Biohacking Stress & Burnout | Dr. Aditi Nerurkar | 1153 | Dave Asprey

Giving yourself a sense of compassion and grace, understanding that if you are struggling with stress and burnout, you are not the exception, you are the rule. Studies show globally that in a room of 30 people, 21 people are struggling with stress and burnout. So if you feel this way, you are not alone. It is not your fault. And so that is my overarching principle and I would say probably the most important lens to look at, ways to rewire your brain and body. Being gentle with yourself is the most effective path.

You're listening to the Human Upgrade with Dave Asprey.

One of the coolest journeys for me with this book launch is that I have been engaging in media. I'm a consumer of media, and then I'm engaging in things that I actually listen to, but this time as a guest. And this is an example of that. So, so thank you for having me.

How fun. And, and thank you for listening to the show.

I love it.

If you guys are wondering who that mysterious voice is, the voice that sounds calm and collected and happy and all of that, that is the author of a book about stress, anxiety and burnout. And so many people are more burned out now, mostly because of government decisions that maybe really weren't good for society over the past few years. And we already had record stress levels below or before the pandemic. In fact, in my work with Upgrade Labs, I came across a study where for the first time since we've been monitoring this stuff, more people are asking for help managing stress than for weight loss, which for years has been the number one goal. People would try to get healthier, go to a health club or something like that. So our guest today is Dr. Aditi Nurokar, who's a Harvard trained stress expert, she's a television correspondent and she speaks globally on what stress does to us. And what do you do about it, how do you manage it, how do you create human resilience, which is, you know, the original, when I started bulletproof, it was the state of high performance. But being bulletproof means I can handle anything that the world brings my way. And today you've probably heard I have nothing to do with the company. I was removed several years ago and they've been purchased. And so I'm all about danger coffee now, which is the next level of that, which is I know that I can handle anything that comes my way, which makes me dangerous, because who knows what I might do? I'll do exactly what's right, no matter how hard it is, because I'm not stressed and I'm not programmable in any way. And that's why I wanted to have Aditi on the show today because her book is called the Five Resets. Rewire your brain and body for less stress and more resilience. And it seems like that's what we're all looking for. So you're gonna learn in the show today why stress is on the rise. And no, it's not just pandemic after effects. You're gonna learn what burnout is, what symptoms it causes, and what to do about it. We're going to talk about screen time. So if you're watching this on YouTube, I'd like you to already feel a deep sense of guilt and shame over that. Okay, Just kidding. But if. If you're watching this on YouTube, it is screen time. And maybe this is valuable screen time, but it is still screen time. And then there are resets you can use that allow you to have gratitude and calm. If you're a longtime listener, you've heard me talk about the reset process from 40 years of Zen, which uses gratitude to create a sense of calm. So Aditi definitely gets how it really works. And with no further ado, welcome to the show, Dave.

It is such a pleasure to join you. Like I told you offline, I am such a fan of your work and it's a thrill to be here today.

This is your first book, right?

My first book.

And you're in the middle of your book tour.

It's been wild. I thought it would finish in like two weeks. And it's just been months of lots of wonderful appearances and interviews and I have loved every minute, truly.

You've also probably dealt with more circadian disruption, more demands on your time, and generally more stress. Launching a book is for people listening. Most people haven't written or launched a big book. It is an enormous amount of work, and that usually brings with it stress. So how do you manage your stress during a really busy book launch?

You know, Dave, the irony doesn't escape me. While writing this book on stress and burnout, of course I experienced my own stress and burnout, but particularly during this book launch process, which is a finite amount of time with lots of demands and competing priorities, I doubled down on the resets. I remember throughout the past couple of months texting friends and saying, oh, my God, guys, these resets really work. And then, you know, we all had a laugh. I definitely walked the talk and always have. I came into this work as a doctor with an expertise on stress first because I was a stress patient looking for answers and Every time in life when the temperature goes up and I'm under the fire, you know, whether it's short term or long term, particularly this book launch, I just double down on all of the information in the book and practice all of these things for myself. And it is tried and true. You have to trust the science and know that your brain and body are responding exactly as they should.

I'm always amused and grateful when a guest is on the show. Who lived it. It's one thing if you're sort of cultural anthropologist and you're studying stressed people from your chill academic lab, but if you've lived it and you're saying, I just gotta solve this, I feel like it becomes a lot more personal. And your book is both personal and prescriptive. Sort of like a doctor who's never been sick might not have the same degree of empathy or understanding as someone who's. I dealt with chronic fatigue and now I'm done and I fixed it and I know how you feel and here's what to do. It just creates trust when, when you have that.

Why were you burned up?

