Chronic Stress: Simple Steps to Regain Control

Mark Hyman, MD

Full Transcript

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Dr. Mark Hyman
Coming up on this episode of The Doctor's Farmacy. But our diet, bad, causes physiologic stress. So when you eat sugar and crap, it actually raises your cortisol and stress hormones. A 100%. Even if you're not mentally stressed, it makes you physically stressed.

Before we jump into today's episode, I'd like to note that while I wish I could help everyone via my personal practice, there's simply not enough time for me to do this at this 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. If you're in need of deepening your knowledge around your health journey, check out my membership community, Hyman Hive. And if you're looking for curated and trusted supplements and health products for your routine, visit my website, supplement store, for a summary of my favorite and tested products.

Hi. I'm doctor 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 jump right in.

Dr. Rangan Chatterjee
The World Health Organization, right now, if you go on their website, will say that stress is the health epidemic of the 21st century. That's an alarming statement.

Dr. Mark Hyman
The health epidemic. Wow.

Dr. Rangan Chatterjee
Yeah. I mean, that's incredible. And then

Dr. Mark Hyman
I might fight a little bit with that. I think food per food problem is a big one. Woah. Woah. Right up there.

It's right up there.

Dr. Rangan Chatterjee
Well, what I think stress and food is linked, actually, because

Dr. Mark Hyman
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.

Dr. Rangan Chatterjee
A 100%.

Dr. Mark Hyman
Even if you're not mentally stressed, it makes you physically stressed.

Dr. Rangan Chatterjee
Well, a lot of these things actually, as you know, Mark, work both ways. So, yeah, the poor poor dietary choices, can send stress signals up to your brain. Good food choices can send calm signals up to your brain. Or this has also to do with the gut brain axis, which, you know, you've written about before, I've written about in this book. But, also, I would say it works both ways.

So if you are chronically stressed Yeah. It's quite hard to make those good healthy food choices. And I you know, let's take January. In in the UK, in the US, every January, people are trying to get healthy. Right?

I'm gonna reduce my sugar intake this year. I'm gonna cut out alcohol this year. But here's the problem I've seen is that people can use willpower for a week, for 2 weeks, maybe 3 weeks. But if the sugar or the alcohol was being used to help them soothe the stresses in their life Yeah. They're never gonna 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 to binge on sugar because they're not feeling as stressed.

Dr. Mark Hyman
If you're happy, you know, you're not gonna eat that bag of Chips Ahoyo cookies.

Dr. Rangan Chatterjee
Yeah. Because a lot of 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 Yeah.

Dr. Mark Hyman
It was interesting. Last night, I I, went out. I 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.

Sure. Everybody's and, like, you know, at the end of the day, we went out and had a celebration and I had, you know, 2 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 made me counterproductive.

Dr. Rangan Chatterjee
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 in my book about this chap who I saw. He was a, you know, busy business guy in his early fifties, and what's really interesting about him is that we started to measure something called heart rate variability on him. So heart rate variability

Dr. Mark Hyman
And what is that?

Dr. Rangan Chatterjee
It's, you know, basically, it's a measure of how what 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.

Dr. Mark Hyman
70 70 70 70.

Dr. Rangan Chatterjee
Yeah. But that's actually incorrect. What we're looking for is a high degree of variability.

Dr. Mark Hyman
Complexity.

Dr. Rangan Chatterjee
Yeah. Complexity. And it shows that we're constantly adapting and able to adapt to this changing environment around us. And what was interesting Yeah.

Dr. Mark Hyman
And the worst heart rhythm is got no variability. It's a flat line.

Dr. Rangan Chatterjee
Yeah. So a low heart rate variability is actually indicative that we've got high stress levels in our body. Yes. 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, etcetera, etcetera, 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?

Dr. Mark Hyman
Alcohol.

Dr. Rangan Chatterjee
Alcohol. So he'd open a bottle of wine, he'd have a glass, that glass one glass would turn into 2, 2 2 would turn into 3, and by the end of the evening, he'd have 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.

Dr. Mark Hyman
Lots of coffee. He needs

Dr. Rangan Chatterjee
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, 2 bottles of wine on Friday, and etcetera etcetera. 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 we we discussed about certain things he might be able to do on a Wednesday evening instead of alcohol. Now there was a yoga

Dr. Mark Hyman
massage, do a yoga class?

