Childhood Stress and Our Health w/ Dr. Nadine Burke Harris

has a choice. Whenever somebody says no, you can't or there's no roles for you, or you have to look like this, I go. I'll show you. I'll show you. Welcome to Go, ask Alli. I'm Alle Wentworth. A few weeks ago, we did a podcast with doctor Lisa Damore about her new book, The Emotional Lives of Teenagers, and as we chatted, she mentioned a couple of times how

trauma causes a concerning level in their well being. So we decided to do a very deep guy into childhood trauma, and we decided that what we need to really explore is aces, which is adverse childhood experiences and they can include poverty, domestic abuse, or maternal depression and can profoundly affect the development of the brain and cause a lifelong harm to children's physical, mental, and emotional health. And there is no better person to talk to about this than

doctor Nadine Burke Harris. She's an award winning physician, researcher and was California's first ever surgeon General. She's a founder of the Center for Youth Wellness, and organization leading the effort to advance pediatric medicine, raise public awareness, and transform the way society responds to children exposes to adverse childhood experiences ACES. Doctor Burke Harris is ted talk how childhood trauma affects health across the lifetime has been viewed almost

eleven million times. Her book, The Deepest Well Healing the Long Term Effects of Childhood Diversity was called indispensable by The New York Times. So, doctor Burke Harris, thank you so much for being with me. I am going to have the audacity to call you Nadine during the rest of this podcast, because I want to be your friend, and the first way to do that is to call you by your first name. We're friends already, yes, we are, so you know, I think everything you're doing is so incredible.

And I've done a lot of child advocacy, so I am fascinated by how childhood trauma affects us as adults,

and I wanted to start. I was worked with Marion Wright Edelman in Washington, d C. With a Children's Defense Fund, and one of the things we did was we had an organization in a charity called Beat the Odds and a lot of times I would go through these files of kids that we were giving scholarships to to college, and we'd have to go through and assess who really beat the odds, which is kind of a crazy idea that we had to determine who went through the worst

childhood traumas to be able to have this college scholarship. But anyway, my point is that I would read these stories that were just heartbreaking about childhood abuse, you know, and you'd have a child who lived in a car, who was raped by their father. I mean, just layer upon layer of trauma, and yet some of them still had a high grade point average. They went on to be you functional adults, and some did not. And to me,

it is all about the childhood trauma. And you have gone even further and researched it because I think a certainly our culture tries to deal with it on a psychological way, like, oh, maybe if they have therapy, everything will be fine, and you basically say that's not exactly true. The ramifications are physical and neurological and biological, and so

I want to talk to you about all of this. Yeah. Yeah, what we experience as children actually gets under our skin and changes our biology, and it can have a profound effect. I think most people recognize it when the effect is on behavior, but we recognize it a lot less when it shows up as asthma or diabetes or heart disease later on down the road. And that's important for a lot of reasons in terms of how it affects our health, our well being, our mental and emotional and behavioral health.

But it's also really important in terms of how we structure solutions because when we approach it in terms of beating the odds, which I think a lot of us do, I mean in the United States but also globally, in terms of beating the odds, I think that's one thing. I think that's what we're able to do when we

start recognizing the problem. I think my focus has been very much in changing the odds, right, So so that so that that's not like, yeah, it's not like a thing, you know what I mean of that association between childhood

adversity and just really really difficult lifelong stressors. So so yeah, you know what's amazing is that the real signature research on this was I think really came together in a study that was done by the CDC and Kaiser Permanente, and it was published in nineteen ninety seven, and it really showed that experiencing adversity and childhood like experiencing abuse or neglect, but even things that I think many of us who kind of don't consider ourselves to have like

this incredibly tough childhood, but things like growing up in a household where there was divorce or where a parent struggled with mental health issues, or where there was intimate partner islands that these factors have a profound impact on our health. And actually, for an individual with four or more of these adverse childhood experiences, you know, we know that they're the risk of something like depression was four and a half times, for attempting suicide was over thirty times.