I was working 80 hours a week. I was seeing death and dying on a daily basis. I was a medical resident and in my second year of medical training, there was no lexicon, there was no vocabulary about self care, burnout, stress. In fact, the mantra I was taught very early in medical school was that pressure makes diamonds and I was a diamond in the making. So all of the pressure that I endured, working 80 hours a week, seeing so much suffering on a day to day basis, erratic sleep, erratic food habits, I was taking care of everyone else, all of my patients, but really not focusing on myself. And in my second year of medical training, I was the senior resident in the cardiac icu, taking care of all of these people's hearts and not really focusing on my own because of my poor lifestyle. And then my diamond cracked and I developed a sensation of a stampede of wild horses across my chest. The first time that never happened to me, knocked the wind out of me, quite literally. I sat down and, you know, my. The nurse I was working with immediately sensed something was going on. Gave me some orange juice. We both laughed it off. It lasted a couple seconds and I was like, oh, low blood sugar. I hadn't slept the night before. We had too many hospital admissions. It never happened again at, at work, but it followed me home. Those palpitations, that stampede of wild horses. Every single night for weeks and weeks as I would go to bed, I would get that sensation. It would last anywhere from 10 to 30 minutes. And then I would fall asleep. And as you can imagine, that was first terrifying and then over time, just really frustrating. So I did what every good patient should do, is I went to go see a doctor. I went to see my doctor and my doctor did the full million dollar workup, including heart ultrasound and blood tests and ekg, you name it. And at the end of all of those tests, she smiled and said, hey, good news, reassuring. Everything is normal. It's probably just stress. Go home and try to relax. And so I did what, you know, what does that mean? Just try to relax. I watched movies, I hung out with friends, took, went to spa days, got massages, retail therapy, and nothing seemed to work. And then that's when I put my scientist hat on and dove deep into the science of stress and burnout, what it does to the brain and body. And over time took me a couple of months and I found my way out of stress. And then when I came out of that dark tunnel, stress is when I said, and really vowed to myself that once I finished my medical training, I wanted to be the doctor that I needed during that difficult time time. So my villain origin story is that I became a doctor with an expertise on stress, burnout, mental health and resilience because I was a stressed patient looking for answers and couldn't find them.

The problem with diamonds is that, yeah, they're, they're sparkly and beautiful. They're also abrasive and cut almost anything and they're brittle. So when those old school Doctors from the 70s say that sort of thing, there is some value. I've interviewed multiple special Forces and Navy SEAL operator guys, and during their training they go through stress inoculation, which is showing you a brief, intense stress, like serious school or, you know, all the, the really intense things. And it's to show you that you'll survive when you're really stressed. But then they finish the training and with doctors and I was married to an ER doctor for 17 years. She didn't practice the whole time, but lots of experience with that. It's almost like, no, we're not going to give you six weeks of stress. We're just going to beat you into the ground and just, you know, hold your face in the dirt for a couple of years where it's more about defeating you than teaching you that you can handle it and how to recover. I want to ask a kind of controversial question to open things up. This comes from the world of biohacking, where I've looked at the Effect of biological stress on men and women. It seems like women respond to stress more quickly than men. Do you think that there's something just neuro hormonal about that? Not that women aren't resilient at all, it's just that the effects of fasting or cold exposure or heavy exercise, they hit women's cortisol in a faster time than they hit men's cortisol. Do you see any evidence of that with the work you've done?

You know, most of my work focuses on people overall. So not looking at differences between men and women. And my response to that would be to say that there are no biological, inherently biological differences between men and women. And a lot of this is societal forces that are placed upon us. So you know, we might see certain changes, changes in the spike of cortisol here and there. But what is the true cause of that? Is it the actual biology or is it systems and the systems have failed us, particularly women.

Oh yeah.

And so I would say that, you know, my counter argument to that would be that it's the society and societal forces. People are resilient, it's the systems that burn us out.

Yeah, systems absolutely create chronic stress. I'm, I'm really interested in knowing how to create the ideal hormetic stress for an individual human, given all of their biology, all their current state. And that's part of what I'm working with AI on doing at Upgrade Labs. You know, it's a biohacking facility, non medical. But one of the tracks for people is how do you manage stress better biologically. So I'm like, how do I assess their stress? And then how do we know how much stress for what period of time causes the most beneficial change versus pushing someone into burnout? So it's, it's a, it's a question of age, it's a question of nutrition, it's a question of inflammation. There's all kinds of variables that go into it. And I, I find it fascinating because I know I like you, I burned myself out in Silicon Valley and I went through that period of, you know, the anxiety things and then a period of just low cortisol that oftentimes happens.

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So walk me through the HPA axis. What is it and how does it respond to stress?

