Mike Taigman: Science of Stress Management & Longevity (11/3/23)

All right, welcome. It's Friday, November 3rd at 11am on the east coast. And as promised, we try to bring the best, the smartest, the most informed and innovative people on this call. And today is a great example of that. For those of you who know Mike Tigman, he is, he is, I think, one of the best speakers that I've heard. He and I crossed paths at some conferences out on the west coast and I just love, I love hearing him talk, I love how he thinks. And today is no different. I probably asked Mike to come on the webinar months ago. I finally, finally corralled him to come on Today to talk about stress management and longevity and all the work that he's doing with First Watch.

How to use data to really help our folks in the field with the micro trauma that they experience every single day. So Mike, thank you so much for joining us. And take it away, my friend.

Sounds good. Why I realized just a couple of minutes ago that I have a half hour instead of an hour. So I'm going to be skipping ahead in some slides here, but my disclosure is up front. I do work for First Watch and, and teach at ucsf and one of the things that, that most, most everybody's familiar with is the concept of lifespan. And lifespan being from when you're born until until when you're dead. That was an interesting study that, that came out of the University of Michigan two summers ago where they looked at nutrition and food and how various foods affect your lifespan. And they their calculations are that a peanut butter and jelly sandwich adds 33 minutes to your life where a hot dog will take away 36 minutes to your life. So one of the key measures of longevity and stress management may be your peanut butter sandwich to hot dog ratio. You always want to have the peanut butter sandwich be on the high side.

Recently folks have added a conversation to this health span about disease span and we've all seen that we take care of patients on a regular basis that are still alive, but they end up with a chronic life limiting disease at some point in time and it impairs their life until they check out at the very end. And up until the last couple of years with COVID the opioid crisis in the United States, our lifespan has been increasing.

Exponentially for like 50 years in a row until the last three years.

But the disease span has actually been increasing at a greater rate than the lifespan. So, you know, one of the things about improving your stress management and some of the research on longevity is maybe we can increase the life Part of our, our lifespan. And I know this is, this is old hat information to everybody here. The natural development of coronary and neurologic arterial disease. At what age? This is where you can jump in the chat. If you're, if you're paying attention, jump in the chat and say at what age do most people in the United States have the beginnings of atherosclerotic disease? The fatty streaks in your coronary and neurologic arteries?

16.

16, 12.

One guess is 12 there. So. And according to this study by Jay Strong and company, the majority of 10 year olds in the United States already have the development of atherosclerotic disease. My contract with Dr. Ran Tevi requires me to include a picture of my son in every slideshow. So this is what an awesome 10 year old looks like when he's 10 years old. And I don't think anybody here is 10 or younger. So for most of us this may be a conversation about reversing some disease. And when it comes to stress management, particularly real time stress management.

If you don't have the ability to activate your stress management tricks in the moment when you're stressed, they're not going to be very helpful to you. So Peter, who taught you to, do you remember learning to drive?

I do. I was like 6 and my uncle from Israel put me on his lap and I would be driving when I was very young age.

Do you know what kind of vehicle it was?

Yeah, it was, it was my parents old Cadillac. The big, the big boat Cadillac.

Big boat, Big boat Cadillac. So the, the part of your brain that you use to retrieve that memory is the hippocampus. Right. Kind of at the floor of your brain where your long term memory is stored. But, but have you driven in the last week?

Yes, I have.

And so it's memory that allows you to drive your car on a, on a, on a regular basis. Right. So when you, when you get in your car to drive, do you sit down and think? Now how do I, how do I start this? Are you a turn signal user? Not everybody in Florida is a turn signal user. Are you a turn signal user?

I would say 50% of the time.

50 of the time. Do you have to get in your car and think? Do I push it up to go right or down to go left? Or has. Do you have to, or you just get in your car and drive? Right. And that's, that's the difference between explicit memory and implicit memory. And implicit memory lives in the anterior cingulate cortex in your brain and is Something that you have access to, to be able to.

