Mind-Body And Lifestyle Medicine Are Powerful Tools For Preventing Common Mental And Physical Diseases, With April Hirschberg, M.D.

Welcome to the Mind Body Space Podcast, where you can stress less and boost your performance and wellness just by listening. Hi, I'm Dr. Juna Bobby MD, a mom MD passionate about sharing evidence-based tips and exploring fascinating topics like neuroscience and meditation with experts in education, medicine, and psychology. Your support makes this possible, so share this podcast and subscribe to our newsletter at mindbodyspace.com.

I'm so happy to see you here today. Thanks for joining me.

Hi, Juna. I'm just so glad we have the technology finally working.

I know we had some mishaps before, but this is excellent. You sound amazing, and I'm so happy to tell all the listeners that you're here to join me every Friday, last week of the month. We are so excited to be partnering together on a, a few courses that we're doing together. I've known you how long now? I, I met you at the Benson Henry Institute.

Yeah, it was pre-COVID, so it's been probably about 5 years, I think.

Yes. When we both got certified at the luncheon, that's when we met, right? Exactly. Um, so at the Benson-Henry Institute at Harvard Medical School where we both trained in mind-body medicine as clinicians. Um, and we found out that we had a lot in common cuz we're both moms. Uh, so I guess between the two of us, we range ages from, uh, high school all the way into college. And beyond. You and I also have in common the fact that you are a board-certified psychiatrist at Massachusetts General Hospital. Mm-hmm. But you have chosen to fully pivot your career because I think that's where we had a lot of similarities together, always having the same core values of like prevention and wellness.

Thank you, Juna Bobby MD. And it was great to meet you then. And, and looking back, I can't believe it's been that long. But obviously life has changed and evolved for all of us. So as you mentioned, I'm trained in psychiatry and I came over 20 years ago to Mass General Hospital and I've had the opportunity to continue there and benefit from so many great programs, first in the women's mental health and then through the Benson-Henry Institute's learning in mind-body medicine where I eventually came to meet you. But that additional training and the lifestyle medicine training I've had has really helped helped evolve my career to, as you point out, work more towards prevention, trying to prevent some of the mental health conditions that so many people struggle with. And if not prevent, then certainly mitigate some of the issues that people are facing today.

Yeah. And I think that's where we bonded, right, April? Because you and I are both moms and we just wanted to prevent some of the most prevalent issues out there today, which is anxiety and depression, you know, especially during the isolation of COVID So I think that's when we really bonded about what we wanna do, you know, because by the time in allopathic medicine, by the time someone is diagnosed with something, that problem has been going on for many years, especially in psychiatry, right? I think the average is 7 to 10 years. Maybe you know better than me.

I don't know the specific number. I honestly, I can't recall, but It's so true. You know, when you interview people over the years, as we both have, you know, many of these health conditions, especially the mental health conditions, started back in childhood. So if we can intervene with the kids, but really if we can intervene with the parents who are raising the kids, that's really where the most bang for the buck will be because we can not only help the child, but we can help the whole family.

Yeah, and I think over the past decade or so, it's becoming well known among psychiatrists and psychologists that there can be a preventative action that could decrease things like anxiety and depression. You know, you can start preemptively.

Absolutely.

The problem is that when you wait till there's a diagnosis and you have to see an MD already or a psychologist, then there's a major issue affecting your life, right? Cuz the DSM, which is the Diagnostic Statistics Manual, which everybody uses to code their medical bills, so to insurers and such. You need to have a diagnosis in order to be reimbursed for that. So you're not seeing a healthcare provider until you actually have something that's diagnosable, which unfortunately means that whatever's going on with you is significantly impacting your day-to-day life.

Absolutely. Yeah. It's either, you know, impairing your function in some way with regard to school, your social situation, your ability to work if you're an adult. So yes, it's when it's, you know, crossed over from You know, maybe a little bit problematic to severely impacting your ability to do things you would typically be able to do or enjoy.

Mm-hmm. Myself being on the anxious kind of side, but a good anxious, right? 'Cause anxiety helps us to prevent things. Anxiety helps us in some ways. It's not all bad. So in the sense that I want to prevent things for my children and myself, our family, and all the students that I've taught over the years. Because I couldn't believe like how powerful these mind, body, and lifestyle medicine skills were in combating the major diseases that we have in our society today. So talk to us a little bit more about how you feel as a psychiatrist. I mean, we have such powerful medications and in psychiatry, especially, uh, physicians, they do prescribe a lot of medication. You know, I remember seeing someone in medical school cause I was stressed out. Had gone through a breakup, and that first day that I entered her office, she wrote me a script for Prozac, which I took for like one month and then I stopped. Didn't really help me that much.

