How To Reduce The Harmful Effects Of Chronic Stress - Transcript

Introduction:
Coming up on this episode of The Doctor's Farmacy.

Elissa Epel:
Our sense of purpose and our ability to make meaning of when traumatic things happen is critical to how well we can live.

Dr. Mark Hyman:
Welcome to The Doctor's Farmacy. I'm Dr. Mark Hyman. That's farmacy with an F, a place for conversations that matter. And if you ever feel stressed or feel like stress is taking over your life, then you might want to listen up to this podcast because we're going to be talking with one of the experts in the research on stress, Elissa Epel, who wrote a book called Seven Days to More Joy and Ease, which is a subtitle. The title of the book is The Stress Prescription. Now, I don't want to get stressed, I want to heal for stress. So I think that's what really the book is focused on.
We're living in a world more and more with stressors that are not of our choosing. Climate change, war, economic pressures, inequities, increasing division, social unrest. I mean, it's really kind of a very disturbing moment. And when you pay attention to the news, it's pretty stressful out there. And we're all struggling with the fallout of COVID and with the fallout of the economic crisis on the heels of that.
And I'm so happy to have Elissa Epel today on the podcast, who I've known for many years. I met her at a Tibetan longevity conference with experts in longevity and Buddhism, God, well over a decade now ago. She's really been a leading force in the field of aging research and the field of stress research. And she's a professor at UCSF, University of California, San Francisco, the director of UCSF's Aging, Metabolism and Emotion Center. Amazing, this is an emotion center at a major academic center.
She's a member of the National Academy of Medicine, which is no small thing to achieve, and past president of the Academy of Behavioral Medicine. She's on lots of scientific advisory board, including those for the National Institute of Health. And she received many awards, including from Stanford, American Psychological Association, and many others. She's the author of the New York Times bestselling book, the Telomere Effect, with Elizabeth Blackburn, which is now in 30 languages. And really it's quite interesting how our longevity and our stress programming is affected by how we think, feel, and emote and all the things that we actually have control over.
Her new book, which we just mentioned, The Stress Prescription: Seven Days to More Joy and Ease is out. I encourage you to go pick up a copy, check it out. It's quite a great map for how we can reset our nervous system. So really thrilled to have you on the podcast, Elissa. It's great to see you again.

Elissa Epel:
Thank you, Mark. It's such an honor to be with you.

Dr. Mark Hyman:
Yeah, it's an important topic. And I asked you for a quote for my new book, Young Forever. You were nice enough to give it to me, because you have been focused on the role of stress and longevity, and we're going to get into that right now. I think right now we're in this incredibly uncertain time for many of us, financial uncertainty, political uncertainty, climate uncertainty, and I think it's kind of a stimulator of exaggerated stress.
So can you talk about how we can learn how to adapt maybe better or understand how to think differently about uncertainty, and the whole idea of uncertainty tolerance because that's something we really don't talk about much, but I think it's an important framework for understanding how we navigate our reality and not just get buffeted about by all the stresses that are happening all the time.

Elissa Epel:
I think it's important to start where you did, which is naming, we're in a different era, we're in a different place. We have our personal dramas. We're trying to manage the inherent stress of life and being a human in this modern world. And then on top of that, we do have this layer of more existential stressors, of global stressors, climate change, war, famine, drought, the climate events that are going to be coming more and more frequent. And so how does our human mind deal with all of that at once? We're not quite well-equipped, but we're not that far off from being able to adopt a new mindset for this new era and strategies.
And uncertainty tolerance is core to how we can remind ourselves to not let this primate body overreact, create accelerated aging, make our life miserable, given that we are just surrounded by uncertainty of the future, volatile uncertainty, meaning not just the inherent uncertainty that we don't know what's going to happen tomorrow, but just the dramatic shifts that we're going to see based on climate and politics and how we create societies as humans.
So the ability to simply be comfortable with not knowing is now a core survival skill. And we're all different. We come with different levels of what we call tolerance or comfort with uncertainty, and those of us who are on the edge of it, the really actually being intolerant and feeling really anxious about when we don't know exactly our plans tomorrow, how things will go, that is a tremendous vulnerability factor for anxiety and depression. We've always known that. We measured that during COVID. We followed 500 people, and the people who were most rigid about uncertainty and tensed up and couldn't feel ease and relaxation with uncertain situations, they had much more trauma from COVID, fear of COVID, climate distress, etc.

Dr. Mark Hyman:
What makes someone more uncertain than another person, being able to tolerate uncertainty, and other people not being able to tolerate uncertainty. Have you found that out?

Elissa Epel:
It's a really good question. We all come with a different level, and what creates that level? Part of it is personality and openness to new experience. Part of it is really our life experience shaping us. And so when we've had a lot of early trauma, we tend to actually have more of a threat response to things that happen and to things that haven't happened. So that vigilance about ruminating about the past but also worrying about the future, feeling that more is at stake, feeling more threatened.
So there are lots of ways to overcome that. In your diagram of stress, in your new book coming out in February, I love your triangle of understanding all the influences on us and our aging biology. And you had one layer of stress that people don't usually think of, which is we're born into this world wired differently because of intergenerational trauma shaping our epigenetics, as well as our experience in the womb for nine months, the level of maternal stress that we've been exposed to.