Be able to dial down your stress and.

Do just kind of activities of daily living without having to consciously think about it. But it's still a form of memory. So when it comes to stress management strategies, I encourage you to, to pick one or two that you will over learn to the point where you can just do it without thinking about it. Most everybody on this call could drop and do CPR or high quality compressions without really having to think about it because you've overtrained and over learned and that's what you kind of need for your, your stress management strategies. And, and there is truth to the fact that that chronic disease does have some genetic contributions to it. And it's estimated that about 20% of chronic disease has a genetic basis, but about 80% is related to lifestyle issues and lifestyle functions. So this is your brain on a PowerPoint on a Zoom, which since Paul Pepe was doing old time jokes here, I figured I'd toss one in. And.

Your brain stem is that part of your brain that encourages you to take a breath now and then regulates your temperature. Basically differentiates you from, from a head of cabbage. The limbic system is that part of your brain that, that holds all of your emotions. So love, joy, happiness, sadness, guilt, stress, frustration, kind of all live in the, the limbic system. And the neocortex, about the outer fifth of an inch thick outside of your brain with all the curlicues in it, is where your, your cognitive and awake functions happen. And when it comes to stress management, we are particularly concerned with the prefrontal lobes of your neocortex, that part of your brain that's right behind your eyes and your forehead. It's also known as the executive center. And it is the part of your brain that if you know how to get from wherever you're sitting right now to the bathroom in your place. It's the part of your brain that holds maps. It's also the part of your brain that exercises impulse control. So when you're on one of these meetings and Dr. Pepe says something that makes you go, oh my freaking God. And you have the impulse to say something really snarky, but you hold it in and keep your inside voice in.

That's the executive center of the prefrontal lobes of your neocortex working for you inside your brain is the thalamus, which is kind of like the 911 communication center for your brain. And right next to your thalamus are the amygdala which are two almond shaped pieces of neurologic tissue that basically function as your body's lifeguard like it's your century. It's on duty 24 hours a day, seven days a week, 365 days a year. And it is constantly assessing every sight, smell, sound in your environment, asking three questions of everything it interacts with. And the first question is, is this something I can mate with? Is this something I can eat? Or is this something that is, that is likely to eat me? And if it gets a no answer to these questions, it does absolutely nothing. If it gets a yes answer to any one of these three, it activates a set of neurochemicals that inspire emotions which are precursors to taking action for survival in our world. So if you're connected with somebody and, and having, having lunch or dinner with somebody who you find kind of attractive and, and things go well. And the amygdala answers yes, this is somebody I can mate with. It'll activate your vagus nerve parasympathetic nervous system response. You'll feel the emotions of love and joy and happiness and you'll feel pretty relaxed and opened. And that's part of the survival mechanism that keeps our species procreating. On the other hand, if it gets a yes answer to the question, could this eat me? It activates the sympathetic nervous system. The fight, flight, freeze or faint response. There's actually some additional research that came out somewhere before last that there's maybe some attachment or detachment that is also part of the sympathetic nervous system response. Particularly important for those of you that are parenting. But all of our sympathetic nervous systems have kind of a variation in how, how reactive they are. Some of us can go through very stressful circumstances and just not be triggered at all. Some of us just have a hair trigger response to almost everything. And it's not good or bad, it's just kind of how our, how our brain works.

And the, the thing is our, our system was programmed to respond to physical threats in the environment back when saber toothed tigers were, were out on the, out on the prowl. It was, it was not designed to see that your girlfriend or your boyfriend might be dating somebody else. When you pop onto social media and all of the stressors that we have in our world today. I picked my 12 year old son up from school yesterday and he was a little bit down and I was like, you know what's happening? And it's like yeah, math homework, I don't like math homework. But you know, God, the crazy politics in our country and everything that's going on in Israel and these shootings in Maine are all things that were kind of weighing on his mind. And they all trip the same neurologic system, creating basically a big old loaf of anxiety for us. And.

