Managing Stress for Year-End Success with Dr. Austin Perlmutter

Well, hello everybody. Thank you so much for taking a little time out of your day to join me in a conversation about stress and hopefully some things that are a little bit more relevant than maybe most of what is discussed. Because one of the things that's true about stress is everybody gets the opportunity to deal with it. But as people are coming into the meeting here, I am curious, as always, where people are tuning in from. So if you want to jump into the webinar chat and let me know where you're tuning in from today, that'd be very interesting to me and probably other people who are joining for this webinar. Fantastic. First person, Costa Rica. We got North Carolina, Oakland, California from Paul Canales. The great Paul Canales. For those who don't know who he is, look him up. He is one of the most amazing chefs that I know and an amazing contributor to the Big Bold Health team. We've got lots of other people tuning in from across the country. We see some Canada's, see several Canadas, and as usual, pretty good diversity of different places. Again, just asking everybody, if you're just showing up, where are you tuning in from today? Where are you in the world? And you know, I'm just always so blown away by all the different places people are coming in to hear me from and all the different time zones. So it looks like still a lot of people are joining right now. So we'll just wait for one more minute. I guess as we're doing this too and as people are saying where they're coming in from. If you want to ask me where or what you're interested in, if you want to tell me what you're interested in as it relates to the stress conversation, post that also in the chat, I don't know that everybody's able to see all the answers from, from other people. We can maybe try to do that, but actually, let's just leave it the way it is. I'll just keep reading out. We got Colorado, Ontario, Florida. We've got Savannah, Georgia, Connecticut. We've got Santa Fe, New Mexico. So lots and lots of people coming in here from all over the United States and the world. But again, question for you all and just let me know, what is it about this conversation that is most interesting to you? In the conversation around stress, there are always so many different opportunities to talk about aspects of this. But I am curious what motivates you to be interested in this conversation today? So, yeah, and just noting here, when you send a message, you can choose if you want to send it to everybody or to just myself, hosts and panelists. So you can set that underneath the two if you're in the chat. And we do have a question about Paul Canales and how do you spell his last name? Paul, if you're here, or Trish if you're able to post. Maybe Paul's Instagram account would be helpful so people can check out the work of Paul Canalis. Okay, well, thank you all for joining. We got lots of people in the room, lots of people, about a hundred people who are listening live and probably many, many of you who will be listening afterwards on this topic. So today's conversation is about stress. Now, as a doctor, I learned about stress in a number of different ways. I learned about stress as it relates to the physical stressors that we put on patients in the hospital, that people experience outside the hospital. And then I learn about stress from the perspective of a psychological stressor. And the reality of it is that there are a ton of overlaps. There's not a huge necessarily difference between a physical and a psychological stress because each of these is perceived by the body as a danger signal from the outside world. I think that's a really important first place to start, which is that stress is basically your body's perception of a need, an unmet need. That doesn't necessarily mean that it is a bad thing. You know, I think about this sometimes in terms of we need stress, otherwise why would you get out of bed in the morning? There's obviously some unmet need that we feel a little bit of anxiety or potentially a lot of anxiety around that propels us to do something, right, that keeps us moving forward. If we're really hungry, that is a stressor. It is our cells saying, hey, we need some fuel. If you're feeling really sleepy, that is a stressor, where your cells are saying, we need to rest and regenerate. So stress is really the body's perception of an unme. And it can be from the perspective of a psychological or a physical stress. Today we're going to focus more on what is generally perceived as psychological stress, because this is the area that we have maybe a little bit more control over because these are aspects of our lives that we can understand and have impact on. So again, what is stress? It is the body's perception of a threat or a challenge. And it leads to, when the body perceives this, an activation of specific physical and mental states. We're going to talk about exactly what those pathways look like. So what happens within the brain that then leads to effects within the body, when we experience stress, you can have like most things, a short term or an acute stressors, acute stressor or a chronic or a long term stressor. Why this matters so much is that our bodies have kind of evolved to handle short term stressors. That is something that we do something about, we resolve. So historically, if that was some sort of a danger, really a physical danger, meaning we were in danger of maybe dying or losing a limb, we would either do something about it or we would have that injury occur. But then we would move to the next phase, which is to be post stress. The issue now is that we have perpetual chronic stressors. And this leads us to a state of really never resolving the issue. And so it leads to augmentation of stress pathways within the body, within the brain, that chronically lead to immune imbalances and metabolic imbalances. I'm sure many of you know about this already, but there is this concept of a stress response. So what happens when the body is stressed? We're going to discuss this in a bit more detail. But considering just why the body does this, Stressors, high level stressors tell the body that there is an immediate threat to survival. That's what our brain is detecting. It's saying we have risk to dying and therefore we are going to produce molecules that will increase our chances of survival. So what does that look like? It is production of cortisol. We'll talk about the