The Dr. Hyman Show - Eat Smart: Quality Foods to Improve Sleep and Reduce Stress

Episode Date: June 17, 2024

View Show Notes From This Episode Get Free Weekly Health Tips from Dr. Hyman Sign Up for Dr. Hyman’s Weekly Longevity Journal Food is more than just fuel - every bite we take has a profound impact on our biology. In this episode, I explain the principles of the Pegan diet, emphasizing the importance of quality, nutrient-dense foods. Joining me are some incredible guests: Dr. Cindy Geyer, a renowned expert in functional medicine, and Dr. Elissa Epel, a leading stress researcher. Together, we'll explore how chronic stress and poor sleep are intricately connected to major health issues like obesity, diabetes, and neurodegenerative diseases. Learn how specific dietary choices can serve as powerful medicine, improving your overall health and longevity. Plus, explore actionable tips and expert insights on integrating these health-boosting foods into your daily routine. This episode is brought to you by Rupa Health, Neurohacker, and Cymbiotika. 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. Decrease your "zombie cells" with Qualia Senolytic. Visit QualiaLife.com/Hyman to get 50% off and use code HYMAN for an additional 15% off your order. Upgrade your supplement routine with Cymbiotika. Get 20% off with free shipping on all orders. Head to Cymbiotika.com and use code HYMAN.

Coming up on this episode of The Doctor's Pharmacy. Food is information, that it's medicine, that it's instructions, it's code, that programs your biology with every bite. So you must understand that you're interacting with things, not just from an energy perspective, not just fuel to run your body, but instructions that code for every single function

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To learn more about senolytic research and to try Qualia senolytic for up to 50% off, visit qualialife.com slash hymen and use the code hymen, H-Y-M-E-N to score an additional 15% off at checkout. That's Q-U-A-L-I life.com forward slash hymen for up to 50% off at checkout. That's Q-U-A-L-I-Life.com forward slash Hyman for up to 50% off. Now, before we jump into today's episode, I'd like to note that while I wish I could help everyone by my personal practice, there's simply not enough time for me to do this at scale. And that's why I've been busy building several passion projects to help you better understand, well, you. If you're looking for data about your biology, check out Function Health for real-time lab insights. And if you're in need of deepening your knowledge around your health

journey, well, check out my membership community, Dr. Hyman Plus. And if you're looking for curated, trusted supplements and health products for your health journey, visit my website, drhyman.com, for my website store and a summary of my favorite and thoroughly tested products. Are you ready to prioritize wellness? Maybe you want to make more informed choices on the latest health trends or simply understand the science. I'm Dr. Mark Hyman. I'm a wellness expert and I want to welcome you to my podcast, Health Hacks. In every episode, I'll provide guidance on how to live a longer, healthier life, helping you wade through all the health ads and the sound bites to bring you the science-backed facts, along with practical tools and insights to make informed decisions.

Health Hacks is available in audio and video, so you can tune in wherever and however you enjoy your podcasts. Join me every Tuesday for a new episode. Just search for Health Hacks, where my goal is to empower you to live well. Hi, I'm Dr. Mark Hyman, a practicing physician and proponent of systems medicine, a framework to help you understand the why or the root cause of your symptoms. Welcome to The Doctor's Pharmacy. Every week, I bring on interesting guests to discuss the latest topics in the field of functional medicine and do a deep dive on how these topics pertain to your health. In today's episode, I have some interesting discussions with other experts in the field. So let's just trump right in. The Pekin diet is

basically the approach that I've created, and it's really a flexible, inclusive framework. It's built on a few key principles, and these are central principles. No matter what nutritional philosophy you ascribe to, I think they're universal. First is focus on quality. The quality of the ingredients, the quality of the nutrients, the quality of the food in an organic little garden you have in the backyard, better quality than an industrially produced tomato that's designed to fit in a box and not squish and last for months on the shelf and tastes like cardboard, the same. No. Focus on quality, whether it's real food or whatever you're eating. Try to get the highest quality, most nutrient-dense food you can. Obviously obviously that means no ultra-processed food. Understand

that food is information, that it's medicine, that it's instructions, it's code that programs your biology with every bite. So you must understand that you're interacting with things, not just from an energy perspective, not just fuel to run your body, but instructions that code for every single function of what's going on in your microbiome, your metabolism, your brain chemistry, your immune system, everything. And I could go on, the list goes on, is regulated by what you eat in real time. And the last principle after quality and food as medicine and information is personalization. Not everybody needs the same diet.

Some people do better on low carbs, some people do better on low fat, and some people do better on paleo. Some people do better on low fat. Some people do better on paleo. Some people do better as vegan. So we have to see what works for you, and we have to be smart about it. But you want to make sure you eat a diet that is very much focused on these principles. And it also follows a few other things. One, it should be low in starch and sugar, low glycemic. Super, super important. I can't stress that enough. I've said it forever, but it's really important because that drives so much of the age-related diseases. Two, it should be full of good fats, avocados, olive oil, nuts and seeds. If you're tolerant of saturated fats and you don't eat them with carbs and sugar, you can have coconut butter or

coconut oil and even grass-fed butter or ghee. And make sure you eat foods that are full of phytochemicals, lots of colorful plant foods with anti-inflammatory, detoxifying, hormone balancing, energy busting, gut healing compounds. And that's a nutrient-dense diet that's full of longevity-rich, I mean, longevity-producing phytochemicals, polyphenols, which are plant chemicals, antioxidants, microbiome-healing fiber, probiotics, prebiotics, postbiotics, all of it. And this is designed to basically regenerate human health and planetary health, which is something you can't separate. So our health is intimately tied to the planet's health.

Our own health is tied to the soil health. The nutrients of the soil are how we get our nutrients. So it really is a beautiful ecosystem that we learned mostly how to destroy. But today I'm going to talk to you about how would you follow the vegan diet? What does it look like? First of all, it's a plant-rich diet, not a plant-based diet. And that's an important distinction. Plant-based implies vegan.

