Chronic Stress: Follow These Simple Steps to Take Back Control
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Coming up on this episode of The Doctor's Pharmacy. But our diet, bad, causes physiologic stress. So when you eat sugar and crap, it actually raises your cortisol and stress hormones. 100%. Even if you're not mentally stressed, it makes you physically stressed.

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Hi, I'm Dr. Mark Hyman, a practicing physician and proponent of systems medicine, a framework to help you understand the why or the root cause of your symptoms. Welcome to The Doctor's Pharmacy. Every week, I bring on interesting guests to discuss the latest topics in the field of functional medicine and do a deep dive on how these topics pertain to your health. In today's episode, I have some interesting discussions with other experts in the field. So let's just jump right in.

The World Health Organization, right now, if you go on their website, will say that stress is the health epidemic of the 21st century. But that's an alarming statement. The health epidemic, wow. Yeah, I mean, that's incredible. And then... I might fight a little bit with that. I think food per food problem is a big one. Right up there. It's right up there. Well, I think stress and food is linked, actually, because... Actually, our diet...

- You probably know this, but our diet, if it's bad, causes physiologic stress. So when you eat sugar and crap, it actually raises your cortisol and stress hormones. - 100%. - Even if you're not mentally stressed, it makes you physically stressed. - Well, a lot of these things actually, as you know, Mark, work both ways. So yeah, the poor dietary choices can send stress signals up to your brain. Good food choices can send calm signals up to your brain. This is also with the gut-brain axis, which you've written about before, I've written about in this book.

But also I would say it works both ways. So if you are chronically stressed, it's quite hard to make those good healthy food choices. And I, you know, let's take January in the UK and the US. Every January people are trying to get healthy, right? I'm gonna reduce my sugar intake this year. I'm gonna cut out alcohol this year. But here's the problem I've seen is that people can use willpower for a week, for two weeks, maybe three weeks,

But if the sugar or the alcohol was being used to help them soothe the stresses in their life, they're never gonna maintain it long term. So I actually, I agree food is a big problem, but I found with some patients addressing their stress levels means they feel less of the need

to binge on sugar because they're not feeling as stressed. - If you're happy, you're not gonna eat that bag of chips or cookies. - Yeah, because a lot of our food choices are dictated by our emotions. And if we're feeling down, if we're feeling stressed, we feel we've got too much on, actually that sugary chocolate bar or that bag of chips actually helps us feel good in that moment. So short-term benefit, but long-term harm. But the other thing-- - It was interesting last night,

Went out, I recorded my public television show for my new book and it was a very intense day and I'd been really, you know, sort of under a fair bit of pressure writing the script and getting it all done and performing it and rehearsing it. You know, it's a big production. And like, you know, at the end of the day, we went out and had a celebration and I had, you know, two tequilas, which is, you know, for me, fair bit.

And I noticed last night that my sleep wasn't as good, that my heart rate didn't go down enough, that it was really impacting me in a negative way. And today I don't feel as sharp as I normally would because I probably did something that was counterproductive to manage the quote stress of all the stuff and I was like giving myself a treat but actually it made me counterproductive.

Yeah, but this is a story that I think many of your listeners will be able to relate to that. In fact, I tell the story in my book about this chap who I saw. He was a busy business guy in his early 50s. And what's really interesting about him is that we started to measure something called heart rate variability on him. So heart rate variability... What is that? It's basically...

it's a measure of how, what is the beat to beat variation between our heartbeats. Now people will think it should be like a metronome, you know, tick-tock, tick-tock. 70, 70, 70, 70. Yeah, but that's actually incorrect. What we're looking for is a high degree of variability. Complexity. Yeah, complexity. And it shows that we're constantly adapting and able to adapt to this changing environment around us. And what was interesting to him... Yeah, I mean, the worst heart rhythm is...

Got no variability. It's a flat line. Yeah. So a low heart rate variability is actually indicative that we've got high stress levels in our body. And this chap actually on a

Wednesday evening, he would find that he was drinking a lot of alcohol. He wasn't sleeping well. He was having a lot of caffeine on Thursday, more alcohol on the Thursday. He was basically, he came in, he was really, really stressed. It was impacting his relationships, impacting his sleep, et cetera, et cetera. The very common story. But as we start to look at his life and actually use HRV, heart rate variability readings, we could see that everything changed for him on a Wednesday. So what happened on a Wednesday afternoon,

at lunchtime, he had a team meeting, right? He found that incredibly stressful. He had to present to his team, you know, it was quite a high pressure meeting and that stress would last throughout the day. So what would happen is on a Wednesday late afternoon when he would leave work, he had to compensate with that stress.