cascading effects of cortisol in a moment. And its production of adrenaline, also known as epinephrine. These have effects across our physiology, but what they do is prepare the body to basically fend off this existential threat. What do we actually experience? I'm going to go out on a limb and say everybody who's listening to this or watching this has experienced these effects. What happens when we get stressed? Now, that could be because somebody cuts us off when we're driving to work. So that could be because we were out camping and we ran into a grizzly bear. That could even be that we went on social media and somebody said something mean about us. But what we experience is similar. We experience an elevation in our heart rate, we experience an elevation in our blood pressure, our muscles get tense, we kind of shut down digestion, we can have trouble sleeping. We feel very activated. These are conserved responses. And again, one of the points I'm going to continue to make here is that even though we could be very smart in terms of our understanding of modern technology and the modern world, our brains haven't necessarily changed in the last couple of thousand years. Which means that even if we happen to see a stressor on the screen again, let's say somebody says something mean about us on social media, apparently that could be very inconsequential, but our brains would still perceive that as a risk. It would perceive it as a potential existential risk. Which means we still rev up those same stress pathways that would be elevated as they would have been many millennia ago if we ran into a cave bear. What does this do in terms of how we kind of interact with the world? Again, most of you probably have experienced these things in your own life. I know I have. But when we get overly stressed, we have trouble maintaining focus. And specifically, we have trouble maintaining focus on things that are outside of our immediacy. This makes a ton of sense. Stress is the body telling us basically we need to focus on the here and now and deal with this threat. But it means that there is an opportunity cost because we're no longer able to focus on things that are further in the future or things that are in our periphery. So if you are concerned about, you know, what gift are you going to buy for your niece's baby shower? And you run into another car on your way to work, all of a sudden you're not worried about the gift for your niece's baby shower. You're fully focused on this stressful event in front of you. When that happens for too long, we kind of lose track of being able to work on the stuff that is in the future and the things that are at our periphery. So, last point on this slide, which is really, really important, is that stress isn't an absolute objective thing. The things that are stressful to some people are completely mundane for others. So one person sees that comment on their social media profile and freaks out, has this whole emotional stressful response. Another person sees it and shrugs it off. It's not as though there are absolute stressors and we can even see this related to major dangers. Meaning if you're walking down the street and you happen to see a diamondback rattlesnake on the side of the road, there are certain people who would say, oh my gosh, that is incredibly scary. I know these are venomous. I know I could die if I bitten by one and have a stress response. And there are other people who would see the snake and say, it's a snake, not a big deal. So really, really important here. And maybe what's most interesting about stress is it's not about the objective level of threat that something poses. It's more about how we individually perceive and respond to those threats in our environment. Okay, let's do a quick survey here. I have a sneaking suspicion, have most of you heard about the HPA axis before? And if you have, tell me something interesting about it and we're going to launch into this, I'm going to do this conversation. What's interesting about the HPA axis is that this is something that is very cornerstone to understanding how hormones work. The endocrine system works in medical school and in post medical training. This is really the prototypical system of feedback, meaning that you're supposed to produce a molecule that then shuts down the molecule that led to the production of the initial molecule. I see some comments here about people thinking about the adrenals. Very interesting and very important part of this, the HPA axis. You don't have to necessarily remember this, but it's the hypothalamus, pituitary and adrenal axis. That's the H, that's the P, and that's the A. What it is is kind of half of the stress response system. I'd say this is the part of the system that gets the most play. And, and it's probably because if we're thinking long term, as far as the downstream effects of chronic stress, HPA dysregulation is where most people spend their time. So what happens here is you have a part of your brain called the hypothalamus. It signals another part of your brain called the pituitary, which then produces molecules that activate your adrenal glands. And then your adrenal glands, which sit right on top of your kidneys, produce a molecule that I'm sure most of you have heard about called correct. Cortisol. Cortisol is thought about as the body's primary stress hormone, but it is only one of many hormones that are produced by the body in the context of stress. So the HPA axis is in part responsible for some of the other things we see regarding input of stress onto our physiology. But the maybe the most important thing long term as we look at the downstream effects of chronic stress is what happens when our body is perpetually flooded by corporate cortisol. Now, in the short run, one of the most interesting and important effects of cortisol on our body is that it suppresses the immune system, meaning it actually calms overall immune activation. And what it does is it messes with metabolism. Specifically, it leads to short term increases in what's called insulin resistance, meaning when cortisol is high, it suppresses immunity and it increases glucose availability, meaning increases our body's exposure to glucose. Those both of those things make sense again in the context of our body's perception of stress as something that is an existential life or death risk, because it expects we're going to be in a little bit of a battle. We want to have higher levels of glucose available