Burned Out? How To Reset Your Life And Health with Dr. Neha Sangwan

Coming up on this episode of the Doctor's Pharmacy. Your heart racing, stomach turning, muscles tightening, sweating. Everybody has a unique language that their body communicates with them in. The job is we have to decipher it.

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Oh, thanks, Mark. Thanks for having me. It's such an honor.

All right, well, here's the deal. We all know that our life today is extremely stressful. We have our work obligations, family obligations, trying to manage things that we care about our health. And we've got all the stresses of society, the economic burdens of our economy. the threat of nuclear war, climate change, I mean, it's a lot. So it keeps us in a state of chronic stress activation. Basically, our bodies are not designed for this level of input and stress. You know, I mean, just the trauma of the news itself. I try not to watch the news because I find it very stressful. I figure if something important happens, I'll hear about it. But, you know, all this puts our bodies in a survival mode. this fight or flight response, which sets the stage for what is termed burnout. Now, burnout is not a medical term, but it actually is a true physiological response to chronic stress. And it's not really about working too hard or feeling exhausted or, you know, being tired for a long period of time. It's not about personal failure either. So what is burnout, Neha, and what causes burnout? Help us sort of understand the context here. And then we'll get into exactly, like, how we navigate it, what you struggle with, I'll share some of my stories and we can kind of get into how do we start to think differently about our lives.

Well, Mark, I think both of us have definitely experienced this multiple times in our lives. And I actually met you. I met you right after I burned out about 20 years ago. And one of the first things you said to me was, we got to get you back on your circadian rhythm. We got to get your wake sleeps. I was a doctor working night shifts and all these things. and I just thought it was unthinkable that that would be your opening line. And I didn't understand burnout then. And you were right. You were absolutely right. So burnout, you're right that it's not considered an actual medical diagnosis, but I will say at least in 2019, the World Health Organization decided to at least say that it was, you know, an occupational phenomenon that occurs with ongoing unresolved stress. So they've delineated it and kind of compartmentalized it to being a work phenomenon. My 25 years in medicine tells me that it can be anywhere in your life. So I think they'll catch up with us in 2019. At least they're acknowledging that work can cause this. So it's really a triad. The triad is of exhaustion, certainly physical, mental, emotional exhaustion. But if it was that, I think the whole world would be burned out. It's you have that going on, and then in a more subtle way, cynicism starts to creep in. You know that voice that starts saying, you know what, it doesn't really matter how hard I work. You know what, all the effort that I put forth, it doesn't really change anything. I don't even know if that, and then once those thoughts start coming in, it's edging you closer and closer to burnout. Until the third factor comes in, which is just hitting the wall of ineffectiveness, like that moment where you just can't function. And the other thing that I want people to know about the context of burnout is that you don't, you know, it's not like I'm okay on Monday and then like on Friday I'm burnt out. It's a way of being over time. These are patterns that we adapt to our environment. And we can talk about that when we start talking about our own burnout. But it's the way people function over time. And so there's three phases also of burnout that people go through. So let's say the alarm phase, that's the first phase. So it's almost like jumping on a treadmill that's going a little too fast. Like your adrenaline, your blood pressure, everything starts going and your alarm response in your body starts. So it's very well named, the alarm phase. well, many of us start to go on that treadmill and we really never get off of it. And we move into the second phase, which is adaptation, which is kind of staying in that alarm phase, never really getting the rest we need. And it almost feels like the treadmill keeps getting turned up slightly. And so we're just hanging on by a thread. Well, then that's the adaptation phase, the second phase. And then one thing happens, just one more thing happens, and we go sliding down the exhaustion phase to ineffectiveness. And that's what happened during the pandemic for a lot of people. They were just hanging on by a thread. And then one more thing happened and they really felt burnt out.

Yeah, it's so true. I mean, it just reminds me of what you're talking about as a paper I read years ago in the New England Journal of Medicine. by Bruce McEwen, where he describes the physiology of this in a very scientific way. So it's not just like, oh, I'm too tired and I'm burned out. There's actually a real biological underpinning and it's not something you can take a pill for, right? So that's the problem.

It's like, oh, is there a pill for that? What you'll get. So there's, when you're falling off a cliff, like you are burned out and you're completely ineffective, the traditional medical system will give you, this is the typical scenario that'll happen if you go to EAP at work, you know, the employee assistance program, and then they send you to a traditional physician. What will happen is you'll get a prescription for 10 days off or some time off, and then they'll give you some cocktail of, you know, an antidepressant, anti-anxiety sleep medication, something to get your biology back in order. And then 10 days later, you'll be sent back in the ring for round two. Right? No new skills, no understanding of how you got there. But listen, very useful in that moment where you are hanging by a thread or you've hit ineffectiveness. Really useful to try and kick you into stopping your world, because you're probably not stopping it yourself, and giving you a cocktail of meds that then, you know, knock you out and make sure you sleep. or don't allow you to feel the anxiety or the depression that you're experiencing. So it's a very temporary Band-Aid but it might be important in that acute, acute situation. But then the real question comes in, which is what's causing it? And I always say, like, we have to have parallel paths to help people, because if you're not figuring out what's solving it, what's causing it, you're never going to solve it.

Yeah. So that's something that we sort of, you know, we don't really think about. How do each of us as individuals respond differently to the same inputs? Because what might burn out one person might not burn out somebody else. So how do we start to look at what's going on in our life and how do we start to shift the conditions that are causing burnout?