How would he do that? Alcohol. Alcohol. So he'd open a bottle of wine, he'd have a glass, that glass, one glass would turn into two, two would turn into three, and by the end of the evening, he'd had the whole bottle of wine. So what happens then? He doesn't sleep well on the Wednesday nights. So Thursday morning, he's feeling groggy. Lots of coffee. Lots of coffee, lots of sugar to get him through. Coffee in the afternoon as well, which again impacts his ability to sleep on Thursday nights. He's not feeling good,

And that cycle continues where he's having a bottle of wine on Thursday, two bottles of wine on Friday, and etc, etc. But what did we do? We identified his trigger point was a Wednesday lunchtime. So,

I could show him that on the data, he could see it very clearly. So we discussed about certain things he might be able to do on a Wednesday evening instead of alcohol. Now there was a- - Get a massage, do yoga class. - Well, there was a yoga class very near his office. So before he went home, he went to the yoga class. So what happens then? He goes to that yoga class, that helps him de-stress. When he gets home, he no longer feels the need to drink a bottle of wine. So he might have a glass,

but it's one glass and it stops there. He sleeps well. Thursday, he feels fresh. He doesn't get as stressed at work. He doesn't have as much coffee. And before you know it, all we had to do was give him a yoga class on a Wednesday

Afternoon and suddenly that changes whole week and people who are listening to this I'd really ask them to reflect on their own life and think actually is there a trigger point in my week where things start to go downhill Yeah, if you can identify that and change your behavior, it is incredible what you what you can achieve It's true. I mean most of us understand, you know, we need to eat well most of us understand how to exercise and what that means and

But very few of us understand how can we actually deactivate that stress response, activate what we call the relaxation response or the healing response in the body,

in a deliberate methodical way, just like we exercise or eat well. And I think those are skills we never learn that are hard for people to understand how to incorporate. And yet they're pretty easy to do and they're actually fun and you feel amazing after. - Yeah, that's the beautiful thing about this is that they're not as hard as we think. They're quite simple. Most of them, I think pretty much all of the recommendations in my book, I think are free.

Like literally you don't have to buy fancy equipment or fancy apps. Actually a lot of this is accessible to all of us. But just to put in context the scale of this problem, Mark, I mentioned what the World Health Organization say. But there was a paper in the Journal of the American Medical Association in 2013. I think it was an editorial piece which suggested that between 70 and 90%,

of what a primary care physician like me sees in any given day is in some way related to stress. - Of course, of course. - These are remarkable statistics. - It's either caused by or made worse by stress. - 100%, and I think once people understand-- - I mean, if you're stressed, your blood sugar goes up. Your blood pressure goes up. Your blood vessels get stiff and hard.

Right? Yeah, I mean, I try to explain this. Create more information. Yeah, I find that when patients understand what the stress response is, I find they're really engaged in trying to change it. So I say to them, look, your stress response is ultimately...

trying to keep you safe. It thinks it's when your body thinks you're in danger, it's trying to keep you safe. So let's go back 2 million years ago and then you can understand what the stress response is, how it's evolved. So you are in your hunter-gatherer tribe and a wild predator is approaching, right? In an instant, your stress response gets activated and your physiology starts to change. So as you said,

your blood sugar goes up, which is gonna help deliver more glucose to the brain. Your blood becomes more prone to clotting so that if you get attacked by that line of bitten, you're not gonna bleed to death, you're gonna survive. Your amygdala, which is the emotional part of your brain, becomes more reactive, so you're hypervigilant to all those threats around you. That is an appropriate short-term response to a threat. The problem now, Mark, is that for many of us,

Our stress response has not been activated by wild predators. It's been activated by our daily lives. By Twitter. By social media, email inboxes. By CNN and Fox News. To-do lists, right? Elderly parents we're looking after. You know, two parents working in a family. One's trying to rush home from work to pick up the kids, et cetera, et cetera. And for many of us, those short-term...

responses that are so helpful become harmful. So if your stress is going up every day, right? And blood sugar going up for a short period of time is not a problem, right? But if that's happening day in day out to your email inbox, well, that's gonna lead to fatigue, lethargy, type two diabetes, high blood pressure, you know, all from the stress response. - Now we have so many more stresses than we used to, right? We have the culture we live in that's stress, we have the toxic food system,

the chronic amount of financial stress that most people feel. I think, you know, 40% of Americans can't withstand a $500 emergency, a hundred million live in poverty or near poverty, which is hugely stressful. I mean, you know, one of the studies that I found most striking a number of years ago was that more than a poor diet, more than smoking, more than lack of exercise, that socioeconomic status and a lack of sense of control

of your life really stress is the number one predictor of death and disease and I think it's something we don't really appreciate and we don't as physicians really learn how to address it how to measure it and how to help treat people yeah I I totally agree and actually the first part of my book is actually on meaning and purpose um and it's relevant to this because