So first off, just a big picture view when you know, you use the example of an ER doctor versus a Navy Seal in the training, right? Your brain and your body are expertly designed to handle short bursts of stress. That is what your brain and body are doing, designed to do very well. And so the example of a Navy Seal or the other examples that you've talked about, this is an acute self limited episode of stress. And then the expectation is that there's a finite start and an end. The challenge right now for most of us, whether you are an ER physician, a physician, an entrepreneur, or just a regular human trying to make it in the world today, is that there are no real short, acute bursts of stress anymore. You know, it is this chronic ongoing stress without an end. And that is the problem for your brain and your body. So when it comes to the HPA axis, what is happening is that HPA axis, which connects the mind to the body and it's the information superhighway of stress that connects your brain to the rest of your body. It's the way your brain and body respond to stress in the moment. And the HPA axis sets off a whole cascade of hormones and chemical reactions called the fight or flight response. And the fight or flight response, which is governed by your amygdala, which is a small almond shaped structure deep in your brain that is all about survival and self preservation. Now, now your amygdala is again doing a wonderful job at managing the fight or flight response in the moment. It was designed evolutionarily your amygdala and the fight or flight response is designed, it's called fight or flight because when we were all cave people living in the forest, you would see a tiger and you would either flee or fight. And then there's a whole cascade of biological processes that happen in the body. Your pupils dilate Your heart starts beating faster to get fresh blood to the tissues. Your lungs start breathing quicker for oxygen. Blood is shunted away from your vital organs to your muscles. So you can either fight or flee. And there's this rush of adrenaline and cortisol and all these different hormones in the body. But that fight or flight response needs to be equilibrated at the end, right? So that tiger, you fight, you flee, and then you go back to your baseline, you go back to shelter, safety and, and you come back down. That's what happens with acute stress. And that's why your brain and your body are expertly designed to handle that through the HBA axis. But now all of these metaphorical tigers just don't seem to go away. Financial pressures, the calamities in the world, marital strife. There are so many chronic ongoing tigers and they are not going away. And so that amygdala, the fight or flight response, and that HPA axis is, stays on in the background at a low hum. And that is what eventually leads to burnout. Because your brain and your body can manage short term stress, come back to baseline, but when it is ongoing, that is when burnout can set it.

We should pause for a second and define HPA axis. And guys, it's hypothalamic, pituitary, adrenal axis. So between the hypothalamus in the brain, your adrenal glands and your pituitary glands. And it's those three things, they call them an axis because they are supposed to say in balance, and when they get triggered or they're not working well, they're transmitted at least in large part through the vagus nerve, which is something that we've had several episodes about. So it turns out there's all these invisible systems that are meant for handling the tiger, but when they're always handling tigers, that just throws everything off. What are the symptoms of burnout?

We all know what those like classic typical symptoms of burnout are. Apathy, feeling bored, unmotivated, unproductive. But what's fascinating is increasingly what burnout looks like is changing and modern day burnout. In one particular study, 60% of people with modern day burnout, their distinguishing feature of burnout was an inability to disconnect from work, which is what makes burnout difficult to identify in ourselves and others, because these are atypical features of burnout that we are seeing increasingly, particularly over the past several years.

I, I can see that in the people around me, people on my team. It's, it's definitely, at least it Feels like it's as strong as it's ever been. But I didn't live through World War II like there's been other probably more stressful times of famine and pestilence and plagues and wars throughout history. And we tend to survive. What happens to people who go through profound long term stress? Are they. Do they recover fully? Does it stick with them for life? What are the implications?

It very much depends. It's a case by case basis. So how you handle stress biologically, psychologically, emotional, emotionally and even spiritually depends on many factors. So of course your biology, but also environmental factors, genetics, your upbringing, There are so many factors. We know that the brain, because of this idea of neuroplasticity, which is a fancy scientific word that simply means that your brain is a muscle and responds to external stimuli. So it's not like the old scientific thinking, which was like the brain you got for life is the brain you're going to have forever. It's the brain that you had at birth. It's like a real grab bag. Now we're learning through this science of neuroplasticity that your brain changes and evolves based on stimuli. And so a lot of my work has focused on this idea of neuroplasticity, that you have the ability to change your brain through your behaviors. And so even if you may have had a difficult time in childhood, early, we know that early childhood trauma, adverse effects that happen in childhood, can of course influence your stress response later in life. And yes, it is important to normalize and validate those difficult experiences if you have them, to seek therapy, trauma, informed care, and all of that. But also to understand that you can, over time, with patience, practice and perseverance, help rewire your brain for less stress and more resilience through the mechanism of neuroplasticity.

It was a huge honor for me to interview Dr. Eric Kandel, who won the Nobel Prize for his work documenting neuroplasticity. And then to be on Dr. Daniel Amen's board of directors now for Amen Clinics, where he's got more than half a million brain scans. And it proves beyond a reasonable doubt that your brain will change when you change the environment around you, when you change your stress exposure and change your stress response. So this is something we can do. And in my, the book that I haven't published yet, the one I'm in the middle of writing now, I'm going through all the different ways we know of that allows you to rewire the brain more quickly, more effectively. What is the single best way for someone to turn stress off, at least for a brief period.