Plant-rich means your diet's mostly plants. And that should be three quarters of your plate covered with colorful veggies. Lots of colors, weird things, mostly non-starchy veggies. I do eat a purple sweet potato or sweet potatoes, fine. Winter squashes are fine, especially if you're not insulin resistant or diabetic. Try to choose organic or regenerative when possible. Use the Dirty Dozen Guide and the Clean 15 Guide from the Environmental Working Group. That's ewg.org. Download those guides, and you'll learn all about which are the foods you want to stay away from that are the worst contaminated.

For example, don't ever eat strawberries unless they're organic, or nectarines, for example, whereas you can eat an avocado or banana if it's not organic. Also, load up on the good fats. What should you be eating? Well, nuts and seeds. Try to eat fats in their whole food forms, seeds and nuts, avocados, pasturized eggs, fatty fish like mackerel, sardines, herring, anchovies, some wild salmon that's small. Olive oil also is a very minimally processed oil. Try to stay away from the hexane extracted, deodorized, solvent, mixed refined oils that we eat are probably refined oils. If you're going to eat canola or soybean oil, I don't highly recommend that, but they

can be part of cooking and other things if you want. And only if they're expeller pressed, only if they're organic, mostly they're GMO, mostly they're sprayed with glyphosate. You just stay away from that. So for cooking, I use extra virgin olive oil for no heat or low heat, avocado for higher heat, avocado oil, I like that, and extra virgin coconut oil. Also use nuts and seeds. They are tremendous. They should be every day, a couple of handfuls of nuts and seeds. Really help with weight loss, diabetes, heart disease. They're a great source of minerals, fiber, fat, protein, and lots more stuff. Almonds, walnuts, pecans, hazelnuts, macadamia nuts, pumpkin seeds, hemp seeds, chia seeds,

sesame seeds are all great. I like pine nuts too. I put that on there. So what about meat? Should we be vegan? Should we be carnivores? Should we be paleo? You know, we do need protein and we need animal protein, especially as we get older to build muscle. If you don't have enough protein in the right forms with the right amount of leucine, which is a very important amino acid to build muscle you will lose muscle as you get older and if you see people who are vegan as they're older they tend to be more frail more thin less muscle mass and muscle mass is the currency of longevity so you want to make sure you keep maintain and build muscle as you get older and so it doesn't mean you have to be eating you know 20 ounce steaks it just means you need 30 grams and that's not much It's a palm-sized

piece of protein or equivalent at each meal. So make sure you're using regenerative meat if you can. There's a company called Force of Nature, which sources regeneratively raised meat from around the country or even around the world. It's really good for you. It's full of phytochemicals. It's raised in humane ways, harvested in humane ways. So it's really a beautiful, beautiful way to support a growing food system that supports regenerative agriculture. If you can, you can get grass-fed, pasture-raised, organic when possible. Also, making sure that if you are plant-based and vegan, you may need extra protein powders. And you're going to be having processed food. It's processed food, which is processed protein powders you're going

to have. Ones are just more from whole ingredients, but you have to make sure they have added amino acids, particularly leucine and particularly branched-chain amino acids, because you will not be able to get enough by just having the basic plant-based protein. When you also look at fish consumption in the addition of meat, it's a great source of protein, but I would stick with the small fatty fish, sardines, herring, anchovies, mackerel, small wild salmon, high in omega-3s, low in mercury.

There's a great company out there called Seatopia.fish that's sourced regeneratively aquacaculture raised fish it's low in toxins tastes great low in mercury and full of omega-3s and and actually great plant-based phytochemicals that come from the feed they're eating so check that out if you want to learn how to lower your intake of more toxic fish go to environmental working group you can use the monterey bay aquarium guide or the nrd NRDC Guide for low mercury fish. Grains, what about grains? Well, whole grains are fine for most people. I wouldn't be eating six cups of brown rice, which is 30 grams of bergen, but small amounts of half a cup

to a cup can sometimes be fine if they're whole grains, if they're more ancient grains, if they're not bred to be super starchy. So I would encourage you to eat weird grains like heirloom grains, if they're more ancient grains, if they're not bred to be super starchy. So I would encourage you to eat weird grains like heirloom grains, Himalayan tartary buckwheat, ancient forms of wheat if you're not gluten sensitive like einkorn, emmer, or farro, but don't have them ground as flours. Except some of them may be okay, like Himalayan tartary buckwheat, a small amount of flour can be fine, but you want to make sure you're actually eating a low glycemic, protein-rich, mineral-rich form of whole grains, not the ones that have been hybridized and processed in the ways we eat them. So don't eat whole grain flour. Don't eat flour products. And try to avoid gluten, especially in America, because there's many reasons. Most gluten in this country is grown

with dwarf wheat. It's sprayed with glyphosate at the end. It's super starchy. It has way more gluten proteins that cause celiac or non-celiac gluten sensitivity. So I'd really reduce that. Sugar, obviously, stay away from that stuff. I mean, a little bit's fine here and there, but as a staple, it should not be part of your diet. It's an occasional treat. It's a recreational drug. And also just remember, below your neck, your body can't tell the difference between a bowl of sugar and a bowl of cereal or a bagel. Also, oils. Eliminate most of those refined oils, all those, especially corn and grapeseed and sunflower.

If they're high oleic, they can be okay. If they're expeller or cold-puronic they can be okay if they're um you know expeller cold press they may be okay but stick with the main oils that come from olive oil and avocado oil you'll be doing fine um and dairy what about dairy well dairy uh you know it typically is raised in this country with a homogenous not homogenized but homogenous genetic cow which is is the Holstein cow. And that's A1 casein. It's very inflammatory. They're pumped full of hormones, growth hormone. They're often milk-full pregnant.

And you get flood of hormones and inflammatory compounds and inflammatory forms of casein. And if you want to have dairy, try sheep or goat. Try A2 cows, which you can get like Guernsey and Jersey cows or A2 cows. And if you have the wrong kind of dairy, it's going to drive inflammation, cancer, osteoporosis. Believe it or not, yes, it's not good for your bones. That's a whole other conversation. You can, I think, read my blog called Six Reasons to Avoid Milk, or you can go on and read about David Ludwig's article on medium on milk, which he reviewed all the literature recently about it, and it showed that it really is not a health food.