Dr. Mark Hyman:
It's such an interesting, I actually, I haven't really talked about this on the podcast or much at all. And it was recently I had this chance to really dig into some deep work on myself, somatic work and other work. And I've also been reading my mother's book about her life with my father in post war Europe. It was sort of a fictionalized account of their life.
But I was born into a very uncertain place. My father didn't really want kids, and my mother had multiple abortions. He wasn't really around when I was born. My mother was very stressed and depressed, and there was a sort of state of lack of safety. And I remember that even growing up in my early childhood, the dynamics of a marriage that was falling apart, and being a little kid watching all that, and my mother being very sick afterwards, just not being able to eat and losing weight and being super depressed and in bed for months. And they were going to put us in foster care. And so there was this whole-

Elissa Epel:
Wow, that's a lot.

Dr. Mark Hyman:
... drama that I had just pushed back and realized that it definitely set me up to have a more sympathetic activation in my nervous system for most of my life. Even though mentally I think I was able to manage it, physiologically it registered, and I think that's something I've really been paying attention to.
And as I began to shift into more parasympathetic states, which we'll get into and talk about that, it allowed this resetting of my nervous system and my biology to actually heal and then be happy and enjoy life and do the things that are really important. So these traumas are real, and they go back generations. I think my own life, and I don't know why I'm talking about this now, but you just kind of made me think about it.

Elissa Epel:
It's absolutely real. I just want to say we actually, I mean Rachel Yehuda's work and others have actually shown our stress response system, even three generations out from being from a Holocaust survivor, as a parent, as a grandparent, we are different.

Dr. Mark Hyman:
Yeah, I mean my grandparents were deaf on my mother's side. So they had that stress and her stress of being in childhood, to be the parent for them. My dad on his side, his mother was one of 13 children and accidentally pushed her sister off a swing and she died at two years old. So she was the black sheep of the family and was chronically neurotic and stressed out and anxious, I remember my grandmother.
So all these things you don't think about, and of course many people have far worse traumas than that, abuse and even worse. But I think it does register in our nervous system and unless we are conscious about how to heal that, it kind of informs our thinking, our life, our way of looking at things, and ultimately our illnesses. I remember going to Herbert Benson's course in the nineties on mind body medicine from Harvard. And he said stress basically either is responsible for causing or exacerbating 95% of all illnesses, which is like what? And it's something in medical school we don't really learn about, how do we manage and how do we think about it, how does it work, what does it do?

Elissa Epel:
And we now know the pathways, and yet we still don't take it seriously. And that's why it's called The Stress Prescription because we're not going to get rid of stress, but there is a way to live with it better that is absolutely medically relevant. It's a prognostic factor for getting mental and physical illnesses, and all of the data, including a recent APA survey, show we are more stressed now than in previous years and decades.
But even worse, I think of our youth, like 70% are reporting stress, such extreme stress they don't know how to manage, it's interfering with their life. And these are really serious red flags. We know what that means biologically. It's a leading indicator to the wear and tear on our cells, on our brain, the conditions where I was trying to avoid. So it's a serious prescription, that we don't have to live each day with a successive level of stress, which really rules out those states that you've been cultivating, which is the restorative states.
And it's a beautiful example you gave, how you are consciously changing them. Because it's not our fault. There's no judgment. We all come out with different levels. That question about why do some people expect negative things to happen? They can't stand ambiguity. Uncertainty feels intolerable. That's part of it. It's partly from how our stress response systems are shaped from all these different influences before our life, including our life starting in the womb.

Dr. Mark Hyman:
And it can change. That's the beautiful thing, is we can rewire our nervous systems. And I think the difference between chronic stress and acute stress is nothing we mostly think about. But one of my favorite scientists is Robert Sapolsky, who wrote a book, Why Zebras Don't Get Ulcers, which is essentially the idea that zebras are out there eating their whatever, their grass, and then the line comes and chases them and they all run like crazy, super stressed. And then the lion catches a zebra who's eating right next to all the other zebras. And they just go back to eating their grass. So they have acute massive stress, and then it goes away.
The problem with humans is we now in our world are experiencing unremitting chronic stress from so many different insults. And a stress can be a psychological stress, it can be a physical stress, it can be an energetic stress. And I think all these things are influencing us now. And so can you talk about the difference between chronic stress and acute stress and how they impact our long term health?

Elissa Epel:
Yes, it's a critical distinction because stress itself is not bad for us. It can be good for us. And so just dividing things up in our mind to think about is this an event? Is this an episode that I can recover from? Or is this a situation in my life that I'm going to live with forever and I have to get used to? So these chronic stressors, like having a child with a chronic condition, having a conflictual relationship, job stress, these are the types of addiction, loved ones with addiction, health problems. I mean, years and years and years go on where we need to be coping with it in a different way because it's not about getting rid of the situation.
The acute stressors are really pointing us to just thinking about the stress response in the moment, in dealing with an episode within a day. What does that stress response look like? And as you were saying, when we think about the peak stress response and the recovery and how our body does that, it's a phenomenally beautiful biological process that we are fully equipped with to have over and over without harm. Without harm.
And in fact, when we shape those stressors to our body, to be short term, brief, and kind of moderate, not too extreme, they're not only not harmful, they're creating all sorts of restorative and anti-aging effects in the cell. And you write about that so well in your book, and that's just, we so easily forget, oh, we could use this for good. We can actually do things like HIIT or sauna or cold exposure and be conditioning our nervous system. Not just our cardiovascular system, but our actual emotional and physiological stress response can get conditioned.

