Feel Better, Live More with Dr Rangan Chatterjee - #56 Becoming Stress Proof with Dr Mithu Storoni

Episode Date: April 3, 2019

Although you can’t see it, stress is everywhere. Once pushed aside as something that couldn’t be explained, stress is now a quantifiable, identifiable, solid thing that has real physical effects on our bodies and our long-term health. But what can we do about it? Neuroscientist, researcher and guest on this week’s episode, Dr. Mithu Storoni, has read over 1,000 academic papers to answer that question. Mithu shares the finding of her research and explains just what stress can do to our bodies and how we can measure it using modern technology. She gives some brilliant practical tips on how we can buffer ourselves from the consequences of stress. I hope you enjoy the conversation! Show notes available at drchatterjee.com/56 Follow me on instagram.com/drchatterjee/ Follow me on facebook.com/DrChatterjee/ Follow me on twitter.com/drchatterjeeuk DISCLAIMER: The content in the podcast and on this webpage is not intended to constitute or be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or other qualified health care provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have heard on the podcast or on my website. Hosted on Acast. See acast.com/privacy for more information.

Stress is now a quantifiable, identifiable, solid thing which we know happens. We can explain what is going on and hence we have the power to eliminate so many conditions and give so many people relief for what they've always assumed was just possibly in their heads or just something going on. Hi, my name is Dr Rangan Chatterjee, medical doctor, author of The Four Pillar Plan and television presenter. I believe that all of us have the ability to feel better than we currently do, but getting healthy has become far too complicated. With this podcast, I aim to simplify it. going to be having conversations with some of the most interesting and exciting people both within as well as outside the health space to hopefully inspire you as well as empower you with simple tips that you can put into practice immediately to transform the way that you feel. I believe

that when we are healthier we are happier because when we feel better we live more. Hello and welcome to episode 56 of my Feel Better Live More podcast. My name is Rangan Chatterjee and I am your host. Today's episode is all about stress. Although you can't see it, stress is everywhere. Once pushed aside as something that couldn't be explained, stress is now a quantifiable, identifiable, solid thing that has real physical effects on our bodies and our long-term health. But what can we do about it? Well, as many of you already know, I wrote a book called The Stress Solution, which outlines my

philosophy on stress and what we can all do to reduce its impact on us. I think that the tools I outline in this book are valuable for pretty much all of us, whether we think we're stressed or not. So if you haven't managed to pick up a copy yet, I would encourage you to check it out. It is available in paperback, ebook, as well as an audio book, which I am narrating. Today's guest on the podcast has also written a book about stress and is Dr. Mitu Storoni, medical doctor, neuroscientist, researcher and author of the fabulous book Stress Proof. Whilst writing her book, Mitu read over 1,000 academic papers and in today's conversation, Mitu shares the findings of her research and explains

just what stress can do to our bodies and how we can measure it using modern technology. Me Too is extremely knowledgeable. She speaks with a lot of clarity and passion and shares some brilliant practical tips on how we can buffer ourselves from the consequences of stress. I really hope you enjoy our conversation. Before we get started, I do need to give a very quick shout out to our sponsors who are essential in order for me to be able to put out weekly podcast episodes like this one. Athletic Greens are a long-term supporter of my podcast. Now, I do prefer that people get their nutrition from food, but for some of us with our busy lives, it may not always be possible. Athletic Greens is one of the most nutrient-dense whole food supplements that I've

come across and contains vitamins, minerals, prebiotics and digestive enzymes. So if you're looking to take something each morning as an insurance policy to make sure that you are meeting your nutritional needs, I can highly recommend it. For listeners of this podcast, if you go to athleticgreens.com forward slash live more, you will be able to access a special offer where you get a free travel pack box containing 20 servings of Athletic Greens, which is worth around £70 with your first order. You can check it out at athleticgreens.com forward slash live more. Now, on to today's conversation. So me too, welcome to the Feel Better Livemore podcast. Thank you so much for having me. It's a huge pleasure to be here.

Well, look, you know, we're in a rather interesting situation where we are both authors who have written books about stress. You've got this brilliant book, Stress Proof, out now in the UK, which I got to say is a fantastic book I'm a big big fan actually but I'm really interested just to start off where did your interest in stress come from? So a few years ago about five years ago or so I moved to Hong Kong I actually moved to Hong Kong a little bit before then but when I first moved to Hong Kong. I actually moved to Hong Kong a little bit before then. But when I first moved to Hong Kong, I moved from, you know, this fast paced city, which is London, to a city with a completely electric vibe. And I was suddenly surrounded by my friends, by my husband, his friends, really showing striking signs of things that they'd not shown signs before. So namely stress, they were all suffering from stress. And they all asked me,

because I was the kind of the doctor they knew, what they should be doing, what's the best cure for stress, what can they do? And I realized then that despite everything I'd learned, I mean, by that time, I'd published papers in neuroscience and neurology. I had a PhD in neuro-ophthalmology. I'd won prizes. And despite all of that, I had no idea what to tell them. And the problem there was that all these people who are in this situation of being in these high pressure jobs high pressured lifestyles they had many options that were constantly put forward to them you walk past you know things that situations or organizations that that claim to get rid of your stress, that sell you stress solutions. But actually, many of them are really running on guesswork. There's very little science behind

many of them. So many of these people, they've tried stress solutions, found ones that are perhaps not supposed to be effective in the first place, but they've tried them. They weren't effective, and then they've given up up and they just sit there reconciled with the fact that they will have stressful lives and it's a part of their lives and they can't do anything until they run down the rabbit hole of mental illness or, you know, depression, for instance, we know is a long-term consequence, possible consequence of chronic stress. So things like that. So there are all these people who are under chronic stress, who couldn't find a solution. And the solutions they found just did not work. So they lost faith in the fact that solutions

were there. And then there's me. I'm supposed to have the answers. I was working at Queen Square before I moved to Hong Kong at an amazing tertiary care center. And I didn't have the answer. So I sat down. I thought, okay, I have to fix this. So I sat down and I made it a mission to dig out as many academic papers published and archived in the National Library of Medicine as possible. So I read, physically read at least a thousand. It took me two, three, four, five years to do that. I then condensed those thousand papers into just under 600 published clinical studies. And then I condensed those just under 600 studies into a simple doable manual, which turned into my book. And then I tested this manual on people without having any intention to publish it as a book. And then people started giving me really good feedback. And then it turned into a book. Oh, that's incredible. I mean, that's a lot of papers to have got through. And then obviously you've been through that whole editing process where you think you've got the papers that you need and you realize there's probably too many.

