The Dr. Hyman Show - Burnt Out, Chronically Stressed, And Exhausted: How To Recover Your Energy In Every Area Of Life

Episode Date: December 11, 2023

This episode is brought to you by Rupa Health, Beekeeper’s Naturals, and HigherDOSE.  Modern life is keeping most of us in a state of chronic stress activation, which puts our bodies in an ongoing state of survival mode—setting the stage for burnout. But burnout is not merely the result of working too hard or feeling physically exhausted, and it isn’t a personal failure.  In today’s episode, I talk with Dr. Neha Sangwan, Dr. Andrea Pennington, and Dr. Elizabeth Boham about how chronic unmitigated stress can lead to burnout and how we can address it before our bodies get sick. Dr. Neha Sangwan is an internal medicine physician, the CEO and founder of Intuitive Intelligence, and an international speaker and corporate communication expert. Her private practice and corporate consulting focus on empowering individuals, organizational leaders, and their teams with the tools for clear, effective communication. She addresses the root causes of stress, miscommunication, and interpersonal conflict, often healing chronic conditions such as headaches, insomnia, anxiety, depression, and burnout.  Dr. Andrea Pennington is an integrative physician, acupuncturist, meditation teacher, and number-one international bestselling author. She received her Doctor of Medicine from Washington University School of Medicine, trained at Georgetown University Hospital, and received certification in Age Management Medicine with the Cenegenics Medical Institute. Her extensive study of medical nutrition, positive psychology, and neuroscience-inspired biohacking led her to create a holistic media platform, In8Vitality, to teach people how to blend ancient wisdom and modern science for enhanced vitality and life mastery. Dr. Elizabeth Boham is a physician and nutritionist who practices Functional Medicine at The UltraWellness Center in Lenox, MA. Through her practice and lecturing she has helped thousands of people achieve their goals of optimum health and wellness. She witnesses the power of nutrition every day in her practice and is committed to training other physicians to utilize nutrition in healing. This episode is brought to you by Rupa Health, Beekeeper’s Naturals, and HigherDOSE. Streamline your lab orders with Rupa Health. Access more than 3,000 specialty lab tests and register for a FREE live demo at RupaHealth.com. Listeners can save 20% off sitewide on Beekeeper’s Naturals. Just go to BeekeepersNaturals.com/Hyman and use code HYMAN. Save 15% on wellness and infrared tech from HigherDOSE. Just go to HigherDose.com/Hyman and use code HYMAN. Full-length episodes of these interviews can be found here: Dr. Neha Sangwan Dr. Andrea Pennington Dr. Elizabeth Boham

Coming up on this episode of The Doctor's Pharmacy. Burnout is not a medical term, but it actually is a true physiological response to chronic stress. It's not just like, oh, I'm too tired and I'm burned out. There's actually a real biological underpinning, and it's not something you can take a pill for. Hey everyone, it's Dr. Mark. They say knowledge is power, and that's definitely the case for those of us who are functional medicine doctors or practitioners. We need the right data to determine and eliminate the root cause of our patient's health issues. But that often means ordering a bunch of labs, which, let's be honest, can be an administrative nightmare. I'm sure many of you can relate to how time-consuming and complicated lab boarding process can be,

but thankfully, Rupa Health has the answer. With Rupa Health, in just a few clicks, you can order labs from over 35 different lab companies in a single portal, free. That's over 3,000 tests like GI Map, Dutch Complete, and thousands more. And best of all, it's free for practitioners. So sign up for free today and get the data you need without the headaches. You can find out more by going to rupahealth.com. That's R-U-P-A-Health.com. Now's the time of year when sniffles and colds start to set in. Being inside all the time puts us in direct contact with tons of germs, which puts extra stress on our immune systems. So how can you beef up your immune system?

I recommend Beekeeper's Naturals. I use their propolis throat spray to get an extra nutritional insurance that I need and feel more resilient during the long, dark months. I also love their liposomal vitamin C plus propolis, which I use when I know I've been exposed to germs, which is a lot. Propolis acts as a protective lining for the beehive, keeping out foreign invaders and germs.

It's the ultimate immunity hack of the beehive, and it can help do the same thing for your immune system too. Plus, it contains multiple compounds that are essential to immune health, like vitamin C, zinc, iron, and more. Right now, Beekeepers Naturals is giving my community an exclusive offer.

Just go to beekeepersnaturals.com forward slash hymen and enter the code hymen to get 20% off site-wide. That's B-E-E-K-E-E-P-E-R-S-N-A-T-U-R-A-L-S.com slash hymen and enter the code hymen. And now let's get back to this week's episode of The Doctor's Pharmacy. Hi, this is Lauren Fee and one of the producers of The Doctor's Pharmacy. Hi, this is Lauren Feehan, one of the producers of The Doctor's Pharmacy podcast. Most of us are faced with endless pressures of work and family and a relentless barrage of tasks to do and requests, all while trying to manage our health, nutrition, and sleep. Over time, this may lead to burnout, leaving us feeling disconnected from the joy in our lives and even result in physical symptoms. In today's episode, we feature three conversations from the doctor's pharmacy about what burnout is

and what to do about living a life in a chronically stressed state. Dr. Hyman speaks with Dr. Neha Sangwin about why we experience burnout and tips to reduce it, with Dr. Andrea Pennington about her burnout story and how this experience changed her life, and with Dr. Elizabeth Boehm about the physiological effects of long-term stress on the body. Let's jump in. We all know that our life today is extremely stressful. We have our work obligations, family obligations, trying to manage things we care about our health. And we've got all the stresses of society, the economic burdens of our economy, the threat of nuclear war, climate change. I mean, it's a lot. So it keeps us in a state of chronic stress activation. Basically, our bodies are not

designed for this level of input and stress. I mean, just the trauma of the news itself. I try not to watch the news because I find it very stressful. I figure if something important happens, I'll hear about it. But all this puts our bodies in a survival mode, in this fight or flight response, which sets the stage for what is termed burnout. Now, burnout is not a medical term, but it actually is a true physiological response to chronic stress. And it's not really about working too hard or feeling exhausted or, you know, being tired for a long period of time. It's not about personal failure either. You're right that it's not considered an actual medical diagnosis, but I will say at least in 2019, the World Health Organization decided to at least say that it was, you know, an occupational phenomenon that occurs with ongoing unresolved stress.

So they delineated it and kind of compartmentalized it to being a work phenomenon. My 25 years in medicine tells me that it can be anywhere in your life. So I think they'll catch up with us in 2019. At least they're acknowledging that work can cause this. Yeah, you know, it's so true. I mean, it just reminds me of what you're talking about as a paper I read years ago in the new England journal of medicine by Bruce McEwen, where he describes the physiology of this in a very scientific way. So it's not just like, Oh, I'm too tired and I'm burnt out. There's actually a real biological underpinning and it's not something you can take a pill for, right? So that's the problem.

