How Chronic Stress Impacts Your Health And Drives Adrenal Dysfunction

Coming up on this episode of the Doctor's Pharmacy.

Over time, our hormone system, if we've got chronic stress because of our perception of the world around us, or we're not taking time to take care of ourselves, or we have a chronic infection, those chronic stressful events can disrupt and it can get dysregulated.

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Hi, this is Lauren Feehan, one of the producers of the Doctor's Pharmacy podcast. When we experience stress or any other threat to our well-being our brain goes on high alert, activating an ancient system designed to protect us from a wide variety of threats and dangers. Unfortunately, modern life is keeping most of us in a state of chronic stress activation. This puts our bodies in an ongoing state of survival mode and sets the stage for burnout, fatigue, and adrenal dysfunction. In today's episode, we feature three conversations.

From the Doctor's Pharmacy about the role of chronic stress in adrenal or HPA access dysfunction.

Dr. Hyman speaks with Dr. Elizabeth Boham about how both real and perceived stress.

Can impact the body with Dr. Isabella.

Wentz about her personal story and the stages of adrenal dysfunction and with Dr. Rangan Chatterjee about how we can reduce stress by choosing to do something joyful every day. Let's jump in.

So stress is that real or perceived threat on our self.

And it can be to your body or your ego.

Absolutely. Right. And it can be, it can be emotional stress and it can be physical stress. I think that's important to recognize. We could talk more about that because Sometimes we always think it's coming from the mind, but we appreciate the fact that it's all connected and sometimes it's coming from the body and impacting the mind as well. So it's either real or perceived and it impacts our body and our health. And we know that- and when you.

Say perceived, you mean imagine. So you could think your spouse is having an affair and they're just late at work trying to make money to take care of your family and you can get the same stress response as if he actually was having an affair.

Absolutely, 100%. Our mind is really powerful and it is not always right, right? And it can create a whole bunch of extra stress for us many times, as can chronic news and our apps and our phones and all those things that create a lot of perceived threat to our health and our wellbeing as well, that creates a lot of stress. That's absolutely true. So, you know, acute stress is something that our body is equipped to handle, right? So a stressful event occurs and we've got all of the things in place to be able to handle that stress. We have a whole endocrine system, we have hormones, we have cortisol, we have that fight or flight response. We can run away from that tiger or give a presentation or or go run a race. And all of that is really good and important. And we have a body that can do that, right? And we wanna be able to handle stress, right? That's good for us. And the problem comes in when it becomes chronic over time and how that impacts our health long term. And we wanted to do this episode because there's this term being thrown around and people talk about it a lot called adrenal fatigue. People are always like, well, what does that mean? Do I have it? Do I not have it? And really, how is it impacting my health?

That's so true. And I think we can't change our external circumstances often very easily. I can't snap my fingers and change politics or climate change or war or civil unrest or even change the economy. I mean, there's things I do have control over, but there's a lot of things that are real stresses, or if I have a family member who's difficult, or if I have, you know, a health condition that's stressing me out. I can't control that, but we have tremendous ability to control our thoughts. And our thoughts are things that influence our biology in a very direct way. There's been a lot written about this, a lot of science on this. Biology of Belief: Unleashing the Power of Consciousness, Matter, and Miracles by Bruce Lipton is an incredible book about how our immune cells, for example, Listen to our mind and Candace Pert, molecules of emotion, the neuro-psycho-neuro-immunology, how our thoughts are literally communicating with our hormones, our brain chemistry, our microbiome, with literally everything in our body. And so when we let our minds run ragged and astray and wild without learning how to regulate our own consciousness and thoughts, it leads to this chronic level of stress. And even the best of us who learn how to do that, it's still hard and you still need to do practices. So we know we're very good at, oh, I know I need to exercise, 'cause that's good for my body. And I know I need to eat better. That's good for my body. But most people don't understand they need to sort of reorient and recalibrate their relationship to stress, 'cause it's never gonna go away. It's just how you perceive it. Woody Allen has a gun put in his head, he's going to be freaking out and having a neurotic panic attack. You know, if James Bond has a gun in his head, he's like, oh, whatever, and he's going to get out of it, right?

Same gun, different person. And I think that's what we all have to learn. How do we respond to that stress that we have?

You know, how do we respond to it? Well said. So tell me about the symptoms. If people are in a state of chronic stress, how would they know it's affecting their biology? Because there's There's a whole list of symptoms that we talk about when we talk about adrenal fatigue or adrenal exhaustion. There's a lot of, I think, skepticism in the traditional community, medical community about this whole idea of adrenal exhaustion. You have Addison's disease, which is an autoimmune disease that nukes your adrenal glands, or you're fine.

But it's not really like that. Right, so we have this whole, really what people are saying the proper term for this situation is HPA axis dysfunction, right? The hypothalamic-pituitary-adrenal axis, adrenal axis, which are really parts of our endocrine system that handle and manage the stress response in our body. And when it gets out of balance, that that can really influence how we feel. And so we can have, and we'll get into this a little more, we can have HPA axis overactivity, right? Or under activity. And so, you know, but those hormones, all of those different, parts of our endocrine system handle that stress response in our body.

So.

When there is a chronic stress over time, when a lot of cortisol gets produced from our adrenal glands. And at the beginning, as we talked about, that acute stress, that cortisol is really helpful for us because it helps increase our blood pressure, it helps us run away from the tiger, it increases our blood sugar, So we can get nutrients and energy to our muscles so we can run away from that perceived threat, which is really important if you were running away from a tiger or a dog or whatever, right? So we need to- and it stops.

Your digestion, 'cause you wanna be digesting your food while you're running from a tiger.

And so, you know- It increases clotting, right? Absolutely.

'Cause you wanna make sure if you get cut or bitten when you're running away that your blood clots very fast.

Yeah, and it's a phenomenal system and it's really good and really important, But over time, if we've got chronic stress for some reason, because of our perception of the world around us, or we're not taking time to take care of ourselves, or we're eating a diet that's really stressful on the body, or we're not getting enough sleep, or we have a chronic infection. I mean, we do see this with illnesses too, like a chronic infection. Those chronic stressful events over time really can disrupt how all aspects of our hormone system works together, that whole HPA axis works, and it can get dysregulated. And so that's that whole talk of that HPA axis dysregulation.

So your hypothalamus, which is in your brain, your pituitary, so it's all the command and control centers in your brain that then send messages to your adrenal glands, which are on top of your kidneys, and they produce adrenaline, cortisol, norepinephrine.

And epinephrine, but also DHEA, which is a hormone that gets turned into testosterone and estrogen and hormones that impact our blood pressure and electrolyte balance. So it's involved in a lot of things. And it's important to recognize that the pituitary also impacts lots of other hormones in our body, our female hormones, our male hormones, and so our thyroid hormones. It's all really connected, which is interesting as well. So when people are under a lot of chronic stress over time, the cortisol levels are remaining higher than they should be for long periods of time. And so this is a whole feedback loop, right? This system in our body is a whole feedback loop. So that high cortisol sort of shifts the way that there's a feedback mechanism that occurs and in a way the body sort of slows everything down. And so over time with high levels of cortisol that are getting released all the time, people start to crash. They have like that what they call burnout or, you know, their body sort of just slows down. We see their thyroid slow down. we can see other hormones shift, but we definitely can, over time, if we look, we can see a decrease in cortisol levels. So we can do some special tests that look at that.