to power our muscles and power our brain. And we don't want to necessarily have too much worry about immune over activation because we expect to be injured. Now, chronically, what that leads to is impact on immune function, on sleep and metabolism. And again, speaking here from experience, I can say that especially in my medical training when I was perpetually stressed, I noted that my sleep was really messed up. I noticed that my metabolic state wasn't as good as I would like it to be, and I didn't necessarily do any immune panels. But I can tell you that I don't think I was as healthy in terms of my resilience against immune issues during that period. And beyond me, that's what the data would suggest. It would suggest that people who are chronically stressed experience these issues. Damage to immune balance, damage to metabolic function, and damage to sleep. What is supposed to happen here is that when you have cortisol go up, it tells the brain actually to decrease the stress response, so it has a feedback response. But if we're chronically stressed, what seems to happen is that we develop a resistance to being able to get that signal. Meaning instead of shutting down the stress axis, our brains actually are less sensitive to these signals and these molecules go on unchecked. Last thing I'll say here, as, as it relates to immunity, again, high levels of stress. But more importantly, chronic stress suppresses the immune system, making us more likely to have issues with immune related problems. Again, these are things that maybe many of you know. The other side of the stress response we have the HPA axis. On one side is the activation of the sympathetic nervous system. And this is fundamental to what our body does in response to stress. So the sympathetic nervous system is one half of what is called the autonomic nervous system. The other half being the parasympathetic nervous system, Often thought about as the rest and digest branch of the autonomic nervous system. But the sympathetic nervous system is known as the fight or flight response system, Meaning if it is activated, it is basically telling our organs and telling our body that we are going to either prepare to run away or we're going to prepare to fight whatever that threat is. When stress occurs in the body through pathways involving the brain's amygdala. It triggers activation of the sympathetic nervous system. And the molecules that are most important for the sympathetic nervous system are adrenaline and noradrenaline, also known as epinephrine and norepinephrine. What do they do? Well, they increase alertness, they increase readiness, they make us more focused on the moment at hand. One of the things that coffee does is increases these molecules, which is why coffee is sometimes seen as a sympathetic stimulant. What happens to our physiology is that when the sympathetic nervous system is activated, our heart rate goes up, our blood pressure goes up. We kind of basically move energy towards things that would allow us to fight off a threat or to run away from a threat. So we create activation of certain organs and decrease activation of other organs chronically, just like what we would see with HPA axis activation. Chronic sympathetic tone is thought to damage overall cardiovascular health. So this leads to basically a hyper alert state where our body is always revved up, where we are feeling perpetually as though we can't go to sleep because of course, we perceive some sort of a threat. And also where we can have issues with sustained high blood pressure and high heart rate, which over time can compromise our overall wellness. The flip side of this is that there is supposed to be a balance between the sympathetic nervous system and the parasympathetic nervous system, where some parts of the day were a little more sympathetic and other parts of the day were a little more parasympathetic. By and large, what has been shown is that most people have too much sympathetic activation, which means they're not getting the benefits of parasympathetic activation. Parasympathetics, as well as sympathetics, influence things like the immune system and metabolism, just as the HPA axis influences these things. So long term, the issue here is that you get this imbalance and this leads to a host of different negative health outcomes. So just to answer a question here, we will be sending these slides out afterwards. You'll have access to all of this in case there's something that you missed or want to read again. Okay, now we're going to focus on what I think is a really helpful way of framing stress, because, again, stress is not a bad thing. I'm going to say this one more time. Stress is not a bad thing. Stress is simply a force. It is a necessary force. It is telling our body there is something that we need to take care of and it is a motivator for us to do anything. But there are different Types of stress. And the worst version of stress is distress. So what is distress? This is the negative stress that overwhelms us, exhausts us. And this is really linked to not having agency over what comes next. That's super important. We'll talk about different forms of stress in a moment. But the stressors in which you feel like there's something really bad or something that you can't take care of and there's really no solution to it. So the existential threats, right, those can be stressors where we feel we have no agency over it. If it's a political stress and we feel like, oh my gosh, I really don't like what these politicians are doing, but I can't do anything about it. These are the distress because these are the scenarios where we are having a negative outcome occur and there's nothing that we can really do about it. Some examples would be financial pressures, relationship conflicts, work overload, prolonged health issues. Again, these are things that just smolder in the background and we don't feel like we're moving towards a solution. What happens with chronic distress is again, what I have said. It damages immune balance, it impairs our overall wellness, and this is the type of stress that significantly contributes to a higher risk for having mental health issues. What about eustress? So who here has heard the term eustress? Let me know in the comments if this is something that you've heard about before and where you heard it. Eustress, as opposed to distress, is actually a good stress. And if you've heard of the term hormesis, this is the idea that actually some