in ounces. More on hydration here.

No matter what you have going on, these dietary recommendations are solid and will help you on your way to wellness.


Imagine you have a hyperactive puppy that you keep inside all day. He’s going to go nuts, right? Well guess what… You are that puppy.

We are far too sedentary in our lives, yet our genetic makeup is telling us we should be moving and grooving. This conflict itself is a stressor.

Is our joint pain in need of glucosamine, or will stretching and range of motion exercises help? Is it truly the joint, or are the muscles around the joint too weak to support the joint?

We blame age, our sneakers, or the wrong protein powder on our weight gain, stress, and anxiety. In reality, it’s the sedentary nature of our lives. If you got a simple 10 minutes of movement in, even it if is spread throughout the day, it’s more than a majority of us do. More muscle mass means better metabolism, leaner bodies, and better support of your posture and movement.

Here are some tips for easy exercise and movement things you can do everyday at home that will make a big impact:

  • Stretch. Spend a few minutes each day after you wake up touching your toes, twisting your body, moving and stretching your arms, and bending your legs.
  • Move. Go for a walk around your house, your block, a local park, or your office. Take the stairs when you can. Park your car far from the mall or a store.
  • Work out. Get on a physician approved exercise program. Do lunges and squats in your house. Do push ups, sit ups, or even yoga at home.
  • Be careful. Don’t fall over, get hurt, and blame my blog 🙂


Broken and disturbed. Short and incomplete. Not just a description of that guy at work everyone hates, but a typical set of adjectives describing most of our sleep patterns. Sleep is the one part of the bottom step of the pyramid that is actually impacted directly by all the other parts. If you don’t eat right, exercise, and have good sleep hygiene (the habits around going to sleep), you will be unrested and ornery.

Here are some sleep tips (more to come on this in future blog posts):

  • Make dietary changes to remove caffeine, fatty meals, sugary treats, and spicy dishes, especially before bed.
  • Limit naps during the day to 30 minutes. Also, congrats on being able to take naps!
  • Have a regular bedtime routine. Take a warm bath, read a book, all the tricks.
  • Keep the bedroom activities to sex and sleep. Great advice. No TV, electronics, or work.
  • Be comfortable. A properly supporting mattress and pillow, at the right temperature and lighting are important.
  • Manage stress as best as you can and practice things like mindfulness and meditation. Keep a pad and pen next to your bed and write down all the thoughts that rush to your head, then trust you’ll address them the next day after some restful sleep.

If you have great sleep hygiene and address any potential stress or diet causes of poor sleep, we can be more confident that any over-the-counter or supplement options will be more beneficial.


We’ve talked at length at the impact of stress on your health. I look forward to a future blog where I talk about my meditation journey and how it’s helped deal with my stress. Until then, make a concerted effort to at least identify all the different stressors you have. Nutritional, physical, emotional and more. Take an inventory and make a plan to address each one as best as you can.

The Middle of the Pyramid

To get control of what ails us, we must conquer each step of the pyramid. Having finally ensured our diet, sleep, and stress are all optimized, we realize we’re still having some difficulties. Sometimes there are things that we can’t get from our diet alone that we need. It’s now when we can confidently walk into a pharmacy or supplement store and look at what options we have to continue building on our wellness plan.

We often discuss the Vital 5, the 5 supplements that almost everyone should take. These are foundational pieces of nutrition that one may not get completely from our diets and the first step of the pyramid. Using our joint pain analogy, someone who removes inflammatory foods and oils from their diet, eats sufficient protein, exercises/stretches regularly, but still has joint pain may benefit from ensuring they get all the essential fatty acids a modern, healthy American diet needs. Fish oil can help achieve those fatty acid intake goals, which may supply the body with the materials to lubricate up those joints.

Beyond the Vital 5, there are mountains of options to choose from to help address any health concern. When choosing supplements, our wrap is to ensure you are giving them a fair shake. Many people talk about what supplement to use, but we barely talk about things like absorbability, dosage, length of use, and evidence showing benefit. If you take the time to live a holistic life, optimizing your “pyramid”, but you take 1/10th of a dose of a poorly made probiotic, your gut won’t get any less “leaky.”