It's so important what you're saying because the stress response is a good thing in the short run, but not in the long term. And we never really had these chronic stresses that we do now. We'd be in threat of danger, we'd mount the response, it was good. you're releasing high amounts of cortisol and it's like a drug we give for people with autoimmune disease called prednisone. Yes. Or when you, for example, have a disease called Cushing's disease where your adrenal glands or a pituitary tumor will produce a lot of cortisol that is not regulated by any feedback mechanisms. Yeah. And when that happens, you get all these problems, right? You get high blood pressure, you get diabetes, you brain shrinks, the memory center in your brain shrinks so you can get dementia. You have muscle loss.

You're more likely to get sick more easily.

Yeah, you get sick, your immune system stops working as well. So you're really accelerating all these age related diseases and you're also suffering from FLC syndrome, which is basically when you feel like crap. So let's drill down into some of the symptoms that people who might have this dysfunction get.

Absolutely. So, you know, a lot of times people with HPA axis dysfunction, they'll say, well, you know, I have a good night's sleep, but I still feel tired in the morning. I can't get going. Or other people, depending on where they are in this whole process, they may feel like they're anxious all the time. They can't calm down. They're tired but wired and they're just, you know, when you get into bed.

And you lay there, you're tired, but you can't fall asleep. Yeah, I've been there.

You know, they can have a hard time dealing with the stress of everyday life. They can feel more depressed or irritable. Things that they used to be able to do really easily are hard to do. So things that they, you know, their job maybe, or handling, going to the grocery store even, you know, things that used to be really easy to do every day become tasks for them. overwhelmed and exhausted.

And.

They might get, as I said, sick more easily. You can have more cravings for foods. You're looking for things to pick you up, right? So sugary foods, salty foods, you can have cravings for them. You may feel more fatigued when you stand up. You get more tired. You may have low blood pressure over time and low blood sugar over time with an underactive HPA axis.

And it's often the syndrome I see all thin women, which is really common where they get sort of adrenal burnout, they get low blood pressure, so dizzy when they stand up, they crave salt, they have anxiety, they have palpitations, they tend to get hypoglycemic, so their blood sugar actually is not coming up when it should. And so you can kind of pretty much tell that this is going on with people. But what's interesting is it might be worth breaking down is that Adrenal burnout, let's just call it that, comes in stages, right?

Absolutely.

The first stage is, tell us about the first stage and how it progresses to full burnout.

Absolutely.

Is the symptoms and the treatment a.

Little different for each person? They are a little different. So at first, when you've got that overactive adrenal gland, it's the beginning, let's say, of just handling all this chronic stress. People feel that wired and tired. They're anxious. They feel like they just can't calm down. upregulated inside. And then over time, what can happen is with having that chronic levels of high cortisol, what can happen over time, as we talked about with that feedback loop, they get a decreased level of cortisol that occurs.

So initially, see high levels.

Initially, when you do the testing. And we'll talk about the testing in a minute.

Yes.

And then over time we see a decrease. And when it's flatline, what it feels like is burnt out.

Yeah.

You know, you just feel exhausted, you can't get going in the morning, you're getting sick more frequently, you're that's when you see a lot of low blood pressure, low blood sugar, you know, salt cravings, but just, you know, literally you feel that burned out, you know, your exhausted feeling.

So one is like chronically high and there's like chronically low and there's kind of in between where you get low in the morning and high at night.

So you're exhausted in the morning, but you can't fall asleep at night because you're yeah, it's like, circadian rhythm is all screwed.

So that's what we do differently than.

Than what, you know, conventional doctors often do.

So, this isn't even a diagnosis in conventional medicine.

No, you know, really, like you were saying, if somebody has really low cortisol or really high cortisol on blood testing, they'll call it, you know, maybe Cushing's or Addison's or a very serious adrenal issue. And we were taught about that in medical school, but we weren't really taught.

About.

These situations where if you did a blood level first thing in the morning, it probably would look okay, and you wouldn't really see a lot of abnormalities in the blood testing. But if you look a little deeper and you do saliva testing and you check saliva four times in a day and you can check saliva for cortisol when you first wake up in the morning, they call that the cortisol awakening response. What we should see with that saliva testing is that when you first wake up in the morning, your cortisol increases. It's almost like a stress test for your adrenal glands. The cortisol awakening response is like a stress test for your adrenal glands. Getting up in the morning is a little bit of a stress for the body, right? It needs to get going and wake up. And so what we typically see is the cortisol increase first thing in the morning. And that's a good thing. We want to see that. That means that the system's working well. And what we see is the cortisol levels in the beginning of the day are higher. And as the day goes on, they come down. So when you check if somebody's saliva tests during the day, we should see it go up when they first wake up in the morning and then start to come down as the day goes on. And that's a very normal pattern. And what we were talking about is over time, if people have a lot of stress and anxiety going on, you might see high levels of cortisol. And then over time, you might see it start to flip where they're low in the morning, but too high at night. And then if things really go on for a while, you might see a low level of cortisol throughout the whole day. this a lot of information about how best to treat somebody and how best to take care of them and what they need to really focus on. This is something you wouldn't get at traditional doctor's office.

They're not gonna look at your salivary cortisol levels. They'll say, oh, you have Cushing's and there's tests for that or Addison's and there's tests for that. But short of these two extremes, and that's what's so different about functional medicine, it's really about this Continuum of dysfunction. It's not just on or off. It's like you have diabetes or you don't. Yeah. Right. And like you have high blood pressure, you don't. gradual worsening over time. And those diseases are very particular because they're either a tumor, which is Cushing's, or they're an autoimmune disease, which is usually caused by gluten, the Addison's disease, which is what President Kennedy had actually. And it certainly impaired affected him. So when you have these patients come in, you do this history, you find these symptoms, you sort of hear their story, how do you start to approach correcting this? Because I found, you know, some things are really easy in functional medicine. Someone has bacterial overgrowth, they have gut issues, adrenal valve, 1-2-3, it's fixed. This takes a little bit of time because of the amount of stress we've put on our adrenals. We have to constantly try to build them back up over time and it takes a little bit of time to recover. Hey everyone, Dr. Mark here. You might think using cooking oil is fine as long as you're the one doing the cooking, but unfortunately most oils have been linked to all kinds of health health or environmental issues. Zero Acre Farms has the solution. Zero Acre Oil is an all-purpose cooking oil with more healthy monounsaturated fat and significantly less inflammatory Omega-6 fat than even avocado and olive oil. And while other oils have had issues with adulteration and rancidity, every bottle of Zero Acre comes with a QR code you can scan to validate purity. It also works for any recipe with its clean and neutral taste and high smoke point. I love that it brings out the taste of my other even something simple like an omelet has more flavor. So head over to ZeroAcre.com for an exclusive offer. Go to ZeroAcre.com/Marc or use the code Marc at checkout to claim the deal. That's Z-E-R-O-A-C-R-E.com/Marc. I'm so excited to share that I have a brand new protein powder called Super Simple Grass Fed Protein. If you follow my work, you know how critical protein is for building muscle, for optimal weight, and overall longevity. I like to get a good amount of protein in every meal, and sometimes that's hard with a busy schedule. That's why I make a protein-rich smoothie every morning featuring my Super Simple Protein made with really clean ingredients and also minimal ingredients from grass-fed beef protein. Right now I'm offering the Doctor's Pharmacy listeners 10% off. All you have to do is go to drhyman.com/protein and use the code PROTEIN10. That's drhyman.com/protein and use the code PROTEIN10.