You need to condense that even further. Then you need to condense even further to put it all in a book that's going to keep people engaged, keep them interested, and then give them some practical solutions at the end, which I think you do really, really well. and practical solutions at the end, which I think you do really, really well. Something about your story there really strikes me that you used to live in London and you went to Hong Kong and you noticed that there was a high level of stress in the culture in Hong Kong. Is that relative to London? Because for me, as someone who doesn't live in London, I live in the northwest of England, near Manchester, and I'm down in London, you know, most weeks, or certainly two or three times a month. And I certainly feel when I get off the train into London, that London seems quite a stressy place to me. I certainly love getting off the train when I get back home, and I almost feel my shoulders dropping. Yet you're sort of saying

going from London to Hong Kong, is Hong Kong more stressful, do you think? Well, when I return to London, I think, oh, I'm in a chill-out place. Are you kidding me? Wow, that's incredible. I'm not kidding at all. Hong Kong is very fast-paced, very, very fast-moving. And there's a very high concentration of very, very stressful jobs. And is there something in the culture there in Hong Kong that is...

Well, not actually is there something in the culture there in Hong Kong that is, well, not actually, is there something in the culture? What I'm trying to get at is, are we seeing the consequences of stress in terms of the symptomatology in which the general population have there, whether it's anxiety, depression, mental health problems, burnout, sleep problems, you know, even things like type 2 diabetes, which I'm sort of always keen to say to people is not just a diet driven illness, sleep deprivation, stress plays a big, big role as well. Are we seeing these kind of things because of stress in Hong Kong? Well, this is a very good point. Because actually, when I was writing my book in Hong Kong, I had a huge range of these aha moments. You know, they're almost like epiphanies. Because as I went through the studies, suddenly, things just clicked and fell into place. So for instance, you mentioned diabetes. Now, as both of us in the medical profession, we know that

patients come to you and say, you know, I'm doing everything, doctor. And you know, the patient is doing everything. But there is still an issue with blood sugar management. What is going on? The doctor's following the right protocol. The patient is super good at doing everything. But there is this ghost lurking around and you think, what is this ghost, right? And then when I was working, for instance, at Queen Square and I was seeing patients with lots of neuro-autoimmune conditions, including manifestations of multiple sclerosis, of MS, as well as relapses of similar conditions, some patients can actually plot a straight line between the relapse and events in their life, events during their day. So maybe they're going through a difficult weekend, they had a difficult relationship over the weekend. And then suddenly you realize, well, actually stress is a identifiable factor in this. You can't just say,

well, I don't know why these relapses are happening. They're just happening out of the blue. So there are all these epiphanies. And of course, the even bigger epiphany, which I had from writing my book, which comes back to the Hong Kong story, which is that you think, you know, we've always heard when we were, you know, anecdotally, that if you get stuck in a stressful job, if you're miserable at work, or if you even feel you are not progressing, you are not treated well, you're not being rewarded for your effort. People who are in these climates, if you look at them they many of them show signs of type 2 diabetes people with these sedentary jobs they have visceral fat which is fat around the middle section and of course many many people in these situations get and these are mostly anecdotes or observations

but they tend to be struck more by certain kinds of illnesses or even things like the common cold than someone who is not in that highly stressed situation. and you're given the cold virus through your nose, you are much more likely to catch a cold from it than if you're in a job where you're not treated as inferior. How extraordinary is that? That's incredible just to hear that. And that's just how powerful our mind is, how powerful the stress response is on our body, on our immune system. Yeah, it really is incredible. So if you go back to Hong Kong, there are many diseases there. So certain things like IBS, which were not previously focused on quite as much as they are now, because all of a sudden, you know, the epiphanies I've gone through are really epiphanies that have happened within the scientific community. And suddenly this ghost in the room who seems to be pulling

these strings of these diseases suddenly has taken shape and it's become an elephant. You know, it's no longer a ghost. We now can say for sure that if you are under a very stressful situation, if you're going through stress or if you live in a life that's filled with stress, you will find your blood sugar is more difficult to manage. Now, obviously, I've explained why that is in my book. There is also a direct link now being elucidated between being in that constantly wired kind of never really calming down state and, of course, hypertension, but also autoimmune conditions, which happens through a pathway in your bone marrow, which is again, extraordinary. And stress is now a quantifiable, identifiable, solid thing, which we know happens. We can explain what is going on. And hence, we have the power to eliminate so many conditions and give so many people relief for what they've always assumed was just possibly in their heads or just something going on.