Dr. Rangan Chatterjee
Well, 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 bottled wine. Yeah. 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 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. Yeah. And and people who will listen 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?

Yeah. Because if you can identify that and change your behavior, it is incredible what you what you can achieve.

Dr. Mark Hyman
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.

Dr. Rangan Chatterjee
Yeah. That that's the beautiful thing about this is that they're not as hard as we think. Mhmm. 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.

Dr. Mark Hyman
Right.

Dr. Rangan Chatterjee
Actually, a lot of this is accessible to all of us. Yeah. But just to put in context, the scale of this problem, Mark, I mentioned what the World Health Organization say.

Dr. Mark Hyman
Mhmm. But

Dr. Rangan Chatterjee
there was a paper in the journal of the American Medical Association in 2013. It was a I think it was an editorial piece which suggested that between 70 90% of what a primary care physician like me sees in any given day is in some way related to stress. Of course. Yeah. But that's these these are remarkable stressors.

Dr. Mark Hyman
Either caused by or made worse by stress.

Dr. Rangan Chatterjee
100%. And I think once people understand

Dr. Mark Hyman
I mean, if you're stressed, your blood sugar goes up. Your blood pressure goes up. Well Your blood vessels get stiff and hard. Right?

Dr. Rangan Chatterjee
Yeah. I mean, I try and explain

Dr. Mark Hyman
this information.

Dr. Rangan Chatterjee
Yeah. I I find that when patients understand what the stress response is, I find they're really engaged in trying to change it. So I 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 2,000,000 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 is 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 gonna help deliver more glucose to the brain. Your blood becomes more prone to clotting so that if you get attacked by that lion bitten, you're not gonna bleed to death.

Yeah. You're gonna survive.

Dr. Mark Hyman
Mhmm. You

Dr. Rangan Chatterjee
know, your amygdala, which is the emotional part of your brain, becomes more reactive. So you're hypervigilant to all those threats around you. That is an appropriate short term response to a threat. Yeah. The problem now, 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.

Dr. Mark Hyman
By Twitter.

Dr. Rangan Chatterjee
By social media, email inboxes.

Dr. Mark Hyman
By CNN, Fox News.

Dr. Rangan Chatterjee
To do lists. Right? Elderly parents we're looking after. You know, 2 parents working in a family. One's trying to rush home from work to pick up the kids, etcetera, etcetera.

Yeah. And for many of us, those short term, 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 gonna lead to fatigue, lethargy, type 2 diabetes, high blood pressure, you know, all from the stress response.

Dr. Mark Hyman
And now we have so many more stresses than we used to. Right? We have the the culture we live in that's stressed. 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 100,000,000 live in poverty or near poverty, which is hugely stressful. I mean, what you know, one of the studies that I I found most striking, 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 where 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.

Dr. Rangan Chatterjee
Yeah. I I I totally agree. And, actually, the first part of my book is actually on meaning and purpose, and it 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 Yeah. In your life.

Dr. Mark Hyman
Yeah.

Dr. Rangan Chatterjee
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 I know you're familiar with. You know, this I saw these 4 circles, and it's where these 4 circles intersect in the middle is your icky guy. 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

Dr. Mark Hyman
Sounds Sounds like you got that nailed, doctor Chatterjee.

Dr. Rangan Chatterjee
Hey. Well, look. I I'm very lucky. I have I now have, in my life, my job I I absolutely love my job. That's that's for sure.

But what's interesting for me is I saw that and I thought, yeah. I want some Mickey guy in my life. That sounds brilliant. I started talking about this concept to my patients. And for many of them Yeah.

They found it a little bit intimidating. They thought, well, how am I gonna find one thing in my life to tick all those 4 boxes? And, actually, when I was giving a talk in London recently, on on stress, this Japanese student put her hand up at the end, and she asked me a question. She said, hey, Doctor. Chastity.

You know, I've grown up with this philosophy, and I've gotta say I find it really stressful. I find it too high a bar to live to.

Dr. Mark Hyman
Yeah.