Sure. so I like to think of burnout on three levels. So there's me, we, world. So there is what I understand about myself and how I'm different than you. Okay, so one thing I know I'm very different than you on is how much you will stretch your physical being. You will climb, you know, Mount Kilimanjaro. You will go to Mongolia for three weeks. Right? What I will do is. I will stretch my mental, emotional, social, spiritual self, but I don't do that to the same capacity I do with my physical being. So there's the me part of me, we world, and it's me knowing myself. I need to understand what's in my comfort zone, what's in my learning zone, and what's in my panic zone. So three weeks in Mongolia hiking, trekking, I would be like, okay, I'm gonna need some help here. And I would be like, I hope I can do this. Right? Whereas you would be like, all right, let's go. Right? So, right, it may cause me stress, but may not cause you stress. So in the me-we world of burnout, I have to know myself. I have to understand what will cause me stress and what will now, if I, what I know is, I could say yes to something like that. If I knew we were supported with people who really knew what they were doing, if we had like great, you know, people with us that I could ask. So, Even if something stresses you out, you also know you want to ask yourself, how could I say yes to this?

Right?

What would it take for me to say yes if it's something I'm interested in? Now, the we part of burnout is oftentimes the toxic work environments, family environments, relationships that we have said yes to. We have gotten ourselves into situations. We've chosen a job for a location or an opportunity or whatever it is. But then it drains us of energy. Every day it drains us of energy, but every day we keep choosing it for the paycheck or for whatever it is. And then world is what you were speaking about with the news and hurricanes and tsunamis and all of that. So I want people to really understand there's a me-we world here that's going on.

Me-we world.

The me-we world, right? So any complex situation, and I think about this with functional medicine, you've taught me this actually, that I must pay attention not only to my biology, but to the relationships I'm in, to the environment that I'm in, whether I'm sleeping and waking, and if my job says that I have to do certain things, you said that all impacts you, pay attention. So the simplest way I can say it is think about things and expand your perspective and see how all of them work together. But let's focus on the me. The me, which is each of us. So this is powered by me. basically, wherever you are on the Spectrum, from burned out to fully charged, I want you to figure out where you have a net gain or a net drain of energy on a physical, mental, emotional, social and spiritual level. That's a great exercise.

Like, how do you catalog each area? And what are those things in each domain that are either robbing you of energy or filling you up with energy? It's a beautiful framework, because we don't think about that. We just kind of like, you know, no. Oh, God. Every. Every time I talk to so-and-so, I just feel like, well, like, well, stop talking to that person, you know? Or gee, if I go out for a walk and, or if I, you know, like, for example, in the morning, I like to go out and sit and watch the sun come up on my deck, and it's super quiet. There's mist in the lawn and little birds and rabbits running around. I just feel like, oh, it's like this beautiful moment of restoration that I get, you know, nowhere before the world starts. So there's, like, those are great examples.

But there's so many more. There's so many more. And just like what you were saying, so, on the social level, empowered by me, right? I ask people to do some simple pulse checks on themselves. So for the social one that you just spoke about, I have, I ask people to write down the five people or groups of people that you spend the most time with in person or online. And then I want you to assess whether you have a net gain or a net drain of energy, a little plus for the net gain, a little minus for the net drain of energy. So the one that you just described would get a little minus if that's in the experience. And so when you look at those five individuals or groups of people that you're spending the most time with, and you look across it and you see three or four drains and one gain, you gotta start evaluating how you're choosing who you're spending time with. I love when you say getting healthy is a team sport. I learned that one from you. And it's so true. I mean, pay attention because these aren't just people that you have to endure. These are people who are changing your physiology by you being around them. So that would be one way. But let me really quick, I'll run through them. a little quickly so that people could get the idea. And I'm happy to give you a link where people can do the assessment themselves. And I would actually walk them through it on video. So it's a free, you know, they can, they can do that. Start at physical. So physical, it would be about food, energy, sleep and movement. And under the energy piece is the adrenaline, cortisol, hormonal balancing, all of that. So food, energy, sleep, and movement. I would ask you to rate how satisfied you are in each of these areas. So how, and it's not about are you perfect at eating the right thing at the right time every day? It's more like how satisfied are you with your energy levels? How satisfied do you feel about your diet and how you're eating? Because the satisfaction piece here is it also indicates where someone's ready to do the work. And if they're not satisfied with their sleep, well, great, that's where we should start. Because you know, it's all interconnected. And so wherever you start is the right place. One of the tips you gave me 20 years ago that has really stuck with me was you told me to bookend my days. You told me, Neha, even if in the middle of the day, you don't know where to start, I want you to do something really good for yourself in the morning, and I want you to do something really good before you go to bed. And I found that so doable, like so like, oh yeah, I could do that. And for you, it might be sitting out and listening to the birds, you know, for five minutes and just kind of, or meditating, whatever grounds you. And then that bath, you told me, take a hot bath with Epsom salt and magnesium right at night, and then a allow my temperature to kind of drop as I go to bed. So what are you doing these days? Are you doing any of those still?

Oh, God, yes. I mean, in the morning this morning, I woke up and I went outside and I sat and it was misty and quiet and I just enjoyed the quiet and had a cup of coffee and did some journaling. And typically my morning routine will be to work out and then take a steam and a cold bath.

At lunch.

And that kind of Pops me up for the day. I have my protein shake, and I'm ready to go.

So.

And at the end of the day, I I usually wind down by, you know, just doing a little bit of reading. I I like to take a hot bath with Epsom salt and then just kind of turn the lights out and kind of gather candlelight or just read a little bit on my Kindle and then go to sleep. I definitely, you know, I'd like to do more, but depending on what I'm doing, I've also got, you know, trying this new device called sensate, which basically resets your autonomic nervous system and you just headphones and it creates vibration in your epigastrium and it activates your vagal nerve and it's really quite powerful.