degree of stress on our bodies increases our health, increases our resilience. So this is a positive stress that actually helps to motivate us, to energize us, and it promotes growth, it promotes accomplishment. Some examples of this eustress or this good stress would be the excitement that comes before you get on a stage. So let's say you're doing a music recital or public speaking for the first time, or you're doing your presentation for work. You know, you can have the jitters, you can have the butterflies, but if you eventually get up there and you're able to get through it, often you'll say, wow, that wasn't a big deal. So actually grow as a function of increasing this eustress. What does it do? Well, it helps us to improve our motivation, our resilience, focus. And actually, eustress can benefit our immune balance. And this is a really, really interesting thing, again, comes back to this idea of hormesis from a physiological perspective, exercise is a eustress. It is a hormetic stress. It actually damages our body a little bit, but in the process improves resilience. And the same can be said for all of these kind of psychological stressors. So for me, as somebody who had never done much public speaking, but realized it was something that was going to be important, I wound up going to Toastmasters when I was living in Portland, Oregon. And I will say, sitting there at that table with seven other people who I didn't know and having to stand up and say a couple of words about myself and say something interesting about myself, I felt some significant stress. But once I got over it and I said my piece, I felt a whole lot better. And then the next time I did it, I was even less stressed. And so the point here being that certain stressors are, are so significant because they bring us to a point of being able to manage further stressors in the future. So these are these eustress events. Okay, seeing as this is big, bold health and seeing as you're here to talk about a big, bold health related topic, how does stress map onto immunity? I'm going to outline what I've already kind of described, but I'll make it a little bit clearer. So chronic stress weakens immune defenses. It is an immunosuppressant. Cortisol chronically suppresses immune function. That makes our bodies and our immune systems less able to handle outside threats. Cortisol is key. Stress increases cortisol in excess. Cortisol levels can suppress immune cell function and dysregulate immune balance. What also happens, however, is that when we are chronically stressed, it actually suppresses the effect of individual immune cell populations to be able to do what they need to do. So it's interesting. It actually suppresses the immune cells ability to go after other issues. It's as though you're basically sapping energy from your immune system to pay for stress. So as you would probably expect, not great. What else does stress do? Well, stress has been shown, and cortisol in particular to actually lead to issues with the gut. Why is that important? So stress may increase leaky gut or gut permeability. When the gut is a bit more permeable, that can actually lead to issues with the gut immune system and in doing so damage systemic immune function. And then finally here, people who have more chronic stress are more prone to getting immune bugs. So that's something that people probably already know. All right, what are our biggest stressors I think this is, this is not the comprehensive list in terms of all of the stressors that people are experiencing today, but these are some of the top ranked stressors in the United States in particular and really around the world in terms of where people are getting the top sources of stress. So work, no argument there. I think most people understand that work can be stressful. Financial strain is a top concern. And we're actually going to go through. I'm going to give you data from the American Psychological association around the top stressors for Americans right now. But financials, social media, health and wellness, relationship, environmental and global issues. The reality is that there is no end to the list of the things that stress us out. Let's talk about what people are actually stressed about in the United States right now. So this is a report that is put out by the American Psychological association each year and they look at what is most stressful to Americans. Does anyone have any guesses as to what number one is going to be? Just throw it out while we're going into this, but we will talk about the specifics. So I'm going to break this down by different age groups because as you might expect, okay, so we see financials thrown out here as a potential topic of top stress. As you may expect, different age groups handle stress differently, have different stressors. So we're going to start with the youngest age group, so 18 to 34. So these are the youngest people that are pulled. The number one stressor for this age group, we had somebody get it right, which was money. 82% of people in this age group are stressed about money. But health was at the exact same level, which I thought was really interesting considering these are young people. Then we have the economy. 72% of people were stressed by that. And then housing costs, 70% of people. Let's move on to the next age Group. So 35 to 44. Money, the economy. Now we see family responsibilities playing a role which makes sense given the demographic. And then finally personal safety becomes more significant for a number of reasons. But as you might expect, if you have a family that you're worried about, then obviously safety concerns become a little bit more important in the 45 to 64 year old age group. Money, health and the economy. And when we look at the 65 and up age group, it's the economy followed by health. I did think it was interesting that as we went across the age demographics that the total amount of or the intensity of the stressors seem to go down a little bit in older age groups relative to younger age groups. And one thing that I think is really interesting as we look at mental health issues is that they do seem to be increasing predominantly in the younger age groups. While things like loneliness preferentially affect those who are more elderly, other mental health states seem to preferentially affect those who are younger. So I think this is really interesting to see what people's top concerns are now when we think about technology, modern technology, not to name any brands, in terms of those who are maybe most at fault in terms of what is creating stressors for us. But it is true. And I think if you're tuning into this live or watching this after the fact, you know this just as well as anyone could, that we are constantly connected through our digital devices. 