Dr. Mark Hyman:
Yeah, so there's a lot of doorways in, is what you're saying. There's a lot of doorways to reset the nervous system. It doesn't have to just be your mind. You can use physical states actually, of hot or cold, or different lights or all kinds of stuff.

Elissa Epel:
And why not?

Dr. Mark Hyman:
Yeah, why not? Right. And I want to talk about how you frame stress in your book around our mind states, and then how our mind can create physiological stress, or conversely, can actually restore us to health. And you mapped out these different spectrums of mind states that help us think about how to understand stress, how to navigate it, how to think about discharging it.
I always say that stress reduction or stress management is not a passive process, it's an active process. And just like you have to exercise if you want to build your muscles, you have to practice various techniques in order to reset your nervous system from this chronic unremitting stress, which is so pernicious and driving so many of our diseases.

Elissa Epel:
Yes. So you want to hear about these mind states?

Dr. Mark Hyman:
I want to hear about this spectrum of these mind states that you talk about.

Elissa Epel:
Yeah, we've been thinking about stress from a different perspective, we and others in the field. So usually we think about how stressed does someone get in the moment, how quickly do they recover? And that's important. We want a quick peak and a quick recovery, and that's a healthy resilience stress response. But it's not just the action during stress, during events, during tough times. The question really becomes what are you carrying in your body and mind when nothing is happening, when you are at rest, or at least you think you are. And that's a window into the unconscious level of stress that we're carrying.
So when we talk about uncertainty stress, that's where it is, because it's a bit vague and we can catch that. Mindfulness, mindful check-ins help us just in this moment just ask, are you tensing up? Do a check-in with your body, your hands, your face, your eyebrows. So often we are tensing up and we sometimes can identify why. And sometimes we can just remember, oh, right now it's not only okay to relax, it's important for my body. I'm not needing to cope with something.
So it's that baseline state or rest state that we're learning is really different in people and is a sign of chronic, low-grade chronic stress that we can actually get to and release through different techniques. So red mind is what we've been discussing about coping in the moment, when you're fired up and you need the energy, you need the stress response. And we just don't want that to kind of go on and on and have sluggish recovery, but otherwise, we need that. It's beautiful. It's why we're here today. That's our survival response. And of course we are triggering it too much as humans with an overdeveloped neocortex and the more chronic ambiguous threat we feel.
So then there's yellow mind state, which is when we think we are relaxed. It's just how are you walking around during the day? Typical day, where are you at? What's your baseline? You probably do some monitoring. You know what your autonomic nervous system is set at. And that is probably higher than we need to be at. So what we think of as our default baseline is actually carrying around a lot of both cognitive load from our thoughts, from different information screens' demands. So we're a bit activated. And then there's also the unconscious stress that we can become aware of and release. So we want to bring down that yellow mind state to a more true resting state. And that's the green mind.

Dr. Mark Hyman:
And how do people start to think about identifying if they're stressed? Because I think for me, I didn't really think I was, but I think I've been able to map out things that, looking at my Oura Ring for example, it could tell me my heart variability or what's happening. I was in Mexico City for a week, and my heart variability went down. I went to the jungle in Costa Rica and it went way up by threefold. So our bodies sort of register all the inputs, even if we don't think they are.

Elissa Epel:
Yeah, I've learned a lot from monitoring, and I think that's one way to raise awareness, as well as asking ourselves to become mindful of our emotions and where we're holding stress in the body, where we're tense. The heart rate tells us a lot of things, but the heart rate variability we think is more specific to that balance between parasympathetic and sympathetic. So more related to psychological stress, not just metabolic demands. So that's super interesting.
So Costa Rica leads you to a different yellow mind, maybe green mind state, better baseline. I monitored with my Oura Ring, I monitored my heart rate variability during a meditation retreat. And we know that when people slow their breathing, immediately they can have a decrease in all the sympathetic activity markers and sometimes in heart rate variability during study. So it's no mystery that doing these practices, and doing them for longer, can lead to these improvements. And those are what we call deep rest states, when we're really allowing ourselves to feel safe and to let down and let ourselves go into restorative mode.
But I was surprised at how long my heart rate variability, my baseline heart rate variability, took to change. So it was only two weeks later, toward the end of the retreat, that my sleeping heart rate variability really improved. And I think that's-

Dr. Mark Hyman:
So two weeks of meditation, hours and hours every day?

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

Dr. Mark Hyman:
I rarely get over 40. And then I think the other night when I was in the jungle and I was in this deep sympathetic, parasympathetic state and doing a lot of somatic body work. And it went to like in the nineties and I was like, holy crap, we don't have a framework for understanding how these things are so impactful for us. So I realized how much I need to pay attention to the practices that I need to do to actually reset my nervous system regularly.
So in the book, you talk a lot about some of these practices, and that's what The Stress Prescription is. So I'd love you to talk about how do we create a lifestyle and a way of thinking about our day and a way of thinking about the beginning and the end of our day and other types of tools or techniques or doorways, other than meditation obviously is powerful, but there's more than that. Let's explore that.

