0:00

Coming up on this episode of The

0:02

Doctor's Pharmacy. Food is information, that it's

0:04

medicine, that it's instructions, it's code, that

0:06

programs your biology with every bite. So

0:08

you must understand that you're

0:10

interacting with things, not just from an

0:12

energy perspective, not just fuel to run

0:14

your body, but instructions that code for

0:17

every single function of what's going on.

0:21

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3:49

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of your symptoms. Welcome to the doctor's pharmacy.

3:58

Every week I bring on interesting guest to

4:00

discuss the latest topics in the field of functional

4:02

medicine and do a deep dive on how these

4:05

topics pertain to your health. In today's episode, I

4:07

have some interesting discussions with other experts in the

4:09

field. So let's just jump right in. The

4:12

peak in diet is basically the approach that

4:14

I've created and it's really a flexible, inclusive

4:16

framework. It's built on a

4:18

few key principles and these are central

4:20

principles, no matter what nutritional

4:22

philosophy you ascribe to, I think

4:25

they're universal. First is focus on quality. The

4:28

quality of the ingredients, the quality of the nutrients, the

4:30

quality of the food you're eating matters so much. So

4:34

is a sun-ripened

4:37

tomato off your

4:39

vine at the end of August in

4:41

an organic little garden you have in the backyard

4:44

better quality than a industrially

4:46

produced tomato that's designed to fit in a

4:48

box and not squish and last for months

4:50

on the shelf and tastes like cardboard the

4:53

same? No, focus on quality

4:55

whether it's real

4:57

food or whatever you're eating, try to get

4:59

the highest quality, most nutrient-dense food you can

5:03

and obviously that means no ultra processed

5:05

food. Understand that food

5:07

is information, that it's medicine, that it's

5:09

instructions, it's code, it programs your biology

5:11

with every bite. So you must understand

5:14

that you're interacting with things not just

5:16

from an energy perspective, not just fuel

5:18

to run your body but instructions that

5:20

code for every single function of what's

5:23

going on your microbiome, your metabolism, your

5:25

brain chemistry, your immune system, everything that

5:27

I could go on, the list goes

5:29

on is regulated by what you eat

5:31

in real time. And the

5:33

last principle after quality and food is

5:36

medicine and information is

5:38

personalization. Not everybody needs the same

5:40

diet. Some people do better on low carbs, some

5:42

people do better on low fat, some people do

5:44

better on paleos, some will do better

5:46

as vegan. So we have to see what works for you

5:49

and we have to be smart about it. But

5:52

you want to make sure you eat a diet

5:54

that is very much focused on these principles and

5:56

it also follows a few other things. One it

5:58

should be low in sugar. starch and sugar,

6:01

low glycemic, super, super important. I can't

6:03

stress that enough. I said it forever,

6:05

but it's really important because

6:07

that drives so much of the age-related diseases.

6:09

Two, it should be full

6:11

of good fats, avocados, olive oil,

6:14

nuts and seeds. If

6:16

you're tolerant of saturated fats and you don't

6:18

eat them with carbs and sugar, you can

6:20

have coconut butter or coconut

6:22

oil and even grasshead butter or

6:24

ghee. And make sure you

6:26

eat foods that are full of phytochemicals, lots

6:29

of colorful plant foods with

6:32

anti-inflammatory, detoxifying, hormone balancing, energy-busting,

6:35

gut healing compounds. And that's a

6:37

nutrient-dense diet that's full of longevity-rich,

6:40

I mean longevity-producing phytochemicals, polyphenols,

6:45

which are plant chemicals, antioxidants,

6:47

microbiome, healing fiber, probiotics, prebiotics,

6:49

postbiotics, all of it. And

6:51

this is designed to basically

6:53

generate human health and

6:56

planetary health, which is something

6:58

you can't separate. So our health is intimately

7:00

tied to the planet's health. Our

7:03

own health is tied to the soil health,

7:05

the nutrients of soil are how we get

7:07

our nutrients. So it really is a beautiful

7:09

ecosystem that we learned mostly how

7:11

to destroy. But today I'm gonna talk

7:13

to you about how would you follow the vegan diet?

7:15

What does it look like? First of all, it's

7:18

a plant-rich diet, not

7:20

a plant-based diet. And that's

7:22

an important distinction. Plant-based implies

7:24

vegan. Plant-rich means your

7:26

diet's mostly plants. And

7:28

that should be three quarters of your

7:30

plate covered with colorful veggies. Lots

7:33

of colors, weird things, mostly non-starchy veggies.

7:36

I do eat a purple sweet potato

7:38

or sweet potatoes fine. Winter squashes are

7:40

fine, especially if you're not insulin-resistant

7:43

or diabetic. Try to

7:45

choose organic or regenerative when possible. Use

7:47

the Dirty Dozen Guide and the Clean

7:49

15 Guide from the Environmental Working Group,

7:51

that's ewg.org. Download those guides and

7:53

you'll learn all about which of the

7:56

foods you wanna stay away from that are

7:58

the worst contaminated, for example. Don't ever. strawberries

8:00

unless they're organic or you

8:04

know avocado or banana if it's not organic. Also

8:07

load up on the good fats. What

8:09

should you be eating? Well nuts and

8:11

seeds. Try to eat fats in their

8:13

whole food forms. Seeds and nuts, avocados,

8:15

pasturates, eggs, fatty fish like

8:18

mackerel, sardines, herring anchovies, some

8:21

wild salmon that's small. Olive

8:23

oil also is a very minimally processed

8:25

oil. Try to stay away from the

8:28

hexane extracted

8:31

deodorized solvent mixed

8:33

refined oils that

8:36

we eat are primarily refined

8:38

oils. If you're gonna eat canola or

8:40

soybean oil, I don't highly recommend

8:42

that but they can be part of cooking and

8:44

other things if you want and only if they're

8:47

expeller pressed, only if they're organic, mostly their

8:49

GMO, mostly their splay wick life is to eat.

8:51

You just stay away from that. So for cooking

8:53

I use extra virgin olive oil for

8:56

no heat or low heat, avocado for

8:58

higher heat, avocado oil I like that and

9:01

extra virgin coconut oil. Also use nuts

9:03

and seeds. They are tremendous. They should

9:05

be every day a couple of handfuls

9:07

of nuts and seeds really help with

9:09

weight loss, diabetes, heart disease. They're a

9:11

great source of minerals, fiber, fat, protein

9:13

and lots more stuff. Almonds,

9:16

walnuts, pecans, hazelnuts, macadamia nuts, pumpkin

9:18

seeds, hemp seeds, chia seeds, sesame

9:21

seeds are all great. I like pine

9:23

nuts too. I put that on there. Also

9:25

what about meat? Should we be vegan? Should we

9:27

be carnivores? Should we

9:30

be paleo? You know

9:33

we do need protein and we need animal

9:35

protein especially as we go to older

9:37

to build muscle. You don't

9:39

have enough protein in the right forms with the

9:41

right amount of leucine which is a very important

9:43

amino acid to build muscle. You will lose muscle

9:45

as you get older and if you see people

9:47

who are vegan as they're older they tend to

9:49

be more frail, more thin, less

9:51

muscle mass and muscle mass is the currency of

9:54

longevity. So you want to make sure you keep

9:56

maintain and build muscle as you get older and

9:58

so it doesn't mean you have to be eating

10:00

20 ounce steaks, it just means you need

10:02

30 grams. And that's not

10:04

much. It's a palm-sized piece of protein

10:07

or equivalent at each meal. So

10:10

make sure you're using regenerative meat if you

10:12

can. It's a company called Force of Nature

10:14

which sources regenerated rice meat from around the

10:17

country or even around the world.

10:19

It's really good for you. It's full of phytochemicals.