Not having that control over your life, not having a sense of meaning, not having something to get up for every day. That is arguably the most stressful thing in your life. Even if you're doing everything else right, if you don't have that. And, you know, a few years ago I came across this Japanese concept of ikigai.

which I know you're familiar with. I saw these four circles and it's where these four circles intersect in the middle is your Ikigai. When you are doing something in your life that you're good at, something that you love, something that the world needs and something that pays you money. And I thought,

Sounds like you got that nailed, Dr. Chatterjee. Hey, well, look, I'm very lucky. I now have in my life, my job, I absolutely love my job. That's for sure. But what's interesting for me is I saw that and I thought, yeah, I want some Ikigai in my life. That sounds brilliant. I started talking about this concept to my patients. And for many of them, they found it a little bit intimidating. They thought, well, how am I going to find one thing in my life to tick all those four boxes?

And actually when I was giving a talk in London recently on stress, this Japanese student put her hand up at the end and she asked me a question. She said, "Hey Dr. Chastity, you know, I've grown up with this philosophy and I've got to say I find it really stressful. I find it too high a bar to live to." And what I did in the book is I created a new framework that I use for my patients. I call it the live framework. It's a much more achievable way, I think, for a lot of people to find their meaning and purpose.

The L is for love, I is for intention, V is for vision, E is for engaged. We probably can't go through all of that, but I use it with my patients to help them start to find meaning and purpose. And the first one I think is really important, love. So the research on this is super clear.

regularly doing things that you love makes you more resilient to stress. Right. So you mentioned a lot of Americans are struggling that they don't have control over their life. And this is the interesting thing about stress, Mark, is that

Sometimes we can't as physicians change the stressors in our patients lives. Right. No, no, you can't change what's happening out there. You just can't. But we can make them more resilient to that. Yes. And regularly doing things that you love makes you more resilient to stress. At the same time, being chronically stressed makes it harder for us to experience pleasure and day to day things. So one of my

recommendations to my patients is have a daily dose of pleasure, even if it's just for five minutes. Can you each day give pleasure the same priorities you might give to the amount of vegetables you have on your plate or whether you go to the gym, this could be going for a walk, it could be reading a book, listening to a podcast, it could even be coming home from work, putting on YouTube, watching your favorite comedian for five minutes and laughing. That is very important and very valuable.

It makes a huge difference. I mean, I'm not in California doing my public television show and I was at the hotel and I was right on the beach and I went out

the beach and I jumped in the water, swam a little bit and I came back and I literally just laid there in the sand doing absolutely nothing. And I can't tell you how pleasurable that was to just be unplugged for a minute and stop. And most of us just keep go, go, go all day long and distract, distract, distract. Well, there's obviously the nature piece there as well, which is very impactful for stress. But let me talk about a patient I saw recently. I think you'll find this interesting. Um,

54 year old chap I think he was, certainly mid 50s. He was the local, he was the CFO of a local plastics company. And you know, he was in a good job, earning good money, married with two kids. He came in to see me and he said, "Dr. Chachi, look, I'm sort of, I'm struggling a bit. I find it hard to get out of bed sometimes in the morning. I find it hard to concentrate at work. You know, I just feel a bit indifferent to things. Is this what depression is?"

I started to chat to him. We did some tests. I was looking into all aspects of his lifestyle. But ultimately, one thing was quite clear to me is that he never did anything that he loved. So I asked him, you know, how's your job? He said, yeah, it's fine. You know, I don't really enjoy it, but it pays the mortgage, pays the bills, feeds the family. I said, okay, how's your relationship with your wife?

"Yeah, so-so, you know, I don't really see her much, but it's, you know, it's fine, I guess." He was very, very indifferent. I said the same about his kids. And I said, "Do you do, you know, have you got any hobbies?" He said, "Dr. Chachad, I don't have time. My work's busy. At the weekends, I've got to do all the chores. I've got to take the kids to their classes and their sports games. I don't have any time." I said, "Did you ever have any hobbies?" And he said, "Yeah, sure. When I was a teenager, I used to love playing with train sets."

I said, okay, fine. Do you have a train set at home?

He said, "Well, yeah, I've got one in my attic, but I haven't played with it for years." And I said, "What I'd love you to do when you get home this evening is get your train set out." Now, look, Mark, I appreciate this may not be the advice- - Did you write that on your prescription, Pat? - Yeah, well, kind of. I'm all for lifestyle prescriptions, right? And he- - Play with train set three times a week for 15 minutes. - But I'll tell you what happened. What was fascinating is that- - Refill's unlimited. - Exactly. But it may not be the advice that he was expecting from his daughter, but he said, "Yeah, okay, sure, I'll do that."

