Dr. Elissa Epel: Control Stress for Healthy Eating, Metabolism & Aging | Huberman Lab Podcast

welcome to the huberman Lab podcast

where we discuss science and

science-based tools for everyday life

I'm Andrew huberman and I'm a professor

of neurobiology and Ophthalmology at

Stanford school of medicine today my

guest is Dr Alyssa eppel Dr eppel is a

professor of Psychiatry and Behavioral

Sciences at the University of California

San Francisco she is also the director

of the center on Aging metabolism and

emotions Dr eppel's laboratory focuses

on stress and the many impacts that it

has on our brain and body both negative

and positive for instance our laboratory

has shown that particular forms of

stress change our telomeres which are a

component of the genetic Machinery of

ourselves that impacts how quickly our

cells and therefore we age we also

discuss exciting work from Dr Apple's

laboratory exploring how stress impacts

our behavioral choices in particular

which foods we elect to eat and how we

experience those Foods today you'll

learn how stress and your interpretation

of your stress impacts the different

aspects of your biology and psychology

you'll also learn about several

important stress interventions that Dr

Apple's laboratory has explored

including Med meditation and breath work

can profoundly influence the way that

stress impacts your brain and body both

For Better or For Worse she's also

explored how specific dietary

interventions such as omega-3 fatty acid

intake impacts stress and our response

to stress and a key and important

feature I believe of Dr Apple's work is

how stress and stress interventions vary

in their effectiveness depending on

whether or not the subjects in her

experiments are male versus female and

their social status by the end of

today's episode I assure you you will

have a much more thorough understanding

of what stress is and how it changes our

biology and psychology as well as the

specific stress interventions that are

going to be most optimal for you in

reducing the negative effects of stress

on the aging process and on negative

behavioral choices and also how to

leverage stress in order to maximize the

positive effects that stress can have on

cellular metabolism mental health

physical health and performance to learn

more about the work from Dr eppel's

laboratory as well as to learn more

about her books entitled the telomere

effect and now more recently the stress

prescription you can find links to those

in the show note captions before we

begin I'd like to emphasize that this

podcast is separate from my teaching and

research roles at Stanford it is however

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livemomentous.com huberman and now for