I recommend mostly avoiding it. Occasional grass fed, you know, sheep or goat cheese or yogurt or milk can be fine. Ghee is fine because it doesn't have the milk solids in it. So grass fed ghee is also fine. So that's basically it. Eat real food.

Personalize your approach, think of food as medicine, focus on quality. You can be super flexible in all that. And hopefully you can follow these principles and activate your body's own healing response, improve your health, and use it like I have in my practice to use food as medicine and live a longer, healthier life. Modern foods aren't nearly as nutrient-dense as they used to be, so we all need a little help from supplements if we want to function and feel our best.

But supplements can also be tricky. Some use low-quality ingredients that are difficult for the body to absorb, and others add cheap fillers and additives. And that's why I love Symbiotica. Cutting-edge formulas they have, like liposomal glutathione and liposomal vitamin C, use liposomal technology, making them the most bioavailable and optimal for absorption. If you're

unfamiliar, liposomes are fatty membranes, like little bubbles, that encapsulate nutrients and prevent them from being broken down in your digestive system and increasing their bioavailability or the percentage of the active ingredient actually absorbed into your body. Not only do they formulate their supplements for higher absorption, but Symbiotica is also extremely transparent about how and where they source their ingredients. So you know you're getting high quality products that are safe, effective without any seed oils, preservatives, toxins, or artificial additives. It also means they taste great. Flavors like citrus vanilla made from organic vanilla extract and organic orange peel oil. I also love they come in convenient packets, so I never have to worry about missing doses or packing big bottles

when I'm traveling. Right now, you can try them for 20% off with free shipping on all orders. Just go to Symbiotica.com slash Hyman and use the code Hyman. That's Symbiotica, C-Y-M-B-I-O-T-I-K-A dot com forward slash Hyman and use the code Hyman for 20% off plus free shipping. So sleep is when we're repairing the powers of both the mind and the body. Sleep is when we reduce inflammation, repair tissues. The discovery of the glymphatic system in 2012, 2013 is this passive channel that runs alongside our arteries and veins in the brain that fills with fluid when we're in deep sleep and allows a washing out of debris we may have accumulated during the day.

So all those bad thoughts get washed out? Well not the bad thoughts, no, but the amyloid plaque, that sticky plaque that we secrete in response to inflammation or injury if it accumulates of course it can damage surrounding neurons and is associated with neurodegenerative disease and alzheimer's disease so in english that means if you don't sleep you're likely to get demented it's definitely playing a role and this concept of bi-directionality we know that sleep disruption circadian rhythm disruption sleep apnea is present in two thirds of people with insulin resistance, prediabetes, diabetes. And it is a chicken and the egg thing is driving

the bus. You know, we used to think, well, you get the sleep apnea because you have insulin resistance and gain weight. But if you have disrupted sleep, your insulins are higher, your cortisol is higher, your glucose is higher, you're looking for highly processed, quick energy dense foods and less able to resist them. Wow, so not sleeping is a risk factor for obesity. Absolutely. And heart disease. Yes.

And cancer. And cancer. And dementia. And flares of autoimmune conditions. Yeah. And chronic pain. Yeah. And fibromyalgia.

So, and anxiety and depression. I mean, it really affects everything. Oh my God, if I don't sleep, I'm depressed and anxious. But the more you worry about it, the harder it gets to sleep. Yeah, it's true. So, okay, so we have that chronic stress. What else is driving this insomnia pandemic,

which is huge, right? How many, 70, 90 million people are struggling with insomnia? Right, so I do think that there's a need to address underlying contributors to anxiety and depression independent of their impact on sleep. So talking about what's going on, bringing in some kind of breath-based practice, whether that's yoga or Tai Chi or meditation, just to ratchet everything down. That's another important component of it. And thirdly, you've already touched on a little bit

about the dopamine with the phone, but it's also the dysregulation in our circadian rhythms. You know, we think about how I there's been a lot of research about how important it is to avoid light exposure at night, for example. But everything we do during the day, and when we do it is ultimately going to influence our ability to go to sleep when we want to and get the rest that we want to. So in other words, when we're eating all day long and snacking late at night and watching TV at night, that's signaling on our computers, that's telling our bodies and brain that it's day, it's day, it's day. So we want to actually reestablish a consistent circadian rhythm. Meal timing, so we're eating earlier in the day and then building

in a fasting interval before we go to bed. So don't eat three hours before bed. No. Interestingly enough, there's, as you know, there's a connection as well with digestive function that eating late at night not only disrupts your sleep, but it's contributing to higher reflux, which can also interrupt sleep. So everything's interconnected. Happened to me last night, actually, because I went hiking and it's summer and it's so

beautiful and it's late and light. So we were like, didn't get down from the mountain until eight o'clock at night. And I'm like, oh, let's go eat. I'm hungry. But then by the time we ate, it was like nine o'clock. And I like last night I tossed and turned for a couple hours before I went to bed, which I usually don't do. I was like, oh, it was the, you know.

So there's eating late at night, there's the circadian rhythm disruption. This morning I went out and sat on my deck and the sunshine was out. So getting light in the morning is so important. So we don't do that, we're all like on our phones or computers right away. We need the natural light to reset our brain.

Because light is medicine. Light is medicine. And also it could be bad medicine if it's the wrong light at the wrong time, right? Exactly. So we have all this like, there's this great book called Lights Out that I read years ago, Cindy, that was really talking about the advent of light bulb driving chronic disease because of the disruption in our rhythms and so on. It's interesting. They even looked at LED streetlights disrupting the circadian rhythm of animals and insects too,

so it's not just humans that are being impacted by this. And there's some other weird stuff that affects sleep that we don't think about, like what else? Well, one of the conditions is restless leg syndrome, and it's hard to diagnose, it's more of what we call a clinical diagnosis. People describe this creepy crawly sensation in their legs or this irresistible urge to rub their feet together and typically it's treated with

dopamine medications it's connected to relatively low dopamine levels in the brain you know dopamine yes revs you up but dopamine also seems to play a role with movement so it's treated with some of the same medications they used to treat Parkinson's disease but it turns out that that can be more prevalent in people who have autoimmune conditions, in which case we want to address the underlying autoimmune conditions. There are some nutrient deficiencies that are going to make the symptom of restless legs more significant. Low iron, low vitamin D, low folic acid, low magnesium. So we really want to look at somebody's nutritional status.

