The Dr. Hyman Show - How Chronic Stress Impacts Your Health And Drives Adrenal Dysfunction

Episode Date: September 4, 2023

This episode is brought to you by Mitopure, AG1, Zero Acre, and Super Simple Protein.  In small doses, stress can be beneficial. However, experiencing too much stress for too long, creates an intense demand for hormones like cortisol and adrenaline to be released. This can lead to adrenal fatigue, or adrenal dysfunction, which could result in burnout, fatigue, weight gain, and so much more. In today’s episode, I talk with Drs. Elizabeth Boham, Izabella Wentz, and Rangan Chatterjee about the link between chronic stress, cortisol, and adrenal dysfunction and how to choose joy to reduce stress. 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. Dr. Izabella Wentz is an internationally acclaimed thyroid specialist and a licensed pharmacist who has dedicated her career to addressing the root causes of autoimmune thyroid disease after being diagnosed with Hashimoto’s thyroiditis in 2009. She is the author of three books on Hashimoto’s: Hashimoto’s Thyroiditis Lifestyle Interventions for Finding and Treating the Root Cause, Hashimoto’s Food Pharmacology, and Hashimoto’s Protocol. Her latest book is Adrenal Transformation Protocol: A 4-Week Plan to Release Stress Symptoms and Go from Surviving to Thriving. Dr. Rangan Chatterjee is regarded as one of the most influential doctors in the UK and wants to change how medicine will be practiced for years to come. He hosts the biggest health podcast in Europe, Feel Better, Live More, which Apple has announced as one of the most downloaded new podcasts of the past year. His first book, How to Make Disease Disappear, is an international bestseller all over the world and has sold over 250,000 copies worldwide. This episode is brought to you by Mitopure, AG1, Zero Acre, and Super Simple Protein.  Support the growth of new healthy mitochondria and get 10% off of Mitopure. Head to timelinenutrition.com/drhyman and use code DRHYMAN10 at checkout. Head to drinkAG1.com/HYMAN to receive 10 FREE travel packs of AG1 with your first purchase. Zero Acre Oil is an all-purpose cooking oil. Go to zeroacre.com/MARK or use code MARK to redeem an exclusive offer. You can get 10% off Super Simple Grass Fed Protein by heading to drhyman.com/protein and use code protein10. Full-length episodes (and corresponding links) of these interviews can be found here: Dr. Elizabeth Boham Dr. Izabella Wentz Dr. Rangan Chatterjee

Coming up on this episode of The Doctor's Pharmacy. Over time, our hormone system, if we've got chronic stress because of our perception of the world around us, or we're not taking time to take care of ourselves, or we have a chronic infection, those chronic stressful events can disrupt and it can get dysregulated. Hey everybody, it's Dr. Mark. In my over three decades of practicing functional medicine, I've learned a few things. Take old age, for example. Aging has long been considered a normal process. We used to think disease, frailty, gradual decline were just inevitable parts of life, but it turns out they're not. The negative health effects of aging are actually treatable if you

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requires ongoing innovation and are dedicated to providing ever-improving formulations driven by the latest in nutrition science. So if you want to take ownership of your health, it starts with AG1. Get 10 free AG1 travel packs with your first purchase. Go to drinkag1.com forward slash hymen. That's drinkag1, the number one,.com forward slash hymen. Check it out. 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 podcast. When we experience stress or any other threat to our well-being, our brain goes on high alert, activating an ancient system designed to protect us from a wide variety of threats and dangers. Unfortunately, modern life is keeping most of us in a state of chronic stress activation.

This puts our bodies in an ongoing state of survival mode and sets the stage for burnout, fatigue, and adrenal dysfunction. In today's episode, we feature three conversations from the doctor's pharmacy about the role of chronic stress in adrenal or HPA access dysfunction. Dr. Hyman speaks with Dr. Elizabeth Boehm about how both real and perceived stress can impact the body, with Dr. Isabella Wentz about her personal story and the stages of adrenal dysfunction, and with Dr. Rangan Chatterjee about how we can reduce stress by choosing to do something joyful every day. Let's jump in. So stress is that real or perceived threat on ourself. And it can be your body or your ego. Absolutely. Right. And it can be, it can be emotional stress and it can be physical

stress. I think that's important to recognize. We could talk more about that because sometimes we always think it's coming from the mind, but you know, we, we appreciate the fact that it's all connected and sometimes it's coming from the body and impacting the mind as well. So it's, it's, it's either real or perceived and it impacts our body and our health. And we know that- And when you say perceived, you mean imagined. So you could think your spouse is having an affair, and they're just late at work trying to make money to take care of your family, and you can get the same stress response as

if he actually was having an affair. Absolutely. A hundred percent. Our mind is really powerful. And it is not always right, right? And it can create a whole bunch of extra stress for us many times, as can, you know, chronic news and our apps and our phones and all those things that create a lot of perceived threat to our health and our well-being as well. That creates a lot of stress. That's absolutely true. So acute stress is something that our body is equipped to handle, right? So a stressful event occurs, and we've got all of the things in place to be able to handle that stress. We have a whole endocrine system. We have hormones. We have cortisol. We have that fight or flight response.

We can run away from that tiger or give a presentation or go run a race. And all of that is really good and important. And we have a body that can do that, right? And we want to be able to handle stress, right? That's good for us. And the problem comes in when it becomes chronic over time and how that impacts our health long term. And we wanted to do this episode because there's this term being thrown around and people talk about it a lot called adrenal fatigue.

And people are always like, well, what does that mean? Do I have it? Do I not have it? And really,, and really how is it impacting my health? It's so true. And I think, you know, we can't change our external circumstances often very easily, right? I can't snap my fingers and change politics or in climate change or in war or civil unrest, or even change the economy. I mean, there's things I do have control over, but there's a lot of things that are real stresses. Or if I have a family member who's difficult or if I have, you know, a health condition that's stressing me out,

I can't control that. But we have tremendous ability to control our thoughts. And our thoughts are things that influence our biology in a very direct way. There's been a lot written about this, a lot of science on this, biology of belief, Unleashing the Power of Consciousness Matter Miracles by Bruce Lipton is an incredible book about how our immune cells, for example, listen to our mind. And Candice Peart, you know, molecules of emotion, the neuropsychoneuroimmunology, how our thoughts are literally communicating with our hormones, our brain chemistry, our microbiome, with literally everything in our body. And so when we let our minds run ragged and stray and wild without learning how to regulate our own consciousness and thoughts, it leads to this chronic level of stress. And even the best of us who learn how to do that, it's still hard.