But for things like heart disease. The number one kill in the United States was more than double. You know, heart disease, chronic lung disease, diabetes, kidney disease, all of these different things. And so we now understand that that experience of scary or traumatic things in our childhood affects our biology by activating our stress response, and then that affects our whole bodies, our brains, our hearts, our cardiovascular system,

our neurologic system, our immune system. And so I think when we when we look at it and we kind of hear this information, it makes a lot of sense. I think for a lot of people it makes sense intuitively. But now that we understand that, it means that we can approach it very differently. So let me ask you

a question in terms of degrees of trauma. So in your research, let's say we take a child from Yemen who right now is experiencing extreme trauma on every level, as opposed to a child right now who has food and shelter, but parents are getting divorced. You know, there's a huge gap between the level of trauma both these

children are experiencing. Does that then equals the physical ramifications of the stress, meaning is this child in Yemen going to have heart disease whereas this child who's experiencing divorce will probably just need some antidepressants. That's a great question. There's two parts to that. So one, what we know is that the dose of adversity. As a doctor, I'm always thinking about things in this way. But the higher the dose of adversity, the greater the risk. And it's

like anything else. It's like if you're exposed to radiation, right, Like the higher the dose, the greater the risk. If you are exposed a little bit, you have you know, you have an elevated risk by a little bit. If you're exposed to a lot, you have an elevated risk by a lot. And what we also know is that the impacts are cumulative throughout the lifetime. So for example, if you experience significant adversity in childhood, like this child in Yemen, you're going to have greater risk. And then

if you so. One thing that's really important is that the doses also of safe, stable, nurturing, supportive relationships and experiences counteract that. Right, So it's this balance between the adversity that you experience the nurturing relationships that you experience that counteract that. And then there's a second component, which is our biology. So each of us has a different threshold, a different biological threshold, just like you know, we're each

a different height, right. So you could even have two kids in the same family that are exposed to, you know, roughly the same dose of adversity, but have different outcomes. So I think those pieces are really important. But the other thing that it's important to remember is that the way that it shows up in our bodies also may

be different. So for example, you may have again two siblings in the same household, or or one of the common things that I saw in my clinical practice is that you might have five kids in the same household, right, who are all experiencing high doses of adversity, and for one child the impact is on their behavior. For another child, they just have really bad asthma. For another child, they're

not growing as quickly as they should, you know. For another child, it may be reflected in their weight, right, they might be really overweight or underweight. And so the way that it shows up in kids and then in us as we carry that forward into adulthood, can be very different. And the reason I mentioned that is because I often hear people say, oh, you know what, I experience a lot of adversity in my childhood and I didn't have any you know, symptoms or outcomes that you're

aware of. So I literally had this conversation with a woman where she's like, oh, you got to meet my friend. She's amazing. She experienced a lot of these adverse childhood experiences that you're talking about, and she was so resilient. She overcame you guys got to connect, But don't call her now because she's in the hospital. She just had a major heart attack. Oh my god. Literally, I'm not making this up. This is an honest conversation that I

had with someone. And so I think that when we do a better job in recognizing what all the potential outcomes are, it really helps us to think about to put systems in place right, to really invest in prevention

right right that that prevention and early identification. When you're saying this, I'm thinking about I have two daughters, and when they came out, they were completely different, right, so just genetically personality was very, very different, And I'm thinking about how, you know, if they had experienced a lot of trauma, which I don't think they did, but you know, they might be telling their therapists something else. But I think that two of them would react to it very differently.

I think one of them would internalize it, which I think would end up showing itself physically more quickly than my other daughter, who is an extrovert and lets everything out and lets people know what's going on and says I'm hurt, I'm angry. And so it seems to me that that does really show up in different degrees and at different times, like you said, depending on literally the person you are when you come into the world. Ali, I'm going to give you some real talk right now.

So we just had something happen in my household. My husband built a go cart for my kids and kind of for himself, but purportedly for the kids. Well, at least he can build a go cart. My husband can't change a light bulb, so that's good. Oh oh, he's I mean, my husband tricked it out. It's an ev He even got an electric motive for it, and he they were all driving the go cart having a great time.