This kind of overstimulation of our sympathetic nervous system is the root of chronic stress.

One of the things that is helpful. Hi Angus, it's good to see you here.

Is that it is possible to reset your kind of baseline stress response. So most of us.

If we have a sympathetic on the vertical here and parasympathetic on the, on the negative side here, we, we generally have a default baseline that is a little bit on the activated sympathetic side. And when we rest, we rest kind of in the middle. And we spend most of our lives going back and forth between these two, occasionally spiking up to acute stress. But if you can build into your life a regular practice of deep rest, whether that comes through massage or yoga or meditation or sitting in a hot tub or, you know, whatever, whatever creates deep rest for you on a, on a several times a week basis, you can basically reset your default baseline a bit lower and, and overall manage your stress. So this, this neurologic system is, is something that we share with, with all mammals.

And it is designed to keep us alive. The difference between other mammals and people is that with these big brains, we can stress over things that happened years ago that might happen later. We can replay them in our mind and go through all kinds of stuff around it. And I don't need with this crowd to go over the physiologic consequences of stress. With heart disease and cancers and immune diseases also contributing to the psychological diseases around depression, anxiety, PTSD and those kinds of things. That's all kind of part of the same continuum. But one thing I thought would be useful from both the stress management and longevity perspective is to talk a little bit about how cells age at a cellular level. This is one of my colleagues at ucsf, Alessia Epel, who is really a world leading authority on both stress management and aging, and particularly stress management among caregivers is one of her areas of expertise. She talks about cells aging through systemic inflammation, which is essentially like having a match dropped into a pile of other matches from the impact on your cells and that contributes to oxidative stress. And we've all heard about free radicals and the damage free radicals do to cells, particularly to the mitochondria, the little battery center in your cells.

One of the things about longevity research that's fun is there's some, there's some bonus things that I find that I find kind of interesting. One is that the regular consumption of dark chocolate, small dose of dark chocolate, has antioxidant properties, antihypertensive, anti inflammatory and antithrombotic. So one of the prescriptions you can take away for yourself from this, from this talk is to, to eat some dark chocolate on a regular basis. The Mike, my. Go ahead.

The other thing is that it's very high in phenylalanine, which is found in the brain of people who are, have, who are, you know, let's say in love. Okay. And so that's really one of the pleasure centers that you were talking about early up there. So just wanted to make sure it's an important ingredient you need every day.

Absolutely, absolutely.

And maybe at the next Eagles conference, we can just give little doses to everybody on their seats when they sign in.

The other thing she talks about is the acceleration of an epigenetic clock. And this is basically a, a constellation of the things that kind of accelerate aging or slow down aging and getting regular physical exercise, getting good deep rest, eating healthy food. And there's really interesting science that's been come out recently about the contribution of highly processed foods.

To disease, separate from their sugar, fat and salt content, that.

The processing really accelerates the development of a number of diseases. And the last.