And you still need to do practices. So we know we're very good at, oh, I know I need to exercise because that's good for my body. And I know I need to eat better. That's good for my body. But most people don't understand they need to sort of reorient and recalibrate their relationship to stress. Because it's never going to go away. It's just how you perceive it. You know, if Woody Allen has a gun put in his head,

he's going to be freaking out and having a neurotic panic attack. You know, if James Bond has a gun in his head, he's like, oh, whatever. And he's going to get out of it, right? Same gun, different person. And I think that's what we all have to learn learn how do we respond to that stress that we have you know how do we respond to it well said so tell me about the symptoms if people are in a state of chronic

stress how how would they know it's affecting their biology because there's there's a whole list of symptoms that we talk about when we talk about adrenal fatigue or adrenal exhaustion. There's a lot of, I think, skepticism in the traditional community, medical community, about this whole idea of adrenal exhaustion. You either, you know, you have Addison's disease, which is an autoimmune disease that nukes your adrenal glands, or you're fine. Right. But it's not really like that. Right. So we have this whole, you know, really the, what people are saying the proper term for this, this situation is HPA axis dysfunction, right? The hypothalamic pituitary adrenal axis,

which are, which are really parts of our endocrine system that handle and manage the stress response in our body. And when it gets out of balance, that that can really influence how we feel. And so we can have, and we'll get into this a little more, we can have HPA axis overactivity, right, or underactivity. And so, you know, but those hormones, all of those different parts of our endocrine system handle when we, you know, handle that stress response in our body. So when there is a, when there is a chronic stress over time, when a lot of cortisol gets produced from our adrenal glands. And at the beginning, as we talked about that, 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, uh, we can get nutrients and, and, 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 don't 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 the whole talk of that HPA axis dysregulation. So it's your hypothalamus, which is in your brain, and 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, right? Yes. Cortisol, norepinephrine and epinephrine, but also DHEA, which is a hormone that gets

turned into testosterone and estrogen, and hormones that impact our blood pressure and electrolyte balance. So it's involved in a lot of things. And it's important to recognize that the pituitary also impacts lots of other hormones in our body, our female hormones, our male hormones, and so our thyroid hormones. It's all really connected, which is interesting as well. So when people are under a lot of chronic stress over time, the cortisol levels are remaining higher than they should be for long periods of time. And so this is a whole feedback loop, right? This system in our body is a whole feedback loop. So that high cortisol sort of

shifts the way that there's a feedback mechanism that occurs. And in a way, the body sort of slows everything down. And so over time, with high levels of cortisol that are getting released all the time, people start to crash. They have like that what they call burnout or, you know, their body sort of just slows down. We see their thyroid slow down. We see 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, you can get dementia, you have muscle loss. You're more likely to get sick more easily you get sick your immune system stops working as well so you're 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 so let's let's drill down into some of the symptoms that people who might have this dysfunction get. Absolutely.

So a lot of times 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 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. 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, you can have cravings for them. You may feel more fatigued when you stand up. You get more tired. You may have low blood pressure over time and low blood sugar over time with an underactive HPA axis. And it's often the syndrome I see 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? Absolutely. So the first stage is, tell us about the first stage and how it progresses to full burnout. Absolutely. 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 they get this um they get a decreased level of cortisol that occurs so initially see high levels initially testing and we'll talk let's we'll talk about the testing in a minute yeah and then over time we see and when 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 you're getting sick more frequently, that's when

you see a lot of low blood pressure, low blood sugar, salt cravings, but just literally you feel that burned out, you're exhausted feeling. So when it's like chronically high and there's 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 circadian rhythm is all screwed. So that's what we do differently than what, you know, conventional doctors often do. So this isn't even a diagnosis in conventional medicine. No, you know, really, like you were saying, if somebody has really low cortisol or really high cortisol on blood testing, they'll call it, you know, 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, for your adrenal glands. The, um, 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, and, 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 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 gonna 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. 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. 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, you know, 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.

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protein. Right now I'm offering the doctor's pharmacy listeners 10% off. All you have to do is go to drhyman.com forward slash protein and use the code protein10. That's drhyman.com forward slash protein and use the code protein 10. That's DrHeiman.com forward slash protein and use the code protein 10. That's one and a zero. I think what's fascinating is, you know, and what we realize is the body has this tremendous ability to heal, right? And we, this is an area where our body can heal. We see it heal all the time. It just sometimes takes a little TLC and some care. And that's where the lifestyle factors really make a huge impact. We work with people to really balance their diet and focus on nutrition. And we can delve into each of these

more, getting good sleep, resting. Resting is important, right? We need to give our body time to rest. And we're living in a world where it's hard sometimes to turn it off and people aren't and so so 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 and breath work and and take time for themselves and turn off the lights at night and you know turn off the computer and the cell phone. 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 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 of us actually do that yeah and get outside and the same thing at night if you are stimulating your eyes with bright light that isn't have all the blue filtered out which is you can see blue black glasses or just getting off screens you will actually stimulate more awakefulness and you will suppress cortisol.

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

touch on it with one of the cases I have because, you know, we'll get into it in a minute, but she was working more in the evening shift. And I think it really is hard for a lot of people with, depending on the shifts that they have to work. But you mentioned that, you know, getting up in the morning, getting outside, getting that sunshine helps for so many reasons. It helps our mood. It helps us fall asleep more at night. And it helps us, you know, our body likes to have regularity and rhythm. And I think that's one thing we really work on with people when they're really struggling

with this is getting them in some pattern and rhythm of, you know, getting a good sleep cycle, getting a good eating cycle, not grabbing and going, not skipping meals. I mean, there's a lot to be said for fasting. You've done a lot of podcasts on this, and there can be really a lot of great things with fasting. But sometimes when people are really, when their HPA axis is really underactive, and it's not working very well and if they've got the signs of burnout or adrenal dysfunction, right? Fasting sometimes for too long can be more stress on their body. Yeah. Some extreme diets can be more stress on their body and they might not be at a point where they

can do it, they can feel good with it, right? They can't get all the benefit from it. So they can still fast for 12 hours, but we might not be fasting them for 16 hours or 18 hours during that time. Well, it's really important what you bring up about food because there are certain foods that actually cause stress in the body independent of your thoughts. And there are certain foods that reduce stress in the body independent of what you're thinking, right? So it's actually food can be a stressor or a relaxer depending on what you're eating. Can you talk about the foods that tend to cause