Elissa Epel:
Yeah, we have these red mind states that we don't want on all day. Drains our batteries, stresses our mitochondria. We have data on daily mood and mitochondria, showing it is really sensitive to daily affect. This was a study with Martin Picard of Columbia, and we were measuring the enzymatic activity. And so when people woke up with more positive emotion and went to bed with more positive emotion, they had higher mitochondria, which we measure in the middle of the week of monitoring, particularly at night. So there's this idea of how are we recovering from the day? Can we maintain positive affect at the end of a stressful long day?
And we certainly found the chronically stressed participants, these were caregivers, had lower mitochondria overall, but this mood effect pretty much mediated that and overrode that. So that's pointing us to, we actually know how to increase positive affect quite quickly, with gratitude exercises and other ways of thinking and being. And so how amazing to think that our mitochondrial activity might be under our control in this short term way.

Dr. Mark Hyman:
Wow. So what are the ways that actually you can affect your mitochondrial activity then for [inaudible 00:23:59]?

Elissa Epel:
Yeah. Well, to get back to your question about how do we live a day without chronic stress. So we might think of red mind as drinking coffee all day and just keeping us in that activated mode. And we want that stress response, but we just want to use it parsimoniously, not take it for granted. When we ignore it, it can just be on all day. The rush, rush, rush. I mean, rushing and packing our days, probably the most common pernicious way that we stay in yellow and red mind.

Dr. Mark Hyman:
Yeah, the Okinawans call it hurry sickness.

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

Dr. Mark Hyman:
Yeah, I mean [inaudible 00:24:40], they just live life. It's slow, and it's about community and people and enjoyment and pleasure and food and hanging out. Somebody's like doing startups and trying to build a career. People are just living and it's just this beautiful phenomena that we see, and I think that's a big part of the longevity in these zones.

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

Dr. Mark Hyman:
I wonder if that's why stress causes fatigue because it affects our ability to make energy.

Elissa Epel:
Yes, I think that's exactly right. And that is a new area. In 2018, we published the first paper showing that chronic stress was related to lower mitochondria. And then we were like, why didn't we measure fatigue and vitality? You would imagine you have low mitochondria, some had as low as people with mitochondrial disorder.
And that is thought to be at the center of both chronic illness and mental health now, these mitochondria as the source of aging breakdown. And so I think it's really helpful to think of our mitochondria and what gives them a boost, and boosting positive affect, having more of these restorative states but also the hormetic stressors, that they probably love them.

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

Elissa Epel:
It's interesting to think of really planning regular, like a lifestyle habit, hormetic stress episodes. So it's very common to be doing ice exposure or sauna or Wim Hof breathing. And those are, I mean to be totally honest, I don't think we have many options in our toolbox for hormetic stress that we know of and we know how to use safely and find the right dose. So people experiment, and it's just a new cutting edge area of stress to really understand how these are affecting aging and mental health.
There is exciting work on depression and hypothermia, showing that when you can raise your core body temperature even just a few sessions, it can lead to over a month of remission from more severe, treatment resistant depression. And of course the cardiovascular effects are well documented. Rhonda Patrick just wrote a beautiful review of what sauna, repeated sauna does.

Dr. Mark Hyman:
Oh wow. We'll put that in the show notes. What's the reference for that?

Elissa Epel:
I'll email that to you.

Dr. Mark Hyman:
Okay, that's great. Because I think we think, oh sauna, it's nice, whatever. But actually, these are very therapeutic, and I know for myself it's sort of how I managed to get through chronic fatigue, was using hot and cold therapies just to be able to function, and also just as a basic maintenance in my life for mood, for energy, for relaxation, restoration. It's quite powerful.

Elissa Epel:
Yes, it is. And it's beautiful in that it's not medical. So it's creating all of these changes in the cell in a dramatic way. Same with cold exposure, same with breath holding, the extreme breathing, and then the recovery response. So we're just kind of inducing the survival response in short bursts and then the counterregulatory response, turning on the autophagy, cleaning up junk in the cell, reducing oxidative stress [inaudible 00:29:32].
And I think in terms of the aerobic stress, I mean we've been trained to think, you've got to change your clothes, do 45 minutes, you've got to get the endurance in. And of course that's important, but what we are talking about, stress fitness, you can go do something for one minute, two minutes, you change up your physiological state, you can go do jumping jacks or sprint. Someone was just encouraging me, I was like, "Yeah, but you've got to change your clothes, you can get sweaty."
And they're like, "No, I do it all the time. You don't. You do it in your work clothes." So it was interesting just to think, no, just take away all those barriers about how we think you have to be prepared for exercise and be in the right place and just do something high intensity in wherever you are, briefly probably. People feel self-conscious. But that is really changing up our state. And we also use that in different therapies that are really needing acute psychological first aid for emotion regulation. What do they do? There's all sorts of strategies that are body up like that. So ice on the cheeks is one, as well as the pushups or jumping jacks.

Dr. Mark Hyman:
Amazing. So I think I once was in a hotel and they had a cryotherapy unit, which is where you go and it's like 200 degrees below zero or something. So you cover up your ears and your nose, and it's basically protect the extremities. But you go in this incredibly cold environment for two or three minutes. And I remember coming out of that just feeling like, holy crap, I feel like a million bucks. All my pain's gone. I feel energetic, my mind is focused. And it lasted all day.
So I think we kind of have these different doorways we can use. We think traditional things like yoga, meditation, massage, breath work, we're all pretty familiar with that, body work, but there's a lot of other ways we can actually do it. I mean, it can be just a cold shower in the morning or it can be a hot bath at night. Really powerful technologies that we've overlooked as key regulators of our biology in our stress response.