Dr. Rangan Chatterjee
And what I did in the book is I created a new framework that I use for my patients. I call it the LIV framework. It's a much more achievable way, I think, for a lot of people to find their meaning and purpose. 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 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, but 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.

Dr. Mark Hyman
Right. No. No. You can't change what's happening out there. You just change But

Dr. Rangan Chatterjee
we can make them more resilient to this.

Dr. Mark Hyman
Yes.

Dr. Rangan Chatterjee
And, regularly doing things that you love makes you more resilient to stress. At the same 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 5 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, listen to a podcast. It could even be coming home from work, putting on YouTube, watching your favorite comedian for 5 minutes, and laughing. Yeah. That is very important and very valuable. And and

Dr. Mark Hyman
It makes a huge difference. I mean, I I, you know, I'm not in California doing my, public television show, and I, you know, 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.

Dr. Rangan Chatterjee
Well, there's 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. 54 year old chap, I think he was, certainly mid fifties. He was a local, he he was the CFO of a local plastics company.

And, you know, he was in a good job, earning good money, married with 2 kids. He came in to see me and he said, doctor Chastgy, look. I'm 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.

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 I was looking into all aspects of his lifestyle.

But, ultimately, one thing was quite clear to me is that he never did anything that he loved. So, you know, 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.

He 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, doctor, I don't have time. My work's busy.

At the weekends, I've gotta do all the chores. I wanna 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 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 get your train set out. Now, well, Mark, I appreciate this may not be the advice.

Dr. Mark Hyman
On your prescription pad? Yeah. Well, I did. No.

Dr. Rangan Chatterjee
I'm all for lifestyle prescriptions. Right? And he

Dr. Mark Hyman
Play with train set 3 times a week.

Dr. Rangan Chatterjee
Well, I see what happened. What was fascinating is that

Dr. Mark Hyman
Refills unlimited. We exactly.

Dr. Rangan Chatterjee
But, yeah, it may not be the advice that he was expecting from his doctor, but he said, yeah. Okay. Sure. I'll do that. Then this was in a conventional medical practice.

These were 10 minutes 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. 3 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, Doctor.

Chastgy, 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 poshring 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.

3 months after that, he comes in for a well man check to my office, and he comes in with his with his blood test. I'm about to go through them with him. And I said, hey, how are you doing? Doctor. Shashi, 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?

Dr. Mark Hyman
He had a train set deficiency. Yeah. Or did

Dr. Rangan Chatterjee
he have a deficiency of passion in his life? And when he corrected that passion deficiency

Dr. Mark Hyman
It's true.

Dr. Rangan Chatterjee
Everything else starts to come back online. So Yeah. I wanna 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 Yeah. That's just as important?

Dr. Mark Hyman
It's true. Chronic stress is deadly. It kills us. Literally kills us from heart disease, cancer, dementia. I mean, just literally being stressed and having high stress levels chronically will shrink the memory center of your brain called the hippocampus.

It also makes you gain weight and it causes you to be diabetic and it causes a whole host of other things including depression and infertility and sexual dysfunction. I mean, you name it, stress is, is a killer. So we now understand how stress impacts our biology in a real practical way. It is in fact the biggest thing that's driving so many of the dysfunctions we see around chronic illness, and it either makes worse or causes most of the things we see every day in medical practice. How will stress jacks up your cortisol levels, which then causes your muscles to waste away, your blood pressure to go up, your blood sugar to go up, increases belly fat, causes your memory to go down, and you see this phenomenon of weight gain and some resistance and diabetes ultimately, even type 3 diabetes which we now refer to as dementia.

So when you when you also are stressed, you reduce you produce adrenaline. And adrenaline also makes you feel hyper, anxious, irritable, gets your heart rate up, your blood pressure up, causes your blood to clot more likely, damage your brain's memory center, and just causes a lot of bad problems. So if you're, you know, thinking about your daily life when you are going about your day, if you start off the wrong way, you're gonna be in trouble. And and one of the things we don't realize is that stress is also controlled by what we eat. Our diet plays an enormous role in our stress response.

