'The Stress Paradox' With Dr. Sharon Bergquist

[SPEAKER_02]: Before we start, just want to make sure we're clear here. [SPEAKER_02]: While this podcast talks about sobriety, mental health and addiction, it is not meant to replace professional medical advice. [SPEAKER_02]: Welcome to Sisters in sobriety. [SPEAKER_02]: I'm Kathleen, and I'm Sonia, and we're X sisters in law brought together in marriage and bonded through our sobriety journey. [SPEAKER_02]: Join us as we talk sobriety, addiction and everything in between.

[SPEAKER_02]: You're in for quite a ride. [SPEAKER_02]: And our sub-stack is buzzing with amazing content from creative mock-till recipes to insightful courses and reflective exercises. [SPEAKER_02]: There is something for everyone. [SPEAKER_02]: Don't miss out. [SPEAKER_02]: It's a great way to add some extra joy and depth to your journey. [SPEAKER_02]: Check it out.

[SPEAKER_02]: This week on the podcast, we're diving into the science of stress, longevity, and plant-powered living with Dr. Sharon Berquist, a physician educator and an author who's redefining what it means to live a healthy life. [SPEAKER_02]: Dr. Berquist is a professor at Emory University and the founding director of Emory's Lifestyle Medicine and Wellness. [SPEAKER_02]: And the bestselling author of the stress paradox and planology.

[SPEAKER_02]: In her work, she combines evidence-based science with practical tools for help. [SPEAKER_02]: So today we're going to explore a little bit about her background in internal medicine, her pivot towards prevention and what she's learned along the way. [SPEAKER_02]: Welcome, Dr. Verkwiss. [SPEAKER_02]: Thank you so much for being here. [SPEAKER_00]: Thank you so much. [SPEAKER_00]: I'm very excited to be here. [SPEAKER_02]: The what drew you to medicine in the first place.

[SPEAKER_00]: What drew me the medicine is really a combination of different life course events. [SPEAKER_00]: I have a fascination with the human body. [SPEAKER_00]: I absolutely love understanding how things work inside us, how our thoughts, our behaviors, our beliefs, [SPEAKER_00]: work the way down to our genes and how they affect us in the long term. [SPEAKER_00]: So I kind of carried over that fascination and looked at two different routes.

[SPEAKER_00]: At one point I was looking into going into the hard science route. [SPEAKER_00]: With PhD, I also looked at the medical route, did some research in the basic sciences. [SPEAKER_00]: And over time realize I also really enjoy working directly with people and seeing the gratification of taking a potentially bad health outcome and turning it around and enjoying the highs and lows with people.

[SPEAKER_00]: So for me, that tangible piece of how to apply that information ends up becoming so important to me. [SPEAKER_00]: So it steered me towards medicine. [SPEAKER_02]: And so you went into internal medicine. [SPEAKER_02]: Did you imagine that you would end up focusing on prevention and lifestyle medicine? [SPEAKER_00]: You know, everything is a windy path. [SPEAKER_00]: Any very, I think a lot of people end up in their career for me.

[SPEAKER_00]: The internal medicine was so appealing from an intuitive level just because

[SPEAKER_00]: I'd like to see health at a fifty thousand foot level. [SPEAKER_00]: I'd like to see how things are connected. [SPEAKER_00]: And I think there's a lot of value to having specialists in the system in that they understand one thing. [SPEAKER_00]: incredibly well that if you have a problem in one area of the body you want someone who does this all day but for me I knew my strength and skill set was being able to see how the different parts were connected.

[SPEAKER_00]: So for me that became the the natural direction and I think over time as I practiced internal medicine [SPEAKER_00]: The outcomes you want to achieve are something that you really learn to understand and focus on because you get to see health longitudinally. [SPEAKER_00]: I have had the same patients in my practice now for twenty-five years because I've been in the same practice for twenty-five years.

[SPEAKER_00]: You get to see over time how health evolves or how disease evolves and for me I realized about a decade into practice that [SPEAKER_00]: Even people who had good numbers, like objectively, we had their blood sugar while controlled if they were diabetic, we had their blood pressure while controlled if they had high blood pressure.

[SPEAKER_00]: That there was underlying progression in the disease process that was leading to high blood pressure leading to diabetes and, for example, metabolic disease and insulin resistance, [SPEAKER_00]: Manifest and so many ways is the most common way that we associate it, but it also increases the risk of cancer, it affects mortality. [SPEAKER_00]: So for me, realizing that the same underlying process was just rearing its head in different ways.