Yeah. And by the way, 80% of the population is efficient vitamin D, 50% in magnesium, you know, like 20% in iron. I mean, it's like a lot of people are deficient in B vitamins and they don't even know it. Right. You know, and you go to your doctor and you have insomnia, they're not checking those things. Exactly. And there's even weirder things in nutritional stuff, right? So if we identify a nutrient deficiency, for example,

the next step is why? What's the why that somebody's nutrients might be low? And there we come back, like so many other things, to the function of the gut. And interestingly enough, there is a higher correlation in people who have small intestinal bacterial overgrowth also having restless leg syndrome. Maybe because it's contributing to ongoing inflammation, maybe because it's also contributing

to difficulty absorbing those nutrients from your food. So we're even going to go a step further and say, is there an underlying issue with digestive function absorption and assimilation of nutrients that are so if your gut's a mess it can also cause insomnia absolutely and then heavy metals are another big one that we don't really hear about right lead mercury things that that are under the radar for many many people and unfortunately can be a problem yeah and i i um i had that and we talked about on the show show. But I've had mercury poisoning 30 years ago almost. And it really totally screwed up my sleep.

What happened with your sleep? I just couldn't sleep. I really couldn't fall asleep, couldn't stay asleep, never felt rested, had chronic fatigue syndrome. Until I got the mercury out, got my fillings out, chelation, everything, I couldn't sleep. And it really took a long time to reset that okay so we've got all these different things that traditional medicine ignoring the hormonal fluctuations the the gut issues heavy metals nutrient deficiencies I mean doctors know about sleep apnea but they often miss it in thin women because that's not the archetype of someone who actually like the pickwickian figure with

you know a huge belly and a thick throat and size 17 neck i mean you know uh so there's all these issues and and yet um you know this continues to be such a struggle for so many people um and the and the traditional treatments really are just stop gapap. They don't really address the cause. So in functional medicine, the way we think about things is to look at some of these other factors. So in your practice, how do you start to dig down, what are the kinds of diagnostic things you look at differently?

We talked about all these different factors, but how do you identify what's the problem in this or that particular person? Well, I think it's the time to take a history and really understand all of the other interconnectedness that could be going on. For example, somebody with sleep concerns might also have digestive concerns,

and then we might be thinking about assessing their digestive function, looking at a nutritional assessment. But I think there's a time and a place, and there's tremendous value in screening somebody with a portable sleep study because that gives you a tremendous amount of information. And we're using it, yes, to diagnose sleep apnea, but also to say, how often do you wake up during the night? How much percentage of

time are you spending in REM sleep and deep sleep? Are you tossing and turning all night long? So it can give us a tremendous overview in terms of somebody's sleep throughout the night. And from that, we can also decide, okay, what else do we need to explore? And then we do some testing, right? You can look at nutritional levels. You can look at these vitamin D and magnesium and folate and iron studies. You can look at, obviously, the sleep apnea test. And there's home tests now you can do that really great. We look at obviously the sleep apnea test and there's home test now you can do really great um we look at heavy metals right and the hormones you can really get a sense of what's going on with hormones for people if they're estrogen and progesterone's all out of balance it just happens in menopause you see a lot of sleep issues um heavy metals like i said we can

test so there's there's a lot of ways we can diagnose using functional medicine testing that you don't really get with traditional doctors that can help get underneath things. So tell me about this patient you had, because it sort of speaks to a lot of the issues that we're talking about. And it gives you a little unusual approach to insomnia, something you wouldn't really get from a traditional doctor. Right. So this is somebody that, and one of the things I want to plant the seed for is sometimes we start with what we think is the most likely issue.

And we gradually uncover more potential contributing issues and peel the layers of the onion. And this was a woman that I had known for years. She was pretty healthy in terms of her lifestyle. She exercised, she wasn't overweight. She ate a healthy diet. Um, she didn't drink any alcohol. She was treated with antidepressants. She was on a serotonin reuptake inhibitor and Welbutrin for her depression.

And she started she was also on hormone replacement therapy. She was post-menopausal in her 60s. And she started complaining of fatigue and difficulty concentrating and just felt scattered. And by Sunday, she would have the need to take a three hour nap. So well, that's unusual. So we did some of the usual testing for causes of fatigue, we tested her thyroid, it was okay, we looked at her iron levels or sugar levels, they were okay. So I decided to do screen her with a sleep study. And it turned out you would not have looked at her and said, Oh, yes, she is the poster child for sleep apnea she turned out to have one of the most striking positional components to sleep apnea i've ever seen when she was on her side her sleep was normal but when she was on her back she had respiratory events that count as either a slowing of airflow or a stopping of airflow more

than 60 times an hour wow stop breathing 60 times yes yes like once a minute that's a lot no wonder she was exhausted right um so in when you see a positional component like that you know i have people who don't want to do a sleep study because they don't want to i don't i'm dead i'd never wear that stupid mask but for her we said okay well let's start with retraining you to learn to sleep on your side and she tried that there's some commercially available positional devices there are all kinds of strategies you can do very very sophisticated technologies called the tennis ball yes strategy where you sew a tennis ball into a t-shirt on the back so if you roll over on your

back it makes you flip over to your side or the fanny pack with the pillow stuffed in it. Yes. There's all kinds of strategies you could do. And of course, it's big business, right? You can buy a slumber bump or a bumper belt. Oh, I didn't know they had those. I was on the tennis ball track. Even more sophisticated, there's now a biofeedback device that's a strap around that vibrates

when you roll on your back. So it's sort of autogenic nighttime training to get you. So that's what she used, interestingly enough. And it helped a little, but she was still tired. So as we're peeling the layers of the onion, she had some digestive symptoms, a lot of bloating, a lot of discomfort. And we had done a full sleep study. She had restless legs and periodic limb movements. She turned out to have a very abnormal breath test for small intestinal bacterial overgrowth. That means bugs growing in your small intestine where they really shouldn't grow. Where they don't belong, right.