There are so many ways that I talk about in the five resets. And so there are five main resets and 15 signs back strategies. But the overarching principle is to have a sense of self compassion and give yourself lots of grace in the process. It has been a difficult time for everyone over the past several years for lots of reasons. First, because of the, you know, individual and collective trauma that we've all experienced. The P word, I won't say it more than once, the pandemic, and then all the aftermath of that. But like we talked about evolutionarily, you know, you need the stress to shut off. And unfortunately, over the past several years, we've had an onslaught, one onslaught after the other. The pandemic ended, we've had a racial reckoning, multiple humanitarian crises, and it's just on and on and on. And so giving yourself a sense of self compassion and grace, understanding that if you are struggling with stress and burnout, you are not the exception, you are the rule. Studies show globally that in a room of 30 people, 21 people are struggling with stress and burnout. So if you feel this way, you are not alone, it is not your fault. And so that is my overarching principle. And I would say probably the most important lens to look at, ways to rewire your brain and body. Being gentle with yourself is the most effective path.

If it's not your fault, doesn't that imply that it's out of your control?

No, I would say that it first, you know, in clinical medicine, it first, the most important thing is to normalize and validate a difficult experience. And so understanding that it's not your fault helps to normalize and validate something very deep. We are all going through this in, in our own way because we are all individuals, you know, seeing the world in different ways through our experiences and what we're experiencing now and our upbringing, etc. And so understanding that you are not alone is actually a very powerful therapeutic tool. It's one of the principles of group therapy. When you go through a difficult experience, there's a lot of shame and isolation. And when you sit in a room with other people who've gone through that same experience, when they share those experiences, there is a healing that happens. It's called the group effect. It's actually a studied phenomenon. And so knowing that you're not alone, knowing it's not your fault, you know, I talk about the stress paradox in the five resets and what the stress paradox is, is I would see this every single day when I would have a patch waiting room of patients, right? And my 12 o', clock, my 12:45, my 1:30, my 2 o', clock, every single patient would be struggling with stress and burnout. They would come into my office, shut the door and burst into tears. But in that waiting room, kept it together at all costs. And it's this idea that we are all struggling. 70% of people have at least one feature of stress and burnout right now. We are all struggling and yet we are isolated in our togetherness. So it's a real paradox. It is not your fault. It is your brain and body doing exactly what it's intended to do. Your brain isn't broken, your body's not broken. You're just responding based on neuroplasticity to your external environment. And these times are tough for so many people, including you and me.

It's funny, I do use that group effect as part of my 40 years of Zen process, because just having the ability to hear someone else who's working on something like, oh, me too, so that feeling of loneliness goes away, the feeling of community builds. And I, I've gone from the kind of it's not my fault. I, I had birth trauma, I had the, the cord wrapped around my neck. And so that creates, you know, early childhood averse effects. And I actually had PTSD that I didn't even know about till I was 30. And I' through all that and at the end of the day, it started out for me as, oh, it's not my fault. And I've kind of evolved to the point where everything is my fault and it's just because I don't know how to solve it yet, right? Like, oh, it's happening to me, but it's still within my control. So maybe it's a difference of semantics about blame or, or just having the deep inner knowledge that this is something that changes. So like, I'm happy to take responsibility. You know, some really bad things happen in my body. Freaks out. I'm like, huh, what did I do or what did I not do to be able to handle that? Right? Knowing full well that my biological response is built into my, my body is built into my meat and it's something that's changeable. How do you give people that sense of agency when they're looking at, at really evolving themselves?

Beautiful question. That sense of agency is so important. And especially when you're feeling a sense of stress, you are living your amygdala is driving the train. And you are living in that moment of survival and self preservation. And so it is all about addressing your immediate needs. The sense of agency requires strategic thinking, forward planning, looking at the future. That part of your brain is the prefrontal cortex, which is the area right behind your forehead. And when you are living in amygdala mode or stress mode, it is very difficult to access the prefrontal cortex, which is another part of your brain. They work very much in tandem. And when you are feeling that sense of stress, it is hard to get out of your own way. Again, your biology working as it should. So how can you move out of amygdala mode and into the prefrontal cortex? And you start with creating what I call your most goal, most as an acronym, M, O, S T. M is create a goal that feels motivating, O is it's objective, S it is small, and T it is timely. You can achieve it in three months. And so when you can see it, you can be it, right? And so creating that most goal gives you your North Star and your why. So it is easier for you to get out of your own way and then you take certain steps to get there. You know, I, I, that's what the first reset is all about. It's about getting out of amygdala mode into back into the prefrontal cortex so that you can have more strategic thinking and start with one step. Because when you take that first step, as small as it is, in fact, the smaller the better, you then build your sense of confidence, you built your sense of self efficacy, and then you can do it a little bit more and a little bit more and a little bit more. But initially your inner critic, and you know, you feel very defeated when you're feeling a sense of stress. It's because your inner critic, also, by the way, powered by your amygdala, has a, Meg has a megaphone. And it's about taking that inner critic's megaphone out of its hand and get your prefrontal cortex back involved in the conversation.