my discussion with Dr Alyssa eppel Dr

eppel welcome thank you so great to have

you here we have colleagues in common

and topics of Interest related to our

Laboratories in common so I've got a lot

of questions today I'd love to just kick

off by you explaining a little bit about

the different forms of stress you know

we hear stress stress is bad stress can

kill us no one likes to feel stressed

Etc but as you and I both know that's

not the entire picture so love for you

to just educate us a bit on what stress

is and what it isn't where it can be

problematic and where perhaps it can

even be beneficial so as a stress

scientist it is

a word I use a lot but it has to be

broken down because it has so many

different kind of dimensions and

meanings so there's good and bad stress

there's acute and chronic stress and you

know technically it just means anytime

we feel overwhelmed that we feel like

the demands are too much for our

resources so that's kind of a very

technical way to put it but really so

much of life is about meeting challenges

and we're never going to get rid of

different stressful situations in life

if anything they are increasing and so

it really comes down to

not the stressors of what happens to us

but really how we respond the stress

response so that's a distinction that

we're still trying to get the field to

talk about stress in a more specific way

so that we can think about well what

situations are in your life

they might be difficult ongoing

situations like caregiving or work

stress or worrying about

Health your own or someone's

and then there's how are you coping with

it so when something happens we mount a

stress response and we recover and

beautiful no harm done we need that

that's why we're here still alive is

that survival response it's it's a

problem these days of just we keep it

alive in our head we keep it alive with

our thoughts our thoughts are the most

common form of stress

even though I expected we would get into

tools to combat stress a little bit

later

since you have now told us that our

thoughts are the biggest sort of

propagator of internal stress

what to your knowledge is the best way

or what are the best ways

for us to manage overthinking and

ruminating on stressful topics because I

certainly experience stress and when I

do I have tools related to you know

breath work running exercise sleep

non-sleep deep rest I'm a huge fan of

all these sorts of things but when we

succumb to stress and the thinking

patterns take over

where the gears are turning and they

won't stop turning what does the science

tell us about ways to manage those

thoughts should we work with them in the

sense that we try and rationalize

um or understand the basis of the stress

or should we try and divert our thinking

away or is there some other tool that

I'm aware unaware of yes yes both and

right so I like to bin it in three

um three categories so one is we well

I'll just say first of all we have to

have some awareness of how our mind

works or we're just like you know a

subject to thinking our thoughts are

real thinking that it's helpful to keep

ruminating and problem solving because

that's our tendency is to go toward

whatever we think there's threat or risk

and to problem solve that but you could

just be stuck there all day in this kind

of threat mode or red mind State and

that's just a shame we don't need to

turn on that that stress response all

the time

it's where we are as a society so that's

why I I wrote the stress prescription

take any survey even pre-pandemic and

people feel the majority of people feel

an overwhelming amount of stress so even

this past year 46 of adults report

feeling overwhelmed by stress and then

you break it down you're like oh this is

really bad for young adults and women

and people of color and so we have these

you know

groups that are targeted for

marginalization that are feeling

an extremely high amount of stress in

most of those subgroups so bottom why

don't you argue that most most everyone

is feeling more stressed now or is it

just or what do the data say yeah so

I think that

we come with different levels of

awareness of our stress and so when I

find someone who really doesn't feel a

lot of stress sometimes I can see right

through that and they're just not aware

and sometimes it really is true they

they're often in a different stage of

life and they control their environment

a lot and they've been through a lot I

mean one of the

big patterns in the

population levels of stress is that the

older people are less stressed period if

you're over 65 you have been through so

much solved so much you just have a

better perspective on life and on

stressors and then our adults our young

adults have like four times the level of

stress as our older adults so so we do

you know we don't have to wait till we

get older but there certainly is true

wisdom and resilience that comes with

age for many people

um often we're so used to feeling daily

stress from our Urban and Modern Life

that we're we don't notice it we're just

used to it and so we're going through

the day with kind of like clenched hands

and just you know for listeners just

even just taking a check in now and

noticing

how you might be holding stress in your

body that's a huge clue it's a huge

place where we accumulate tension so we

might not be aware that we're stressed

but we're crunching our hands and in

fact

um

my taxi driver who drove me here

um

let me know that he's exactly that point

that he doesn't realize he's stressed

until he realizes that he's tensing his

shoulders and his fists and so great

signal you know doing a check-in to like

notice where in our body we're holding

stress is step one to releasing it

so um going back to this notion of

overthinking what are the tools that

um are most efficient for

dealing with overthinking or ruminating

uh when people just can't seem to let go

of the thing that's the stress or

thinking about not the stress in their

body but the thing that caused the

stress the difficult conversation the

thing that irked them on social media or

in their personal life or professional

life or simply out in the world

so I I wish I had one answer but I'm

going to say lots of strategies tackle

that and so in those three bins one are

top-down strategies of awareness and

things that we can say to ourselves

since our beliefs and mindsets can

really help us release stress view

stress more positively the second bucket

is

um not that the Mind changes the body

but the body changes the mind and those

are the set of strategies that you tend

to use the most right where where we're

working stress out of the body we're

metabolizing it we're burning it up and

we get relief changes are you know

amygdala activity and moves us to more

an experiential state where we're more

in our somatosensory cortex and then the

third bucket is change the scene just

getting away from

all the stress triggers that we have in

our office or in

um in the city and being an environment

that we find calming it might even be

just be a corner of the house but

implanting what I call safety signals

where just these animals that are

conditioned to signals whether we're

aware of it or not so having having

things like comforting pets pictures

smells music

why not we need those they help they add

up yeah I like the idea of having a

small physical space or I suppose it

could be a large physical space but for

most people who don't have the resources

some small pre-designated physical space

that represents a safe Zone

um and uh creating or I should say

populating that safe Zone with things as

you said

um as a visual neuroscientist originally

I guess now I study stress um but uh as

a visual neuroscientist we know that

photographs are extremely powerful cues

for the memory system especially actual

physical photographs

um

and I I believe there is some work on

this that if people keep a photograph of

something that draws positive memories

that that photograph actually they keep

it with them that actually can be a

positive cue for alleviating stress and

just enhancing mood

um this has probably done less so

nowadays because everyone keeps things

on their phones and it's just kind of a

scroll through but um in any event

you know when we talk about stress

uh it's clear that there's short-term

medium-term long-term stress you've

studied all these different forms of

stress

um if you would be so kind as to just

give us an overview of the different

forms of stress uh how we can learn to

recognize those and then I'd love to

transition from there into talking about

some of the work that you've been doing

on stress and stress related eating and

stress and how it relates to Aging in

particular but before we do that

um to get make sure everyone's on the

same page

um if you could just uh pepper our minds

with knowledge about stress and all its

um beautiful and not so beautiful forms

so

when we think about

stress we usually think feeling stress

you know reporting stress and that's

important what are bodies doing is also

important it's not always related to our

minds so measuring levels of the nervous

system and how Vigilant we are is

another way that we can understand

stress and that's particularly important

and interesting because that's how

stress gets under the skin and we might

not be aware we might not report stress

but we're still holding tension and

being much more

sympathetically dominated meaning that

we're our body is Vigilant and scanning

for cues and we don't feel safe and so

we're mobilizing a lot more energy than

we need to

and stress is so expensive to the body

the stress response uses a tremendous

amount of energy ATP that's made by your

mitochondria and if we have that kind of

vigilant stress response on all day

we're just going to feel exhausted and

we all feel exhausted at this stage of

the kind of long shadow of the pandemic

and it's really no mystery because we're

not good at turning the stress response

off and that's what we want to really

focus on is understanding we need to

mount a big stress response to cope with

things when we need extra energy but

then we can actually let our body

relax and we can turn it off and that's

where the rumination comes and we want

to catch ourselves rehearsing and

reliving stress or worrying about the

next thing saying right now I'm safe and

you know there's the breathing

strategies I'm right with you where

those are the most direct and fast path

to reducing stress in the body period

yeah our colleague David Spiegel our

associate chair of Psychiatry at

Stanford and also a colleague of yours

um as well

um has I think said it best which is

that breathing is unique among the

functions of the brain because it really

originates as a brain function and then

extends of course to the body in that it

represents a bridge between the

conscious and the unconscious because at

any given moment we're breathing

and of course at any given moment we can

take control of our breathing there are

very few brain circuits that impact the

body in that way like I can't suddenly

just change my rate of digestion because

I decide to but we can do that with

breathing

we will definitely get into some of the

um work that you've been doing on breath