more cortisol, adrenaline, and stress in the body? And then some of the foods that we would be thinking about that might help reduce that. That's such a great point. You know, if we eat a donut with coffee and sugar, i'm going to an extreme here for breakfast that's not that extreme it's probably the breakfast of most americans that is really stressful on the body right or because it causes this spike in our blood sugar because it gets digested and absorbed really quickly our blood blood sugar goes up quickly and the body goes, oh no, right? It gets stressful

for the body. The body produces a bunch of insulin to help lower it. And then what happens is the blood sugar drops afterwards. And so those ups and downs in blood sugar like that are really stressful for the body. And when the blood- If your blood sugar is dropping, it's a life threatening emergency. You got to go get food. Right, right. So those, you know, if you're, if you're, you know, eating a lot of foods that cause your blood sugar to go up and then drop with, you know, those, those easily to digest and absorb, you know, you have a can, a can of soda. I mean, we're, you know, those things really are stressful for the body. They create this stress, they create the cortisol response. It's one of the reasons we get a lot of weight gain around the belly when we

eat those kinds of foods, because they are stressful for the body. And so instead we want to be really balancing our blood sugar. And before you get into how to fix it, I just want to point out this study that was just so mind blowing when I read it years ago by a friend of ours, Dr. David Ludwig from Harvard. And he took kids that were overweight and fed him three different breakfasts right oatmeal steel cutouts and an omelet same calories okay same calories but different carbohydrate protein different fat what he found was that the kids who had the regular oatmeal, like the quickly absorbed oatmeal, we think oatmeal is healthy, right? It's not like you're having a donut.

Their insulin went up, obviously their blood sugar went up, but their cortisol went up, their adrenaline went up. So the body perceived it as a stress. Whereas the kids who ate the omelet didn't happen. And then the kids who ate the oatmeal were hungrier, wanted more food. So we know that starch and sugar create a biological stress response in the body. And that's bad.

In addition to the fact that the sugar causes a problem, your brain chemistry and your neurotransmitters are talking to your fat cells. And they're telling them when they're under stress to store more fat. So literally stress makes you gain weight independent of what you're eating. So it's really, it's fascinating when you look at weight and other issues, it's so connected. Can you talk about this sort of ancient system that allows us to kind of respond to stress, but how our modern life keeps us in a state of chronic stress and survival mode, which ultimately leads to our adrenal dysfunction. So talk about how that works and what are the symptoms? How do people

know if they have this? Absolutely. And I know that the term adrenal fatigue, maybe it's not like scientifically accurate. There was a naturopathic doctor that coined the term and his initial theory was that the adrenals were actually sluggish and it was a naturopathic doctor that coined the term and his initial theory was that the adrenals were actually sluggish and it was a mild sense of Addison's, but we now understand it's more of an adaptation, right? So we know that it's the way that our adrenal glands and our brain communicate when we've been subject to chronic stress for long, long periods of time. And that initial high cortisol response is what we typically will hear about on the news. Like cortisol, you have cortisol that's too high. That's bad, right?

You have, you know, bad cortisol, bad cortisol, cortisol is too high, but we do need cortisol to actually live, right? So cortisol helps manage our immunity. It helps to manage our, you know, our immune function, our inflammation in the body. It gives us energy in the morning. And we actually do want to secrete cortisol throughout the day, right? Right, right. What most of the people I've seen with Hashimoto's, with chronic fatigue syndrome, with autoimmunity, they actually don't have enough cortisol on board. And they have these flatlined adrenal curves. And part of why this occurs is, you know, our bodies are adapted to

respond to stress. And in ancient times, it was something like a bear chasing us or a lion or a tiger, right? And then we'd produce high cortisol and then we'd get out of the threat, we'd shake it off, we'd go back to, you know, maybe sleep it off, shake it off, whatever. We'd go back to having this healthy stress response. But when we're constantly getting stress signals from our environment,

our body shifts into this survival mode. And in order to like conserve resources and energy, eventually we're not going to be producing lots of cortisol. Cortisol is very, when we're in that high cortisol state, that could be a very catabolic process on the body. And that can be very stressful on the body. And so I kind of feel like it's a bit of the boy who cried wolf syndrome where the body's like, okay, you you're stressed. Okay. I get it.

You're still stressed. You're still stressed. You're still stressed. We're just going to keep cortisol low. So we're going to save it for like when that bear actually comes. Right. So that I can give you a burst of cortisol. And usually this is, um, this is in the evening time for many people so that they will say

I'm so tired all day long. And then I get this burst of cortisol at night. And they don't know that it's cortisol at night. They just think that maybe they're night owls or they just have trouble falling asleep. They'll wake up throughout the night. They have unrefreshed sleep because their body essentially gets out of alignment with our circadian rhythm. So they're exhausted during the day and they're wired and tired at night. And yeah, if you know you go to bed and you're like exhausted and you're like laying there

and you can't fall asleep and you feel wired, that's what she's talking about. It's a very real phenomenon. And I feel like it's not a disease per se, but it is exactly what happens when your body's been under chronic stress for a long time. And there's also a very predictable way of getting out of it. I know people will say they have brain fog. They have trouble waking up in the morning. They have salt cravings.

They might have coffee, caffeine dependencies. They're like, you know, crawling to their coffee maker in the morning. That's probably a sign that you might have some sort of adrenal dysfunction. 3 p.m. crash, feeling hangry, feeling irritable, anxious, like everybody around you is just really draining your energy, light sensitivity, addiction to or dependency on alcohol in the evenings to help you wind down. These are some of the sugar and sugar, absolutely, to give you energy. These are some of the kind of patterns that we see with people in this state. And again, it's not a disease, but it is a very predictable way the body adapts when we're under a lot of stress. Yeah. And I see, you know, a lot of people get low you know, low blood pressure.