Contributor to how cells age has to do with telomeres. And telomere shortening. And telomeres are the end caps on your DNA. Alessia and her partner Elizabeth Blackburn at UCSF, I think they won the Nobel Prize in Science 38, 39 years ago for their contribution around telomeres. And telomeres, they basically function like the end caps on your shoelaces. They keep things from unraveling. And when you're, when you're born, your telomeres are pretty long. And as you age and experience stress, they shorten. And when they get to the place where they unravel, it is the setup for cancer, inflammation, and aging. And since they discovered telomeres is a relatively simple blood test that will assess the length of your telomeres, they've been doing all different kinds of research studies to see what lengthens your telomeres and what shortens your telomeres. And the things that shorten your telomeres are chronic threat, stress, processed foods, sugar, smoking, cigarettes, those kinds of things. Whereas deep restful sleep, spending time in nature, and mindfulness practices are really helpful for lengthening your telomeres. And my, my favorite study around this, they had a trauma conference in San Jose, California. About 500 people attending. Trauma surgeons, emergency medicine physicians, critical care nurses and paramedics all together at this conference. They got everybody to sign an informed consent waiver when they came in and had their blood drawn at the beginning of the day at lunch. They used a random number generator and divided everybody in half and everybody got the same box lunch. And half of the people were sent outside to eat lunch in the park next to the convention center, koi pond there, birds in the trees, whatnot. The other half stayed inside the convention center and ate, ate lunches like so many as so many of us have hundreds of times. And they found that they redrew everybody's blood when they came back in from lunch. And spending just an hour in in nature measurably lengthened people's telomeres where the people who stayed inside didn't have any change to their telomere length. If you're interested, here's a couple of books on the subject. They're both written for normal people to be able to consume. You don't have to be a super scientist to understand them. The one on the left is Dr. Epel and Dr. Blackburn's book. The one on the right is by Mike Fossil, who runs the center for Aging at Stanford. He's also an emergency medicine physician in Grand Rapids, Michigan, and a pretty interesting guy. So when it comes to stress management.

The question is, so what can you do? What can you do? And some people just don't do anything to manage their stress and they suffer and sooner or later they're likely to end up with some kind of an injury that's likely to hurt them. Some people have a maladaptive response to stress. Any of you who've none of you have ever said this, but other people, you've heard people say, God, I need a beer, I need a drink. Which is like a testimonial to alcohols ability to in the moment, reduce your stress even though it has some significant consequences. Some people manage stress by just getting away from it. And certainly when Covid hit. I've got a bunch of friends on Facebook who are involved in EMS and medicine in general. And about April or May of 2020, the number of people who were taking early retirement to just get away from, you know, having to PPE all the time and shower in your garage and all that kind of stuff just kind of skyrocketed. I had like 45 friends take early retirement within those two month period. Some people try to change the source of Your stressor and, and those of you who are partnered and in relationships, you may have attempted some of this stuff and it doesn't, doesn't work that well. The things that, that work better are focus, focus on, on really changing your brain.

And so there's a few tricks around this. And if you're interested in the studies behind any of this stuff, I'll give you my email at the end of the talk and I will give you a link to my Dropbox that's got all the science behind this. But most of you have seen pictures like this with a cat chasing prey.

Both of these animals are experiencing an acute stress response. The gazelle in this case is experiencing an acute threat stress response. Increased heart rate, increased respiratory rate, peripheral vasoconstriction, decreased sensation in your extremities so that if you get bit, it doesn't hurt so much and you can still fight. The cat, on the other hand, is experiencing what's referred to as challenge stress.

Challenge stress looks kind of similar from your physiologic response. Increased heart rate, increased respiratory rate, blood shunted to the brain and the heart and the major muscle groups.

And the emotion associated with threat stress is fear. With challenge stress, it's excitement. And.

The way your body processes threat stress and challenge stress is different. Chronic threat stress leads to the heart disease and the depression and the cancers and immunologic diseases we talked about earlier, diabetes. Challenge stress actually increases your resilience and increases your strength and increases your ability to deal with the vicissitudes of life. So one of the practices they recommend in stress management is called cognitive reappraisal, where if you kind of notice yourself feeling afraid and feeling stressed, you kind of catch that feeling and ask yourself, I wonder if I'm actually.

Feeling excited. This could be excitement. I wonder if this is excitement and you can talk yourself into feeling excited more than stressed. And it will improve your, improve your performance. And it is believed that it will decrease the negative effects of stress in your life.

And one of the things you can do on a regular basis is submit yourself to regular little bits of challenge stress. And whether it's in athletics, whether it's.