Elissa Epel:
And I think it helps to just realize we really are monkeys in clothes. We really do have this mind body of an animal. We're animals, and we don't like to think of ourselves that way. We think the kind of higher status way is meditation and controlling our thoughts. And the truth is, we do really well with body up therapies, and they can be even more powerful for some people than the top down therapies.

Dr. Mark Hyman:
And I think now there's a whole psychedelic renaissance too, talking about how do we re-pattern our brains in trauma, and a lot of has to do with the meaning we make from the world. And one of the most helpful frames I ever heard was from [inaudible 00:32:15] which is that trauma isn't what happens to us, it's the meaning we make from what happens to us. And I think this is very much akin to the framework of Buddhism, which is where I met you, was at this sort of Buddhist conference with the Dalai Lama at a Buddhist retreat center.
And the perspective of Buddhism is essentially that all of our suffering comes from our interpretation of reality and that it has no sort of objective meaning, but that we kind of put our meaning onto reality, which is why you can have, the analogy I always use is James Bond can have a gun to his head and he's fine. Woody Allen would not be so fine. Same gun, very different response.

Elissa Epel:
Very different.

Dr. Mark Hyman:
Right. So it's not necessarily the external thing that happens, although there are real physical stresses and things that can happen, but it's how we talk to ourself about how we think about it, the meaning we make from it, and all that meaning is what causes the suffering. And I think that's what people don't realize, is they have the power to change their frame and their mindset when it comes to how they address the challenges in their life and the things that come up, whether it's being late for a plane or whether it's a more serious life event. We have a choice.
And I think most of us are kind of like you said, animals, like monkeys in a suit, where we just are reactive and our primitive brains are very much in charge. And a lot of this work that you talk about in The Stress Prescription is about how to get our higher level of self organization and self regulation through mastering our minds. I mean, that's really ultimately meditation. How do we master our minds? We talked about exercise to build our bodies and eating right, but the activity of training our mind is something that we don't really even think about in this culture very much. So can you talk about how our mindset and our self talk and our framing of reality regulates our stress response, and what we can do to shift that?

Elissa Epel:
A lot of those are strategies that we can use in the moment, and I will talk about those and how much mindset matters. But let's take a step back because you brought up purpose, the meaning we make about events, but also about our lives. What story are we telling ourselves? And that's kind of the master stress tip, which is our sense of purpose and our ability to make meaning of when traumatic things happen is absolutely critical to how well we can live.
So we were at this meeting, we both know a lot of people who fully live a Buddhist life, and as part of that, there's a whole worldview and a mindset of noble truth number one, that things will happen, there will be stress and suffering as humans, and that the future is ultimately uncertain. And I had the opportunity to have a Zoom conversation with his holiness, the Dalai Lama, and that was my first question, we're measuring uncertainty and how do we get more tolerant of uncertainty?
It's such an important fundamental belief of Buddhism. So what can we do to embrace uncertainty? And I wanted specific ideas and practices, of course, and that's not quite how he lives. He lives from the worldview of living your beliefs. And so his answer was unbelievably simple, which is, it is a fundamental belief that the future is uncertain. And that's my answer. So he didn't point us to practices, he pointed us to a mindset, a shift in how we see the world. Now, we know even Buddhists get stressed. We have to keep reminding ourselves of this.
So I think there are a couple assumptions we make that lead us to stress, depression, and hopelessness. So one is that we have unlimited time, and we don't really see, it feels like we have days and days and days and we're going to live until we're much older. And that's our hope and assumption, and that's how we live.
And another is that things should be somewhat controllable, at least in the west, controllable and certain. We should actively control things. And then when things don't go as planned, it really does set us up to have interpretation of victimization, of this thing shouldn't be this way. And so flipping our mindset so that we can really embrace uncertainty and see the fragility of life and really live the impermanence that's there. We're just rushing.
We don't notice it, but this moment with you will never happen again. This moment in time for all of us is gone forever, and each day is so unique, and just remembering that and living in this unit of a day and appreciating it because we don't know what will happen and how long we'll live, both in our individual lives, when we'll die, but also as a human species, we really don't know.

Dr. Mark Hyman:
Well, a lot of the practices of Buddhism are sort of meditating on death, right?

Elissa Epel:
Yes, exactly.

Dr. Mark Hyman:
It's not avoided, or many say that meditation's a practice for being in the bardo state and being in this transition from this life to who knows what's next. You know what I mean?

Elissa Epel:
And there's also ways to get there besides consciously having death practices, death and impermanence practices. And that is facing life-threatening situations, yours or people you care about. And it shifts people into a state of spiritual urgency. And spiritual urgency really is that understanding what is forcing us to think about our purpose on life and what matters to us and to prioritize our time to match that.
And so I really like to remind myself to have some spiritual urgency, and that can help us really appreciate the joy and what's in front of us. And appreciation and gratitude is one of the most powerful antidotes to stress, seeing what's here now today.

Dr. Mark Hyman:
So how do you do that? If you feel overwhelmed, you feel like life's hard, I mean, it's hard to focus on gratitude when you're in that state. So how do you help people with the practices, maybe that you describe in your book about how to start-

Elissa Epel:
Changing up the scene is so helpful. So getting out of our routine and into a sensory experience is important. And maybe part of your routine is some mind body practices or immersion in nature. I think those, as well. So meditation, nature immersion, plant medicine, these have all gotten me very much more in touch with impermanence, purpose, spiritual urgency, not getting caught up in the small things that we so easily spend a lot of mental real estate on.