Yeah, I mean, that's incredible. There's so many threads I want to pick up on there. I mean, the first one, I guess, is when you mentioned these MS relapses and how stress often precedes a relapse. And over the last five or six years, one of the big differences in the way I practice medicine, since I've really been going around the world to study root cause medicine, how do you get to the root cause of a patient's problems rather than simply suppress the symptoms? And with my autoimmune patients in my practice, when I do a timeline, I go back through the whole life from childhood, teenage years, 20s, 30s, you know, when did they first get symptoms? When did relapses happen? It is uncanny how many times just before the first onset of symptoms, some form of stressful episode occurred in their life,

whether it's lost a job, whether it's a relationship breakup, a bereavement, you know, a period where they were understaffed at work so they were working all the hours you know it's incredible you see this enough times and you think this is a pattern there is something going on here in terms of how stress impacts autoimmune disease and you maybe explore some of those mechanisms a bit later but but the other thing I really want to touch on is you said it's like a ghost in the background isn't that one of the main problems with stress is that because we we don't think we can see it. It's sort of sitting there like a ghost. Is that one of the fundamental problems

as to why maybe as a society, we've not taken stress as seriously as obviously you and myself both think we need to? I think you're absolutely right. See, the problem is in medicine, unless you can measure something and follow it and turn that measurement into an entity that you can use to predict what's going to happen next, or that you can identify in other settings, that thing kind of, we don't say it doesn't exist, of course, but we just leave it to the side because it's much more dangerous to explain something wrongly than to try to, than to just ignore it. Appreciate it there, but ignore it because we don't know what it is. And I think stress is this thing. So for instance, you know, we talk about the word, we use the word functional symptoms. And in, you know, when I was working,

when I was working in Queen Square, we used to see cases that were really, I like to call them black swans. They were really the cases that broke all the rules. So you go to medical school, you then specialise, you do your board exams, and then suddenly you meet patient after patient after patient who doesn't follow any of the rules. And working there was probably the most stimulating time of my life. For people listening, can you explain what Queen Queen Square is in case people don't know? Of course. So the National Hospital of Neurology and Neurosurgery is a tertiary referral centre for neurology related problems, where we get referrals from all over the UK and also from across Europe. And I was a clinical fellow there.

Great, thank you. And I worked with some amazing people. My particular mentor there was this incredible genius of a person who would always say to me, never feel afraid of saying you don't know. And he knew more than all of us combined. And he never hesitated at saying, I don't know. Because the moment you say, I don't know, as a clinician, you don't know as a clinician you are allowing the fact that there is another entity there and we can't explain it today but we will be able to explain it tomorrow and stress has now emerged as offering an explanation for this entity in many situations and I think that what you say is exactly right.

In the past, we couldn't measure stress. So if you said to me, me too, I'm feeling really stressed, I'd say, oh, show me proof. What's your proof? And then you'd say, well, I don't know. And as a clinician, I wouldn't be able to give you,

you know, be able to really get any proof. But, you know, there are things that are really exciting in the stress world that have turned stress from being a ghost into being a measurable entity that you can actually use to explain symptoms. So the first thing, which is probably the route through which I was kind of introduced to stress, is I worked, I spent some of my time when I was doing research for my PhD looking at pupilometry. So you're looking at pupils. Pupils, yeah. But it's a very, very exciting area because when we are talking about functioning in our day-to-day lives, breathing, letting our hearts beat, etc.,

we are talking about an automatic nerve network which is constantly at work inside ourselves we call it the autonomic nervous system it's this automatic nerve network which is keeping us alive and modulating the way in which we respond to our environment so this automatic nerve network which sends signals to the heart, is responsible for suddenly raising our heartbeat if we think we're about to be, you know, chased by something or an animal or something. And it's also responsible for calming us down at the end of the evening when we're falling asleep at night. And this flexibility is an underappreciated aspect of our functioning. And what we're now slowly discovering is that this automatic nerve network is, we've already known, it is responsible for our stress response. Okay. So when we talk about being chronically stressed, the part of that

automatic network that doesn't make us calm down is unbalanced, which is why we feel the symptoms of chronic stress. But what's so exciting is this automatic nerve network, which is responsible for the stress response, has got two windows that you can see from the outside world. Okay. Now it likely has more, but these are two windows that we have come across. One window are the pupils. So by looking at the very fine dynamics of how the pupils move, the flutterings and a microscopic level and breaking it down, breaking the waves down, you can elucidate the moment-to-moment fluctuations of this automatic nerve network. That's incredible. And the second area is the heart. There is now a tool called heart rate variability monitoring, HRV monitoring.

And the same nerve network manifests itself in how responsive the heart is to changes in demand. So if you're sleeping, your heart rate is slow. But if you now have to run up and, you know, wake up and run, your heart rate has to suddenly accelerate. And the ease with which it does this is known as HRV. And the higher, the more likely it is, the easier it is for the heart to change between these two zones, the healthier the heart is. So the heart and the pupils in this way allow you to measure this nerve network, which when it doesn't easily slide from a calm state to a stressed state, when that easy sliding of this nerve network becomes impaired, that is what we call stress. So when I was doing pupillometry, I really saw the effects of stress on the pupils. Because if you really look into people's eyes, if they're going through, and I was testing lots of healthy people as well as people with illnesses, autonomic conditions. If you look at healthy people, you see a certain pattern. If you look at people who've

just had stress in the last hour, you see a completely different pattern. Is this something, obviously looking at pupils is pretty detailed, pretty specialist stuff. Heart rate variability, obviously there's lots of apps now, lots of things that people can do at home to try and measure their own HRV reading, which is something I do, we can maybe touch on a bit later. But is there anything people can do at home with their own pupils? Or is that quite a specialised way to look at stress? So I think what I was trying to say is now we are able to measure the pupils and the heart. We now have apps, as you just alluded to, to help us do these. So we can download apps, we can measure these apps.

Now, with a pupil, we're still at the transition stage. But with a heart, as you say, we can do it. But as soon as we realize that these are two entry points into this mysterious nerve network that's responsible for our stress response, and we can measure these entry points, suddenly stress starts to take form. Because the other really exciting thing is we talk about cortisol all the time in terms of stress. But actually perceived stress doesn't always correlate with cortisol. And it's the perceived stress that correlates with disease. And that's kind of thrown us for a while because when we started, you know, there are studies in the past that have tried to correlate stress to diseases, so to relapses or whatever. But the studies didn't really show anything because they were looking at cortisol, for instance.

