Pain Solution: How to Decrease Pain When You Are Injured or Having Chronic Pain

Hi, welcome to the Mind Body Space Podcast, where you can boost your resilience just by listening. Please subscribe and share to support this free evidence-based content curated just for you. I'm Dr. Juna Bobby MD, a board-certified radiologist and lifestyle medicine specialist. I'm here to help you stress less and thrive in today's complex world. Join me as I meet fascinating experts in meditation, neuroscience, education, and lifestyle medicine. To get special tips and tools, head on over to mindbodyspace.com and sign up for the newsletter. Links are below. Today I'm so excited to speak with Dr. Saloni Sharma. Dr. Sharma is a physician specializing in pain. She's also trained in acupuncture, and she's the medical director of Orthopedic Integrative Health Center at Rothman Orthopedics. She's the author of the award-winning book, The Pain Solution: 5 Steps to Relieve and Prevent Back Pain, Muscle Pain, and Joint Pain. Without medication. Dr. Sharma has studied lifestyle medicine and functional medicine and integrative medicine through Dr. Andrew Weil's program at University of Arizona. She's a student of yoga and meditation and was trained in acupuncture at Harvard University. Dr. Sharma serves as co-chair for spine and pain rehabilitation for the American Academy of Physical Medicine and Rehab, is on the Diversity and Inclusion Committee, and on the National Opioid Task Force. She supports alternatives to opioids and has directed a national physician course on navigating the opioid crisis. For multiple years, she's been voted top doctor by her peers, and she's a popular speaker at Google and an award-winning clinical assistant professor at Thomas Jefferson University Hospital.

Hi, Juna, how are you?

Thank you so much for being here, Saloni.

Thank you for having me.

So nice to meet you. Me too.

I'm so excited. It's so neat what you're doing. This is such an awesome podcast.

I'm so interested in this Pain Solution, the book that you just recently wrote. About alternatives to relieving pain.

Thank you. I'm so excited to be here and talk with you about ways we can do this and sort of help ourselves without getting into more pills.

Yeah. So, I mean, if you're human, you're going to have pain, right?

Yes, unfortunately. Yeah, it's part of the human experience.

And yeah, and in fact, we can't, you know, we need pain because it's giving us messages to not do something. It's one of the most valuable sensory information that we're going to get from our environment. So we definitely need pain, but we don't like pain.

Yeah, that's a great way to put it. Yeah, we need the messages. We don't need the messages to keep going on well after the injury though, and I think that's where it gets tricky.

That's so fascinating. Yes, my daughter just had 4 of her wisdom teeth out and she was definitely in pain, but thank goodness she did not have to go on opioids. I gave her enough meds, basically just Motrin and Tylenol. Obviously she was in some discomfort, and you know, the minute she was feeling pain, I was like, oh my gosh, what can I give you? Because you don't want to see your kids in pain. But I'm definitely more for mind-body intervention over pharmaceuticals and to be able to titrate as much as possible or to give the minimal effective dose of whatever you're using and then be able to take them off it immediately, right?

Exactly. Yeah. Yeah. So I, I think it really boils down to how much inflammation you have in your body, how long the pain lingers. So if your body's kind of revved or primed with more inflammation, kind of sympathetic system, your fight or flight's revved up, everything's on hyper alert, and then you have this factor is event like wisdom teeth out. And if your baseline's already so high and then you get your wisdom teeth out, your body's like, ah, you know, and the messages kind of go into overdrive. And then that's when people get lingering pain and maybe need, you know, pain medications or things for longer than they really ideally should.

Mm-hmm. When we talk about getting into a chronic pain med use, what are we talking about here? Like after a week, 2 weeks, 3 weeks?

Yeah, I mean, for wisdom teeth that, you know, it should definitely be less than a week. Even for surgeries, there's a study that's mentioned in the book. In other countries outside of the United States, for things like carpal tunnel surgery or gallbladder surgery, they don't even give narcotics.

Ah.

But, but we do here.

So what do they give? Just Motrin?

Yeah, just anti-inflammatories. Yeah. And a lot of these places are, you know, more into mindfulness and topicals and, and things like that. So I think part of it's our sort of our societal culture feeling that, oh, we need pain medication, we're supposed to get pain medication, that expectation. But I think if you have an orthopedic surgery, you know, it may be a few days or a week, but hopefully it won't linger too much beyond that.

Mm-hmm. So pain is caused by inflammation, but we need inflammation to actually heal at the same time, right? But we don't want to feel that pain.