Dr. Mark Hyman:
Yeah, I tend to avoid things that are just kind of brain pollution, I call them, mind pollution. I mean, I do pay some attention to the news, but it's a rabbit hole. And I think it's just designed to activate our amygdala to create fear and distress. Like, there's no good news channel. It's all bad news. So yeah, you talk about managing our consumption of media and news and how we can begin to regulate ourselves a little bit differently.

Elissa Epel:
Media create dangerous signals. Just turning on the TV, you're all of a sudden getting a ticker tape headline and visual images, often the worst scenes possible. And so whether we are close to a disaster or across the world watching it, it is getting under the skin and affecting us. And there's such great research showing that dose response relationships with visual images, with media exposure, after 9/11, of course there were epicenter effects. Blood pressure went up in New York City, but blood pressure also went up in Washington state, just less.
So there's this connectedness that we should remember and acknowledge and protect ourselves, but then not just about avoiding the stress signals but actually really increasing safety signals. And so we know a lot about safety signals from rodent studies of fear conditioning and stress. And we can turn off some of the stress response by having positive signals that tell us there is no stress right now. It's okay to feel safe. And so that comes down to our sensory world. So visualizing beautiful scenes from nature that make us feel safe. Having a weighted blanket. I mean, this is becoming popular in adults. It's not just-

Dr. Mark Hyman:
A weighted blanket.

Elissa Epel:
Kids with sensory issues, having touch, massage, all of these physical and sensory cues can be powerful safety signals. And so I love it when I see, for example, people have a part of their room or part of their house where they have their meditation, they have maybe a picture if they have a Buddha or they have a picture of Jesus if it's prayer. And so they have this place their body's conditioned to, so the body is conditioned through repeated exposure to safety signals, whether it's conscious or unconscious. That's what I love. You don't have to be thinking about this, you just do it. And your body is basically turning off the stress response for you without you having to exert conscious effort.

Dr. Mark Hyman:
It's very powerful. So we have a lot more access and more techniques and tools to go into our nervous system than we really use. And the more we can start to learn these simple practices, whether it's breath work for a few minutes, or jumping in an ice bath or doing 10 minutes of meditation, there's all sorts of tools and resources out there now. Qigong is a great practice I started recently that helps me sort of ground in the morning.
And so there's just all this stuff out there, but we don't think about how necessary these are for our survival, particularly living in this sort of modern world. And maybe if we all lived in [inaudible 00:43:23], we wouldn't need to meditate and do all these things, but we have to buffer the reality that we live in through some of these practices. And that's really what's so great about your book, the Stress Prescription. I encourage everybody to get a copy. Seven days to more joy and ease. Seven days seems pretty doable. So what are the kinds of things that you offer in the book that maybe you can highlight for people as we think about the importance of managing ourselves, not just resting, but really getting this deep blue mind restoration states?

Elissa Epel:
And so I will go through the seven days, but I don't want to forget to point out when you are talking about all the different ways we can change, we really think about what we can do as a single body and that's what we control the most. But we also so intensely influence each other with our emotional states. And so that's another thing to think about. Who are you surrounding yourself with, and what are you emanating? It's an active influence if you are always stressed all the time.
I mean, I certainly stressed out my staff for years before I got a better handle on how to handle the life of soft money and research. So I am very different now. And just that rush, that the Okinawans don't have, we can't really have ease and think we're going to decrease stress when we look at our schedule and we see that kind of day. So that's been an active goal of mine, is to really not rush. And that allows us those sensory experiences to see beauty, to see awe, to not just walk by things. So the seven days are organized.

Dr. Mark Hyman:
Slowing down is great.

Elissa Epel:
Yes, right. And think about that to the cell. Slowing down allows it, it sends messages, time for housekeeping. So the seven days, they start off more with these kind of mindset, looking at how negatively we view stress and how we might shift to more of a positive mindset of framing stressors as positive, exciting, a resource, the opportunities for dealing with stress, but also what our body's doing. And so putting on a positive feedback loop for a positive stress response that's more energizing and the hemodynamics are much more strong cardiac output, good oxygenation, versus that threat response, which feels terrible. And we know what that is. That's the vasoconstrictive response.
So our beliefs in the moment are really important, and what we're saying to ourselves. And so arming ourselves beforehand with whatever statements that make us feel really resourced. I even just had a friend text me before, I was dealing with something, and she just wrote, "You got this." That's all she wrote. It just felt so supportive. It was like, yeah, I got this. I've been here before. I'm going to survive.
So I have people step back and do a stress inventory and just reflect what in your life, first of all, is creating the dark cloud of stress, pressure, what's making you not be able to feel ease each day? So looking at situations in our lives, sorting them into what's controllable, what's not controllable, and of course the gray area, trying to cut some of some the ropes we have to the uncontrollable stressors that we're always trying to solve in our head. And we carry them around. It's like pulling on a rope that's attached to a brick wall. It's like, yes, it takes energy. Yes, we're using excessive mitochondrial enzymes, and we don't need to be. So just dropping the rope. Literally, I say to myself sometimes, drop the rope.

Dr. Mark Hyman:
Drop the rope. Yeah.