That'S one in a zero. I think what's fascinating is, you know, and what we realize is the body has this tremendous ability to heal, right? And we this is an area where our body can heal. We see it heal all the time. It just sometimes takes a little TLC and some care. And that's where, that's where the lifestyle factors really, really make a huge impact. You know, we work with people to, to really balance their, their diet and focus on nutrition. And, and we can delve into each of these more, you know, getting good sleep, resting. Resting is important, right? We need to give our body time to rest and We are living in a world where it is hard sometimes to turn it off and people are not. So they are really having issues because of it. So we have to help them rest and recuperate and get in their regular meditation and breath work and take time for themselves and turn off the lights at night and turn off the computer and the cell phone. Diet makes a huge difference. There is so much we can do.

-Before you get into diet, let us go back to what you just said. the light thing, the computers, the screens, it's not just that they're distracting. There's a biology around your adrenals that has to do with something called your circadian rhythm. And it requires certain types of stimuli at certain times of the day and different kinds of stimuli at the other times of the day. So in the morning, the way to get going with your circadian rhythm and your adrenal glands to properly function is to have sunlight for 20 minutes in the morning, which how many of us actually do that? Yeah. And get outside. And the same thing at night, if you are stimulating your eyes with bright light that isn't have all the blue filtered out, which is you can see blue-black glasses or just getting off screens, you will actually stimulate more awakefulness and you will suppress cortisol because like, I mean, suppress melatonin.

Yes. Right?

Because in the morning you wake up and you see the sunlight, well, your melatonin levels go down so you don't feel sleepy all day. But if you're having light at night, it actually keeps the melatonin down so you can't fall asleep.

Yeah, I mean, so circadian rhythm is critical and we're gonna touch on it with one of the cases I have because, you know, we'll get into it in a minute, but she was working more in the evening shift and I think it really really is hard for a lot of people with, depending on the shifts that they have to work. But you mentioned that, you know, getting up in the morning, getting outside, getting that sunshine helps for so many reasons. It helps our mood, it helps us fall asleep more at night, and it helps us, you know, our body likes to have regularity and rhythm. And I think that's one thing we really work on with people when they're really struggling with this is, is getting them in some pattern and rhythm of, of, you know, getting a good sleep cycle, get, getting a good eating cycle. not grabbing and going, not skipping meals. I mean, there's a lot to be said for fasting. You've done a lot of podcasts on this, and there can be really a lot of great things with fasting. But sometimes when people are really, when their HPA axis is really underactive and it's not working very well, and if they've got the signs of burnout or adrenal dysfunction, right? Fasting sometimes for too long can be more stress on their body. Some extreme diets can be more stress on their body and they might not be at a point where they can do it, they can feel good with it, right? They can't get all the benefit from it. So they can still fast for 12 hours but we might not be fasting them for 16 hours or 18 hours during that time.

Well, it's really important what you bring up about food because there are certain foods that actually cause stress in the body. independent of your thoughts. And there are certain foods that reduce stress in the body, independent of what you're thinking. Right? So it's actually food can be a stressor or a relaxer, depending on what you're eating. Can you talk about the foods that tend to cause more cortisol, adrenaline and stress in the body? And then some of the foods that we would be thinking about that might help reduce that.

That's such a great point. You know, you know, if we, if.

We eat.

A donut and with coffee and sugar.

I'm going to an extreme here for breakfast. It's not that extreme.

It's probably the breakfast of most Americans.

Dunkin' Donuts, it's really stressful on the body, right? Why? Because it causes this spike in our blood sugar because it gets digested and absorbed really quickly. Our blood sugar goes up quickly and the body goes, oh no, right? It gets stressful for the body. The body produces a bunch of insulin. to help lower it. And then what happens is the blood sugar drops afterwards. And so those ups and downs in blood sugar like that are really stressful for the body. And when the blood sugar is dropping.

It'S a life-threatening emergency. You've got to go get food.

Right, right. So those, you know, if you're eating a lot of foods that cause your blood sugar to go up and then drop with, you know, those easily to digest and absorb, you know, you have a can of soda, I mean, we're, you know, those things really are stresful for the body. They create this stress, they create the cortisol response. It's one of the reasons we get a lot of weight gain around the belly when we eat those kind of foods because they are stressful for the body. And so instead we want to be.

Really balancing our blood sugar. And before you get into how to fix it, I just want to point out this study that was just so mind-blowing when I read it years ago by a friend of ours, Dr. David Ludwig from Harvard. And he took kids that were overweight and fed them three different breakfasts, right? Oatmeal, steel cut oats, and an omelet. Same calories, okay? Same calories, but different carbohydrate, protein, different fat. What he found was that the kids who had the regular oatmeal, like the quickly absorbed oatmeal, we think oatmeal is healthy, right? It's not like they're having a donut. Their insulin went up, obviously their blood sugar went up, but their cortisol went up, their adrenaline went up. the body perceived it as a stress. Whereas the kids who ate the omelet didn't happen. And then the kids who ate the oatmeal were hungrier and wanted more food. So we know that starch and sugar create a biological stress response in the body, and that's bad. In addition to the fact that the sugar causes a problem, your brain chemistry and your neurotransmitters are talking to your fat cells. And they're telling them when they're under stress to store more fat. So literally stress makes you gain weight independent of what you're eating. So it's really it's fasting when you look at weight and other issues. It's so connected. Can you talk about this sort of ancient system that allows us to kind of respond to stress but how our modern life keeps us in a state of chronic stress and survival mode which ultimately leads to our adrenal this function. So talk about how that works and what are the symptoms. How do people know if they have this?

Absolutely. And I know that the term adrenal fatigue, maybe it's not scientifically accurate. There was a naturopathic doctor that coined the term and his initial theory was that the adrenals were actually sluggish and it was a mild sense of Addison's, but we now understand it's more of an adaptation, right? So we know that it's the way that our adrenal glands and our brain communicate when we've been subject to chronic stress for long, long periods of time. And that initial high cortisol response is what we typically will hear about on the news, like cortisol, you have cortisol that's too high. That's bad, right? You have, you know, bad cortisol, bad cortisol, cortisol is too high. But we do need cortisol to actually live, right? So cortisol helps manage our immunity. It helps to manage our, you know, our immune function, our inflammation in the body. It gives us energy in the morning. And we actually do want to secrete cortisol throughout the day.

Right, right.

What most of the people I've seen with Hashimoto's, with chronic fatigue syndrome, with autoimmunity, they actually don't have enough cortisol on board, and they have flatlined adrenal curves. And part of why this occurs is, you know, our bodies are adapted to respond to stress. And in ancient times, it was something like a bear chasing us or a lion or a tiger, right? And then we'd produce high cortisol, and then we'd get out of the threat. We'd shake it off. We'd go back to, you know, maybe sleep it off, shake it off, whatever. We'd go back to having this healthy stress response. But when we're constantly getting stress signals from our environment, our body shifts into this survival mode. And in order to, like, conserve resources and energy, eventually we're not going to be producing lots of cortisol. Cortisol is very, when we're in that high cortisol state, that could be a very catabolic process on the body, and that can be very stressful on the body. and so I kind of feel like it's a bit of the boy who cried wolf syndrome where the body's like, okay, you're stressed. Okay, I get it. You're still stressed. You're still stressed. You're still stressed. We're just gonna keep cortisol low, so we're gonna save it for, like, when that bear actually comes, right? So that I can give you a burst of cortisol. And usually this is, this is for in the evening time for many people so that they will say, I'm so tired all day long, and then I get his burst of cortisol at night. And they don't know that it's cortisol at night. They just think that maybe they're night owls or they just have trouble falling asleep. They'll wake up throughout the night. They have unrefreshed sleep because their body essentially gets out of alignment with our circadian rhythm. So they're exhausted during the day and they're wired and tired at night.