Yeah, so you're right. Pain is needed sometimes and inflammation is needed. Inflammation's not all bad. It's how our body responds to an injury, musculoskeletal injury or a surgery or trauma. So it helps, it helps clean out that tissue and helps no repair tissue, but it's the lingering again, just like the pain. It's the chronic pain or the chronic low-level inflammation that we really want to try to minimize.

Mm-hmm. And so that chronic stuff, I mean, I teach the science of stress. So I talk about low-level chronic toxic stress, not the acute stressors, but the low-level chronic ones, how that's going to affect you down to the cellular level. So when you're talking about this low-level inflammation and pain, is that exacerbated by everyday stressors or is that your brain just responding, your nerves overreacting?

Yeah, I think, I think all of that. So yeah, it's sort of those daily stressors, you know, the old thought is that, which I think, you know, rings true is that our fight or flight or sympathetic system is meant to be activated with acute stressors, you know, like the traditional analogies like a lion or robber or fire. But with our daily stressors, the threshold's just a little bit higher. It's always just a little bit higher than it should be. So that when we do have an injury or surgery or something, we're kind of not starting out from a great place already. So we can sort of work on having our chronic stress and chronic inflammation sort of at a normal balance level. And the idea is when we have something happen, and that could be a car accident, that could be a fight with a neighbor, that could be a stressful meeting, you know, that things don't go haywire.

Mm-hmm. In regards to pain, which is what your book is about, can you give us a little background about what is going on with opioids? I'm pretty sure most people have heard about it, but maybe you can tell us why you wrote this book book and what your mission is?

Sure, I'd love to talk about that. So unfortunately, you know, there is an opioid crisis that most of us are aware of. I would venture to say that everyone knows someone who's been affected by this, whether it's professionally, personally, or even in your neighborhood or, you know, community. It's a shame, but it's really— if you take a step back, it's fueled by a pain crisis because we have a pain crisis in America. Let's take another step.

Oh really?

Yeah, people have so much pain so they get put on these opioids. And if you take a step back from the pain crisis, it's an inflammation crisis, right? So excess inflammation feeds more pain. And so that's really what the book gets at is trying to tame or calm painful inflammation so you don't end up on narcotics or not for a prolonged period at the very least. And it's really about empowering people. There's so many things we can do. And as you know, Western medicine's very passive. You know, here's a pill, cure me, doctor. And it really should be a partnership and that we can work together and there's a lot an individual can do to help reduce their pain and inflammation. And that's why I wrote the book. It's all the things I want to say to a patient I don't have time to in a little 15-minute, 20-minute visit. Let's talk about their stress, their nutrition, their exercise, their relationships, their sleep. So all these sort of lifestyle medicine or integrative factors that affect pain and inflammation that typically physicians don't get the time, not that they don't want to, but they don't have the time to discuss with our patients.

Mm-hmm. Mm-hmm. So your basic recommendation is to keep your daily levels of stress kind of at a lower level than the modern normal levels of stress that we carry around. So you talk about micro boosts of pain relief or micro boosts that help you to decrease your overall inflammation. Is that your foundational sort of plan for your patients?

It is.

Or anyone?

Yeah, for everyone. It's kind of, you know, talking about micro boosters was a term that I coined and it's little steps that add up to big relief, right? So it's what can we do? I love it. It's like you were saying, it's what we can do in our daily lives to keep our base level pain inflammation level low. There's a 5-step program that I talk about in the book too. So it's refuel, which is nutrition, revitalize, which is activity, recharge, which is sleep, refresh, which is stress reduction, and sort of having a purpose, and relate, which is supportive relationships. And what's interesting about these, and they may be familiar to you, It's a lot of what lifestyle medicine or integrative medicine talks about, but they really haven't honed in on taking an approach for pain and opioid crisis, which is what I was trying to do here. And if you step back even further, I work with a lot of orthopedic surgeons in my practice, and their national academy, the AOS, if you look at their surgical toolkit, these are the factors they talk about to have better surgical outcomes. So there's— they're evidence-based. They're out there. They're known. I just feel like they're not communicated well to everyone.

That's awesome. So you want people to sort of lower their levels of daily stress with these micro-boosts of healthy lifestyle choices, basically. I love that because I was talking to my coworker about micro-stressors today. It was in the Harvard Business Review. And that's what the Mind-Body Medicine and the Benson-Henry Institute at Harvard Medical School talks about, those micro-stressors, and Bruce McEwen about how these micro stressors kind of add up. So your Micro Boost would be like anti-micro stress.