It's like, oh, is there a pill? Isn't that what you'll get? So there's, when you're falling off a cliff, like you are burned out and you're completely ineffective, the traditional medical system will give you, this is the typical scenario that'll happen. If you go to EAP at work, you know, the employee assistance program,

then they send you to a traditional physician, what will happen is you'll get a prescription for 10 days off or some time off. And then they'll give you some cocktail of, you know, an antidepressant, anti-anxiety, sleep medication, something to get your biology back in order. And then 10 days later, you'll be sent back in the ring for round two. Right? No new skills, no understanding of how you got there. But listen, very useful in that moment where you are hanging by a thread or you've hit ineffectiveness, really useful to try and kick you into stopping your world because you're probably not stopping it yourself and giving you a cocktail of meds that then, you know, knock you out and make sure you sleep or don't allow you to feel the anxiety or the depression that you're experiencing. So

it's a very temporary bandaid, but it might be important in that acute, acute situation. But then the real question comes in, which is what's causing it? And I always say, like, we have to have parallel paths to help people, because if you're not figuring out what's solving it, what's causing it, you're never going to solve it. Yeah. So so that's something that we sort of, you know, we don't really think about now is how do each of us as individuals respond differently to the same inputs, right? Because what might burn out one person might not burn out somebody else. Yeah. And so how do we start to sort of look at what's going on in our life and how do we start to sort of shift the conditions that are causing burnout? Sure. So I like to think of burnout on

three levels. So there's me, we, world. So there is what I understand about myself and how I'm different than you. Okay. So one thing I know I'm very different than you on is how much you will stretch your physical being. You will climb, you know, Mount Kilimanjaro. You will go to Mongolia for three weeks, right? What I will do is I will stretch my mental, emotional, social, spiritual self, but I don't do that to the same capacity I do with my physical being. So there's the me part of me, we world, and it's me knowing myself. I need to understand what's in my comfort zone, what's in my learning zone and what's in my panic zone. So three weeks in Mongolia, hiking, trekking, I would be like, okay, I'm going to need some help here. And I

would be like, I hope I can do this. Right. Whereas you would be like, all right, let's go. Right. So it may cause me stress, but may not cause you stress. So in the me, we world of burnout, I have to know myself. I have to understand what will cause me stress and what will now, if I, what I know is I could say yes to something like that. If I knew we were supported with people who really knew what they were doing, if we had like great, you know, people with us that I could ask. So even if something stresses you out, you also know you want to ask yourself, how could I say yes to this? Right. What would it take for me to say yes if it's something I'm interested in? Now, the we part of burnout is oftentimes the toxic work environments, family environments, relationships that we have said yes to.

We have gotten ourselves into situations. We've chosen a job for a location or an opportunity or whatever it is. But then it drains us of energy. Every day it drains us of energy. But every day we keep choosing it for the paycheck or for whatever it is. And then world is what you were speaking about with the news and hurricanes and tsunamis and all of that. So I want people to really understand there's a me-we world here that's going on. The me-we world. says that I have to do certain things. You know, you said that all impacts you, pay attention.

So the simplest way I can say it is think about things and expand your perspective and see how all of them work together. But let's focus on the me. The me, which is each of us. So this is powered by me. Basically, wherever you are on the spectrum from burned out to fully charged, I want you to figure out where you have a net gain or a net drain of energy on a physical, mental, emotional, social, and spiritual level. That's a great exercise. Like how do you catalog each area? And what are those things in each domain that are either robbing you of energy

or filling you up with energy? It's a beautiful framework because we don't think about that. We just kind of like, you know, oh God, every time I talk to so-and-so, I just feel like shit. Well, like, well, stop talking to that person, you know, or gee, if I go out for a walk and, or if I, you know, like for example, in the morning, I like to go out and sit and watch the sun come up on my deck and it's super quiet. There's mist in the lawn and little birds and rabbits running around. I just feel like, oh, it's like this beautiful moment of restoration that I get, you know, nowhere before the world starts.

So there's like, those are great examples, but there's so many more. There's so many more. And just like what you were saying. So on the social level, empowered by me, right? I ask people to do some simple pulse checks on themselves. So for the social one that you just spoke about, I ask people to write down the five people or groups of people that you spend the most time with in person or online. And then I want you to assess

whether you have a net gain or a net drain of energy, a little plus for the net gain, a little minus for the net drain of energy. So the one that you just described would get a little minus if that's in the experience. And so when you look at those five individuals or groups of people that you're spending the most time with, and you look across it and you see three or four drains and one gain, you got to start evaluating how you're choosing who you're spending time with. I love when you say getting healthy is a team sport. I learned that one from you. And it's so true. I mean, pay attention because these aren't just people that you have to endure. These are people who are changing your physiology by you being around them. So, um, that would, that would be one way, but let me, let me really quick. I'll run through them a little quickly so

that people could get the idea. And I'm happy to give you a link where people can do the assessment themselves. And I would actually walk them through it on video. So it's a free, you know, they can, they can do that. Start at physical. So physical, it would be about food, energy, sleep, and movement. And under the energy piece is the adrenaline, cortisol, hormonal balancing, all of that. So food, energy, sleep, and movement. I would ask you to rate how satisfied you are in each of these areas. So how, how, and it's not about, are you perfect at eating the right thing at the right time every day? It's more like, how satisfied are you with your energy levels? How satisfied do you feel about your diet and how you're eating? Because the satisfaction piece here is it also indicates where someone's ready to do the work. And if they're not

satisfied with their sleep, well, great. That's where we should start because you know, it's all, it's all interconnected. And so wherever you start is the right place. One of the tips you gave me 20 years ago that has really stuck with me was you told me to bookend my days. You told me, Neha, even if in the middle of the day, you don't know where to start, I want you to do something really good for yourself in the morning. And I want you to do something really good before you go to bed. And I found that so doable, like so like, oh yeah, I could do that. And for you, it might be sitting out and listening to the birds, you know, for five minutes and just kind of, or meditating, whatever grounds you. And then that bath, you told me take a hot bath with Epsom salt and magnesium

right at night, and then allow my temperature to kind of drop as I go to bed. So what are you doing these days? Are you doing any of those still? Oh God, I, yes. I mean, in the morning, this morning, I woke up and I, you know, went outside and I sat and just, and it was misty and quiet. And I just enjoyed the quiet and had a cup of coffee and did some journaling and uh you know typically my morning routine will be to work out and then take a steam and and a cold bath punch and that kind of pops me up for the day i have my protein shake and i'm ready to go and at the end of the day i usually wind down by uh you know just doing a little bit of reading. I like to take a hot bath with epsom salt and then just kind of turn the lights out and kind of either candlelight or just read a little bit on my Kindle and then go to sleep.

I definitely, you know, I'd like to do more, but depending on what I'm doing. I've also got, you know, I'm trying this new device called Sensate, which basically resets your autonomic nervous system and use headphones and creates vibration in your epigastrium and it activates your vagal nerve. And it's really quite powerful. Wow. Okay. I'd love to try that. That sounds fun. So basically on the physical level, people assess how satisfied they are, food, energy, sleep, movement, and the way that you, when you're answering these questions, it's really important, yes, to use your brain. But more importantly, you know how your body keeps score. Even if my brain can talk me into something, my body never lies. And so my body will start talking. So then I say to them, okay, anything where you rated yourself less than a 10,

tell me what would make it a 10. What would make it a 10 for you? So they start to get really clear about where they are and what they need. And then at the end, I say, okay, on physical energy, look at your answers and then check in with your body. Are you feeling constricted, tight, heavy? Do you have throat constriction? Are your muscles tight? Are you breathing shallow? Or do you feel relaxed, open, and easy as you're answering these questions? So they're not just answering mentally.