And you know, it has like a chain, almost like a bike chain, and they're driving around sometimes a chain would fall off and the chain fell off and my husband was putting it back on and there was some horrible accident and he amputated like piece of his finger, like it got cut off, your husband, my husband. Literally this happened three weeks ago, and it was right there

in front of the kids. Oh my god. And so that is like dramatic like it m So it was pretty you know, and of course, you know, I'm checking in with them, I'm doing all the things. And my ten year old was like, oh my god, Mom, I saw it. I saw the figure, I saw the finger, Bob, I saw it. I saw the blood, and he was really you know, and my seven year old was just like, you know, he just he kind of was like, I hope that doesn't happen to me when I grow up.

But he otherwise like you wouldn't see anything on the surface, right and literally probably oh it was you know earlier last week maybe, And last week my ten year old says to me, Hey, mom, what's mental health? And I started explaining it to him and he said, I think I'm having some mental health because I'm feeling like I'm having you know, a hard time around daddy and his finger and it was amazing to see the ways in

which the two of them just reacted so differently. Yeah, and I have to say, I'm super proud of my ten year old. And I literally was able to sit down and say to him, Hey, you know what, these are the things that make a difference when you are struggling with your mental health and when you are you know, because he literally said, he said, I think I'm traumatized. My ten year old said this to me though, and I said, well, here are some of the things you

can do. You find somebody who you trust, who you feel safe with, and you just talk to them about how you're feeling and just, you know, really just share everything in your heart, the things that you're afraid of, the things that you're worried about, what the thoughts that are happening in your in your mind, and we just, like, you know, went through the whole thing. And he just said, you know, anytime you feel overwhelmed, getting connected with someone

you feel safe with. And so literally we're in the middle of it right now in my household. Yeah. Wow, there's a lot more to come after the short break and we're back. Well, let me ask you this. It sounds like you're saying, if you are able to verbalize it, if you're able to go to somebody that you trust and discuss it, is that sense of relief, way of physically helping yourself is at the first step towards healing.

That is an absolute yes. And this is why it's so important for us to create safe spaces for young people. And this is one thing that I would say is that every adult has the opportunity to be that safe relationship, because this is not just a thing that like, oh

it feels better. When we look at research that's done and it's you know, around the world, when kids have safe, stable, and nurturing relationships and environments, the risk of negative mental and physical health outcomes as a result of ACES drops dramatically by more than fifty percent. Wow. And so yeah, so these things really really do make a huge difference. And the thing that I that I also want to say about that is that the earlier you do that right,

the better. So are there are things Some of the things that make a difference in addition to nurturing supportive relationships include things like exercise that actually just helped to metabolize stress hormones, right because stress hormones are going wild in your body. You get out there, you go for a long walk, you play some basketball, you do whatever.

That also helps to metabolize stress hormones. Having good sleep hygiene and having a really good sleep schedule because stress disrupts sleep, but also lack of sleep increases stress hormones. So that's another thing. Being in nature. Like you know how when you get out in this really beautiful natural environment, how you kind of just you just like xmail, you kind of feel your blood pressure go down a little bit. It's actually being in nature helps to regulate the brain's

stress response. Also, things like mindfuls like meditation, that also helps to regulate the stress response. So these are things that are actual interventions that are demonstrated to reduce stress hormones and reduce actually inflammation, so reducing some of that health damaging aspect of it, and then at increase some of the endorphins and healthy hormones that really actually protect

us from the effect of stress. So in a perfect world, a world that you're managing, if I presented a child who has lived in poverty in the foster care system, Let's say there's been abuse emotional and physical and let's say she's eight years old and I presented her to you, would you first deal with the psychological things before you got into any kind of physical stuff that's beginning to

grow within her body. So what you just described as the clinical practice that I had in Hunter's Point for a decade and a half, and what I would say is that we start with wherever the family and the child is ready to start. So in my practice, which was very low income, predominantly African American, Latino and Pacific Islander, some folks were ready to start with therapy and mental

health interventions. Some folks weren't. Some folks were, you know, what they could do to start was really starting with joining a basketball team, you know, and having that nurturing, caring relationship be with a coach. Some folks were able to start by you know, parent and child going for a walk together, or caregiver, you know, foster mom and child going for a walk together every day and just