They're like the antidote. Yeah. And so, and it's just little steps you can take each day. It's really meant to be practical because, you know, most of us don't have time to spend hours at the gym or have a personal chef and do things like that. But there's just little tweaks we can do which can make a big difference.

So this is something you recommend on a regular basis. So now what if somebody has an injury or has surgery coming up, what would you recommend?

Then we would sort of talk about specific things. So we talk about mindfulness and meditation and breathing, you know, even when you're laying on the table, but also the night before when there's a lot of anxiety. And then in the post-operative period, it's very important as well. With most surgeries, as you know, and maybe your audience knows, especially there's anesthesia that can affect your circadian rhythm and your sleep.

Let's talk about that a little bit.

Yeah. So circadian rhythm is a big piece of this. So keeping your inflammation down and your sympathetic system, you know, sort of balance, uh, and helping with pain. So if there's a lot of disruptions to circadian rhythm, that can increase your pain, alter your pain threshold. It can affect your restorative sleep. So things like surgery, social jet lag, which just means, you know, staying up late on the weekends, and also the way you eat food and when you eat food can affect your circadian rhythm. So it's really interesting.

I just released a course today on Insight Timer, and it'll also be on my website, but it's on sleep, like giving yourself the Gift of Sleep, and one of the lessons in it is about circadian rhythms. So I love that you're talking about this. Maybe you can explain circadian rhythms a little bit and how that affects not just your mood but your pain thresholds.

Yeah, sure. So circadian rhythm is kind of a general term for our 24-hour biological clock. There's a master clock in the brain, but they found that every organ and cells have their own circadian rhythm and circadian clocks as well. They kind of work in synchrony or synchronized together. So there is a way we're designed. We're designed to do certain things at certain times. And when we don't do that, our body doesn't function as well. So one of the things, for example, that I'm big on is with nutrition. We're not designed to have a lot of food right before bed. That's not the way our body's designed. We're designed to have it in daylight hours. If you think back to even 200 years ago, refrigerators weren't as widespread or really around. There weren't 7-Elevens, there weren't vending machines. So you kind of ate during daylight hours. And then when it was after sunset, so following circadian or daylight rhythm, then you didn't eat. And that's what works well for our body. So you might see, and your audience might see things on social media and elsewhere about don't eat 3 hours before bed, right? Sometimes people come across that, and there's a reason for that. There's something called autophagy, which is cellular cleanup in our body, and that happens at night. And if that doesn't happen, then these cells that are injured and are supposed to be at the end of their life cycle and cleaned up, they don't get cleaned up and they just stay there. And they're called senescent cells, but the fun term is zombie cells. So they're these zombie cells and they keep, they keep on going and they pump out inflammatory molecules and that causes more inflammation and more pain. So when we say try not to eat a couple hours before bedtime, it's not just about nutrition, it's also about inflammation and it's about your sleep. And you're going to sleep better if you haven't eaten just before bedtime too. So all the circadian stuff, it all connects together.

So let me just recap that. If you are eating in rhythm with your circadian rhythm, which most of us have like a 24-hour-ish— I know some people are a little bit earlier, you know, early risers, and other people are night owls. But other than that, we basically sleep and eat around a certain clock, and we're supposed to kind of eat our last meal before the sun goes down. Is that what you're saying? And then if we don't, then the fact that we're still digesting food is causing a level of inflammation, or that we're just not sleeping well because maybe we ate too much and that we're not sleeping very well, and we have reflux and all that stuff that can happen when you eat near bedtime. And then that causes us to not sleep enough. And we know that during sleep everything's being cleaned out, including these senescent zombie cells and also waste products and byproducts of metabolism, and that our brains are getting washed out. By the glymphatic system. Did I say it right? Am I missing anything?

No, I think that's exactly right. Yeah. If your body can either do cleanup or it can process the food you just ate. So it can't do both at the same time efficiently. So if it's busy—

Oh yeah. I love that.

If it's busy digesting.

So if it's busy—

Yeah. If it's busy digesting, then it can't do the cleanup and the waste products and deal with the zombie cells. It's gotta process your food and move it through your system. So yeah, that, that's exactly right.

Interesting. And then it's 3 hours of digesting before it moves through your gastric— moves through your stomach?

That's the concept, yeah. And like you said, it varies for individuals. Like if you have diabetes or you're pregnant or you have eating disorder, there's some caveats to it. But in general, yeah. And if 3 hours is hard, you could try 2 hours, you could try 1 hour. I think it's just ideal to not have a meal or dessert or a snack and then just lay right down. And like you had mentioned, reflux and other things too.