We're integrating their body. And if there's a difference, if the mind is saying, oh, yeah, I'm tens and all the physical, but then I get to the end and they're like, why am I so tight and constricted? It may be because they're telling themselves that they're fine and they don't want to give up their bagel and latte and whatever it is. So they're like very satisfied, right? But their body is like, oh, that doesn't feel right. So you go through each of the sections this way, like in thoughts, it's about what are the top three repetitive thoughts that are going on in your mind. And like when you're in the shower, when you're driving, when you wake up first thing in the morning, or when you're up in the middle of

the night, what are those thoughts that are occupying your mental real estate that you may not even be paying attention to? They just are so automatic. Once you write them down on paper or on your screen, next you want to say, does that thought give me energy or does it drain me of energy? And more often than not, boy, those automatic thoughts that are going on, they can really drain you of energy. And you don't even know that you're the one

that could really plug that leak pretty quickly. So there's a whole bunch of things like that under emotional energy. It would be what areas of your life are you avoiding conflict? You used to be all of them, but I'm better at that now. Yeah. But then you read TalkRx and you know how to lean into conflict now. Yeah, no, that's one of them that if it wasn't safe when you were young, if it wasn't safe to speak up, if you got reprimanded for doing it, it's very natural that you would be conflict avoidant. And I think you and I have had conversations about that for you and that you really had to overcome and realize it was safe to speak the truth. Hey everyone, it's Dr. Mark. Let's talk about a common challenge many of us face this time of year, seasonal effect disorder or SAD. If you have it, you know the symptoms, feeling listless, losing interest in things you usually enjoy,

having low energy, feeling sluggish. Well, dealing with SAD can be a real downer, but with Higher Dose's Red Light Therapy and Infrared Sauna Blankets, you've got some powerful allies in your corner. These wellness wonders do more than just keep you warm. They can elevate your mood by reducing cortisol levels and give your dopamine, oxytocin, serotonin, and endorphins a boost. It's like your personal recipe for feeling fantastic. Higher Dose is your one-stop wellness tech solution armed with infrared, red light therapy, PEMF therapy. And right now they're offering an exclusive 20% discount with the code HYMAN at checkout. Just go to higherdose.com and take advantage of this great deal.

This offer is not valid on bundles, full saunas, or subscriptions. And now let's get back to this week's episode of The Doctor's Pharmacy. And how much better our lives are if we're willing to go through the short-term discomfort of the honest conversation rather than the long-term yuck of never really having it and then our relationships breaking apart. So it's, you know, where is it in your family life, your work life, you know, finances, wherever it is, you want to pay attention to where you're avoiding conflict. And then the flip side of that with emotions is where are you experiencing joy and play in your life? And you look through all of those as well. And that's a quick pulse on the emotional energy section. Social, we already talked about, which was name the top five people or groups of people you spend time with in person or online, give them a net gain or a net drain rating when they come up. Just by bringing them up in your body, your body will respond. It will tell you, even if you just think about it.

And then the last one is spiritual and spiritual energy. Spiritual is about what matters most to you. It's about your highest values. Some people think of it as, you know, connecting with nature. Some people think of it as their faith. Some people, you know, have think of it as, you know, we're all connected as one, whatever that is for you, you got to know your highest values. And so in this section, I'm asking you questions like, give me the top three things. Some you would be so proud if someone said when you weren't in the room. What do you want? What would what would that be?

Do you have any any thoughts on that? What would really light you up? About what people would say to me? About you when you weren't in the room. Oh, that I was present, not tired, distracted, and burnt out, exhausted. That I was really, you know, showed up fully, that I was kind. I think that, and that, you know, I cared about their experience. So really that you're present, that you're kind, that you're energized, and you care deeply about others. And so those are some of your highest values, even just right there. If that's what matters most, you know, then that's going to give you a really big clue. And that's also how you're going to make your decisions. Because in the spiritual section, it's also about how you use

your highest values to navigate complex decisions in the world. The world is not slowing down and the decisions aren't becoming easier. And so people need a framework to be able to do that. And so you do that with values. Well, you talk about that in your book now. You talk about this whole concept of this internal navigation system and how you use this sort of navigation system to track what's happening in your body, in your mind, your heart relationships and your spirit and how there's different energy levels related to all of those and how we can identify where we're out of balance and at risk for burnout in any one of those areas. Sometimes we've got all of them. Like, you know, I remember when I was, you know, a young man as a doctor,

I had, you know, was working 80 hours a week in the small town in Idaho. I had two kids. My wife was an alcoholic. I was just delivering babies all night and running the ER and working all day in the clinic and trying to deal with everything at home because it was a disaster and try to raise two kids and the stresses of all that. And I really was overwhelmed and burnt out. And I think i probably wasn't

listening to the the kind of signals that were going on in my body i just kind of push push push through it and you know it was interesting when i stopped working um i remember this experience and i was you know 34 i was pretty healthy uh i remember that i i plan to take this road trip to go see this friend of mine, you know, with my family. And I had to drive from Idaho to California. And I literally could not get up off the floor. It was like I sort of quit my job in Idaho. And I literally couldn't get up off the floor for months.

And I was like, it took me that long of doing nothing to recover and to kind of restore my nervous system. And I was like, wow, you know, I was really out of touch that I let myself get that far off. And, and so how do we, how do we start to use those energy levels to identify where we're, we're at risk, right? It's like, you know, you can check your blood pressure, see if you have hypertension, right? What are the, what are the metrics that you kind of help people use with this navigational system that you describe in your book? Well, first, thank you for sharing that.

It's clear to me that you've done some work around it because you say it just like it's a normal story. But it's a pretty dramatic story that you just described. Literally, you hit the wall of burnout and you couldn't get up off the floor. I literally couldn't. I literally just couldn't drive. I couldn't, I couldn't, I was like, I had to just lay there for a long time. Yeah. It's almost like your body had to say like, enough, Mark, enough. Like it stopped you. And I think that as physicians, our training has, first of all, we have to do 36-hour shifts.

We had to do all these things that were superhuman. And in order to get where we got, we had to push through our body rather than partner with it. And we became so used to that and accustomed to that. It was like, listen, whatever the stress is, I just need to be focused on the next patient crisis, the next heart attack, the next stroke, whatever it is. And you just applied that to your whole life. And so when you tune out of your own physiology, your heart racing, stomach turning, muscles tightening, sweating, you know, everybody has a unique language that their body communicates with them in. The job is we have to decipher it. And our body is giving us these, you know, in medicine,

we call it symptoms. So we're like, oh, well, tell me about your symptoms. How long has that been going on? Oh, your heart skips a beat. Tell me how long has it been happening? How often? What does it feel like? So we take it in a real literal physical sense that it could mean something's physically wrong. Your body, I don't know how to say it better than, like, sometimes it just wants to chat. Like, it just wants to say, like, it just wants to talk to you, like, every day, all the time. It's like, yes, this, not that. Sometimes your body is going to tell you after a while that you're feeling really fatigued. And it's like, no, we're giving you some signals now. I'm not going to replete because I haven't had enough sleep. And so it's giving you more,

you know, consistent signals. And then there's the catastrophic signals where you're having crushing chest pain and you need to get help. But there's all different intensities. But our body is talking. The question is, are we listening? It's talking all the time. And so, like right now, tell me something your body's telling you right now. Because I can see you slouching in your chair a little bit. Yeah, I mean, basically, what he's telling me is I need more sleep because I've been getting ready to go on a long trip.