Right. Which can cause inflammation. Absolutely. And low iron. Her iron wasn't terribly low, but one of the sidebars here, I think the other thing we do in functional and integrative medicine is understand the difference between a normal blood test, should put quote normal blood test and an optimal blood test yeah ferritin is a classic example of that ferritin looks at your total tissue iron and i think how much iron is in your iron bank in your body in your iron back your iron stores right and normal can be anywhere from 15 to 250. yeah so it's a big range it's a big range and what we know the threshold is for somebody who's got restless leg symptoms is you actually don't want to be normal you want to be over 100 because there's some evidence even comparing it head to head with those dopamine drugs we mentioned earlier getting somebody's ferritin over 100 was as effective as the

dopamine medications. That's amazing. That's amazing, right? As simple as correcting a nutrient deficiency, not to the normal range, but the optimal range for that condition. Yeah, what's interesting is heme iron is the best absorbed kind of iron, but that usually comes from meat. Right.

And if people are vegan, the platforms of iron aren't as well absorbed. Right. And you often see very significant iron deficiency in these patients, especially women who are menstruating. And I think that, you know, I learned actually in traditional medicine that ferritin was connected to sleep. Actually, I learned that at a lecture on insomnia

that I went to by some drug company. I was like, wow, that's interesting. But yeah, I think it's something that's often overlooked and it's an easy blood test to check your ferret, which most doctors won't look at. And Mark, I think from the internal medicine standpoint too, it's equally important to say, don't just correct the iron, figure out the why.

You don't want to miss blood loss somewhere. Stomach ulcers, she's just menstruating heavily, does she have a bladder cancer or something, right? Socer. She's just menstruating heavily. Does she have a bladder cancer? Like something, right? So I think that's really important. You're right. Just don't look at the symptom. Look at the cause.

Right. Because low iron is a symptom. Right. It's not a cause. Right? Low iron may cause insomnia, but what causes low iron? So that's what functional medicine does. It keeps going upstream.

And you said something a couple of times that I just want to come back to, which is peeling the onion. So one of the principles of functional medicine from our mentor, Sid Baker, who is this cool old guy, Yale professor, erudite, super smart, one of the most thoughtful men in medicine, people in medicine, period. And he said, you know, we have the TAC rules that help us sort of determine how to figure things out. One is if you're standing on a TAC, it takes a lot of aspirin to make you feel better, right? Take out the TAC. So if, you know, the bacterial overgrowth is causing the restless leg syndrome,

you can take a lot of these traditional medications, but it can take a lot of medication to make it away. Or if you fix the bacterial overgrowth and the, you know, that'll help. But then also if you're standing on overgrowth and the you know that'll help but then also if you're standing on two tacks taking one of them out doesn't make you 50 percent better so she had bacterial overgrowth and she had iron and she had the positional thing so it's like usually three or four or five things and the problem with medicine is we are so focused on the one thing you know you know there was one other piece related to her story that I think is also important to call out.

Addressing all of those things, her sleep quality was still not what she wanted to be. So we had a conversation and she relayed the fact that when she was growing up, things were pretty unsettled in her home of origin. There were a lot of late night parties, a lot of noise, and bedtime became a time where she didn't really feel safe and quiet and comfortable. So we also talked about referring her to a life management behavioral therapist to really talk about what it meant to be safe and regaining that sense of being okay being in bed. And I think that goes hidden as well that a previous history of trauma or not feeling

safe can also show up with insomnia and difficulty sleeping yeah and i think that's a big thing for a lot of people um you know there's a questionnaire you can do online called the ace questionnaire it's adverse childhood events and you get a score and if you have a high score it means you've had a crappy childhood and you probably have some level of trauma and different people respond differently to the trauma. But PTSD is so prevalent and our nervous systems are so jacked up in general. So it's sort of like acute on chronic.

We've got our acute stresses on this chronic level of PTSD and it leads to so many physical, psychological, emotional stresses for people. And there's a lot of ways to sort of access that. You shared about how you use cognitive behavioral therapy or yoga or meditation or breath work or emotional freedom techniques. There's all kinds of techniques out there. But now people are exploring psychedelic-assisted therapy, MDMA, psilocybin therapy. It's legal in Oregon now.

And, you know, there's some interesting research going on, Johns Hopkins and NYU and others are really looking at how do we help people with some of these chronic, long-term traumatic events and experiences. And I think, you know, sort of listening to, it's just so interesting to hear that dealing with, you know, something as simple as insomnia can be quite complicated.

You have to look at inflammation in the body. It's like, where's it coming from? Is it the gut? Is it heavy metals? Is it hormonal changes? Is it nutrient deficiencies? Maybe it's food sensitivities or allergies. Maybe it's low thyroid.

There's things that we just don't often think about. And so what's so satisfying with functional medicine is we're able to actually dig into these things and look and see the why. We say functional medicine is the medicine of why, not what, not what disease you have, which is helpful, but it's not the end of the story. We go, well, why do you have that disease?

And that's the challenge with traditional medicine. It's like you make the diagnosis and you stop thinking. Okay, you've got depression, here's antidepressant you've got insomnia you take the sleep pill oh you've got rheumatoid arthritis take the retrat spill like not why do you have insomnia or depression or rheumatoid arthritis or migraines but like why and and that's what's so powerful so and then you sort of there's some basic sleep practices that are really good we've covered some of this but i think it'd be good to go over it. And I think, you know, and I think it's important to emphasize

that everything matters, sleep, exercise, stress. No, obviously your diet plays a huge role, nutrient status. And that's what we do in functional medicine. So we dig down into it. So talk about some of the other factors around sleep hygiene that we sort of haven't touched on in terms of diet and lifestyle and food and exercise. Sure.