Wow. Okay, I'd love to try that. That sounds fun. So basically on the physical level, people assess how satisfied they are, food, energy, sleep, movement. And the way that you, when you're answering these questions, it's really important, yes, to use your brain. But more importantly, you know how your body keeps score, even if my brain can talk me into something, my body never lies. And so my body will start talking. So then I say to them, okay, anything where you rated yourself less than a 10? Tell me what would make it a 10. What would make it a 10 for you? So they start to get really clear about where they are and what they need. and then at the end I say, okay, on physical energy, look at your answers and then check in with your body. Are you feeling constricted, tight, heavy? Do you have throat constriction? Are your muscles tight? Are you breathing shallow? Or do you feel relaxed, open and easy as you're answering these questions? So they're not just answering mentally. We're integrating their body. And if there's a difference, if the mind is saying, oh, yeah, I'm tens in all the physical, But then I get to the end and they're like, why am I so tight and constricted? It may be because they're telling themselves that they're fine and they don't want to give up their bagel and latte and, you know, whatever it is. So they're like very satisfied, right? But their body is like, oh, that doesn't feel right. So you go through each of the sections this way, like in thoughts. It's about what are the top three repetitive thoughts that are going on in your mind. And like when you're in the shower, when you're driving, when you wake up first thing in the morning, or when you're up in the middle of the night, what are those thoughts that are occupying your mental real estate that you may not even be paying attention to? They just are so automatic. Once you write them down on paper or on your screen, next you want to say, does that thought give me energy or does it drain me of energy? And more often than not, boy, those automatic thoughts that are going on, they can really drain you of energy and you don't even know that you're the one that could really plug that leak pretty quickly. So there's a whole bunch of things like that under emotional energy. It would be what areas of your life are you avoiding conflict?

It used to be all of them, but I'm better at that now.

Yeah, but then you read TalkRx and you know how to lean into conflict now. Yeah, no, that's one of them that if it wasn't safe when you were young, if it wasn't safe to speak up, if you got reprimanded for doing it, it's very natural that you would be conflict avoidant. And I think you and I have had conversations about that for you and that you really had to overcome and realize it was safe to speak the truth.

Yeah, totally.

Yeah, and how much better our lives are if we're willing to go through the short-term discomfort of the honest conversation rather than the long-term yuck of never really having it and then our relationships breaking apart. So it's, you know, where is it in your family life, your work life, you know, finances, wherever it is, you want to pay attention to where you're avoiding conflict. And then the flip side of that with emotions is where are you experiencing joy and play in your life? and you look through all of those as well. And that's a quick pulse on the emotional energy section. Social, we already talked about, which was name the top five people or groups of people you spend time with in person or online, give them a net gain or a net drain rating when they come up. Just by bringing them up in your body, your body will respond. It will tell you, even if you just think about it. And then the last one is spiritual and spiritual energy. Spiritual is about what matters most to you. It's about your highest values. Some people think of it as, you know, connecting with nature. Some people think of it as their faith. Some people, you know, have think of it as, you know, we're all connected as one. Whatever that is for you, you got to know your highest values. And so in this section, I'm asking you questions like, give me the top three things. Some, you would be so proud if someone said when you weren't in the room, what do you want? What would, what would that be? Do you have any, any thoughts on that? What would really light you up?

About what people would say to me.

About you when you weren't in the room.

Oh, that, that I was present and not tired, distracted and burnt out, exhausted. That I was really, you know, showed up fully. that I was kind. I think that, and that, you know, I cared about their experience.

So really that you're present, that you're kind, that you're energized, and you care deeply about others. And so those are some of your highest values, even just right there. If that's what matters most, you know, then that's going to give you a really big clue. And that's also how you're going to make your decisions, because in the spiritual section, it's also about how you use your highest values to navigate complex decisions in the world. The world is not slowing down and the decisions aren't becoming easier. And so people need a framework to be able to do that. And so you do that with values. Hey, everybody, it's Dr. Mark.

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Off.

And so how do we start to use those energy levels to identify where we're at risk? It's like you can check your blood pressure to see if you have hypertension, right? What are the metrics that you kind of help people use with this navigational system that you describe in your book?

Well, first, thank you for sharing that. It's clear to me that you've done some work around it because you say it just like it's a normal story, but it's a pretty dramatic story. that you just described. Literally, you hit the wall of burnout and you couldn't get up off the floor.

I literally couldn't. I literally just couldn't drive. I couldn't, I couldn't, I was like, I had to just lay there for a long time.

Yeah, it's almost like your body had to say, like, enough, Mark, enough. Like, it stopped you. And I think that as physicians, our training has first of all, we have to do 36 hour shifts. We had to do all these things that were super human. And in order to get where we got, we had to push through our body rather, rather than partner with it. And we became so used to that and accustomed to that. It was like, listen, whatever the stress is, I just need to be focused on the next patient crisis, the next heart attack, the next stroke, whatever it is. and you just applied that to your whole life. And so when you tune out of your own physiology, your heart racing, stomach turning, muscles tightening, sweating, you know, everybody has a unique language that their body communicates with them in. The job is we have to decipher it. And our body is giving us these, you know, in medicine we call it symptoms. So we're like, oh, well tell me about your symptoms. How long has that been going on? Oh, your heart skips a beat. Tell me how long has it been happening? what does it feel like? So we take it in a real literal physical sense that it could mean something's physically wrong. Your body, I don't know how to say it better than, like, sometimes it just wants to chat. Like, it just wants to say, like, it just wants to talk to you, like, every day, all the time. It's like, yes, this, not that. Sometimes your body is going to tell you, after a while, that you're feeling really fatigued and it's like, no, we're giving you some signals now. I'm not going to replete because I haven't had enough sleep. And so it's giving you more, you know, consistent signals. And then there's the catastrophic signals where you're having crushing chest pain and you need to get help. But there's all different intensities. But our body is talking. The question is, are we listening? It's talking all the time. And so, like right now, tell me something your body's telling you right now. Because I can see you slouching in your chair a little bit.