10:22

It's raised in humane ways, harvested

10:24

in humane ways. So it's really

10:26

a beautiful way to support a growing

10:29

food system that supports regenerative agriculture. If

10:31

you can, you can get grass fed,

10:34

pasture raised, organic when

10:36

possible. Also, making

10:40

sure that if you

10:42

are plant-based and vegan, you

10:44

may need extra protein powders. Now you're going

10:46

to be having processed food, processed food which

10:49

is processed protein powders you can have. Ones

10:51

are just more from whole ingredients but you

10:53

have to make sure they have added amino

10:55

acids particularly leucine and particularly branched-chain

10:57

amino acids because you will not be able

10:59

to get enough by just having the basic

11:02

plant-based protein. When

11:04

you also look at

11:07

fish consumption in addition to meat,

11:09

it's a great source of protein

11:12

but I would stick with the

11:14

small fatty fish, sardines, herring, anchovies,

11:16

mackerel, small wild salmon, high in

11:18

omega-3s, low in mercury. There's a

11:21

great company out there called Cetopia.fish

11:23

that's sourced for generally aquaculture raised

11:25

fish. It's low in toxins, tastes

11:28

great, low in mercury and full

11:30

of omega-3s and actually great

11:32

plant-based phytochemicals that come from the feed they're

11:34

eating. Check that out if you want

11:36

to learn how to lower your intake of more

11:38

toxic fish, go to an environmental working group, you

11:40

can use the Monterey Bear Aquarium

11:43

Guide or the NRDC Guide for

11:45

a low mercury fish. Grains,

11:47

what about grains? Well, full grains are fine

11:50

for most people. I wouldn't

11:52

be eating six cups of brown rice which is

11:55

30 grams of bergine but small amounts of half

11:57

a cup to a cup can sometimes be fine.

12:00

whole grains if they're more ancient grains if

12:02

they're not bred to be super starchy. So

12:04

I would encourage you to eat weird

12:07

grains like heirloom grains, Himalayan turmeric buckwheat, ancient

12:09

forms of wheat if you're not gluten sensitive

12:11

like einkorn, emmer, ferro but don't have them

12:14

ground as flowers except some of them you

12:16

know may be okay like Himalayan turmeric buckwheat,

12:18

a small amount of flour can be fine

12:21

but you want to make sure you're

12:23

actually eating a low

12:25

glycemic protein rich mineral rich form

12:27

of whole grains not the the

12:30

ones that have been hybridized and

12:32

processed in the ways we eat

12:34

them. So don't eat whole grain

12:36

flour, don't eat flour products and

12:38

try to avoid gluten especially in

12:41

America because there's many reasons you

12:43

know most most gluten in

12:45

this country is grown with dwarf wheat it's

12:47

sprayed with glyphosate at the end it's super

12:50

starchy it has way more gluten

12:52

proteins that cause celiac or non-celiac

12:54

gluten sensitivity so I'd really reduce

12:56

that. Sugar obviously you know stay

12:58

away from this stuff I mean a little bit

13:00

fine here and there but as a

13:02

staple it should not be part of your diet it's

13:05

occasional treat as a recreational drug and

13:07

also just remember below your neck your body can't

13:09

tell you between a bowl of sugar and a

13:11

bowl of cereal or a

13:13

bagel. Also oils eliminate

13:15

most of those refined oils all

13:17

those especially corn and grape seed

13:19

and sunflower if they're high lake

13:21

they can be okay if they're

13:23

you know speller or cold-pressed they

13:25

may be okay but stick with the main

13:28

oils that come from olive oil and avocado

13:30

oil you'll be doing fine and

13:32

dairy what about dairy? Well dairy

13:35

you know it typically is raised

13:37

in this country with a homogenous

13:39

not homogenized but homogenous genetic cow

13:42

which is the Holstein cow and

13:44

that's A1 casein it's very inflammatory

13:46

they're pumped full of hormones growth

13:49

hormone they're often milk while pregnant and

13:51

you get you know flood of hormones

13:53

and inflammatory compounds and inflammatory forms

13:55

of casein and if you want

13:58

to have dairy try sheep or goat try A2 cow

14:00

cows, which you can get like Guernsey and

14:02

Jersey cows or A2 cows. And if

14:04

you have the wrong kind of dairy, it's going to

14:06

drive inflammation, cancer, osteoporosis, believe it or not, yes, it's

14:08

not good for your bones. Well,

14:11

that's a whole other conversation you can, I think

14:14

read my blog called Six Reasons to Avoid Milk and or

14:16

you can go on

14:18

and read about David Ludwig's article

14:20

on Milk, which he

14:22

reviewed all the literature recently about it and it showed

14:25

that it really is not a

14:27

health food. I recommend mostly

14:29

avoiding it, occasional grass fed, you

14:32

know, sheep or goat, cheese or

14:34

yogurt or milk can be fine. Ghee

14:37

is fine because it doesn't have the milk solids

14:39

in it. So grass fed ghee is also fine.

14:41

So that's basically it. Eat real food, personalize

14:44

your approach. Think of food as medicine,

14:46

focus on quality. You can be

14:48

super flexible and all that. And hopefully

14:50

you can follow these principles and activate

14:52

your body's own healing response, improve

14:55

your health and use it like I have

14:57

in my practice to use food as medicine

14:59

and live a longer healthier life. Modern

15:05

foods aren't nearly as nutrient dense as they used

15:07

to be. So we all need a little help

15:09

from supplements if you want to function and feel

15:11

our rest. But supplements can also be tricky. Some

15:14

use low quality ingredients that are

15:16

difficult for the body to absorb

15:18

and others add cheap fillers and

15:20

additives. And that's why I love

15:22

symbiotica, cutting edge formulas they have

15:24

like liposomal glutathione and liposomal vitamin

15:26

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15:29

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15:31

absorption. If you're unfamiliar, liposomes are

15:33

fatty membranes like little bubbles that

15:35

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15:37

broken down in your digestive system and

15:39

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15:41

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15:43

body. Not only do they

15:46

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15:50

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15:52

getting high quality products that are safe, effective

15:55

without any seed oils, preservatives, toxins or artificial

15:57

additives. It also makes it taste great. citrus

16:00

vanilla made from organic vanilla

16:02

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16:04

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16:06

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16:25

shipping. So

16:28

sleep is when we're repairing the powers of

16:30

both the mind and the body. Sleep

16:32

is when we reduce

16:35

inflammation, repair tissues, the

16:39

discovery of the glymphatic system

16:41

in 2012-2013 as this passive

16:44

channel that runs alongside our arteries and

16:46

veins in the brain that fills with

16:48

fluid when we're in deep sleep and

16:50

allows a washing out of debris we

16:52

may have accumulated during the day. So

16:55

all those bad thoughts get washed out? Well

16:57

not the bad thoughts, no but the

17:00

amyloid plaque, that sticky plaque

17:02

that we secrete in response to inflammation

17:04

or injury. If it accumulates of course

17:06

it can damage surrounding neurons and is

17:08

associated with neurodegenerative disease and Alzheimer's disease.

17:10

So in English that means if you

17:12

don't sleep you're likely to get demented.

17:14

It's definitely playing a role

17:17

and this concept of bidirectionality. We

17:19

know that sleep disruption, circadian rhythm

17:21

disruption, sleep apnea is present in

17:24

two-thirds of people with insulin

17:26

resistance pre-diabetes. Diabetes and it is a chicken

17:28

and the egg thing is driving the bus.

17:30

You know we used to think well you

17:32

get the sleep apnea because you have insulin

17:34

resistance and gain weight but if

17:37

you have disrupted sleep your

17:39

insulins are higher, your cortisol are

17:41

higher, your glucose is higher, you're

17:43

looking for highly processed quick energy

17:45

dense foods and less able to

17:47

resist them. Wow so not sleeping

17:49

is a risk factor for obesity.