beginning to build up those bonds of trust. But even before starting with an intervention, I think one of the most important things to do was to recognize what folks were doing right, because I think many of us have these innate you know, just survival skills, right, Yeah, definitely. I had one patient who would just music was his meditation and he you know, he was in foster care and he was really struggling, but the place where he felt tuned in and that he felt at his best

was in his music. And so really just figuring out how to number one really validate and be like, wow, you are knowing yourself and you are tuning into what really works for you, and let's do more of that, and let's figure out, let's let's layer on that. What is the next thing that we can do to help support you. And then just having these regular check ins and moving, you know, jointly setting a goal and so,

you know, sometimes it was therapy, sometimes it wasn't. I will say that one of the most effective therapies that I've seen for little kids kind of under six is child parents psychotherapy, where both the caregiver and the child are doing therapy together as a diad. And you're talking about the caregiver or the parent. They're not the ones that were being abusive, right, You're not taking the abuse of Oh so you are, so you I'm going to say that. Yeah, So the number one thing, and I

should have said this before. The number one, number one, number one thing is to establish safety. So people can talk about like oh, therapy and learning to manage your emotions and learning to dada. But if you're not safe, if you continue to be in this situation where you are threatened and your trauma response is being activated on a daily basis, multiple times a day, no amount of external intervention is going to solve the problem. So the

number one thing is safety. So yes, definitely with the parent who is safe you when you're talking about doing child parents psychotherapy, But you know, surprisingly, ultimately we have seen, for example, if there's a situation where there's visitation or where the parent who has been the harming parent, we have seen situations where as part of trying to get their custodial rights back, you know, in that whole process, that that parent and the child have done child parents

psychotherapy together. And it really because I'm just going to say this, I have seen a lot of parents who have been harming their kids, unfortunately a lot, and almost

every single one was harmed themselves as a child. Yeah yeah, right, So when we do this work, what we also have the opportunity to do is break that intergenerational cycle and help that parent to see that they themselves have an overactive stress response, right right, so for them it does feel like life or death and for them and just being able to help them reregulate themselves literally helps the entire family and ultimate if that parent is able to

successfully do that, right, Like, we're not for sure not going to put anybody in harm's way, but if that parent is ultimately able to successfully do that, then that is a huge breakthrough. Do you find that there's a correlation between the kind of trauma and how it manifests itself physically? You know, just based on my small amount of reading, a lot of times, if there's sexual abuse, there's abesity, or there's some kind of eating disorder, correlation

does that exist in aces? So a lot of people have looked at that and studied trends, and it's really interesting. It's a little tricky because when you look at there is a strong association between sexual abuse and disordered eating, whether it's you know, overeating or restricting or under eating or bulimia or any of the above. I think where it gets more tricky is that if you if you look at all of the people who are OBEs. Right,

it's a smaller proportion that have experienced sexual abuse. So that being said, there's no like clear formula, right, I would say again, it's all it's filtered through an individual's biology, their experiences, their cultural norms, they're you know, all of the above. How do you deal with an adult who's had a lot of childhood trauma. Let's say an adult in their fifties, Is there hope for them? Is there?

And they're dealing with all kinds of physical issues. Let's say they have, you know, gout, depression, suicidal thought, all those things. Is it possible to reboot that adult and deal with some of the childhood trauma that is causing all this? For sure? Good. I just want to say that that is a sounding yes. Great. So for that adult, one of the things that is really important is number one,

just understanding what we're dealing with. So I think that for many people who are struggling with that depression or those suicidal thoughts, who are struggling with those those health conditions that seem to especially get worse and flare up when we're under stress or when we're experiencing conflict, and so many of those people have been told it's in their head, that it's you know, maybe that they're the problem, or they just they feel Oftentimes a person can feel broken, right,

and I one thing that I want to say is is number one, they're not broken, They're injured and they can heal. And number two that actually what's happening in their body is actually the normal biological response to trauma. They've just experienced an abnormal amount of trauma, right, like

an unhealthy amount of trauma. And so that piece of recognizing, you know, some of the things that I talked about earlier, in terms of sleep, exercise, nutrition, mindfulness, mental health, healthy relationships, and time in nature, they're as important for adults as they are for kids. Now they you know what they when we say that the announce of prevention is worth a pound of cure, like when we intervene earlier, when