Then this was in a conventional medical practice. These were 10 minute consultations. This is in the National Health Service in the UK. We don't get the chance to follow up all our patients. We see maybe 40 to 50 patients a day. We simply can't follow them all up. I didn't know what was going on with him. Three months later, I'd finished my morning surgery and I was in the car park about to go and do my home visits. And I bumped into his wife and I said, hey, how's your husband getting on?

She said, "Dr. Chastity, I cannot believe the difference. I feel like I've got the guy I married back again. My husband comes home from work. He's pottering around on his train set. He's always on eBay looking for collector's items. And he's now subscribed to this magazine." I thought, "Okay, that's incredible." I still hadn't seen him. Three months after that, he comes in for a well-man checked to my office.

And he comes in with his blood tests. I'm about to go through them with him. And I said, hey, how are you doing? Dr. Chachi, I feel incredible. I've got energy. My mood is good and I feel motivated. I said, how's your marriage? Marriage is great. I'm getting on really, really well with my wife. How is your job? Love it. Really, really enjoy the job. So why is that so powerful, Mark, is this. Did he have a mental health problem?

- Or train said deficiency. - Yeah, or did he have a deficiency of passion in his life? And when he corrected that passion deficiency, everything else starts to come back online. So I wanna expand the conversation about stress to go, yeah, sure, breathing, nature, meditation, exercise, these things are fantastic. And of course I talk about them and I go into the science and the practical implications of people. But what about something about passion, doing things that you love? It's just as important. - It's true.

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Chronic stress is deadly. It kills us, literally kills us from heart disease, cancer, dementia. I mean, just literally being stressed and having high stress levels chronically will shrink the memory center of your brain called the hippocampus. It also makes you gain weight and it causes you to be diabetic and it causes a whole host of other things, including depression and infertility and

Sexual dysfunction, I mean, you name it, stress is a killer. So we now understand how stress impacts our biology in a real practical way. It is, in fact, the biggest thing that's driving so many of the dysfunctions we see around chronic illness, and it either makes worse or causes most of the things we see every day in medical practice.

How? Well, stress jacks up your cortisol levels, which then causes your muscles to waste away, your blood pressure to go up, your blood sugar to go up, increases belly fat, causes your memory to go down.

And you see this phenomenon of weight gain, insulin resistance, and diabetes. Ultimately, even type 3 diabetes, which we now refer to as dementia. So when you also are stressed, you produce adrenaline. And adrenaline also makes you feel hyper, anxious, irritable, gets your heart rate up, your blood pressure up, causes your blood to clot more likely, damages your brain's memory center, and just causes a lot of bad problems. So if you're thinking about your daily life, when you

are going about your day, if you start off the wrong way, you're going to be in trouble. And one of the things we don't realize is that stress is also controlled by what we eat. Our diet plays an enormous role in our stress response. And so when we eat certain foods, it literally jacks up adrenaline and cortisol. What foods are those? Sugar and starch. Basically anything that turns to sugar in your body is seen as a biological stress. Even if you think you're happy and relaxed while you're eating it, the

the consequences in your body are just like those of when you're attacked by a mugger or you're being chased by a tiger. The real physiologic response is

that happen in relation to our daily lives are no different depending on what the stress is. So whether you're running from a tiger or being, you know, being upset with your spouse, or you imagine somebody's mad at you and they're really not, the stress response is the same. In fact, stress is defined as the real or imagined threat to your body or your ego. So it could be a real threat to your body, like a tiger chasing you, or it could be an imagined threat

through your ego, maybe you think your boss is mad at you and is going to fire you, but actually doesn't think that at all and wants to give you a raise. You have the thought, the thought creates a stress response. So our thoughts create our biology and we have to learn how to manage our minds in order to manage our biology. And so let's talk sort of a

What we found from the studies is that when you eat food, it's not all the same. Food is information. It's not just calories. And the information in processed food and starch and sugar increase our stress hormones, adrenaline and cortisol. And I remember one study, they looked at overweight kids, I think boys, and they, teenage boys, and they gave them three different breakfasts, an omelet, steel cut oats, and regular oats.