So they basically stand up and they get dizzy or they get palpitations or, you know, they feel like they crave salt, like you said. So these are really common things where you see crash in the morning, can't get out of bed in the morning, crash in the afternoon. I mean, can't get out of the boarding, tired and worried at night when you go to bed. These are really common symptoms. And I've certainly had them. i think you've had them and then i bet you people listening i'm going all right yeah i kind of recognize that and it doesn't mean that there's something

fundamentally wrong with you it means you know our bodies are not adapted to chronic stresses there's a great book by robert sapolsky who's amazing i hope you have him on the podcast sometimes but he's a professor at stanford who studied baboon stress responses. Anyway, he wrote a book called Why Zebras Don't Get Ulcers, which is because they basically get chased by a lion. They go full out, total stress response. The lion kills one of the zebras, and then they all go back to eating grass, and they just chill. And we just keep going. We just don't stop running. And I want to hear your story because I think it's an important thing to start with. Yeah, I feel like as healthcare professionals, we go through intense training and there's

so many exams that we have to do and wake up super early and then you stay up the night before and cram. And so I personally think that my fatigue issues really started in college, probably in my first year in college. And I was taking like chemistry, biology, and physics, and I was doing the whole major of that. And then also I thought it'd be really fun to stay out all night to like go to the bars, right? So all the things you do when you're 18 years old and you're, maybe you're, you know, your brain's not fully formed yet. And so my issues with fatigue actually started with my first year in college. And I went from this like really bubbly and bright-eyed and bushy-tailed person that started college to all of a sudden sleeping through my exams, right? So I

slept through one of my final exams. And as you can imagine, like being a type A person, I was like, oh my gosh, why did I sleep through my exam? And I had laid down the day before at like three to 4 PM to just take a nap. And then following morning, uh, my exam was supposed to start at 7 AM. And. and I ran into the exam room at 8 a.m. because I had just woken up. And I was on this journey of like, you're always so tired. Why are you so lazy? Right. I had to eventually like come up with accommodations to to make up for my fatigue so I could study. And I kind of figured out during my second year in undergrad and by pharmacy

school, I just really had a system where I just really learned how to be very efficient and studying and getting things done and very productive in the time with the little energy that I did have. But I did require like 12 hours of sleep a night. And I was just like, you know, I'd wake up tired. I'd be tired all day. And I had to drink like six cups of caffeine to get myself, get like, you know, get my brain working and get myself through the day. Finally, I was diagnosed with Hashimoto's after becoming a pharmacist. And I went to some conference and it was like, oh, you're not supposed to sleep 12 hours a night. And I was like, huh, is're not supposed to sleep 12 hours a night. And I was like, huh,

is that interesting? Finally pursued additional testing. The Hashimoto's diagnosis came. I was like, this is amazing. Finally going to get on some medications to help me. The medications helped a little bit. So I went from sleeping like 12 hours a night to 11 hours a night. I was grateful for that, right? That helped. And then also, but I still had the fatigue and I still had all these like digestive symptoms and acid reflux and IBS. And so I went through a process of really discovering how to get back my own health. And part of that was the gluten-free, dairy-free diet that your books were life-changing for me. I was reading them when I was listening to audio books

on my way to work and getting off of those foods helped me get rid of the acid reflux. But then I still had the brain fog and the fatigue and somebody brought up adrenal fatigue. And I was like, well, this, I Googled it and this was 10 plus years ago. I'm like, that doesn't exist. It's like, you know, clearly this reputable site says it's not a thing.

So I just kind of went on and looked for other things. And finally, the 15th person brought up adrenal fatigue. And I was like, oh, okay, well, maybe this is a thing because I have all the symptoms. And I tried the interventions and I got better. Holy cow, my brain works. I'm waking up early in the morning. I don't need 11 hours of sleep. I'm sleeping eight to nine hours, waking up refreshed. I don't have that anxiety. I don't have the panic attacks. I'm not hangry anymore.

I'm sleeping and it's a refreshing type of sleep. And so that was over 10 years ago. And that was part of my healing journey where I was like, wow, I feel like myself again. Turns out I'm actually a calm and relaxed and happy person. I'm not like anxious and exhausted all the time, right? So the adrenal system has an adaptive response. So it doesn't just fail all at once or doesn't just kind of get dysfunctional at once. What are the stages that people go through and how do people recognize

that so they can actually avert the kind of final thing, which I had, which was chronic fatigue? Usually people start off with that heightened stress response where they'll release a lot of cortisol throughout the day. And typically I think of like, you know, rock stars in a hotel room, like you just have all this energy and you feel like you just drank a whole bunch of Red Bull and you're you can't sleep. You're wired. You're like on the go. You're doing tons of things. Everybody around you is too slow, not smart enough, like they just don't get it. And so this is how people usually feel in the high cortisol state, very like irritable. And they're kind of jumpy right um if time goes on long enough then they'll get on

what i call the cortisol roller coaster where they might start off with high cortisol in the morning so they kind of jump out of bed and they're ready to go but then they'll have a dip in cortisol levels maybe in the afternoon sometimes that's irritability sometimes that feels like anxiety sometimes that feels like getting really hungry or you you know, maybe they need to take a nap at 3 p.m. And then as the day goes on, they'll have another spike of cortisol where they can't sleep at night. They get to bed and they're like, oh, I have a million things to do.

I need to do them. As this goes on long enough, then they'll go into, um, more of the, more of the reversed cortisol curve where their total output of cortisol throughout the day will be lower. And most of the cortisol will be low early in the morning. So they'll have trouble waking up in the morning. There'll be like a person that was an early bird and a early riser will say, holy cow, I just woke up at 930. I like I used to wake up at 6 a.m. and go running.

What is going on with me? And then throughout the day, they'll feel tired. But finally, in the evening, they will get that surge of energy where they'll be like, oh, well, I finally feel alive now and it's time to sleep. Right. And they'll have a hard time falling asleep. And then if this progresses long enough is where most of my clients that I've worked with end up with the chronic fatigue, with the Hashimoto's, with the autoimmune conditions is they'll have flatlined adrenals. So these are people that are waking up tired and they're going to bed tired. Um, and they're

sleeping like I was, you know, 11, 12 hours a night in some cases and feeling unrefreshed. And they're like, well, people tell me to exercise, but I feel worse when I exercise. People tell me to fast, but if I fast, I feel awful. If I, you know, if I get more sleep, I just, you know, I'll try to sleep for 12 hours and I'm still tired. I sleep less and I'm still tired. And they are just, you know, they're really stuck in that state where their body, just every little stressor can be so overwhelming. Like even things, positive stressors can be too much for them. Yeah. I mean, I think that's true. You know, I think the, the, the sense of being exhausted in the morning is really a big deal. It's a rush for the coffee, a sign of, of, you know, just being constantly irritated. It's like, it's like,