I love this concept cuz I never really talked about it this way or I never really heard anybody talking about it exactly this way. So thank you, because, you know, when you think about it, you want your body to be able to do what it's supposed to do during sleep, not digest. That's what you're saying.

Exactly. Yeah, exactly. It's designed that way.

That's cool. This also relates back to pain, because if you're not getting all those toxins removed, you said the zombie cells are excreting inflammatory cytokines, or like little chemicals that cause inflammation in our body. Can you go a little bit into that? Yeah, exactly.

They're pumping out, they're just thinking about like inflammatory factories are just pumping out inflammatory cytokines. Inflammation, like we talked about earlier, can be good. It prolonged is usually not necessary. And it leads to swelling, it leads to more pain. And so what we wanna do is really squash that down. But yeah, if these cells don't get cleaned out, they're contributing to inflammation. If you don't get good sleep 'cause your body's digesting, that also can affect your pain threshold. So your brain, 'cause it didn't rest, it can't process pain as well. And I think a lot of us know this, right? So if you haven't slept well, you might be a little snappy the next day, right? But have a little bit of a harder time dealing with things. Your threshold for nonsense has changed. And it's the same with pain. You know, like a little paper cut might be like, oof, but it's kind of just like the final straw. And so sleep is so important and timing with your circadian rhythm really makes a difference.

But I'm thinking about it in a new way because of you now. So because you have all this inflammation going on, your pain levels are increased. It's not, only because you can't handle your emotions as well because you didn't sleep well.

Yeah.

It's literally more inflammation.

Yeah, most certainly it's more inflammation. And then, and they've done studies on this about people's pain thresholds, like you're saying, separate from the emotional mental piece of it and your pain threshold changes. So yeah, it affects your brain directly.

Mm-hmm. What about athletes though? Do they, should they not eat 3 hours before bedtime also? Because a lot of times that's difficult. Sometimes they might be increasing their calorie intake. What do you suggest?

I mean, I think it would probably, they work with a sports nutritionist, but I think it would depend on what they're ingesting, right? So if they're taking a protein shake close to bedtime, that's different than going to a fast food restaurant and having a value meal or whatever. Your body's gonna process those things differently. I think, and if you have to eat later for whatever reason, it's clean food, right? Not processed food is something to focus on. Things that aren't hard for your body to digest and don't just sit there. Especially if they're super fatty with unhealthy fats.

So something more like a smoothie or something?

Yeah, like a healthy smoothie. Yeah, ice cream at bedtime is such a no-no. I have so many patients who, who like that, and we have to work on that. That's—

yeah, that's like the classic, right? Curl up with a bowl of ice cream in front of the TV.

Exactly. Especially with all these streaming services and just keep watching. Yeah.

Oh my gosh. What about this connection between pain and your gut microbiome? So maybe we can talk about our gut microbiome in the first place? What is that for the audience and how is that coming to play with our perception of pain?

Sure. The gut microbiome are organisms that live in our gut. They're supposed to be there. They're a combination of bacteria, virus, fungi, and other organisms, and they help us ideally. So it's a symbiotic relationship. We help them, they help us, and they help us process food. They help us get vitamins from our food. But if there's an imbalance, the simplistic way to look at it is if there's an imbalance, then the bad guys outweigh the good guys. And then that can affect the way we process food. It can affect the way our immune system functions. It can affect our hormones. So it was sort of a cascade. So we really wanna have good gut balance, meaning a healthy gut microbiome. And ways to do that is to think about prebiotics and probiotic foods. Mm-hmm.

And everybody has a different gut microbiome. Partly it's genetic and partly it's, Lifestyle and what we're eating. So if you're eating a lot of processed foods, your gut microbiome is going to totally shift and maybe towards more inflammatory situations as well as if you take antibiotics, it's going to clean out your entire gut of all of the normal microbiomes that you have. And I just read a recent study about how they're identifying the gut microbiomes. They're getting closer and closer to identifying and relating them to risks of colon cancer. As well, like different, very specifically. So it's really important to have a healthy gut microbiome. And one thing that's been shown to make it not as healthy is red meats and also all the junk food, right? So how do we know and how do we keep our gut microbiome healthy?

It's easy to say, but you want to minimize stress. Stress can affect your gut.

You want to avoid Talk more about that. That's all I teach.

So there's a sympathetic layer to that, but there's also a lot of our serotonin or some of our help— helpful feel-good neurotransmitters live in our gut. But we—

yeah, because we have nerves in our gut.