What was interesting is that they were all identical in calories. So the calories are the same. And what they did was they said to these kids, why don't you go and sit in this room and hang out, read, play games, whatever you want to do. But when you're hungry, just hit this button, we'll bring you food. And so what they found out was when the kids had the oatmeal, they ate 81% more food than the omelet.

even though it was the same calories over the course of the day. And with the steel kiddos, it was still 51% more food. But what was interesting was that they also had a catheter in their blood vessels and they drew their blood every little bit. And they found that when the kids ate the oatmeal, it was like a stress response in the body there. Not only their insulin and blood sugar went up, but their adrenaline and their cortisol went up. So when we eat refined foods, they are hugely damaging. So just in the same way, you can eat food to actually help

reduce your cortisol level. You can actually balance your insulin levels. You can actually reduce adrenaline by eating foods that help you calm your nervous system, which are whole real foods. Good healthy fats like olive oil, avocados, nuts and seeds, high quality protein, regeneratively raised animal foods, eggs, chicken, fish, regeneratively raised meats,

you know even whole beans and whole grains can be very calming and helpful although if you eat too much starch and you're insulin resistance it can still be a problem and and then of course all the the plant foods vegetables they just are super full of phytochemicals anti-inflammatory compounds stress reducing compounds uh and and they're they're really powerful so when you shift your diet you're literally going to change your stress response and change your biology so what can you do

other than looking at your mindset, because a lot of the stress we respond to is the creation of our mind. You know, Gabor Mate, who's written a lot about trauma, which is real trauma, he says, trauma is not what happens to you, it's the meaning you make from what happens to you. So two people can experience the same event and have very different responses, and it can be registered very different in their biology. So it's important to understand that

You have to get your mind straight. And that's not as easy as it sounds because we are kind of conditioned to believe our thoughts. And, you know, my friend Daniel Amon says, you know, we should stop the ants in our head, the automatic negative thoughts. Easier said than done, but it's an important practice. Start witnessing and looking at your mind. And some of the practices that I'm going to share with you now are very effective in helping us reset our minds as well as our bodies.

The first is a deal with the root causes of stress, right? So there can be physical stresses like a disease. I mean, I had mercury poisoning, Lyme disease, mold toxicity. These create a stress in the body. So you have to deal with whatever true physical stressors there are and get rid of them. Gluten, nutritional deficiencies, all the things that are really driving so much disease. And we see this in functional medicine. And it really is looking at the whole scope of what creates balance or imbalance in the body.

and dealing with that. But once you've done that, and there are no sort of objective external stresses, how do you start to reset? Well, you have to learn to actively relax. It's something we don't get taught. We know we have to sleep and eat and exercise, but most of us don't understand that we have to actively relax. It's not just sitting on a couch watching TV. It's actually helping your body get into what we call a parasympathetic state.

And this is not as easy as it sounds. You can do it through meditation. You can do it through a breath work. You can do it through massage. You can do it through prayer, through chanting, through yoga, through various kinds of things that help your body reset your nervous system from an overactive state

stressed, sympathetic response to what we call the relaxation response. Meditation is a very powerful tool. It's available to all of us. It's free. You can learn how to do it online. There's courses and programs. You can read a book about it. It's not that hard to do. It's basically just sitting and watching your thoughts and not

getting caught up in them, but letting them pass using your breath as an anchor or a mantra. There's a lot of different techniques out there. Exercise also is a powerful stress reducer. Think about it. When you're running from a tiger, you know, you're producing huge amounts of stress hormones and then you run and you burn them off.

off. That's what happens in a book called Why Zebras Don't Get Ulcers by Robert Sapolsky, who studied baboons and stress response actually and the hierarchy of baboon societies. And I highly recommend his book, A Primate's Memoir, which describes his research. But he wrote another book called Why Zebras Don't Get Ulcers,

which is based... Oh, no, I think that was written by Jon Kabat-Zinn. Sorry. No, I can't remember. Anyway, one of those guys. And the book basically said, you know, a zebra's out there eating his grass and hanging out, and there's all the other zebras, and the lion comes, starts chasing them, and they all run like crazy, highly stressed. And then the lion catches one of them, and then the lion eats the zebra he caught. And

then the other zebras just go back to eating the grass, even though the lion's still standing there. So they discharge the stress. We don't. We continue to accumulate the stress. So exercise is a great way to reduce depression, anxiety, to improve mood, to reduce stress response in the body. And that's why you often feel relaxed and calm after exercising.