17:52

Absolutely. And heart disease. Yes. And

17:54

cancer. And cancer. And dementia. And

17:56

flares of autoimmune conditions. Yeah. And

17:58

chronic pain and fibromyalgia. So

18:00

it and anxiety and depression. I mean it

18:02

really affects. Oh my god if I don't

18:04

sleep I'm depressed and anxious but the

18:06

more you worry about a daughter it gets to sleep Yeah,

18:09

it's true. So okay. So we have that

18:11

chronic stress What what else is what else

18:13

is driving this insomnia pandemic which is huge,

18:15

right? I mean 70 90 million people are

18:18

struggling with insomnia, right? So I

18:20

do think that there's a need to

18:22

address underlying contributors to anxiety and depression

18:24

independent of their impact on sleep So

18:27

talking about what's going on bringing in

18:29

some kind of breath-based practice whether that's

18:31

yoga or tai chi or meditation Just

18:34

to ratchet everything down. That's

18:37

another important component of it And

18:39

thirdly you've already touched on a little bit

18:41

about the dopamine with the phone But it's

18:44

also the dysregulation in our circadian rhythms,

18:46

you know We think about how I

18:48

there's been a lot of research about

18:50

how important it is to avoid light

18:52

exposure at night for example but

18:55

everything we do during the day and when we

18:57

do it is Ultimately going

18:59

to influence our ability to go to sleep when we want to and

19:01

get the rest that we want to So

19:03

in other words when we're eating all day

19:06

long and snacking late at night and watching TV at

19:08

night That's signaling our nurse. Yes

19:10

and on our computers. That's telling our bodies and

19:12

brain that it's a day. It's day. It's a

19:14

day So we want to

19:17

actually Reestablish

19:19

a consistent circadian rhythm Meal

19:22

timing so we're having eating earlier in the

19:24

day and then building in a fasting interval

19:26

before we go to bed So don't eat three hours

19:28

before bed. No interestingly enough

19:30

there's As you know,

19:32

there's a connection as well with digestive function

19:35

that eating late at night

19:37

not only disrupts your sleep But it's

19:39

contributing to higher reflex, but you can

19:41

also interrupt sleep. So Everything's

19:43

interconnected. I haven't been last night actually

19:45

because I went hiking and it's summer and

19:47

it's so beautiful and it's a slate light

19:49

So we were like didn't get down from

19:51

the mountain till 8 o'clock at night And

19:55

I'm like, oh, let's go eat. I'm hungry. But then by the time

19:57

we ate it was like 9 o'clock and I

19:59

like last night I toss and turn for a couple

20:01

hours before I went to bed which I usually don't do. I'm

20:03

like, oh, it was the, you know, so

20:05

there's the reason late night, there's the

20:09

circadian rhythm disruption. This morning I

20:11

went out and sat on my deck and the sunshine was

20:13

out so getting light in the morning is so important. Absolutely.

20:15

We don't do that we're all like on our phone, on

20:17

the computer right away. We need the natural light to reset

20:20

our brain. Because light is medicine.

20:22

It is. Light is medicine. It is. And also

20:24

it could be bad medicine if it's the wrong

20:26

light at the wrong time, right? Exactly. So we

20:28

have all this like, like there's this great book

20:30

called Lights Out that I read years ago, Cindy,

20:34

that was really talking about the advent of the

20:36

light bulb driving chronic disease because of

20:38

the disruption in our rhythms and so on.

20:40

It's interesting. They even looked at LED street

20:42

light disrupting the circadian rhythm of animals and

20:44

insects too. So it's not just humans that

20:46

are being impacted by this. And there's some

20:48

other weird stuff that affects sleep that we

20:50

don't think about. Like what

20:52

else? Well one of the

20:54

conditions is restless leg syndrome. And

20:57

that's it's hard to diagnose. It's more of what

20:59

we call a clinical diagnosis. People describe

21:01

this creepy crawly sensation

21:03

in their legs or this irresistible urge

21:05

to rub their feet together. And

21:08

typically it's treated

21:10

with dopamine medications. It's connected to relatively

21:12

low dopamine levels in the brain. You

21:14

know dopamine yes revs you up but

21:16

dopamine also seems to play a role

21:19

with movement. So it's treated with some

21:21

of the same medications they used to

21:23

treat Parkinson's disease. But

21:25

it turns out that that can be more

21:28

prevalent in people who have autoimmune conditions.

21:30

In which case we want to address

21:33

the underlying autoimmune conditions. There are some

21:35

nutrient deficiencies that are going to make

21:37

the symptom of restless legs more significant.

21:40

Low iron, low vitamin D, low

21:42

folic acid, low magnesium. So we

21:45

really want to look at somebody's

21:47

nutritional status. Yeah and by the way 80% of the

21:50

population is efficient vitamin D, 50% in

21:53

magnesium, you know like 20% iron.

21:55

I mean it's like a

21:57

lot of people are deficient to B vitamins. and

22:00

they don't even know it. And you go

22:02

to your doctor and you have insomnia, they're

22:04

not checking those things. And there's even weirder

22:06

things than nutritional stuff, right? So,

22:09

if we identify a nutrient deficiency, for

22:11

example, the next step is why? What's

22:14

the why that somebody's nutrients might be low

22:16

and there we come back like so many other

22:18

things to the function of the gut. And

22:20

interestingly enough, there is a

22:23

higher correlation in people who

22:25

have small intestinal bacterial overgrowth

22:27

also having restless leg syndrome. Maybe

22:30

because it's contributing to ongoing inflammation, maybe

22:32

because it's also contributing to difficulty absorbing

22:34

this nutrients from your food. So, we're

22:36

even going to go a step further

22:38

and say, is there an underlying issue

22:41

with digestive function absorption and assimilation of

22:43

nutrients that are very low? So, if

22:45

your gut's a mess, it can also

22:47

cause insomnia. Absolutely. And then

22:49

heavy metals or another big one that we

22:51

don't really hear about. Right. Lead,

22:53

mercury, things that are

22:56

under the radar for many, many people

22:58

and unfortunately can be a problem. Yeah.

23:00

And I had that.

23:03

We talked about it on the show, but

23:05

I've had mercury poisoning 30 years ago almost

23:08

and it really totally screwed up my

23:10

sleep. What happened with your sleep? I

23:12

just couldn't sleep. Like I just I

23:14

was just really couldn't fall asleep, couldn't

23:16

stay asleep, never felt rested, had chronic

23:18

fatigue syndrome until I got the mercury

23:20

out, got my feelings out, chelation,

23:22

everything. I couldn't sleep

23:25

and it really took a long time to reset that. Okay.

23:28

So, we've got all these different things

23:30

that traditional medicine ignoring, the hormonal fluctuations,

23:33

the gut issues, heavy metals, nutrient deficiencies.

23:35

I mean doctors know about sleep apnea,

23:37

but they often miss in thin women

23:40

because that's not the archetype of

23:42

someone who actually like to

23:44

pick Wicke and figure with, you know,

23:47

huge belly and a thick throat and size

23:49

17 neck. I mean, you know, so

23:52

there's all these issues and yet,

23:56

you know, this continues to be such a struggle for

23:58

so many people. And

24:01

the and the traditional treatments really are just stopgap.

24:03

They don't really address the cause So

24:05

in functional medicine the way we think about things is to

24:08

look at some of these other factors So so

24:10

you're in your practice any how do you how

24:12

do you start to dig down? What are the

24:14

kinds of diagnostic things you look at differently?

24:16

We talked about all these different factors But how do you

24:19

identify what's the problem and this or that particular person? Well,

24:22

I think it's the time to take a

24:24

history and really understand all of the other Interconnectedness

24:27

that could be going on for example

24:29

somebody with sleep Concerns might also have

24:31

digestive concerns and then we might be

24:33

thinking about assessing their digestive function Looking

24:36

at a nutritional assessment But

24:39

I think there's a time and a

24:41

place and there's tremendous value in screening

24:43

somebody with a portable sleep

24:45

study because that gives you A tremendous amount

24:48

of information and we're using it. Yes to

24:50

diagnose sleep apnea, but also to say how

24:52

often do you wake up during the night?