Do you still have an inner critic?

Of course I do. We all do. My inner critic is it, you know, like I said, this book launch, and there's many times in my life that my inner critic starts, you know, gets that megaphone back and then it's my, it's the work of continually working to take that megaphone out during periods of stress. But the difference is because I've been doing this for now 25 years, when I hear that inner critic's Voice. It's like meditation, right? When you. You've been meditating. I've meditated for many years. And so it's observing, oh, there's that inner critic again. All right, time for me to start taking charge again. And there's these various steps that I can take. But when you are mired in stress and burnout and can't see the forest from the trees, it's very difficult. And so then inner critic, instead of being a voice, becomes the voice.

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I've done a lot of healing work like you have, and after six months of electrodes on my head for a week at a time and just doing really deep states meditation, I can see there are times, especially if I'm just really tired or, you know, ate something that was not good for my biology, where I can be reactive, but I don't hear an inner critic in my. In my head anymore, not like the way I used to at all. So there's times when I'm reactive or actually emotional, and usually I see it as it's happening, and if I don't, I usually see it, you know, Without a little while. And I go, sorry about that. But it. There isn't like the shame and guilt and critical stuff that I dealt with for a huge amount of my life. It just feels like it calmed down.

Yes, me too. I had my inner critic was very loud in my medical training also because, you know, sleep deprivation and working 80 hours a week. And I really changed the infrastructure of my life from then to now. And so that, of course, helps because I just have more reserves now. And, you know, but of course, that inner critic, it's more of a whisper, but you're right. When you do the work and you spend that time really, you know, focusing on healing, the inner critic isn't as loud, but it certainly creeps up. And then you're also much quicker to recognize it. I call it the canary in the coal mine. We all have this thing. And so some people, you know, for me, it was palpitations like the stampede of wild horses across my chest. For others, it might be abdominal pain or headaches or some sort of physical tell of, wait, this is too much stress right now. Or it could be a mental manifestation. Difficulty sleeping, anxiety, depression. There's so many. You know, stress has many flavors, a million flavors. And it's about recognizing what your canary song is, what your body's trying to tell you. My body likely had many other tells, and maybe I just noticed a, you know, skipped beat or something. And then only because I wasn't paying attention as a medical resident, only it had to get so bad. Only when I had that stampede of wild horses is when I was like, okay, it's time to pay attention.

In your book, you talk about toxic resilience versus regular resilience. What's the difference?

So think back to 2018, you know, and you heard the word resilience, and it had a positive connotation. And we all know what that means. It's your innate biological ability to adapt, recover, and grow in the face of life's challenges. But since the pandemic, particularly during the pandemic and over the past several years, that word has changed. And what has happened is it's become and morphed into toxic resilience. So true. Resilience, the scientific definition, which I shared with you, it honors your boundaries, celebrates your ability to say no leads with self compassion. But toxic resilience is productivity at all costs. It's a mind over matter mindset, and it is a manifestation of hustle culture. Over the past several years, you hear that word resilience, you know, I really grapple Dave with putting that in the subtitle of my book, because I hear the word resilience and I cringe. I have a visceral response now when someone says something like, just try to be resilient. There's lots of toxic resilience messaging. You can work and parent. You know, we're taught, right, like you, especially women, that we should work like we don't have a family and parent, like you don't have a job. You are told over the past several years, particularly so much messaging around toxic resilience. They don't call it toxic resilience, it's just called resilience. You can take on another project, you're resilient, you can stay late at work, you're resilient, or oh, you can't handle that. You must not be very resilient. And it's a myth that resilient people can't get burned out. Studies show that even amongst the most resilient workers, resilience is protective, but by no means does it prevent burnout. And so this idea of toxic resilience, every country has it, the us, we have the Energizer Bunny. Just keep going in the uk, keep calm and carry on. And every country has its own version of toxic resilience. And so a lot of my work has been to dismantle this idea of toxic resilience and, and really go back to true resilience, where you really do put boundaries on your time energy, again, to protect your mental health and to reset your stress. So it's not this chronic ongoing thing where you can't see the borders, but it's something that is manageable and ultimately can be tamed.

What I've learned to do with, with biohacking is to develop the sensation for where is the boundary of what I can do versus what I want to do? And to be able to make a conscious decision for a brief period of time that even though I'm beyond the sustainable thing, I am choosing to be unsustainable for 48 hours because I flew to Dubai, I gave a killer speech, and I got on a plane and flew home. That's just bad stress, all that flying, all that stuff having to be turned on. But I have all the mechanisms to deal with it. Some of them pharmacological, some of them nutritional, some of them lifestyle, some of them breathing, meditation, all that stuff. So you realize that's a kind of resilience that you can only have if you know when you've hit the wall. And the risk of someone who's embraced that productivity at all costs. With the tools that are in your book, the tools that are in the world of biohacking, you can move the wall out pretty far. So your capacity is higher. But that means if you hit the wall because you're unaware of it, you're going to hit it really hard because you have more time to build up speed and you're more likely to get into that burnout state. So it's a matter of knowing what's your real boundary and knowing how do I stay safe if I briefly exceed it like you would in a high intensity workout, you know, you went beyond your normal heart rate, but it then you've stopped and it was okay. In fact, it was good for you. How do people know where that wall is?