we identify these things earlier. Which is why when I was Surgeon General of California, we actually trained our healthcare workforce how to screen for average childhood experiences, and not just train folks, but paid them so we like actually made it reimbursable for healthcare providers to screen the earlier we detect the earlier we intervene. It's just like any other health condition. The easier it is to treat, the more likely the treatment is going to be, you know,

have a major effect. Right, But for adults, I really want to say that it's never too late, and that these interventions first of all, understanding that they may have a disregulated stress response and that stress response can be impacting their health, their mental health, their behavioral health, their substance use, you know, any of that, and that there

are effective treatments. And I think that piece is really important, really important, and it's time for a short break, welcome back to go ask Gali, what if the childhood trauma, let's say as a child they had to have their leg amputated, or being in a car accident, any you know, any one of those rights. Yeah, so there is really

good data. You know, we look at the research around medical trauma and how that shows up, so you know, having a severe chronic illness or having an amputation or something like that, and the data actually shows that the outcomes are pretty similar. Really, they're they're pretty similar. Yeah, do they hold trauma in their body? In other words, if you were in a car accident, you went through the windshield and you severely cut your head. Would the

trauma live in that place? So they may have symptoms related to that place, or they may not cold. It could show up in any way. But one of the things that I want to recognize is that, for example, when a child goes through the windshield, or when someone goes through the windshield, the likelihood that that will be recognized as something traumatic and they will receive intervention can be a little higher, right, And that's an important component

of it. But if it is not recognize, if it is not addressed, which is the case sometimes, then we see those profound impacts. But one of the key things that I want to note about the research on adverse childhood experiences is that so many of these outcomes speak to what happens when people don't receive the appropriate intervention.

And that's why I want to say, over again, like when people do receive the appropriate intervention, when they have those nurturing relationships, or when they receive that mental healthcare, when they are able to do some of these interventions that help to reduce those risks, over and over and over and over again, we see these outcomes improving. So yeah, and would you say and I know that you've said this, but adverse childhood experience they are the single greatest unaddressed

public health threat today. Absolutely, I think without a doubt, and in fact, you know, I've been saying that for some time, and I think that post pandemic, I think we're seeing that even more. I think that when the COVID nineteen pandemic hit, what we saw was not just an infectious disease emergency, but also an emergency of adversity and stress. And we're seeing that now play out in terms of you know, record levels of mental health sees among our children and youth. Yeah, I say that every

day we're in a mental health crisis. So I can only imagine the levels of crisis that children experience during COVID when they were locked in with abusive parents or not getting any of the mental health needs or facilities available to them. You know, it's a scary time. And I'm so glad that you do the work that you do because certainly in my parents time, they would have seen all childhood trauma as psychological and not put together

the medical component at all. I've asked you a million questions, and certainly with our show notes where We are going to have lots of links and lots of information for people to read more, to dive into more and understand this. But before we end this podcast, you get to ask me a question anything you want. I failed biology. Nothing that made My question to you is how has your self care changed pre and post pandemic. Oh that's a

great question. During the pandemic, when I was scared for myself and my family and we had no answers and we didn't know what was what was going on in the world, I self care went out the window. In other words, I was not doing anything physical. I was eating three scoops of ice cream every night and watching things like Below Deck, like Poison to the Mind television. And I have a tendency to, in my response distress,

to abandon myself. And when I abandoned myself, I don't sleep well, I eat horribly, and so sort of the end of COVID, which I feel like we're still in the end of COVID. But when things opened up and my cholesterol was three fifty, and you know, I had clearly gone to war with my own body, I snapped two and I started walking. Now I walk seven miles a day, I eat a lot better, i have a lot more mindfulness, and I'm very clear on what I need to do to be a strong human being psychologically

and physically. However, this goes with what we've been talking about. I do notice when I'm in a stressful situation how easy it is for me to self abandon So, for instance, my mother's in the hospital right now, and you know, I will come back to the hotel after a long day of being in the hospital and rather than meditate or maybe have a healthy salad, I want a hot budge Sunday. I'm too tired to brush my teeth. So those are things that I'm now very aware of and