And I have been cramming work and staying up late and getting up early and just not getting my full rest. So that's what my feeling is now. Yeah, but also, doesn't it, it speaks to you when you know you're sitting outside in your backyard in the morning and it's like, oh, everything just opens up. So that's when it just wants to chat and it just wants to let you know. But each person has different signals. So for me, when I met you, I told you about throat constriction and stomach turning. And you said to me, Neha, you've been scoped twice. You've been put under anesthesia twice. I'm pretty sure it's your stress response.

And I remember thinking like, okay, thank God it's not cancer or something else. But like, what am I supposed to do with that? What am I supposed to do with someone telling me that? And so if, what is yours, by the way, what, what, how do you know, uh, when you're outside your comfort zone, do you know, do you know what I call it? Your body map, but I mean, I, I think, I think I get, uh, a sense of just like tilt, you know, like it's like, you know, the red light goes on and I'm like, okay, I can't deal with one more thing. I can't look at one more email. I can't answer one more phone call. I can't talk to one more person. Just leave me the hell alone and I want to go watch a stupid movie.

Okay. You got to give me your favorite stupid movie. I want to hear it. Well, I mean, my favorite is actually CIA television series. So I'm kind of a junkie for that. I just don't know why I like that. Okay. And you just want to tune out. So the interesting thing, Mark, is just like the spectrum of burnout goes from burned out to fully charged. You don't just show up one day burned out, right? It's like this gradual process that ends up, you start coping, you use mechanisms, you outgrow those because those aren't working anymore. Like let's say someone has a glass of wine to take the edge off of work each day. They're not happy in their work, they're disconnected

and they have a glass of wine to take the edge off. And then pretty soon COVID happens and all these things happen and suddenly they're drinking two glasses at the end of every day or three, right? Hey, give me the bottle, right? And you don't realize it because you're starting to need more coping mechanisms to get the same effect. And then one day they hit burnout and they're like, how did I get here? Like, how did it- There's no gas left in the tank, right? Exactly. And so what you're describing actually is a pretty late signal. So what I'd be saying to you is Mark, tell me what happens before you can't do one more email. You can't do, tell me what, how your body's talking to you earlier than that, because it tells me you're a master at overriding it. You're a master.

I'm really good at that. I think I could win the Olympic gold medal in that. Well, that's why you accomplish so much because you know how to optimize your body's physiology. You've mastered how to be well. And at the same time, you push your body to the same extreme. Like your body gets treated really well. It gets nourished with the best ingredients and boy, does it work for it? Right. Yeah. So no, I do all the right things, but the reality is, uh, you know, I, I, I know what I need to do, but it's sort of my mother, you know, voice echoes in my head. And I think you've met my mother. She, she, she said, do not do nothing and rest afterwards. And I always like would get mad at her because she's like, Oh, whenever I feel

the urge to exercise, I lie down until it goes away. And I'm like, that's terrible. But you know, she had a point. She's like, she had a point. And so I think that's one of my, you know, I mean, it's like I have such a voracious appetite for life, for learning, for doing, for seeing things, for experiences, for people, for making difference in the world. Like it just it just never ends. So, you know, I I some you know, I sometimes have to realize that I can't do it all. My mother also said that your motor is too big for your chassis, right? Meaning I have a Ferrari engine, but like a little VW Bug body. And I can't run it like a Ferrari all the time. And so I had to learn how to sort of down shift and uh i basically have two gears which is you know uh zero and and five fifth gear right and and so i've had to learn all these other gears and actually kobud was really an interesting moment for me because you know i

went through divorce and i maybe the world stopped and i had back surgery and i just my body was broken my heart was broken and i was like you know I, I literally just pulled the plug. I got on a plane and I moved to Maui for, cause I figured I might as well be in a nice place during COVID and you can't do anything anyway. So I could ride my bike, I could swim, I could be in nature, I could be in waterfalls. And I, and I, I literally went there and I felt like slowly like the gas gauge kept going up and up and up. And my heart rate variability like doubled when I got there. And I was like, oh, God, you know. And actually, it's an interesting metric.

I can tell like my ring tells me like when my heart rate variability starts to go, my stress level goes up. And it's like it's kind of an interesting barometer. So I'm kind of using feedback tools to know, oh, gee, maybe I'm like a little. So I'm like, literally next week, I'm going, getting on a plane, I'm closing everything, closing my computer, closing my phone. And I'm going off into the wilderness in the most remote place on the planet, because I think that's what it takes for me to basically go in the Mongolian hinterland for a week and camp. And that I think is going to be helpful. But I can't just do those things. I have to daily do the things that keep me going, like meditate. And it's when I drop those practices, when I'm just too busy, I got too much on my plate, I got too many things to accomplish,

I will start to sort of drop off the things of like getting enough sleep or meditating on a regular basis or just doing nothing for periods of time. And I think I've had to learn how to navigate that in myself because I'm always sort of the guy who will always move towards burnout. And so that's- You're the guy that always moves towards saying yes to a new opportunity, Right. Yeah. Yeah. Of course. So we got to do it. Right. Yeah. Well, that's,

that's the other thing my mother said, no, as a sentence and I'm like learning how to do no better. Like it's hard for me, but I learned how to do no better. Isn't it amazing when people are no longer in our lives and the things we remember about them and how, how they're just, you know, they move from being physically in our world to being like ever present in our hearts. Yeah. So you can hear her voice so clearly. Oh, a hundred, a hundred percent. Yeah. So I think this is just, it's so important to know yourself and that's the me, the part of the me part of me, we world, right? That if you don't know yourself, if you don't know your tendencies, if you don't

really pay attention to whether the environments you choose to be in are the ones that give you energy or drain you of energy, boy, how on earth are you going to navigate the crazy world we're in? You had this, you know, traditional training, but then you kind of had a window into a different way of healing. But then something happened to you where you kind of burnt out, crashed, and that led to what you're doing now. So can you take us on that journey? Yeah. So what I didn't mention about med school was there was a moment where I became incredibly depressed and not unlike many of the other people that I was studying with. But it was interesting because when I went to student health services

and, you know, confessed to the doctor how I was really feeling, she asked me, you know, how, how often are you playing piano? And I kind of like looked at her like, what? But it was interesting because when I applied for medical school school she was one of the people who interviewed me and she remembered that i play classical piano yeah so i'm like um i'm not playing piano at all i mean who has time for that like it's intense and i was surrounded by all these brainiacs who seemed to like know way more than me she was like you know you should just play piano for 30 minutes a day. And like, even that was radical. So eventually she said, okay, 30 minutes a week. And even though I thought it was weird at the time,

I hadn't heard anything about music, art, or creativity, you know, impacting our wellbeing. I did it. And I'm convinced that reconnecting to music was part of what got me through medical school. So what I didn't share with you is that also in my childhood, I was always involved in the arts. So performing arts, theater, singing, dance, doing radio shows with my best friend, Allison.