And, yeah, that's, I mean, you're. Yeah, if, you know, you go to bed and you're, like, exhausted. and you're laying there and you can't fall asleep and you feel wired. That's what she's talking about.

-It'S a very real phenomenon. And I feel like it's not a disease per se, but it is exactly what happens when your body's been under chronic stress for a long time. And there's also a very predictable way of getting out of it. I know people will say they have brain fog, they have trouble waking up in the morning, they have salt cravings, They might have coffee, caffeine dependencies. They're crawling to their coffee maker in the morning. That's probably a sign that you might have some sort of adrenal dysfunction. 3:00 p.m. crash, feeling hangry, feeling irritable, anxious, like everybody around you is just really draining your energy, light sensitivity, addiction to or dependency on alcohol in the evenings to help you wind down. these are some of the- Sugar. And sugar absolutely to give you energy. These are some of the kind of patterns that we see with people in this state. And again, it's not a disease, but it is a very predictable way the body adapts when we're under a lot of stress.

Yeah, and often I see, you know, there's a lot of people who get, you know, low blood pressure. So they basically stand up and they get dizzy or they get palpitations or, you know, they feel like they, you know, crave salt like you said. So these are really common things where you can see crash in the morning, can't get out of bed in the morning, crash in the afternoon, I mean, can't get out of the boarding, tired, wired, and wired at night when you go to bed. These are really common symptoms and I've certainly had them. I think you've had them. And, I bet you have people listening and going, yeah, I kind of recognize that. And, it doesn't mean that there's something fundamentally wrong with you. It means, you know, our bodies are not adapted to chronic stresses. There's a great book by Robert Sapolsky who's amazing. I hope you have him on the podcast sometimes. But he's a professor at Stanford who studied baboons' stress responses. Anyway, he wrote a book called why Zebras Don't Get Ulcers, which is because they basically get chased by a lion, they go full out total stress response, the lion kills one of the zebras, and then they all go back to eating grass and they just chill. And we just keep going. We just don't stop running. And I want to hear your story because I think it's an important thing to start with.

Yeah, I feel like as healthcare professionals we go through intense intense training, and there's so many exams that we have to do and wake up super early, and then you stay up the night before and cram. And so I personally think that my fatigue issues really started in college, probably in my first year in college. And I was taking, like, chemistry, biology, and physics, and I was doing the whole major of that. And then also, I thought it'd be really fun to stay out all night to, like, go to the cars, right? So all the things you do when you're 18 years old and maybe your brain's not fully formed yet. And so my issues with fatigue actually started with my first year in college. And I went from this really bubbly and bright-eyed and bushy-tailed person that started college to all of a sudden sleeping through my exams, right? So I slept through one of my final exams, as you can imagine, like being a type A I was like, oh my gosh, why did I sleep through my exam? And I had laid down the day before at like 3 to 4 p.m. to just take a nap. And then following morning, my exam was supposed to start at 7 a.m. and I, you know, ran into the exam room at 8 a.m. because I had just woken up. And I was on this journey of like, you,'re always so tired. Why are you so lazy? Right? I had to, I eventually come up with accommodations to make up for my fatigue so I could study. And I kind of figured out during my second year in undergrad and by pharmacy school, I just really had a system where I just really learned how to be very efficient in studying and getting things done and very productive in the time with the little energy that I did have. But I did require like 12 hours of sleep a night. And I I was just like, you know, I'd wake up tired. I'd be tired all day and I had to drink like six cups of caffeine to get myself, get like, you know, get my brain working and get myself through the day. Finally, I was diagnosed with Hashimoto's after becoming a pharmacist and I went to some conference and it was like, oh, you're not supposed to sleep 12 hours a night. And I was like, huh, is that interesting? finally pursued additional testing. The Hashimoto's diagnosis came. I was like, this is amazing. Finally gonna get on some medications to help me. The medications helped a little bit. So I went from sleeping, like, 12 hours a night to 11 hours a night. I was grateful for that.

Right.

That helped. And then also. But I still had the fatigue, and I still had all these, like, digestive symptoms and acid reflux and IBS. And so I went through a process of really discovering how to get back my own health. and part of that was the gluten-free dairy-free diet. That your books were life-changing for me. I was reading them when I was listening to audiobooks on my way to work. And getting off of those foods helped me get rid of the acid reflux. But then I still had the brain fog and the fatigue. And somebody brought up adrenal fatigue, and I was like, well, this, I Googled it, and this was 10 plus years ago. I'm like, that doesn't exist. It's like, you know, clearly this reputable site that says it's not a thing. So I just kind of went on and looked for other things and finally the 15th person brought up adrenal fatigue and I was like, oh, okay, well maybe this is a thing because I have all the symptoms and I tried the interventions and I got better. Holy cow, my brain works. I'm waking up early in the morning. I don't need 11 hours of sleep. I'm sleeping eight to nine hours, waking up refreshed. I don't have that anxiety. I don't have the panic attacks. I'm not hangry anymore. I'm sleeping and it's a refreshing type of sleep. And so that was over 10 years ago and that was part of my healing journey where I was like, wow, I feel like myself again. Turns out I'm actually a calm and relaxed and happy person. I'm not anxious and exhausted all the time, right?

So the adrenal system has an adaptive response. So it doesn't just fail all at once or doesn't just just kind of get dysfunctional at once. What are the stages that people go through and how do people recognize that so they can actually avert the kind of final thing which I had, which was chronic fatigue?

Usually people start off with that heightened stress response where they'll release a lot of cortisol throughout the day. And typically I think of like, you know, rock stars in a hotel room, like you just have all this energy and you feel like you just drink a whole bunch Red Bull and you can't sleep, you're wired, you're on the go, you're doing tons of things, everybody around you is too slow, not smart enough, they just don't get it. And so this is how people usually feel in the high cortisol state, very irritable and they're kind of jumpy, right? If time goes on long enough, then they'll get on what I call the cortisol roller coaster, where they might start off with high cortisol in the morning, so they kind of jump out of bed and they're ready to go, But then they'll have a dip in cortisol levels maybe in the afternoon. Sometimes that's irritability, sometimes that feels like anxiety, sometimes that feels like getting really hungry, or maybe they need to take a nap at 3:00 p.m. And then as the day goes on, they'll have another spike of cortisol where they can't sleep at night. They get to bed and they're like, oh, I have a million things to do. I need to do them. If this goes on long enough, then they'll go into more of the reversed cortisol curve where their total output of cortisol throughout the day will be lower and most of the cortisol will be low early in the morning. So they'll have trouble waking up in the morning. They'll be like a person that was an early bird and an early riser will say, holy cow, I just woke up at 9:30. I used to wake up at 6:00 AM and go running. What is going on with me? and then throughout the day they'll feel tired, but finally in the evening they will get that surge of energy where they'll be like, oh, well, I finally feel alive now and it's time to sleep, right? And they'll have a hard time falling asleep. And then if this progresses long enough is where most of my clients that I've worked with end up with the chronic fatigue, with the Hashimoto's, with the autoimmune conditions, is they'll have flatlined adrenals. so these are people that are waking up tired and they're going to bed tired and they're sleeping like I was, you know, 11, 12 hours a night in some cases and feeling unrefreshed. And they're like, well, people tell me to exercise, but I feel worse when I exercise. People tell me to fast, but if I fast, I feel awful. If I, you know, if I get more sleep, I just, you know, I'll try to sleep for 12 hours and I'm still tired. I sleep less and I'm still tired. And they are just, you know, they're really stuck in that state where their body, just every little stressor can be so overwhelming. Like even things, positive stressors can be too much for them.