24 7. I actually had the power go out last night because we had a windstorm up here in the Pacific Northwest. So no Internet, no text, nothing for the entire night. And it was shocking how much there was in terms of a silence when we're no longer able to engage with our digital devices. This is the reality we find ourselves in now, which is perpetually being online. We are also being inundated with information, whether it's the news or social media or text messages. Hey, did you read this blog? Did you listen to this podcast? We are absolutely overwhelmed with data. And then there's this social media comparison. Now, I'm sure none of you have ever compared yourselves with other people on social media. I'm being facetious. You probably have. But what is true is that our brains have trouble recognizing that these are not necessarily real people having real lives that can be different degrees of gray. You know, you could have somebody who only posts on social media when they're on vacation. And so every time you see them, you think to yourself, wow, I'm inferior because I'm not in Bali or Fiji right now to the more extreme examples, which is that now there are a number of people on social media who are actually AI images. And so when you see some of these people, when you see some of these images, they. They do not exist. They're not even human. Our brain, however, doesn't recognize that. It still compares us to these surreal alternate versions of humans that are perfect in every way, shape, or form, and we internalize that as a inferiority. Stressor, disrupted sleep patterns could do a whole lecture on that. But one of the issues that comes from our constant exposure to digital media is that it disrupts our sleep. This can actually promote stress the next day, because we know that stress and sleep are very tightly located or tightly wound together, that sleep and cortisol go together very closely. If we're exposed to screens before bed, we can suppress our melatonin. One of our colleagues, Deanna Minick, often talks about the role of melatonin across a number of different systems within our bodies, including the immune system and including on stress pathways. So issues with sleep is a major consideration here. And then one of the other things that I think is so important in our understanding of what our digital technology does to things that are related to stress is that one of the most potent ways of decreasing psychological stress is by having meaningful interactions with other humans. Now, you don't have to have those interactions in person, but historically we do best when we are spending time with other people that we care about. If we are perpetually spending time on our devices, either mindlessly scrolling through Instagram and TikTok, or just basically deciding we're going to only communicate with people through our devices, as opposed to getting coffee, going for a walk with people, or meeting people in person, that also is a net deficit in terms of our stress. So we're going to talk in the last little bit about what to do about this and we're going to focus in particular on the role of stress and helping to support the immune system because again, this is big bold health. And kind of the, the mo of big bold health is to help people to improve immune balance through personalized strategies. So as we're talking about stress here, we're really going to focus on what does this do in terms of decreasing stress activation and how does that then help us to build a more resilient immune system? Number one thing that I'm going to start with is setting boundaries. There are a lot of people who have mentioned this in far more eloquent terms than I'm able to, but I think that something that is is so relevant for the modern world is unless you define the things that you care about, the world will do it for you. The best example here is the news, right? So the average American spends 11 plus hours of their day consuming media, of which around four hours is watching TV, a couple hours listening to the radio, two hours on social media. And one of the things that people spend the most time doing is consuming news content. This does not mean that the news does not matter. But if you only listen to news stations in terms of what you're supposed to be doing in a given day, they will basically tell you that unless you are glued to your screen 24 hours a day, you are not caring about your country, you're not caring about the planet. So this is just a great example of scenario that would lead to an incredible amount of stress without being able to actually do anything about it because we didn't set a boundary and kind of decide for ourselves what was relevant. So learning to say no to things that increase stress in our lives without much of an ROI in terms of benefit, really important digital boundaries I think are key. It's easier said than done. For the book Brainwash that I wrote with my dad, we developed a tool called the Test of Time. And basically what it is is applying a lot of the criteria that we apply to other aspects of our lives to our digital devices. So very quickly, it's an acronym, T I M E T T is for making it time restricted. If you're going to be engaging if with your digital devices, which you probably are, consider setting a time window for that. So if you want to go Instagram, great. Set a 10 minute timer. If you want to watch TV, great. Watch one episode and then have your timer go off. These help to keep you from going perpetually down these spirals. I is intentional, meaning you want to make sure that you are the person driving the car if you're engaging with this content rather than just finding yourself two hours later consuming this content without any idea how you got there. M is for mindful, which means to be aware of how your digital content is changing you. If you feel increasingly stressed by watching a TV program, be mindful about it, take a pause. And finally, E is for enriching, which means you should be benefiting from your engagement with digital media. If you can't walk away and say, here is what it did for me, that was not necessarily a good use of your time. Beyond