Here are some tips for making smart choices around supplements and over-the-counter options:

  • Have a trusted professional to bounce choices off of.
  • Know the supplement industry isn’t regulated, and as a result your vitamins may be lying.
  • Do one (or a couple) things at once. Adding 6 new supplements or making dramatic changes may feel like the right thing to do, but we need to know what’s working and what’s not.
  • Start low. Go slow. But go. When adding something new, take the product consistently at low doses to ensure you tolerate it. Increase the dose slowly to target amounts. Be deliberate: don’t just take a few doses then quit, don’t stay at super low doses forever.
  • Don’t believe the hype. There’s so much misinformation, it’s critical to take all of the pervasive messaging out there with a grain of salt.

The Top of the Pyramid

You’ve done it! You’ve removed bad, unhealthy foods. You’re getting a solid 8 hours regularly. You exercise and fuel your body with healthy foods and fluids. You are one with the universe. You take only supplements that you need, in forms that get absorbed, at doses that matter. But… something’s still not right. Time to call the pros.

I’m not saying that if you have a concern, you shouldn’t first call your doctor. I’m just saying that using supplements or medicines in some situations is putting a Band-Aid on a bullet hole.

The medical industry is crazy in this country. I read a recent study that said most people get 11 seconds of time with their doctor before they are interrupted. There is an average of 3 minutes of time for questions total. It’s not doc’s fault; he’s getting paid nearly nothing for the visit by the insurance companies, so the mega-corp he had to sell to so he can continue practicing medicine without having a stroke says he has to see 45 patients a day instead of the 8-15 he used to. You have to be prepared because unfortunately this isn’t going to be a leisurely visit.

Here are some tips for a successful chat with your doctor:

  • Bring a list of questions you want answered in advance.
  • Bring a list of your current medicines and supplements and how you take them.
  • List out all of the things you’ve done to try to remedy the situation yourself.
  • List out all the healthy things you do on a regular basis.
  • List out any professional intermediates (like pharmacists) you’ve used for advice and what they’ve told you to do.
  • Be ready to give the “executive summary”: these are my original symptoms, this is when it started, this is what i’ve done, this is what I am currently doing, this is what I currently feel.

It’s insane that this is the way it is, but that’s the breaks. I believe this is why so many charlatans are so popular in the cult of personality. If you charge for your consultations and make profit from the products you sell, you can afford to sit around and have lengthy conversations with people. You can afford to listen. And that’s what we want most.

One Foot In Front Of The Other

Conceptually we all get it. We’ve heard these things before. They are boring bits of advice that some of us dismiss, though, and instead look for a magical cure at a store with lots of green and brown branding.

You can and should use supplementation when done properly. If we are to subscribe to a holistic model of care, we can’t forget the “whole” part of it. Diet, stress, sleep, exercise, and lifestyle factors contribute greatly to many modern ailments. Addressing them today, even incrementally better than we had yesterday, will eliminate variables that stand in the way of our success.

The best thing we can do here is to help people make a plan to address these issues. We stress the importance of quality in supplements, but we need to equally beat the drum of taking less stuff. To do this wellness thing right, work with a proper professional, trained in health in wellness, who is concerned more about what you should do than what you should take.

Just trying to keep it real…

Neal Smoller, PharmD
Owner, Pharmacist, Big Mouth

Dr. Neal Smoller, Holistic Pharmacist

About Neal Smoller

Dr. Neal Smoller, PharmD, is a licensed pharmacist: and owner of Village Apothecary, an independent pharmacy in the most famous small town in America—Woodstock, NY. He’s also the host of the popular wellness podcast, The Big Mouth Pharmacist.”


The Vital 5

Nutrients you shouldn’t live without
The Vital 5 Nutrients You Shouldn't Live Without