Yeah, I mean, I think that's true. You know, I think the sense of being exhausted in the morning is really a big deal. It's a rush for the coffee, a sign of, you know, just being constantly irritated. It's like, it's like thinking about, you know, if you haven't slept for, you know, a while and you become more cranky and irritable, it's not because you're a jerk. It's just because your nervous system is just fried. And so, you know, we see, we see this. And, and the questions, symptomatically, we can diagnose it, but are there tests that we can do to actually help figure out what's really going on?

I love recommending tests. I do a lot of them myself, and if I had my way, I would have everybody do various functional medicine tests. The adrenal saliva test can be incredibly helpful for figuring out what your cortisol pattern looks like. Then there's also the Dutch Profile, which goes a little bit deeper. It's a urine test, and it can look at how your body metabolizes the various stress hormones and how much it's putting out. The tricky part is I've been recommending this for 10 years now, and then people will say, I went to my doctor and I asked my doctor to test my adrenals. They said, I don't have Addison's. And I'm like, okay, well, you've got to go to a doctor that has integrative mind, that is an integrative practitioner. And they're like, oh, well, I found one, but they're very expensive and these tests I have to pay out of pocket for. So that's kind of another barrier to getting the help. And then they get the test, They get them home and then they're like, But it's been sitting on my shelf for three months, right? And then finally they do the test and they get the results a few weeks later, sometimes a couple of months. And it's like six months have gone by where I could have told you based on your symptoms that you are-- if you're chronically fatigued, there's a good chance that you're in that stress response. If you're in that fight-or-flight mode and you're feeling really irritable all throughout the day and you can't sleep, I'm pretty sure you have too much cortisol. So I do love tests and I recommend them, but I wanted to create a program and a protocol that was entirely based on symptoms and how to reverse and address the symptoms so people could work with their doctors and get the tests that they need, or they can really be empowered to take charge of their own health. I don't know if you've had the same experience, too.

Yes, I think it's so true because I think the, you know, most of the time people walk in and they tell me their symptoms, I can tell them what's going on, and then the tests we'll confirm it. And I think we do see stages of the test where we'll see, for example, high cortisol at night and low in the morning or high cortisol all day initially, then it kind of drops in the morning and then it ends up being low all the time, kind of flat lining. And I think that that's something that is sort of an end stage process. And in terms of the sort of treatments and the diagnosis of but you sort of, you challenge some of the traditional view of this. You say this is sort of, you know, doctors talk about this as a bogus diagnosis and dismiss it. And, you know, why do you think that is?

I think, you know, unfortunately, I think it has to do a lot with the nomenclature where the term adrenal fatigue, it was initially coined where the person that, and the the brilliant people that coined the term and started educating the world about it, the initial understanding of the mechanism of action behind of what was going on was kind of like a mild Addison's or that the adrenals were not capable of producing cortisol, where we know it's more of an adaptive system where the adrenals are capable of producing cortisol, they're just not releasing the cortisol at the right time. times throughout the day. And so that's what ends up, I think, kind of boggling a lot of people. And some practitioners argue about the terminology. So they'll say adrenal fatigue doesn't exist, but then you'll look at HPA axis dysfunction or hypothalamic-pituitary-adrenal axis dysfunction. And that is a real thing. And there's published literature around it. And same with leaky gut 10 years ago, it was like, it doesn't exist. And then it's like you go to And there's like intestinal permeability. So basically, you know, you just have to use the right terminology, I think, for them to get it. But it's, you can call it burnout, you can call it adrenal fatigue. I call it adrenal dysfunction because I feel like it rolls off the tongue a little bit easier than hypothalamic pituitary adrenal axis dysfunction. And it's a little bit more of an updated term to reflect the mechanism of what's going on as far as we understand it these days.

Dr. The truth is, that you can't avoid stress. Stress is just a part of life. And the question is, you know, how do you define stress? How do you relate to stress? How do you interact with it in a way that doesn't control you or affect you in the way that it could? You know, I learned that the stress is defined as the perception of a real or imagined threat to your body or your ego. So it could be a lion chasing you. That's a real threat to your body. Or it could be you think your spouse is having an affair, even if they're not. your body has the same response as if it's being chased by a tiger or a lion. And I think we don't in our society have mechanisms or systems for addressing that. And not only do we not have systems, but we are exposed to chronic unremitting stress day in, day out, minute to minute from the minute we wake up to the minute we go to sleep. And we haven't any structures in our society for really managing that. And most cultures have had ritual, have had prayer, have had ceremony, have had meditation, have had various kinds of rituals that take a pause in life to stop and to reset and to reconnect with what matters. And we just don't do that. So what inspired you to sort of write this book and deal with this big, often addressed epidemic of chronic stress?

Mark, I think in my first book, How to Make Disease Disappear, I spoke about what I consider to be the four sort of pillars of health, as it were, the four things that I think have the most impact on our health, but also we've got a fair degree of control over food, movement, which we've been talking about for years, but equally important, sleep and relaxation. And what was quite clear to me is that People were feeding back to me that the pillar they were struggling with the most, or many of them were, was the whole relaxed pillar, this whole piece about stress. People were sort of thinking about their food and their movement, but they really struggled with stress. And I thought, you know what? Food gets a lot of airtime, movement gets a lot of airtime. I don't think stress is getting the airtime that it deserves. And that's why I thought, well, I'm gonna write a book on stress to really elevate it. In terms of our consciousness, in terms of what we're thinking about. And you mentioned in the introduction, the World Health Organization right now, if you go on their website, will say that stress is the health epidemic of the 21st century.

That's an alarming statement.

The health epidemic, wow.

Yeah, I mean, that's incredible. And then- I might fight a little bit with that. I think food problem is a big one.

Well, right up there, it's right up there. Well, I think stress and food is.

Linked actually, Actually, our diet, you probably know this, but our diet, if it's bad, causes physiologic stress. So, when you eat sugar and crap, it actually raises your cortisol and stress hormones. 100%.

Even if you're not mentally stressed, it makes you physically stressed. Well, a lot of these things actually, as you know, Mark, work both ways. So, yeah, the poor dietary choices can send stress signals up to your brain. Good food choices can send calm signals up to your brain. this is all to do with the gut-brain axis, which you've written about before, I've written about in this book. But also, I would say it works both ways. So if you are chronically stressed, it's quite hard to make those good, healthy food choices. Let's take January in the UK and the US. Every January, people are trying to get healthy. I'm going to reduce my sugar intake this year. I'm going to cut out alcohol this year. but here's the problem I've seen, is that people can use willpower for a week, for two weeks, maybe three weeks, but if the sugar or the alcohol was being used to help them soothe the stresses in their life, they're never going to maintain it long term. So actually, I agree food is a big problem, but I found with some patients addressing their stress levels means they feel less of a need to to binge on sugar because they're not feeling as stressed.