So, mm-hmm.

And thinking back, you know, it was a situational issue. It was a breakup. So I don't really think that it warranted medication, honestly. And don't get me wrong, I love medications when it's warranted.

From your point of view as a psychiatrist and as a mom, what made you really decide to go full on into non-pharmaceutical coaching versus the usual paths of pharmaceuticals and psychiatry therapy?

Well, I think for me personally, as you, as you point out, there are a lot of situations that do cause us stress, increased stress or distress, or a little bit of anxiety may then, you know, get exacerbated. So there are times in our lives that we may benefit from a medicine and that might be the only option. But sometimes when people are coming in to see a psychiatrist, that's actually what the only thing they want or think that they might be getting is a medicine. But really we do have other things to offer people. But in our training, in the traditional medical training, we didn't maybe get as much of that. And I think the pendulum has swung now. And I think as we are a little bit further out, Juna Bobby MD, from our medical training, I do think it's changed a little bit, but For me personally, when I was seeing people either in women's mental health or in the cancer center, I didn't want the only thing I could offer somebody to be a medicine. So that's why I wanted to get that additional training with the mind-body practices because we do as individuals have a lot of power to lower our own stress or distress levels and increase our body's relaxation ability or elicit the relaxation response, which is really our parasympathetic nervous system. I know you know all this, but our listeners maybe They don't yet. And so what you and I do, we try to educate people about the power that they have to take control of their own bodies and their own minds and health. And I think once you educate people about that, you give them back the power that they feel they are missing, especially in this day and age. I think many people feel like they don't have much control around their surroundings, but we do have control of our own reactions to our surroundings. So you may not be able to remove all the stressors from someone's life, but you can give them the tools to respond to those stressors. And that mind-body medicine is one of the biggest tools that we have as humans, but we never really learned about it. And that's why your courses are so important. And that's why it's important to be getting into the schools and getting the ability to intervene at a younger and younger age, because if we teach these skills to younger people, they will be able to do this throughout the rest of their lives. And it's never too early, as you know, Juna Bobby MD, and it's never too late to learn these skills. So we're just so excited that we have people listening to us and, and learning because it's a real journey and it's not always linear, but we always have the ability to learn and gain new skills about how to take control of our health and improve our life through lifestyle and mind-body medicine.

Well, I love everything you just said. Obviously that's why, that's why we're both on this path together. And I wanna go back to what you said about teaching kids younger and younger because as you know, I've been, I'm a big fan of primordial prevention, which it's the step before primary prevention where you actually decreases the conditions in which precursors to disease settle into your body. We now know that kids as young as 7 years old, 10 years old, have the beginnings of the inflammation of the endothelial cells, which is the lining of the vessels in our body that increases the chance of developing cardiovascular diseases. Well, hypertension, which would be the marker that would increase your risk for cardiovascular disease in the future. Starting really young is so important. Not that everybody has to be eating perfectly all the time. It's almost impossible in our culture. However, every choice you make adds up. Let's say you used to eat healthy, but then you took a year where you were just stressed and you were terrible with your nutrition and didn't really exercise much. Well, those habits that you had for that year, and especially the younger you get, the better. Think about things like brushing your teeth, right?

Mm-hmm.

We learn those things when we were very young. When we learn those things, it's still there. We now know with neuroscience that these kind of habits are ingrained in our brain. Those habits are always there to be uncovered. So even if you have those setbacks, it's much easier to go back when 5 years old, oh, you know, that was comforting to me when I ate apples, you know, or in season or something like that. So our brain like just recalls all those things. And the earlier you start, the better. The CDC recently came out with statistics that were just overwhelming. You know, they said teen girls who persistently felt sad or hopeless increased dramatically from 2011 to 2021. And that was before even the pandemic started. Went from like 36% to 57% of girls who felt persistently sad or hopeless. And then for boys, it was from 21% to 29%. Although I, I really think that's probably underreported. And I wonder, as a psychiatrist, how do you feel about these numbers and what the role of kids understanding their brains and neurobiology and the, the science of stress, how would that come into play to prevent or decrease this sort of epidemic we're having?