think about, you know, if you haven't slept for, you know, a while and you become more cranky and irritable, it's not because you're a jerk. It's just because your nervous system is just fried. And so, you know, we see this and the question is, symptomatically we can diagnose it, but are there tests that we can do to actually help figure out what's really going on? I love recommending tests. I do a lot of them myself. And if I had my way, I would have everybody do various functional medicine tests. I do a lot of them myself. And if I had my way, I would have everybody do various functional medicine tests. The adrenal saliva test can be incredibly helpful for figuring out what your cortisol pattern looks like. Then there's also the Dutch profile, which goes a little bit deeper. It's a urine test and it can, it could look at how your body metabolizes the various stress hormones and how much it's putting out. The tricky part is I've been

recommending this for 10 years now. And then people will say, I went to my doctor and I asked my doctor to test my adrenals. They said, I don't have Addison's. And I'm like, okay, well, you've got to go to a doctor that has integrative mind that is an integrative practitioner. And they're like, Oh, well, I found one, but they're very expensive. And these tests I have to pay out of pocket for. So that's kind of another barrier to getting the help. And then they get the tests, they get them home. And then they're like, but it's been sitting on my shelf for three months, right? And then and then finally, they do the test. And they get the results, you know, a few weeks later, sometimes a couple of months. And it's like six months have gone by

where, you know, I could have told you based on your symptoms that you are, um, you know, if you're chronically fatigued, there's a good chance that you're in that stress response. If you are, um, if you're in that fight or flight mode and you're feeling really irritable all throughout the day and you can't sleep, I'm pretty sure you have too much cortisol. So I do love tests and I recommend them, but I wanted to create a program and a protocol that was entirely based on symptoms and how to reverse and address the symptoms. So people could work with their doctors

and get the tests that they need, or they can really be empowered to take charge of their own health. I don't know if you've had the same experience too. Yes, I think it's so true because I think the, you know, most of the time people walk in and they tell me their symptoms, I can tell them what's going on and then the test will confirm it. And I think we do see stages of the test where we'll see, for example, you know, high cortisol at night and low in the morning or high cortisol all day initially, then it kind of

drops in the morning and then it ends up being low all the time, kind of flat lining. And I think that, you know, that's something that is sort of an end stage process. And, you know, in terms of the sort of treatments and the diagnosis of it, you know, you sort of, you challenge some of the traditional view of this. You say this is sort of doctors talk about this as a bogus diagnosis and dismiss it. Why do you think that is? I think, unfortunately, I think it has to do a lot with the nomenclature where the term adrenal fatigue. It was initially coined where the person that, um, and the, the brilliant people that coined the term and started educating the world about it, the initial understanding of the

mechanism of action behind of what was going on was kind of like a mild Addison's or that the adrenals were not capable of producing cortisol where we know it's more of an adaptive system where the adrenals are capable of producing cortisol. They're just not releasing the cortisol at the right times throughout the day. And so that's what ends up, I think, kind of boggling a lot of people. And some practitioners argue about the terminology. So they'll say adrenal fatigue doesn't exist, but then you'll look at HPA axis dysfunction or hypothalamic pituitary adrenal axis dysfunction. And that is a real thing. And there's published literature around it. And same with like leaky gut 10 years

ago. It was like, it doesn't exist. And then it's like, you go to PubMed and there's like intestinal permeability. So basically, you know, you just have to use the right terminology, I think, for them to get it. But it's, you can call it burnout. You can call it adrenal fatigue. I call it adrenal dysfunction because I feel like it rolls off the tongue a little bit easier than hypothalamic pituitary adrenal axis dysfunction. And it's a little bit more of an updated term to reflect the mechanism of what's going on as far as we understand it these days. The truth is that you can't avoid stress. Stress is just a part of life.

And the question is, you know, how do you define stress? How do you relate to stress? How do you interact with it in a way that doesn't control you or affect you in the way that it could. I learned that the stress is defined as the perception of a real or imagined threat to your body or your ego. So it could be a lion chasing you, that's a real threat to your body. Or it could be you think your spouse is having an affair, even if they're not, your body has the same response as if it's being chased by a tiger or a lion. And I think we don't, in our society, have mechanisms or systems for addressing that.

And not only do we not have systems, but we are exposed to chronic, unremitting stress day in, day out, minute to minute, from the minute we wake up to the minute we go to sleep. And we haven't any structures in our society for really managing that. And most cultures have had ritual, have had prayer, to sleep and we haven't any structures in our society for really managing that. Most cultures have had ritual, have had prayer, have had ceremony, have had meditation, have

had various kinds of rituals that take a pause in life to stop and to reset and to reconnect with what matters and we just don't do that. So what inspired you to sort of write this book and deal with this big, un-often addressed epidemic of chronic stress? Yeah Mark, I think in my first book, How to Make Disease Disappear, I spoke about what I considered to be the four sort of pillars of health as it were, the four things I think have the most impact on our health but also we've got a fair degree of control over food movements, which we've been talking about for years, but equally important sleep and relaxation. And what was quite clear to me is that people were feeding back to me

that the pillar they were struggling with the most, or many of them were, was the whole relaxed pillar, this whole piece about stress. People were sort of thinking about their food and their movement, but they really struggled with stress. And I thought, you know what? Food gets a lot of airtime. Movement gets a lot of airtime. I don't think stress is getting the airtime that it deserves. And that's why I thought, well, I'm going to write a book on stress to really elevate it in terms of of our consciousness in terms of what we're thinking about and you mentioned in the introduction the world health organization right now if you go on their website will say that stress is the health epidemic of the 21st century but that's an alarming

statement the health epidemic wow yeah i mean that's incredible and then i might fight a little bit without i think food per food problem is a big one. Right up there. It's right up there. Well, I think stress and food is linked actually because- Actually our diet, you probably know this, but our diet, if it's bad, causes physiologic stress. So when you eat sugar and crap,

it actually raises your cortisol and stress hormones. 100%. Even if you're not mentally stressed, it makes you physically stressed. Well, a lot of these things actually, as you know, Mark, work both both ways so yeah the poor poor dietary choices um can send stress signals up to your brain good food choices can send calm signals up to your brain or this is all to do with the gut brain axis which you know you've written about before i've

written about in this book um but also i would say it works both ways. So if you are chronically stressed, it's quite hard to make those good healthy food choices. And I, you know, let's take January in the UK and the US. Every January, people are trying to get healthy, right? I'm going to reduce my sugar intake this year. I'm going to cut out alcohol this year. But here's the problem I've seen is that people can use willpower for a week, for two weeks, maybe three weeks. But if the sugar or the alcohol was being used to help them soothe the stresses in their life, they're never going to maintain it long term. So I actually, I agree food is a big problem, but I found with some patients addressing their stress levels means they feel less of the need to, you

know, to binge on sugar because they're not feeling as stressed. If you're happy, you know, you're not going to eat that bag of chips or cookies. Yeah, because a lot of our food choices are dictated by our emotions. And, you know, if we're feeling down, if we're feeling stressed, we feel we've got too much on, actually that sugary chocolate bar or that bag of chips actually helps us feel good in that moment. So short term benefit, but long term harm. But you know, the other thing was interesting last night, I went out, I recorded my public television show for my new book. And it was a very intense day. And I've been really, you know, sort of under a fair bit of