So cortisol in many ways was a proxy that we were using to try and say, that's how stressed someone is. Is there a correlation with disease? But what you're saying is actually, it's not necessarily your cortisol level, although that can be useful in some cases, of course. It's more, how do you measure someone's perceived stress? And I guess, I mean, we both, you know, I've read your book and you cover HRV just as I do in the stress solution. And I think HRV is brilliant because it allows us to, the way I look at it, and I've been treated to whether you sort of share the same view, it allows us to look at all the various stress inputs into our body, whether it's nutritional stress, whether it's work stress,

whether it's emotional stress. And it's like an equation, everything goes in. And then at the other end, you get a reading, which is sort of absorbed all the various stresses, your perception of those stresses, and ultimately it's telling you how stressed is my body at the moment. Is that how you see it as well? Certainly. I mean, I think that what's really exciting is that we have come a long way to actually understand what is happening to our bodies when we're going through the stress response. So for instance, we know that when, you know, if you are running across the road and you suddenly see a lorry coming your way and you have to run fast, that elicits a stress response. Now we know that when you take a stress

response, we can break it down into certain parts. Okay, the first part is really immediate. And because it's immediate, it has to be moderated by electrical signals. And that's mediated by your automatic nerve network, this autonomic nervous system. Now, in that immediate setting, the parameters of these nerve networks change such that you get an immediate rise in inflammation. You get an immediate rise in things like blood pressure and your ability for your blood to clot. You get an immediate rise in your heart rate. And then this nerve network, which is immediate, feeds into the hormonal network. And what happens further along the line of the hormonal network is this release of cortisol. So where the nerve network increases

inflammation, which we associate with, which happens the moment you become stressed, you know, as an aside, even emotional stress makes you more inflamed, which is so exciting. So if you go and have an encounter with your boss or with a colleague and you feel emotionally negative after that, that in itself raises your inflammatory markers momentarily. I think it's so key, isn't it, for people listening to this to understand that stress is not just this ghost in the background. Stress has physical effects on our body. Even that emotional stress does that. I don't know if you've come across Professor George Slavich's work on social genomics at UCLA, but I've seen a couple of his lectures and it's really incredible just to show how, you know, he talks about how if we are rejected in a social situation, I think within 45 minutes, our genetic expression has changed. We become more inflamed. That's just emotional stress that is changing our biology. enjoy their work, when they don't feel valued, how that can impact their susceptibilities to getting ill. And, you know, I guess that leads to, you know, the next question for me really is,

obviously, you live now in Hong Kong, but you spent a lot of your life in the UK. In the modern world, in 21st century living, what are the common sources of stress, would you say? So I think that the reason why stress is such an issue today is because our lives have changed so drastically that they've resulted in two things. We have lost little habits we used to have incorporated in our day-to-day lives, which used to buffer up the consequences of stress and push us back down to our baseline. Okay, we've lost these. I'll name some of these in just a second. And we've also introduced things into our lives which have created new stress triggers. So if we talk about the things that we've introduced very quickly. So if you imagine the brain, because ultimately

stress stems from the brain, which is why I find it so fascinating. The brain is a prediction machine. That's what a lot of the data is pointing at. We have no idea what the world around us looks like. So the brain is creating a model of the world using the cues it's receiving. Now, the brain, what is its aim in trying to do this? Why bother? So it's trying to do this because if it cannot model the world, the world stays uncertain. And if the world stays uncertain, the uncertainty masks danger. So by bringing the world into a predictable form that the brain can predict, it reduces uncertainty.

It is able to control the world, gain mastery of the world. And in doing so, it can predict what's about to happen next and be prepared. Okay. Now, many of the cues that we've always used to create this picture of the world are suddenly disappearing. And these are cues we've evolved to rely on. So one wonderful cue I love to refer to is the notion of sunrise and sunset. Our ancestors, all our ancestors of all humanity, have always relied on one thing that's definitely going to happen tomorrow morning. And that's the sun is going to rise. And one thing that's going

to happen tonight, the sun will set. Now, obviously, this breaks down if you live in the Arctic, but most of us, we come from the Horn of Africa. And as we evolved, we've always relied on sunset and sunrise. detects the fall in blue light. These receptors at the end of the day are not detecting this fall anymore. So they're not talking to the center in the brain, to the suprachiasmatic nucleus, to say that, hey, the day's ended, it's sunset now. So as far as the brain is concerned, we continue to have daylight as we look into our blue light emitting smartphones and Kindles and we watch Netflix in the evenings. And that in itself, through multiple pathways, creates uncertainty. You know, as an aside, melatonin, which is the darkness hormone I know you've spoken about before, which we produce overnight. Melatonin is now being shown in head-to-head studies with anti-anxiety medications to have really significant efficacy against anxiety. What does that mean?

It means nature has given us this natural anxiolytic we have taken every night like a pill. And suddenly with modern technology, modern lives, globalized living, we have cut short this regular nature's anti-anxiety pill dose. And that stress karma has gone away. While at the same time, we've increased uncertainty by not being able to predict sunrise and sunset anymore, which has created a new stressor. So that's one example. And then there's another example, movement and exercise. And this is one of my favorite examples. See, in the past, I know when both of us were young, we used to have to get up and run to the telephone to answer the phone. We used to have to get up and walk to the post office to post a letter. Okay. And I used to write to my pen friends,

they'd wait two weeks, three weeks, one month for a reply. Anyway, we used to have to do, our environment used to nudge us into behaviors in the past, nudge us into moving constantly. And we used to actually move doing low to moderate intensity exercise intermittently throughout the day. Today, we have the wonderful luxury of being able to do everything from these little phones. So we hardly move because we don't need to. We're clever. We don't do things unless we really need to. We're lazy.