That was kind of like my lifeline while I was doing all of the pre-med stuff. But my father, as I mentioned, my parents were divorced. And the influence of my dad was such that when he found out I was doing all this extracurricular stuff, he was like, you know, your grades. You're wasting your time. Exactly. Because he's like, that's not a guaranteed path to, you know, a sustainable future. So it started to create in me, and it definitely broke down in med school,

it created in me this stifling of my own creativity and this rejection and neglecting to honor the things that were naturally coming up for me. And so it happened in medical school. I got through that. Then I got into my clinical practice. And again, I'm like super stressed. I was at that time doing television and running a medical center. And it was my COO, a very dear friend of mine, Nadal, who came to me and was like, I can see that something's not right. Like I was heading towards burnout again. And he was like, are you singing? Are you like write music? And I'm like, what are you talking about? He's like, I just kind of noticed that when you're doing your music thing,

your mood's a lot better. And it was again, this kind of outsider who was pointing to me like, why are you not doing the things that bring you joy and happiness and fulfillment? And so it was kind of a long way to get to this realization that the arts and the things that come naturally to us are meant to be expressed. And from a Chinese medical perspective, we know that these energies that normally flow through our bodies and even

our environments, they need to flow. Otherwise, that's when we get off balance and we create dis-ease. Yeah. So you talk about how you've had all these accomplishments, but a lot of them were driven from a need, a need for approval, a need for somebody to say you're great, first from your father, later from your medical colleagues and the media. And it was just this this outside influence that was helping you drive your sense of self-worth but behind it you felt like you were dying inside yeah and what what was the shift that allowed you to realize you needed to move more from the external validation and quote love to self-love and to be really who you are.

For me, it was getting to that proverbial mountaintop. I think I had published my first book, had been on Oprah a couple of times and had all of sort of the outer trappings of success. And I was miserable. And I happened to confide in someone that I was dealing with depression. And she looked at me like, girl, you need to be grateful. I mean, of course I was grateful. But she was looking at me like, you have everything. You've got the job, the career, the fame, the money, the everything. But I was miserable. And I came to realize that it didn't matter how many accolades I had, how much money, how many degrees I had, I was still miserable. And that's what kind of led me on this path of self-discovery. Because it was like, if all of this stuff that I had been programmed to believe,

including from my father, and like you said, the media, I had everything. But I wasn't feeling fulfilled. And I would have never guessed that it was as simple as just self-expression and self-love until it was that. So what was the process of you going from the outside validation to the inside validation? What was that step that helped you to sort of break free from that prison of needing the external validation to feel okay about yourself which most of us do i mean we live in this instagram culture everybody's posting selfies but there's no self-love and they're you know look at me how great i am and all these weird it's very weird culture and it makes everybody

feel bad about themselves because they're not as good as the Photoshop version of somebody else. And, you know, we end up in this cycle of even creating more depression, more isolation, more social disconnection through the social media. Right. So how is that for you? Well, thank God all of that social media did not exist then because the pressure would have been too great. Ultimately, I got to a point where I was so overcome with anxiety that literally just waking up in the morning, it was like I had to muster all of my resources to just put on that happy mask and go do the TV shows and the documentaries. And it became unbearable. I mean, I got to a point, Mark, it sounds silly, but I got to a point where I just didn't want my life anymore.

You felt suicidal? I had those kinds of thoughts. Now, because of my spiritual tradition, I knew that suicide was not an option. But I ended up going on a vacation. So I'm just going to take you there. This is the pivotal moment for me. I happened to be in the South of France. This was at a time when all of the TV shows that I was doing in America hadn't yet made it to Europe. So nobody knew who I was. I was able to go there anonymously

and I wanted to just be the artistic version of me. And I ended up in this nightclub in Saint-Tropez. And this guy was like, oh, okay, so you're a jazz singer. You know, we're going to get you up in the booth. And there I am. I'm like singing and I'm like sharing my love. And I felt like everyone was like receiving me for the real me, even though they had no idea who I was.

I wasn't famous. But I got back to my hotel in Cannes and I was like, what just happened? I just experienced that flow state, that bliss state where I felt complete acceptance from myself and from everyone around me. I felt like that bliss of love. And then it hit me that in two days I have to go back to America, back to what I considered almost like a prison of responsibility. And, and that's when I success. I know. And I, I hate that it sounds like so, you know, it's true. It's actually very true. People get locked in, but that's exactly how it felt. And that's when this, this depression just mounted up within me. And I, I literally called

out to God or anyone listening and said, take it, take my life, take my business. I don't know what I'm doing with it. And it was in that moment of surrender that I broke down. I was sobbing and crying. And what happened next, I now understand, but I didn't understand at the time. I literally started melting into the bed, you know, as I'm like sobbing. And then there was this intensely bright light and I felt myself being drawn into the light. So I thought God was answering my prayer because I felt myself leave my body. I went over to this other side and I saw a life review. And like in a split second, I could see how every decision I made had led me to that point of depression. And then there was sort of like this vision of how we as souls are like a little drop of consciousness. And as we incarnate and come into this human body, it's up to us to determine who we will be and what we will accomplish. So I'm getting this vision and this knowing, and I'm like,

so I could have chosen what I'm going to do and be in this lifetime? And it was in that moment that I was shown this vision. And it was a vision of me living a completely different life on the French Riviera, walking hand in hand with a child. I was singing professionally. And I was healing with my hands, which, you know, at the moment I was like, God, are you serious? You're going to make me like a woo-woo doctor?

Like, fuck. But that sense of love and peace and bliss was there. And I said, okay, if that's the life for me, fine. Pack your bags. I came back into my body and the depression was gone. And I left wondering like, what the F was that? Because I had heard of people who had flatlined or in surgery, they'd had these out of body or near death experiences,

but I'd never heard of someone who wasn't in an accident or something. So I started to do research on consciousness. The old you was dying. That's exactly what it is, which is so, I mean, it sounds so cliche. Thank God you didn't have to get in a car accident for that. Exactly, or flatline and have my body in jeopardy. But that was the experience that shifted it for me.

I think having that experience of complete oneness and knowing who I really am as a spiritual being, where all of that earth stuff, the accumulation stuff, that isn't even really what mattered most. And that's what led me on this path of understanding the science of consciousness and how that impacts our health and our wellbeing. Because like like you probably remember this. I mean, you and I are old enough to remember. Back in the day, people told us that depression was like a brain disease or it's hereditary or it's all about your brain chemistry. I had never heard that decades of depression could disappear like that.

