Burned Out? How To Reset Your Life And Health - Transcript

Introduction: Coming up on this episode of the Doctor's Pharmacy,

Dr. Neha Sangwan: Your heart racing stomach, turning muscles tightening, sweating. Everybody has a unique language that their body communicates with them in the job is we have to decipher it.

Dr. Mark Hyman: Welcome to the Doctor's Pharmacy. I'm Dr. Mark Hyman, that's pharmacy with have a place for conversations that matter. And if you've ever felt burned out in your life and promise you I have in many ways, many times in my life, this is going to be a conversation I think you're going to enjoy because it's with someone who's spent her life focusing on how we heal from stress and burnout. It's Dr. Neha Swan, who is a good friend of mine. She's an internal medical physician, c e o, and founder of the Intuitive Intelligence Approach. And she's an international speaker, a corporate communications expert. She works in private practice and corporate consulting, focusing on helping individuals, organizational leaders and their teams with tools for clear and effective communication. Because without that ain't got nothing. She addresses the root causes of stress, miscommunication, and interpersonal conflict, and who has that, right?

Dr. Mark Hyman: Nobody has any of that. So if you don't have any conflict in your life, just tune out and turn out another podcast. But I think most of you're going to find this helpful and it really helps to heal so much that's wrong with us. If we're not in integrity with our emotional spiritual self, then we end up getting sick with things like chronic disease, headaches, insomnia, anxiety, depression, and just plain old burnout. She worked with all sorts of groups called including the American Heart Association, Amex, apple, Kaiser, Google. She's been on TEDx multiple times. She's author of Powered By Me From Burned Out to Fully Charged at Work and in Life, and also Talk RX five Steps to Honest Conversations that create connection, health and happiness. And her new book, this book, powered by Me from Burnout to Fully Charged at Work in Life is something I think you all need to go get right now. I think many of us in this modern life are overwhelmed, overstressed, under underappreciated in many ways, and don't know how to take care of ourselves. And today we're going to talk about just that. How do we take care of ourselves in a overburdened, overstressed world where we feel like we have too many things going on and too little time and not enough time for ourselves? So welcome Dr. Sanguine, or as I like to call you, Neha.

Dr. Neha Sangwan: Oh, thanks Mark. Thanks for having me. It's such an honor.

Dr. Mark Hyman: Alright, well, here's the deal. We all know that our life today is extremely stressful. We have our work obligations, family obligations, trying to manage things. We care about our health and we've got all the stresses of society, the economic burdens of our economy, the threat of nuclear war, climate change. I mean it's a lot. So it us in a state of chronic stress activation, basically our bodies are not designed for this level of input and stress. I mean, just the trauma of the news itself. I try not to watch the news. I find it very stressful. I figure if some important happens, I'll hear about it. But all this puts our bodies in a survival mode. It's fight or flight response, which sets the stage for what is term burnout. Now, burnout is not a medical term, but it actually is a true physiological response to chronic stress. And it's not really about working too hard or feeling exhausted or being tired for a long period of time. It's not about personal failure either. So what is burnout neha and what causes burnout? Help us sort of understand the context here and then we'll get into exactly how we navigate it, what you struggle with. I'll share some of my stories and we got to get into how do we start to think differently about our lives.

Dr. Neha Sangwan: Well, mark, I think both of us have definitely experienced this multiple times in our lives. And I actually met you, I met you right after I burned out about 20 years ago, and one of the first things you said to me was, we got to get you back on your circadian rhythm. We got to get your wake sleep. So I was a doctor working night shifts and all these things, and I just thought it was unthinkable that that would be your opening line. And I didn't understand burnout then. And you were right. You were absolutely right. So burnout, you're right that it's not considered an actual medical diagnosis, but I will say at least in 2019, the World Health Organization decided to at least say that it was an occupational phenomenon that occurs with ongoing unresolved stress. So they've delineated it and kind of compartmentalized it to being a work phenomenon.

Dr. Neha Sangwan: My 25 years in medicine tells me that it can be anywhere in your life. So I think they'll catch up with us in 2019. At least they're acknowledging that work can cause this. So it's really a triad. The triad is of exhaustion, certainly physical, mental, emotional exhaustion. But if it was that, I think the whole world would be burned out. You have that going on. And then in a more subtle way, cynicism starts to creep in that voice that starts saying, you know what? It doesn't really matter how hard I work, what all the effort that I put forth, it doesn't really change anything I don't even know if. And then once those thoughts start coming in, it's edging you closer and closer to burnout until the third factor comes in, which is just hitting the wall of ineffectiveness, that moment where you just can't function.

Dr. Neha Sangwan: And the other thing that I want people to know about the context of burnout is that it's not like I'm okay on Monday and then on Friday I'm burnt out. It's a way of being over time. These are patterns that we adapt to our environment and we can talk about that when we start talking about our own burnout, but it's the way people function over time. And so there's three phases also of burnout that people go through. So let's say the alarm phase, that's the first phase. So it's almost like jumping on a treadmill that's going a little too fast. Like your adrenaline, your blood pressure, everything starts going and your alarm response in your body starts. So it's very well named the alarm phase. Well, many of us start to go on that treadmill and we really never get off of it. And so we move into the second phase, which is adaptation, which is kind of staying in that alarm phase, never really getting the rest we need. And it almost feels like the treadmill keeps getting turned up slightly, and so we're just hanging on by a thread. Well then that's the adaptation phase, the second phase, and then one thing happens, just one more thing happens and we go sliding down the exhaustion phase to ineffectiveness. And that's what happened during the pandemic for a lot of people. They were just hanging on by a thread and then one more thing happened and they really felt burnt out.