Yeah. Yeah. And some people call it the second brain, the gut. It's such a big nervous system. But stress affects it. Chronic infections, anti-inflammatories. So too much of the anti-inflammatories is not good either. Acid medications can affect your gut balance at the pH.

You mean like Pepcid and like anti— antacids? When people have reflux or something, everybody goes on these beta blockers and they're like, it's not a big deal. But actually it is a huge deal because some of them could cause vitamin B12 deficient. Yeah, you end up not absorbing everything you need to.

Exactly. Same thing with antibiotic overuse, right? So there's many reasons why physicians are sometimes say if something's viral, don't use antibiotics. One, it doesn't make sense. But two, it can cause antibiotic resistance, but it can also affect your gut because it's called antibiotic, right? So against the bugs, really against living organisms. So it can't just attack an antibiotic medication, can't just clear out the bad guys, it clears out some of the good guys too. And so that's why we don't want too much antibiotic use. And I mean, if someone has a real infection and they need to be treated, of course be treated, but it's something to be mindful of that you may wanna do some more prebiotic and probiotic foods during it and even after it.. And mm-hmm. You wanna avoid extensive preventative antibiotics.

So let's go into a little bit more about what's a prebiotic and what's a probiotic.

Sure. So I'm very much food first. Obviously there's lots of products out there that are prebiotic and probiotic, but I think we can get a lot of it from our food. So prebiotics are actually foods that support a healthy microbiome. They kind of feed the good guys or feed our beneficial bacteria. So it, Examples where you're gonna think of like fibers things. So onions, apples, asparagus, leafy greens, almonds, flaxseed, seaweed, these kinds of things are food for our good guys. And then there's probiotics. Those are actually foods that contain the good bacteria or beneficial bacteria. So you wanna think of cultured and fermented foods like unsweetened yogurt, kimchi, sauerkraut, pickles, miso, tempeh, things like that that are fermented with good bacteria.

Mm-hmm. And can we bring this back to pain again, just so we remind ourselves why the gut microbiome, what it has to do with pain?

Yeah. So there are many studies that show that unbalanced gut microbiome leads to chronic ongoing musculoskeletal pain. And the theory is that it's through inflammation, right, that we start talking about. So if your gut's unbalanced, it kind of causes low-grade systemic or whole body inflammation, and that causes more rapid osteoarthritis or joint degeneration, for example. If you have a disc problem, you can make more inflammation or swelling around your disc and your back if you're hurting a disc. So there's a lot of studies that show that, and so there's a lot of recommendations, especially for things like knee arthritis or hip arthritis, to really go after the gut and get a healthy gut.

How do we measure that? Are there things that you can ask your doctor to measure? Is there a nutritionist that you should go see? Is there a genetic test you should take? What can you do to actually know what you're doing? Because you can experiment forever, and it could be very frustrating because I know a lot of people who have a lot of sensitivities to things like gluten, but they're not diagnosed with celiac disease, but it's still like low-level inflammation. They have muscular pain, they have muscle cramping, swollen hands, but they don't know how to put their finger on it. So what would you do for that?

If you want to meet with a specialized physician who looks at stool tests, you could do that. There's also stool tests where they analyze your own microbiome that you don't need a physician, the private sector things that you could to yourself. It slowly— they send you a baggie and you send away your poop, and they analyze it and they tell you about it.

They tell you what you should eat or what you shouldn't or what you're sensitive to?

I mean, I think a lot of them tell you just what your gut is composed of, meaning what microbiome, what species of bacteria are dominating. And then if you're a physician, then they would interpret that about how much is good guys, how much is bad guys. But I think for most people, unless you're suffering from severe disease, you can just sort of change your diet and treat it preventatively, you're even on its own, assuming that it's there or assuming that you don't want it there and just change your diet.

So you've like noticed that if you eat white bread or something, then all of a sudden you feel kind of achy and things like that. Is that what you're saying? Just keep a food diary and see what works and what doesn't.

I think that's a great way to do it. And sometimes with things like that, it could be a delayed reaction where you might not feel bad until 8 hours later. So sometimes not so black and white when you have the bread, it's not that same hour. It's 8 hours later and then you don't really necessarily think that it was maybe the bread. But I think if you just start eating whole clean foods that aren't processed, then you don't have to worry about that. You don't have to worry about, "Well, did this do that or that do that?" If you can just start eating clean foods the best you can, then you already know that you're feeding your good guys.

Mm-hmm. This is something that comes up a lot and sometimes they think like clean food is just all about salads. I just want to add that there's something so important about eating clean food. You have to mix First of all, you need a variety, and second of all, you really need to mix raw and cooked because you can really mess up your gut and your bowel movements and everything if you're only eating raw things. You really need to have like steamed and cooked vegetables and not too much fiber because like too much fiber can be a bad thing also, right?