will stop myself. But I find that it is definitely the nature of so many people to self abandoned when they're in a stressful situation, And probably because I felt abandoned as a child, that this is my kind of go to place to be. But you also, like I want to I think you maybe probably know this already, but you also know that there are like real biological reasons why you crave that half edge sunday right tell

me please, so. Cortisol, which is one of our bodies stress hormones, yep, they drive us to crave high sugar, high fat foods. Okay, So when we are experiencing, especially a chronic stressor, and back in the day, when you know, we were just developing, the major chronic stressor was famine. Right, So cortisol as a hormone was very evolutionarily adaptive because it, first of all, it media a little kind of cranky

and mildly more aggressive. So you we were willing to fight and expend energy to get high sugar, high fat foods, which was associated with survival. Well, now that pint of hogandas it is not associated with survival, but that is kind of why we're wired that way, and there's a lot of the way the stress response works that that kind of favors immediate survival at the expense of long

term survival. So what's interesting about it is because I think a lot of people have that same impulse and it's so I find it so helpful to be able to recognize, oh, there's me craving high sugar, high fat foods. That's a sign of stress for me, and it means that my cortisol is going through the roof. And so one of the things that will actually help to bring that cortisol down. Is that if I go for you know, a walk around the block, or if I do my meditation,

you know that that'll lower my cortisol. But just arming people with that information I think is really helpful. Is that the same with alcohol. I know I certainly have friends that were, you know, going through a bottle of wine a night during COVID. So stress impacts the part of the brain that is the pleasure and reward center, and that is the area that is activated by cocaine, heroin, sugar, alcohol,

all substance of dependence, right. And what it does is that it makes it so that people get slightly less pleasure from activities that are typically pleasurable. It's it's counterintuitive, and as a result, people seek higher and higher dose it is of that thing that should be pleasurable in order to satisfy this part of the brain. It's called the ventral tech mental area in the nucleu succumbents. But

this is like, yeah, real stuff. So if you had childhood trauma, you're much more susceptible to becoming an alcoholic or a drug addict. I would have said yes because of biological changes to this part of the brain. And this is what I tell people all the time, Like, you don't just suck, like you don't just have no willpower and you're whatever. When you look at the experiences that you've experienced compared to someone who hadn't had that experience,

your biology is different. And what that means is that that we just we need to put some extra supports in place to support you to be able to live the healthy life that you want to live. But one of the most important pieces is just pulling out that shame in that blame. Right, Like you know, if someone if someone develops diabetes as so there's a strong someone who has experienced four more aces is almost twice as

likely to develop diabetes. But if they develop diabetes, they don't sit there and going, oh, I suck my pancreas. It's the worst pancreas in the world. Right, They look in and say, oh, my gosh, this is awful because of this what happened to me when I was in my childhood. Now I'm dealing with this health condition. And I think it's a very similar thing when it comes to substance dependence or depression, or you an eating disorder, anything else. We just it's not what's wrong with you,

it's what happened to you. So thank you so much. By the way, your ted talk on how childhood trauma affects health across the lifetime is a mussy for everybody. I know you already have eleven million views. I think it speaks to everything we've been talking about on this podcast, and I think it's helpful for everybody that has acknowledge or unacknowledged childhood trauma. So thank you, Nadine. Thank you for the work that you do. Thank you for speaking to me about this. And I said it before in

our show notes. We are going to have a lot of links, particularly to your books, so people can really understand this even more. Thank you, Thank you. It's my pleasure. It's great talking to you. Thank you for listening to go ask Allie. You know, there's a lot to think about with this episode, and one of the things I wonder is even the smallest amount of childhood trauma probably

plays itself out in our adult life. I was thinking about my parents divorce and how you know, on the scale of trauma, it's not level ten, but certainly the stress of divorce has had an effect on me, which is why I reach for the hot Fudge Sunday. Doctor Burke Harris's book The Deepest Well, Healing the long term effects of childhood adversity. You can buy it anywhere you buy your books. And for a lot more information on what you heard in this episode, check out our show notes.

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