Dr. Mark Hyman: Yeah, it's so true. It just reminds me of what you're talking about as a paper made years ago in the New England Journal Medicine by Bruce McEwen, where he describes the physiology of this in a very scientific way. So it's not just like, oh, I'm too tired and I'm burnt out. There's actually a real biological underpinning and it's not something you can take a pill for. So that's the problem. It's like, isn't

Dr. Neha Sangwan: That what you'll get? So there's, when you're falling off a cliff, you are burned out and you're completely ineffective. The traditional medical system will give you, this is the typical scenario that'll happen. If you go to e a P at work, the employee assistance program, and then they send you to a traditional physician, what'll happen is you'll get a prescription for 10 days off or some time off, and then they'll give you some cocktail of an antidepressant, anti-anxiety, sleep medication, something to get your biology back in order. And then 10 days later you'll be sent back in the ring for round two. No new skills, no understanding of how you got there, but listen, very useful in that moment where you are hanging by a thread or you've hit ineffectiveness really useful to try and kick you into stopping your world, you're probably not stopping at yourself and giving you a cocktail of meds that then knock you out and make sure you sleep or don't allow you to feel the anxiety or the depression that you're experiencing. So it's a very bandaid, but it might be important in that acute, acute situation. But then the real question comes in, which is what's causing it? And I always say we have to have parallel paths to help people because if you're not figuring out what's solving it, what's causing it, you're never going to solve it.

Dr. Mark Hyman: So that's something that we don't really think about is how do each of us as individuals respond differently to the same inputs? Because what might burn out, one person might not burn out somebody else. And so how do we start to look at what's going on in real life and how do we start to shift the conditions that are causing burnout?

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

Dr. Neha Sangwan: Whereas you would be like, all right, let's go. Right? So it may cause me stress, but may not cause you stress. So in the me we world of burnout, I have to know myself. I have to understand what will cause me stress and what now what I know is I could say yes to something like that if I knew we were supported with people who really knew what they were doing, if we had great people with us that I could ask. So even if something stresses you out, you also know you want to ask yourself, how could I say yes to this? Right? What would it take for me to say yes if it's something I'm interested in? Now we, part of burnout is oftentimes the toxic work environments, family environments, relationships that we have said yes to. We have gotten ourselves into situations. We've chosen a job for a location or an opportunity or whatever it is, but then it drains us of energy. Every day it drains us of energy, but every day we keep choosing it for the paycheck or for whatever it is. And then world is what you were speaking about with the news and hurricanes and tsunamis and all of that. So I want people to really understand there's a Mei world here that's going on

Dr. Mark Hyman: Mei world,

Dr. Neha Sangwan: The Mei world. So any complex situation, and I think about this with functional medicine, you've taught me this actually that I must pay attention not only to my biology, but to the relationships I'm in, to the environment that I'm in, whether I'm sleeping and waking, and if my job says that I have to do certain things. You said that all impacts you pay attention. So the simplest way I can say it is think about things and expand your perspective and see how all of them work together. But let's focus on the me, the me, which is each of us. So this is powered by me basically wherever you are on the spectrum from burned out to fully charged, I want you to figure out where you have a net gain or a net drain of energy on a physical, mental, emotional, social and spiritual

Dr. Mark Hyman: Level. That's a great exercise. How do you catalog each area and what are those things in each domain that are either robbing you of energy or filling you up with energy? It's a beautiful framework. We don't think about that. We just kind of like know, oh God, every time I talk to so-and-so, I just feel like shit. Well look, well stop talking to that person, Margie. If I go out for a walk or for example in the morning, I like to go out and sit and watch the sun come up on my deck and it's super quiet. There's mist in the lawn and little birds and rabbits running around. I just feel like it's this beautiful moment of restoration that I get where before the world starts there. Those are great examples, but there's so many more.

Dr. Neha Sangwan: There's so many more. And just like what you were saying, so on the social level, empowered by me, I ask people to do some simple pulse checks on themselves. So for the social one that you just spoke about, I asked people to write down the five people or groups of people that you spend the most time with in person or online. And then I want you to assess whether you have a net gain or a net drain of energy. A little plus for the net gain, a little minus for the net drain of energy. So the one that you just described would get a little minus if that's in the experience. And so when you look at those five individuals or groups of people that you're spending the most time with, and you look across it and you see three or four drains and one gain, you got to start evaluating how you're choosing who you're spending time with. I love when you say getting healthy is a team sport. I learned that one from you. And it's so true. I mean, pay attention because these aren't just people that you have to endure. These are people who are changing your physiology by you being around them.

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

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

Dr. Mark Hyman: Oh God, yes. I mean, in the morning this morning I woke up and I went outside and I sat and it was misty and quiet, and I just enjoyed the quiet and had a cup of coffee and did some journaling. And typically my morning routine will be to work out and then take a steam and a cold bath lunch, and that kind of pops me up for the day. I have my protein shake and I'm ready to go. And at the end of the day, I usually wind down by just doing a little bit of reading. I like to take a hot bath with E of salt and then just kind of turn the lights out and either candlelight or just read a little bit on my Kindle and then go to sleep. I definitely, I like to do more, but depending on what I'm doing, I've also got trying this new device called Sensate, which basically resets your autonomic nervous system and you just headphones and creates vibration in your epigastric and it activates your vagal nerve and it's really quite powerful.

Dr. Neha Sangwan: Wow, okay. I'd love to try that. That sounds fun. So basically on the physical level, people assess how satisfied they are, food, energy, sleep movement, and the way that when you're answering these questions, it's really important to use your brain, but more importantly, you know how your body keeps score. Even if my brain can talk me into something, my body never lies. And so my body will start talking. So then I say to them, okay, anything where you rated yourself less than a 10, tell me what would make it a 10? What would make it a 10 for you? So they start to get really clear about where they are and what they need. And then at the end I say, okay, on physical energy, look at your answers and then check in with your body. Are you feeling constricted, tight, heavy? Do you have throat constriction?