24:55

How much percentage of time are you spending

24:57

in REM sleep and deep sleep? Are you

24:59

tossing and turning all night long so it

25:01

can give us a tremendous? overview

25:03

in terms of somebody's sleep throughout the

25:05

night and from that we can also

25:09

Decide. Okay. What else do we need to

25:11

explore? And then

25:13

we do some testing right? You can look at you

25:15

can look at nutritional levels You can look at these

25:17

vitamin D and magnesium and folate and and

25:19

iron studies And you can look at obviously the

25:21

sleep apnea test and there's home test now you

25:23

can do it really great We

25:26

look at heavy metals, right? And the

25:28

hormones you can really get a sense of right

25:30

hormones for people if their estrogen Progesterone's all out

25:32

of balance and just happened in menopause. You see

25:34

a lot of sleep issues Heavy

25:38

metals like I said we can test so that there's

25:40

there's a lot of ways we can diagnose using functional

25:42

medicine testing That you don't really get with

25:44

traditional doctors that can help get underneath things

25:48

so Tell me about

25:50

this this patient you had because you know

25:52

it sort of speaks to a lot of the issues that

25:54

we're talking about And it gives you

25:57

a little unusual approach to insomnia something you wouldn't

25:59

really get from a traditional doctor.

26:01

Right, so this is somebody that, and one of

26:03

the things I want to plant the seed for

26:05

is sometimes we start with what we think is

26:08

the most likely issue, and we gradually uncover

26:10

more potential contributing issues and peel the

26:12

layers of the onion. And

26:14

this was a woman that I had known

26:16

for years. She was pretty healthy in terms

26:19

of her lifestyle. She exercised, she wasn't overweight,

26:21

she ate a healthy diet, she

26:23

didn't drink any alcohol, she was

26:26

treated with antidepressants, she was on

26:28

a serotonin reuptake inhibitor, and well-butened for

26:30

her depression. And

26:32

she started, she was also on hormone replacement therapy.

26:34

She was post-menopausal in her 60s. And

26:37

she started complaining of fatigue and

26:39

difficulty concentrating, and just felt scattered.

26:42

And by Sundays, she would have the need to

26:44

take a three-hour nap. So, well,

26:46

that's unusual. So we did

26:48

some of the usual testing for causes of

26:50

fatigue. We tested her thyroid, it was okay.

26:52

We looked at her iron levels

26:54

or sugar levels, they were okay. So I

26:56

decided to do, screen her with a sleep study. And

27:00

it turned out, you would not have looked at her

27:02

and said, oh yes, she is the poster child for

27:04

sleep apnea. She

27:06

turned out to have one of the

27:08

most striking positional components to sleep apnea

27:10

I've ever seen. When she was

27:12

on her side, her sleep was normal, but when

27:14

she was on her back, she

27:17

had respiratory events that count as

27:19

either a slowing of airflow or a stopping of

27:21

airflow more than 60 times an

27:23

hour. Wow, when she stopped breathing 60

27:25

times an hour. Yes. It was like once a

27:27

minute. That's a lot, no wonder

27:29

she was exhausted, right? So

27:32

when you see a positional component like

27:34

that, I have people who

27:36

don't wanna do a sleep study because they

27:38

don't wanna, I'd never wear that stupid mask.

27:41

But for her, we said, okay, well, let's start with

27:44

retraining you to learn to sleep on

27:46

your side. And she tried

27:48

that. There's some commercially available positional devices. There

27:51

are all kinds of strategies you can do.

27:53

There's a very sophisticated technology, it's called the

27:55

tennis ball strategy, where you sew

27:57

a tennis ball into a T-shirt. the

28:00

back so if you roll over on your back and

28:02

makes you flip over to your side or the fanny

28:04

pack with the pillow stuff Yeah, there's all kinds of

28:07

strategies you could do and of course it's big business

28:09

right you can buy a slumber bump or a bumper

28:11

belt Oh, I didn't know they had this guy was

28:13

still in the tennis ball track even

28:16

more sophisticated. There's now a biofeedback Device

28:18

that's a strap around that vibrates when you

28:21

roll on your back So it's sort of

28:23

a lot of genic nighttime training to you

28:26

So that's what she used interestingly enough and it

28:28

helped a little but she was still tired So

28:31

as we're peeling the layers of the onion she had

28:33

some digestive Symptoms a

28:35

lot of bloating a lot of discomfort and

28:38

she had we had done a full sleep study

28:40

She had restless legs and periodic

28:42

limb movements. Mm-hmm She turned out to

28:44

have a very abnormal breath test for

28:47

small intestinal bacterial overgrown It's bugs growing in your

28:49

small intestine where they really where they don't belong,

28:52

right? Right which can cause

28:54

inflammation Absolutely and low iron

28:56

her iron was it terribly low but

28:59

one of the sidebars here I think the

29:01

other thing we do in functional and integrative

29:03

medicine is understand the difference between a normal

29:06

blood test I should put food normal

29:08

blood test and an optimal blood test.

29:10

Yeah, ferritin is a classic example of

29:12

that Ferritin looks at your

29:14

total tissue iron and I think

29:16

much iron is in your iron bank in your body

29:19

your iron stores right and normal can be

29:21

anywhere from 15 to 250.

29:24

Yeah So

29:27

big range it's a big range and what

29:29

we know the threshold is for somebody who's

29:31

got restless leg symptoms Is you

29:33

actually don't want to be normal you want to be over

29:35

a hundred? Because there's some evidence even

29:38

comparing it head to head with those dopamine drugs.

29:40

We mentioned earlier Getting

29:42

somebody's ferritin over a hundred was

29:45

as effective as the dopamine medications. That's

29:47

amazing. That's amazing Right as simple as

29:49

correcting a nutrient deficiency not to the

29:51

normal range, but the optimal range for

29:54

that condition Yeah, I was just

29:56

saying is you know if you know heme iron is the

29:58

best absorb kind of iron, but that usually comes from

30:00

meat. Right. And people are

30:02

vegan, the plant forms of iron are as well

30:04

absorbed. Right. And you often see very significant iron

30:06

deficiency in these patients, especially women who are menstruating.

30:09

And I think that, you know, I learned

30:13

actually in traditional medicine that ferritin was connected to

30:15

sleep. Interesting. I learned that

30:17

in a lecture on insomnia that

30:19

I went to by some drug company. Well, that's great.

30:22

I was like, well, that's interesting. But

30:25

yeah, I think it's something that's often overlooked and it's

30:27

an easy blood test to check your ferritin, which most

30:29

doctors won't look at. And

30:31

Mark, I think from the internal medicine

30:33

standpoint too, it's equally important to say don't

30:35

just correct the iron and figure out the

30:37

why. Right. You don't want

30:39

to miss blood loss. Yeah, she got colon cancer. Absolutely. Her

30:42

stomach ulcers, she's just menstruating heavily. She's got bladder

30:44

cancer or just like something, right? Right.

30:47

So I think that's really important. You're right. Just

30:50

don't look at the symptom, look at the cost. Right. Because

30:52

low iron is a symptom. Right. It's

30:54

not a cost. Right. A low iron

30:56

may cause insomnia, but what causes low iron? So that's what functional medicine does.