Yeah. I mean, you bring up many important points and I want to just go back to one of the earlier ones in terms of the, the health of our vessels, right? I mean, I think of that as being so important because our blood vessels are impacted by our heart. Our cardiovascular system is impacted by so many things. Including, as you point out, the nutritional aspect, but also we know that promoting physical activity and eliciting the relaxation response can really promote the improvement of our cardiovascular system. I was listening to another lecture this week and it was talking about if we think of our brains as being the top, so many people just talk about cardiovascular system as our core, like our heart and our lungs, but we have blood vessels all the way up into our brain. So we really are benefiting our entire brain and our mental health and our our brain health, when we're improving our whole cardiovascular system with the healthy eating, with the promoting physical activity and eliciting that relaxation response that we're teaching kids and adults of all ages, because it is a startling statistic that the CDC has put out about this increase in mental health conditions among young adults and really across the, the entire lifespan. It's dramatic and it's really should be a call to action for all of us. We do have ability to intervene, you know, within our own homes. As we know, Juna and I just was talking to my daughter the other day. She's like, "Don't tell me about another study. I don't wanna hear about it." Because I was talking to her about this study and how important nature is and getting out into nature on the snow day we had. I was like, "You know, we have to go outside. It's good for us." And she's like, "I don't wanna hear about it." But I did convince her to go out. And her mood did seem to improve after we, you know, we had gone out for that walk.

Did she admit that?

She, no, she didn't. Oh, not yet, Juna Bobby MD.

But this—

we'll follow up on that. Yeah.

Yeah.

We'll follow up.

I just wanna say that sometimes we sound like broken records, but the repetition is so important. I know your daughter doesn't wanna hear about another research study, but I promise you she will be telling you about research studies when she goes off to college.

Right. It's true. You know, there's growing literature about the importance of nature and it doesn't have to be like the best nature experience, but getting outside, you know, for a little bit each day is really going to improve because in another opportunity to break the train of everyday thought. The issues with teens is multifactorial. You know, it's hard to tease apart what is driving that dramatic increase in sadness and hopelessness and all of those markers of how difficult it is now to be a teen. But there are multiple ways that we can target that issue. But we need to start and we need to, to your point, like intervening on one little area then can cause a ripple effect in so many of the other areas. We have to do something. And that's why I'm so glad we're doing this now. And helping people to find just little ways that they can intervene in their own lives.

I'm so excited because I know that you're also interested in, so nutritional psychiatry and the genomics of mind-body medicine, which means, you know, we can basically turn our genes, certain codes on and off with how we handle stress, right? So, yes. Even though there are many studies showing meditation and how it's beneficial, et cetera. I think it's so important that children and parents and educators start to understand the actual neurobiology of their brain because this is a possibility now for anybody to really start to understand their brain because we have so many more methods of studying the brain over the last 20 years and we really know a lot more than we did ever did before. And it's gonna continue to increase. I think this is just something that we should know as much as we know about how to handle a cut that we might get on our hand. To be able to understand our minds better, how what we think, how we handle stress has actual chemical response in our body. To learn it in so many different ways is really important. Whether you're learning about mindfulness just from a spiritual side versus, you know, for kids in school, I really think it's great if they learn it as part of STEM education to understand their own brain and nervous system. My mission is to get the neuroscience of stress get that basic fundamental neuroscience into schools, even into mom's hands as the kids are growing so that this is just part of the conversation and it's gonna decrease so much suffering and prevent so much preventable diseases, serious things from cancers to heart disease. It's February, it's heart disease month, as well as mental health issues.

Absolutely.

I'm just so excited to do these conversations every month now, April. I think we can really bring something to this field of stress management as moms and as medically trained doctors. You know, we've seen so much out there, right? Between the two of us, April, you and I are so passionate about this and we've been bringing this into our local communities. You're gonna go over to Danny's Place, which is an organization you introduced me to, and their amazing staff, Katie, the executive director, who is the sister of Danny, who the place was named after, who tragically passed away in an automobile accident. Having met Katie and Anne, who's on the board of directors, I'm so excited that we're going to be partnering with them for you to go and speak to the parents and to bring some of our Science of Resilience programs to their community.