Dr. Neha Sangwan: Are your muscles tight? Are you breathing shallow or do you feel relaxed, open and easy as you're answering these questions? So they're not just answering mentally, we're integrating their body. And if there's a difference, if the mind is saying, oh yeah, I'm tenses and all the physical, but then I get to the end and they're like, why am I so tight and constricted? It may be because they're telling themselves that they're fine and they don't want to give up their bagel and latte and whatever it is. So they're very satisfied, but their body is like, oh, that doesn't feel right. So you go through each of the sections this way in thoughts, it's about what are the top three repetitive thoughts that are going on in your mind? And when you're in the shower, when you're driving, when you wake up first thing in the morning or when you're up in the middle of the night, what are those thoughts that are occupying your mental real estate that you may not even be paying attention to? They just are so automatic. Once you write them down on paper or on your screen, next, you want to say, does that thought give me energy or does it drain me of energy? And more often than not, boy, those automatic thoughts that are going on, they could really drain you of energy and you don't even know that you're the one that could really plug that leak pretty quickly. So there's a whole bunch of things like that under emotional energy. It would be what areas of your life are you avoiding conflict?

Dr. Mark Hyman: It used to be all of them, but I'm better at that.

Dr. Neha Sangwan: But then you read RX and you know how to lean into conflict now. Yeah, no, that's one of 'em that if it wasn't safe when you were young, if it wasn't safe to speak up, if you got reprimanded for doing it, it's very natural that you would be conflict avoidant. And I think you and I have had conversations about that for you and that you really had to overcome and realize it was safe to speak the truth.

Dr. Mark Hyman: Yeah, totally.

Dr. Neha Sangwan: Yeah. And how much better our lives are if we're willing to go through the short-term discomfort of the honest conversation rather than the long-term yuck of never really having it. And then our relationships breaking apart. So it's where is it in your family life, your work life, finances, wherever it is you want to pay attention to where you're avoiding conflict. And then the flip side of that with emotions is where are you experiencing joy and play in your life? And you look through all of those as well. And that's a quick pulse on the emotional energy section, social we already talked about, which was name the top five people or groups of people you spend time with in person or online. Give them a net gain or a net drain rating when they come up, just by bringing them up in your body, your body will respond.

Dr. Neha Sangwan: It will tell you even if you just think about it. And then the last one is spiritual and spiritual energy. Spiritual is about what matters most to you. It's about your highest values. Some people think of it as connecting with nature. Some people think of it as their faith. Some people think of it as we're all connected as one. Whatever that is for you, you got to know your highest values. And so in this section, I'm asking you questions. Give me the top three things. You would be so proud if someone said, when you weren't in the room, what do you want? What would that be? Do you have any thoughts on that? What would really light you up

Dr. Mark Hyman: About what people would say to me

Dr. Neha Sangwan: About you when you weren't in the room?

Dr. Mark Hyman: Oh, that I was present, not tired, distracted and burnt out, exhausted, that I was really showed up fully, that I was kind. I think that I cared about their experience.

Dr. Neha Sangwan: So really that you're present, that you're energized and you care deeply about others. And so those are some of your highest values, even just right there. If that's what matters most, then that's going to give you a really big clue. And that's also how you're going to make your decisions because in the spiritual section, it's also about how you use your highest values to navigate complex decisions in the world. The world is not slowing down and the decisions aren't becoming easier. And so people need a framework to be able to do that. And so you do that with values.

Dr. Mark Hyman: Well, you talk about that in your book now. You talk about this whole concept of this internal navigation system and how you use this sort of navigation system to track what's happening in your body and your mind, your heart relationships, your spirit, and how there's different energy levels related to all of those, and how we can identify where we're out of balance and at risk for burnout in any one of those areas. Sometimes we've got all of them. I remember when I was a young man as a doctor, I was working 80 hours a week in the small town in Idaho. I had two kids. My wife was an alcoholic. I was just delivering babies all night and running the ER and working all day in the clinic and trying to deal with everything at home because it was a disaster and try to raise two kids and the stresses of all that.

Dr. Mark Hyman: And I really was overwhelmed and burnt out, and I think I probably wasn't listening to the kind of signals that were going on in my body. I just kind of push pushed through it. And it was interesting when I stopped working, I remember this experience and I was 34, I was pretty healthy. I remember that I planned to take this road trip to go see this friend of mine with my family, and I had to drive from Idaho to California, and I literally could not get up the floor. It was like I sort of quit my job in Idaho, and I literally couldn't get up the floor for months. And I was like, it took me that long of doing nothing to recover and to kind of restore my nervous system. I was like, wow, I was really out of touch, said I let myself get that far off. So how do we start to use those energy levels to identify where at risk, it's like you can check your blood pressure to see if you have hypertension. What are the metrics that you help people use with this navigational system that you describe in your book?

Dr. Neha Sangwan: Well, first thank you for sharing that. It's clear to me that you've done some work around it because you say it just like it's a normal story, but it's a pretty dramatic story that you just described. Literally you hit the wall of burnout and you couldn't get up off the floor.

Dr. Mark Hyman: I literally couldn't. I literally just couldn't drive. I was like, I had to just lay there for a long time.

Dr. Neha Sangwan: Yeah, it's almost like your body had to say enough, mark, enough, it stopped you. And I think that as physicians, our training has, first of all, we have to do 36 hour shifts. We had to do all these things that were super human, and in order to get where we got, we had to push through our body rather than partner with it. And we became so used to that and accustomed to that, it was like, listen, whatever the stress is, I just need to be focused on the next patient crisis, the next heart attack, the next stroke, whatever it is. And you just applied that to your whole life. And so when you tune out of your own physiology, your heart racing, stomach turning, muscles tightening, sweating, everybody has a unique language that their body communicates with them in the job is we have to decipher it.