Okay, that's a good thing. And as a result, we stay in our sedentary jobs. We stay sitting all day long without these natural movements. And then what I find happens a lot in Hong Kong, and I'm sure it happens in London as well, people try to squeeze in their exercise because they're told exercise is really good for them. And it is good for us. It's very important for us. But they spend the whole day sitting down and then they do this intense high intensity exercise in the evening.

Now, during the day, our ancestors had stress, we have stress. But every time we get a little stressor, the movement we do for the next hour or so buffers the effects of that stress away. Because low to moderate intensity exercise lowers levels of cortisol. Because low to moderate intensity exercise lowers levels of cortisol. So a little bit of blip of stress and a long buffer of movement. A little blip of stress, go for a 15 minute walk and you're back to baseline. Okay. So if you had these movement intervals throughout your day,

the little blips of stress didn't accumulate throughout the day. Today, we no longer have those buffers. We still get those little blips of stress. So instead, by the end of the day, we have this accumulation of cortisol. And then we go for super high intensity exercise in the evening, and we raise that cortisol even further. And that adds to our stress load, because that accumulates from one day to the next. So this is another example of a new stressor and an absence of a stress buffer. Yeah, me too. I love it. I mean, I think it's such a fresh perspective for me, that whole idea that the brain is trying to model things all the time and actually predict. And that's when it feels safe. That's when it doesn't feel stressed it sort of knows

you know and I guess in many ways that's how that's why I find my patients myself my children respond so well to routine um that it's I think just the way we've always been isn't it right that this you know we need routine we like routine yet many of those routines are now routine. We like routine, yet many of those routines are now just being eroded out of society, frankly. One of the chapters I really liked in your book was the one on tuning your body clock. For people who've not read this and are considering getting it, what I love is that you've got these seven agents of stress and these seven mechanisms that can happen in the body as a response to stress. And it's such a, it's a very different way that you're describing stress. For me, lots of

similarities, but it's a very fresh way for me to read it. And I really enjoy it. And if we just dive into these, tuning your body clock a little bit, these daily rhythms, you mentioned exercise, high intensity exercise in the evening. So there's a lot of good evidence, for example, on high intensity exercise. So do you think that there are various things that we can do in our day, but we should be doing them at a particular time? And for example, exercise. So you're absolutely right. There is some superb evidence for high intensity interval training and exercise. So let's look at exercise in two lights. Okay. So the first thing to preface it all with is the fact that one of the mistakes we all make, I think, both as our patients, members of the public, but also as clinicians. I think one of the mistakes we make is we forget that every intervention, everything you do has a place

depending on context. Okay. Context is everything. And that's why, you know, for me personally, you come across in the book, I don't like things like, I don't like labels of marathons or, you know, running the desert run, all of those things. These are really intense experiences. Now they have effects that are so far reaching that the benefits of those effects outweigh the temporary rise in inflammation and the temporary negative effects. So for instance, if you do something as challenging as, you know, an ultra marathon, for instance, or even a marathon, then one of the ways in which that's really good for you is it creates a sense of self-efficacy. Okay, because the brain, as I've covered in one of the chapters, I talk about growth, it's a metaphor. The brain always needs and wants to upgrade itself. You and I, we need and want to upgrade ourselves every single day compared to

the day before. We need to be better in some way, in some shape or form, because this constant improvement gives us a sense of self-confidence. And so doing these big challenges in the form of big sporting activities adds to that sense of self-efficacy. So I completely understand and applaud the intention and the achievement of doing extremely intense challenges because it has a wide range of benefits. Now, bringing that back down a notch, when it comes to exercise in general, we are used to seeing it under the banner, most of us, and I was for a long time, of calories. Okay, if you exercise and heart, right? You exercise, you keep your heart healthy and you don't get fat. Okay.

But actually, exercise is so much more than that. So for instance, we know that exercise increases in animals. It's not been shown in humans, but in animals, it increases the growth of new brain cells in a region of the brain called the hippocampus and also actually plasticity in a region called prefrontal cortex. Now we know that that happens and the next question to ask is why is this important? Why is this relevant? Well we know that exercising makes your brain resist the effects of stress. It makes your brain more resilient. And it also, there have been correlative studies, so not causal studies, to suggest that exercise offers a protective benefit against things in the future, such as dementia, neurodegenerative conditions.

So exercise has that effect on the brain. Now, when it comes to exercise intensity, brain. Now, when it comes to exercise intensity, high intensity exercise does indeed have that effect on the brain cells, but the way you do it matters. So for instance, if you take a bunch, and I've referenced this study in my book, if you take a bunch of extreme, well, people training for something something extreme and you put them through a lot of really intense exercise for, say, a period of four or five weeks, and then you look at scans of their brain, because in humans you can't actually look inside our brain so easily, you look at scans of the brains, you find that even though their fitness improves over that course of time, you find that their inflammatory markers rise. Okay. Now, if you look at scans of the brain in human brains,

we see expansion or we see an increase or a decline in brain volume, but it's not possible to tell by looking at a scan always whether that is simply increased blood circulation temporarily, whether that is something else. But we know that inflammation, inflammatory markers correlate to excessive intense exercise carried out over a long period of time. That said, we know that bouts of high intensity exercise training increases mitochondrial biogenesis, which makes muscle cells more efficient. So if you look inside the muscle cells, you find increased rates of mitochondrial biogenesis with high intensity exercise. So that's really good for your muscles as well.

So if you again bring that back down a notch further, we know that we're finding very gradual evidence that when we exercise, the movement of aerobic exercise training, so just general running, general jogging, etc. Possibly, this is still an emerging field, increases, possibly because it's been shown really only in animals, increases the drainage of this special drainage system that exists in the brain called the glymphatic system. And it increases drainage of essentially the junk in your brain during the period of exercise. of essentially the junk in your brain during the period of exercise. Now, that has been shown to happen in aerobic training. An increased rate of new baby brain cells being born in animals has been shown in aerobic training.