[SPEAKER_00]: made me want to look at how can we prevent this underlying process, right?

[SPEAKER_00]: We weren't scratching the surface deep, you know, we weren't getting deep enough with the standard approach in healthcare. [SPEAKER_00]: And so for me, that became a pivot in my career about fifteen years ago to

[SPEAKER_00]: First understand how do we treat that underlying cause and then how you know it led to a lot of research in lifestyle interventions that impact disease outcomes it led to also looking at a lot of research at earlier biomarkers like how do we even detect these disease states at earlier and earlier phases because sometimes people come to the doctor we do standard panel and we say quote you're fine [SPEAKER_00]: But we're just not catching things early enough and people aren't fine.

[SPEAKER_00]: A lot of these diseases that we see in mid and late life really are rooted in childhood. [SPEAKER_00]: We call them adult on that. [SPEAKER_00]: But I think of a missed childhood on said, even things like heart disease are starting decades before their manifest dementia similarly, cancer similarly. [SPEAKER_00]: For me, that became a really interesting and fascinating area to do some research around.

[SPEAKER_00]: So really, the lifestyle medicine became these are the most powerful levers we can possible for impacting those earlier stages, changing the trajectory of our health in our later life. [SPEAKER_00]: So that became a fascination and it still is. [SPEAKER_02]: So what are some of those levers, especially you mentioned, some of them are rooted in childhood and what are some of those levers?

[SPEAKER_00]: the the levers to to me the if you go at root cause the fundamental like if you peel back layers and go deeper into root and deeper into root you land at the level of the cell because our cells are like our smallest units we have thirty seven trillion cells or cells make our tissues or tissues make our organs and our organs systems ultimately run our body so I look at the

[SPEAKER_00]: impact of different interventions at how do we make ourselves healthy? [SPEAKER_00]: And this is really the tie-in between what I call good stress and cellular health. [SPEAKER_00]: And there are five main good stressors that [SPEAKER_00]: not just beneficially impact ourselves, but they're regenerating ourselves.

[SPEAKER_00]: So we're talking about regenerative medicine through lifestyle, which I think is hugely exciting because we have this innate ability to heal ourselves, to heal and repair the damage, to actually recycle different components of ourselves that aren't functioning well. [SPEAKER_00]: And to me, this is where there's so much excitement because we think every generative medicine is procedures or interventions like stem cell injections that we have to go somewhere to get.

[SPEAKER_00]: But we can do this every day through the choices we make and regenerative medicine is accessible and practical to each and every one of us through these good stress interventions. [SPEAKER_00]: And there are five main ones, so one is using plant-type chemicals that give plant-survivant colors, exercising with intervals of intensity.

[SPEAKER_00]: heat and cold to thermal stress and then fasting stress so eating in a window that's twelve hours or less and a circadian pattern and then mental and emotional challenges are also on a list of how we can grow and regenerate and strengthen three stress. [SPEAKER_00]: So to me, these are the biggest levers because they are essentially mitigating so much of the harm that we experience every day.

[SPEAKER_00]: And that is so powerful because we spend so much time talking about how to remove the things that are creating the harm which are essentially the bad stressors and certainly that's incredibly valuable and important.

[SPEAKER_00]: But sometimes at least to this mindset that [SPEAKER_00]: If we can't that we, you know, are just failing at our health goals and the idea of just add good stress to me is just so liberating because we can be flawed, we can have the junk food, we can have days of being set in tears, but we all have this power.

[SPEAKER_00]: to add good stress and work on mitigating the hormone. [SPEAKER_00]: It's ultimately a balance of, yes, remove the things that cause the damage, but also add in as much as you can of the things that are activating your body's natural healing ability. [SPEAKER_00]: So that's where the power is. [SPEAKER_02]: So now that we know what good stress is, what is toxic stress? [SPEAKER_00]: Yeah, toxic extract can be physical. [SPEAKER_00]: It can be emotional.

[SPEAKER_00]: It can be mental. [SPEAKER_00]: So there are so many dimensions to stress. [SPEAKER_00]: And stress really is anything that challenges your body. [SPEAKER_00]: So it generally pushes your body out of this natural balance that we call homeostasis and then our bodies have to re-establish that balance, but sometimes in the process we incur harm and that's what bad stress is.