Yeah, I mean, basically, I know what it's telling me is I need more sleep because I've been getting ready to go on a long trip and have been cramming work and staying up late and getting up early and just, you know, not getting my full rest. So that's what my feeling is now.

Yeah, but also, doesn't it speaks to you when you know you're sitting outside in your backyard in the morning, and it's like, ah, everything just opens up. So that's when it just wants to chat and it just wants to let you know. But each person has different signals. So for me, when I met you, I told you about throat constriction and stomach turning. And you said to me, Neha, you've been scoped twice. You've been put under anesthesia twice. I'm pretty sure it's your stress response. and, and I remember thinking, like, okay, thank God it's not cancer or something else, but, like, what am I supposed to do with that? What am I supposed to do with someone telling me that? And so if, what is yours, by the way? What, what do, how do you know when you're outside your comfort zone? Do you know? Do you know what? I call it your body map, but.

I mean, I, I think, I think I get the sense of just like tilt, you know, like it's like, you know, the red light goes on and I'm like, okay, I can't deal with one more thing. Like I can't, I can't like one more email, I can't answer one more phone call, I can't talk to one more person, just leave me the hell alone and I want to go watch a stupid movie.

Okay, you gotta give me like your favorite stupid movie. I want to hear it.

Well, I mean, I like, my favorite is actually CIA television series, so I'm kind of a junkie for that. I just, I don't know why I like that.

Okay. And you just want to tune out. So the interesting thing, Mark, is just like the spectrum of burnout goes from burned out to fully charged. You don't, you don't just show up one day burned out, right? It's like this gradual process that ends up, you, you start coping, you use mechanisms, you outgrow those because those aren't working anymore. Like, let's say someone has a glass of wine to take the edge off of work each day. They're not happy in their work, they're disconnected, and they have a glass of wine to take the edge off. And then pretty soon COVID happens and all these things happen and suddenly they're drinking two glasses at the end of every day or three, right? Hey, give me the bottle, right? And you don't realize it because you're starting to need more coping mechanisms to get the same effect. And then one day they hit burnout and they're like, How did I get here? Like, how did I get here?

There's no gas left in the tank, right?

Exactly. And so what you're describing actually is a pretty late signal. So what I'd be saying to you is, Mark, tell me what happens before you can't do one more email. You can't do. Tell me what, how your body's talking to you earlier than that, because it tells me you're a master at overriding it.

You're a. I'm really, I'm really good at that. But I think I could win the Olympic, you know, gold medal in that.

Well, that's why you're, you accomplish so much, because you, you know how to optimize your body's physiology. You've mastered how to, you know, be well. and at the same time, you push your body to the same extreme. Like, your body gets treated really well. It gets nourished with the best ingredients. And, boy, does it work for it, right? Yeah.

So, yeah, no, I do all the right things, but the reality is, you know, I I I know what I need to do, but instead of my mother, you know, voice Echoes in my head. And I think you met my mother. She, she said, you know, do not, do nothing and rest afterwards.

Words.

And I always like would get mad at her because she's like, oh, whenever I feel the urge to exercise, I lie down till it goes away. And I'm like, that's terrible. But, you know, she had a point. She's like, she had a point. And so I think that's one of.

My.

You know, I mean, it's like I have such a voracious appetite for life, for learning, for doing, for seeing things, for experiences, for people, for making difference in the world. Like it just it just never ends. So, you know, I sometimes have to realize that I can't do it all. You know, my mother also said that your motor is too big for your chassis, right? Meaning I have like a, I have a, you know, a Ferrari engine, but like a little VW bug body, you know, and I can't run it like a Ferrari all the time. And so I had to learn how to sort of downshift, and I basically have two gears, which is, you know, zero and fifth gear, right? And so I've had to learn all these other gears. And actually COVID was really an interesting moment for me because, you know, I went through divorce and I, maybe the world stopped and I had back surgery and I just, my body was broken, my heart was broken, and I was like, you know, and I literally just pulled the plug. I got on a plane and I moved to Maui because I figured might as well be in a nice place during COVID and you can't do anything anyway. so I could ride my bike, I could swim, I could be in nature, I could be in waterfalls. And I, and I, I literally went there and I, I felt like slowly, like the, like the gas gauge would kept going up and up and up. And my heart reactivity, like doubled when I got, you know, got there. And I, I was like, oh, God, you know? And actually, it's interesting metric. I can tell, like, my, my ring tells me, like, when my heart reactivity starts to go, my stress level goes up, and it's like, it's, it's kind of an interesting barometer. So I'm kind of using feedback tools to know, oh, gee, maybe I'm like a little. So I'm, I'm like literally next week, I'm going, getting on a plane, I'm closing everything, closing my computer, closing my phone, and I'm going off into the wilderness in the most remote place on the planet because I think that's what it takes for me to basically go in the Mongolian hinterland for a week and camp. And, and, and that I think is going to be helpful, but it's, it's, I can't just do those things. I have to daily do the things keep me going, like meditate. And it's when I drop those practices, when I'm just too busy, I got too much on my plate, I got too many things to accomplish, I will start to sort of drop off the things of like getting enough sleep or, you know, meditating on a regular basis or just doing nothing for periods of time, you know, like, and I think, you know, I've had to learn how to navigate that in myself because I'm always sort of the guy who will always move towards burnout. And so that's, you're the guy that.