Yeah, they're definitely a balance. And like you said, maybe for some people it'd be beneficial to meet with a nutritionist so that you have a balanced diet of healthy fats and protein, not just salads, so that you don't have other kind of gut issues in terms of, you know, diarrhea and things like that, flatulence.

Yeah, we don't know. Okay. And, and I always say like, a happy gut, happy person.

I love that.

If you're not regular, and that's— that could be like one of the most uncomfortable things, not to mention pain from irritable bowel.

Yep, for sure.

So we can eat healthy, we can sleep and eat in a cycle that works for us, especially eating at least 3 hours before bedtime. And what else can we do to microboost our— so that we have lower general inflammation? And even before, during, and after surgery or some kind of injury, what's your favorites? Let's say, oh yeah, what's your favorite tactics? Yeah, what do you use in your life as much?

I think for me what I do is I'll have a spoonful of chia seeds before I eat most anything. Okay.

And raw or soaked?

I sometimes just eat them raw. Yeah. And that's not for everyone, but you asked me what I do.

So, well, they're kind of like poppy seeds. You can sprinkle it on.

Yeah. Yeah. So you can sprinkle them on yogurt, for example, which I have, you know, right next to me right now. Or have proteins or almonds before I eat. If you're reaching for something sweet, if you can have that protein and fat before you have that carb, I think that's a nice way to not get that big glucose and insulin spike, which we know again leads to more inflammation, which then leads to more pain. That's one microboost.

Okay, good to know.

Yeah, something with protein or fiber before you go for your carbs. So I think the food order matters, right? That sort of thing is coming out more and more.

Food order, that's good.

Yeah, so, you know, if you're going out for— some of my patients always brings up, you know, this like Italian meal where typically You start with bread and then maybe there's a veggie on the side, it's a lot of pasta, and then possibly a meatball or some other protein. You really want to start with the salad, the vegetable, or you could even start with the meat first if you wanted to. But most people will start with the vegetable first, then the meat, then the pasta. And then if you ever even really want bread, go for it. But— Okay. Yes.

So they had— they did it with intelligence when they had that 3-course meal, right? The soup, the salad, and then the main course, right? That really made sense. But if you get the bread first, at least dip it in maybe olive oil, or—

Yeah, I mean, that helps a little bit. I don't eat the bread, but I think it's personal for everyone. But that's a way to mitigate it, is with olive oil or with the salad. If you get a little bit of salad first before you have the bread, I think that's a nice way to do it too.

And this is all to decrease that insulin spike.

Yeah, exactly. That's gonna lead to more inflammation.

Okay, awesome. And then what are your favorite things to do as far as how you keep yourself moving throughout the day? Almost everybody is at their computers these days.

Yeah, so I will do— I see patients in an office and I will do every hour or two, I'll do 10 squats at my desk, which is just an easy, you don't need equipment kind of thing. You're activating your large muscle groups. So I'll do that. The one I like a lot that my patients like a lot too is a mindfulness activity. Like Insight Timer, like you mentioned. I'll tell people to even do it in their car, in the parking lot at their workplace because some of us, we don't get to transition from work person to home person. And we also feel like once we get home, the demands are on us, whether it's a partner, another family member, or just other responsibilities at home that we're not going to do any mindfulness or meditation when we get home. It's just not going to happen. We have good intentions. And so I tell a lot of people just when you get into your car after work, do use an app and do 5 to 10 minutes there and just separate yourself and kind of regroup. And a lot of people find that helpful.

I love that. I always say the car is like one of the most expensive meditation capsules. A lot of people have cars, so that's great. You just put on your sunglasses and just sit there. Yeah, I'm a teacher on Insight Timer, by the way.

Yeah, I already sang that. Yeah, so I think that's great. They can listen to one of your practices.

When you relax, you go into that rest and digest system, right? So you really are lowering that inflammation.

Yes, definitely. So you activate that parasympathetic system, the relaxation response. Well, another way to do that, this is what I learned in one of my mindfulness classes, was they call it 3 deep teenage sighs. It, it sounds a little ageist, but it's—

wait, can you say that again?

Sure. 3 deep teenage sighs, or 3 teenage sighs, like teenager. And it's a little bit like tongue in cheek, but If you have a teenager or you recall being a teenager or you work with teenagers, you may recall the big dramatic sighs. And so it's doing that on purpose 3 times in a row and kind of with the eye roll, the shoulder shrug, the big, huh, a really audible dramatic sound. And if you do this 3 times before a stressful meeting or after a stressful meeting, you can sort of trigger that relaxation response and just take that sympathetic response down a notch.