[SPEAKER_00]: And with some stressors, when we re-establish the balance, we re-establish at a higher set point where we build resilience and then those are good stressors. [SPEAKER_00]: So that's really the differentiating factor. [SPEAKER_00]: And when stress is harmful, the physical stressors that are harmful, I think we can kind of know because we hear so much about so process foods. [SPEAKER_00]: For example, being sedentary is another really big one.

[SPEAKER_00]: There are environmental bad stressors that toxins, microplastics, pollutants. [SPEAKER_00]: And then the psychological ones are the chronic stressors, the ones that stem from relationships that are really just depleting us. [SPEAKER_00]: And there's not really a good resolution to the complex.

[SPEAKER_00]: Things like also financial hardship, these are just [SPEAKER_00]: Tenuous chronic stressors day in day out dealing with a family illness, a sick child, these are just things that there's no sense of mastery over that stressor and often not even a sense of weak control it. [SPEAKER_00]: So those are the ones that I think over time lead to depletion exhaustion and burnout. [SPEAKER_00]: And I think what's exciting is this whole idea that not all stress is harmful though, right?

[SPEAKER_00]: So those are the bad stressors. [SPEAKER_00]: The good stressors, the beauty is that they have an energizing effect.

[SPEAKER_00]: They have this ability to help you grow to build resilience. [SPEAKER_00]: And to me that the paradox that I write about is that you can use these good stressors to build resilience and grow so you can better handle [SPEAKER_00]: The bad stressors that we can't always control and sometimes we just have to work through, but it gives you that greater ability to handle these circumstances that life throws your way.

[SPEAKER_02]: So with the toxic stressors, when you're listing out, socially the psychological ones, the way I used to cope with those was drinking. [SPEAKER_02]: And so knowing that they're not always controllable, what is the effect of using drinking or any sort of like numbing substance to treat that? [SPEAKER_02]: Or, yeah, what is that? [SPEAKER_02]: What is the effect of using something like alcohol? [SPEAKER_02]: What is a healthy way to deal with toxic stress?

[SPEAKER_00]: Yeah, I think, you know, most people find that when they drink alcohol, it's a way that they cope because their alcohol relaxes a lot of people gives people pleasure. [SPEAKER_00]: It's, you know, not healthy coping mechanism, but it's a very common reason, I think, you know, what you just mentioned is what a lot of people experience and then turn to alcohol for [SPEAKER_00]: What happens when we do that in our brain chemistries?

[SPEAKER_00]: When we drink alcohol, we get an increase or a surge in dopamine, released from the nucleus of compounds. [SPEAKER_00]: And the dopamine gives that pleasure relaxation effect. [SPEAKER_00]: And so that is what drives people to use alcohol as a way to cope and sway to relax. [SPEAKER_00]: But our brains are created so that we always want to have this sense of balance in our body, this homeostasis, and the part of our brain that controls this pleasure also regulates pain.

[SPEAKER_00]: And what our body does to compensate is the natural dopamine that a person makes goes down. [SPEAKER_00]: And the dopamine receptors have reduced sensitivity. [SPEAKER_00]: We down regulate the dopamine receptors. [SPEAKER_00]: So if a person drinks over time, there's a depletion of dopamine. [SPEAKER_00]: And then this low of this dopamine deficit where people experience, like anxiety, depression, just feeling kind of down.

[SPEAKER_00]: And then people feel they need to drink alcohol to quote feel normal to get that. [SPEAKER_00]: I do dopamine again, and that's what leads to that spiral of depending on the alcohol. [SPEAKER_00]: When a person uses a good stress, [SPEAKER_00]: you know, as a way to get dopamine. [SPEAKER_00]: So for example, if we go to the five of the ones that we mentioned, if a person exercises and does it with intensity or experiences cold, like extremes of cold.

[SPEAKER_00]: There's an unpleasantness to that when you do something hard, right? [SPEAKER_00]: The exercise can actually be a little bit painful or uncomfortable to the joints. [SPEAKER_00]: The cold can be incredibly uncomfortable. [SPEAKER_00]: When the brain experiences that, it releases dopamine along with serotonin and norepinephrine as a way to kind of compensate for the discomfort.