If you're happy, you're not going to eat that bag of chips or hoya cookies.

Yeah, because a lot of our food choices are dictated by our emotions. And if we're feeling down, if we're feeling stressed, if we feel we've got too much on, actually that sugary chocolate bar or that bag of chips actually helps us feel good in that moment. So short-term benefit, but long-term harm. But the other thing-- yeah, it was interesting.

Last night I went out, I recorded my public television show for my new book, and it was a very intense day. And I've been really, you know, sort of under a fair bit of pressure writing the script and getting it all done and performing it and rehearsing it. You know, it's a big production. And like, you know, at the end of the day, we went out and had a celebration, and I had, you know, two tequilas, which is, you know, for me, a fair bit. and I noticed last night that my sleep wasn't as good, that my heart rate didn't go down enough, that it was really impacting me in a negative way. And today, I don't feel as sharp as I normally would because I probably did something that was counterproductive to manage the stress of all the stuff. And I was giving myself a treat, but actually it may be counterproductive.

Yeah, but this is a story that I think many of your listeners will be able to relate to that. If I tell a story in my book about this chap who I saw, he was a busy business guy in his early 50s and what's really interesting about him is that we started to measure something called heart rate variability on him. So heart rate variability.

What is that?

It's basically a measure of what is the beat to beat variation between our heartbeats. People will think it should be like a metronome, you know, tick tock, tick tock.

70, 70, 70, 70.

But that's actually incorrect. What we're looking for is a high degree of variability.

Complexity.

Yeah, complexity, and it shows that we're constantly adapting and able to adapt to this changing environment around us. And what was interesting, the worst heart.

Rhythm is got no variability. It's a flat line.

Yeah, so a low heart rate variability is actually indicative that we've got high stress levels in our body. this chap actually on a Wednesday evening, he would find that he was drinking a lot of alcohol. He wasn't sleeping well. He was having a lot of caffeine on Thursday, more alcohol on the Thursday. He was basically he came in, he was really, really stressed. It was impacting his relationships, impacting his sleep, etc., etc. The very common story. But as we start to look at his life and actually use HRV heart rate variability readings, we could see that everything changed for him on a Wednesday. So what happened on a Wednesday? lunchtime, he had a team meeting, right? He found that incredibly stressful. He had to present to his team. It was quite a high pressure meeting and that stress would last throughout the day. So what would happen is on a Wednesday, late afternoon, when he would leave work, he had to compensate with that stress. How would he do that? Alcohol. Alcohol. So he'd open a bottle of wine, he'd have a glass, that glass, one glass would turn into two, So, two would turn into three and by the end of the evening, he'd have the whole bottle of wine. So, what happens then? He doesn't sleep well on the Wednesday nights. So, Thursday morning, he's feeling groggy. He needs lots of coffee. Lots of coffee, lots of sugar to get him through. Coffee in the afternoon as well, which again, impacts his ability to sleep on Thursday nights. He's not feeling good and that cycle continues where he's having a bottle of wine on Thursday, two bottles of wine on the Friday. And etc, etc. But what did we do? We identified his trigger point was a Wednesday lunchtime. So, I could show him that on the data, he could see it very clearly. So, we discussed about certain things he might be able to do on a Wednesday evening instead of alcohol. Now, there was a yoga- Get a massage? Do a yoga class? Well, there was a yoga class very near his office. So, before he went home, he went to the yoga class. So, what happens then? He goes to that yoga class, that helps him de-stress. when he gets home, he no longer feels the need to drink a bottle of wine. So he might have a glass, but it's one glass and it stops there. He sleeps well. Thursday, he feels fresh. He doesn't get as stressed at work. He doesn't have as much coffee. And before you know it, all we had to do was give him a yoga class on a Wednesday afternoon, and suddenly that changed his whole week. And people who are listening to this, I'd really ask them to reflect on their own life and think, actually, is there a trigger point in my week where things start to go downhill?

Yeah.

Because if you can identify that and change your behavior, it is incredible what you can achieve.

It's true. I mean, most of us understand, you know, we need to eat well. Most of us understand how to exercise and what that means. But very few of us understand how can we actually deactivate that stress response, activate what we call the relaxation response or the healing response in the body. in a deliberate, methodical way, just like we exercise or eat well. And I think those are skills we never learn that are hard for people to understand how to incorporate, and yet they're pretty easy to do and they're actually fun and you feel amazing after.

Yeah, that's the beautiful thing about this, is that they're not as hard as we think. They're quite simple. Most of them, I think pretty much all of the recommendations in my book, I think are free. literally you don't have to buy fancy equipment or fancy apps. Actually a lot of this is accessible to all of us. But just to put in context the scale of this problem, Mark, I mentioned what the World Health Organization say. But there was a paper in the Journal of the American Medical Association in 2013, I think it was an editorial piece, which suggested that between 70 and 90% of what a primary care physician like me Season any given day is in some way related to stress. Of course, of course. These are remarkable statistics.

It's how they're caused by or made worse by stress.

100% and I think once people understand...

I mean if you're stressed, your blood sure goes up. Your blood pressure goes up. Your blood vessels get stiff and hard, right?

Yeah, I mean I try and explain this. Yeah, I find that when patients understand what the stress response is, I find they're really engaged in trying to change it. So I say to them, look, your stress response is ultimately trying to keep you safe. It thinks it's when your body thinks you're in danger, it's trying to keep you safe. So let's go back two million years ago, and then you can understand what the stress response is, how it's evolved. So you are in your hunter-gatherer tribe, and a wild predator is approaching, right? In an instant, your stress response gets activated and your physiology starts to change. So as you said, your blood sugar goes up, which is going to help deliver more glucose to the brain. Your blood becomes more prone to clotting so that if you get bitten by that lion, you're not going to bleed to death.

Yeah.

You're going to survive. You know, your amygdala, which is the emotional part of your brain, becomes more reactive. So you're hypervigilant to all those threats around you. That is an appropriate short-term response to a Yeah. The problem now, Mark, is that for many of us, our stress response has not been activated by wild predators. It's been activated by our daily lives.

By Twitter.

By social media. Email inboxes.

By CNN and Fox News.

To-do lists. Elderly parents we're looking after. You know, two parents working in a family. One's trying to rush home from work to pick up the kids, etc., etc.

Yeah.

For many of us, those short-term responses that are so helpful become harmful. So if your stress response is going up every day, right, and blood sugar going up for a short period of time, it's not a problem, right? But if that's happening day in, day out to your email inbox, well, that's going to lead to fatigue, lethargy, type 2 diabetes, high blood pressure, you know, all from the stress response.

Now we have so many more stresses than we used to, right? We have the cultures we live in that stress, we have the toxic food system, we have the chronic amount of financial stress that most people feel. I think 40% of Americans can't withstand a $500 emergency, 100 million live in poverty or near poverty, which is hugely stressful. I mean, one of the studies that I found most striking a number of years ago was that more than a poor diet, more than smoking, more than lack of exercise, that socioeconomic status and a lack of sense of control over your life, really stress, is the number one predictor of death and disease. And I think it's something we don't really appreciate and we don't, as physicians, really learn how to address it, how to measure it, and how to help treat people.