work particular I know you have a study

that's actually explored the Wim Hof

method quite directly one of the few

studies I'm aware of that's done that so

we'll get to that a little bit later

um so you describe stress as a way that

the body and mind mobilize energy yeah

and I didn't quite answer your question

so there's there's that acute stress

response when everything every hormone

and cell in our body is having a stress

response and that is allowing us to

reorient focus problem solve it's really

beautiful how much we can increase our

capacity to do things during stress and

then if it you know lasts minutes or

hours we eventually recover and

that is

um what happens all day in a small you

know to small extents with daily

stressors we don't necessarily get so

threatened that we release a lot of

cortisol but our nervous system is going

up and down all day then there are then

there's kind of moderate stressful

events that maybe take days or months to

cope with and what's important there is

that noticing like right now am I really

coping acutely with something or can I

restore so that kind of daily

restoration is very important and then

there are chronically stressful

situations that go on for years many of

us not all of us but many of us have

those in our life These are situations

I'll just use caregiving as an example

of that we can't change we we can't

change other people we can't change

certain situations or resources and we

can

be thinking about them

chronically problem solving trying to

wish things were different

or we can use acceptance radical

acceptance strategies and other

strategies to live well with them and

and so that's a really important

strategy for people who

feel like their their life is going to

be stressful forever because of X or Y

that that's not true you have a harder

life you're going to do more coping but

you can actually be dealing with

uncontrollable chronic stress

in ways that it's not going to take that

toll on your body I mean I study chronic

stress and how it accelerates cell aging

and I can tell you there's so much

variance between people people are so

different so among caregivers some of

them look as biologically young or

younger than our controls people with no

identifiable big tough situation in

their life

I'd love to hear about the um lack of

inevitability around aging and stress I

I realize that there's a big landscape

of of discussion around aging and stress

for us to cover but since you brought it

up in one of your papers there's a

beautiful graph and since a lot of

people are listening not watching and we

don't use visual diagrams for that

reason

I'll try and explain this as best I can

you distinguish between optimal aging

typical aging and accelerated aging I

think everyone

I can imagine would want optimal aging

right certainly not accelerated aging

and what's interesting about this graph

in your paper is that well of course it

appears that toxic stress chronically

unmitigated stress that makes us feel

like we are at the world's Mercy or the

other people's Mercy will accelerate

aging

turns out that under exposure to stress

leads to more rapid aging than what you

describe as ideal

amounts of stress in other words that no

stress is not the answer

rather to have some stress is ideal if

you want to have so-called optimal aging

can you explain a little bit about the

mechanisms behind that maybe this is a

good opportunity also to tell us about

your telomere work

so the questions are

how does one measure optimal versus

accelerated aging and why would it be

that some stress is better than no

stress when it comes to aging uh ideally

so

having no stress means we're not really

living like we're not engaging in the

gifts of Life which are inevitably have

some Challenge and risk and let me give

you an example one study took um

elderly people who retired and they you

know Society kind of labels them as

you're kind of done with your meaningful

work in life and

um your you know you are pretty much not

able to contribute to society I mean

there's so many negative stereotypes

that people then kind of embody and then

live

um in this program brought them to work

in schools and tutor young at-risk

students and what happened to them is

they went from feeling maybe safe and

under stressed to feeling

challenged but generative they were

feeling more purpose they were feeling

like they were growing and they were

feeling like their day had more meaning

they had more relationships they had

these caring relationships with the

students the students had all sorts of

issues and troubles drugs and and maybe

not having lunch poverty and so they

felt the stress of that but they also

saw how much they could help with their

support and their tutoring and in these

study they they took images of the

hippocampus and those who engaged in the

program particularly the men actually

had growth of their hippocampus during

this program so at any stage in life we

can be growing and challenging ourselves

even in our much later years and growing

our brain and you know more than anyone

like what is that hippocampal growth

mean for their well-being and their

cognitive function

yeah it's interesting that hippocampus

of course a brain area involved in

formation and recall of memories mostly

formation of memories

um it's super interesting because it's

so plastic it's so amenable to the

addition of new memories I think the

most striking study to me is the one

and I should point out that most of the

data say that the addition of new

neurons is not the main reason for

improvements in memory but it is one of

them

um but Rusty gauged out the Salk

Institute did a study in the I think the

early 2000s where they took terminally

ill people and these people agreed to

have their bodies injected with a Dye

that would label new neurons and then

after they died their brains were

processed

um and they didn't die from the dye

injection by the way folks they died

from other causes they were terminally

ill and what they discovered was that

even in terminally ill or or and some of

these people were quite old those people

were still generating new neurons

especially in the context of still

trying to learn and and acquire new

information so wow um of course they're

dead so they can't apply that

information after that but of course

none of us can right none of the

information but why not up to when you

die right absolutely yeah absolutely one

other example of this my colleague Dave

Almeida he measures you know daily

stressful events in huge National

populations and a small percentage of

people report no stressors and so you

wonder like what's happening are they

not engaging in life are they really not

having stressors it it looks like they

are it's not just that they're not

getting stressed by things they're not

they're not really going out and doing

much and what he found is that their

level of kind of memory and cognition

their cognitive Health was significantly

lower so you can imagine the hippocampal

you know the lack of those

um neuroprogenerative cells they're just

not being stimulated it's super

interesting I wasn't aware of that

result so I appreciate you sharing it I

almost have to wonder if it's like

exercise where you know so many people I

think now everybody hopefully

understands that exercise is going to

lower blood pressure reduce resting

heart rate and proof musculoskeletal

function and bone density all that stuff

but that if you took a snapshot of the

bodily response during exercise

blood pressure is way way up heart rate

is way way up

stress hormones are way up cortisol is

through the roof during a hard workout

immediately afterwards and yet that sets

in motion a series of adaptations that

brings you to a better place most of the

time I almost wonder if stress is the

same

is there any evidence that

short bouts of stress provided that

they're managed well meaning that we

don't spend the next 24 or 48 Hours

ruminating on the stressor but that

we're able to move through the stressor

and resolve it in some way that that's

actually beneficial for us because of

the mobilization of energy stores and

maybe

maybe even changing our threshold for

reacting to stressors in the future

it's a great question and it's one that

I have been chewing on for a while

because we we know as you said that

physical stressors when they're short

and repeated like high intensity

interval training They are promoting not

just aerobic fitness but stress Fitness

people feel less rumination less

depression less anxiety so they're kind

of tuning up the nervous system what

about psychological stressors and we we

know two things so one is I do think

that there is a level of Engagement with

moderate stressors that when we are used

to them we get fit and our stress

resilience builds meaning we're less

threatened by them so let me go deep

into that we can two people can approach

the exact same stressor and one person

is having a pretty overreactive stress

response where they basically are

feeling their survival is threatened so

it's high cortisol High vasoconstriction

and blood pressure goes up equally in

both but the person who's feeling super

threatened either their survival or

their social survival of their ego their

blood pressure went up because of the

vasoconstriction the other person who's

viewing the same stressor as

I can do this this is a great Challenge

and opportunity I have what it takes

those types of thoughts generate a

different hemodynamic response which is

actually more cardiac output so blood

pressure is going up but in this

healthier way more oxygenation to the

brain better problem solving they're

able to maintain this positive outlook

so we've measured the threat challenge

response in many lab studies and we know

lots of things so if you're having more

of the challenge response at the end of

it you're less inflamed so just in the

lab within an hour or two we see that

there they didn't trigger all that

pro-inflammatory response and their

telomeres tend to be longer which is a

measure we can talk more about but

basically it looks like they have a

slower

speed of Aging

that is super interesting you call this

a stress challenge response so we could

call this kind of a

um

to to be really simplistic two types of

psychological stress response feeling

threatened like you're gonna fail you're

embarrassed

um you know that social pain response we

know well that feels terrible

um but that also that huge stress

response when we you know we feel it in

our stomach our heart is pounding it's

just an over exaggerated response that

response biologically is different and

the thoughts that go with it are

different and we recover a lot slower

and then there's the challenge response

which is this it's more of that kind of

activated

um excited response and the beauty is

that there are lots of studies out there

done by emotions and social

psychologists that tilt people toward

the challenge response we can actually

promote that challenge response and so

when you asked about like is it good to

have a repeated stress response

yes if it's if it's manageable right

then we're kind of building the muscle

of stress resilience

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are the sorts of things that