this, I think being able to communicate what we need and being able to pause and maybe duck out of scenarios that are no longer good for us. If you're at a conference and you're, you know, kind of already wrapped up in all that education, you don't have to keep staying and absorbing it if you've already hit your limit. Similarly, in a conversation with somebody, if they only want to talk about a specific conflict happening in the world and you've already done it for 30 minutes and you just feel like you're not getting anywhere, it's okay to say, hey, listen, thank you so much. I actually need to take a pause. And good friends, family, hopefully will respect that work, life balance. I won't speak to this in too much detail, but just recognizing that these things are good and Then a self care routine, which to me is most important in the morning and in the evening, but maybe more so in the evening because so often the things that are major stressors in our lives can encroach upon our evening routine. Taking away from quality of sleep and taking away from quality of time with the people we care about. One of the other variables that I think is so important is introducing more nature into our lives. Now, nature time has been shown to decrease levels of stress. What's really great about nature is that it also is associated with a number of other health outcomes and mental health outcomes. Being outdoors has a number of benefits to stress, but it also seems to have a number of benefits to the immune system. So you're getting kind of a double dose of benefit when you spend time outside. It encourages mindfulness and improves sleep. And maybe most important, nature exposure is both accessible and cheap. Now I get it. Depending on where you live in the world right now, it might be very cold out, you might be experiencing still a bomb cyclone, which is a thing. The point here is not perfection. It's like exercise. If you can't go exercise one week, you don't say, well, I'm now no longer an exerciser with nature. It's trying to get doses of it when you can. And research shows in little as 20 minutes is sufficient to help decrease certain markers of stress. Okay, now let's talk about another great one, which is animals. So why are animals so wonderful? First of all, they're just amazing, and that's just an objective truth. But interacting with animals can actually help to promote lower levels of stress. Caveat to this, you know, if you buy a Komodo dragon and it's walking around your house biting your heels, maybe not the lowest stress creature, but when we're talking about most pets, so cats and dogs maybe a little more so dogs, if we're going to be honest. In terms of what the literature says, that pets seem to improve overall stress levels. And in the case of dogs, what we've actually seen is a improvement in long term cognition as a function of interacting with pets. This isn't to bash cat owners or cats or anything like that. I'm just basically saying this is what the research says because one of the major variables here is this feeling of unconditional love and companionship. So animals are great. Dogs in particular have been more associated with mental well being. That may in part be a reflection of needing to walk them, it may in part be a reflection of how they interact with humans. But any type of Pet is an interaction with mindfulness and with kind of bringing your center of focus back to the present moment. Okay, community is both a good thing and a bad thing. Why do I say that? It's because, again, I'm telling you all things you know very well. But positive relationships are perhaps the single best predictor of overall good mental health, overall lifespan. Positive relationships are the glue. With that said, when we are with people who are not so positive, who are stressful in our lives, that can be a major contributor to stress. So the goal here is to become part of a community if you're not already. Again, so much easier said than done. But finding opportunities to interact with other people is something that is incredibly beneficial to stress pathways. And again, something that I'll say is not always so straightforward, but limiting time with people who are, in essence, detracting from your overall quality of life energy. Vampires or other things have been used. I've heard those terms. You know, we all have family and friends, and we have to find the right balance. But I do think in the aggregate, finding meaningful relationships is probably the most important thing any person can do for overall health span, which has a lot to do with what it does for our stress. There are just some opportunities, some ideas here. You know, these are things that we've all heard, but I feel like we. We often forget, and we kind of make it more complicated than it needs to be. Hobbies, like playing pickleball, is something that I really enjoy, but volunteering, anything that gets you out and into the community, these are ways to benefit from the interpersonal interactions that can decrease stress pathways. All right, how about diet? How does diet relate to stress and the interaction with the immune system? So stress is really just a biological pathway run amok in the context of distress. You know, as much as we think about stress as a psychological construct, which is somehow separate from a biological construct, the reality is that, as we've already discussed, stress occurs because of brain programming, and it is perpetuated because of physical molecules like cortisol and norepinephrine. So one of the things that's been shown is that when we eat a diverse range of foods that are rich in vitamins and minerals, that this may actually help to offset some of the negative effects of stress. Because, again, when we're talking about the negative effects, and especially around the immune system, we recognize that there are overlaps between pathways activated by stress that are also activated by nutrition. So it is not to say that if you simply eat a bowl of kale, it's going to take away the stress you have because you hate your job. But it is to say that if we're looking to overall enhance immune balance, that if we eat a diverse range of nutrients that can help to program our immune system towards balance, then it can offset some of the negative effects of what is happening with stress. Another correlation here is with blood sugar. So eating healthy meals, specifically those that are lower in refined carbohydrates and added