Yeah, I totally agree. And actually, the first part of my book is actually on meaning and purpose, and it's relevant to this because not having that control over your life, not having a sense of meaning, not having something to get up for every day. That is arguably the most stressful thing in your life, even if you're doing everything else right, if you don't have that. And, you know, a few years ago, I came across this Japanese concept of Ikigai, you know, which, and I know you're familiar with, you know, this. I saw these four circles, and it's where these four circles intersect in the middle is your Ikigai. You know, when you are doing something in your life that you're good at, something that you love, something that the world needs, and something that pays you money.

Yeah. And I thought, sounds like you got that nail, Dr. Chad.

Hey, well, look, I'm very lucky. I have, I now have in my life, my job, I absolutely love my job. That's for sure. But what's interesting for me is I saw that and I thought, yeah, I want some Mickey Guy in my life. That sounds brilliant. I started talking about this concept to my patients, and for many of them, Yeah, they found it a little bit intimidating. They thought, well, how am I gonna find one thing in my life to tick all those four boxes? And actually, when I was giving a talk in London recently on stress, this Japanese student put her hand up at the end and she asked me a question. She said, Hey, Dr. Chaturvedi, you know, I've grown up with this philosophy and I've got to say, I find it really stressful. I find it too high a bar to live to. And what I did in the book is I created a new framework that I use for my patients. I call it the LIV framework. It's a much more achievable way, I think, for a lot of people to find their meaning and purpose. The L is for love, I is for intention, V is for vision, E is for engage. We probably can't go through all of that, but, you know, I sort of, I use it with my patients to help them start to find meaning and purpose. And the first one I think is really important, love.

Yeah.

Right. So the research on this is super clear. Regularly doing things that you love makes you more resilient to stress. Right, so you mentioned a lot of Americans are struggling that they don't have control over their life. And this is the interesting thing about stress, Mark, is that sometimes we can't as physicians change the stressors in our patients lives.

Right, no, no, you can't change what's happening out there, you just change- But.

We can make them more resilient to it.

Yes.

And regularly doing things that you love makes you more resilient to stress at the same time, being chronically stressed makes it harder for us to experience pleasure in day-to-day things. So one of my recommendations to my patients is have a daily dose of pleasure, even if it's just for five minutes. You know, can you each day give pleasure the same priorities you might give to the amount of vegetables you have on your plate, or whether you go to the gym. This could be going for a walk, it could be reading a book, listening to a podcast, it could even be coming home from work putting on YouTube, watching your favorite comedian for five minutes and laughing. Yeah, that is very important and very valuable. And it makes a huge difference.

I mean, I, I, you know, I'm now in California doing my public television show, and I, you know, I was at the hotel, and I was right on the beach, and I went out to the beach and I jumped in the water, swam a little bit, and I came back, and I literally just laid there in the sand doing absolutely nothing. And I can't tell you. how pleasurable that was to just be unplugged for a minute and stop. And most of us just keep go, go, go all day long and distract, distract, distract.

Well, there's obviously the nature piece there as well, which is very impactful for stress. But let me tell you about a patient I saw recently. I think you'll find this interesting. 54 year old chap, I think he was, certainly mid-50s he was the local, he was the CFO of a local plastics company and. you know, he was in a good job, earning good money, married with two kids. He came in to see me and he said, Dr. Chashee, look, I'm sort of. I'm struggling a bit. I find it hard to get out of bed sometimes in the morning. I find it hard to concentrate at work. You know, I just feel a bit indifferent to things. Is this what depression is? Now I started to chat to him. We did some tests. I was looking into all aspects of his lifestyle. but ultimately one thing was quite clear to me is that he never did anything that he loved. So I asked him, you know, how's your job? He said, yeah, it's fine. You know, I don't really enjoy it, but it pays the mortgage, pays the bills, feeds the family. I said, okay, how's your relationship with your wife? Yeah, so, so, you know, I don't really see her much, but it's, you know, it's fine, I guess. It was very, very indifferent. I said the same about his kids, and I said, do you do, you know, have you got any hobbies? I said, do you have time? My work's busy at the weekends. I've got to do all the chores. I want to take the kids to their classes and their sports games. I don't have any time. I said, did you ever have any hobbies? And he said, yeah, sure. When I was a teenager, I used to love playing with train sets. I said, okay, fine. Do you, do you have a train set at home? He said, well, yeah, I've got one in my attic, but I haven't played with it for years. And I said, what I'd love you to do when you get home this evening is get your train set out. Now, look, Mark, I appreciate this may.

Not be the advice. Write that on your prescription pad.

Yeah, well, I'm all for lifestyle prescriptions, right? And he-- Play with train set three times a week.

I'll tell you what happened.

What was fascinating is that-- Refills unlimited. Exactly, but it may not be the advice that he was expecting from his daughter. But he said, yeah, okay, sure, I'll do that. Then this was in a conventional medical practice. These were 10 minutes. consultations. This is in the National Health Service in the UK. I, we don't get the chance to follow up all our patients. We see maybe 40 to 50 patients a day. We simply can't follow them all up. I didn't know what was going on with him. Three months later, I finished my morning surgery and I was in the car park about to go and do my home visits and I bumped into his wife and I said, Hey, how's your husband getting on? She said, Dr. Chaturvedi, I cannot I don't believe the difference. I feel like I've got the guy I married back again. My husband comes home from work, he's pottering around on his train set, he's always on eBay looking for collectors items, and he's now subscribed to this, you know, this magazine. I thought, okay, that's incredible. I still hadn't seen him. Three months after that, he comes in for a well-man check to my office, and he comes in with his blood tests. I'm about to go through them with him. and I said, Hey, how are you doing? Dr. Satchi, I feel incredible. I've got energy, my mood is good, and I feel motivated. I said, How's your marriage? Marriage is great. I'm getting on really, really well with my wife. How is your job? Love it. Really, really enjoy the job. So why is that so powerful, Mark, is this? Did he have a mental health problem?

Or train said deficiency?

Or did he have a deficiency of passion in his life? And when he corrected that passion deficiency, it's true, everything else starts to come back online. I want to expand the conversation about stress to go, yeah, sure, breathing, nature, meditation, exercise, these things are fantastic. And of course I talk about them and I go into the science and the practical implications of people. But what about something about passion, doing things that you love? That's just as important. That's true.

You know, I often talk about what are the ingredients for health and one of them is meaning and purpose. And I was just shocked a number of months ago to see an article in the Journal of the American Medical Association that that people who lacked meaning and purpose had a higher risk of death and disease. I mean, it's just striking. It turns out in the research that it's not just smoking or bad diet or lack of exercise, but lack of meaning and purpose that increases your risk of death. I mean, that's a very striking finding.