For them, it takes time and practice. And that wall, like you said, changes. It's not static. It's always in flux. You know, I think the myth is that all stress is bad. And the sign shows that there are two kinds of stress. There's good, healthy stress. Like you were saying, you flew to Dubai, you gave a great talk, you felt great. Yes, it was stressful, but it was a healthy kind of stress for versus. And that's called adaptive stress versus, scientifically, another kind of stress, the bad, unhealthy, dysfunctional stress called maladaptive stress. When you and I and others use that word, oh, I'm so stressed, this week's going to be stressful. I had a stressful day. What you're referring to is maladaptive stress. That is the cascade, you know, causes lots of mental and physical manifestations. But good healthy stress can help move your life forward. Giving a talk in Dubai and flying home or getting a promotion, buying a new car, having a child, planning your next vacation, rooting for your favorite sports team, all examples of healthy, positive stress. So it is not that all stress is created equal. In fact, there are two discrete types of stress. And the goal is to really transform your unhealthy maladaptive stress back to healthy levels. And that is about what it means. You know, when you talk about moving that wall, it's understanding that there is a wall first. Where is it? Where is it for you? It's different than where it is for me or others. And then knowing that you have the capacity to move that wall, but only with time, practice and a little bit of perseverance, not much effort, believe it or not, it's not. Doesn't take hours and hours of your day to rewire your brain for less stress. It just Takes a couple of minutes. And you can do it in the midst of a, you know, you don't need like a six month vacation to Bali for surf camp though. Sign me up for that plan. You can do it in the midst of your over scheduled life where you have so many priorities and it's just so difficult. We can't all just take off and, you know, be checked out for six months. We have financial constraints, responsibilities, obligations. You can rewire your brain for less stress and more resilience. Believe it or not, in the messy middle of your everyday life.

For me, it feels like it. It goes way deeper than the brain. For instance, on one of those, you know, global bender trips for public speaking, I will take extra adrenal extract and herbs like licorice root that support my body's ability to have a healthy stress response. And if I still feel burned out or like I'm getting brain fog or on the edge of catching a cold or something, I just take 5 milligrams of Cortef, which is bioidentical cortisol, which allows my body's stress response to do what it's supposed to do. Maybe. In fact, I know mine is maladactive, I don't make enough cortisol sometimes. And that appears to be a lifelong thing, not just a stress response. So it feels like you can physiologically support your biology as well as knowing those are limited time things. And you've got to do all the mental and breathing and emotional and things like that. But if you did all those and you're still about to crash, you can buy a little bit of extra time. So as a doctor, shoot holes in that.

You know, I have had, over my decades of clinical practice, so many patients who have come to see me with bags of medication. Polypharmacy, we call it.

Yep.

And polypharmacy is a word that's used mostly for medications prescribed by a physician. Now, my take is always that I don't prescribe nutraceuticals, herbaceuticals or anything like, you know, any medicine. For example, polypharmacy and prescribing herbs and supplements, et cetera. My take. And again, every sphere of medicine is different and a different focus. My take is that you can use the power and wisdom of the body to help with your stress and burnout. That's not to say that you don't need medication. If you're experiencing anxiety, depression, ptsd, insomnia, et cetera, you have to work in concert with a physician and ideally a team of physicians all of the patients that I have ever seen have been referred to me. You know, I'm an MD working in the conventional medical system, referred by other MDs also working in the conventional medical system. I don't see patients any longer. But when I did have a clinical practice, it. I very much believe in the conventional medical system, taking medication, seeing your physician, etc. But I never prescribed any. And I know this is. This is work that you do, but it was not my focus. So when you're asking, like, poking holes, I. I don't necessarily want to poke holes, but I will simply say that my work and my focus is always about fanning that flame of empowerment and that inner sense of agency. Because often where my patients are and where they would like to go feels like a wide chasm for many people. And my job is to close that gap, is to hold up that mirror and say, you can do this. You can take that first step. And by showing them that these steps are actually quite small, and that when you take that first step, you feel a greater sense of agency and efficacy. And then you want to do it again and again and again and over time. That's my work, is to really help people close that gap from where they are, their origin, to where they would like to be, their destination.

The chasm can feel really big. I mean, I. I've had times in my career, especially early on, where I feel like I was in a car and had the accelerator pushed all the way to the floor, and it's slowing down and there's. There's no more pushing left. And, you know, that's a symptom of burnout, but it also makes you feel helpless. And, you know, when you feel helpless, like, there's nothing I can do. So I like that idea of just showing people the way you're doing in your book, okay, you know, something you can change.