Elissa Epel:
Yeah, it's very freeing. You don't need to be solving, it's going to come back. I mean, I'll remember it again. Drop the rope again, or put down the luggage so that we're not always carrying this load around of unsolvable things, figuring out where we can solve. So stress inventory helps us actually align our time with what matters to us, our daily schedule, not just our more long term projects.
And then we go into how to have a healthy stress response, both top down, some of the mindsets, as well as bottom up, some of the body strategies. And then there's changing the scene. So that's nature and creating safety signals around us and having deep rest dates, not thinking, okay, I'm relaxed, watching my favorite movie, and I'm having a social conversation. That's good, and we can do better.
And then breathing, the breathing is just, I think we could all ... I love hearing James Nester and Patrick McEwen, two breathing experts I've learned a lot from, and how they talk about changing baseline breathing. And that is something we can all nudge ourselves towards, so that breathing through the nose, breathing slower, different breathing techniques to reset and energize versus just the normal functional breathing that most of us are not doing right.

Dr. Mark Hyman:
Yeah, I mean, talk about the breath as a doorway to managing and sort of reframing our biology.

Elissa Epel:
I've been working on a paper for several years with colleagues, including Alexandra Croswell, and basically what we pose is all of the mind body activities work. People want to know what's best, and the answer is what's best is what you like and what you'll do, because they all have great effects. It's very rare that you'll ever see a study saying one is better than another. And the common denominator is that they slow the breathing and they create more rhythmic breathing.
And then in turn, we're creating greater heart rate variability. And so the breath is an immediate window. When we slow it down six breaths per minute to increasing vagal tone, if we can go right there, that is the most direct and efficient route to getting toward deep rest states, to unlodging the hypersympathetic balance that we carry. And the contemplative practices create that safety. We need to feel safe. So they create the perceived safety that we need in order to actually relax, restore, and especially to go into deep rest.
So there's a lot to think about there. How safe do you feel? Is this the right environment? How deeply can you release and let go here now? I mean for me, these retreats that have been extended days on days of an environment that has all of these conditions, you're supported in all these ways. And so you can really feel the hundred percent safety. You might still have thoughts that are threatening, but in terms of the conditioning of the body, those are when I have reached my best insights and deep rest states. And that's what it took for me.
So I'm curious, when you were in the jungle and your heart rate variability went up so much, from our model, we would think your breathing would've also changed, your respiration rate.

Dr. Mark Hyman:
Interesting. Yeah, it probably did. My heart rate went down, a lot of things happened, and a lot of it, I just was in the jungle and I was just in waterfalls all day. And in these pools and in nature and just kind of getting away from all the ... And there was also no wifi, there was no cell phone service. It's like, I don't know how those things affect us, but I think they do register in our nervous systems because we're energetic beings and organisms. So we really can be highly influenced by all that.

Elissa Epel:
I think that's a great way to view us. We are energetic beings, that we need to think of our daily battery and how we're restoring it, how we're spending it, how we're restoring it.

Dr. Mark Hyman:
Yeah. Tell us about some of the research you've done because you've really, not just sort of talking about this from a philosophical perspective, but some of your research has been really profound, and particularly around in the longevity stuff. I don't know if you talk about it in The Stress Prescription, but for example, I remember at that conference that we were at years ago, it was Elizabeth Blackburn, you were talking about meditation, for example, and telomere length and how telomeres are one of the hallmarks of aging. We shorten our telomeres as we age, and that causes inability to [inaudible 00:52:27] cells to replicate and eventually affects our longevity. So talk about how powerful these techniques are, to not just influence our way of feeling or being, but actually our hardcore, hardwired biology.

Elissa Epel:
We have been measuring telomere length a lot in the last 18 years and have done a lot of intervention studies, what can move around telomerase and telomere length. And the bottom line is that, I mean, when I read your book, it's all about telomere health. In my view, everything that's good for the heart and the brain is good for the telomeres and the cell aging system.
And I now think of it much more as a system because all of these aging mechanisms are best friends and talking to each other all the time. So the mitochondria, the telomeres, when one goes bad, the other goes bad. When mitochondria start becoming faulty and release too much oxidative stress, the telomeres shorten. When a telomere gets to a critical length and sends out its danger, danger [inaudible 00:53:30] signals, then it's also creating an impairment to the mitochondria. And then the inflammation is the third partner that's really responsive, both creating aging in those systems as well as when those systems go bad, inflammation rises. So they're just an interrelated system.
And the epigenetic clocks are interesting as they're also associated, but in much different ways. So those are more of a marker, not a mechanism. So we know that trauma is associated with, or I'm going to say more PTSD symptoms, what we make of trauma, the imprint is related to faster epigenetic clocks, shorter telomeres, more inflammation. And so these systems are all telling us the same thing, and they're all interrelated. So I talk less just about telomeres today and more about the system, when we are so lucky to have multiple measures.
But to answer your question about telomeres, the meditation studies tell the story that there is some consistent evidence that telomerase, the enzyme that boosts telomeres, the intracellular enzyme that adds back base pairs to our telomeres, tends to go up with meditation studies. I can tell you about some of those studies. We did a TM study with Deepak Chopra, so a week at his resort. And telomerase only went up in the experienced meditators. And so they came with a prepared or trained mind and they benefited more in certain ways. Everyone had a dramatic change in their gene expression away from stress and immune activity. So again, that fighting response that we always have was like, the volume was turned way down on creating proteins related to stress and immunity.
But they did not have a boost in telomerase. In other studies, telomerase has been increased in meditation retreats. In Cliff Saron's three month Shamatha Project, which maybe we talked about back then, it was maybe 13 years ago, Liz Blackburn was talking about what we know about telomeres. And in the Shamatha study, we only got to measure telomeres at the very end. And what Cliff Saron and [inaudible 00:55:56] found was that the more people increased in their feelings of purpose in life, the more their telomerase went up. So I thought that was a nice correlation.
But the telomere length doesn't change quickly. We don't measure it very accurately. The studies are very mixed on whether we can increase telomere length from an intervention. And I think it's just a, it's not worth measuring at an individual level. We just have too much error in it.