So for me, I was completely, you know, with my little nerdy research hat going, okay, we've got to figure this out. What happened to me and how can I help other people? That's fascinating. You know, I noticed in some of the pictures of you online that you have a Buddha tattooed on your arm. I do. Which is kind of cool. And a lot of the things you're saying are actually making me think of the buddhist framework you know i studied buddhism in college and it was the the sort of self the little self versus the big self yes and most of us identify with the little self which is the ego it's our body it's our life circumstances it's the dr andrea Pennington, the media personality, the famous doctor,

the whatever it is, and how that takes us away from our bigger self. So when you have written this book, The Real Self-Love Handbook, a proven five-step process to liberate your authentic self, build resilience, and live an epic life, which who doesn't want that, you know, you're not talking about the little self-love. You're not talking about the narcissistic culture we live in of self-love, the Kardashian self-love. You're talking about a very different kind of self-love. So can you kind of help us understand the distinction between the little self and the big self and what that and and where we get stuck in our egos that take us away from the big self that we should be drawn to to actually help us feel happy and free well this whole experience

that i went through um kind of showed it to me where i experienced it in living color like i got the distinction you didn't read in a book no i, I got it. It was like, that's little self. That's not even real. That's illusion based on programming circumstance. But the real me, this higher self or self with a big S, that's our true essence. And I think as I started to study more, especially like Jungian psychology and looking into how do we form these personalities? You know, looking at my upbringing, for example, you know, I got fascinated by divorce and how siblings within the same household could have completely different reactions to like family drama. So we know that when a baby is born, they're typically born expecting and accepting unconditional love and affection,

because that's the kind of womb experience we've just come from. But over the process of our early childhood development, we develop this ego, this identity that is a construct. I mean, it's literally a construct based on the programming and the experiences that we have. It's not the real self. So, you know, in this early childhood period where we're developing this ego personality, it's all based on survival. It's all about, you know, how do we fit into our surroundings and how do we ensure that we are accepted and liked within our tribe, whether that's our family tribe or at school. And over time, many of us do identify with that ego or with whatever roles that we're playing. And eventually we get to, whether it's on your deathbed or earlier, you come to realize that there's a

part of you. There's a fundamental essence that is the true you. People call it the soul. The soul. Yeah. Some people call it soul or spirit. So ego, soul, little self, big self, same thing, right? Exactly. Sometimes when we end up identifying with the roles that we're playing, we can find our identity becomes very, very fragile and our sense of self-worth and self-esteem becomes fragile. So I noticed with some of my patients that I could specifically tell that there were certain illnesses that were clearly tied to their belief systems, things that they had taken on during childhood. And of course, now we know, 20 years later, we know now that our childhood experiences, these adverse childhood experiences

and stress, isolation, loneliness, they impact our physiology, you know, our brain chemistry, our immune system. You know, just to stop you there for a sec, for every patient who comes in to see us in our practice, we have them fill out an ACE questionnaire, adverse childhood experiences, because when they fill that out and we see there's a problem, you have to deal with that because you can't just focus on the physical or they won't get better. Yeah. And that's precisely what I was discovering. Now, on the physical or they won't get better. Yeah. And that's precisely what I was discovering. Now, in the beginning, I thought I was a weirdo because trying to talk to my other medical colleagues to say, you know, this person's got repressed anger and that's what's causing her interstitial cystitis. Or this person went into a career path because her parents said this was the safe way to go and now she's burnt out.

And it's not just because she's overworking. So being able to see that this ego personality that we create is trying to ensure our survival. But sometimes the practices and behaviors that we adopt and the belief systems that we adopt end up causing us illness and dis-ease. So how do you like dis-identify with the ego? Because it's so strong for most of us. We don't even understand that there is a possibility of separating from that. And on the show, we've had Michael Pollan and others who've talked about

the default mode network in the brain that is sort of the ego in a sense, which gets suppressed with psychedelics. Or we've had Daniel Goleman talking about meditation and the power of that to actually suppress that same default mode network, which is the strength of the ego and allow other areas of the brain to communicate. How do you do that? Because we shared a little bit earlier when we were chatting about neurofeedback, which is another technology that helps you to sort of regulate your brain waves

and your brain chemistry and your brain function. So it's not easy for most people to want to understand that there's a difference between their ego and their soul, that they're two different things, that you're not your body, you're not your mind, you're not your thoughts, you're not your feelings, right? That there's something else going on that you can connect to that's eternal,

that's everlasting, that's in you, that's always present, that if you touch it, it's like what happened to you in that bed, you got to touch that for a moment and you realize, oh, darn, this isn't all there is, is this personality, there's something else. How do you help people? Because that seems like a very difficult thing for people to get through. It is, it is the biggest challenge. And I think that's why I

bring together all of these different modalities to help people have an experience of the real self. So I, as you mentioned in the intro, I've been teaching meditation for 15 years now. Meditation is the number one thing that I recommend, whether a person's dealing with stress or cancer or trying to find their true self, having that regular practice of getting to that point of stillness where you can perhaps have that flash where you touch that bliss and you recognize, whoa, there's something more to me. But not everybody's a huge fan of meditation, or they know that it's going to take a while to get there. So you mentioned psychedelics. We now work with people who do plant medicine and other shamanic ceremonies to help people get into expanded states of consciousness where they can also have an experience of the true self.

We're also doing a lot with narrative therapy. So one of the things I learned very early on in my positive psychology days was about the benefit of just writing and journaling. And what we've discovered is that many of our patients, they did it because I told them it was their homework, but they were finding out over time that by writing their experiences, it can be the mundane stuff of just daily life, but also revisiting their past, they were able to recognize that same concept of all of the programming that led them to where they were.

And then we would take them through other exercises of writing. So, for example, writing about a peak experience in your life, a time where you felt bliss or a time where you did feel loved and accepted. And by getting it out of your head and onto paper or onto a screen, you're able to start to reflect back on what elements are actually you that are not just, I was coerced into doing this by my parents or by the media or whatever. And it's these regular experiences of the self that little by little

get strengthened. But I mean, I wish, you know, I wish everyone could like wave a magic wand and either, you know, through the magic of plant medicine or an out of body experience, they could have that oneness experience that tells them there is so much more to you than what you see in the mirror. But, you know, that's why... We get so attached to that. We get so attached to, you know, our physical body. I've shared on the show that I've had an experience when I was really sick a couple of years ago where my mind was gone. I had no emotional capacity.

I couldn't focus. My body was completely broken. I was literally in bed, nothing I could do. And what was left was just that sort of real self, as you call it, just that sort of real self, as you call it, you know, was that sense of something that's abiding always that I can touch and that isn't really all this physicality and this sort of thoughts and job and identity.