Dr. Neha Sangwan: And our body is giving us these. In medicine, we call it symptoms. So we're like, oh, well, tell me about your symptoms. How long has that been going on? Oh, your heart skips a beat. Tell me how long has it been happening? Often, what does it feel like? So we take it in a real literal physical sense that it could mean something's physically wrong, your body, I don't know how to say it better than sometimes it just wants to chat. It just wants to say it just wants to talk to you every day all the time. It's like, yes, this, not that. Sometimes your body is going to tell you after a while that you're feeling really fatigued, and it's like, no, we're giving you some signals now. I'm not going to replete because I haven't had enough sleep. And so it's giving you more consistent signals. And then there's the catastrophic signals where you're having crushing chest pain and you need to get help. But there's all different intensities, but our body is talking. The question is, are we listening? It's talking all the time. And so right now, tell me something your body's telling you right now. I can see you slouching in your chair a little bit.

Dr. Mark Hyman: Yeah, I mean, basically I know what it's telling me is I need more sleep because I've been getting ready to go on a long trip and have been cramming work and staying up late and getting up early and just not getting my full rest. So that's what my feeling is now.

Dr. Neha Sangwan: But also it speaks to you when you're sitting outside in your backyard in the morning and it's like, ah, everything just opens up. So that's when it just wants to chat and it just wants to let you know. But each person has different signals. So for me, when I met you, I told you about throat constriction and stomach turning. And you said to me, Neha, you've been scoped twice. You've been put under anesthesia twice. I'm pretty sure it's your stress response. And I remember thinking, okay, thank God it's not cancer or something else, but what am I supposed to do with that? What am I supposed to do with someone telling me that? And so what is yours, by the way? How do you know when you're outside your comfort zone? Do you know what I call it your body map, but decipher?

Dr. Mark Hyman: I mean, I think I get a sense of just tilt. It's like the red light goes on and I'm like, okay, I can't deal with one more thing. I can't one more email. I can't answer one more phone call. I can't talk to one more person. Just leave me the hell alone and I want to go watch a stupid movie.

Dr. Neha Sangwan: Okay, you got to give me your favorite stupid movie. I want to hear it.

Dr. Mark Hyman: Well, my favorite is actually C I A television series. So I'm kind of a junkie for that. I just dunno why I like that.

Dr. Neha Sangwan: And you just want to tune out. So the interesting thing, mark, is just like the spectrum of burnout goes from burned out to fully charged. You don't just show up one day burned out, right? It's like this gradual process that ends up, you start coping, you use mechanisms, you outgrow those because aren't working anymore. Let's say someone has a glass of wine to take the edge off of work each day, they're not happy in their work, they're disconnected and they have a glass of wine to take the edge off. And then pretty soon covid happens, and all these things happen, and suddenly they're drinking two glasses at the end of every day or three, Hey, give me the bottle. And you don't realize it because you're starting to need more coping mechanisms to get the same effect. And then one day they hit burnout and they're like, how did I get here? How did

Dr. Mark Hyman: It, there's no gas left in the tank. Right?

Dr. Neha Sangwan: Exactly. And so what you're describing actually is a pretty late signal. So what I'd be saying to you is, mark, tell me what happens before you can't do one more email. You can't tell me how your body's talking to you earlier than that because it tells me you're a master at overriding it.

Dr. Mark Hyman: You're a, oh, I'm really good at that. I think I could win the Olympic gold medal in that.

Dr. Neha Sangwan: Well, that's why you accomplished so much, because you know how to optimize your body's physiology. You've mastered how to be well. And at the same time, you push your body to the same extreme. Your body gets treated really well, it gets nourished with the best ingredients. And boy does it work for it, right?

Dr. Mark Hyman: Yeah, no, I do all the right things, but the reality is I know what I need to do, but my mother voice echoes in my head, and I think you met my mother. She said, do nothing and rest afterwards. And I always would get mad at her like, oh, whenever I feel the urge to exercise, I lie down until it goes away. And I'm like, that's terrible. But she had a point. She had a point. And so I think that's one of my, I mean, I have such a voracious appetite for life, for learning, for doing, for seeing things, for experiences, for people, for making difference in the world. It just never ends. So I sometimes have to realize that I can't do it all. My mother also said that your motor is too big for your chassis, meaning I have a Ferrari engine, but a little VW bug body, and I can't run it like a Ferrari all the time.

Dr. Mark Hyman: And so I had to learn how to downshift, and I basically have two gears, which is zero and fifth gear. And so I've had to learn all these other gears. And actually Covid was really an interesting moment for me because I went through divorce and maybe the world stopped and I had back surgery and my body was broken, my heart was broken, and I was like, I literally just pulled the plug. I got on a plane and I moved to Maui because I figured might as well be in a nice place during Covid, and you can't do anything. Anyway, so I ride my bike, I could swim, I could be in nature, I could be in waterfalls. And I literally went there and I felt like slowly the gas gauge kept going up and up and up, and my heart rate variability doubled when I got there.

Dr. Mark Hyman: And I was like, oh God. And actually, it's an interesting metric. I can tell. My ring tells me when my heart variability starts to go, my stress level goes up, and it's kind of an interesting barometer. So I'm kind of using feedback tools to know, oh gee, maybe I'm a little, so I'm literally, next week I'm going getting on a plane, I'm closing everything, closing my computer, closing my phone, and I'm going off into the wilderness in the most remote place on the planet. I think that's what it takes for me to basically go in the Mongolian hinterland for a week and camp. And that I think is going to be helpful, but I can't just do those things. I have to daily do the things that keep me going, meditate. And it's when I drop those practices when I'm just too busy, I got too much on my plate, and I got too many things to accomplish, I will start to drop off the things of getting enough sleep or meditating on a regular basis or just doing nothing for periods of time. And I think I've had to learn how to navigate that in myself, because I'm always sort of the guy who will always move towards burnout. And so that's the

Dr. Neha Sangwan: Guy that always moves towards saying yes to a new opportunity, right? Yeah.