people I can do in order including me I

should say

um can do in order to wage that

challenge response is this purely based

on mindset like instead of saying why me

why this why now I can't believe this is

happening is it a mental pivot to okay

this is a great opportunity for growth

I don't know how I'm going to manage

this but I'll manage this

um you know you want to stop me you got

to kill me type of type of mindset is

that is that the switch that then the

body follows because this is an

interesting instance where

the uh most all the

stress mitigation work that my lab does

is focused on using the body to control

the mind but here we're talking about

the Mind controlling the body first and

then the body following suit which I

find equally fascinating so are there

some specific mental scripts that people

follow and are we all able to follow

those those scripts yes to some extent

we control the script we can use that

script to prepare ourselves going into a

stressful situation and we can use it at

any point during the stress or so some

of us are just wired to have a big

threat response period maybe it's you

know it's uh epigenetics We've inherited

maybe it's early trauma that has shaped

us to be ex have this exaggerated

emotional response and yes we and others

have found that trauma sensitizes our

emotional stress response so that we are

feeling more threatened but that's okay

because that's the part we can't control

and we just have to have a lot of

self-compassion and awareness that okay

the this is what I do my body reacts

like this but what happens next that's

when we can start to use those

statements self-comforting

self-compassion distancing there's all

sorts of statements that allow us to

then recover more quickly

so when we want to shift from a

threatened response to a kind of

challenge response

are there any data that dictate whether

or not we should

keep those statements in our head write

them down say them out loud I guess what

I'm trying to do here is trying to get

to a little bit more of the the meat of

the the actionable so since a lot of our

listeners so I think we'll be

um as I am very excited about the idea

that a mere shift in our mentality about

stress can give us the opposite outcome

I mean before you're talking about

vasoconstriction and inflammation and

all these bad things

to um put it lightly and then

in the challenge response to stress

getting the exact opposite more

vasodilation more resources used and

more positive effects on the brain and

body yeah so what what are some um if if

you can recall from the papers if not

that's fine but I'm just curious what

what those specific tools might be every

statement you said Andrew is good it's a

good one the whole trick here is that

people need to find the the strength

statements the stress Shields I call

them that fit them that that feels right

and that they believe and so they're you

know I list a bunch of options in

chapter three which is called be the

lion instead of the gazelle so the Blind

and gazelle are both you know high blood

pressure high stress and the Lion's

chasing the gazelle but the gazelles

having this total threat

vasoconstriction response because

um she might die lion might get dinner

right so it's needing to mount the

stress response because it's so excited

to get the tasty dinner for you know the

next few days and so the lion is having

that challenge response and so we can

remind ourselves be the lion we it's

it's not that we're always lying or

gazelle we get to shape that and so some

of those statements are well let's say

right when when we're going into it list

your resources why have you ever dealt

with any situation like this remind

yourself of past successes remind

yourself of someone you can call or text

or feel supported by remind yourself

that this outcome is not going to affect

your life in 10 years or five years

that's a distancing kind of um

perspective taking so there's all these

strategies and and you got to use what

works for you telling yourself I got

this I can do it I can get through it I

have what it takes those are all good

Shields and another set is you know

we've some of us feel really stressed

out by stress like once we get feel our

heart racing that leads to oh no you

know this is bad for me and so rather

than than getting stressed by stress we

actually want to remind ourselves that

this stress response is empowering this

is going to help me cope

my body's excited my body is doing just

what it should right now

so that reframing in Studies by Wendy

Mendez and others my my colleagues who

do these reappraisal research they have

basically trained people to view stress

as positive during the stressful

situations in the lab people do better

they perform better they feel more

positive emotion they problem solve

better they recover more quickly so

pretty powerful stuff

yeah that is powerful stuff I'm

wondering if we can talk about the

relationship between stress and eating

and I think that's also a great

opportunity for us to talk about the

opioid system a lot of people are

familiar with the so-called um opioid

epidemic and opioid crisis

um you know sadly you know

far too many people are dying a fentanyl

overdoses and we all know about the oxy

content epidemic and all these people

addicted to opioids and

that's not really what this is about

um what we're about to talk about is the

fact that we have an opioid system

within us that is neurons and other cell

types that can reduce excuse me can

release substances into our brain and

body that make us feel less pain and

make us feel sedated but at a healthy

level right and yet there are a lot of

things besides drugs that can activate

this opioid system

um I think sexo activates the endogenous

opioid system as far as a last read

there was a paper out recently but also

food can do it

um and again to healthy levels um

provided the context is healthy of

course what is the relationship between

stress and eating

and eating and the opioid system

stress and eating is an interesting one

so most people when they feel stressed

or you know I'm just gonna ask you do

you eat more or less when you're

stressed less definitely I feel like I

can go two three days without food when

I'm when I'm really stressed but I came

up in a profession where

um sadly for me all-nighters were

part of the regular until pretty

recently a couple years ago when I just

called an end to that

um and no it wasn't just because of

procrastination it was just work

overload but I can go a long period of

time without eating although I love to

eat so I do point out that I do love to

eat and what does the body feel like

when you're in that stress State when

you're not even hungry you're kind of

shut down in your digestion that I have

enough energy from my neural resources

from adrenaline and

generally those periods of time when I'm

not hungry coincide with a hyper focus

on the stressor the deadline whatever it

is in life that that needs tending too

and um food just doesn't appeal to me as

much it doesn't taste as good and it's

not as enticing yeah so we think that

either type of

um body temperament is high sympathetic

and so when you have a big stress

response your digestion is is pretty

much shut down like it would be the

opposite eating would be the opposite of

what your body's telling you to do I

should I'm just gonna forgive me for

interrupting uh for those of you hearing

sympathetic we're we're not talking

about sympathy we're talking about the

uh the sympathetic arm of the autonomic

nervous system which is the so-called

fight or flight as opposed to the

parasympathetic in any event sorry to

interrupt but want to make sure that

um sometimes people hear sympathy and

then they think emotional sympathy

um I like to think I have that too but

um okay so I so I tend to lean more

towards the sympathetic meaning

um more alertness arousal yeah on the

Seesaw of the autonomic nervous system

and I I'm a High

um sympathetic reactor I lose weight

when I go through like writing my

dissertation I look like a skeleton at

the end

um but that's not what most people

complain about it's not weight loss most

people complain about overeating or

binge eating when they're emotional when

they're stressed and so that's the more

common pattern and what that that looks

different

both in the brain and biologically and

so what it looks like is that the stress

response is driving cravings and also

let's say high insulin or an insulin

resistant State and what goes along with

that is tending to be overweight or have

obesity and so just by whether it's

through conditioning or genetics having

that kind of larger body with a big

stress eating temperament that is a

challenge in life and I've been you know

I've worked with people with different

eating conditions Eating Disorders binge

eating and it is

a um what's hard about it is number one

it's very common and normative to just

feel like

you can't feel satiated so it's this

compulsive eating tendency that stress

brings you to and

so the so what it mean we measure this

is very easy to measure it means that

people feel like they can't control

their eating they don't get full

um they think about food a lot and so

stress kind of exacerbates that tendency

and that is a you know it's a it's a

common phenotype like we've studied it

and maybe 50 of people with obesity have

that

um do lean people have that some not

many like less than 20 percent but what

they also have is this tremendous kind

of uh diet what we call dietary friend

or control over their eating so they're

they're able to

to not overeat even though they're

thinking about food a lot

so that's that is you know that explains

that unusual

body of someone who's really more

um still has those compulsive traits so

why does this matter this makes it

really hard to eat well because when

you're stressed you Dr you're craving

the comfort food the high fat high sugar

high salt

depending on your temperament and that

is

that means with repeated bouts of stress

you're just going to be gaining weight

and particularly in the intra-abdominal

area that's what we've seen we've seen

it cross-sectionally we've seen it in

rest studies in my studies and now we've

seen it in people and many stuff for

about 10 years I study this and the

question was is what's happening in

people the same thing that's happening

in mice if you stress them out and you

give them Oreos the mice develop binge

eating they get really compulsive and

they get this you know terrible

metabolic Health profile metabolic

syndrome where they're they're round you

know they're in their belly fat