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

Yeah, but this is a story that I think many of your listeners will be able to relate to that. In fact, I tell the story in my book about this chap who I saw. He was a, you know, busy business guy in his early 50s. And what's really interesting about him is that we start to measure something called heart rate variability on him so heart rate variability and what is that it's you know basically it's a measure of how what is the beat to beat variation between our heartbeats now people will think it should be like a metronome you know tick tock tick 70 70 70 yeah but that's actually incorrect what we're looking for is a high degree of variability complexity yeah complexity and it shows that we're constantly adapting and able to adapt to this changing environment around us and what was interesting to him the worst heart rhythm is got no variability it's a flat line

yeah so a low heart rate variability is actually indicative that we've got high stress levels in our body and this chap actually on a Wednesday evening, he would find that he was drinking a lot of alcohol. He wasn't sleeping well. He was having a lot of caffeine on Thursday, more alcohol on the Thursday. He was basically, he came in, he was really, really stressed. It was impacting his relationships, impacting his sleep, etc., etc.

The very common story. But as we start to look at his life and actually use HRV, heart rate variability readings, we could see that everything changed for him on a Wednesday. So what happened on a Wednesday lunchtime, he had a team meeting, right? He found that incredibly stressful. He had to present to his team, you know, it was quite a high pressure meeting and that stress would last throughout the day so what would happen is on a wednesday late afternoon when he would leave work he had to compensate with that stress how would he do that alcohol alcohol so he'd open a bottle of wine he'd have a glass that glass one glass would turn into two to two would turn into three and by the end of the

evening he'd had the whole bottle of wine so what happens then he doesn't sleep well on the wednesday nights so thursday morning he's feeling groggy he needs lots of coffee lots of sugar to get him through coffee in the afternoon as well which again impacts his ability to sleep on thursday nights he's not feeling good and that cycle continues where he's having a bottle of wine on thursday two bottles of wine on the Friday, and et cetera, et cetera. But what did we do? We identified his trigger point was a Wednesday lunchtime. So I could show him that on the data, he could see it very clearly. So we discussed about certain things he might be able to do on a Wednesday evening instead of alcohol. Now, there was a yoga class very near his office. So before he went home, he went to the yoga class.

So what happens then? He goes to that yoga class. That helps him de-stress. When he gets home, he no longer feels the need to drink a bottle of wine. So he might have a glass, but it's one glass and it stops there. He sleeps well. Thursday, he feels fresh. He doesn't get as stressed at work. He

doesn't have as much coffee. And before you know it, all we had to do was give him a yoga class on a Wednesday afternoon. And suddenly that changed his whole week. And people who are listening to this, I'd really ask them to reflect on their own life and think, actually, is there a trigger point in my week where things start to go downhill? Because if you can identify that and change your behavior, it is incredible what you can achieve. It's true. I mean, most of us understand, you know, we need to eat well. Most of us understand how to exercise and what that means. But very few of us understand how can we actually deactivate that stress response, activate what we call the relaxation response or the healing response in the body

in a deliberate methodical way, just like we exercise or eat well. And I think those are skills we never learn that are hard for people to understand how to incorporate. And yet they're pretty easy to do and they're actually fun and you feel amazing after. Yeah, that's the beautiful thing about this is that

they're not as hard as we think. They're quite simple. Most of them, I think pretty much all of the recommendations in my book, I think are free. Like literally you don't have to buy fancy equipment or fancy apps. Actually, a lot of this is accessible to all of us. But just to put in context the scale of this problem, Mark, I mentioned what the World Health Organization say. But there was a paper in the Journal of the American Medical Association in 2013. I think it was an editorial piece which suggested that between 70% and 90%

of what a primary care physician like me sees in any given day is in some way related to stress. Of course, Of course. These are remarkable statistics. It's either caused by or made worse by stress. 100%. And I think once people understand...

I mean, if you're stressed, your blood sugar goes up. Your blood pressure goes up. Your blood vessels get stiff and hard, right? Yeah. I mean, I try and explain this. Create more inflammation. Yeah. I find that when patients

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

survive you know your amygdala which is the emotional part of your brain becomes more reactive so you're hyper vigilant to all those threats around you that is an appropriate short-term response to a threat yeah the problem now mark Mark, is that for many of us, our stress response has not been activated by wild predators. It's been activated by our daily lives. By Twitter. By social media, email inboxes. By CNN and Fox News. To-do lists, right? Elderly parents we're looking after. You you know two parents working in a family one's trying to rush home from work to pick up the kids etc etc yeah for many of us those short-term uh responses that are so helpful become harmful so if your stress is going up every day right and

blood sugar going up for a short period of time is not a problem right but if that's happening day in day out to your email inbox, well, that's going to lead to fatigue, lethargy, type 2 diabetes, high blood pressure, you know, all from the stress response. Now we have so many more stresses than we used to, right? We have the culture we live in, the stress, we have the toxic food system, we have the chronic amount of financial stress that most people feel. I think, you know, 40% of Americans can't withstand a $500 emergency, a hundred million live in poverty or near poverty, which is hugely stressful. I mean, you know, one of the studies that I, I found most striking, uh, a number of years ago was that more than a poor diet, more than smoking, more than lack of exercise, that socioeconomic status and a lack of sense of control

of your life really stress is the number one predictor of death and disease and i think it's something we don't really appreciate and we don't as physicians really learn how to address it how to measure it and how to help treat people yeah i i totally agree and actually the first part of my book is actually on meaning and purpose and it's relevant to this because not having that control over your life not having a sense of meaning not having something to get up for every day that is arguably the most stressful thing in your life even if you're doing everything else right if you don't have that and you know a few years ago i came across this japanese concept of ikigai you know which i know you're familiar with you know this i saw these four circles and it's where these four