And the other thing, you know, just thinking about that accelerator, One question that I often ask patients is, what's your end game? Especially my young entrepreneurial patients. I had a clinical practice in Boston, which is an entrepreneurial capital. And so many young patients who are entrepreneurs who would come in with the everything but the kitchen sink, right? Like binders of information and all of the things that they were doing. My first question is always, what is your end game? And then if they say that, you know, I want to be doing this for 50, 60 years, you can't be full throttle, all systems go for 50, 60 years. That's just not how your brain and your body work. So if you want to play the long game, as I imagine many of your listeners are entrepreneurs, you have to do it in a slow, measured way, particularly because your brain change, even positive change, is seen as a stressor on your brain. So your brain doesn't recognize. You know, of course there is good stress and bad stress, but change. So when I've had patients who come in with the binder of like a million things, this is why. This is why New Year's resolutions don't always work. Because we want to do 20 things and we want to do them all. And the truth is that your brain sees any change as a stress. And so your brain can only do two new things at a time. I call it the rule of two. If you want those changes to stick, and it takes eight weeks to build a habit, so try two things and bring them and fold them into your life. Incorporate it into your daily life. Give yourself eight weeks, understand that you're going to fall off the wagon and get back up. That is part of habit formation. And then after eight weeks, add two more things and keep doing that until you get to your destination. But if you just aim to do all of it all at once, chances are that you know, in a month, six weeks, you're going to say, I can't manage. It has to be sustainable. You need to work with your biology rather than against it. If you want to think about the long game, which is what we all want, right?

It's so cool. You were saying this at the biohacking conference that's happening at the end of May, beginning of June, in Dallas. By the way, guys, biohackingconference.com if you're not already signed up, expecting more than 3,000 people there. And I will be launching a tool that helps people identify their number one goal when it comes to health and performance. Because like you said, you know, everyone wants to be smarter, faster, stronger. You want to live forever, be great in bed, get a good night's sleep, get lean, have more endurance, and manage our stress better. Guys, just do it all at once. And just like you said, you can do one or maybe two of those at a time. So it's just helping people even clarify their goals. And then knowing what do you do is really important. And it's funny, because the first of your five resets is get clear on what matters most. Talk to me about the techniques of getting clear on your priorities.

The goal is to get out of amygdala mode and into your prefrontal cortex. Your prefrontal cortex is what we Call adulting in common language, right? Memory, planning, organization, solving complex problems. When you are an entrepreneur or if you are, you know, working in this world and you want to solve some problem, whether it be your work or your life or whatever it may be, we all have complex problems to solve in the world. That's your prefrontal cortex. But when you are under stress, you are governed solely by your amygdala. That is cave person mode, focused on survival and self preservation. And this first reset get clear on what matters most, helps you move out of amygdala mode and back to giving your prefrontal cortex your the ability to drive the train forward. And there are three strategies in this particular reset. The first is uncover your most goal. The second is creating a backwards plan. And the third is to uncover your buried treasure. And so going through each of those very briefly, we talked about your most goal and having a clear why. So this is not an existential why. What is my purpose for life? This is a clear, very simple, small why. Something that you can achieve in three months. And there's lots of examples. So I've had patients say to me, I want less knee pain so I can take a bike tour through the Netherlands. I want to go to my reunion and feel confident with my high school class, or I want more energy to throw a baseball with my grandson, or I want to sleep better so I can wake up feeling more refreshed and have more energy so I can find a new job. And so when you are depleted and running on empty, living in your amygdala, it is very difficult to make changes for your future because you are in your own way. And so creating a most goal helps you get out of your own way. And then the second backwards plan, the second step is the backwards plan and it helps you move, you know, work backwards. So looking at your destination first and then moving back to where you are and when you have it written out, it's just easier to achieve. And then the third sort of part of that first reset is uncover your buried treasure that is all about getting into a state of flow when you are feeling a sense of stress. That flow state, which you've talked about lots of times with many guests, that flow state is so therapeutic. And it's hard to get in a state of flow when you're feeling a sense of stress because the amygdala and your flow state don't exactly jive. And, and so you know, the key is when you give yourself that sense of self, compassion and grace, understanding that you are not alone. What's happening in the world has been difficult for everyone. And it's your brain and biology responding exactly as it should. But the next step, the next part of that is you are not alone. It is not your fault. But you also have the power to make a change in your life for the better, for less stress and more resilience by doing some small resets along the way. And that first reset helps you get there. It lays the foundation. It's like a roadmap for everything that's to follow.

What is your most goal right now?