But at the same time, increasing strength training and increasing resistance training also have their individual roles. Now, with timing of exercise, there is evidence that if you exercise in the morning rather than in the evening, you can increase your levels of REM sleep by 10%. You can also increase melatonin levels in the evening by exercising in the morning rather than the evening. So for every individual,

you have to put all of these factors into place. Okay. You have to think, what is your intention? Is it general day-to-day upkeep? Is it you want to increase your sense of self-efficacy, which has enormous effects on your mental wellbeing? Or are you trying to, you know, conquer a particular sport? So all of these come into play. Yeah, so beautifully put. I think, just go back to what you just started with a few minutes ago, context. Context is something that often just isn't there in health discussions, particularly I find on social media or particularly on Twitter. Obviously, sometimes the context just goes and it's just good or bad, black or white. And there's a certain nuance to everything.

I love that analogy with ultra endurance runners because ultra endurance runners, you know, they are increasing that sense of self-efficacy. They're helping to achieve something, to learn something new, to push themselves, which will clearly have so much value for themselves, for their mental well-being. There may be some downsides as well, I guess, of excessive inflammation, excessive intestinal permeability, or what's colloquially known as leaky guts from doing too much exercise, all these kinds of things. But it's context, isn't it? What are you looking for? Do the pros outweigh the cons? And I think that's something that we all have to figure out in our own lives. I mean, all that we can do as authors, as clinicians, is really guide people and showcase stuff for people. But ultimately, true long-term health, true long-term ability to

manage our stress levels comes from a bit of self-experimentation, I think, in figuring out what works for us in the context of our own lives. So I think that's super fascinating. But so as well as being highly qualified in terms of your academic credentials. You're also a yoga instructor and you do cover yoga and its role in stress a little bit in the book as well. And I just wonder, you know, why did you become a yoga instructor and B then, how does yoga help us de-stress? Thank you. Yes. I do love yoga and I teach yoga. So I was very fascinated by yoga because with my background, I've always been kind of questioning, well, why does this work? Does it really work? So I had to really do it to be convinced. Now, what I found during my own journey practicing yoga,

because I practiced yoga for a long time before I started teaching it, is again coming back to this sense of the brain and its image of the world and its image of uncertainty. What is stress? When we undergo, when our brains push the stress response button, it's really a kind of a full-blown recalibration system to prepare us for the immediate future, which the brain cannot predict and hence has no control over. So you are preparing yourself for every single possible outcome in the best all-encompassing way possible. That is essentially what the stress response is. Okay? If that uncertainty remains, that stress response stays and it becomes chronic stress.

We know that bringing the environment into our control makes us feel we are in control and we feel calmer. Okay. Now, one of the problems with the stress response is when most of us suddenly go through a stressful experience, we have no control over what's going on in our own bodies. Okay. You can tell your mind what to think. You can try to tell your mind what to think, but your mind isn't going to listen to you. You can tell your heart to stop beating so fast. It's not going to listen to you. So you have no control over your sense of self, of your body, of your sensations. And this ties in with the whole fear of uncertainty, because this lack of control over yourself translates to a lack of control over the

situation. So if you're in a situation that doesn't need to be stressful, but you've picked up on one cue or other that's made you stressed, your body and brain kick off these mechanisms, which further intensify that sense of uncertainty and not being in control, which potentiate the stress even more. So one of the most effective things to be able to do at that point is learn which buttons to push in yourself, by yourself, in any situation, so that whatever chaos is taking place around you, you have control over yourself. You want to enter into any situation and immediately learn how to bring yourself under your control. But I mean, can you do that on top? Could you? Can you do that on top? Could I do that on top? Not at all. I'm going to bring in another analogy here before we zoom into yoga. And that is the concept of brain training games, which I've also described in my book, or rather the rationale behind those.

Now, most of us don't know which buttons we need to push. Most of us don't even know these buttons exist. So if you imagine you're playing a video game, okay, just imagine this for a second. You're playing a video game, you're wired up with lots of sensors and you're driving a car along a road on that video game. And imagine that every time you feel a little bit anxious, the car just veers off the road. And nothing you do, your steering wheel, nothing you do brings the car back onto the road. To bring the car back onto the road, you have to calm down. You have to calm yourself down. But you don't know how to do it. up on something that you've done, you don't know what you've done, but something has, you know, you've just done something, maybe it's your breathing, maybe it's what you just focused on. And the second time you do it, you identify those, you remember those buttons again.

And the third time you pick up more buttons, and by the fourth or fifth time, you are able to bring your car back into control on tap, on command. And yoga teaches you to do that and yoga lets you discover these buttons that are lurking inside you which most of us have never learned are there and we don't know how to push them but it teaches you through a formal feedback system and in the long run that translates to your having command and self-control over yourself in situations which are highly uncertain because when everything else is full of uncertainty around you controlling yourself gives you the perception of enhanced control yeah that's such a great way of looking at it and i've got to say i've never thought about yoga in those terms before, because you're really expanding this idea of what yoga is good for, in the sense that many people, the common sort of view of yoga for many people is it's about certain body positions. It's about becoming more flexible, right? And of course, you know, it can serve that role for some people, but it's so much more than that, isn't it? I love that. It's how you teach yourself self-control, self-regulation. How do you control those automatic functions in your body as much as possible?

You know, getting back to the starts here, where your drive to write this book in many ways was to help your friends, your husband's friends in Hong Kong, who turned to you for advice on stress. So you've gone away, you've researched it, you've written the book. You didn't write it to be published, but you wrote it to help people. And then actually, you've got it published. It's been out in America. It's out now in the UK. In your experience, with your expertise, is there a stress prescription of some sort that you would give to everybody, to your friends in Hong Kong, let's say? So coming back to the idea that the brain is creating a model of the world. Yeah. Okay. William James, the eminent psychologist, American psychologist from 19th century, he said, my experience is what I choose to attend to.