Oh, that's funny. But don't think those teenage irritating thoughts.

No.

Yeah, yeah.

Don't be annoyed. Just be like, huh, I'm going to get it out and sort of release the stress. Yeah.

That's interesting. I also read recently about nasal breathing and how we have nitrous oxide in our nose. And so it slows down the breathing actually.

So that's a neat thing to think about. I mean, I think, are you familiar with alternate nostril breathing?

Yes, I am. I train with Dharma Mitra. Do you have a yoga certificate?

I train in India. There's no certificate. I did train in India.

Well, that's the original place. I wanted to hear more about that.

I just mentioned that because, you know, if people learn alternate nostril breathing, which is a breathing technique where you have one nostril closed and one nostril open, and you breathe through your mouth and nose in a certain pattern. The beauty of that is it's such a mindless activity because you really have to think about it, so you can't think about anything else. So it really brings— yeah, it's kind of like a double win. So it brings you into the present, present moment, but then it also helps with your breathing and sort of de-stress you. It's really neat.

It kind of like slows it down, right? Because you have to think about it, you have to hold it, and then— yeah, it has more beneficial effects because of what I was talking about with the carbon monoxide. It's more beneficial than like, let's say, rubbing your tummy, tapping your head, and trying to breathe. That also makes you focus on your breath. But I think the alternate nostril breathing actually has a neurochemical effect to it with the slowing down.

Yeah, that would make sense. Again, where I was taught, they weren't talking about the nitty-gritty science.

But they knew. Yeah, but somehow they knew.

They did.

It's so interesting. And any other tips on how to decrease your inflammation on a day-to-day basis? You have little kids, right?

I do.

And you're working. And so how do you manage? I guess you meditate in the car before you see them, but are there any other things that you do?

Yeah, I think some of it is my main form of exercise. I used to be part of a fancy gym and then the pandemic happened and I decided not to return. After a while. And so I just walk, just walking outside. It sounds kind of basic, but there's so much data about it. Forest bathing or nature deficit disorder or whatever term you want to use for it. But being outside is so good for our mental and physical health. And that's really my main form of exercise is trying to get— and this is not for everyone, but for me, 10,000 steps in and then also do some weightlifting on the side. Those are really the only two exercises I do formally.

So you do that on a daily basis?

The steps I try to do every day. Yeah, the weightlifting is probably every other day. But the beauty of it is, but when you mentioned the kids are feeling unburdened, they can come with me. So you don't have that mom guilt of you're leaving them, you're home but you're not with them. So they won't come for my whole walk, but they'll come for some of it. I think that's a nice thing to do together.

And so again, exercise is another massive anti-inflammatory thing that you can do for yourself.

Oh, it's so huge. I mean, that's, I have a whole section called Revitalize just about exercise or activity. The release of 5-HTP. There's sort of a secret sauce, I like to call it, of exercise. And exercise is like an antidepressant because it affects serotonin. It's like an opioid because it affects your natural endorphins. It's like medical marijuana because it affects your endocannabinoid system. And then it's also like an anti-inflammatory because it affects inflammation through myokines. So the— it's 4 different pills in 1, which is amazing. It's an antidepressant, I love it. Yeah. And anti-inflammatory. And then it's also everything we talked about. So it's a really neat, it's mood enhancer. Yeah. Mood enhancer. So it's mood enhancer. It's natural medical marijuana. You don't have to go get certified anywhere. You can just exercise. So it's wonderful and it's what you can do, right? So not everyone's gonna walk 10,000 steps and that's okay. There was an article in JAMA, which is sort of, it's the, you know, like the holy grail in the medical world, the Journal of the American Medical Association. And it says for elderly women that walking 4,000 steps a day reduces mortality or early death rates. So you don't have to do 10,000. It's different to know. And if there's some kind of impairment or other things, it's what you can do, but it's moving more and more often. And that's the big thing. If you can't walk for 30 minutes, it's okay. Do 3 10-minute walks throughout the day. It still gets you similar benefits and maybe better. There's some studies show that doing an hour of work at the gym and then sitting or laying for the next 23 hours is not as good as doing 10 minutes 6 times throughout the day.

So, and that's for any age group, right?

Yeah, for any age group. So it's really about moving more often. There was a great study that came out in the Sports Medicine Journal last year about just walking for 5 or 10 minutes after you have dinner or a meal, how that helps again temper that glucose or insulin spike, which leads to more inflammation and more pain. And if you just walk for 5 minutes within an hour after eating can affect how your body processes that meal and those sugars. And that's really easy.