Dr. Mark Hyman: It's like, of

Dr. Neha Sangwan: Course, yes, we got to do it right.

Dr. Mark Hyman: Well, that's the other thing. My mother said no is a sentence, and I'm like learning how to do no better. It's hard for me, but I am learning how to do no better.

Dr. Neha Sangwan: Isn't it amazing when people are no longer in our lives and the things we remember about them and how they're just, they move from being physically in our world to being ever present in our hearts. So you can hear her voice so clearly.

Dr. Mark Hyman: Oh, a hundred percent.

Dr. Neha Sangwan: Yeah. So I think this is just, it's so important to know yourself, and that's the part of the me world that if you don't know yourself, if you don't know your tendencies, if you don't really pay attention to whether the environments you choose to be in are the ones that give you energy or drain you of energy, boy, how on earth are you going to navigate the crazy world we're in?

Dr. Mark Hyman: Yeah, I think this is such a powerful exercise, and there's so much more of that in your book Powered by Me. And I think that simple exercise of taking a piece of paper, writing two columns and go energy drain, energy gain, and writing down what they are, and then you go, oh, let's see how many of these energy drain ones can I get rid of? And how many of these energy gained ones can I add? And sometimes it's just as simple as few little adjustments that can make a big difference for people. What are the things that you find make the most difference and helping people recover from burnout? And you have in your book a plan, but can you walk us through practically, how do you take people from burnout to fully charged?

Dr. Neha Sangwan: Sure. Well, of course I'm going to tell you, it's a little bit of an intricate answer, but I'm going to simplify it for you. It depends on your style. Just like we talked about how you and I are really different on the physical versus the emotional. I dive in headfirst, emotional, social, spiritual conflict, whatever, I dive headfirst. But this whole, let's just swim every day in the ocean in Hawaii. I'm like the ocean, not with sharks. And are you kidding me? Right? So it's knowing yourself.

Dr. Mark Hyman: You grew up in Buffalo. That's what, oh,

Dr. Neha Sangwan: Shoot, listen, not my fault, not my fault. And so there's, let's just think of different people in our lives have different styles. I call them work styles. So some people are real doers. They love checking things off their to-do list. And oftentimes that gives them a sense of control. And so what they are most afraid of is vulnerability, vulnerability, checking things off your list. Boy, society rewards us for that. Boy, look at what you've accomplished. Look how many degrees you have. Look at this, right? And so oftentimes that action oriented, it's good. And sometimes when we overdo it and we avoid vulnerability, we find ourselves in a pickle. We feel disconnected from other people, we get a lot of accolades, but we feel empty. Now, let's take another, I'm going to give you four examples. Another one would be the thinker. The thinker who loves to solve complex problems.

Dr. Neha Sangwan: They love taking their time, slowing down, figuring things out. By the way that the doers are made crazy by the thinkers. The doers want to keep going and getting everything done. But the thinkers, the reason they have to slow down solve complex problems, and they love it so much, is they don't want to look foolish. They think to themselves, do it once and do it right. And then there's the seers. I think you and I are a little bit of Sears in medicine where we love possibilities, innovation. We want to brainstorm and think of every cool way we could do something and be cutting edge, except you know what we're most afraid of feeling trapped. Don't make me just pick one. What about all those other ideas? And what about this and this and this? And then another type of, I call it a work style, is the feelers, right?

Dr. Neha Sangwan: The people who are the glue of any family, of any community, of any company, of any team, and they're the ones who are really in tune and connected to people. Well, what's going to drain them of energy faster than anything? Feeling rejected, feeling like they are outside the pack. So people have to first understand who they are, and then they have to understand what drains them of energy. And once they do that, then it's about really kind of taking this pulse check, figuring out, because at different points in your life, mark, different areas will have a net gain and a net drain. Right now for you on a social level, it's a net gain. You're feeling good, you are really excited, you're going on a trip with your partner. All of these things are a net gain. But there were times in your life where if we would've done a snapshot of you, social would've been a net drained. So what I want people to know is wherever you are on the spectrum from burned out to fully charged, it can change depending on where you are in your life. So you want to just take the assessment and figure out, oh, I'm having a net drain in mental and emotional, but it looks like my spiritual, social and physical are doing great. So I think,

Dr. Mark Hyman: And the book actually has the ways to sort this out for yourself. You bet it's in there.

Dr. Neha Sangwan: You bet. And it's all broken out by sections so that if you really know that you need help in a certain section, go to that section, go straight to that section once you figure out what it is so that you can focus. The other thing that I'll say is at the beginning of our podcast, we talked about how there's acute burnout where people are just in it and they're at the edge, they're falling off the cliff. Well, after the first chapter, second chapter, maybe I say emergency toolkit, exit here, if that's you, because you need emergent help. You don't need to be reading a book. This is, I mean, you're not sleeping at night. You can't function. The book isn't where you're going to go there and go to an emergency toolkit that's going to give you guided imageries. It's going to teach you breathing, it's going to give you all the ways to calm your physiology.

Dr. Neha Sangwan: And then you find a health professional, you start working with them, you get whatever you need to, and then you continue to figuring out the root causes and how to change it. Now, mark, I'm not just doing this for individuals. I'm actually doing entire companies at once. So from c e o to frontline to everybody in between all of the company, they're all learning together. And when you acknowledge that, how did we not learn this in education in our families, now companies need to be the ones who help the next generation coming in bridge. And with our mental health crisis, everything that's going on, it's going to be our job now to educate the next level of workforce on all of this. And by the way, all of us too, we never learned it in medical school either.