And so when we eat certain foods, it literally jacks up adrenaline and cortisol. What foods are those? Sugar and starch. Basically, anything that turns to sugar in your body is seen as a biological stress. Even if you think you're happy and relaxed while you're eating it, the consequences in your body are just like those of when you're attacked, by a mugger or you're being chased by a tiger.

The the real physiologic responses that happen in the latest relation to our daily lives are are no different depending on what the stress is. So whether you're running from a tiger or being, you know, being upset with your spouse or you imagine somebody's mad at you and they're really not, the stress response is the same. In fact, stress is defined as the real or imagined threat to your body or your ego. So it could be a real threat to your body like a tiger chasing you or it could be an imagined threat to your ego. Maybe you think your boss is mad at you and is gonna fire you, but actually doesn't think that at all and wants to give you a raise.

You have the thought, the thought creates a stress response. So our thoughts create our biology and we have to learn how to manage our minds in order to manage our biology. And and so wait let's talk sort of a little bit about about diet again because what what we found from the studies is that you know, when you eat food, it's not all the same. Food is information. It's not just calories, and the information in processed food and starch and sugar increase our stress hormones, adrenaline and cortisol.

And, I remember one study they looked at at overweight kids, I think boys, and they teenage boys, and they gave them 3 different breakfasts, an omelet, steel cut oats, and regular oats. What was interesting is that they were all identical in calories. So the calories are the same, and what they do is they to these kids, why don't you go and sit in this room and hang out, read, play games, whatever you wanna do. But when you're hungry, just hit this button and we'll bring you food. And so what they found out was when the kids had the oatmeal, they ate 81% more food than the omelette even though it was the same calories over the course of the day.

And with the steel cutouts, it was still 51% more food. But what was interesting was that they also had a catheter in their blood vessels, and they drew their blood every every little bit. And they found that when the kids ate the oatmeal, it was like a stress response in the body there. Not only their insulin and blood sugar went up, but their adrenaline and their cortisol went up. So when we eat, refined foods, they are hugely damaging.

So just in the same way, you can eat food that actually help reduce your cortisol level. You can actually balance your insulin levels. You can actually reduce adrenaline by eating foods that help you calm your nervous system which are whole real foods. Good healthy fats like olive oil, avocados, nuts and seeds, high quality protein, regeneratively raised animal foods, eggs, chicken, fish, regenerative raised meats. You know, even whole beans and whole grains can be very calming and helpful.

Although if you eat too much starch and you're in some resistance, it can still be a problem. And, and then of course, all the the plant foods, vegetables, they just are super full of phytochemicals, anti inflammatory compounds, stress reducing compounds, and and they're they're really powerful. So when you shift your diet, you're literally gonna change your stress response and change your biology. So what can you do, other than looking at your mindset? Because a lot of a lot of the the stress we respond to is the creation of our mind.

You know, Gabor Mate, who's written a lot about trauma, which is real trauma, he says trauma is not what happens to you. It's the meaning you make from what happens to you. So 2 people can experience the same event and have very different responses, and it can be registered very different in their biology. So it's important to understand that you have to get your mind straight. And that's not as easy as it sounds because we are kinda conditioned to believe our thoughts.

And, you know, my friend, Daniel Ammons says, you know, we should stop the ants in our head, the automatic negative thoughts. Easier said than done, but it's an important practice. Start witnessing and looking at your mind. And some of the practices that I'm gonna share with you now are very effective in helping us reset our minds as well as our bodies. The first is I deal with the root causes of stress.

Right? So there can be physical stresses like a disease. I mean, I had mercury poisoning, Lyme disease, mold toxicity. These create a stress in the body. So you have to deal with whatever true physical stresses there are and get rid of them.

Gluten, nutritional deficiencies, all these all the things that are really driving so much disease. And we we see this in functional medicine, and it really is is looking at the whole scope of what creates balance or imbalance in the body and dealing with that. But once you've done that and there are no sort of objective external stresses, how do you start to reset? Well, you you have to learn to actively relax. It's something we don't get taught.

We don't have to sleep and eat and exercise, but most of us don't understand that we have to actively relax. It's not just sitting on a couch watching TV. It's it's actually helping your body get into what we call a parasympathetic state. And and this is not as easy as it sounds. You can do it through meditation.