Okay. What does that mean? It means that every one of us, we have different brains and our models of the universe are slightly different. So the universe you're living in, Rangan, it's very different to the universe I'm living in right now. Our perception of this conversation in this room right now are very different. Okay? Even though it's the same conversation. So the brain is creating a completely different model of the world in every individual. And it's taking in the cues that that individual is being subjected to and is paying attention to. Which means, given that this model of the world that the brain is creating is responsible for the

brain triggering stress when the model doesn't satisfy, it doesn't predict the future when there's uncertainty in its model. Given that the brain's model of the universe is so unique in every one of us with our different experiences. the universe is so unique in every one of us with our different experiences so someone living in i mean i used to live i used to work a while ago in i did the east anglia rotation when i was doing ophthalmology for a little while and i worked in norwich and oh what a beautiful town it's so quiet the cues that someone is waking up to in norwich are very different to the cues that someone is waking up to in bustling central in Hong Kong, which is where I live now. And this is important because these cues are what

gives rise to your individual stress reaction in every situation. And it's also these cues that are giving rise to chronic stress, which means that every single person has a unique prescription for themselves. Now, in my book, I talk, I have hundreds of strategies for stress relief. Yeah, you really do. Okay, from just under 600 scientific papers, like literally hundreds of strategies. But not all those strategies are for every reader. The idea is, you need to, by reading that book, you will be able to see which of these cues apply to you. So as an analogy, I have some friends who are pilots and who fly the hong

kong new york route which is a crazy route for your circadian rhythms how many time zones is that it's 12 hours difference yeah so morning and evening yeah wow and it's a 13 hour journey so yeah um so when they do this so for them if you tell someone like that to, let's say, do focused attention meditation to relieve your stress, they will say, I'm not. Thank you. Doesn't work for me. I'll go for pills. For someone like that, you need to focus on circadian rhythms, primarily. And everything else in the book are frills. They're the extra icing on the cake. So they need that chapter on circadian rhythms. They need to focus that chapter. It will be more impactful for them than for someone else. On the other hand, if you're waking up in Norwich, where I used to love waking up, and I didn't have good circadian rhythms because I was working nights. But if you are not working nights, if you're waking up in beautiful Norwich with a regular circadian rhythm, but you are in a difficult relationship. Or you are in a work setting where you are surrounded by a lot of emotional attack or emotional trauma.

For someone like that, my emotion regulation chapter is what's most relevant where I talk about focused attention, practicing focused attention training, about cognitive appraisal training, but all these things that you can do by yourself. For instance, I talk about meditating on a coffee mug in the office. That was great, actually. That's such a great tip for people, I think. Thank you. So that is an example. For someone like that, for that person in Norwich, that person could have been me, to focus on circadian rhythms is not really impactful because that person probably is already fine there, but this is where their biggest gap is.

So I think the problem we have is we try to give everyone the same strategies. And that's why it works brilliantly for some people. But for some others, they get frustrated because it just doesn't work for them. So this, which you described so beautifully as well, this context specific prescription is more important in the context of stress than for anything else. So, for instance, also, if you are someone who ticks all the right boxes in every setting, but you have a very sedentary job and you eat really badly, in the sense that you eat foods that increase inflammation and your timing of food intake, which again, I cover in my book, these are all, you know, dysregulated. And you find that you're doing everything according to the book, but you're still piling on this visceral fat.

For someone like that, the inflammation and the insulin resistance chapters are probably more relevant. You don't have to worry about circadian rhythm. I mean, this is one of the big issues I see with general health information per se is that it's too prescriptive. It's like, you know, you've either got to be low carb or low fat. You've, you know, you either do it this way or that way. And sort of in both the books I've written so far, I talk about, let's say the first one, I talk about these four pillars of health. I talk about, let's say the first one, I talk about these four pillars of health. And I say, when I'm talking to people live, I say, look, ask yourself a question, which of these four areas are you struggling with the most at the moment?

And we all sort of intuitively know that. Start there. And it's, you know, in some way you're saying a very similar theme, which is many of us, we like to, as humans, we like to focus on the stuff that we're already doing well and do those things a little bit better. But actually the most, you know, as you say, we're going to get the most impact or, you know, to take an American phrase, the most bang for your buck if you do the ones where actually you're not doing so well and try and do a few small things in those areas. And you'll probably find you have much faster and much bigger impacts.

That being said, Mitsu, I'm just going to close off now to finish off the conversation. I thought that came to my head. Sometimes I ask researchers this question. If you rewind yourself to back before you wrote this book and you went through the research, you wrote this book, what have you changed in your own life since embarking on this journey to become a stress expert? So the short answer is a lot. But I'll give you three examples. So the first thing is I've drastically changed how I exercise. So I have a gym membership.

So I have a gym membership, but now I focus more on moving throughout the day. And my aim with exercise is just one thing. By the time my head hits the pillow at the end of the day, I want to feel physically exhausted every single day. And I get there by gradual bits of intermittent movement throughout the day. And if I do have to do a big dose of exercise, I do it in the morning. Okay. So that's my first thing. The second thing is, of course, and I know you've talked about this, blue blocking glasses and light. Now, I'm very lucky because we live near Japan and Japan was actually the pioneer of many of these blue blocking glasses because they

started giving out blue blocking glasses to their office workers as part of a corporate package years and years ago. I didn't know that. Wow. And they pioneered much of the research on blue light. Blue light actually uses the same path in the brain as the pupil reflex. So they also are wonderfully ahead on all this technology. Anyhow, so I go to Japan and I have my 30%, 40%, 60%, and 100% blue light blocking glasses, which you can get there everywhere, not expensive at all.