30:58

It keeps going upstream. And you said something a couple

31:00

of times that I just want to come back to, which is peeling

31:03

the onion. So one

31:05

of the principles of functional medicine from

31:07

our mentor, Sid Baker, who

31:09

is this cool

31:11

old guy, Yale professor,

31:14

erudite, super smart, one of the

31:16

most thoughtful men in medicine, people

31:18

in medicine period. And

31:21

he said, you know, we have attack rules

31:23

that help us determine how to figure things

31:25

out. So if you're standing on attack, it takes

31:27

a lot of aspirin to make you feel better, right? Take

31:30

out the attack. So if, you know,

31:32

the bacterial overgrowth is causing the restless

31:34

leg syndrome, you can take a lot

31:36

of these traditional medications, but you can

31:38

take a lot of medication and make

31:41

it go away. Or if you fix the bacterial overgrowth

31:43

and the, you know, that'll help. But

31:45

then also if you're standing on two tacks, taking

31:47

one of them out doesn't make you 50% better.

31:51

So she had bacterial overgrowth and she had iron

31:54

and she had the positional thing. So it's

31:56

like usually three or four or five things.

32:00

medicine as we are so focused on the one thing,

32:02

you know. You know, there

32:04

was one other piece related to her story

32:06

that I think is also important to call out.

32:09

Addressing all of those things for sleep quality was

32:11

still not what she wanted to be. So

32:14

we had a conversation and she relayed the

32:16

fact that when she was growing up, things

32:19

were pretty unsettled in her home of origin.

32:21

There were a lot of late night parties,

32:23

a lot of noise and bedtime became a

32:26

time where she didn't really feel safe

32:28

and quiet and comfortable. So

32:30

we also talked about referring her to

32:32

a life management behavioral therapist to really

32:35

talk about what it meant to be

32:37

safe and regaining that sense of being

32:39

okay, being in bed. And I think

32:41

that goes hidden as well that a previous

32:44

history of trauma or not feeling safe

32:47

can also show up with insomnia and

32:49

difficulty sleeping. Yeah, and

32:51

I think that's a big thing for a lot of people. There's

32:54

a questionnaire you can do online called the

32:56

ACE questionnaires, Adverse Childhood Events and

32:59

you get a score and if you have a

33:01

high score, it means you've had

33:03

a crappy childhood and you probably have some

33:05

level of trauma and different people respond differently

33:07

to the trauma. Of course. But

33:10

you know, PTSD is so prevalent and our

33:12

nervous systems are so jacked up in general.

33:15

So it's sort of like acute on chronic. Absolutely.

33:18

You know, we've got our acute stresses on this

33:20

chronic level of PTSD and

33:22

it leads to so many physical, psychological,

33:25

emotional stresses for people and

33:27

there's a lot of ways to sort of

33:30

access that. You know, I mean, you

33:32

shared about how you use cognitive behavioral therapy

33:34

or yoga or meditation or breath work or

33:37

you know, emotional freedom techniques. There's

33:39

all kinds of techniques out there but

33:42

now people are exploring you know, psychedelic

33:44

assisted therapy, MDMA, psilocybin therapy. It's legal

33:46

in Oregon now and there's

33:48

some interesting research going on. Charles Hopkins and NYU

33:50

and others are really looking at how do we

33:53

help people with some of these chronic long term

33:55

traumatic events and experiences. And

33:59

I think you know, So listening to you, it's just

34:01

so interesting to hear that in

34:03

dealing with something as simple as

34:05

insomnia can be quite complicated. You have

34:07

to look at inflammation in the body. It's

34:09

like where is it coming from? Is it

34:11

the gut? Is it heavy metals? Is it

34:13

hormonal changes? Is it nutrient deficiencies? Maybe

34:16

it's food sensitivities or allergies. Maybe it's

34:18

a little thyroid. There's things that we

34:20

just don't often think about. And

34:23

so with so satisfying with functional medicine is we're able to

34:25

actually dig into these things and look and

34:27

see the why. You

34:29

know, we say functional medicine is the medicine

34:31

of why, not what, not what disease you have,

34:34

which is helpful but it's not the end of

34:36

the story. We go, well why do

34:38

you have that disease? Like you know and that's the

34:40

challenge with traditional medicine. It's like you make the diagnosis

34:42

and you stop thinking. Okay you've

34:44

got depression. Here's the antidepressant. You've got insomnia, you take

34:46

the C pill. Oh you've got rheumatoid arthritis, take the

34:48

rheumatoid arthritis pill. Like not why do you have insomnia

34:51

or depression or rheumatoid arthritis or

34:53

migraines but like why and that's

34:56

what's so powerful. So there's

34:59

some basic sleep practices that are really good. We've

35:01

covered some of this but I think it'd be

35:03

good to go over it and I think you

35:05

know and

35:08

I think it's important to emphasize that everything

35:10

matters. Sleep, exercise,

35:12

stress, no

35:15

obviously your diet, your

35:17

usual nutrient status and

35:19

that's what we do in functional medicine so we dig

35:22

down into it. So talk about some of the

35:25

other factors around sleep hygiene that we sort of haven't

35:27

touched on in terms of

35:29

diet and lifestyle and food and

35:31

exercise. Sure. I think

35:33

first and foremost we have to recognize that sleep,

35:35

you know you and I trained in an era

35:37

where sleep deprivation or how little sleep you kick

35:39

a buy on was a badge of honor. Yeah.

35:42

We need to shift that internal dialogue that we

35:45

all have that oh if I'm not, if I'm

35:47

sleeping I'm wasting my time and I'm not getting

35:49

my stuff done. So first honor the importance of

35:51

sleep for your overall health and well-being and

35:54

even your ability to stick to your

35:56

intentions around choosing healthy foods and sticking

35:58

to your exercise plan. Then

36:01

create a sanctuary that's really conducive

36:03

for rest and relaxation. Dark,

36:05

quiet, cool, ideally electronics out

36:07

of the bedroom or

36:09

turned off if you can. Getting

36:12

rid of all of the light exposures, even your chargers,

36:14

you know, that have that light. Yeah,

36:17

like those like lights, like those red green

36:19

lights on different devices. I'm like, that drives

36:21

me crazy. I used to, I

36:23

had a patient who told me she traveled around with

36:25

black electrical tape whenever she went to Hotel and she

36:27

would put it over all the little light sources of

36:29

the light. I traveled with eye shades because

36:31

you never know where you're going to

36:34

be. So those two, quiet, calming

36:36

and I think this idea that you go,

36:38

go, go, go, go, go, hop a bit and turn

36:40

it off like a switch, that doesn't work either. So

36:42

building in a transition to rest and

36:45

relaxation. If you can do an

36:47

hour, that's great and getting off

36:49

the devices, not watching TV, maybe reading

36:51

a book or journaling or doing something,

36:53

taking a bath, stretching in the tub.

36:55

I mean, there's all kinds of wonderful

36:58

ways to ease into rest and relaxation.

37:00

I like the hot Epsom salt bath

37:02

and lavender drops because the lavender lowers

37:04

your cortisol, the magnesium relaxes you and

37:06

the sulfur and the Epsom salt helps

37:08

you detox. That's my

37:11

favorite as well. And then you go to your cool bedroom

37:13

and you do your legs up the wall,

37:15

yoga, restorative yoga position and bingo,

37:17

you've got your transition to rest

37:19

and relaxation. So powerful and

37:21

alcohol obviously is a good thing for people. Yeah,

37:24

that's a tough one. That's a tough one. So

37:27

the rough analogy is this, it's

37:30

funny when they asked

37:32

partners of people with insomnia, how

37:34

many of them were suggesting that they have a

37:37

drink to go to sleep? It was about a

37:39

third of them. So people think alcohol is going

37:41

to help you sleep and it might

37:43

make you fall asleep. But then as it clears out of

37:45

your system, there's an arousal, it can exacerbate

37:47

hypoglycemia, it makes you wake up, it's going

37:49

to make sleep apnea worse. If you're a

37:52

woman in midlife, oh boy, it's a bladder

37:54

irritant, it's a hot flash trigger. So it's

37:56

really affecting sleep in a lot of ways.