Submitting papers to conferences and doing the work to present on those, there's some interesting research on the WIM HOF method and the ice plunges where you expose your body to extreme cold or extreme heat. Being challenged stress, that helps build your resilience. Certain foods help build your resilience. As a bit of challenge stress. Turmeric, blueberries and those kinds of things. And the other next stress management strategy is about spending time in nature. And you don't have to go to some national park forest and do a seven day retreat. You can just find a park in your neighborhood or trees in your backyard and you know, walk, walk quietly with your ears open so you notice the sounds, feel the wind on your skin, feel the, the earth on your feet, notice the, the changing views and pause frequently so that you, you really experience it.

Oops. I don't know how that, I don't know how that slide ended up in here. That was not the right slide. But I'm not, I'm not recommending smoking marijuana as a stress management strategy, but I know nobody on here has actually smoked marijuana, but you've seen people in movies and whatnot smoke weed and the process that they use for smoking weed where you take a super deep breath and hold it so that the smoke and the effects will be absorbed. That breathing pattern, taking a suit, you can do it with me right now. Take a deep breath and hold it and then blow it all the way out and then take another deep breath in like you were taking a second hit. I, I believe that the breathing pattern is the relaxing part of smoking cigarettes or smoking marijuana, that the breathing pattern is the key and you can do the breathing pattern without the smoke. Another strategy is to train yourself to label your emotions. And if you, when you're feeling an emotion, if you can actually put a label on it. And the more kind of nuanced and specific the label can be, the more effective it is at helping kind of decrease your, your stress around it. There's something about the, the cognitive process of labeling things that decreases your stress response.

And it, it doesn't take very long to kind of dial down a little bit of a sympathetic hijack. You can, you can do it at about 60 seconds if you take regular breaks during your day. You know, if you're somebody at work who likes hot beverages, if you're a coffee drinker, a tea drinker or whatever, make your cup of coffee, make your tea, put in whatever mixings you like and turn your phone upside down, don't be doom scrolling and actually smell the liquid. Feel the warmth of the liquid through the cup on your hands when you take a sip, actually taste it and feel the warmth of it as it goes down your esophagus and really enjoy your drink. Is a good strategy.

And then the last one I will mention here, this is one. When Covid first got started, I was seeing people all over the place, stressed to the max. And I called up the folks at lexapool who do EMS 1 and Fire 1, Police 1 Corrections 1. I said, you know, people are really stressed. Maybe we should do a stress management webinar for people. And.

The guy, Greg Freeze, who runs Lexapool, said, that sounds great. I called him on a Thursday night. He said, when do you want to do it? I said, well, sooner is probably rather, rather than better because better than later because people are really stressed now. And he said, how about Tuesday? I said, I can crank together a PowerPoint over the weekend. And he just put it out to the different channels that he has available. And we had 10,500 people register over the weekend. That's the largest audience I've ever spoken to in my life. And I didn't even have pants on. And one of the things I mentioned in the webinar is that if you regularly wiggle your toes and you can do this right now, just wiggle your toes for a minute. Wiggling your toes will dial down your stress a bit because it kind of counteracts that kind of numbness that tends to go to your extremities with the stress response. And after the webinar, I got an email from a US Navy fighter pilot who said when I was getting ready to fly my first mission over Iraq, my squadron commander was up on the ladder next to my cockpit giving me my last minute flight instructions about call signs and our target and mission and all those kinds of things. And. And he said now, just before he closed the hatch, he said, now there's just one thing I want you to remember throughout your flight. And, and he said he was thinking, I'm supposed to pay attention to my aileron or look at my wingtips for other aircraft or whatever. And his flight commander said, I want you to wiggle your toes throughout the flight. And if you do that, you'll increase your performance. Your head will be more in the game. And I was teaching stress management to the, the OB GYN Reproductive Medicine faculty at the University of Pennsylvania shortly after that. And they mentioned that they, when they're doing painful procedures on patients, they frequently will tell them to wiggle their toes. So I know all this stuff can be a little bit scary, but I am confident that you can master some stress management skills. Here's my email and my cell phone number if you're interested in this full slide deck. I only, I only did about half of the, half of the slides because of a short period of time. There's a bunch more information in there if you're interested, or if you're interested in a link to my Dropbox with all of the science behind this stuff, I'm happy to share it with you. And with that, I will turn it back to you. Peter.