I think first and foremost, we have to recognize that sleep, you know, you and I trained in an era where sleep deprivation or how little sleep you could get by on was a badge of honor. Yeah. So we need to shift that internal dialogue that we all have that, oh, if I'm sleeping,

I'm wasting my time and I'm not getting my stuff done. So first, honor the importance of sleep for your overall health and well-being and even your ability to stick to your intentions around choosing healthy foods and sticking to your exercise plan. Then create a sanctuary that's really conducive for rest and relaxation. Dark, quiet, cool, ideally electronics out of the bedroom or turned off if you can. Getting rid of all of the light exposures, even your chargers, you know, that have that little light. Yeah, like those lights, like those red, green lights on different devices.

I'm like, that drives me crazy. I used to, I had a patient who told me she traveled around with black electrical tape whenever she went to a hotel and she would put it over all the little light sources. I travel with eye shades because you never know where you're going to be. So those two, quiet, calming. And I think this idea that you go, go, go, go, go, go, hop in bed and turn it off like a switch, that doesn't work either. So building in a transition to rest and relaxation. If you can do an hour, that's great. And getting off the devices, not watching TV,

maybe reading a book or journaling or doing something, taking a bath, stretching in the tub. I mean, there's all kinds of wonderful ways to ease into rest and relaxation. I like the hot Epsom salt bath and lavender drops because the lavender lowers your cortisol, the relaxes you and the sulfur and the epsom salt helps you detox that's my favorite as well and then you go to your cool bedroom and you do your legs up the wall yoga restorative yoga position and bingo you've got your transition to rest and relaxation so powerful

and and alcohol obviously is yeah that's a tough one That's a tough one. So the rough analogy is this. It's funny, when they asked partners of people with insomnia, how many of them were suggesting that they have a drink to go to sleep? It was about a third of them. So people think alcohol is going to help you sleep. And it might make you fall asleep. But then as it it clears out of your system there's an arousal it can exacerbate hypoglycemia it makes you wake up it's gonna make sleep apnea worse if you're a woman in midlife oh boy it's a bladder irritant it's a hot flash trigger so it's really affecting sleep in a lot of ways the rough equivalent is there's about an hour of sedation followed by an hour of arousal yeah so if you had a

glass of wine at six and you go to bed at ten it's probably not going to impact your sleep as much as if you have two glasses at eight or like your late dinner last night if you had a glass or two of wine yeah you're here yeah that has another impact on your sleep i just noticed it actually i had an aura ring for a while i was tracking my sleep and I noticed whenever I drank, my sleep pattern was so disrupted. Quality of sleep, the depth of sleep, the amount of REM sleep, deep sleep, snoring, you know, all that. It's really interesting.

And then caffeine also is another big one, right? Yeah, absolutely. And we're all different in terms of our caffeine metabolism ability. Some people are really fast metabolizers. I happen to be one of those. But if you're a slow metabolizer, half of your cup of coffee from noon could still be in your system at 9 o'clock at night. And most of the time, we're not thinking back to that new cup of coffee.

With food, it's really about quality, quantity, and timing of food. It's all three. Yet another area that's impacted with the health of the gut microbiome is sleep. And data is suggesting that people who eat a wide variety of colorful fruits and vegetables tend to have better sleep quality, whereas a highly processed standard American diet is associated with more sleep disruptions and less deep sleep. So quality matters. We already touched a little bit on the timing of eating.

So eating your calories earlier in the day also helps re-regulate those circadian rhythms. So the clocks in the brain and the clocks in the body that are ideally gonna be working in sync with each other, they're influenced by light, by movement and by food. So when we line all those things up during the day, it's going to help us get the rest that we need at night. So important. This is such good information. Stress itself is not bad for us, it can be good for us. And so just just dividing things up in our mind to think about, is this an event? Is this an episode that I can recover from? Or is this a situation in my life that I'm going to live with forever and I have to get used to? So these chronic stressors like having a child with a chronic condition, having a conflictual relationship, job stress.

These are the types of addiction, loved ones with addiction, health problems. I mean, years and years and years go on where we need to be coping with it in a different way because it's not about getting rid of the situation. The acute stressors are really pointing us to just thinking about the stress response in the moment in dealing with an episode within a day. What does that stress response look like? And as you were saying, when we think about the peak stress response in the recovery and how our body does that, it's like a phenomenally beautiful biological process that we are fully equipped with to have over and over without harm, without harm. And in fact, when we shape those stressors to our body to be short-term, brief, and not, you know, kind of moderate, not too extreme, they're

not only not harmful, they're creating all sorts of restorative and anti-aging effects in the cell. And you write about that so well in your book. And that's just, we so easily forget like, oh, we could use this for good. We can actually do things like HIIT or or, um, cold exposure and be conditioning our nervous system, not just our cardiovascular system, but our actual emotional and physiological stress response can get conditioned. Yeah. So there's a lot of doorways in is what you're saying. There's like a lot of doorways to kind of reset the nervous system, right? It doesn't

have to just be your mind. You can use physical states actually of hot or cold or different light or all kinds of stuff. And why not? Yeah, why not? Right, right. You know, right now we're in this incredibly uncertain time for many of us, financial uncertainty, political uncertainty, climate uncertainty. And I think it's kind of a stimulator of exaggerated stress. So

can you talk about how we can learn how to adapt maybe to better or understand how to think differently about uncertainty and the whole idea of uncertainty tolerance? Because that's kind of something we really don't talk about much, but I think it's an important framework for understanding how we navigate our reality and not just get buffeted about by all the stresses that are happening all the time. I think it's important to start where you did, which is naming. We're in a different era. We're in a different place. We have our personal dramas.