37:59

The rough equivalent is there's about an hour of

38:01

sedation followed by an hour of arousal. Yeah. So

38:04

if you had a glass of wine at 6 and you go to

38:06

bed at 10, it's probably not going to

38:08

impact your sleep as much as if you had two

38:10

glasses at 8 or like your late dinner last night

38:12

if you had a glass or two of wine. I had a beer.

38:15

Yeah. It has another impact

38:17

on your sleep. I just noticed it actually. I

38:19

had an aura ring for a while. I was

38:22

tracking my sleep and I noticed whenever I drank,

38:24

my sleep pattern was so

38:26

disrupted. Quality of sleep, the depth of sleep,

38:28

the amount of REM sleep, deep sleep, snoring,

38:32

you know, all that. It's really interesting. And

38:34

then caffeine also is another big one, right?

38:36

Yeah, absolutely. And we're all

38:39

different in terms of our caffeine

38:41

metabolism ability. Some people are

38:43

really fast metabolizers. I'm sorry,

38:45

fast metabolizers. I happen to be one of those. But

38:48

if you're a slow metabolizer, half

38:51

of your cup of coffee from noon could still

38:53

be in your system at 9 o'clock at night. And most

38:55

of the time, we're not thinking back to that new cup

38:57

of coffee. With

39:00

food, it's really about quality, quantity,

39:02

and timing of food. It's all

39:04

three. Yet

39:06

another area that's impacted with the

39:09

health of the gut microbiome is sleep.

39:12

And data is suggesting that people who eat a

39:15

wide variety of colorful fruits and vegetables

39:17

tend to have better sleep quality,

39:19

whereas a highly processed standard

39:22

American diet is associated with more

39:24

sleep disruptions and less deep sleep.

39:26

So quality matters. We

39:28

already touched a little bit on the timing

39:31

of eating. So eating your calories earlier

39:33

in the day also

39:35

helps to reregulate those circadian rhythms.

39:37

So the clocks

39:39

in the brain and the clocks in the

39:42

body that are ideally going to be working

39:44

in sync with each other, they're influenced by

39:46

light, by movement, and by food. So when

39:48

we line all those things up during the

39:50

day, it's going to help us get the rest that we need

39:53

at night. I think this is such good information.

39:56

Stress itself is not bad for us. It can be good

39:58

for us. And so just Just dividing

40:01

things up in our mind to think

40:05

about, is this an event? Is

40:09

this an episode that I can recover from?

40:11

Or is this a situation in my life

40:13

that I'm going to live with forever and

40:15

I have to get used to? So

40:17

these chronic stressors like having

40:22

a child with a chronic

40:24

condition, having a conflictual relationship,

40:26

dog stress, these are

40:28

the types of addiction, loved ones

40:30

with addiction, health problems. I

40:33

mean, years and years and years go on where we

40:35

need to be coping with it in a different

40:37

way because it's not about getting

40:40

rid of the situation. The acute stressors are

40:42

really pointing us to

40:44

just thinking about the stress response

40:47

in the moment in dealing with

40:49

an episode within a day. What does

40:51

that stress response look like? As

40:54

you were saying, when

40:56

we think about the

40:59

peak stress response and the recovery and how

41:02

our body does that, it's

41:04

like a phenomenally

41:06

beautiful biological

41:08

process that we are fully

41:10

equipped with to have over

41:13

and over without harm, without

41:15

harm. In fact, when

41:17

we shape those stressors to our

41:19

body to be short-term,

41:22

brief, and

41:24

not moderate, not

41:27

too extreme, they're not only not

41:29

harmful, they're creating all sorts of

41:31

restorative and anti-aging effects in the cell.

41:34

You write about that so well in your book. We

41:37

so easily forget, like, we could use this for

41:39

good. We can actually do things like HIIT or

41:42

SANA or cold

41:45

exposure. The

41:48

conditioning, our nervous system, not just our

41:50

cardiovascular system, but our actual emotional

41:53

and physiological stress response can get

41:55

conditioned. Yeah. There's a lot of

41:57

doorways in, is what you're saying. There's a lot

41:59

of doorways in. to kind of reset the nervous

42:02

system, right? It doesn't have to do with your

42:04

mind. You can use physical states actually of hot

42:06

or cold or different light or

42:08

all kinds of stuff. So, yeah, we're

42:11

not right. Right now we're in

42:13

this incredibly uncertain time for

42:16

many of us, financial uncertainty, political

42:18

uncertainty, climate

42:20

uncertainty. And I think

42:23

it's kind of a a

42:26

stimulator of exaggerated stress. So can you

42:28

talk about how we can learn how

42:30

to adapt maybe to better or understand

42:32

how to think differently about uncertainty and

42:34

the whole idea of uncertainty tolerance? Because

42:36

that's kind of something we really don't

42:38

talk about much, but I think it's

42:40

an important framework for understanding how we

42:42

navigate our reality and not just get

42:44

buffered about by all the stresses that

42:46

are happening all the time. I

42:49

think it's important to start where you did,

42:51

which is naming. We're in a different era.

42:53

We're in a different place. We have our

42:56

personal dramas. We're trying to manage the

43:00

inherent stress of life and being a

43:02

human in this modern world. And then

43:05

on top of that, we do

43:07

have this layer of more existential

43:09

stressors, of global stressors, climate change,

43:12

war, famine, drought, the

43:14

climate events that are going to become

43:16

more and more frequent. And

43:18

so how does our human mind deal with

43:20

all of that at once? We're

43:24

not quite well equipped, but we're

43:26

not that far off from being able

43:28

to kind of adopt a

43:30

new mindset for this new era

43:32

and strategies. And uncertainty tolerance is

43:35

core to how

43:37

we can remind ourselves to

43:40

not let this primate

43:43

body overreact, create

43:45

accelerated aging, make our life miserable,

43:48

given that we are just surrounded

43:51

by uncertainty of the future.

43:54

Volatile uncertainty, meaning not just the inherent uncertainty that

43:56

we don't know what's going to happen tomorrow, but

43:59

just the reality. that we're going to

44:01

see based on climate and

44:03

politics and how

44:05

we create societies as humans. So

44:09

the ability

44:12

to simply

44:15

be comfortable with not knowing is

44:18

now a core survival skill. And

44:21

we're all different. We've come with different

44:23

levels of what we call tolerance or

44:26

comfort with uncertainty. And

44:28

those of us who are on the edge

44:30

of it, really actually

44:32

being intolerant and feeling really

44:35

anxious about when we can't, we

44:37

don't know exactly our plans tomorrow, how

44:40

things will go. That

44:42

is a tremendous vulnerability factor for anxiety

44:44

and depression. We've always known that. We

44:48

measured that. And

44:50

during COVID, we followed 500 people. And

44:52

the people who were

44:54

most rigid about

44:56

uncertainty and tensed up and

44:59

couldn't feel ease and relaxation with uncertain

45:02

situations, they had much more

45:04

trauma from COVID, fear of

45:06

COVID, climate distress.