It's like, who are you if you're not all that? And I think it's something people often don't think about. And there are ways to touch it. You've talked about meditation, psychedelics know neurofeedback and it's something that i think we all need more of because part of the reason we get into conflict part of the reason we have this divisive world we live in part of the reason that we're struggling in society because we're attached to that little self and we're all in this kind of completely polarized world. And what you talk about is when you do connect with self-love, it actually allows you to have compassion and to be able to be in the world in a way. So it's not just this narcissistic self-love that you're talking about. It's something really different. So I'd really love for you to sort of help walk us

through what are those five steps that you teach people that help them get to that place of real self-love? Well, the cornerstone process is a five-step process that begins with awareness. So as I mentioned, there are several exercises and questionnaires that we invite people to explore because becoming aware of who you are and who you are not is essential. Again, as you said, we get so attached to the roles we play, the things that we've done in the past. So in addition to the Values in Action Survey, which is from the beautiful people at UPenn with positive psychology, we invite you to do that in action survey, which is, you know, from the beautiful people at, uh, at UPenn with positive psychology. We, we invite you to do that in this first step. Um, there's also, um,

the vitality test, which is a, a, a questionnaire that helps you identify which of the five Chinese elements is your main influence because there's wood, metal water fire right exactly and there's so much insight that comes when you start to recognize that the elements the time of your birth and you know it's not woo-woo but i mean there's 5 000 years of you know chinese science when you start to see that your makeup is not random this is who you. It gets you even closer to step two, which is about self-acceptance. So after you go through this awareness phase where there's several exercises we take you through, then you get to a point of recognizing that, okay, the past is the past. And for many of my clients, they have had traumatic pasts. They've had things that

you don't even want to bring up in terms of trauma and abuse and neglect absolutely but there comes a moment of reckoning when we realize we can no longer blame our parents or society or the economy or any or even our own bad behavior we've got to get into this present moment and accept that here's where we are and so that's when we move into compassion as you mentioned and forgiveness. So we have exercises in this second step that really bring about a detox, detoxing body and mind, environment, relationships, so that you can start to accept that this is your life. And from this point forward, you're the one in charge of it. Step three is all about accountability. And this is where we invite

people to start to rewrite. That's not something that people like. No, it's not. Be self-accountable. It's generally not. To own your stuff. A friend of mine calls it cop-to-itiveness. Cop-to-itiveness. Yeah. I mean, but that's where we have to cop to it because if you continuously blame everything outside of yourself for your woes, whether justified or not, then you remain a victim. But if you're willing to say, I'm going to cop to it. These are the things that I did. These are the things that other people did. I'm ready to clean the slate, forgive. It doesn't mean you're condoning bad behavior. It just means from this point forward, I want to be accountable for my life.

I'm moving from the victim into the hero. Because that's what we're all on. We are all on a hero's journey. And it's up to us to start to pick up that pen and decide that I want to be the one who gets to write the rest of my life story. Right. You get to be the author of your life instead of being the victim of your life. Exactly.

Amazing how many people don't understand that, the empowerment of being able to really author, design, create, imagine, dream your own life. And I think it's kind of a force in the universe that you can tap into that people don't realize. It's sort of like Dorothy and the Ruby Red Slippers, you know? She's got the power. She just has to learn how to click her heels. And I and two, that people don't realize. It's sort of like Dorothy and the ruby red slippers. She's got the power. She just has to learn how to click her heels. And I think for most of us, it's not part of our culture. It's not part of our cultural framework.

It's not part of our religious teachings. I mean, it is in certain cultures, like in Buddhism. But most of the time, we're not really thinking about our capacity to tap into this sort of real phenomena that's surrounding all of us which is the sort of connection between everything that's going on jung called it synchronicity and when you begin to sort of notice what's happening in your life and pay attention to the signals and the signs and what feels right you actually can be guided in a way that is so beautiful. It takes you to where you are. It's sort of how I've done what I've done. I really didn't have a master plan. I've just really listened to the signs that came in front of me. And then when the door opened,

I went in. And when something happened, the big things in life that really matter, that made me who I am, I didn't plan. I didn't plan to get sick. I didn't plan to get a job at Kenya Ranch. I didn't plan to go to Cleveland Clinic. I didn't plan exactly to write a book. I felt compelled because I got sick and wanted to share my story and that led to this and that and the other thing. So it's really, you know, it's fascinating when you look back at your life, you can see that there's this thread connecting everything. Going forward, it's hard to see, but you know, you told the story of your struggle and how that actually led to where you are in this moment

and gave you the understanding, the skills, the knowledge to be able to do what you're doing and teach what you're teaching. It's not just that you read it in a book, it's actually was coming out of the grist in the middle of your life. If people are in a state of chronic stress, how would they know it's affecting their biology?

Because there's a whole list of symptoms that we talk about when we talk about adrenal fatigue or adrenal exhaustion. There's a lot of, I think, skepticism in the traditional community, medical community, about this whole idea of adrenal exhaustion. You either, you know, you have Addison's disease, which is an autoimmune disease that nukes your adrenal glands, or you're fine. But it's not really like that. Right. So we have this whole, you know, really what people are saying the proper term for this situation is HPA axis dysfunction, right? The hypothalamic pituitary adrenal axis, which are really parts of our endocrine system that handle and manage the stress response in our body. And when it gets out

of balance, that that can really influence how we feel. And so we can have, and we'll get into this a little more, we can have HPA access overactivity, right, or underactivity. And so, you know, but those hormones, all of those different parts of our endocrine system handle that stress response in our body. So when there is chronic stress over time, when a lot of cortisol gets produced from our adrenal glands. And at the beginning, as we talked about, that acute stress, that cortisol is really helpful for us because it helps increase our blood pressure. It helps us run away from the tiger.

It helps us, it increases our blood sugar so we can get nutrients and energy to our muscles so we can run away from that perceived threat, which is really important if you were running away from a tiger or a dog or whatever, right? So we want, we need to be- And it stops your digestion because you want to be digesting your food while you're running from a tiger. And so, you know- It increases clotting, right? Absolutely. Because you want to make sure if you get cut or bitten when you're running away that your

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

system works together. That whole HPA axis works, and it can get dysregulated. And so that's that whole talk of that HPA axis dysregulation. So it's your hypothalamus, which is in your brain, your pituitary. So it's all the command and control centers in your brain that then send messages to your adrenal glands that are on top of your kidneys and they produce adrenaline, cortisol, norepinephrine and epinephrine, but also DHEA, which is a hormone that gets turned into testosterone and estrogen and hormones that impact our blood pressure and electrolyte balance.

So it's involved in a lot of things. And it's important to recognize that the pituitary also impacts lots of other hormones in our body, our female hormones, our male hormones. And so our thyroid hormones, it's all really connected, which is interesting as well. So when people are under a lot of chronic stress over time, the cortisol levels are remaining higher than they should be for long periods of time. And so this is a whole feedback loop, right? This system in our body is a whole feedback loop. So that high cortisol sort of shifts the way that there's a feedback mechanism that occurs. And in a way, the body sort of slows everything down.

And so over time, with high levels of cortisol that are getting released all the time, people start to crash. They have like that, what they call burnout, or their body sort of just slows down. We see their thyroid slow down. We can see other hormones shift, but we definitely can, over time, if we look, we can see a decrease in cortisol levels. So we can do some special tests that look at that. It's so important what you're saying because the stress response is a good thing in the short run, but not in the long term. And we never really had these

chronic stresses that we do now. We'd be in threat of danger. We'd mount the response. It was good. Right now, you're releasing high amounts of cortisol. And it's like a drug we give for people with autoimmune disease called prednisone. Or when you, for example, have a disease called Cushing's disease, where your adrenal glands or pituitary tumor will produce a lot of cortisol that is not regulated by any feedback mechanisms. And when that happens, you get all these problems, right? You get high blood pressure, you get diabetes, your brain shrinks, the memory center in your brain shrinks so you can get dementia. You have muscle loss.