circles intersect in the middle is your ikigai you know when you are doing something in your life that you're good at something that you love something that the world needs and something that pays you money yeah and i thought that's how Sounds like you got that nailed, Dr. Chatterjee. Hey, well, look, I'm very lucky. I now have in my life, my job, I absolutely love my job. That's for sure. But what's interesting for me is I saw that

and I thought, yeah, I want some Ikigai in my life. That sounds brilliant. I started talking about this concept to my patients and for many of them, they found it a little bit intimidating. They thought, well, how am I gonna find one thing in my life to tick all those four boxes? And actually, when I was giving a talk in London recently on stress, this Japanese student put her hand up at the end and she asked me a question. She said, hey, Dr. Chastity, you know, I've grown up with

this philosophy and I've got to say, I find it it really stressful I find it too high a bar to live to yeah and what I did in the book is I created a new framework that I use for my patients I call it the live framework it's a much more achievable way I think for a lot of people to find their meaning and purpose um the L is for love I is for intention V is for vision E is for engage we probably can't go through all of that but you know i i sort of i i use it with my patients to help them start to find meaning and purpose and the first one i think is really important love yeah right so the research on this is super clear regularly doing things that you love makes you more resilient to stress right so you mentioned a lot of americans are struggling that they don't have control over their life. And this is the interesting thing about stress, Mark, is that sometimes we can't, as physicians, change

the stressors in our patients' lives. Right. No, no. You can't change what's happening out there. But we can make them more resilient to this. Yes. And regularly doing things that you love makes you more resilient to stress. At the same time time being chronically stressed makes it harder for us to experience pleasure in day-to-day things so one of my recommendations to my patients is have a daily dose of pleasure even if it's just for five minutes you know can you each day give pleasure the same priorities you might give to the amount of vegetables you have on your plate or whether you go to the gym this could be going for a walk. It could be reading a book,

listening to a podcast. It could even be coming home from work, putting on YouTube, watching your favorite comedian for five minutes and laughing. That is very important and very valuable. It makes a huge difference. I mean, I'm now in California

doing my public television show and I was at the hotel and I was right on the beach. And I went out to the beach and I jumped in the water, swam a little bit. And I came back and I literally just laid there in the sand doing absolutely nothing. And I can't tell you how pleasurable that was to just be unplugged for a minute and stop. And most of us just keep go, go, go all day long and distract, distract, distract. Well, there's obviously the nature piece there as well which is very impactful for stress but let me talk about a

patient i saw recently i think you'll find this interesting um 54 year old chap i think he was certainly mid 50s he was the local um he was the cfo of a local plastics company and you know he was in a good job uh earning good money uh married with two kids he came in to see me and he said dr chassie look i'm sort of i'm struggling a bit i find it hard to get out of bed sometimes in the morning i find it hard to concentrate at work um you know i just feel a bit indifferent to things is this what depression is now i started to chat to him we did some tests i was looking into all aspects of his lifestyle um but ultimately one thing was quite clear to me is that he never did anything that he loved so i asked him you know how's your job he said

yeah it's fine you know i don't really enjoy it but it pays the mortgage pays the bills feeds the family i said okay how's your relationship with your wife? Yeah, so-so, you know, I don't really see her much, but it's, you know, it's fine, I guess. It was very, very indifferent. I said the same about his kids. And I said, do you do, you know, have you got any hobbies? He said, don't judge me, I don't have time. My work's busy. At the weekends, I've got to do all the chores. I want to take the kids to their classes and their sports games. I don't have any time. I said, did you ever have any hobbies? And he said, yeah, sure. When I was a teenager, I used to love playing with train sets. I said, okay, fine. Do you have a train set at home? He said, well, yeah, I've got one in my attic, but I haven't played with it for years. And I said, what I'd love you to do when you get home this evening is get your train set out. Now, look, Mark, I appreciate this may not be the advice.

You write that on your prescription, Pat? Yeah, well, kind of. I'm all for lifestyle prescriptions, right? And he- Play with train set three times a week for 15 minutes. What was fascinating is that- Refills unlimited. Exactly. But it may not be the advice that he was expecting from his daughter, but said yeah okay sure i'll do that then this was in a conventional medical practice these were 10 minute consultations this is in the in the national health service in the uk i we don't get the chance to follow up all our patients we see maybe 40 to 50 patients a day we simply can't

follow them all up i didn't know what was going on with him. Three months later, I finished my morning surgery and I was in the car park about to go and do my home visits. And I bumped into his wife and I said, hey, how's your husband getting on? She said, Dr. Chastity, I cannot believe the difference. I feel like I've got the guy I married back again. My husband comes home from work. He's pottering around on his train set. He's always on eBay looking for collector's items. And he's pottering around on his train set he's always on ebay looking for collector's items and he's now subscribed to this you know this magazine i thought okay that's incredible i still hadn't seen him three months after that he comes in for a well man check to my office and he comes in with his with his blood tests i'm about to go

through them with him and i said hey how are you how are you doing? Dr. Chachi, I feel incredible. I've got energy. My mood is good. And I feel motivated. I said, how's your marriage? Marriage is great. I'm getting on really, really well with my wife. How is your job? Love it. Really, really enjoy the job. So why is that so powerful, Mark, is this. Did he have a mental health problem or train said deficiency yeah or did he have a deficiency of passion in his life and when he corrected that passion deficiency it's true everything else starts to come back online so yeah i want to expand the conversation about stress to go yeah sure breathing nature meditation exercise these things are fantastic and of course i talk about them and i go into the science and the practical implications of people but what about something about passion doing

things that you love it's just as important it's true you know i often talk about what are the ingredients for health and one of them is meaning and purpose and i was just shocked a number of months ago to see an article in the journal the american medical association that people who lacked meaning and purpose had a higher risk of death and disease. I mean, it's just striking. It turns out in the research that it's not just smoking or bad diet or lack of exercise, but lack of meaning and purpose that increases your risk of death. I mean, that's a very striking finding. Yeah, it's amazing. And obviously, the way we look at health, we're looking at all of these multiple inputs that play a role in someone's health. And of course, I'm just as passionate about food, physical activity, sleep, you know, all these things that are critical.