45:10

What makes someone more like uncertain, another

45:12

person being able to tolerate uncertainty and other

45:14

people not be able to tolerate uncertainty? Have

45:16

you found that out? It's

45:19

a really good question. We

45:21

all come with a different level. And

45:23

what creates that level? Part

45:28

of it is personality and

45:30

openness to new experience. Part

45:33

of it is really our

45:36

life experience shaping us. And

45:38

so when we've had a lot of early trauma, we

45:41

tend to actually have more

45:44

of a threat response to things

45:46

that happen and to things that

45:48

haven't happened. So that vigilance about

45:50

ruminating about the past, but

45:53

also worrying about the future, feeling that more

45:55

is at stake, feeling more threatened. So

45:58

there are lots of ways to... overcome that in

46:01

your diagram of stress, I love in

46:03

your new book coming out in February,

46:05

I love your triangle of understanding all

46:08

the influences on us and our aging

46:10

biology. And you had one

46:12

layer of stress that people don't usually

46:14

think of, which is we're

46:16

born into this world wired

46:18

differently because of intergenerational trauma,

46:20

that shaping our epigenetics as well

46:23

as our experience in the womb for

46:25

nine months, the level of maternal stress

46:27

that we've been exposed to. It's

46:30

interesting, I actually haven't really talked about

46:32

this on the podcast too much at all

46:34

and it was sort of recently I had the chance to really dig

46:37

into some deep work on

46:39

myself and somatic work and other work

46:41

and kind of just I've

46:43

also been reading my mother's book about

46:45

her life with my father in post-war

46:48

Europe, it was sort of a fictionalized account

46:50

of their life. I

46:53

was sort of born into a very uncertain

46:56

place, my father didn't

46:59

really want kids and my mother

47:01

had multiple abortions, he wasn't

47:03

really around when I was born, my

47:05

mother was very stressed and depressed and

47:08

there was a sort of state of lack of safety

47:11

and I remember that even growing up in my early

47:13

childhood, sort of the dynamics of a marriage

47:15

that was falling apart and being a

47:17

little kid watching all that and my

47:20

mother being very sick afterwards just not

47:22

being able to eat and losing weight

47:24

and being super depressed and in bed

47:26

for months and they were going to

47:28

put us in foster care and so there

47:30

was this whole drama that I kind of

47:32

had just sort of like pushed back and

47:34

realized that it definitely set

47:36

me up to sort of have a

47:38

more sympathetic activation in my nervous system

47:40

for most of my life even though

47:43

I mentally I think I

47:45

was able to sort of manage it

47:47

physiologically and registered and I

47:49

think that's something I've really been paying

47:51

attention to and I began to sort

47:54

of shift into more parasympathetic states which

47:56

we'll get into and talk about that. sort

48:00

of this resetting of my nervous system and

48:02

my biology to actually heal and

48:05

then be happy and enjoy life and do

48:07

the things that are really important. So these

48:09

traumas are real and they go

48:11

back generations. I think in my own life and I

48:13

don't know why I'm talking about it now but it

48:15

just kind of made me think about it. It's

48:19

absolutely real. Like I just want to

48:21

say we actually, I mean Rachel, Yajuda's

48:23

work and others have actually shown our

48:25

stress response system, you know, even three

48:28

generations out from being, from a

48:31

Holocaust survivor as a parent or as a

48:34

grandparent, we are different. Yeah.

48:36

I mean my great, my grandparents were deaf

48:38

on my mother's side so they had that

48:40

stress and her stress of being a childhood

48:43

to be the parent for them. My

48:45

dad on his side, his mother was,

48:47

you know, one of 13 children and

48:49

accidentally pushed her sister off the swing

48:51

and she died at two years

48:54

old. So she was the black sheep of

48:56

the family and was chronically neurotic and stressed

48:58

out and anxious. I remember my

49:00

grandmother, you know, all these things, you know,

49:02

you don't think about but, and

49:05

of course many people have far worse traumas

49:07

than that and, you know, abuse and even

49:09

worse but I think it does register in

49:11

our nervous system and unless we are conscious

49:13

about how to heal that, it

49:16

kind of informs our thinking, our life, our way of

49:18

looking at things and ultimately

49:20

our illnesses. You know, I remember going

49:23

to Herbert Benson's course like in the

49:25

90s on the mind, body, medicine from

49:27

Harvard and he said, you know, stress

49:30

basically either is responsible for causing or

49:32

exacerbating 95% of all

49:34

illnesses, which is like, what? Like

49:36

and it's something in medical school we don't really learn

49:38

about. How do we manage it? How do we think

49:40

about it? How did it work? What did it do?

49:43

Right? And we now know the pathways

49:45

and yet we still don't take it seriously

49:47

and that's why it's called the stress prescription

49:50

because we're not going to get rid of

49:52

stress but there is a way to live

49:54

with it better that is absolutely medically relevant.

49:57

It's a prognostic factor for

49:59

getting men and physical illnesses,

50:01

and all of the data, including

50:04

a recent APA survey, show we

50:06

are more stressed now

50:08

than in previous years and decades, but

50:10

even worse, I think of our youth,

50:12

like 70% are, you know, reporting

50:16

stress that they, such

50:18

extreme stress, they don't know how to manage it,

50:20

it's interfering with their life. These are really serious

50:22

red flags. We know what that means biologically. It's

50:25

a leading indicator to the

50:28

wear and tear on our cells, on

50:31

our brain, the conditions we're always trying to

50:33

avoid. So it's

50:35

a serious prescription that we can, we

50:37

don't have to live each day with

50:39

a successive level of stress, which

50:42

really rules out those states that you've

50:44

been cultivating, which is the restorative states.

50:47

And it's a beautiful example you gave, how you

50:49

are consciously changing them, because it's not our

50:51

fault. There's no judgment. We all come out

50:54

with different levels. That question about why

50:56

do some people expect negative

51:00

things to happen, they can't stand ambiguity, that

51:03

uncertainty feels intolerable, that's

51:06

part of it. That's like partly from how

51:09

our stress response systems are shaped from all

51:11

these different influences before our

51:13

life, including our life starting in the womb.

51:16

And it can change. That's the beautiful thing, is

51:18

that we can rewire our nervous systems. And I

51:21

think the difference between chronic

51:23

stress and acute stress is nothing we

51:25

mostly think about. But one of my

51:28

favorite scientists is Robert Sapolsky, who wrote

51:30

a book, Why Zebras Don't Get Ulcers,

51:32

which is essentially the

51:34

idea that zebras are out there

51:37

eating their grass, and

51:39

then the line comes and chases them. They all

51:41

run like crazy, super stressed. And then the line

51:43

catches on the zebra, and then is eating it

51:45

right next to all the other zebra. And they

51:47

just go back to eating their grass. They

51:49

have a cute, massive stress, and then it

51:51

goes away. I want to talk

51:53

about how you kind

51:56

of frame stress in your

51:58

book around our mind. mind

52:00

states. And then

52:02

how our mind can create physiological

52:04

stress or conversely can actually restore

52:06

us to health. And

52:09

you sort of mapped out these

52:11

different spectrums of mind states that kind of

52:13

help us think about how

52:16

to understand stress, how to navigate it, how to

52:18

think about discharging

52:20

it. You know, I say stress reduction

52:23

or stress management is not a passive

52:25

process, it's an active process. And

52:28

it's like you have to exercise going to, you know,

52:30

build your muscles, you kind of have

52:32

to practice these techniques in order to

52:34

reset your nervous system from this chronic

52:36

unremitting stress, which is so pernicious

52:39

and driving so many of

52:41

our diseases. Yes. You

52:44

want to hear about these mind states. I want

52:46

to hear about this spectrum of these mind states

52:48

that you talked about. Yeah, we've

52:50

been thinking

52:52

about stress from

52:54

a different perspective, we and others in the field.

52:56

So usually we think about how stressed does

52:59

someone get in the moment? How quickly do

53:01

they recover? And that's important. We want a

53:03

quick peak and a quick recovery. And

53:06

that's the healthy, resilient stress response.

53:10

But it's not just the action during

53:12

stress during events during tough times. The

53:15

question really becomes, what

53:18

are you carrying in your body

53:20

and mind when nothing is happening,

53:22

when you are at rest,

53:25

or at least you think you are. And

53:27

that's a window into the unconscious

53:29

level of stress that we're carrying. So

53:31

when we talk about uncertainty stress, that's

53:34

where it is. That's because it's a

53:36

bit vague. And we can

53:38

catch that mindfulness, mindful check ins help

53:41

us just in this moment, like just

53:43

ask, are

53:45

you tensing up? Do

53:47

a check in with your body, your hands,

53:49

your face, your eyebrows. So

53:51

often we are tensing up. And

53:53

we sometimes can identify why.