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

So a lot of times people will, people with HPA axis dysfunction, they'll say, well, I have a good night's sleep, but I still feel tired in the morning, I can't get going. Or other people, depending on where they are in this whole process, they may feel like they're anxious all the time. They can't calm down. They're tired, but wired. And they're just, you know, really feeling anxious. You get into bed and you lay there, you're tired, but you can't fall asleep. Yeah. I've been there. You know, they can have a hard time dealing with the stress of everyday life.

They can feel more depressed or irritable. Things that they used to be able to do really easily are hard to do. So things that they, you know, their job maybe or handling going to the grocery store even, you know, things that used to be really easy to do every day become tasks for them. They feel overwhelmed and exhausted. And they might get, as I said, sick more easily. You can have more cravings for foods. You're looking for things to pick you up, right?

So sugary foods, salty foods. Can you have cravings for them? You might feel more fatigued when you stand up. You get more tired. You may have low blood pressure over time and low blood sugar over time with an underactive HPA axis. And it's often the syndrome I see of tall, thin women, which is really common where they get sort of adrenal burnout. They get low blood pressure, so dizzy when they stand up. They crave salt. They have anxiety.

They have palpitations. They tend to get hypoglycemic, so their blood sugar actually is not coming up when it should. And so you can kind of pretty much tell that this is going on with people. But what's interesting is it might be worth breaking down is that adrenal burnout, let's just call it that, comes in stages, right? So the first stage is, tell us about the first stage and how it progresses to full burnout. Because the symptoms and the treatment are a little different for each one. They are a little different. So at first, when you've got that overactive adrenal gland, it's the beginning, let's say,

of just handling all this chronic stress. People feel that wired and tired. They're like anxious. They feel like they just can't calm down. They feel upregulated inside. And then over time, what can happen is with having that chronic levels of high cortisol, what can happen over time, as we talked about with that feedback loop, they get a decreased level of cortisol that occurs.

So initially, you'll see high levels when you do the testing. And we'll talk about the testing in a minute. Yeah. And then you see this flat line. And when it's flat line, what it feels like is burnt out. Yeah. You know, you just feel exhausted. You can't get going in the morning.

You're getting sick more frequently. That's when you see a lot of low blood pressure, low blood sugar, you know, salt cravings. But just, you know, literally you feel that burned out, you know, you're exhausted feeling. So when it's like chronically high and it was like chronically low, and there's kind of an in-between where you get low in the morning and high at night. So, you're exhausted in the morning but you can't fall asleep at night because your whole circadian rhythm is all screwed. So, that's what we do differently than what conventional doctors often do.

So, let me tell you- By the way, this isn't even a diagnosis in conventional medicine. No, really like you were saying, if somebody has really low cortisol or really high cortisol on blood testing, they'll call it, you know, it might be Cushing's or Addison's or a very serious adrenal issue. And we were taught about that in medical school, but we weren't really taught about these situations where if you did a blood level first thing in the morning, it probably would look okay. And you wouldn't really see a lot of abnormalities in the blood testing. But if you look a little deeper and you do saliva testing and you check saliva four times in a day, and you can

check saliva for cortisol when you first wake up in the morning, they call that the cortisol awakening response. What we should see with that saliva testing is that when you first wake up in the morning, your cortisol increases. It's almost like a stress test for your adrenal glands. The cortisol awakening response is like a stress test for your adrenal glands. Getting up in the morning is a little bit of a stress for the body, right? It needs to get going and wake up. And so what we typically see is the cortisol increase first thing in the morning. And that's a good thing. We want to see that. That means that the system's working well. And what we see is the cortisol levels in the beginning of the day are higher. And as the day goes on, they come down. So when you check

somebody's saliva tests during the day, we should see it go day goes on, they come down. So when you check somebody's saliva tests during the day, we should see it go up when they first wake up in the morning and then start to come down as the day goes on. And that's a very normal pattern. And what we were talking about is over time, if people have a lot of stress and anxiety going on, you might see high levels of cortisol. And then over time, you might see that it starts to flip where they're low in the morning, but too high at night. And then if things really go on for a while, you might see a low level of cortisol throughout the whole day. And it really gives us a lot of information about how best to treat somebody and how best to take care of them and what they need to really focus on.

This is something you wouldn't get at a traditional doctor's office. They're not going to look at your salivate cortisol levels. They'll say, oh, you have Cushing's and there's tests for that or Addison's and there's tests for that. But short of these two extremes, and that's what's so different about functional medicine. It's really about this continuum of dysfunction. It's not just on or off. It's not like you have diabetes or you don't. Yeah.

Right? Like you have high blood pressure or you don't. It's a gradual worsening over time. And those diseases are very particular because they're either a tumor, which is Cushing's, or they're an autoimmune disease, which is usually caused by gluten, the Addison's disease, which is what President Kennedy had, actually. Yes. And it certainly, I'm sure, affected him.

So when you have these patients come in, you do this history, you find these symptoms, you sort of hear their story. How do you start to approach correcting this? Because I found some things are really easy in functional medicine. Someone has bacterial overgrowth or they have gut issues, irritable bowel, one, two, three, it's fixed. This takes a little bit of time because of the amount of stress we've put on our adrenals. We have to constantly try to build them back up over time. And it takes

a little bit of time to recover. Yeah. I mean, I think what's fascinating is, you know, and what we realize is the body has this tremendous ability to heal, right? And we, this is an area where our body can heal. We see it heal all the time. It just sometimes takes a little TLC and some care. And that's where, that's where the lifestyle factors really, really make a huge impact. You know, we work with people to, to really balance their, their diet and focus on nutrition. And we can delve into each of these more, you know, getting good sleep, resting, resting is important, right? We need to give our body time to rest. And, you know, we're living in a world where it's hard sometimes to turn it off and people aren't. And so they're really having issues because of it.

So we have to help them rest and recuperate and get in their regular meditation and breath work and take time for themselves and turn off the lights at night and turn off the computer and the cell phone. You know, diet makes a huge difference. There's so much we can do. Wait, wait, before you get into diet, let's go back to what you just said because the light thing, the computers, the screen, it's not just that they're distracting. There's a biology around your adrenals that has to do with something called your circadian

rhythm and it requires certain types of stimuli at certain times of the day and and different kinds of stimuli at the other times of the day so in the morning the way to get going with your circadian rhythm and your adrenal glands to properly function is to have sunlight for 20 minutes in the morning which how many many of us actually do that and get outside? And the same thing at night, if you are stimulating your eyes with bright light that isn't, have all the blue filtered out, which is you can see blue, black glasses, or just getting off screens, you will actually stimulate more awakefulness and you will suppress cortisol because like, I mean, suppress melatonin, right? you will actually stimulate more awakefulness and you will suppress cortisol.

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

I hope you enjoyed today's episode. One of the best ways you can support this podcast is by leaving us a rating and review below. Until next time, thanks for tuning in. Hey everybody, it's Dr. Hyman. Thanks for tuning into The Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do

and introducing you to all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff from foods to supplements, to gadgets, to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays. Nothing else, I promise. And all you do is go to drhyman.com forward slash PICS to sign up.

That's drhyman.com forward slash PICS, P-I-C-K-S, and sign up for the newsletter, and I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger longer. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner.

If you're looking for a functional medicine practitioner, you can visit ifm.org and search Thank you.