Uh, other techniques are really good breath work techniques, uh, saunas, uh, cold plunges, a lot of things that now are being used to help with longevity and biohacking also help to reduce the stress response. My favorite is a, a hot steam and a

a cold dip and uh and that really just kind of cuts all the stress for me a hot bath with epsom salt very easy to do there's also some supplements you can take we use a lot of nutrients when we're stressed vitamin c the b complex vitamins vitamin b5 zinc and magnesium magnesium is so important it's the relaxation mineral so i highly recommend that people take magnesium regularly to calm their nervous system herbs can be very helpful adaptogenic herbs can help

you manage stress. The astronauts were using it, and the Russian astronauts often took these compounds like rhodiola, Siberian ginseng, cordyceps, ginseng, ashwagandha. These are what we call adaptogenic herbs that help modulate the stress response. Also adaptogenic mushrooms, ashwagandha and reishi and many, many others are very effective for helping modulate the nervous system. Look at your mind. Find a way to look at your beliefs, your attitudes, how you respond. Think about

choices you have. You know, I think, uh, uh, Viktor Frankl, who was a Auschwitz survivor said, you know, between stimulus and response, there's a pause. And in that pause lies a choice and that choice lies your freedom. And I think all of us have just kind of collapsed that stimulus response or just reactive instead of slowing down and

looking at our beliefs, our thoughts. And he, in the concentration camp, chose not to be angry or mad at his Nazi captors. I remember when I was a young medical student, I went to Nepal and I met with a Tibetan doctor

who'd been in a Chinese gulag for 22 years. And I said to him, I said, what was the hardest part about being a prisoner in this Chinese gulag? And he said, well, there were a few times when I thought I would lose my compassion for my Chinese jailers.

And I thought, wow, this guy was in jail for 22 years in a gulag. And that was his biggest stress was thinking that he could lose his compassion for his Chinese jailer. So that just shows you the power of the mind to relate to your environment in quite a different way. And I think the other thing is sleep. All of us are lacking sleep and sleep is a huge important factor.

medicine for all of us. Lack of sleep creates a whole host of diseases, but also increases our reactivity, our stress response, cortisol levels, makes us hungrier, increases railing the hunger hormone, decreases PYY, the appetite suppressing hormone. So sleep is a big medicine when it comes to helping reduce stress. We are more stressed now than in previous years and decades, but even worse, I think of our youths, like 70% are

you know, reporting stress that they-- such extreme stress, they don't know how to manage it, it's interfering with their life. These are really serious red flags. We know what that means biologically. It's a leading indicator to the wear-- you know, the wear and tear on our cells, on our brain, the conditions we're always trying to avoid.

So it's a serious prescription that we don't have to live each day with this excessive level of stress, which really rules out those states that you've been cultivating, which is the restorative states. And it's a beautiful example you gave how you are consciously changing them. Because it's not our fault. There's no judgment. We all come out with different levels. That question about why do some people expect change?

negative things to happen that can't stand ambiguity, that uncertainty feels intolerable.

That's part of it. It's like partly from how our stress response systems are shaped from all these different influences before our life, including our life starting in the womb. And it can change. That's the beautiful thing is that we can rewire our nervous systems. And I think the difference between chronic stress and acute stress is nothing we mostly think about. But, you know, one of my favorite scientists is Robert Sapolsky, who wrote a book, Why Zebras Don't Get Ulcers, which is fantastic.

Essentially, the idea that zebras are out there eating their grass, and then the line comes and chases them. They all run like crazy, super stressed. Then the line catches a zebra and is eating it right next to all the other zebras. They just go back eating their grass. They have a cute, massive stress, and then it goes away. I want to talk about how you frame...

stress in your book around our mind states and then how our mind can create physiological stress or conversely can actually restore us to health. And you sort of mapped out these different spectrums of mind states that kind of help us think about how to understand stress, how to navigate it, how to think about

discharging it. I say the stress, you know, stress reduction or stress management is not a passive process. It's an active process. And it's like you have to exercise, you know, build your muscles. You kind of have to practice various techniques in order to reset your nervous system from this chronic unremitting stress, which is so pernicious and driving so many of our diseases.

Yes. So you want to hear about these mind states. I want to hear about the spectrum of these mind states that you talked about. Yeah, we've been thinking about stress from a different perspective, we and others in the field. So usually we think about how stressed does someone get in the moment? How quickly do they recover? And that's important. We want a quick peak and a quick recovery. And that's a healthy, resilient stress response.

But it's not just the action during stress, during events, during tough times. The question really becomes, what are you carrying in your body and mind when nothing is happening? When you are...

at rest, or at least you think you are. And that's a window into the unconscious level of stress that we're carrying. So when we talk about uncertainty stress, that's where it is. That's because it's a little bit vague and we can catch that. Mindfulness, mindful check-ins help us just in this moment, like just ask, are you tensing up? Do a check-in with your body.

your hands, your face, your eyebrows. So often we are tensing up and we sometimes can identify why and sometimes we can just remember, oh, right now it's not only okay to relax.