Sure. I just want to say too, Danny's Place is such a wonderful place that's really grown over the years in the approximately 14 years that I've lived here in Acton. You know, it started out in one small space kind of close to the schools, and then it's grown. And this is their third space, at least I know of. And it's really just a safe space for youth in the area to discover themselves and discover tools in which they can enhance their own well-being. And this talk that I'll be doing will be directed towards the parents and guardians. We'll provide some resiliency tips and also a brief introduction to the course that we're going to be offering, the stress management course for parents. And hopefully it'll be a very robust conversation. You know, I'll provide some tips and they'll ask some questions so they can bring home this information to their kids of ages. Some of these parents will have preschoolers, but they'll also probably have some college kids too. So it's gonna be a great evening and I'm really looking forward to it.

Yeah. And I'm really looking forward to more of these conversations and we're gonna be taking questions from the audience. So if anybody wants to ask April or questions about mind-body medicine or lifestyle medicine as it pertains to psychiatry and also preventative wellness for everyone.

But it's gonna be great in order to bring this information to the listeners and you know, really engage people and, and try to dispel any myths about mind-body medicine or meditation, because really this is based on science, and this is science that we all can learn. One of the slides I always share at these talks is a very complicated slide that defines the stress response and the body's relaxation response, and it's an elaborate display of hormonal changes and heart rate variability. I think it just drives home the point that what we're talking about is based on science. When some people think or hear meditation, they think it's not for them because, you know, maybe they've tried. I think once people understand the science behind it and what— how they're impacting their own body's ability for profound rest and restoration, then they'll take a second look at some of these practices that they may have passed by thinking that it wasn't for them. So it really is for everyone.

And, you know, science is not perfect, as we all know. And, you know, you have to be very careful about reading the different kinds of studies that are out there, but we do have to have a measure of something, right? If you're doing something, at least I, for me, I want to know that there is some research associated with it, how it works, if there's any downsides, what is the optimal dose of doing things, how tools like changing your perspective, your mental perspective on things can actually benefit you or not. You know, all of these things have been studied and I think that's really important, right? That when you're talking about complementary medicine, that we're using evidence-based tools.

Oh, absolutely. And you mentioned a few other ones that kind of touch upon not just mind-body medicine, but one of the main components of the stress management program we're talking about embodies the best of cognitive behavioral therapy. We're not teaching people or, or offering therapy to individuals. We're taking the components of some of what is taught within that therapy and taking out the important educational pieces that you can apply to your own life, in your kid's life, that's the best of that without pathologizing it really.

And also, you know, we're talking about how exercise affects us down to the cellular. We're talking about how foods affect us to the cellular level. Example of how impactful it is when you know some of this hard science. I have a guest coming up, which I'm really excited about. His name is Dr. Thomas Robinson. He's He's the Irving Schulman Professor in Child Health and Professor of Pediatrics and Medicine at Stanford Medical School. Uh, he's coming onto the podcast to talk about a telomere study, which is basically showing biological aging. I won't go into the telomere thing now because he, he's gonna be on, but it goes into showing actual biological measure of aging in children who were obese and then they lost weight and they measured it. Gained a little weight back, and then they, they measured the telomeres again. And the biological age was showing how obesity actually changes your telomere length. So understanding it from that point of view is so much more different than, you know, I, I think it takes the onus off of psychological kind of shame or guilt when you actually see numbers and you see like how it's affecting the genes or see how your brain is working, how ultra-processed foods are actually making our brains addicted to it. So when you look at the science of it, it takes away that whole shame and difficulty that can actually lead to anxiety and depression. And instead of treating it like a cut that you might have on your hand, all of a sudden it becomes, oh, I'm a terrible person. I don't know how to eat the right foods. So when you have all the science behind it, it really removes all Yeah, it's, it's so true.

And you point out that study about the young people and BMI being higher and affecting their telomere length. Again, there's also the studies, as you probably know, showing some of the blood vessels of young people, even, you know, seeing some of the damage at that young age. So I think helping people have a little bit more background or knowledge about the science, to your point, it does take away, hopefully, some of the shame or some of the burden people feel, you know, that they're doing things wrong. But there are ways in which to repair this. And again, it's trying to give people the power to try to each day make a small change that can change things in the right direction. So there's always that power. And with knowledge, there's even more power. So I can't wait to listen to your podcast with him because the work is fascinating.

It is fascinating. Thank you so much for being here, April, and you guys will hear from us again last Friday of the month.

Excellent. Thanks so much, Juna. I really appreciate all the work you're doing to advance this work and bringing the important information to everyone that's willing to listen.

So if you want to send us questions, go to mindbodyspace.com/podcast, sign up, and ask us any questions that you would like addressed on the last Friday of each month.

So fun.

That is fun!

Yay!

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