basically expands like a cushion and

that's because that's this really good

immediate source of energy during stress

so like we're really well wired to if

our body thinks we're under chronic

stress we're going to store stress fat

or abdominal fat so we can just mobilize

that in a second and then the second

question we've asked is can you reverse

that with different interventions can

you can you block the compulsive eating

um so I can I can tell you what we found

there but the opioid system that you

mentioned is certainly involved and in

studies with people lean people and

people with obesity my colleague rajita

Sinha Yale it's basically found that

when you stress them out people with

obesity are having a different reward

response and they're having their the

more insulin resistant they are the more

their Reward Center lights up during

stress and what's causal there like

what's the chicken what's the egg sir

because I can imagine these were people

that at one time were not obese who got

stressed

the opioid system

reacted in a particularly potent way to

food and they were able to clamp their

stress and so then they become or binge

eaters in the context of stress yeah and

that leads to insulin insensitivity

exactly I could also imagine that they

were insulin insensitive therefore they

need to eat more in order to feel come

of an increase in uh

satiety because we know this

um now based on brain and body

mechanisms and then that set off a

Cascade of things leading to obesity

um not that it necessarily matters but

what's causal do we know I think it

really does matter I think there's been

a you know a mistake of kind of

confounding all obesity with food

addiction and

um and metabolic disease and it's

completely heterogeneous so I I think

it's the developmental path that you're

describing which is that

um there's a tendency toward having a

bigger reward response and hunger during

stress so it becomes a way of coping a

lifestyle and and that is a pathway

toward obesity and so some obese people

have a dysregulated stress response

but I but not all of them I mean it

really is a certain type of person so

that's why we target people with

Cravings in all of our intervention

studies now we want to know who has more

of the compulsive eating type because

they need a different set of skills to

cope with stress and to lose weight if

that's their goal

there's a drug I'm sure you're familiar

with Naltrexone which it can block the

opioid receptor it's used to block the

opiated receptor in the context of

different types of addiction have people

tried to use Naltrexone in the context

of binge eating and does it help people

lose weight because

it presumably reduces some of the

rewarding properties of food

that's one of the very few drug

combinations that has been used for

binge eating so it was a combination of

Naltrexone and Wellbutrin and I'm not

sure at this moment how much

um that's favored for binge eating but

certainly the early trials showed that

it really does damp down on the

compulsive eating interesting so is that

a commonly prescribed uh kit of drugs

now for for obesity I know there's a lot

of excitement nowadays about these

semi-glue tied yeah

um uh analogs because they do seem very

effective in blocking hunger especially

in type 2 diabetics I don't know if

you're familiar with but right they're

sort of all the rage uh mostly because

people saw the before and after photos

of Elon he had his shirt off on a boat

and there were some not so nice comments

made about him and then sometime later

he was quite a bit lighter and um he

announced that he had been taking one of

these semi-glue tied agonists yeah yeah

I really hope that we come up with

um safe and effective drugs and one

thing to think about is that the the

challenge that we all have particularly

for prone to obesity is the toxic food

environment and particularly the refined

sugar and regardless of what we're on

Metformin or one of these drugs we

override it with our diet and and really

the improved nutrition is the only way

to solve it as a public health problem I

mean the drug companies are saying

everyone should be you know everyone

with a certain I should be on one of

these new drugs and it's just rubbish

and it's not going to lead to long-term

health

well I know you have a colleague there

at UCSF um Dr Robert lustig who's been

talking about sugars and hidden sugars

for years and the problems with that and

and we don't want to demonize sugar as

the only cause of the Obesity epidemic

but it's certainly one of them at least

that's my belief according to the data

yes and Rob is the biggest proponent of

you know of helping people understand

the big problem and the root is in the

processed food and the sugar and that

the drugs don't touch that we just we

override effects of any drugs with our

diet and and so it's

um It's been a

a losing battle really because of the

force of big food and big Pharma

so let me go back to the the compulsive

eating so we've we've we've um there are

some clues about how to break that cycle

so one is in our weight loss trials or

our healthy mindful eating trials we

find that

mindful eating is not going to cause a

lot of weight loss period but the people

who benefit most from learning this kind

of calm self-regulation where you check

in with your hunger you slow down you

increase your awareness of your body so

in terreceptive awareness

that

um type of

skill is really critical for people with

compulsive eating and so in our trials

we find that if they people with

compulsive eating if they get that if

they get randomized to the mindful

eating they do better in terms of their

insulin resistance and their glucose and

their long-term weight loss so that's

one good clue another is

the positive stress pathway looks

important for breaking the compulsive

eating cycle so high intensity to

interval training or you know maybe some

of these other ways that we've been been

talking about to increase the bodily

stress in these short-term ways to

metabolize stress in our body can help

with the cravings

so what would that look like in the

context of let's say somebody

um has the opposite phenotype to me they

get stressed and they find themselves

reaching for snack food or that they

simply can't reach satiety they just

want to eat and eat and eat

um what are some of the aside from

Naltrexone and Wellbutrin and some of

these prescription approaches because I

always say while I value certainly value

prescription drugs in certain contexts I

always feel like behaviors should come

first do's and don'ts

than nutrition then supplementation and

then if and only if it's still needed

prescription drugs but that's just my

bias based on my observations

I like to think so uh it also is a uh it

starts at a zero cost um Endeavor I mean

behaviors require time but it certainly

um includes everybody not just those

that have insurance or that live in a

particular region of the US or the world

so anyway

um that's my bias and at least for the

time being I'm sticking with it

um it's the basis of a lot of what we

talk about on this podcast but

nonetheless if somebody is uh finding

themselves in that category of binge

eating or heading towards binge eating

or using food to comfort or alleviate

stress

how should they intervene in their own

thoughts and behavior we talked about

the the bins top down strategies

changing the body changing the scene we

need all of those I mean the the

compulsive drive to eat is one of our

you know strongest impulses if we've

developed that pathway and so the we

train people for example in mindful

awareness of separating out emotions

from Hunger so they get really wrapped

up together so just labeling how you're

feeling labeling your hunger from one to

ten and figuring out is it am I really

hungrier as a boredom that helps people

and if you do that check-in right before

you eat that helps the most so that's

the top-down mindful check-in the uh

other thing we help people do is like

right the craving surf the herbs so if

we deal a lot with soda Drinkers and it

is addictive and there is nothing worse

than drinking sugar soda for our body so

we help people by help um having them

watch their craving pass and and knowing

that it's a matter of time that they can

surf the urge without jumping to

consuming and so that practice helps

some people especially with practice

the push-ups the taking a walk the

changing the scene getting away from

food is always going to be a huge strong

strategy if you can get yourself away

from it the the problem is as you know

is that the Cravings get you to the

buffet they drive you to the the soda

Etc and so just you know creating safe

environments both at home and in the

workplace where you don't have soda is

really important so we try that at UCSF

my colleagues and I um including Rob

lustig the anti-sugar doctor we just saw

the absurdity of being a medical center

people come with these chronic diseases

and what are they served in the

cafeteria or even at their bedside

sugared Coke in the hospital in the

hospital and so my colleague Laura

Schmidt who's uh partly responsible for

the soda tax she rallied the all the

um we went top down to Administration

but bottom up to vendors got rid of all

the soda in all of our hospitals and

campuses and we found two things number

one

people who were heavy drinkers

lost weight in the most important Place

their waste heavy soda drinkers so when

we took it out of the workplace

they actually had their health improved

and number two those with compulsive

eating they score high on our our little

scale for

um reward based Drive

it didn't help them

so then we randomized half of them to

get some extra boost we call it

motivational interviewing where we're

really supporting them more and helping

them you know think of goals like being

with their grandchildren not getting

diabetes and in that little bit of

support helped them tremendously and so

now we're trying to roll that out in you

know a big controlled trial but at least

100 hospitals have adopted the

um stop selling sugary drinks because

people don't want to be sick but they

can't help it if they have the reward

drive and if they have the compulsivity

and it's right there at work we're just

working against health

super interesting I think that um

for most of us we think about sodas the

kind of thing that maybe we have every

once in a while or that we drank more

when we were kids I seem to have lost my

appetite for soda at some point you just

know too much teen years maybe or just

at some point I I started to feel like

there were better Alternatives