It's important for my body. I'm not needing to cope with something. So it's that baseline state or rest state that we're learning is really different in people and is a sign of chronic, low-grade chronic stress that we can actually get to and release through different techniques. So red mind is what we've been discussing about coping in the moment when you're fired up and you need the energy, you need the stress response to

And we just don't want that to kind of go on and on and have sluggish recovery. But otherwise, we need that. It's beautiful. It's why we're here today. That's our survival response. And of course, we're triggering it too much as humans with an overdeveloped cortex and the more chronic ambiguous threat we feel. So then there's yellow mind state, which is when we think we are...

relaxed. It's just, how are you walking around during the day? Typical day, where are you at? What's your baseline? You probably do some monitoring, you know what your autonomic nervous system is set at. And that is probably higher than we need to be at. And so that's what we think of as our default baseline is actually

carrying around a lot of both cognitive load from our thoughts, from different information, screens, demands. So we're a bit activated. Then there's also the unconscious stress that we can become aware of and release. So we want to bring down that yellow mind state to a more true resting state. And that's the green mind. Yeah. How do you, how do people start to think about

identifying if they're stressed. 'Cause I think for me, I kind of, you know, I didn't really think I was,

I think I sort of, I was able to sort of map out things that, like looking at my aura ring, for example, could tell me my heart rate ability or what's happening. I was in Mexico City for a week and my heart rate ability went down. I went to the jungle in Costa Rica and it went way up by three-fold. Yeah. So our bodies sort of register all the inputs, even if we don't think they are. Yeah. I've learned a lot from monitoring and I think that's one way to raise awareness and

as well as asking ourselves to become mindful of our emotions and our bodily, where we're holding stress in the body, where we're tense. The heart rate tells us a lot of things, but the heart rate variability we think is more specific to that balance between parasympathetic and sympathetic, so more related to psychological stress, not just metabolic demands.

So that's super interesting. So Costa Rica leads you to a different yellow, maybe green mind state, better baseline. I monitored my, with my aura ring, I monitored my heart rate variability during a meditation retreat. And we know that when people slow their breathing, immediately they have, they can have a decrease in all the energy.

the sympathetic activity markers, and sometimes in heart rate variability during studies. So it's no mystery that doing these practices and doing them for longer can lead to these improvements. And those are what we call deep rest states when we're really allowing ourselves to feel safe and to let down and let ourselves go into restorative mode.

But I was surprised at how long my heart rate variability, my baseline heart rate variability took to change. So it was only two weeks later toward the end of the retreat that my sleeping heart rate variability really improved. And I think that's... So two weeks of meditation, like hours and hours every day. Yeah. So for me, it wasn't easy to change my baseline, particularly my sleeping baseline, but it was possible. And it was, you know, I was super excited that it finally changed.

Yeah. I had, I, I had, uh, you know, rarely get over 40. And then I think the other night when I was in the jungle and I was in this deep sympathetic parasympathetic state and doing a lot of social somatic body work and it went to like in the nineties and I was like, Holy crap. Like we, we don't, we don't have, um,

That's sort of a framework for understanding how these things are so impactful for us. So I realized how much I need to pay attention to the practices that I need to do

to actually reset my nervous system regularly. So in the book, you talk a lot about some of these practices and that's what the stress prescription is. So I'd love you to sort of talk about how do we sort of create a lifestyle and a way of thinking about our day and a way of thinking about the beginning and the end of our day and other types of tools or techniques or doorways, other than meditation, obviously, is powerful, but there's more than that. I'd love to sort of explore that. Yeah, we...

We have these red mind states that we don't want on all day. Drains our batteries, stresses our mitochondria. We have data on daily mood and mitochondria showing it is really sensitive to daily affect. This was a...

a study with Martin Picard of Columbia, and we were measuring the enzymatic activity. And so when people woke up with more positive emotion and went to bed with more positive emotion, they had higher mitochondria, which we measured kind of in the middle of the week of monitoring. And when they, you know, particularly at night, so there's this idea of how are we recovering from the day? Can we maintain positive affect at the end of a stressful long day?

And we certainly found the chronically stressed participants, these were caregivers, had lower mitochondria overall. But this mood effect pretty much mediated that and overrode that. So that's this pointing us to...

We actually know how to increase positive affect quite quickly with gratitude exercises and other ways of thinking and being. And so how amazing to think that our mitochondrial activity might be under our control in this short-term way. Wow.

Wow. So what are the ways that actually you can affect your mitochondrial activity then? Yeah. Well, to get back to your question about the how do we live a day without chronic stress? So we might think of Red Mind as like having, you know, drinking coffee all day and just keeping us in that activated mode. And we want that stress response, but we just want to, you know...