sugar, this can help to stabilize blood sugar. And what I'd say is not everyone, but some people are very sensitive to ups and downs in their blood sugar, and that can actually lead to feelings of anxiety and stress. So again, a way in which diet can help to offset some of the negative effects of stress. Omega 3 fatty acids, I think, are an interesting group of nutrients for a number of reasons. But most important for our conversation here is they may help to act on and mitigate some of the downstream targets of stress in our bodies, Similar to the kind of blood sugar stabilization. I think avoiding stimulants for people who are experiencing a lot of stress is really important. I like caffeine. I'm having a delicious cup of coffee right here. But it can definitely exacerbate feelings of stress if we're not getting to the underlying reasons why we're feeling stressed. So, similar with added sugar, I would say these are scenarios where we really need to be cautious in terms of whether the molecules we're consuming from our diet are exacerbating what's happening. Gut brain connection so again, what happens in the gut significantly influences the immune system. So eating foods rich in fiber and probiotics and whole foods can help to balance the gut state, including the microbiome and the gut immune system. These are things that have been independently associated to be associated with better mental health. So this is another great way to look at this connection. Okay, how about mindful time and breath work? So again, there's a lot to be said here. You all probably are familiar with a number of people, Wim Hof, James Nestor and others, who have been big educators on the role of breathing and why paying attention to breath is so important to mental state. But the fundamental bottom line to this is that in a world in which we are perpetually distracted by stressors, anything that focuses us on what is within our control, the here and now is of benefit. And that is the intrinsic nature of mindfulness. I think that there are a number of ways to get caught up in my meditation is better than your meditation. If you're not doing transcendental Meditation, then you're not doing it right. But for the purposes of stress mitigation, anything you do, whether that's being in nature and being fully present in nature or simply doing breathwork in your home, is an offset to what happens within our brains, which is a over concerned state of the future or the past, which is really what stresses. So five to 10 minutes a day, I shoot for 10 minutes a day, closing my eyes, paying attention to my breath. And research shows that in as little as 10 minutes a day, you can start to get some significant benefit. It may not be the first time you do it. Paying attention to your breath may feel a little bit stressful, but doing this over time helps your brain to get into a place of focusing on the here and now. And that can be so, so important for people, myself included, who tend to get a little bit wrapped up in the future. Here's a quick technique. Something that you might enjoy is simply box breathing. Basically the idea. And if you look up a diagram, you can see it looks like a box. You inhale, you hold, you exhale, but you do each one for four seconds. And you just do this over and over. And it really can help to regulate the nervous system. Um, one task focus again, coming back to mindfulness, whatever it is you're doing, just do that. Whether it's brushing your teeth or eating a meal or tying your shoelace, it is simply focusing on the present moment. Last one here. Nature, as I mentioned, is a great way to bring more mindfulness into what you're doing. A couple more things we'll say here. So on the front of exercise, physical activity can improve mood. I'm sure many of you have experienced this. Physical activity also acts on pathways related to the downstream effects of chronic stress. Regular exercise promotes good sleep. Regular good sleep promotes decreased stress. Experience exercise offsets Number a number the effects of stress. By working on blood flow to the brain, it improves focus, mental clarity. So again, a number of reasons how it mitigates stress. It is a really healthy way when it's done the right way. But I think here's the point I would want to make is that we probably all know somebody, or maybe we are the person who is the incredibly intense exerciser and is also very stressed. There are a number of people that I knew during my medical training who you'd see in the gym and they would just be so intense about their exercise. Maybe you know, people who start doing really long distance training or whatever it might be. The key here is to understand that as it relates to the Immune system, and specifically the stress related immune dysfunction that overdoing it with exercise actually adds to that stress related immune dysfunction. So moderate intensity exercise is the way to go as we're looking at what most benefits the immune system. You can define this in a number of different ways, but I think we all kind of intrinsically know the difference. So, you know, multiple hours in the gym where you're, you're exercising to your peak capacity, that's a little different from moderate intensity. And really what the research would show here would be five days a week, around 30 minutes at a time where you're able to get your heart rate up. But we're not talking about ultra marathons here. Again, not taking anything away from an endurance athletes and people who are spending hours each day exercising. But when it comes to protecting your immune system, the research would say that it's more about moderate intensity that is beneficial. The last thing I'll mention here, which I think is always important to say in any conversation where we're discussing mental health, is professionals. So professional assistance. As much as I am a proponent of using lifestyle modification to help to decrease the effects of chronic stress, there are certainly scenarios where it becomes so significant that you benefit from seeing a person acutely and longitudinally. I think there's a huge benefit, especially in a society where we've become more and more disconnected from friends and family to having somebody on side who can work with you on trying to find tools and long term strategies to decrease your experience of stress. Therapists, counselors, other people who can be on your team in this way, they should be, you know, professionally trained. And I think