You can do it through breath work. You can do it through massage. You can do it through, prayer, through chanting, through yoga, through various kinds of things that help your body reset your nervous system from an overactive stressed sympathetic response to what we call the relaxation response. Meditation is a very powerful tool. It's available to all of us.

It's and it's free. You can learn how to do it online. There's courses and programs. You can read a book about it. It's not that hard to do.

It's basically just sitting and watching your thoughts and not getting caught up in them, but letting them pass using your breath as a as an anchor or a mantra. There's a lot of different techniques out there. Exercise also is a powerful stress reducer. Think about it. When you're running from a tiger, you know, you're producing huge amounts of stress hormones, and then you run and you burn them off.

That's what happens, in the book called Why Zebras Don't Get Ulcers by Robert Sapolsky, who studied, baboons and stress response, actually, in in the hierarchy of baboon societies. And I highly recommend his book, A Primates Memoir, which describes his research. But he wrote another book called Why Zebras Don't Get Ulcers, which is based oh, no. I think that was written by Jon Kabat Zinn. Sorry.

No. I can't remember. Anyway, one of those guys. And and and the book basically said, you know, the zebra's out there eating his grass and hanging out and there's all the other zebras and the lion comes, starts chasing them and they all run like crazy, highly stressed. And then the lion catches one of them and then the lion eats the the zebra he caught.

And then the other zebras just go back to eating the grass even though the lion's still all standing there. So they discharge the stress. We don't. We continue to accumulate the stress. So exercise is a great way to reduce depression, anxiety, improve mood, to reduce stress response in the body.

That's why you often feel relaxed and calm after after exercising. Other techniques are really good. Breath work techniques, saunas, cold plunges. A lot of things that now are being used to help with longevity and biohacking also help to reduce the stress response. My favorite is a a hot steam and a cold dip, and, and that really just kinda cuts all the stress for me.

A hot bath with Epsom salt, very easy to do. There's also some supplements you can take. We use a lot of nutrients when we're stressed. Vitamin c, the b complex vitamins, vitamin b 5, zinc, and magnesium. Magnesium is so important.

It's the relaxation minerals. So I highly recommend that people take magnesium regularly to calm their nervous system. Herbs can be very helpful. Adaptogenic herbs can help you manage stress. The astronauts were using it and the Russian astronauts often took these compounds like rhodiola, Siberian ginseng, cordyceps, ginseng, ashwagandha.

These are what we call adaptogenic herbs that help modulate the stress response. Also adaptogenic mushrooms, chaga, and reishi, and many many others are very effective for helping modulate the nervous system. Look at your mind. Find a way to look at your beliefs, your attitudes, how you respond, think about choices you have. You know, I think, Victor Frankl, who was a Auschwitz survivor, said, in between stimulus and response, there's a pause.

And in that pause lies a choice, and that choice lies your freedom. And I think all of us are just kinda collapsed that stimulus response or we're just reactive instead of slowing down and looking at our beliefs, our thoughts. And he he and in the concentration camp chose not to be angry or mad at his Nazi, captors. I remember, when I was a young medical student, I went to Nepal, and I met with a Tibetan doctor who'd been in a Chinese gulag for 22 years. And I said to him, I said, what was the the hardest part about being a prisoner in this Chinese gulag Gulag?

And he said, well, there were a few times when I thought I would lose my compassion for my Chinese jailers. And I thought, wow. This guy was in jail for 22 years in a Gulag. And, that was his biggest stress was was was thinking that he could lose his compassion for his Chinese jailer. So that just show shows you the power of the mind to relate to your environment in quite a different way.

And I I think the other thing is sleep. All of us are lacking sleep, and sleep is a huge important medicine for all of us. Lack of sleep creates a whole host of diseases, but also increases our reactivity, our stress response. Cortisol levels makes us hungrier, increases ghrelin, the hunger hormone, decreases PYY, the appetite suppressing hormone. So sleep is a big a big medicine when it comes to helping reduce stress.

Dr. Elissa Epel
We are more stressed now than in previous years decades, but even worse, I think of our youth, like, 70% are, you know, reporting stress that they 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, you know, the wear and tear on ourselves, on our brain, the conditions where I was trying to avoid. So it's a it's a serious prescription that we can we don't have to live each day with a successive level of stress and 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. You know, 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 in 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.