Always moves towards saying yes to a new opportunity.

Right?

Yeah. Of course.

Yes.

We gotta do it, right?

Yeah. That's the other thing my mother said, no is a sentence. And I'm like learning how to do no better. Like it's hard for me, but I learned how to do no better.

Isn't it amazing when people are no longer in our lives and the things we remember about them and how they're just, you know, they move from being physically in our world to being like ever present in our hearts.

Yeah.

So you can hear her voice so clearly.

Oh, 100%.

Yeah. So I think this is just, it's so important to know yourself. And that's the me, the part of the me part of me, we world, right? That if you don't know yourself, if you don't know your tendencies, if you don't really pay attention to whether the environments you choose to be in are the ones that give you energy or drain you of energy. Boy, how on earth are you going to navigate the crazy world we're in?

Yeah, it's such a, I think this is such a powerful exercise and there's so much more of that in your book, powered by me. And I think that simple exercise of like taking a piece of paper, writing two columns ago, energy drain, energy gain, and like writing down what they are. And then you go, oh, let's see how many of these energy drain ones can I get rid of?

Yeah.

And how many of these energy gain ones can I add? Yeah, sometimes it's just as simple as kind of a few little adjustments that can make a big difference for people. What are the things that you find make the most difference in helping people recover from burnout? And you have in your book a plan, but can you kind of walk us through practically? How do you take people from burnout to fully charged?

Sure. Well, of course, I'm going to tell you it's a little bit of an intricate answer, but I'm going to simplify it for you. It depends on your style. Just like we talked about how you and I are really different on the physical versus the emotional. I dive in head first, emotional, social, spiritual, conflict, whatever. I dive head first. But this whole, let's just swim every day in the ocean in Hawaii. I'm like, the ocean, not with sharks and are you kidding me? So it's knowing yourself.

It's because you grew up in Buffalo. That's what I say.

Listen, not my fault, not my fault. And so there's, let's just think of different people in our lives have different styles. I call them work styles. So some people are real doers. They are, they love checking things off their to-do list and.

Right.

Oftentimes that gives them a sense of control. And so what they are most afraid of is vulnerability. Vulnerability. checking things off your list. Boy, society rewards us for that. Boy, look at what you've accomplished. Look how many degrees you have. Look at this, right? And so oftentimes that action-oriented, it's good. And sometimes when we overdo it and we avoid vulnerability, we find ourselves in a pickle. We feel disconnected from other people. We get a lot of accolades, but we feel empty. Now let's take another, I'm going to give you four examples. Another one would be the thinker, the thinker who loves to solve complex problems. They love taking their time, slowing down, figuring things out. By the way, that the doers are made crazy by the thinkers. Okay, the doers want to keep going and getting everything done. But the thinkers, the reason they have to slow down, solve complex problems, and they love it so much is they don't want to look foolish. They think to themselves, do it once and do it right. And then there's the Sears. I think you and I are a little bit of Sears in medicine, where we love possibilities, innovation. We want to brainstorm and think of every cool way we could do something and be cutting edge. Except, you know what we're most afraid of? Feeling trapped. Don't make me just pick one. What about all those other ideas? And what about this and this and this? Yes. And then another type of, I call it a work style, is the feelers, right? The people who are the glue of any family, of any community, of any company, of any team. And they're the ones who are really in tune and connected to people. Well, what's going to drain them of energy? Faster than anything, feeling rejected, feeling, you know, like they are outside the pack. So, people have to first understand who they are, and then they have to understand what drains them of energy. And once they do that, then it's about really kind of taking this pulse check, figuring out, because at different points in your life, Mark, different areas will have a net gain and a net drain. Like right now, for you, on a social level, it's a net gain. you know, you're feeling good, you are really excited, you're going on a trip with your partner, like all of these things are a net gain. But there were times in your life where if we would have done a snapshot of you, social would have been a net drain.

Yeah.

So what I want people to know is wherever you are on the spectrum from burned out to fully charged.

It.

Can change depending on where you are in your life. So you want to just take the, you know, assessment and like figure out, oh, I'm having a net drain in mental and emotional, but it looks like my spiritual, social and physical are doing great.

So I think and the book actually has the ways to sort this out for yourself. So it's in there.

You bet. And it's all broken out by sections so that if you really know that you need help in a certain section, go to that section. Right? Go straight to that section once you figure out what it is so that you can focus. The other thing that I'll say is at the beginning of our podcast, we talked about how there's acute burnout where people are just in it and they're at the edge, they're falling off the cliff. Well, after the first chapter, second chapter maybe, I say, emergency toolkit, exit here if that's you because you need emergent help. You don't need to be reading a book. this is if you're, I mean, if you're not sleeping at night, you can't function. You know, the book isn't where you're gonna go there and go to an emergency toolkit that's gonna give you guided imageries, it's gonna teach you breathing, it's gonna give you all the ways to calm your physiology. And then you find a health professional, you start working with them, you get whatever you need to, and then you continue to figuring out the root causes and how to change it. And now, Mark, I'm doing I'm not just doing this for individuals. I'm actually doing entire companies at once. So from CEO to frontline to everybody in between, all of the company, they're all learning together. And when you acknowledge that, like, how did we not learn this in education, in our families? Now companies need to be the ones who help the next generation coming in, Bridge, and with our mental health crisis, everything that's going on, it's going to be our job now to educate the next level of workforce on all of this. And by the way, all of us too, because we never learned it in medical school either.

That's right.

Yeah.