We're trying to manage the inherent stress of life and being a human in this modern world. And then on top of that, we do have this layer of more existential stressors of global stressors, climate change, war, famine, drought, you know, the climate events that are going to be coming more and more frequent. And so how does our human mind deal with all of that at once. We're not quite well equipped, but we're not that far off from being able to kind of adopt a new mindset for this new era and strategies. And uncertainty tolerance is core to how we can remind ourselves to not let this primate body overreact, create accelerated aging, make our life miserable, given that we are just surrounded by uncertainty of the future, volatile uncertainty, meaning not just the inherent uncertainty that we don't know what's going to happen tomorrow, but

just the dramatic shifts that we're going to see based on climate and politics and how we create societies as humans. So the ability to simply be comfortable with not knowing is now a core survival skill. And we're all different. We've come with different levels of what we call tolerance or comfort with uncertainty. And those of us who are on the edge of it, the really actually being intolerant and feeling really anxious about when we can't, we don't know exactly our plans tomorrow, how things will go, that is a tremendous vulnerability factor for anxiety and depression. We've always known that. We measured that during COVID. We followed 500 people. And the people who were most rigid about uncertainty and tensed up and couldn't feel ease and relaxation

with uncertain situations, they had much more trauma from COVID, fear of COVID, climate distress. What makes someone more like uncertain than another person being able to tolerate uncertainty and other people not be able to tolerate uncertainty? Have you found that out? It's a really good question. We all come with a different level. And what creates that level? Part of it is personality and openness to new experience. Part of it is really our life experience shaping us. And so when we've had a lot of early trauma, we tend to actually have more of a threat response to things that happen and to things that haven't happened. So that vigilance about worrying about the remaining of the past, but also worrying about the future, feeling that more is at stake, feeling more threatened. So there are lots of ways to

overcome that in your diagram of stress. I love in your new book coming out in february i love your triangle of understanding all the influences on us and our aging biology and you had one layer of stress that people don't usually think of which is we're born into this world wired differently because in of intergenerational trauma that's shaping our epigenetics as well as our experience in the womb for nine months the level of maternal stress that we've been exposed to you know it's interesting i actually i haven't really talked about this on the podcast or much at all and it was sort of recently i had a chance to really dig into some you know deep work on myself and somatic work and other work and kind

of just i've also been reading my mother's book about her life with my father and post-war Europe. It was sort of a fictionalized account of their life. But, you know, you know, I was sort of born into very uncertain place. My,

you know, my father didn't really want kids and, and my mother had multiple abortions. There was, you know, he wasn't really around when I was born. My mother was very stressed. There was, you know, he wasn't really around when I was born. My mother was very stressed and depressed. And, you know, there was a sort of state of lack of safety.

And I remember that even growing up in my early childhood, sort of the dynamics of a marriage that was falling apart and being a little kid watching all that. And my mother being very sick afterwards, just not being able to eat and losing weight and being super depressed and in bed for months. And they were going to put us in foster care. And so there's this whole drama that I kind of had just sort of like pushed back and realized that it definitely set me up to sort of have a more sympathetic activation in my nervous system for most of my life,

even though I mentally, I think I was able to sort of manage it physiologically at registered. And I, and I think that's, you know, something I've really been paying attention to. And as I began to sort of shift into more parasympathetic states, which we'll get into and talk about that, you know, it, it, it allowed sort of this, this resetting of my nervous system and my biology to actually heal and then be happy and enjoy life and do the things that are really important so these these traumas are real and then and they go like they go back generations like i think you know my own my own life and i don't know why i'm talking about this now but you just kind of made me think about it um it's absolutely

real like i just want to say we actually i mean rachel you who does work and others have actually shown our stress response system you know even three generations out from being from a Holocaust survivor as a parent, as a grandparent. We are different. Yeah. I mean, my great, my grandparents were deaf on my mother's side. So they had that stress and her stress of being a child who had to be the parent for them. My dad on his side, his mother was, you know, one of 13 children and accidentally pushed her sister off a swing and she died at two years old. So she was the black sheep of the family and was chronically neurotic and stressed out and anxious. I remember my grandmother, you know, so all these things, you know, you don't think about.

But and of course, many people have far worse traumas than that and, you know, you don't think about but and of course, many people have far worse traumas than that. And, you know, abuse and even worse, but I think it does register in our nervous system. And unless we are conscious about how to heal that, it kind of informs our thinking our life, our way of looking at things and ultimately our illnesses. You know, I remember going to Herbert Benson's course, like in the nineties on the mind body medicine from Harvard. And he said, you know, stress basically either is responsible for causing or exacerbating 95% of all illnesses, which is like, what? Like, and it's, it's something in medical school, we don't really learn about how do we manage it? How do we think about it? How does it work? What does it do? Right.

And we now know the pathways and yet we still don't take it seriously. And that's why it's called the stress prescription, because we're not going to get rid of stress, but there is a way to live with it better. That is absolutely medical, medically relevant. It's a prognostic factor for getting mental and physical illnesses and all of the data, including a recent APA survey, show we are more stressed now than in previous years and decades. But even worse, I think of our youths, 70% are reporting such extreme stress, they don't know how to manage it, it's interfering with their life. These are really serious red flags. We know what that means biologically. It's a leading indicator to the wear and tear on our cells, on our brain, the conditions we're always trying to avoid. So it's a serious prescription that we don't have

to live each day with this excessive level of stress, which really rules out those states that you've been cultivating, which is the restorative states. And it's a beautiful example you gave how you are consciously changing them because it's not our fault. There's no judgment. We all come out with different levels that question about why do some people expect negative things to happen? They can't stand ambiguity that uncertainty feels intolerable. That's part of it. It's like partly from how our stress response systems are shaped from all these different influences before our life, including our life starting in the womb. And it can change. That's the beautiful thing is like we can rewire our nervous systems. And

I think the difference between chronic stress and acute stress is nothing we mostly think about. But, you know, one of my favorite scientists is Robert Sapolsky, who wrote a book, Why Zebras Don't Get Ulcers, which is essentially the idea that zebras are out there eating their whatever, their grass. And then the line comes and chase them. They all run like crazy, super stressed. And then the line catches and zebra and then who's eating it right next to all the other they really just go back to eating their grass and so they have like a cute cute massive stress and then it goes away um i want i want to talk about how uh you kind of frame um stress in your book around our mind states um and then how our mind can

create physiological stress or conversely can actually restore us to health. And you sort of mapped out these different spectrums of mind states that kind of help us think about how to understand stress, how to navigate it, how to think about discharging it. You know, I say the stress, you know, stress reduction or stress management is not a passive process. It's an active process. And and it's like you have to exercise if you want to you know build your muscles you you kind of have to practice various techniques in order to reset your nervous system from this chronic unremitting stress which is so pernicious and driving so many of our diseases yes so you want to hear about these mind states.