Dr. Mark Hyman: That's right, that's

Dr. Neha Sangwan: Right. Yeah,

Dr. Mark Hyman: Yeah. It's so true. These are basic life skills. We don't even know how to manage our nervous system. It's such a ridiculous thing that we learn reading, writing, arithmetic, but we don't learn the fifth, fourth, third, fourth R, which is restoration. How do we restore ourselves? What do we need to actually take care of our organisms? I mean, it's embarrassing a little bit, but I work with a trainer, and we were working out yesterday. I was like, okay, what are we doing tomorrow? I was like, well, you need a recovery day. It's really important. Don't do anything. I'm like, what do you mean, mom? I want to work out mom, mom, I want to work out. Mom was family. She's like, no. She's like, he's like, no, you need a recovery day's as important as the training days. And I'm like, all right, fine. Okay. I won't do any training today. And in the morning I woke up, I'm like, oh, what can I do? Can I go exercise? Can I ride my bike? Can I go play tennis? I'm like, I'm going through this thing in my head. It's very funny. Wow.

Dr. Neha Sangwan: I am always in awe of your energy levels. I mean, one thing you really do have, you've got a lot of energy. I blame it. I blame you for the reason I don't have that much energy. I'm like, Mark's got extra. He took

Dr. Mark Hyman: Three people's energy. I don't think it's a zero sum game. That's not how it works. It's not a zero sum.

Dr. Neha Sangwan: No, I think you're exactly right. You're exactly right.

Dr. Mark Hyman: So I just want to get into this whole idea of boundaries, because part of the reason we burnout, and for sure, the reason I burnout is not saying no is not having good boundaries around work, around personal life, around family, around what I need to schedule myself in so that I make sure I get what I need done for me. And I think most us don't learn how to have healthy boundaries, dunno how to communicate healthy boundaries in a loving way. Don't know how to even identify what those should be or how to figure out what to do to create those for ourselves. Can you guide us through, do we, you talk about different kind of boundaries, porous boundaries or good boundaries. How do you start to think about boundaries and getting the right balance and not having too rigid boundaries or not too leaky boundaries? We talk about leaky gut, but you can have a leaky self, right?

Dr. Neha Sangwan: The answer's always in nature, right? Think about every single cell, a phospholipid bilayer boundary on every cell for the membrane. Nature knows how to do it right? Keep out the bad stuff, put in the good stuff, allow that all in. So yes, what happens? So first of all, I want to say, people ask me, how do I know where to draw boundaries? And I say anywhere that there's a drain of energy. That's where a boundary is needed. Burnout is boundaries. Those two words, boy, they really belong together. And that's the heart of burnout, which is now, if someone's gotten hurt in their life, maybe young, something happened when they were young, boy, they will drop armor and protect themselves from never feeling that pain again, something that caused them pain, something they were afraid of, some sort of trauma, anything that happened, and even every day needing to protect ourselves from feeling disappointed.

Dr. Neha Sangwan: And so over time, people can form too rigid of boundaries to protect themselves. Now, the way that it's too rigid is because it also, while it protects you and you don't feel the disappointment and you don't get hurt, maybe someone's been hurt in love and now they're like, okay, listen, no more. I'm not going to do that. I am happy by myself and I'm not going to venture into love. Okay, well, your boundaries are too rigid. When you start to feel lonely and disconnected and you wonder why things feel so empty, right? Because it can keep out the pain, but it also keeps out the connection and love and affection and everything else. Now, if you're Indian or in the Jewish community, I don't know if this is true, you can tell me, but we really didn't have a lot of boundaries growing up in our family.

Dr. Neha Sangwan: It was like everybody's in everybody's business. How many people are going to fit in this car? Well, as many as there are. This was before seat belts and all this stuff. Or we go to India and it's like, who's staying at our house? Well count however many people there are. They're all staying over. No one's missing the party. So there were never really clear boundaries. It was like with family, there are no boundaries. You take care of everyone. And so when you grow up that way, you may have really porous boundaries. Or if you're the feeler, like I was speaking about earlier, if you really resonated with being the glue of the team and you're afraid of being rejected, you may be someone who thinks that you can't draw boundaries, because if you do, it will disappoint another person. You might lose connection with somebody. And so for whatever fears you have might cause you to have two porous of boundaries. And the way that you know have two porous of boundaries is when your energy fluctuates by the room, every room you move into, it changes because it's actually sensing the external environment and you're leading from the outside in rather than from the inside out.

Dr. Neha Sangwan: So that's porous boundaries that are just kind of too wide open. And then there's rigid boundaries, and then there's just right boundaries. I feel like we're talking about Goldilocks here, but so the just right boundaries are the ones that you feel really good about. They might be a little hard to set. I might need to tell you, Hey, mark, what really works for me is to do something for two days. What does not work is doing it for a week, or I can work two days a week, but not five, whatever that is. It's about whether people are willing to take the dip of discomfort, the short-term dip of discomfort for the long-term high of what they want. Most people, when they come to a choice point, they take term the short-term high, meaning they avoid having the conversation saying what they need, asking for what they want, and then they get the long-term yuck, which is okay, that didn't go well. And I don't know why this person's so unreasonable, but the truth is, I never gave you the boundary in the beginning, but I'm really mad that you crossed it.

Dr. Mark Hyman: And

Dr. Neha Sangwan: So it's really, you know what I mean? It's like you really want to talk about things and set expectations upfront. I don't know if you remember this, but I remember us kind of going through this when I had your daughter, come stay with me. Do you remember this?

Dr. Mark Hyman: Yeah. Oh yeah.