Awesome. Mike. Amazing. And I was just on a meta call for the last two minutes. I didn't hear the end of it. And so she mentioned that I. Please excuse me. But from the standpoint, you know, if you can just speak a few minutes on what First Watch is able to do and you know, we have tons and tons of data coming into the medical record. We know which medics are on which calls and so can you just talk a little bit about what you guys are doing to impact our medics in the field based on that data?

Yeah. So we, we basically build systems that monitor the data in the background and we'll reach out and grab a human when a certain set of things happen. So we do it custom for each system that we work with based on what they want to be alerted about, whether it's, you know, a pediatric cardiac arrest or somebody who's trapped and alive in a fire, who's talking when they get there, but dies before they're able to extricate them, or a multiple shooting situation or, you know, kind of whatever the user defined criteria is from, from your system. We monitor that data in the background and when those calls happen, we can alert your, your chaplain, your peer support team, your EAP team, your leadership team to go in and provide psychological first aid and support for people right off the bat. We can also analyze patterns of people of have handled more pediatric calls in a week than they normally would and cluster them. There's a lot of information that we can do around that to help support people in taking care of their folks. And we do this with all different kinds of data that's called a trigger. And we have 50,000 different triggers we've created for everything from opioid use to ketamine administration to bundles of clinical quality care. That's kind of our sweet spot and specialty is that we can take data from almost any source and mix and match it and do analysis in the background and give you dashboards and reach out and grab you from an alert perspective for things that you care about in your system.

And then you ask the agency itself to then provide the resources and support.

To those medics.

Absolutely, absolutely. And I'm also involved. I'm chair of the All Clear Foundation. We've got a website that has got resources for stress management all over the country, including text based things and a bunch of things that are free. And there's fortunately a lot of resources out there to help support people if they'll reach out and kind of tap into them.

And I know that Angus is been looking at, studying this. I know Angus is on the call today. And Angus is one, is one of the agencies I know that's used First Watch very successfully over the years. So I'm always curious to see how and what he's doing since he's going ahead of the curve. But this is something that we all deal with and unfortunately at our agencies we only deal with that after it happens instead of understanding and seeing, you know, seeing it months in advance that it was going to happen.

So I'm kind of like into the prevention aspect of this in our, with our, with our folks and just more of us were doing what you're talking about. I don't think we do it enough.

Yeah, building, building your resilience, you know, with good sleep, good nutrition and exercise being the, being the basics, you know, it, it allows you to recover faster and better when you get into a situation, if you've got a good basis to start with, if you're, if you're already, you know, underslept and depleted and, and out of shape and those kinds of things, those stressful situations, they hit you harder. You're deeper in the hole and it's harder to pull out.

So the last thing is that one of my EMS captains, she just wrote up an article for EMS World on this topic. She had these struggles. She's come out of it with exercise, nutrition, sleep, breathing. She actually now takes her units out of Service at Station 42 here in Hagen Ranch.

In Palm beach and she'll do yoga for 45 minutes. Love it. And now the other stations are asking, hey, how come we don't get that? So there's clearly a need and a want. People want this kind of understanding how to handle their, their sympathetic tone and maybe reduce it while they're at work. So you're doing great work, my friend and thank you so much for joining us today.

Thank you for the invitation, really appreciate it.

And for everybody, there's a link in the chat. Go ahead and pop over to the Eagles webinar. Obviously, Mike, you're more than welcome to join as well. That's where Dr. Pepe takes us around the world with EMS. So I'll leave that up here. I'll wait for everybody to pop on over and this recording will be up in the YouTube link by the end of today.