I want to hear about this spectrum of these mind states that you talked about. Yeah. We've been thinking about stress from a different perspective, we and others in the field. So usually we think about how stressed does someone get in the moment? How quickly do they recover? And that's important. We want a quick peak and a quick recovery. And that's a healthy, resilient stress response. But it's not just the action during stress, during events, during tough times. The question really becomes, what are you carrying in your body and mind when nothing is happening, when you are at rest, or at least you think you are. And that's a window into the unconscious level of stress that we're carrying. So when we talk about uncertainty stress, that's where it is. That's because it's a little bit vague and we

can catch that. Mindfulness, mindful check-ins help us just in this moment, like just ask, are you tensing up? Do a check-in with your body, your hands, your face, your eyebrows. So often we are tensing up and we sometimes can identify why. And sometimes we can just remember, oh, right now it's not only okay to relax. It's important for my body. I'm not needing to cope with something. So it's that baseline state or rest state that we're learning is really different in people and is a sign of chronic, low-grade chronic stress that we can actually get to and release through different techniques. So red mind is what we've been discussing about coping in the moment when you're fired up and you need the energy you need the stress response and we just don't want that to kind

of go on and on and have sluggish recovery but otherwise we need that it's beautiful it it's why we're here today that's our survival response then and of, we're triggering it too much as a, you know, humans with an overdeveloped cortex and the more chronic ambiguous threat we feel. So then there's yellow mind state, which is when we think we are relaxed. It's just, how are you walking around during the day? Typical day, where are you at? What's your baseline? You probably do some monitoring, you know what your autonomic nervous system is set at. And that is probably higher than we need to be at. And so that's what we think of as a, our default baseline is actually carrying around a lot of both cognitive load from our thoughts, from different information, screens, demands. So we're a bit activated. And then there's also the unconscious stress that we can become aware of and release. So we want to bring down that yellow mind state to a more true resting state.

And that's the green mind. How do you, how do people start to think about identifying if they're stressed? Because I think for me, I kind of, you know, I didn't really think I was, but I think I sort of, I was able to sort of map out things that, like looking at my aura ring, for example, I could tell my heart rate ability or what's happening. I was in Mexico City for a week and my heart rate ability went down. I went to the jungle in Costa Rica and it went way up, like by three-fold. Yeah. So our bodies sort of register all the inputs, even if we don't think they are.

Yeah. I've learned a lot from monitoring. And I think that's one way to raise awareness as well as, you know, asking ourselves to become mindful of our emotions and our bodily, where we're holding stress in the body, where we're tense. The heart, you know, heart rate tells us a lot of things. But the heart rate variability, we think, is more specific to that balance between parasympathetic and sympathetic. So more related to psychological stress, not just metabolic demands. So it's that's super interesting. So Costa Rica leads you to a different yellow, maybe green mind state, better baseline. I monitored my, with my aura ring, I monitored my heart rate variability during a meditation retreat. And we know that when people slow their breathing,

immediately they have, they can have a decrease in all the sympathetic activity markers and sometimes in heart rate variability during studies. So it's no mystery that doing these practices and doing them for longer can lead to these improvements. And that those are what we call deep rest states when we're really allowing ourselves to feel safe and to let down and let ourselves go into restorative mode. But I was surprised at how long my heart rate variability, my baseline heart rate variability took to change. So it was only two weeks later toward the end of the retreat that my sleeping heart rate variability really improved. And I think that's...

So two weeks of meditation, like hours and hours every day. Yeah. So for me, it wasn't easy to change my baseline, particularly my sleeping baseline, but it was possible. And it was, you know, I was super excited that it finally changed. Yeah. I had, I had, uh, you know, rarely get over 40. And then I think the other night when I was in the jungle and I was in this deep sympathetic parasympathetic state and doing a lot of sort of somatic body work and it went to like in the nineties and I was like, holy crap. Like we, we don't, we don't have, um, a sort of a framework for understanding how these things are so impactful for us.

So I, you know, I realized how much I need to pay attention to the practices that I need to do to actually reset my nervous system regularly. So, so in the book, you talk a lot about some of these practices and that's what the stress prescription is. So I love you to sort of talk about how do we sort of create a lifestyle and a way of thinking about our day and a way of thinking about the beginning and the end of our day and other types of tools or techniques or doorways other than meditation obviously is powerful but there's there's more than that a little bit so you explore that yeah we we have these red mind states that we don't want on all day drains our batteries stresses our mitochondria we have data on daily mood and mitochondria showing it is really sensitive to daily affect this was a

a study with martin picard of columbia and we were measuring the enzymatic activity and so when we when people woke up with more positive emotion and went to bed with more positive emotion they had higher mitochondria which we measured kind of in the middle of the week of monitoring. And when they, you know, particularly at night, so there's this idea of how are we recovering from the day? Can we maintain positive affect at the end of a stressful long day? And we certainly found the chronically stressed participants, these were caregivers, had lower mitochondria overall. But this mood effect pretty much mediated that and overrode that. So that's this pointing us to, we actually know how to increase positive affect quite quickly with gratitude exercises and other ways of thinking and being.

And so how amazing to think that our mitochondrial activity might be under our control in this short term way. Wow. So what are the ways that actually you can affect your mitochondrial activity then? Yeah. Well, to get back to your question about the, how do we live a day without chronic stress? So we might think of red mind as like having, you know, drinking coffee all day and just keeping us in that activated mode. And we want that stress response, but we just want to, you know, use it parsimoniously, not take it for granted. When we ignore it, it can just be on all day and rush, rush, rush. I mean, rushing and packing our day is probably the most common pernicious way that we stay in

yellow and red wine. Yeah. The Okinawans call it hurry sickness. Yeah, that's good. Yeah. They don't, they don't have much of that, do they? We must look so weird to them. Yeah. I mean, in the blue zones, right. Cause it, you know, they just live life.

They just, it's slow and it's, it's about community and people and enjoyment and pleasure and food and hanging out. There's like, nobody's like doing startups and trying to like build a career. It's just, people are just living. And it's this beautiful phenomena that we see. And I think that's a big part of the longevity in these zones. Thanks for listening today. If you love this podcast, please share it with your friends and family.

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