there's some liability now because anybody can claim expertise because they've done some sort of a program online. But finding those who are actually qualified to work with you on these things can be an amazing benefit. So working with a professional helps to provide you with a support network and they can also provide you with referrals to connect you, especially if you're feeling really isolated with networks of people who can support you. Also, if you're working with a professional, this is a great way to prevent what may be a more mild or moderate stressor from developing into a fulminant and really intense stressor. There are a number of techniques involved here, some of which, you know, I've, I've taken courses in myself, including CBT or cognitive behavioral therapy. I think it's a really interesting modality. But the bottom line of what I'm saying with this slide is sometimes there is a significant benefit that comes from working with practitioners who have access to additional tools and specialized training. So if you are experiencing a whole lot of stress or somebody in your immediate circle is experiencing a whole lot of stress, I think it is a good idea not to try to handle it fully on your own. And as much as lifestyle matters, it always is not always the only solution. Okay, so what do you do to pull all of this together? We've covered some stuff. I feel like it's always challenging to compress what is a complex biological system within the bounds of a short online seminar. But hopefully you've learned a few things. Hopefully you've seen a couple of insights that can provide you with additional context for what stress is and what we can do about it. Some of the main bullets here would be, as we look at stress, appreciate that this is a major driver of problems throughout the western world and really around the world. And that one of the reasons why it becomes so significant is that we don't do as good of a job as we could in prioritizing our own own mental well being. So taking steps to create boundaries, to prioritize self care. These are so important. Realistic expectations. You are not going to resolve stress overnight, nor should we want to. You know, you always see in the movies or you hear about people who have their epiphany and then they solve all of their stressors overnight, they quit their job, they move to Bali. I guess that's a Julia Robert specific reference there. But the point being these things don't necessarily resolve overnight. You know, it takes time. And so finding ways to slowly mitigate stress is usually the best strategy for most people. Planning ahead is really important. So thinking ahead as to how you're going to be experiencing your next day, your next week and creating a plan for that so we don't feel what is such an important driver of stress, which is this feeling of loss of agency is incredibly important. And then I think here just I'm always going to say this. Most battles when it comes to health are one with the one to two yard plays, not the touchdown throws. So it's going to be trying to find small ways to win across the course of the day. So finding small mindful moments where you can focus on one thing and to maintain healthy habits, really, really important. One of the cascades that many of you may have experienced, again I know I have, is where you start having one stressor combined with another stressor and all of a sudden you find yourself in a spiral where things are getting more and more significant and more and more stressful. So healthy habits would mean things like prioritizing that 10 minutes of mindful time, prioritizing your time at the gym, prioritizing your sleep. Because when you start to get those basic building blocks in place, it decreases your chances that things get out of hand. Because now you've put some guardrails into place to help mitigate some of those stressors. Limiting technology time. I know the irony of saying that while we're all here on technology, but as you can, I think overall limiting time on screens, especially when that content is mindless and stress inducing, and then to that end, setting boundaries in general with any sort of content that is highly stressful. Last one here is I think social support is so important. So we have, you know, 120 or so people who are tuning in live right now. All of you are obviously interested in this topic. You know, we do what we can at Big Bold Health to create opportunities for people to come together and interact on social media and otherwise. But you know, there are a lot of people who care about this stuff. I was recently at a conference with the Big Bold Health team in West Palm beach and it was just so wonderful to see how many people there are who are working on these things and doing what they can to decrease the effects of some of the isolation and social stressors that can be so prevalent. So leaning on healthy social support. And again, the caveat being that you know the difference between people and interactions that are sapping your energy and taking your stress to the next level and people who are helping you to bring down to a more grounded sense. So finding your community is so important. So with that said, here's some additional resources. If you want to learn more about stress and the brain, you can check out my Brain Health newsletter. You're welcome to connect with me on my social media. We also have the Big Bold Health social media which you probably already are following@bigbold health.com or at Big Bold Health on Instagram. And then if you're looking for more science, you know some really exciting news. As of this week, we just had our peer reviewed publication go live in a journal called Frontiers in Nutrition. So for those who are interested to learn more about how nutrients impact a number of pathways within our bodies and our brains, you'll be able to find that now on the Frontiers of Nutrition website. But for more science in general, you can go to bigboldhealth.com so with that said, I so appreciate all of you here. If anybody has any outstanding questions, now is the moment to put them into the webinar chat and if you have them, I will try to get to them in real time right now. And if not, I will ask to shut this down. Looks like no major questions for the moment, so thank you all so much. For those who are celebrating with family, Happy Thanksgiving. And Trish, if you were able to shut down the meeting, I would so appreciate it. Thank you all so much.