You know, my most goal has changed, and I would say I try to have a most goal every six months or so. It's probably time for me to think of a new most goal. My most goal six months ago was to launch the book and really focus on taking care of myself in the process. I walk the talk. And so my most goal was to have enough energy and, you know, for the velocity that was to come. And so I really doubled down on my sleep. I focused on daily exercise, Zone 2 Fitness, which works the best for me, and meditation, and really just grounding myself very deeply in the moment, knowing that I was about to get on a roller coaster ride and understanding that of course there will be ups and downs and it's going to be fast and so many other things that I cannot control. But what I can control, I call it the tea kettle of stress. You know, we always try to change that dial of, you know, we think about a tea kettle and a on a stove with that fire burning so many times. We waste our time spending time trying to adjust the dial when the heat of the moment is external and out of our control. So what can we do? We can open that lever to blow off some therapeutic steam. And so I have worked very much. My most goal over the past six months is to open that lever to blow off therapeutic steam so that I could show up fully, authentically as myself over the past several months. Now I'm at a slightly different juncture of life and I have to think about the next most goal. And that for me is going to be about sustainability and keeping the momentum going, but in a much more sustainable way. I knew that the last most goal was just a short, finite period of time. And so I will be thinking about my most goal next month. That's what I had told myself. And so I'll have a new most goal. And it's also okay that as you're going through the process of resetting your stress to change your most goal because what will likely happen is that you'll achieve it and then you, you know, it's time for the next most goal.

Do you work with an accountability partner, a therapist or someone who says, hey, you know, it's been three months reassess.

That is a wonderful thing to start off with. I've been doing this for 25 years. I did a lot of these strategies on myself as a stressed patient and while I was in medical training. And yes, I had multiple accountability partners. But over time now I know what my tells are like the canary, you know, when I know what's happening. And so I typically don't have accountability partners. But it, as we know, based on the science, it is proven that when you have someone that can say, hey, did you go for your walk today? Or you know, did you get to bed early today? Or you know, digital boundaries, etc. I, my accountability partner now is kind of, you know, I can almost tell very quickly within like two days of if something's gone awry and I can quickly self correct. But that's taken years, years of work, Dave, as likely for you.

Yeah, you eventually get to be kind of like a Jedi master, like, okay, I know what's going on in there finally. And I know the corrective steps to take. I still find that it helps to have a third party who has independent view of me that's not filtered through my own biology, my own ego just to do a check in with. And I know we have hundreds of thousands of care providers and health care people and health coaches and whatnot. Even executive coaches listen to the show. So guys, there's gold here for you that check in every three months about that midterm most goal with your clients. And that can be a huge gift of just helping them to have accountability so they don't just chase a goal that they set a year ago, even if it's maybe not the one that serves them best today. So I like the idea of, of a scheduled check in to see where your goal is now because once you solve a problem and my goal is not to have migraines anymore. Well, if you don't have migraines and you haven't had them for two years, maybe that's not your top goal anymore.

Right.

Like it needs to evolve.

Yeah. And I think for me, my accountability partner very much, I just digitally do it now, you know, like I. It's very easy to talk yourself out of certain things. So I just have, I have check marks, I have tallies, I have certain apps that I use Where I can say like, did I really go to bed at 10pm Every night? I thought I did, but did I? And then I say, oh man, no, I gotta get back on that.

So, so screen time is good for you, right?

Haha. Screen time.

I'm just teasing you because that's your second reset is finding quiet. So your appropriate use of technologies is what you're using for accountability. But talk about your second reset, finding quiet, how does that work?

Yeah, so there's two main buckets in find your quiet in a noisy world. And they're very, very much tied together. It's creating a digital boundary and your sleep. And the reason they are so tied together is because think about what you do first thing in the morning. Maybe not you, Dave, but think about what you do first thing in the morning. Most people, over 50% of people, and I think that's an underreported statistic. You look at your phone, your second eye isn't even open. You haven't even acclimated to the light of day and you've just woken up and your phone is on your nightstand and you scroll, you scroll. Headlines, news, social media, email. So think about what that does to your brain. These are not benign things that are happening. They have a direct hit on your dopamine, your cortisol, your stress response. And so before you are even up fully, second eye isn't even open yet, you're not even out of bed, you've just woken up, that is what you're doing. And so that primes your brain for the whole day. Instead, take your phone and keep it off your nightstand. It doesn't have to be in another room, just, you know, people are taking care of elderly parents, or maybe there's a sick relative, or we're all caregivers in some capacity. And so some people say that I can't remove my phone altogether, so keep it out of arm's reach. And the reason is because digital boundaries are really important. So there's geographical boundaries, logistical boundaries. And so when the reason that digital boundaries are important is because we have a boundary in every single relationship in our life with our partners, our colleagues, our friends, our children. And yet we have no boundaries when it comes to this little device here. Porous boundaries. And it's not about becoming a digital monk, it's about reconsidering your relationship with your devices. Because studies have found that for optimal health and well being, abstinence is not the solution. It doesn't do as much for your health and well being to abstain from digital devices. What does bode well for health and well being is decreasing your reliance on your digital devices. And how do you do that? By creating digital boundaries. So the first practical step is to take your phone off your nightstand, invest in a low cost alarm clock instead, and.