But we've also got to think about those social pieces, you know, our community, the relationships we've got. You know, why do we get up each morning? Do we feel that we've got control over our life? Or do we feel, you know, do we sit in traffic for two, three hours a day in a job that we can't stand for a boss who doesn't value us? The reality is that that is the case. You know, we've got to have to think about with our patients how we tackle that. Of course, not all our patients can leave that job, right? So I'm passionate. And I've used these tips that I've, you know, the book is i've used these tips that i've you know that the book is full of so many tips so people can literally choose the ones that are relevant for their life but i have worked in deprived areas in the uk for many years and these tips also work

for people in deprived areas on low incomes because the common criticism of wellness is that it's just for the wealthy it's for the middle classes and i'm passionate to say no it is applicable to everyone you give people these tools of nature of passion of um you know a quick five minute workouts even if you're living in a in a lifestyle that you don't enjoy that there are lots of stresses in your life, you can help process that stress. You really can, and it can make a huge difference. And one of the things that people don't realize is they think stress is subjective, but it's subjective, right? It's the perception of how something impacts us. It's our beliefs about something, right? So I think if that's true, then how do we sort of create a different mindset so that when something happens, you know, it's not stressful. And I think for most of us, we get caught in this vicious cycle

of stress and worry about things that are not really worth worrying about. And I think it's our beliefs about it that make it seem so. And I think there are real things to worry about. You know, if you have income issues, if you have, you know, real trauma in your family or, I mean, there are real things that are going on that are stressful. Like my dad died last summer and that was very stressful for me. But I think there are ways of looking at changing our mindset. So can you talk about how that works? Yeah. Well, I think there's a couple of things to say there. I think when it comes to stresses,

I think we need to think about what we can control and what we can't control. Many of us, I have for years spent time and energy worrying about things I have no control over. And that's something that I've changed a lot in my life. I've really had to work hard on that. And once you get into that mindset, it's amazing how your stress levels just come down because so many of those things like traffic, I can't do anything

about traffic. I just don't let it worry me anymore. I'm just like road rage, Dr. Chan. Hey, you know, I, if I'm honest, seven, eight years ago, you know, when I was a carer for my dad's, when I was working a busy job, when my kids were very young and wasn't sleeping very much, you know what, if I was driving to work and someone would come in front of me or cut me up, I'd probably get quite agitated if I'm honest. But now I just don't. I'm like, ah, they're probably having a bad day if they're sort of screaming at me from the window. And I'm just a lot more chilled and relaxed. I mean, you give your power over to other people if you let them affect you that way.

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

sweet treats and they might be thinking, which one am I going to have? You know, they'd be daydreaming a little bit. Now, if you go to any cafe, what's everyone doing? They're on their phone, computer. Yeah. And look, to be clear, I'm not criticizing. I will do that as well a lot of the time, okay? But my point is-

Just to be. Just lack of time. You know, it's fascinating. I just went to give a talk at the CIA, the Central Intelligence Agency. Wow. And it's a highly secure building, Langley. And there's no technology allowed. So you can't bring in a phone, computer, nothing.

Not even a Fitbit. And what was striking to me is that everybody was present. I gave a lecture to 300 people and nobody was on their phone. I was in a room giving a talk to 30 or 40 doctors and health professionals. Nobody was on their phone. And everybody was focused room giving a talk to 30 or 40 doctors and health professionals. Nobody was on their phone. And everybody was focused and paying attention. It was the most remarkable thing. It was like going back on a time machine.

But only a time machine of 15 years. Yeah. That's how quickly things have changed. The iPhone was 2009. Yeah. And I don't think we've realized how toxic that is. Because you may say, well, why does that matter? What's the problem that we're using this downtime to get ahead? You know, we're sending an email, we're quickly

updating our Instagram. Well, I'll tell you the problem with that. There's many problems with that, but we used to think that our brain went to sleep when we switched off, right? When we stopped focusing on a task in front of us, our brain went to sleep. Neuroscience shows us that's not the case. When we stop focusing on a task in front of us, there's a part of the brain called the default mode network or the DMN that goes into overdrive. Now, what does that part of the brain do? Well, there's many things, but two things I think listeners will find really interesting is that part of the brain helps us solve problems and helps us be more creative.

So this is why so many of us get our best ideas when we're out for a walk, out for a run, or we're in the shower. I don't know if it's just me or you. I get my best ideas when I'm in the shower. Totally. When I go for a run or a bike ride and I can just wander off in my head. This is because, Mark, our brain is trying to solve problems for us if we give it the downtime to do that. And I think showers are one of the few places still where our phones haven't, you know, we don't, I don't know about you, I certainly don't take my phone into the shower with me. I'm sure that will change very soon. Yeah, now the new phones, they go down to four meters underwater.

Yeah, I mean, this is why I'm keep trying to swimming actually, because I think swimming is again one of those sports now where you can still do without technology you know even in the gym now people are posting selfies of them doing their workout updating their feed you know and and the dmn is a really important part of our brain and i i go into a lot of companies now to talk to them about employee well-being. And one of my top tips for them is take a tech-free lunch break. Digital detox. Even if it's just for 15 minutes, take a tech-free lunch break.

And last year, actually, I made, actually, it was earlier this year, I made an ITV documentary on stress. And we got to take three or four people, we got to measure their stress levels minute to minute throughout the day for three days. And one chap in particular, he was a manager of his local company. He took his job seriously.

He wanted to lead by example, but he was complaining of stress. He was thinking, he was complaining that he was drinking too much alcohol. His relationship with his wife was under strain and he was always tired. Now we measured his stress levels. It hrv heart rate variability and we could see that actually on his work day his stress levels would climb throughout the morning at lunchtime he would work through his lunch and they'd keep climbing and all afternoon as well they were just constantly elevated he would go home late he He would drink alcohol to unwind. He wouldn't be present with his wife. That would cause issues. He wouldn't

sleep well. And the cycle would continue. All I changed with him, Mark, was I said, okay, look, I want you to take a 15 minute break at lunchtime. I want you to leave your phone in your drawer and go outside for a walk. He was very lucky he had a rivet nearby and we can maybe touch on why nature is so important. So all he did was for 15 minutes at lunchtime, he went for a walk in nature without his phone. Now, when we re-measured his data, objectively, his stress levels were right down,

but subjectively, what did he say? He said, Dr. Chachi, I feel like a different person yeah i'm more creative in the afternoon i enjoy my job more i'm leaving early now rather than late it's not just on time i'm leaving early i'm drinking less alcohol and my relationship with my wife has improved yeah so this is what i call the ripple effects right one small thing it's powerful so when we say that wellness is for the middle classes, well, hold on a minute. Who doesn't have the ability to have a 15-minute tech-free lunch break?

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