53:56

And sometimes we can just remember, oh, right

53:58

now, It's. Not

54:01

only okay to relax. It's

54:03

important for my body. I'm not needing

54:05

to cope with something so it's sad

54:07

face find, state or rest state that.

54:10

We're. Learning is really different and

54:12

people and is a sign of

54:14

chronic low grade chronic stress that

54:16

we can actually get to release

54:18

through different technique. So read mind

54:21

is what What we've been discussing

54:23

about coping in the moment when

54:25

you're fired up. And you

54:27

need to energy. In a the stress

54:29

response and we just don't want that,

54:32

it kind of go on and on

54:34

and have sluggish recovery, but otherwise we

54:36

need that. It's beautiful. It's It's why

54:38

we're here today. That's our survival response.

54:41

Than. And of course, we're

54:44

triggering a too much as you

54:46

know, humans with an overdeveloped cortex.

54:48

and it. Said. I'm to

54:50

me more chronic and biggest threat

54:53

we feel. So then there's yellow

54:55

mind state which is when we

54:57

think we are. Relaxed.

54:59

It's just a how are you walking

55:01

around during the day? Typical

55:04

day. Where. You at what's

55:06

your baseline. New probably

55:08

might do some monitoring. You know what year

55:10

are? no. Mixers. Your

55:13

autonomic nervous. System is set

55:15

at. And. That

55:17

is. Probably higher than we

55:20

need to be and so that's

55:22

what we think of as a

55:24

our default baseline is actually. Carrying.

55:27

Around a lot of. Both. Cognitive

55:29

load from. Our. Thoughts from

55:31

different information screens demand so were

55:33

a bit activated. And then there's

55:36

also the unconscious stress that we

55:38

can become aware as and release.

55:40

So we want to bring down

55:42

that yellow mind state to at

55:45

a more true resting state. And

55:48

that's the green light you. Know

55:50

how do you? How do people start to think about.

55:53

Some. identifying if they're stressed because

55:55

i think for me i couldn't the

55:57

and and rubio was but I

56:00

think I sort of like being able to

56:02

sort of map out things that looking at

56:04

my orang for example, my heart variability or

56:06

what's happening. I was in Mexico City for

56:08

a week and my heart variability went down.

56:10

I went to the jungle in Costa Rica

56:13

and it went way up like five people.

56:15

Yeah. So our body sort of register all the inputs

56:17

even if we don't think they are. Yeah.

56:21

I've learned a lot from monitoring and I

56:23

think that's one way to raise awareness as

56:25

well as asking ourselves

56:28

to become mindful of our emotions

56:30

and our bodily where

56:32

we're holding stress in the body, where we're tense. The

56:36

heart rate tells us a lot of things,

56:40

but the heart rate variability we think

56:42

is more specific to that

56:45

balance between parasympathetic and sympathetic,

56:47

so more related

56:50

to psychological stress,

56:52

not just metabolic

56:55

demands. So that's

56:57

super interesting. So Costa Rica

57:01

leads you to a different yellow,

57:03

maybe green mind state, better baseline.

57:06

I monitored my, with

57:08

my orang, I monitored my heart

57:10

rate variability during a meditation retreat and

57:12

we know that when people flow their breathing

57:14

immediately they have, they can have a decrease

57:17

in all the sympathetic

57:21

activity markers and sometimes

57:23

in heart rate variability during study.

57:25

So it's no mystery that doing these practices

57:27

and doing them for longer can

57:29

lead to these improvements and that those

57:32

are what we call deep rest states

57:34

when we're really allowing ourselves to feel

57:36

safe and to let down and let

57:39

ourselves go into restorative mode. But

57:42

I was surprised at how long my

57:44

heart rate variability, my baseline heart rate

57:46

variability took to change. So

57:49

it was only two weeks later toward

57:51

the end of the retreat that my

57:53

sleeping heart rate variability really improved and

57:55

I think that's... So two weeks

57:58

of meditation, like hours and hours every day. day.

58:00

Yeah. So for me,

58:03

it wasn't easy to change my baseline, particularly

58:05

my sleeping baseline, but it was possible and

58:07

it was super excited

58:09

that it finally changed. Yeah,

58:12

I had, you know, rarely get over 40

58:15

and then I think

58:17

the other night when I was in the jungle,

58:19

I was in this deep sympathetic person that stayed

58:22

and doing a lot of systematic bodywork and it

58:24

went to like in the

58:26

90s. I was like, holy

58:28

crap. Like we don't have

58:30

a framework for understanding how

58:33

these things are so impactful for

58:35

us. So, you know, I realized how

58:37

much I need to pay attention to

58:39

the practices that I need to do

58:42

to actually reset my

58:44

nervous system regularly. So

58:46

in the book, you talk a lot about

58:48

some of these practices and that's what this

58:50

just prescription is. So I love you

58:52

to sort of talk about how do we sort of create

58:54

a lifestyle and a way of thinking about our day and

58:57

a way of thinking about the beginning and the end of

58:59

our day and other types of tools

59:01

or techniques or doorways. Other

59:03

than meditation, obviously is powerful, but there's

59:05

more than that. I'll sort of explore

59:07

that. Yeah.

59:12

We have these red-mind states that

59:14

we don't want on all

59:16

day. Drains are batteries, dresses are

59:19

mitochondria. We have data on daily

59:22

mood and mitochondria showing

59:24

it is really sensitive to

59:27

daily affect. This was a study

59:31

with Martin Picard of Columbia and we

59:33

were measuring the enzymatic activity. And so

59:36

when people woke up with

59:38

more positive emotion and went to bed

59:40

with more positive emotion, they had higher

59:42

mitochondria, which we measure

59:44

kind of in the middle of the week of monitoring. And

59:47

when they, you know,

59:49

particularly at night, so there's this idea

59:51

of how we are recovering from the

59:53

day, can we maintain positive affect at

59:56

the end of a stressful long day. We

1:00:01

certainly found the chronically stressed participants,

1:00:03

these were caregivers, had lower mitochondria

1:00:05

overall, but this mood effect pretty

1:00:08

much mediated that and overrode that.

1:00:10

So that's this pointing us to,

1:00:13

hmm, we actually know how to increase

1:00:15

positive affect in the mode, you know, quite quickly

1:00:17

with gratitude, exercise, and other ways of

1:00:21

thinking and being. And so how

1:00:24

amazing to think that our mitochondrial activity might

1:00:26

be under our control in this way. Wow,

1:00:30

so what are the ways that actually you can affect

1:00:32

your mitochondrial activity then? Yeah, well to

1:00:34

get back to your question about the, how do

1:00:36

we live a day without chronic stress? So we

1:00:38

might think of red mind as like having,

1:00:41

you know, drinking coffee all day

1:00:43

and just keeping us in that

1:00:45

activated mode. And we want

1:00:47

that stress response, but we just want to,

1:00:49

you know, use it

1:00:51

parsimoniously, not take it for granted. When

1:00:53

we ignore it, it can just

1:00:55

be on all day, and rush, rush, rush. I

1:00:58

mean rushing and packing our days, probably the most

1:01:00

common pernicious way that we stay in yellow and

1:01:02

red time. Yeah, the Elkanawans call

1:01:04

it hurry sickness. Yeah,

1:01:07

that's good. Yeah, they don't have much of

1:01:09

that, do they? We

1:01:11

must look so weird to them. Yeah,

1:01:14

I mean, the blue zone's right, because they just

1:01:16

live life. They just, they just flow,

1:01:18

and it's about community and

1:01:21

people and enjoyment and pleasure and food

1:01:23

and hanging out. It's like nobody's like

1:01:25

doing startups and kind of like building

1:01:27

a career. It's just people are

1:01:29

just living, and it's this beautiful phenomena that

1:01:32

we see, and I think that's a big

1:01:34

part of the longevity in these zones. Thanks

1:01:36

for listening today. If you love this podcast,

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Leave a comment on your own best practices,

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