um and you know like what well okay well

people want ideas yeah well full

confession I mean okay most of my

non-water uh beverage consumption is

going to be either coffee

um usually black coffee or nowadays I

sometimes will throw some ketones in

there not because I'm on a ketogenic

diet but for I do feel like it makes my

uh level of focus and cognition better

pouring in this morning yeah I do use it

before podcasts and we're prepping for

podcasts it

um there are good data showing that uh

we can all utilize ketones as a as a

brain fuel even if we're not on a

ketogenic diet that's um clear to me

based on my experience and the data as I

see them and understand them

um or yerba mate tea which is just a

caffeinated tea from South America which

I like very much

um

however I am guilty of drinking the

occasional diet soda every once in a

while and I know that you know some of

my audience will just gasp how could I

do that but we're talking about the

occasional diet soda the occasional Diet

Coke mostly because I I don't like the

taste of sugary soda and I actually

really like the taste of diet soda

Aspartame is a particularly rewarding

taste for me

um and as a consequence I try and avoid

drinking it more than I might have a can

of Diet Coke once a month maximum

usually on a plane or something like

that so that's the extent of it but if I

have the choice between a really great

coffee and a soda it's going to be

coffee or yerba mate soda it's gonna be

yerba mate

um or food and soda I'm gonna eat

instead and so that's me but I do recall

you know as a teenager soda was kind of

a default you just kind of like go to

the soda fountain and fill the drink it

felt like such a rewarding thing

um and I think the reason we're drilling

into this more deeply is it sounds to me

based on what you said earlier in my

read of the literature also brings me

the idea that that

drinking sugar in the form of liquid is

one of the worst things that we can do

in terms of our bodily regulation of

insulin and glucose

um it's I don't want to use the words

empty calories because that's kind of a

loaded phrase but it is essentially

empty calories it doesn't work it's

harmful calories they're not empty yeah

I mean there are no amino acids in there

they're no essential fatty acids and

there aren't many carbohydrates that you

can really utilize for

um long-term bouts of mental or physical

work so so what do you view soda as one

of the um the worst certainly not the

best but one of the worst culprits out

there I mean it is really prominent

especially nowadays also we should

include energy drinks a lot of kids

especially males by the way it's it's

almost this is crazy it's almost 95 of

energy drink consumption is males

interesting and I don't know what what

is maybe it's the packaging or who how

the marketing has been pitched but by

the way as soon as I say that someone

will be in the YouTube comments telling

me that that's completely false but we

can point you the data um so what are

your thoughts on sugary drinks and what

that's doing

um

how it do you think this is a reaction

to how much stress people people are

experiencing is this like people's

attempt to to inoculate their stress or

is it simply that it tastes good and

it's easy to consume and it's relatively

inexpensive people have not and we have

not really studied the sugary drinks in

the same way we have studied the comfort

food and the binge eating and so

um my guess is that it is part of a

stress response but even more than that

it's part of the hedonic cycle so when

you get the sugar

especially if it's packed with caffeine

that's going to be a more addictive

drink you get this you know really feel

good response right away and then you

get the low and it's the hedonic

withdrawal so which is this you actually

feel bad when it's been a while since

you've had it and so then it drives the

compulsivity you want it again because

you wanna not because you want to feel

better you want to get rid of feeling

bad so that's what happens with both

food addiction and we think that happens

with sugary drinks now let me tell you

that

when you asked is is a sugary drink one

of the worst things we can do for our

health yes because sugary food

doesn't go to our brain as quickly as a

liquid liquid sugar a sugary drink so

think about cocaine and crap crack goes

to the brain immediately and it's that

much more addictive that's how we think

of liquid sugar

The View on sugar I I think is starting

to change and I think in the years to

come provided folks like you and Dr

lustig continue to uh be vocal about it

which I hope you will

um I think it's going to shift things

quite a bit I look at it a little bit

like trans fats you know I was growing

up people ate margarine and now like

trans fats are banned in many cities

um it's kind of incredible how these

things have have changed

um over time and it requires an effort

not just on social media but podcasts

and I think also lobbying

uh lobbying our politicians really

getting them to understand

um just how pernicious this stuff is

there's a lot of social norms that go

into like what's good for for all of us

as a as a group or community and what's

personal choice it's very fiery you know

I just I've heard a colleague talking

about how bringing junk food or soda to

work is like passive smoking you're like

you're bringing something and that's

going to pollute other people's health

and you shouldn't do it so that's that's

much more Edge energy and people will

fight them on that

um but the the basic reality is yeah

we're gonna eat the donuts if they're in

front of us and so in it is much more

considerate to bring a bowl of fruit

I'm glad you brought up smoking I don't

want to take us off topic but as long as

we're venturing into these general or I

should say more General and yet really

important themes around public health

and food yes I learned something

interesting about smoking and why so few

people now smoke

um I always thought that the campaigns

around smoking and how terrible it is

for us showing pictures of lungs that

are you know caked with all this tar and

like you you know cancer and all this

stuff was the effective message but what

I learned was that one of the most

effective messaging systems in the the

battle against smoking was to get young

people to stop smoking not by telling

them it was bad for them but by showing

them videos of these um

rich men sitting around tables cackling

about the fact that they're making so

much money on the health problems of

other people because of smoking in other

words what they did is they made being a

non-smoker anti-establishment and so I

find it very interesting anytime there's

something like soda or highly processed

foods that are so woven into the

establishment it seems like though you

can we can tell people until you know

we're blue in the face about all the

health concerns with with these things

you know sugar is bad and this is bad

highly processed food is bad some people

might change their behavior but seems

like for the younger generation the

thing that's most effective is to

activate their sense of rebellion this

has been true for probably hundreds of

thousands of years but it's certainly

true in the last hundred years

and let them see that there is a very

strong

um big food sometimes big Pharma but

certainly big food system that is

working against them and that it in

order to take control of their health

actually we want to activate their sense

of rebellion so that they're like no I'm

going to take excellent care of myself

I'm not going to fall victim to this

monetary scheme and here I'm not

pointing to any conspiracy I mean this

has been seen with smoking this has been

seen with a number of different

Pharmaceuticals again not all

Pharmaceuticals are bad this is true of

a number of different aspects of of kind

of a big markets absolutely it's like

pull the blinders off let people know

that we're vulnerable to all the

marketing and that there's there really

are suppression of data behind a lot of

it so it had it's happening with

um with eating disorders too Eric Stice

who's at Stanford with you has been

using this method we call it dissonance

showing people with eating disorders how

the food industry has been manipulative

and has tried to

design foods for addiction for the

highest bang for the buck with dopamine

Etc and so that has helped reduce eating

disorders in these studies and it has

even helped reduce reward drive that

isn't that amazing that the dissonance

could do that so interesting yeah I

think uh what it's telling us is that um

few things are as strong as the

um no I won't I refuse to response in

terms of changing behavior

um especially when there's something to

push against so it's not just a battle

with ourselves I want the soda but I'm

not going to drink it it becomes a well

I want it but I want it because you are

making me think I want it I don't

actually want that so um I don't know

maybe this is getting me back into my

teenage mindset but I think a sense of

rebellion provided it's in the direction

of Health one's own health and the

health of others of course

um can be a positive thing yeah so we do

that with the mindful eating we really

we have them bring in the junkiest

processed food they can think of like a

Twinkie and eat that really slowly and

mindfully and few people finish it and

they're like that actually wasn't nearly

as good as the picture of it and the

idea of it and so it's like that reward

predictive error that you've talked

about where they they think the brain is

driving them to have it because of the

ad advertising and their expectation

that they'll feel good but if they're

really paying attention it's that it's a

very disappointing experience versus we

also have people Savor a piece of good

chocolate whichever they like milk or

dark and that experience teaches them to

eat slowly and really enjoy small

amounts of rewarding food so that

they're not they don't need to feel full

and binge oh so interesting

um

darker milk chocolate dark yeah

I actually like the 100 chocolate

there's one brand of Venezuelan

chocolate that's 100 which sound it

might sound awful but it's actually

quite good I think that was the first

time I could actually taste the the real

elements of chocolate interesting yeah

that is not rewarding it's way too

bitter for me I need the mouth feel you

know give me some fat in it oh my well

yeah it's hard to find but um it's out

there I'd like to just take a brief

moment and thank one of our podcast

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while we're talking about stress eating