So just 5 minutes within an hour of eating. That's great to know. There's also something about exercise though, because it's a little paradoxical because you can exercise to the point where you have inflammation. And in fact, you do have inflammation when you exercise, but there seems to be a different physiology related to that, that it's helpful and beneficial. I don't know if there's an actual threshold yet about where you should stop. What harms you? I mean, obviously if you overuse and you get injured, that's harmful. You're right.

It, it does cause inflammation, can cause some localized inflammation for sure. And there's definitely data on that. Again, I honestly don't know a lot of the details, but I would imagine that there would be some micro muscle injury, right? That from intense exercise. And so there would have to be some inflammation related to that. But I think for most people, aside from, you know, really professional athletes, just walking is fine. Just walking, do some squats after dinner if you want to do some squats then. If it's bad weather or you're not safe walking outside, that's fine. You could vacuum or do the dishes. So even these like little tasks, they count. The idea is not to have a meal and then just sit on the couch and do nothing. That's sort of the concept.

You're a speaker at Google, so can you tell us what you tell the Googlers about how to take care of themselves? I know they must be sitting all day, probably programming, right?

Yeah.

And with what they're up to with AI these days, It's amazing what they can create.

Yeah, I gave a talk about burning bright or trying to avoid burnout there. One of the big things, I mean, we talked about microbeast, very specific for people who work from home because a lot of them, you know, work from home. And we talked about outdoor time and, you know, stretching, but we also talked about the fake commute. You know, a lot of your audience members may work from home or study at home, and there is no line between your work day and your home day, your school day, your home day. And so it's sort of creating that. So Have a fake commute where 8 o'clock or 9 o'clock you walk around your neighborhood. You can listen to Inside Timer, you can listen to something relaxing, you can just listen to nature sounds. And the same thing at the end of your day, have a walk where you separate your work day from your home day and have a separate work or school area at home too that's only used for that. So we talked about more practical things like that.

And if you're in a small apartment, maybe you could just even change what's on your desk.

Yeah, I love that.

To go from work to relaxation, you could change out the flowers or something. Yeah, change your tablecloth.

Just something, you know.

I totally can relate to that. Really, the days blend into the other. You're on the East Coast too, right?

Yes, I'm Philadelphia area.

I mean, we can't really go outside anymore because some days the air quality is gonna be so bad this summer, and they're predicting that it's gonna be coming and going all summer and is probably here to stay, which is terrible. But what are we gonna do now? I mean, yes, you can strap on an N95, but you still maybe not want to go outside and exercise on those days, so Any thoughts on that aside from really good HEPA filters around the house?

Yeah, I mean, I think having a lot of natural light, so being closer to windows is still important to sort of set your circadian rhythm and have it distinguish in time between day and night. I think the other thing is you could increase cruciferous vegetables, which are things like broccoli, cauliflower, kale, the things that look like little baby trees. They actually help with through glutathione with your liver. Detoxification. And so if you're getting more pollutant air and the higher stress level in your body with that, then this can help process that. So I think you would modify your diet and be mindful of not increasing your alcohol and other things that we may do in which we're quote unquote trapped in our house because our body already has this stress where this sort of partially puffs the air.

Those are really great tips and I love all your Micro Boost tips. Any last minute tips?

Just, I think You know, we have the power to feel better. And it's really simple things like improving your gut microbiome with just small food changes, reducing your stress with 5-minute little microboosts. It doesn't have to be hard, doesn't have to cost a lot of money, and we can live better. It's sort of up to us if we just have information.

Everybody should buy this book, The Pain Solution. We're going to put a link to it. And yeah, it's such an incredibly necessary book to have, especially now.

Thank you.

Thank you so much for spending your time with us.

Thank you so much for having me. It was fantastic. And thank you for all the wonderful work you're doing too. It's so amazing.

That was Dr. Sharma. You can find out more about her at solonisharmaMD.com. Look out in your email inbox and on our social media platforms. You can see the links in the show notes for a giveaway of her bestselling book, The Pain Solution. Thank you so much for listening. Forward this to a friend, a family member, anyone who needs to stress less, and soon enough you'll be surrounded by more Zen people. Your support is literally what makes this possible. Subscribe and head on over to YouTube to my Fall Asleep Easy channel. Sign up for your updates at mindbodyspace.com and get special tips into your inbox. Until next time, this is Dr. Juna wishing you wellness.