And I wear them to regulate my circadian rhythms and I wear them starting in the evening. What time do you go to sleep and what time do you start wearing them in general? Okay, so I start wearing them around 8 o'clock in the evening. So a sunrise and sunset in Hong Kong is slightly different to the UK. It's more stable. But I start wearing them around eight o'clock in the evening. And I wear them until I go to sleep. And sometimes even if I'm reading and I stay up or watching Netflix, I watch everything with a red tinted hue.

And I find that they are really, really very effective. And if I start early on, I wear lower intensity blue blocking glasses. So you really, you sort of gradate it. I grade it, yeah. Yeah, according to what you need to do. But I think for many people, just simply getting some blue blocking glasses and wearing them. Well, it's interesting because it's not, the important thing with blue light is it's not just blue light. You have to also block white light.

Because I say this because I studied this for part of my PhD. Bright light stimulates the same melanopsin containing ganglion cells as blue light, if it's bright enough. So your light has to be both dim and it has to be not blue. And it has to be not blue. So it's important to not just keep a dim environment, but also to keep it dark. Sorry, to keep it blue light free, but also to eliminate things like excitement, fun. So that's the second thing that I've changed. I very rarely go out in the evenings during the week. I mean, obviously I have the odd fun night out, but I try to kind of wind down.

I'm much more disciplined about winding down in the evening. And I socialize kind of earlier on in the week. I mean, obviously I have the odd fun night out, but I try to kind of wind down. I'm much more disciplined about winding down in the evening. And I socialize kind of earlier on in the day. Can I just sort of interject there, because there's something that's super interesting there about white lights. So we talk a lot about blue lights. And I think although people struggle to do this, you know, getting those screens off, or at least putting some blue light blocking glasses on when you're watching those screens, I've seen be hugely impactful personally, professionally, in all different areas in life. But white light's interesting, isn't it? Because a lot of bathrooms these days, for example, have got these really bright white LEDs, spotlights.

And so people are getting ready for bed and often people will use the bathroom before they go to bed and have been exposed to this big, bright white light in the bathroom. Is that potentially problematic for some people who are susceptible? So yes, it is. It is definitely problematic. And one way of overcoming this, and I've quoted the study in my book, is the more daylight you get during the day, the less susceptible you are for your melatonin to stop, to being interfered with, with having to go up in the middle of the night and go to the bathroom. So someone, for example, who's outdoors all day may not be as susceptible to blue light exposure in the evening. I think that's quite empowering for people because it is that give and take, isn't it? Which is a great way for people to think is that give and take, isn't it? Which is a great way

for people to think about this, I think. So number one, feel physically exhausted at the end of the day before you hit the pillow. Brilliant. Second tip was wear blue blocking glasses in the evening as a way of limiting that blue glass exposure. And what's the third one? Have a hot bath whenever you can. We have lost the tradition in England of having a hot bath. People now go for houses and flats with showers. Raising your core body temperature by just over half a degree on just one occasion can protect you from depressive symptoms for over six weeks, at least according to one study. Now, it is a study. We can't always extrapolate, but there is proof out there. If you're feeling low, have a hot bath. And that's the third thing I try to do. Love it. So you've heard it from a neuroscientist, from a stress

expert, have a hot bath every evening. Well, certainly anytime you possibly can. Missy, I think that's absolutely fantastic. Look, I'm sure there was so much more we could have covered. I'm going to have to close down the conversation now. For people who want to get in touch with you, obviously, we'd highly recommend that they buy your book, Stress Proved, The Ultimate Guide to Living a Stress-Free Life, which I think is fantastic. Can they connect with you online? Absolutely. So I'm on Twitter at SteroneyMitu. I have a Facebook site, DrMituSteroney. I have a website. If you have any questions about stress on a one-to-one level, find me a question. You can contact me through my website,

metustoroni.com. Yeah, and guys, I'm going to link to everything that we've spoken about, all Metu's social media handles, the book in the show notes page for this episode of the podcast. Metu, thank you for giving me some of your time today. I hope you enjoy the rest of your stay in the UK

and I hope we get to do this again at some point. Thank you so much, Ryan, for having me and keep doing your amazing work. I love it. That concludes today's episode of the Feel Better, Live More podcast. I really hope you enjoyed the conversation. I thought my chat with Mitu has made you think about the impact that stress might be having in your own life. And also that you may feel inspired to make some changes on the back of our conversation. As always, please do let me too and I know what you thought of today's show on social media.

Me Too, like myself, is on Twitter. Her handle there is at SteroneyMeToo. And on Facebook and Instagram, her handle is at DrMeTooSteroney. Everything that we discussed today on the podcast, as well as links to some brilliant articles that me too has written in the popular press is available on the show notes page for this episode, which is drchastji.com forward slash five, six, a quick reminder that my book, the stress solution is available to order right now in paperback, but also as an audio book, which I am narrating, which you can get on Amazon and on Audible. If you enjoy listening to the podcast each week, then getting the audiobook

for The Stress Solution will probably be like listening to four or five bonus episodes of the podcast all in a row. The Stress Solution will tell you about the impact stress has on us, how prevalent stress is in society, but most importantly, what you can actually do about it. It is full of simple and achievable tips. So if you do pick up a copy of The Stress Solution or my first book, The Four Pillar Plan, I really hope you enjoy. If you do enjoy my weekly podcast, one of the best ways that you can support them is by leaving a review on whichever platform you listen to podcasts on guys it really does make a difference if you could spare one minute to go on and leave a review that would be really appreciated of course you can also help me spread the word by taking a screenshot right now and sharing with your friends and family

on your social media channels or you can do it the old-fashioned way and simply tell your friends about the show. I really do appreciate your support. A big thank you to Richard Hughes for editing the podcast each week and to Ali Ferguson and Liam Saunders for creating the theme tune. That is it for today. I hope you have a fabulous week. Make sure you have pressed subscribe and I'll be back in one week's time with my latest episodes. Remember, you are the architects of your own health. Making lifestyle changes always worth it because when you feel better, you live more. I'll see you next time. Thank you.