Dr. Neha Sangwan: And so all you do is anytime you're making an agreement to do something, to live with someone, to bring someone on, for a job, to partner on a vacation, so important to just drop in and really kind of figure out what are my expectations for this trip? What agreements do I need to make so that it goes really well? And what agreements, if things don't go well, what should we decide would be a good way to handle that? So one of the things I decided was that wouldn't it be a great idea that anybody could call a house meeting if something went wrong? Anybody can call a house meeting. If we're going to live together, then wouldn't that be nice? And so you kind of come up with ways that allow people to bring up and surface what's going on so that it doesn't fester, and then you lose the relationship altogether. So boundaries are, whatever boundaries we create are the ones that allow us to be in a really healthy relationship because they have to work for both people.

Dr. Mark Hyman: Well, what if they don't work for the other person and they don't like your boundaries?

Dr. Neha Sangwan: Well, some people really don't. And sometimes that means you've outgrown the relationship. Sometimes that means you've come here and learn the lessons you were meant to learn. Sometimes it means that the other person could counter that and say, okay, I'd like it if you worked twice, two days a week and not five at my practice, let's say. And I'm wondering if once a month you could take a Saturday day call, would you be willing to do that? And so it's a bit of a negotiation until two people can come to what works for both of you, but be creative. Don't allow somebody's idea or saying no to you to have you think they're rejecting you. What they're trying to do is put in place what would allow them to say yes? They want to say yes, and they're telling you what it would take for it to be a yes. And the other thing, mark, you said you want to say yes to everything and everyone, and that depletes you sometimes. And I'm wondering that reframing that anytime you say yes to something, you're saying no to something else. And so what if you saying no to something outside an event or whatever it is, is actually you saying yes to a good night's sleep? So if you're somebody who has a hard time with that, think about what you're saying yes to. I think that'll make it a little bit easier.

Dr. Mark Hyman: Well, I'm actually struggling this right now because a friend of mine invited me tonight to go to Savannah in New York City, and I know it was four in the morning getting work done before I left, and they're going to want to hang out and have dinner, and I'm going to want to go to bed. And I'm like, I want to see them and have fun and do that, and I don't want to disappoint them, but I also want to go to bed. So it's like I have this kind of battle going in my head, and I often don't choose myself is the truth, and I'm learning how to do it better. But I think your book is such a great roadmap for people to think about how they can actually do it better, and giving them the tools and the language and the thinking and the structure to start to navigate where are they in the spectrum of burnout?

Dr. Mark Hyman: Because it's not like a linear scale. Everybody's got different levels of things that are, maybe they're not taking care of their physical health, or maybe their relationship are great, but their spiritual health is failing, not really dealing with that part of their life or addressing it. So it's really about how do you figure out how to navigate and overcome some of the things that you call mind traps, right? We have a lot of those perfectionism, judgment, control, blame comparison that actually drain us. So can you talk about how do people start to deal with these sort of negative mental habits, these ruts, these mine traps as you call them, that keep us looped in this cycle of burnout?

Dr. Neha Sangwan: Yeah. Well, I think you and I are, one of the things we value is excellence. We like doing things and we like doing 'em really well. We want to get an A. That's part of how we got here. And I think

Dr. Mark Hyman: Doctors got a's for sure, you're sure a doctor, you got a lot of A's, or you don't get to be a doctor.

Dr. Neha Sangwan: And there's an unwritten, unspoken competition in it all. And really we're competing with ourselves. And I think even when we achieve whatever we've set out to achieve, I'm not sure we give up on that. And there's a lot of people who do it in different ways. And so one of these mind traps that I would say is, let's actually go back a little bit. I want you to think about how you form your thoughts. So let's say tonight you tell your friend, yeah, I'll see you there at 8:00 PM Okay, I, I'll be there at 8:00 PM Actually, we would flip it. Let's say it was you inviting somebody else to come and they said, yeah, I'll be at your party at 8:00 PM I'll be at the event tonight in New York. And you look at your watch and it's eight 30, no text, no voicemail from your friend who was supposed to be there. And you're starting to realize you might be going solo to this event, right? They're not here. What's the first thing you would think? What's your first thought, the first way you'd put together that data?

Dr. Mark Hyman: You mean if they weren't going and I was just going by myself?

Dr. Neha Sangwan: Well, let's say it was reversed. You were the one in New York asking your friend, which is you, to come up and you say, yes, okay. The friend says, yes, now you're waiting at 8:00 PM You're waiting for this friend to go into the event and there's no show for 30 minutes, so there's an empty glass. Well,

Dr. Mark Hyman: I wouldn't do that, but I wouldn't do that, but I would, let's

Dr. Neha Sangwan: Just say there was, let's just say somebody didn't show up. What's your first thought?

Dr. Mark Hyman: If I invited them and they didn't show up, I would think, oh, what happened to them? Did they get an accident? Are they okay? Are they tired? Are they embarrassed to tell me they don't want to go? I probably wouldn't take it personally, but that's just me. I kind of tend to think about the situation that they might be in. But I think other people will have a different interpretation. They go, oh, they don't like me. They don't love me. They don't want to see me, they hate me, whatever. I'm not good enough. I don't have those thoughts. But

Dr. Neha Sangwan: Think about if it was a date, if it was a date, right now, your date doesn't show up and you're pretty excited. You're hoping that

Dr. Mark Hyman: That's more disappointing.

Dr. Neha Sangwan: And then you might think, what?

Dr. Mark Hyman: She doesn't like me maybe? And if I be attractive, maybe I'm boring, whatever.