Dr. Mark Hyman
And and it can change. That's the beautiful thing. It's like we can rewire our nervous systems. And, I I think the the 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 that, you know, 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 a zebra and then who's eating it right next to all the other zebra, and they just go back eating their grass. And so they have, like, a cute, cute massive stress and then it goes away. I want I wanna talk about how, you kind of frame, stress in your book around our mind states, and then how our mind can create physiological stress or conversely can actually restore us to health. And and you you sort of mapped out these different spectrums of mind states that kinda help us think about, how to understand stress, how to navigate it, how to think about, discharging it.

I you know, I always say the stress you know, stress reduction or stress management is not a passive process. It's an active process. Yeah. And it's just like you have to exercise if you wanna, you know, build your muscles. You you kinda have to practice various techniques in order to reset your nervous system from this chronic unremitting stress, which is so pernicious in driving so many of our diseases.

Dr. Elissa Epel
Yes. So you wanna hear about these mind states?

Dr. Mark Hyman
Here, I wanna hear about the spectrum of of these these mind states that you're talking about.

Dr. Elissa Epel
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 peek 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 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 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 course, we're triggering it too much as, you know, humans with the overdeveloped neocortex and the the, 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 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. Then there's also the unconscious stress that we can become aware of and release. So we wanna bring down that yellow mind state to a a more true resting state.

And that's the green mind. Yeah.

Dr. Mark Hyman
Now how do you how do people start to think about identifying if they're stressed? Because I I think, for me, I kind of, you know, I didn't really think I was, but I I think I sort of, like, be able to sort of map out things that looking at my aura ring, for example, could tell me my heart rate variability or what's happening. I was in Mexico City for a week, and my heart rate variability went down. I went to the jungle in Costa Rica, and it went way up, like, by 3 fold.

Dr. Elissa Epel
Yeah. So

Dr. Mark Hyman
our body sort of register all the inputs even if we don't think they are.

Dr. Elissa Epel
Yeah. I've learned a lot from monitoring, and I 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 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 it's that super interesting.

So Costa Rica leads you to a different yellow mine, maybe green mine state, better baseline. I monitored my with my Oura 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 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 2 weeks later toward the end of the retreat that my sleeping heart rate variability really improved. And I think that's

Dr. Mark Hyman
So 2 weeks of meditation, like, hours and hours every day.

Dr. Elissa Epel
Yeah. So for me, it wasn't easy to change my baseline, particularly my sleeping baseline, but it was possible. And it was be you know, I was I was super excited that it finally changed.

Dr. Mark Hyman
Yeah. I had I I had, you know, rarely get over 40. And then I think the other night when I was just sitting in the jungle, I was in this deep sympathetic, parasympathetic state doing a lot 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 a sort of a framework for understanding how these things are so impactful for us. So Yeah. I, you know, I I realized how much I need to pay attention to the practices that I need to do to actually reset my nervous system regularly. Yeah. 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 a lifestyle and a way 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. Let me sort of explore that.

Dr. Elissa Epel
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 Piccard 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 measure 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 motor 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 in the you know, quite quickly with gratitude exercises and 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.

Dr. Mark Hyman
Wow. So what are the ways that actually you can affect your mitochondrial activity then for

Dr. Elissa Epel
Yeah. Well 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 line.

Dr. Mark Hyman
Yeah. The, Okinawans call it hurry sickness. Good thing.

Dr. Elissa Epel
Yeah. That's good. Yeah. They don't they don't have much of that, do they? We must look so weird to them.

Dr. Mark Hyman
Yeah. I mean, the blue zones are because 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 it's just people are just living, and it's this this beautiful phenomena that we see.

And I think that's a big part of the longevity in these in these zones.

Dr. Elissa Epel
Yeah. That's beautiful.

Dr. Mark Hyman
So

Dr. Elissa Epel
the the mitochondria are responsive most likely they haven't been studied to death like all the other biomarkers in terms of health behaviors and all, but they certainly are related to the hormetic stressors like exercise, increasing them. And, we don't actually we only now, I think, have really good ways to measure them in healthy humans in a monitoring way. So we're learning more and more, but we do know that they tend to secrete the cell, like, lets out fragments of mitochondrial DNA into the serum during acute stress. And so that's not a good thing. That's not a good sign.