Use it parsimoniously, not take it for granted. When we ignore it, it can just be on all day and rush, rush, rush. I mean, rushing and packing our day is probably the most common pernicious way that we stay in yellow and red wine. Yeah. The Okinawans call it hurry sickness. Yeah, that's good. Yeah. They don't, they don't have much of that, do they? We must look so weird to them.

Yeah, I mean, the blue zones where I visited, you know, they just live life. It's slow and it's about community and people and enjoyment and pleasure and food and hanging out. Nobody's like doing startups and trying to like build a career. People are just living. And it's this beautiful phenomena that we see. And I think that's a big part of the longevity in these zones. Yeah, that's beautiful. So the mitochondria are...

most likely, they haven't been studied to death like all the other biomarkers in terms of health behaviors and all, but they certainly are related to the hormetic stressors like exercise, increasing them. And we don't actually, we only now, I think, have really good ways to measure them in healthy humans in a monitoring way. So we're learning more and more, but we do know that they tend to

secrete the cell like lets out fragments of mitochondrial DNA into the serum during acute stress. And so that's not a good thing. That's not a good sign. That's a sign that our mitochondria are, you know, overstressed and responding to stress with, with this excessive, what we call cell-free mitochondrial DNA. So they're outside of,

I wonder if that's why kind of stress causes fatigue, because it affects our ability to make energy. Yes, I think that's exactly right. And that is a new area. In 2018, we published the first paper showing that chronic stress was related to lower mitochondria. And then we were like, why didn't we measure fatigue and vitality? You know, because these you would imagine you have low mitochondria, some had low

as low as people with mitochondrial disorder. And that is thought to be at the center of both chronic illness and mental health now, these mitochondria as the source of aging, breakdown. And so I think it's really helpful to think of our mitochondria and what gives them a boost and boosting positive affect, having more of these restorative states, but also the hormetic stressors.

They probably love them. Well, yeah. So let's talk about the hormesis because this is a really important idea. We think of stress as bad, but there are actually good stresses, right? And how do we start to go about thinking about how do we incorporate those in our life as a way of actually impacting our nervous system and the parasympathetic and the sympathetic state, which are often so dysregulated in our culture? It's interesting to think of...

really planning regular like a lifestyle habit hormetic stress episode so there you know it's very common to be doing ice exposure or sauna or Wim Hof breathing and those are I mean to be totally honest I don't think we have many options in our toolbox for hormetic stress that we know of and we know how to use safely and find the right dose so we're people experiment and

It's just a new cutting edge area of stress to really understand how these are affecting aging and mental health. There is exciting work on depression and hypothermia showing that when you can raise your core body temperature, even just a few sessions, it can lead to over a month of remission from more severe treatment resistant depression. And of course, the cardiovascular effects are well documented. Rhonda, Patrick just mentioned.

wrote a beautiful review of what repeated sauna does.

Oh, wow. We'll put that in the show notes. What's the reference for that? I'll email that to you. Okay, that's great. Because I think, you know, we think, oh, sauna, it's nice, whatever. But actually, these are very therapeutic. And I know for myself, it's sort of how I managed to get through chronic fatigue was using hot and cold therapies just to be able to function. And also just as a basic maintenance in my life for mood, for energy, for relaxation, restoration. It's quite powerful. Yeah.

Yes, it is. And, you know, it's beautiful in that it's not medical. So it's doing it's, you know, creating all of these changes in the cell in a dramatic way. Same with cold exposure, same with breath holding, extreme breathing, and then the recovery response. So we're just rejuvenating.

We're kind of like inducing the survival response in short bursts and then the counter regulatory response turning on the autophagy, cleaning up junk in the cell, reducing oxidative stress, free radicals. And I think in terms of the aerobic stress, I mean, we've been trained to think you got to get into change your clothes, do 45 minutes. You got to get the endurance in and

And of course, that's important. But what we're talking about, stress fitness, you can go do something for one minute, two minutes. You change up your physiological state, right? You can go do jumping jacks or sprint. And someone was just encouraging me. I was like, yeah, but you got to change your clothes so you can get sweaty. And they're like, no. Right?

I do it all the time. You don't. You do it in your work clothes. So it was interesting just to think like, no, just take away all those barriers about how we think you have to be prepared for exercise and be in the right place and just do the, you know, something high intensity exercise.

In wherever you are briefly, probably fulfill self-conscious, but that is really changing up our state. And we also use that in different therapies that are really needing acute psychological first aid for emotion regulation. What do they do? There's all sorts of strategies that are body up like that. So ice on the cheeks is one, as well as the pushups or jumping jacks.

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