Dr. Mark Hyman:
So even though this is your work and you research it, you really have to stay on top of it. You really have to stay focused on your own self regulation.

Elissa Epel:
In my experience, there's no real long term fix. It really is about daily and weekly management, and there are those mind shifts that we can make about what is our purpose. And I think that's become more important in this era of existential stress, is really looking for contagious hope and people to work with on common goals and how to make this a better world, even though we feel as an individual so little control.

Dr. Mark Hyman:
Yeah, exactly. And I think that's really one of the things you talk about in the book is this sort of how do we reclaim control in a good way, not in a way that actually makes us more stressed by trying to control things we can't, right?

Elissa Epel:
Yeah, exactly. What about you, Mark? What's one of your number one stress reducers?

Dr. Mark Hyman:
For me, I use a combination of things, but I do meditate regularly. I love yoga and breath work. I recently started Qigong in the mornings. I definitely use hot and cold therapy a lot when I have access to it, because I find it one of the most incredible ways to sort of reset my nervous system and discharge the stress. Sometimes when I'm tired, I think I'm tired, but it's actually stress in my body that I'm registering. And when I can discharge that stress through exercise or through hot and cold therapies or other techniques, I actually find that really powerful.
So I think those really simple practices you can start to incorporate, they're often mostly free and they're available to us, and we just have to learn about how to make these not just an optional part of our day, but actually a regular part of our day. You talk about the bookends. What would be some things you suggest at the beginning and the end of the day for people, to help them?

Elissa Epel:
From our research, it looks like how you wake up is quite predictive of your day, as well as quite habitual. How you wake up, how joyful you wake up or how anxious you wake up on one day is quite predictive of how you wake up in general. So seizing that power of moments that we can actually shape and that will affect the trajectory of our day and how we end the day is really powerful. And lots of contemplative traditions focus on the morning as a sacred time, and many religions have vows in the morning.
And so that's something I've been playing with and I've been learning from other people. What do you say to yourself? If you do a short meditation or you have a hope vow or a prayer, how does that work? And I got very interested in that from role models really. I mean, his Holiness of course, talks a lot about his vows with Shantideva, the Bodhisattva vow, Joanna Macy is someone who's really popularized vows.
And I feel like with the hopelessness that we have, particularly among our youth, we are going to need strategies like that and we're going to need to do them together so that they become part of our ritual. It's hard in our secular society, and how we don't tend to think of something like a prayer as powerful. I mean, certainly if you're a religious person, you know the power, but what about the rest of us? So I think that's setting intention and focusing on love and what's meaningful for us right now in this day ahead can be very powerful. And it can take two minutes. Wake up, take some breaths, close your eyes, have a few things that you say to yourself. I have a friend that says, may I lead with love?

Dr. Mark Hyman:
Yeah, it's easy. It's actually remarkable how accessible these things are, but we just kind of are too busy or too distracted or we don't think they're important enough. But by just adding these little things, little sort of, almost like mini health bites, you can start to reverse this impact of chronic stress on our nervous systems.

Elissa Epel:
And gratitude is the antidote. That's another good question. What am I grateful for right now?

Dr. Mark Hyman:
Yeah. It seems simple, but it actually works, right?

Elissa Epel:
Yeah.

Dr. Mark Hyman:
There's quite a bit of research on it too, so this is great.

Elissa Epel:
Yes, yes.

Dr. Mark Hyman:
Well, this has been such a great conversation. I think people listening hopefully got something out of this reframing of stress and how we navigate it, how we think about it, practices we can do to kind of reset our nervous systems and to start to heal from the world we live in, which is really important. And to sort of have it be like just eating or breathing or brushing your teeth. It's things that you actually do on a regular basis. And that's-

Elissa Epel:
Short term, right? Everything we've talked about you could probably do in 10 minutes. So adopting even just one, I mean, it's a whole range of both the low arousal and the hormetic stress or the high arousal. If we just have one of each, and we do it every day, wow.

Dr. Mark Hyman:
So great. I love it. And everybody, The Stress Prescription is available everywhere you get books, Seven Days to More Joy and Ease. I encourage you to check it out. It's a really important book, particularly in our very stressful time. And I think it's the antidote to a lot of the things that are happening right now in the world that are impacting us and driving us to more disconnection, separation and dis-ease. And so thank you for writing it, and thank you for sharing your incredible depth of knowledge in this space and bringing all this hard science into really simple, practical, accessible tools. Really, really, thank you so much.

Elissa Epel:
Well, Mark, I've learned so much from you over decades, so my gratitude for you and your work and the amazing impact you've had on the public's health and the honor of speaking with you today. Thank you.

Dr. Mark Hyman:
Well, thank you so much, and for those listening, please share this podcast with your friends and family. I'm sure they'd love to hear this conversation, how you navigated stress in your life. What are the ways you've learned that work for you? We'd love to learn. Leave a comment. Subscriber wherever you get your podcasts, and we'll see you next week on The Doctor's Farmacy.

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.