It's so true. We just, we just don't, these are basic life skills. We don't even know how to manage our nervous system. It's like such a ridiculous thing that we, you know, learn reading, writing, arithmetic, but we don't learn, you know, the fifth, fourth, third, fourth R, which is restoration. How do we restore ourselves? What do we need to actually take care of organisms? And, you know, I, I was, I mean, it's embarrassing a little bit, but, you know, I work with a trainer. And we were working out yesterday. And I was like, okay, what are we doing tomorrow? I was like, well, you need a recovery day. It's really important. Don't do anything. I'm like, what do you mean? I want to work out. I want to work out. And she's like, no. She's like, he's like, no, you need a recovery day. It's just as important as the training days. And I'm like, all right, fine. Okay, I won't do any training today. And in the morning, I woke up and I'm like, oh, what can I do? Can I go exercise? Can I ride my bike?

Can I go play tennis? I'm like, I'm going through this thing in my head.

It's very funny.

Wow. I am always in awe of your energy levels. I mean, one thing you really do have, you've got a lot of energy. I blame it, I blame you for the reason I don't have that much energy. I'm like, 'cause Mark's got extra.

He took, he took like three people's energy. I don't think it's a zero-sum game, Nia.

That's not how it works. That's not a zero-sum.

No, I think you're exactly right. You're exactly right. So I just want to get into sort of this whole idea of boundaries, because part of the reason we burn out, for, for sure. The reason I burn out is not saying no is, is not having good boundaries around work, around personal life, around family, around, you know, what I need to schedule myself in so that I make sure I get what I need done for me. And, and I think, you know, I think most of us don't learn how to have healthy boundaries, don't know how to communicate healthy boundaries in a loving way, don't know how to even identify what those should be or how to figure out what to do to create those for ourselves. Can you guide us through, like, how do we, you know, we kind of, you talk about, like, you know, different kind of boundaries, right? Porous boundaries or good boundaries. How do you start to think about boundaries and getting the right balance and not having too rigid boundaries or not too leaky boundaries? We talk about leaky gut, but you can have a leaky self, right?

You know, it's always, the answer is always in nature, right? Think about every single cell, a phospholipid bilayer, you know, boundary on every cell for the membrane. Like nature knows how to do it right. Like keep out the bad stuff, put in the good stuff, right? Allow that all in. So, yes, what happens? So first of all, I want to say, people ask me, how do I know where to draw boundaries? And I say anywhere that there's a drain of energy, that's where a boundary is needed. Burnout is boundaries. Those two words, boy, they really belong together. And that's the heart of burnout, which is, Now, if someone's gotten hurt in their life, maybe young, something happened when they were young, boy, they will drop armor and protect themselves from never feeling that pain again. Something that caused them pain, something they were afraid of, some sort of trauma, anything that happened, and even every day, needing to protect ourselves from feeling disappointed. And so over time, People can form too rigid of boundaries to protect themselves. Now, the way that you know that it's too rigid is because it also, while it protects you and you don't feel the disappointment and you don't get hurt, maybe someone's been hurt in love. And now they're like, okay, listen, no more. I'm not gonna do that. I am happy by myself and I'm not gonna venture into love. Okay, well, you know your boundaries are too rigid when you start to feel lonely and disconnected and you wonder why things feel so empty, right? Because it can keep out the pain, but it also keeps out the connection and love and affection and everything else. Now, if you're Indian or, you know, in, in the Jewish Community, I don't know if this is true. You can tell me, but we really didn't have a lot of boundaries growing up in our family. It was like, how everybody's in everybody's business, like, how many people are going to fit in this car? Well, as many as there are. This was like before seat belts and all this stuff, right? Or we go to India and it's like, who's, who's staying at our house? Well, as count, however many people there are, they're all staying over because no one's missing the party, right? So there were never really clear boundaries. It was like, with family, there are no boundaries. You take care of everyone, right? And so when you grow up that way, you may have really porous boundaries. Or if you're the feeler, like I was speaking about, earlier, if you really resonated with being the glue of the team and you're afraid of being rejected, you may be someone who thinks that you can't draw boundaries because if you do, it will disappoint another person. You might lose connection with somebody. And so for our whatever fears you have might cause you to have too porous of boundaries. And the way that you know you have too porous of boundaries is when your energy fluctuates by the room, every room you move into, it changes because it's actually sensing the external environment and you're leading from the outside in rather than from the inside out. Yeah. So that's porous boundaries that are just kind of too wide open. And then there's rigid boundaries, and then there's just right boundaries. I feel like we're talking about Goldilocks here, but. So the just right boundaries are the ones that you feel really good about. They might be a little hard to set. Like, you know, I might need to tell you, Hey, Mark, what really works for me is to do something for two days. What does not work is doing it for a week. Or, I can work two days a week, but not five, right? Whatever that is. It's about whether people are willing to take the dip of discomfort, the short-term dip of discomfort for the long-term high of what they want. Most people, when they come to a choice point, okay, they take the short-term, the short-term high, meaning they avoid having the conversation, saying what they need, asking for what they want, and then they get the long-term yuck, which is, okay, that didn't go well. and I don't know why this person's so unreasonable. But the truth is, I never gave you the boundary in the beginning, but I'm really mad that you crossed it. And so it's really, you know what I mean? It's like you really want to talk about things and set expectations up front. I don't know if you remember this, but I remember us kind of going through this when I had your daughter come stay with me. Do you remember this? Yeah.

Oh, yeah.