That's a sign that our mitochondria are, you know, overstressed and responding to stress with with this excessive, what we call, cell free mitochondrial DNA. So they're outside.

Dr. Mark Hyman
Well, I wonder if that and that's why kind of stress causes fatigue because it affects our ability to make energy.

Dr. Elissa Epel
Yes. I think that's exactly right. And that is a new area. In 2018, we published the first paper showing that chronic stress was related to lower mitochondria. And then we were like, why didn't we measure fatigue and vitality?

You know, because these you would imagine you have low mitochondria, some had as low as people with a mitochondrial disorder, and, you know, that's that is thought to be at the center of both chronic illness and and mental health now, these mitochondria as the source of of aging breakdown. And so I think it's really helpful to think of our mitochondria and what gives them a boost and boosting positive affect, having more of these restorative states, but also the hormetic stressors that they probably love them.

Dr. Mark Hyman
Well, yeah. So let's talk about the hormesis, because this is a really important idea. We think of stress as bad, but there are actually good stresses. Right? And and how do we start to go about thinking about how do we incorporate those in our life as a way of actually impacting our nervous system and the parasympathetic and the sympathetic state, which are often so dysregulated in our culture.

Dr. Elissa Epel
Mhmm. It's interesting to think of really planning regular, like a lifestyle habit, hormetic stress episode. So they're you know, it's very common to be doing ice exposure or sauna or Wim Hof breathing. And those are I mean, to be totally honest, I don't think we have many options in our toolbox for hormetic stress that we know of, and we know how to use safely and find the right dose. So we're people experiment, and it's just a new cutting edge area of stress to really understand how these are affecting aging and and mental health.

And I there is exciting work on depression and and hypothermia, showing that when you can raise your core body temperature even just a few sessions, it can lead to over a month of remission from more severe treatment resistant depression.

Dr. Mark Hyman
And, of

Dr. Elissa Epel
course, the cardiovascular effects are well documented. Rhonda, Patrick just wrote a beautiful review of of what sauna repeated sauna does. So

Dr. Mark Hyman
Oh, wow. What what what's the we'll put that in the show notes. What's the reference for that?

Dr. Elissa Epel
I'll get I'll email that to you.

Dr. Mark Hyman
Okay. That's great. Because I think I think, you know, we we, you know, we think all sauna is nice, whatever. But, actually, these are very therapeutic. And I I know for myself, it's sort of how I managed to get through chronic fatigue using hot and cold therapies just to be able to function.

And, also, just as a just a basic maintenance of my life to for mood, for energy, for relaxation, restoration, it's quite powerful.

Dr. Elissa Epel
Yes. It it is. And, you know, it's beautiful in that it's not medical, so it's doing it's, you know, creating all of these changes in the cell in a dramatic way, same with cold exposure, same with breath holding, the extreme breathing, and then the recovery response. So we're just we're kind of, like, inducing the survival response in short bursts and then the counter regulatory response turning on the autophagy, cleaning up junk in the cell, reducing oxidative stress, free radicals. And and I think in terms of the aerobic stress, I mean, we we've been trained to think, I gotta get into change your clothes, do 45 minutes.

You gotta get the endurance in. And, and, of course, that's important. But what we're talking about, stress fitness, you can go do something for 1 minute, 2 minutes. You change up your your physiological state. Right?

You can go do jumping jacks or sprint, and you don't and you can someone was just encouraging me. I was like, yeah. But you gotta change your clothes so you can get sweaty. And they're like, no. I do it all the time.

You don't. You you do it in your work clothes. So it was interesting just to think, like, no. Just take away all those barriers about how we think you have to be prepared for exercise and be in the right place and just do the, you know, something high intensity in wherever you are briefly, probably, will feel self conscious, but that is really changing up our state. And we also use that in different therapies that are really needing acute psychological first aid for motion regulation.

What do they do? There's all sorts of strategies that are body up like that. So ice, you know, ice on the cheeks is 1 and as well as the push ups or jumping jacks.

Dr. Mark Hyman
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