obesity and

um here we've also broadened the

discussion to include different

Generations we're talking about teens

and adults I'd love for you to share

with us your findings around this study

that you did of pregnant women

and how stress and pregnancy and

different patterns of eating

and physiological changes that people

experience during pregnancy could you

share with us what those findings were

because I think those are relevant not

just to people who are pregnant or

planning to become pregnant but to

everybody because I think they shed

light on how we manage stress and

sometimes how we fail to manage yeah so

with overweight and obesity we know we

can't just change calories it's just not

going to work the next stressful event

is going to come along and people will

you know go back to what their brain is

driving them to do is to you know binge

on comfort food and so we've done these

interventions with men and women that

show that we can help them regulate

using somebody's mindful eating

strategies or checking in

we wanted to do this with pregnant women

because when you have excess weight and

you're pregnant you're really vulnerable

to gaining excessive weight during

pregnancy which is not healthy for the

mom or the The Offspring so we we did

this study it took us probably 10 years

total to you know get the Grant and

recruit groups of 10 women who are

pregnant in the same stage and give them

this training and mindful eating mindful

nutrition stress reduction and then my

colleague Nikki bush has been following

the babies for I think it's been almost

10 years since then and here's what we

found

first of all we couldn't stop excess

weight gain the women in the control

group gained about about 60 of them

gained excess weight during pregnancy

and same with our mindful group so maybe

it's end of story you'd stop there and

say it fails don't do it there have been

so many beautiful developments in the

women who got the training that we just

keep are you know being shocked by how

impactful the stress reduction training

was it was just two months of their life

but but pregnancy is a very critical

period when these women were changing

their habits and they're very motivated

to help their baby so here's what we

found

within that first month of the

intervention they all got this oral

glucose tolerance test so they all had a

they got a blood test to see how well

their body was metabolizing food sugar

and so it's like a pre-diabetes test and

what we found was that twice as many

women in the no treatment control group

had impaired glucose tolerance during

pregnancy it's a it's a common high risk

and half that many women had this in the

mindfulness group so by reducing stress

they improved their insulin sensitivity

during pregnancy so imagine what that's

doing to the baby too then the babies

have come out with less obesity

less illnesses in their first year of

life and more of this kind of healthy

stress response when they've been

stressed out in in the lab study

and so then eight years later we looked

at the mental health of the mom so right

after the intervention eight weeks later

everyone in our mindfulness stressor I

can do it felt great they felt less

depressed they had less stress and less

anxiety that's what you'd expect right I

mean they've just gone to a weekly class

they got all the support but eight years

later they still showed improved mental

health every year that we measured them

they still looked better so it's

probably one of the longest

studies looking at long-term effects of

a mindfulness training and I don't think

it was a coincidence that was during

pregnancy I think this is a very

important time to have these skills and

being in a group adds that social

support piece that we know is powerful

it's an incredible result could you

share with us what the mindfulness

intervention was and when it was

initiated when it was stopped so we're

talking about 10 minutes a day of

meditation as many details as you can

possibly give us because I know

um even though I don't think I'll ever

be pregnant I don't plan on it and uh

you never know well um yeah hi

zero minus one probability in my mind

but anyway maybe other people have other

ideas for me but

um zero minus one probability in my mind

and yet I'm very interested in this

mindfulness intervention because it

sounds like a very potent one so much so

that it's multi having a

multi-generational impact so how many

minutes a day

um how many days per week we had them

they met once a week we they had little

reminder cards I mean we need all the

reminders we can you know Post-its on

the fridge timers on our phone to do

this mindful check-in and so they were

during the week doing this check-in and

it was simply

um

a mindful check in closing their eyes

and feeling their body feeling their

labeling their emotions so it was

mindful breathing

and then it was some movement and we

taught them prenatal yoga but really any

mind body movement people like different

things there's Qigong

um there's

there's

um even just slow walking would have

worked

um so it was uh mindful check-in breathe

move my body that's what the reminder

card said so close your eyes and look

inside do slow breathing they also put

their hands on their belly and so they

felt that they were taking care of their

baby and then more movement so they they

did increase their walking

and the mindful of check-ins are as we

were talking about at the very beginning

I would say necessary but not sufficient

we've got to stop during the day and

check in and look inside if we're not

aware of where our mind is we are just

subject to the you know believing the

stressful thoughts thinking that we need

to keep ruminating their sticky thoughts

so the mindful check-in is really

important and then I think the breathing

as we've talked about is is probably the

more direct way that they're influencing

the prenatal environment the uterine

environment to reduce the stress

in that the baby's being exposed to and

the movement refocuses us from our mind

and our ruminative thoughts

to the experiences to what we feel in

the body there's even been a study that

showed that overweight people with a lot

of Cravings if they do the body scan

that's simply focusing on the body from

the head to the toe you know just

reminding ourselves to

focus on each part of the body breathe

into it release tension it's very basic

and simple the body scan would

significantly reduced cravings

I mean to me that's it's really hard to

reduce Cravings so like just that

refocusing on the body took away stress

anxiety self-referential thoughts that

kind of our favorite topic thinking

about ourselves thinking negative

thoughts about ourselves to relaxing

feeling ease feeling well-being

I can't help but ask about what that

body skin might have been doing at a

little bit more of a mechanistic level

um some of the listeners might be

familiar with these terms but some won't

so I'll just um briefly Define them we

can perceive things in terms of extra

reception or basically paying attention

to and focusing on things beyond the

confines of our skin or interoception I

realize you know all this but for their

sake

um no one really understands

interoception go for it so in

interception essentially the sensory the

sensory innervation of the of the

internal organs of our own skin that

includes proprioception and which is our

knowledge or our sense of where our

limbs are where we are relative to

gravity all that stuff and you know it

raises this body scan result that that

is the fact that a brief body scan can

reduce Cravings raises this question in

my mind which is is craving a heightened

sense of inter-reception or heightened

sense of extra reception so I could

think of one form of craving where for

instance the donut again donuts for me

is in front of me and I'm saying

thinking that I want that and so I'm

almost in complete extra reception but

I'm Tethered to it like my internal

world is Tethered to the donut it's

almost like the donut is in control of

me briefly

right and then I eat it

um but it's hijacked your prefrontal

cortex it's it's hijacked everything

yeah yeah and then if I do a body scan

so I'm putting myself in this experiment

and it's kind of uh a hypothetical

scenario I'm putting myself into this

experiment I do a body scan which

without question is

shifting me more towards interception

right I'm focusing on my skin my heart

rate all these things interception so I

could see how that would draw my

attention off of the external stimulus

and reduce craving and that makes me

wonder whether or not craving is

a

form of extra reception where our

interception is just exquisitely locked

to extra reception and if so you know

because I do think this is a remarkable

result it is very hard to stop Cravings

I mean we had a guest on here a former

colleague of mine at Stanford who's now

the chair of neurosurgery at UPenn uh

School Medicine which is Casey Halpern I

mean they do they literally drill down

through the skull of people who have

binge eating disorder and start

stimulating different brain areas

because these people are so out of

control in terms of their binge eating I

mean that's the kind of intervention

that is considered necessary for a lot

of folks who binge eat so here you're

telling me a body scan in some

individuals can reduce that and I have

to wonder whether or not it's somehow

breaking that interoceptive

extracceptive tether anyway I'm

speculating here but I'd love your

thoughts on on binge on craving and

binging and breaking binging

um do you think that there are

behavioral interventions

um that could be layered on top of body

scan should we all be doing body scans

routinely yes why not you know and some

people aren't going to like that lying

down is maybe not comfortable and so any

Mind Body activity is going to do the

same it's going to be you know I think

breaking that link

that you talked about yeah I I find this

all intersective extra receptive

balancing um one of the more interesting

conversations these days in Neuroscience

because we're starting finally starting

to understand what some of the the

circuitries are and they do link to

these reward Pathways in any event

um getting back to the relationship

doing stress and food and maybe even

just weaving back a little bit to the uh

opioid system

have there been any

long-term studies of stress intervention

you know in the studies that we do in

our laboratory we get people for a month

they do one intervention we swap them to

another intervention a month we analyze

data takes a couple years to do all that

but we write papers and we move on

um it sounds like your laboratory has

been involved in doing a lot of studies

where you're examining people over a

very long period of time even their

children what can we learn about the

long-term outcomes of things like body

scans meditation and then we'll get into

breath work

there hasn't been that many long-term

studies of

stress interventions now that you

mention it I think the meditation

studies are probably the best example

there are some studies that have either

followed people who have taken up

meditation or just these cross-sectional

studies where you compare a long-term

meditator to someone who's never

meditated and they they are interesting

I mean let's talk about the

cross-sectional studies you're already

you know studying someone who eats like

kale chips instead of potato chips

there's a lot of differences in who

decides to be a meditator

we in terms of the

health and biology

we have found that there is slower

biological aging and other people have

found that in these meditation

interventions we do the short-term ones

that inflammatory Pathways of gene

expression are dampened way down

and cross-sectionally other people like

Elizabeth hoji have found longer

telomeres in the meditators versus the

controls so we we haven't really found

telomere lengthening in our short-term

meditation studies but we do find boosts

in telomerase activity which is this

enzyme that protects our cell aging

slows our cell aging rebuilds the

telomeres

so those are um those are those are

studies that suggest if someone were to

continue meditating they might keep up

that slower rate of Aging

so there's one study we did which I

think was particularly

um fun we went to uh Retreat Center

where Deepak Chopra leads us one week

Transcendental Meditation Retreat so

people got a mantra and they were

focusing for probably eight hours a day

on different uh yoga meditation and

reflective exercises and then we had

half the group just walk around the

resort take walks hear some boring

Health talks so that was our control

group and what we found from that study

was that in the short run a week later

everyone felt fantastic after the week

right they weren't allowed to bring

their laptop and work and they ate this

great anti-inflammatory diet an

ayurvedic diet and then the gene

expression Pathways were like night and

day from day one to the last day and our

model of um machine learning model was

able to identify people over 90 it could

say whether they're on day one or day

seven and the difference really emerged

over the long run we went and we

followed them about 10 months later and

we found that not everyone felt great 10

months later the group who learned

meditation still had lower depression

but the control group bounced right back

up

and then we looked a little bit further

and we saw that people with early

adversity benefited the most from the

meditation condition oh what was the

meditation condition how long per day

yeah it well so they did they learned

transcendental primordial sound

meditation which is similar to TM where

you have a your focused attention on

your on a word over and over but there's

also more awareness of the

um the body

and that was you know I I couldn't say

how many minutes a day but it was on and

off during the day okay so repeatedly

but for a fairly short period of time

one week yeah all right yeah I've never

done one of these extended meditation

Retreats are you interested well various

people in my life have told me that I

needed to go do a silent meditation but

they probably were emphasizing the

silent part the um uh I recommend them I

think they're amazing ways to get to

know the mind and to really calm the

body in ways like a you know a Quantum

shift in our level of stress that we

don't get it's very hard to get in short

bounce

I do a daily meditation practice but

it's a relatively brief meditation

practice I do tend to focus more on

things like deliberate cold exposure and

breath work and yes exercise and

sunlight and all the things I talk about

on the podcast but I'm certainly not

averse to uh doing a longer meditation

are all of these

um uh TMA meditations are they silent

meditations

and they range from what two days to a

week is that

well the Retreats you can always find a

retreat that's you know half a day one

day a week two weeks so you don't go

right into a two-week you work up to it

so the longest I've ever done is a

two-week silent Meditation Retreat and

that was after you know 10 years of

doing yearly shorter retreats and then

when you you know I think it would be

too hard and stressful if you haven't

been able to I mean meditation can be

stressful if you know you think that

you're failing at it and

um so you need to have kind of developed

the skill a little bit before you go on

the Retreats and so lots of classes can

do that and online but I think the short

bouts every day are that is what is the

most important message for people for

for managing daily stress and that's the

in the stress prescription it's very

much about how we can do short daily

nudges to reduce our stress arousal so