And so all you do is. anytime you're making an agreement to do something, to live with someone, to bring someone on for a job, to partner on a vacation, so important to just drop in and really kind of figure out, what are my expectations for this trip? What agreements do I need to make so that it goes really well? And what agreements, if things don't go well, what should we decide would be a good way to handle that. So one of the things I decided was that wouldn't it be a great idea that anybody could call a house meeting? If something went wrong, anybody can call a house meeting. If we're going to live together, then wouldn't that be nice? And so you kind of come up with ways that allow people to bring up and surface what's going on so that it doesn't fester and then you lose the relationship altogether. So boundaries are whatever boundaries we create are the ones that allow us to be in a really healthy relationship because they have to work for both people.

Well, what if they don't work for the other? What if they don't work for the other person? They don't like your boundaries.

Yeah, well, some people really don't. And sometimes that means you've outgrown the relationship. Sometimes that means you've come here and learned the lessons you were meant to learn. Sometimes it means that the other person could counter could counter that and say, you know, okay, I'd like it if you worked twice two days a week and not five at my practice, let's say. And I'm wondering if once a month you could take a Saturday day call. You know, would you be willing to do that? And so it's a bit of a negotiation until two people can come to what works for both of you. But be creative. Don't allow somebody idea or saying no to you to have you think they're rejecting you. What they're trying to do is put in place what would allow them to say yes. They want to say yes, and they're telling you what it would take for it to be a yes. And the other thing, Mark, you know, you said you want to say yes to everything and everyone, and that depletes you sometimes. And I'm wondering, right, that that reframing that anytime you say yes to something, you're saying no to something else.

Right.

And so what if you saying no to something, you know, outside an event or whatever it is, is actually you saying yes to a good night's sleep. So if you're somebody who has a hard time with that, think about what you're saying yes to. I think that'll make it a little bit easier.

Well, I'm actually struggling with this right now because a friend of mine invited me tonight to go to this event in New York. city. And, you know, I know I was at four in the morning getting work done before I left, and I, you know, I'm gonna. They're gonna want to hang out and have dinner, and I'm, like, gonna want to go to bed. And I'm like, I want. I want to see them and have fun and do that, and I don't want to disappoint them, but I also, like, want to go to bed. And I'm, like, so it's like I have this kind of battle going in my head, and I often. I often don't choose myself, is the truth. And I'm learning how to do it better. But I think your book is such a great roadmap for people to think about how they can actually do it better and. And giving them the tools and the language and. the thinking and the structure to start to navigate, you know, where are they in the spectrum of burnout? Where, because it's not like a, you know, linear scale, right? Everybody's got different levels of things that are maybe, maybe they're not taking care of their physical health or maybe their, you know, relationships are great, but they're, you know, they're, you know, spiritual health is failing because they're not really dealing with that part of their life or addressing it. So it's really about how do you kind of figure out how to navigate and overcome some of the things that you call mind traps, right? We have a lot of those, like like perfectionism, judgment, control, blame, comparison, that actually drain us. So can you talk about how do people start to deal with these sort of negative mental habits, these ruts, these mind traps, as you call them, that keep us looped in this cycle of burnout?

Yeah, well, I think you and I are, one of the things we value is excellence. We like doing things and we like doing them really well. We want to get an A. That's part of how we got here. And I think.

Doctors got A's for sure. You're sure a doctor, you got a lot of A's or you don't get to be a doctor.

Yeah, and there's an unwritten, unspoken competition in it all. And really we're competing with ourselves. And I think even when we achieve whatever we've set out to achieve, I'm not sure we give up on that. And there's a lot of people who do it in different ways. And so one of these mind traps that I would say is, Let's actually go back a little bit. I want you to think about how you form your thoughts. So, let's say tonight you tell your friend, yeah, I'll see you there at 8 p.m. Okay? I'll be there at 8 p.m. Actually, we would flip it. Let's say it was you inviting somebody else to come and they said, yeah, I'll be at your party at 8 p.m. I'll be at the event tonight in New York. And you look at your watch and it It's 8:30, no text, no voicemail from your friend who was supposed to be there. And you're starting to realize, like, you might be going solo to this event, right? Like, they're not here. What's the first thing you would think? What's your first thought? The first way you'd put together that data?

You mean that if they weren't going and I was just going by myself?

Well, let's say it was reversed. Like, you were the one in New York asking your friend, which is you to come up and you say, you say yes. Okay. The friend says yes. Now you're waiting at 8:00 p.m. you're waiting for this friend to go into the event. Okay. And there's no show for 30 minutes. Okay. So there's an empty glass.

Well, I wouldn't do that, but I wouldn't do that.

But I would, let's just say there was, let's just say somebody didn't show up.

What's your first thought? If I invited them and they didn't show up, I would think, oh, what happened to them? Did they get an accident? Are they okay? You know, are they tired? Like, are they embarrassed to tell me they don't want to go? You know, I probably wouldn't take it personally, but that's just me. I kind of tend to think about like, you know, the situation that they might be in, but I think other people will have a different interpretation. They go, oh, they don't like me. They don't love me. They don't want to see me. They hate me, whatever. You know, I'm not good enough.

I don't have those thoughts. But, you know, think about if it was a date. If it was a date, right? Now, your date doesn't show up and you're pretty excited.

You're hoping that's more disappointing.

Okay. And then you might think what?

Oh, I shouldn't like me.

Yeah.

And if I'm attractive, maybe I'm boring. Okay, whatever.