Dr. Neha Sangwan: So this is the deal. I think of how we form our thoughts. We take data from outside. You look at your phone, there's no message. You look at the time, it's 30 minutes later inside you'll have some physiological response, like the body map that we were speaking about. That's all data. You take that data inside you and outside you that you have an empty glass of whatever you're drinking, empty chair next to you, the person isn't there, and you form your thoughts in one of three main ways. First, the way that you just said, which was maybe this person isn't really that into me. That's personalization. You make it yourself. You can imagine how that could be a little draining. If anything that happens, you think, oh my God, what did I do wrong? It's my fault.

Dr. Neha Sangwan: A different way that you could show up. You could say, oh, she is so rude, or He is so rude. Didn't even text, didn't even call. So-and-so's parents, didn't even raise them properly. Or you could go to what you did with your friend and you could say, wow, I hope this person's okay. If they didn't get in an accident. And you could go to generalization, which is something that's not about you or the other person. It's literally about bigger events than them. So it's personalization, projection, and generalization. Now, when you're, we live in a world where now with social media and the internet and all these things, AI and blah, blah, blah, everybody is in everyone's business. They at least get the half of the highlight reel of their life fantastic. Showing across social media. And so the comparison game, there's always someone who's going to be younger looking than you got more money invested earlier, whatever it is thinner.

Dr. Neha Sangwan: I don't know what it is, richer. So the game of comparing yourself to other people is just an endless trap. Now, the people who do it really well, they look at a picture of themselves 10 years younger and they're like, oh my God, I was so much better looking back then. And they compare themselves to the younger version of themselves. Now that is like an endless game. So there's lots of ways, perfectionism versus excellence, we were talking about that. So that's really about what you're focusing on. If you keep going over something, keep going over something to get it right, and you're really worried about what other people think about you, and it needs to be perfect. That's perfectionism versus excellence is you give it your all. You do the best job. You know how you put it out there, and then you're open to the feedback and learning. And if you don't get it or you make a mistake, that's okay. And so these are the ways that as we start to know ourselves, we can unlock ways that we're having a net drain of energy. And that would be on the thoughts level and the mind trap level. But you know this, whether it's biologically in your bank account or in your relationships, a net drain of energy is not sustainable anywhere.

Dr. Mark Hyman: Oh, that's true. So just to close, Neha, tell us what are the top things you do every day to support your physical, emotional, mental, and spiritual health? What's your routine now that you've sort of gone through burnout, you've come the other side, you're teaching this, what do you do and where do you struggle?

Dr. Neha Sangwan: I think there's a few myths. I've written a book on how to lean into conflict. And I think that people think that because I did that, it means all my relationships are perfect. They're not. And in fact, if you and I got in a conflict, my stomach would be turning and I would be nervous about bringing it up and it would be all the same things, but I just happened to have a bigger toolkit to draw from to work through it. And the same thing about burnout. And I think I can tell you're a little tired right now. I can feel it in you when you say, I stayed up until four in the morning and all this stuff.

Dr. Mark Hyman: No, I got up at four in the morning.

Dr. Neha Sangwan: You got up at four in the morning. So I think it's really about, even in this book, in launching this book, I came to Lake Como because I wanted to figure out if I was going to tell the world that they could go from burned out to fully charged at work and in life, how was I going to deliver this in the world and be fully charged myself? And so what I'd say there is, it's not like I don't have the tendencies of all or nones still I do. And sometimes I can feel myself starting to get the energy draining. It's just that when I fall off the horse, I get back on much quicker. It's about the timeframe. So you asked what I do, and I actually wanted to ask you about this, but I've had autoimmune issues with my thyroid, and I had a parasite maybe six years ago that really caused all sorts of skin issues and my gut biome.

Dr. Neha Sangwan: I came to you and we were working through all of that. And I just started every morning, starting my day with lemon water to kind of wake up my liver and get things moving. And then celery juice, which has actually, I cannot believe this, but it's actually really kind of healed the last parts of my skin. So I have 32 ounces of celery juice every day, and then I follow that with a heavy metal detox. And now I've started to work through, you had done the testing on me that showed that I still had things that needed to come out, but while I was out here, I bought a juicer. I've been doing it every day. I love journaling and I love being in nature. So for me, my grounding place is when I can be surrounded by people that I love and I feel authentic around and connected. So for me now, I've weeded out the people in my lives, my life that drain me of energy because I am that feeler that really cares about who's around me. I get energized by that. So I sleep really well. So I'd say that I sleep at least eight to nine hours every night, and I love it. And it would take something pretty big and important to get me to say I'd be getting up at 4:00 AM. So

Dr. Mark Hyman: Yeah, well, I'm just doing it because I'm trying to get to Mongolia and not have anything on my plate. So it's a short term, short-term thing,

Dr. Neha Sangwan: But that's important. It's short term. That's what I mean. You and I can get tired, but we also know that it better be short-lived and we're going to recover quickly. And so we have burned out and we aren't free of ever feeling that exhaustion, but we recognize it early and we turn it around and we make ourselves important.

Dr. Mark Hyman: Well, I think that's the bottom line here is make yourself important. If you're suffering from burnout, if you feel tired and exhausted, if you are overwhelmed, there is a solution. It's not just about having to endure that and deal with it. And yes, we all have pressures on our lives and things we have to deal with and do, but I think it's like a life skill. And this is a really important life skill because if you're burnt out, it's a sign of high levels of stress and that exacerbates every known disease. So I encourage everybody to check out, NE has a new book powered by Me from Burned to Fully Charged at Work and in life. I certainly am going to use it as a roadmap for me, and I encourage you to share this podcast with your friends and family on social media. I'm sure they're going to love it. I think everybody can relate. Certainly I do. And leave a comment, how have you learned to deal with your burnout and what have you found successful? We'd love to hear from you, and we'll see you next week on The Doctor's Pharmacy.

Closing: Hi everyone. I hope you enjoyed this week's episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their find a practitioner database. It's important that you have someone in your corner who's trained, who's a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health.