breathing is one of the best body-based

examples of getting right there but

there are other ways so being in nature

that's a really strong stimulus an

environment that sends all sorts of

safety signals to us

yeah certainly it's not an either or but

it seems like nowadays A lot of the

discussion that used to be had around

meditation and its ability to evoke

neuroplasticity and things of that sort

has shifted over to it um an increased

focus on psychedelics so the common

theme on this podcast but it just seems

like in you know taking the pulse of

social media and the landscape out there

there's so much excitement about

psilocybin both in microdose and macro

dose and MDMA and some of the other

trials that are out there

that

many people are starting to forget the

incredibly rich and vast literature

supporting the use of even brief

meditation practices for reshaping the

mind so I'm glad that um we're talking

about meditation but I mean even going

into plants medicine experiences is

enhanced if you have a little bit of

training in how to in metacognition how

to view the mind and thoughts you can

observe the whole experience with that

much more kind of calmness skill and

wisdom knowing this is just the mind

doing these cool things so it's not

they're not separate and then I think

the the psilocybin experiences enhance

daily meditation so they really go well

together

yeah and then just as a little editorial

on uh psychedelics

um what's interesting I think about the

clinical data is that

um you know we think of the the

Psychedelic Journey as the time in which

all the changes occur because it has all

these properties of hallucinations and

altered thinking Etc that acts as kind

of a gravitational pull around our our

ideas about what psychedelics do but

it's actually in the window after the

Psychedelic Journey that the actual

rewiring of the rain takes place so when

people talk about integration afterwards

they're not just talking about the few

hours where they're you know parachuting

back down to to uh uh typical

Consciousness let's call it that but

that there's these long perhaps even

weeks or month-long tale of plasticity

and that's actually when most of the

rewiring is happening and which I find

really interesting which is not unlike

meditation where sure in one bout of

meditation you might see a adjustment or

rewiring of the brain but at least from

the book altered traits which I'm a big

fan of

um talked about these daily repeated

short meditations or these longer TM

Retreats as they're sometimes called

almond inducing uh this big time brain

plasticity all right well I'm now I'm

gonna have to do it and I'll report back

to everybody uh what my experience was

although I might do it silently

um

I'd love to talk a little bit about some

of the other health metrics that you've

explored not just in the context of

mindfulness but I'm particularly

intrigued by uh a graph here I'm showing

my really nerdy side there's a graph in

one of your papers it's the Picard paper

2018 we will provide a link to to this

in the show note captions if people want

to take a look but it essentially

describes the relationship between

mitochondrial health and mood

um in the context of people who have

different type of mood Tendencies if you

um if you would be willing to just kind

of describe the top Contour of that

study and some of the the points that

that you find most interesting I think

it's a fascinating study and and I I'm

so glad you did it but I'll let you tell

us about it yeah we've we've done these

in-depth studies where we are looking at

people under a lot of daily demand

caregivers and then we look and look at

you know normal people parents of

neurotypical children who still have a

lot of stress but we that we then ask

you know does do people under chronic

stress have accelerated aging so we look

at telomeres epigenetics mitochondrial

health and then what explains those who

looked really good who look resilient

and don't look vulnerable and so then we

can find out like what's the magic sauce

in the day that protects them from

chronic stress so Martin bakar my

colleague who has been obsessed with

mitochondrial Health as a pathway to

understanding both stress address and

really health and disease he has

developed a way to measure mitochondrial

in health in humans so we can measure a

bunch of enzymes and then we can adjust

it for how many mitochondria we have so

we have this really nice index we can

get from the blood

and in this study of

young mothers who were who had either

typical children or children with autism

we found that the caregiving moms had

significantly lower or dampened

mitochondrial activity what that means

is they can't produce as much energy so

if they're feeling more exhausted from

the chronic stress we know why I mean

it's it really is a it was quite

dramatic and Martin commented some of

those low levels even looked like people

with some genetic reasons to have low

mitochondrial activity but here's the

beauty of that study we then get to look

within their day at their mood and ask

well what about the caregivers who have

really great mitochondrial

enzymes and and thus should be making a

lot of ATP they had more positive

emotions both waking up and in the

evening but especially in the evening

and what's so interesting that is all of

these daily diary studies of stress and

mood

one of the things we know that matters

for long-term health is how positive you

feel at night so especially on a

stressful day so at the end of a

stressful day can you muster from some

feelings of content ease confidence Joy

do you have any of that or has it just

wiped out your positivity and so for

people who feel

either lower negative or higher positive

they tend to have better health

trajectories so like a decade later less

depression less heart disease less early

death so what so that's why we care so

much about daily moods and in our study

it looks like the daily mood was really

quite correlated with the mitochondria

levels that same day then we measured

mood like you know days away from that

it was much less correlated so that it's

just our first study on this but it

really leads us to think that our

mitochondria are sensitive to our

thoughts and our feelings probably on a

daily basis

incredible so for those of us that find

ourselves in it in a state of chronic

stress and here I'm talking about the

kind of stress that you mentioned before

which is you know they're

is unlikely to be a Simple Solution like

we're just going to be grappling with

this thing

um and you mentioned the words radical

acceptance which I'd like to uh drill

into a little bit too because there's a

theme in the self-help literature and

it's a

theme that now I think in the formal

psychology literature actually

um was talking to a dialectical

dialectical psychology expert recently I

think that's the the correct title

dialectical behavioral therapy correct

yeah that's a common great one yeah

you're correct I I was I was grasping

and um that's correct and they were I'm

talking about

um some of the misconceptions about

radical acceptance because I think a lot

of people hear the words radical

acceptance at least this is what they

they told me and think oh that means

that you have to just accept what is and

deal with it there's another form of

radical acceptance which is ironically

accept the fact that I'm not going to

deal with this right I'm gonna walk away

from it but what you're talking about is

chronic stress of the sort that really

the stress or the fact that a very close

relative or family member is dealing

with a lifelong condition or the fact

that um we can't extract ourselves from

a situation that we are not in full

agency to remove the stressor

that

radical acceptance of that fact then can

ratchet into an understanding of okay

and yet there are tools that we can use

to not just offset the negative health

effects but maybe even thrive in the

context of this essentially turning what

initially was thought of as a curse into

a blessing at least biologically

speaking

what are the data around the practices

that can help make that conversion

possible I realize there's a lot of

psychological work that needs to be done

ongoing people need coping mechanisms

support groups it's always better to

have more social support than last of

course but are we

again talking about

a daily mindfulness practice or is it

daily mindfulness of a certain type what

do we know about best practices for

mitigating these essentially

non-negotiable stressors

it's

it's a great question and it's not a

quick answer

I think it is partly how we view life

and our

our purpose in our own life

what's this game that you know we were

born into and even just the idea that

bad things shouldn't happen sets us up

for vulnerability to feel victimized to

feel

um like we can't you know accept bad

things that have happened so so just

stepping back and asking

everyone listening do you have a

situation in your life that is unwanted

and you can't change

it could be small it could be huge

how much time do you spend thinking

about this

the more we spend time trying to problem

solve or worry or just wishing things

were different

the more we are creating

a chronic stress state

and so just even

taking that first kind of step back to

get perspective on what are the

situations in my life that stress me out

and and which of these can I Circle

those that I can't change

they're still they're on my list so

they're they're on my mind they're still

upsetting they haven't receded in the

background they haven't gone away just

that recognition of this isn't going to

go away is incredibly

powerful because we can as I say put the

baggage down and give ourselves some

relief and some freedom from from the

big space it holds in our mind and in

our body

and this is not a one-time thing it's a

practice radical acceptance is something

we practice over and over to help us

loosen our grip on unwanted situations

on letting them control our well-being

and taking up you know this mental real

estate that's so precious our attention

so I would

um

there are statements that we can say

that help us

and it's I have you know there are a few

metaphors so I'm an expert at this

because I have I'm a caregiver and I

often need to refocus from wishing

things were different trying to solve

things to

really

um radical acceptance of this is how

things are right now this is the reality

and

by just reminding ourselves that there

is freedom within that that there are

things that you can do you can actually

live better live well with these

situations so let me tell you what we

found from our caregivers we measure

where their mind is at night we we ping

them and we say in the last five minutes

how much have you been wishing things

were different

how much have you been engaged and

focused and what you're doing right

right before we pinged you and just

those two questions

tell us so much about that person's

well-being so people and actually yes

the caregivers are doing more of

what I'll call suffering wishing things

were different not being present for

their lives but regardless of that

difference whether people are a

caregiver or not this negative

mind-watering state of not being present

for your evening wishing things were

different instead of being engaged

predicts

more unhappiness it predicts

shorter telomeres

so it suggests that it's a pattern that

has gone on for days months and years

that has been wearing on them

and so some of the metaphors that I

think are helpful for this are thinking

of yourself think of this unwanted

situation and think of how your

your pulling a rope that's attached to a

brick wall

and you're doing that because you care

you want things to be better for

yourself or this person

and

or a group I mean it's it's something

you're passionate about

and so you're pulling and pulling and

every day you're pulling and and you

can't move that brick wall so the only

thing that's happening is that you're

chafing your hands that tinge that

chronic tension

what if you just drop the Rope

I say that to myself drop the Rope

when I start get you know getting going

on trying to solve unsolvable problems

the brick wall is still there it's never

going to move yet my hands are free

and so I can be freed up to live in the

ways that I do have control over to do

things that help around the edges so I

was just talking with someone who's just

so concerned about their aging parents

and you know them not getting the care

they need not taking care of themselves

you know things aren't going well but

there was so little that they could do

to help their parents and so by dropping

the Rope for them meant realizing there

were things they could do being present

being loving

uh doing the little bit of care that

they could from a distance was all they

could do and that's enough that's that

loving presence is like a gift that we

don't realize that we we always have

that to give

where do you think the tenancy for us to

try and pull on brick walls comes from I

mean it's so non-adaptive

um and I've also heard it stated that

people do this in the reverse Direction

too meaning in time trying to control

the past

through current behaviors as well as try

and control the future

um so give me an example of that yeah

this is something I learned from a guest

we had on here Dr Paul Conti is a

psychiatrist to

um extremely skilled psychiatrist who

wrote a book on trauma which I think is

the best book on trauma frankly

um and he talked about how the limbic

system that engages these

fight-or-flight responses has no sense

of time and that's why developmental

scripts get reactivated in particular

parent child or caretaker child uh

neural circuits that were engaged in

those relationships when we were really

young get reactivated in adult

relationships I mean in some sense it

doesn't make any sense like why wouldn't

the human mind have separate circuits

for adult like romantic attachment

versus child parent attachment is all

sounding very Freudian And yet when you

look at the the neural Imaging it's like

you get one set of circuits for

understanding of relationship of course

you adjust according to context and they

get repurposed you don't just set that

aside say that was for childhood but

what he said was that the limbic system

and the stress system when it's

activated

um distorts our perception of time

and that

um this is what he was uh saying leads

to the what's sometimes called the

repetition compulsion people try and

will repeat the same uh Place themselves

into mildly to severely traumatic

circumstances over and over again

despite the presence of a of a trauma it

doesn't have to be childhood trauma you

think well that doesn't make any sense

it's like the most illogical thing in

the world like you get burned on the

stove or you keep going back to the

stove and the idea is that these

circuits when they get activated really

engage entire like cognitive scripts

that make it very hard to escape it's

like it pulls you into a story that is

exquisitely hard to to get away from it

so that this repetition compulsion is an

attempt to try and rewrite the story and

this is this is a theory not just a

Freudian psychology but kind of modern

trauma and Neuroscience informed trauma

therapies in any event

as you describe the this pulling on a

brick wall I find a very compelling

image

um and one that uh makes total sense to

try and drop the Rope as you describe it

because of the incredibly High energetic

demand that pulling on that Rogue

represents as you said it's sort of a

way of diverting resources towards

something that has no conclusion right

and in dropping the Rope you can divert

those resources towards other things

um so I was just curious again I wasn't