So this is the deal. I think of how we form our thoughts. We take data from outside. You look at your phone, there's no message. You look at the time, it's 30 minutes later. Inside, you'll have some physiological response like the body map that we were speaking about, that's all data. You take that data inside you and outside you, that you have an empty glass of whatever you're drinking, empty chair next to you, the person isn't there, and you form your thoughts in one of three main ways. First, right, the way that you just said, which was maybe this person isn't really that into me. That's personalization. You make it about yourself. You can imagine how that could be a little draining. If anything that happens, you think, oh my God, what did I do wrong? It's my fault. Second, second way that a different way that you could show up, you could say, oh, she is so rude or he is so rude. Didn't even text, didn't even call. You know, so-and-so's parents didn't even raise them properly. Or you could go to what you did with your friend and you could say, wow, I hope this person's okay. I hope they didn't get in an accident. And you could go to generalization, which is something that's not about you or the other person. It's literally about bigger events than them. So it's personalization, projection, and generalization. Okay? Now, when you're, we live in a world where now with social media and the internet and all these things, AI and blah, blah, blah, everybody is in everyone's business, right? They at least get the half of the highlight reel of their life that's like fantastic, right? Showing across social media. And so the comparison game, there's always someone who's going to be, you know, younger looking than you, got more money, invested earlier, you know, whatever it is, thinner, like, I don't know what it is, richer. So the game of comparing yourself to other people is just an endless trap. Now, the people who do it really well, they look at a picture of themselves 10 years younger, and they're like, oh, my God, I was so much better looking back then. And they compare themselves to, like, the younger version of themselves. Now, that is, like, an endless game. So it really, you know, there's lots of ways. Perfectionism, right? Versus Excellence. We were talking about that. So Perfection, that's really about what you're focusing on. If. If you keep going over something, you keep going over something to get it right, and you're really worried about. other people think about you and it needs to be perfect, that's perfectionism. Versus excellence is you give it your all, you do the best job you know how, you put it out there and then you're open to the feedback and learning and if you don't get it or you make a mistake, that's okay. And so these are the ways that as we start to know ourselves, we can unlock Ways that we're having a net drain of energy and that would be on the thoughts level and the mind trap level. But you know this, whether it's, you know, biologically in your bank account or in your relationships, a net drain of energy is not sustainable anywhere.

That's true. So, so just to close Neha, tell us what are the top things you do every day to support your physical, emotional, mental and spiritual health? Like what's your routine now that you've sort of gone through burnout? you come to the other side, you're teaching this, you know, what do you do? And where do you struggle?

So one, I think there's a few myths. I've written a book on how to lean into conflict. And people think that, I think that people think that because I did that, it means all my relationships are like perfect. They're not. And in fact, if you and I got in a conflict, my stomach would be turning and I would be nervous about bringing it up and It would be all the same things, but I just happen to have a bigger toolkit to draw from, to work through it. And the same thing about burnout. And I think, you know, I can tell you're a little tired right now. Like, I can feel it in you, you know, when you say, I stayed up until four in the morning and all this stuff.

I got up at four in the morning.

You got up at four in the morning. So, you know, I think it's really about, I, even in this book, in launching this book, I came to Lake Como because I wanted to figure out if I was going to tell the world that they could go from burned out to fully charged at work and in life, how was I going to deliver this in the world and be fully charged myself? And so what I'd say there is, it's not like I don't have the tendencies of all or none still, I do, and sometimes I can feel myself starting to get the energy draining, It's just that when I fall off the horse, I get back on much quicker. It's about the timeframe. So you asked what I do and I actually wanted to ask you about this. But you know I've had autoimmune issues with my thyroid and I had a parasite maybe like six years ago that really caused all sorts of skin issues in my gut biome. I came to you and we were working through all of that. You know, I've started every morning starting my day with lemon water to kind of wake up my liver and kind of get things moving. And then celery juice, which has actually, I cannot believe this, but it's actually really kind of healed the last parts of my skin. So I have 32 ounces of celery juice every day, and then I follow that with like a heavy metal detox, and now I've started work through. You had done the testing on me that showed that I still had things that needed to come out. But while I was out here, I bought a juicer. I've been doing it every day. I love journaling and I love being in nature. So for me, my grounding place is when I can be surrounded by people that I love and I feel authentic around and connected. So for me now, I've weeded out the people in my life, my life that drain me of energy because I am that feeler that really cares about who's around me because I get energized by that. So I sleep really well. So I'd say that I sleep at least eight to nine hours every night and I love it. And it would take something pretty big and important to get me to say I'll have You know, I'd be getting up at 4:00 a.m. So.

Yeah, well, I'm just doing it because I'm trying to get to Mongolia and not have anything on my plate. So it's a short term, short term thing.

But that's important. Like it's short term. That's what I mean. Like you and I can get tired, but we also know that it better be short lived and we're going to recover quickly. And so, you know, we have burned out and we aren't like free of ever feeling that exhaustion. but we recognize it early and we turn it around and we make ourselves important.

Well, I think that's the bottom line here is make yourself important. If you're suffering from burnout, if you feel tired and exhausted, if you are overwhelmed, there is a solution. It's not just about having to endure that and deal with it. And yes, we all have pressures in our lives and things we have to deal with and do, but I think it's like a life skill and this is a really important life skill because if you're burnt out, it's a sign of high levels of stress and that exacerbates every known disease. So, I encourage everybody to check out Naya's new book, Powered by Me, from Burned Out to Fully Charged at Work and in Life. I certainly am going to use it as a roadmap for me. And, I encourage you to share this podcast with your friends and family on social media. I'm sure they're going to love it because I think everybody can relate. Certainly I do. And, leave a comment. How have you learned to deal with your burnout and what have you found successful? We'd love to hear from you and we'll see you next week on the Doctor's Pharmacy.

Hi everyone. I hope you enjoyed this week's episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their find a practitioner database. It's important that you have someone in your corner who's trained, who's a licensed.

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