Yeah, it's amazing. And obviously, the way we look at health, we're looking at all of these multiple inputs that play a role in someone's health. And of course, I am just as passionate about food, physical activity, sleep, you know, all these things are critical. But we've also got to think about those social pieces, you know, our community, the relationships we've got, you know, why do we get up each morning? Do we feel that we've got control over our life? Or do we feel, you know, do we sit in traffic for two, three hours a day in a job that we can't stand for a boss who doesn't value us? The reality is that that is the case. you know, we're going to have to think about with our patients how we tackle that. Of course, not all our patients can leave that job, right? So I'm passionate and I've used these tips that I've, you know, that the book is full of so many tips so people can literally choose the ones that are relevant for their life. But I have worked in deprived areas in the UK for many years and these tips also work for people in deprived areas on low incomes because the common criticism of wellness is that it's just for the wealthy, it's for the middle classes. And I'm passionate to say it is applicable to everyone. You give people these tools of nature, of passion, of, you know, a quick five minute workouts. Even if you're living in a lifestyle that you don't enjoy, that there are lots of stresses in your life, you can help process that stress. you really can and it can make a huge difference.

Now, one of the things that people don't realize is they think stress is subjective, but it's subjective, right? It's the perception of how something impacts us. It's our beliefs about something, right? So, I think if that's true, then how do we sort of create a different mindset so that when something happens, you know, it's not stressful. And I think for most of us, we get caught in this vicious cycle of stress and worry about things that are not really worth worrying about. And I think it's our beliefs about it that make it seem so. And I think there are real things to worry about, you know, if you have income issues, if you have, you know, real trauma in your family or, I mean, there are real things that are going on that are stressful. Like my dad died last summer, and that was very stressful for me. But I think there, there are, are ways of looking at changing our mindset. So can you talk about how how that works?

Yeah, well, I think there's a couple of things to say there. I think when it comes to stresses, I think we need to think about what we can control and what we can't control. Yeah. Many of us, I have for years spent time and energy worrying about things I have no control over. And that's something that I've changed a lot in my life. I've really had to work hard on that. And once you get into that mindset, it's amazing how your stress levels just come down because so many of those things like traffic, I can't do anything about traffic. I just don't let it worry me anymore. You don't get road rage, Dr. Chatterjee. Hey, you know, if I'm honest, seven, eight years ago, you know, when I was a carer for my dad, when I was working a busy job, when my kids were very young and wasn't sleeping very much, you know what? If I was driving to work and someone would come in front of me or cut me up, I'd probably get quite agitated if I'm honest. But now I just don't. I'm like, ah, they're probably having a bad day if they're sort of screaming.

At me from the window and, I'm.

Just a lot more chilled and relaxed.

I mean, you give your power over to other people if you let them affect you that way.

Yeah, for sure. But it's something we have to work on. And I think the reason why many of us struggle with this is because of time. Now, let's explain what I mean by that. I think one of the biggest stressors in the modern world today in the 21st century is our lack of downtime. So the modern world has stolen downtime from us. It's gradually been eroded out of our lives. I'll give an example. We're here in Santa Monica, right? In California. I bet 10 years ago if we were here and we went into a local cafe to buy a coffee, I bet people would be standing in line, they'd be looking around, they might bump into a friend, they might be looking at all the sweet treats and they might be thinking, which one am I gonna have? They'd be daydreaming a little bit. Now, if you go to any cafe, what's everyone doing?

Everyone on their phone, computer.

Yeah. And look, to be clear, I'm not criticizing. I will do that as well a lot of the time, okay? But my point is- Just to be.

Just lack of time. It was fascinating. I just went to give a talk at the CIA, the Central Intelligence Agency. And it's a highly secure building, Langley, and there's no technology allowed. So you can't bring in a phone, computer, nothing. Not even a Fitbit. And what was striking to me is that everybody was present. I gave a lecture to 300 people and nobody was on their phone. I was in a room giving a talk to 30 or 40 doctors and health professionals Nobody was on their phone and everybody was focused and paying attention. It was the most remarkable thing. It was like going back on a time machine.

But only a time machine of 15 years.

Yeah.

That's how quickly things have changed.

I thought it was 2009.

Yeah, that's... And I don't think we've realized how toxic that is, because you may say, well, why does that matter? You know, what's the problem that we're using this downtime to get ahead? You know, we're sending an email, we're quickly updating our Instagram. well, I'll tell you the problem with that. There's many problems with that, but we used to think that our brain went to sleep when we switched off, right? When we stopped focusing on a task in front of us, our brain went to sleep. Neuroscience shows us that's not the case. When we stop focusing on a task in front of us, there's a part of the brain called the default mode network or the DMN that goes into overdrive. Now, what does that part of the brain do? But there's many things. But two things I think listeners will find really interesting is that part of the brain helps us solve problems and helps us be more creative. So this is why so many of us get our best ideas when we're out for a walk, out for a run, or we're in the shower. I don't know if it's just me or you. Do you get, I get my best ideas when I'm in the shower.

Totally. When I go for a run or a bike ride and I can just wander around.

And this is because, Mark, our brain is trying to solve problems for us if we give it the down time to do that. And I think showers are one of the few places still where our phones haven't, you know, we don't, I don't know about you, I certainly don't take my phone into the shower with me. I'm sure that will change very soon. Yeah, now the new phones, they go.

Down to four meters underwater, so.

Yeah, I mean, this is why we keep trying to swimming actually, because I think swimming is again one of those sports now where you can still do without technology, you know, even in the gym now people are posting selfies of them, doing their workout, updating their feed, you know, and the DMN is a really important part of our brain. And I go into a lot of companies now to talk to them about employee well-being. And one of my top tips for them is take a tech-free lunch break.

Digital detox.

Even if it's just for 15 minutes, take a tech-free lunch break. And last year actually I made, actually it was earlier this year, I made an ITV documentary on stress. and we got to take three or four people, we got to measure their stress levels minute to minute throughout the day for three days. And one chap in particular, he was a manager of his local company, he took his job seriously, he wanted to lead by example, but he was complaining of stress. He was thinking, he was complaining that he was drinking too much alcohol, his relationship with his wife was under strain, and he was always tired. Now, we measured his stress levels. It was HRV, heart rate variability, and we could see that actually on his workday, his stress levels would climb throughout the morning. At lunchtime, he would work through his lunch and they'd keep climbing. And all afternoon as well, they were just constantly elevated. He would go home late, he would drink alcohol to unwind, he wouldn't be present with his wife, that would cause issues, he wouldn't sleep well, and the cycle would continue. All I changed with him, Mark, was I said, okay, look, I want you to take a 15-minute break at lunchtime. I want you to leave your phone in your drawer and go outside for a walk. He was very lucky he had a rivet nearby and we can maybe touch on why nature is so important. So all he did was for 15 minutes at lunchtime, he went for a walk in nature without his phone. Now, when we remeasured his data objectively, his stress levels were right down. But subjectively, what did he say? He said, Dr. Stacy, I feel like a different person.

Yeah.

I'm more creative in the afternoon. I enjoy my job more. I'm leaving early now rather than late. It's not just on time. I'm leaving early. I'm drinking less alcohol. And my relationship with my wife has improved.

Yeah.

So this is what I call the ripple effects, right? One small thing.

It's powerful.

So when we say that, this is for the middle classes. Well, hold on a minute. Who doesn't have the ability to have a 15 minute tech free lunch break?

Yeah, right.

That is free.

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Hey, everybody, it's Dr. Hyman. Thanks for tuning into the Doctor's Pharmacy. I hope you're loving this podcast. it's one of my favorite things to do and introducing you to all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff, from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays. Nothing else, I promise. And all you have to do is go to drhyman.com/picks to sign up. That's drhyman.com/picks, P-I-C-K-S, and sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger longer.

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