[SPEAKER_00]: So we release them the dopamine and the serotonin that into cannabinoids that endorphins with exercise or with cold exposure as a way to help us endure. [SPEAKER_00]: So you can run a further distance, you can stay in the cold [SPEAKER_00]: It's really a response to doing something hard. [SPEAKER_00]: So when you're doing the hard thing first, you get the spike in dopamine, but you do it transiently in response to the hard.

[SPEAKER_00]: So after the exercise or after the cold shower, [SPEAKER_00]: The dopamine level just goes back to baseline. [SPEAKER_00]: You don't create the deficit. [SPEAKER_00]: So it becomes a really healthy coping way to get the pleasure, the relaxation, the motivation, but without creating this dopamine deficit that becomes that cycle of addiction.

[SPEAKER_00]: Yeah, so that the key is your baseline dopamine is not getting reduced when you do that hard thing first and that's really the key but you're getting the same spike in dopamine so you get the same pleasure.

[SPEAKER_02]: When you talk about cold exposure as being, and I avoid it like the plague. [SPEAKER_02]: And so that's, that is really interesting. [SPEAKER_02]: And whenever people try to get me to go do a cold plunge, I like a cringe. [SPEAKER_02]: And so, and I am somebody who has, you've mentioned the idea of over-optimizing. [SPEAKER_02]: comfort. [SPEAKER_02]: And so I think in my sobriety, I've tend to over-optimize comfort.

[SPEAKER_02]: And so what does that mean when we someone like me avoiding the cold water? [SPEAKER_00]: Yeah, well, Starfleet saying the good news is that you can do this with heat, which is a lot more pleasant as a way to get a lot of these positive hormones or neurotransmitters like dopamine. [SPEAKER_00]: Norepinephrine, et cetera. [SPEAKER_00]: You get to choose your heart and you get to choose how you create discomfort.

[SPEAKER_00]: And the good part of that is every time you put yourself in a situation when you create a discomfort and you grew your stress tolerance, your ability to handle that discomfort. [SPEAKER_00]: It makes it easier for subsequent ones. [SPEAKER_00]: So a lot of people starting with cold may not be the right place to start.

[SPEAKER_00]: But when you trust that you can handle the hard, whether it be through sauna instead or through exercise, you gain the confidence and physiologically the adaptations that help your body cope with higher levels of discomfort in these other realms.

[SPEAKER_00]: So you can pick whether you want to start with a physical dimension, an emotional or a mental dimension, and they're all synergistic. [SPEAKER_00]: So to me that is kind of the beauty of that. [SPEAKER_02]: Yeah, I love knowing that resilience has a scientific explanation. [SPEAKER_02]: It makes it very concrete. [SPEAKER_02]: Are there modern lifestyle habits that unintentionally make us fragile or whatever the opposite of resilient is?

[SPEAKER_00]: Yeah, you know, I think it's really what you had just previously asked. [SPEAKER_00]: It's a comfort, right? [SPEAKER_00]: Like, there is such a temptation for comfort for easy for pleasure. [SPEAKER_00]: But we're wired to seek comfort and pleasure. [SPEAKER_00]: But I think because we are now in an environment where it's so easy to get the pleasure in the comfort that it's becoming maladaptive for us.

[SPEAKER_00]: For example, we are wired to seek fat sugar and salt because our ancestors [SPEAKER_00]: needed motivation to risk, you know, leaving the safety of their caves going out and potentially facing predators of, you know, hunting, et cetera. [SPEAKER_00]: So there had to be a motivating reason. [SPEAKER_00]: And that desire to seek fat sugar and salt that pleasure that dopamine served as well.

[SPEAKER_00]: And now because you can pretty much, you don't even have to drive to a grocery store, you can have pleasure delivered at your doorstep. [SPEAKER_00]: But we have it available, twenty-four-seven. [SPEAKER_00]: And the comfort is now becoming this temptation that is leading us down to path where we're not forcing our bodies to go past this comfort zone to stress ourselves in a way that activates our body's healing ability.

[SPEAKER_00]: So that is this risk factor for all these mental and physical illnesses that are becoming so prevalent today because the way our bodies become stronger, like you just said, the physiologic basis for resilience, is structurally and functionally being built every time you do something hard.

[SPEAKER_00]: You know, for years, you hear these mantras like, oh, you grow from adversity, and there's this abstract way that we understand that intuitively. [SPEAKER_00]: What we know now through the science of good stress and through hormesis, which is essentially the science of good stress, is what is the physiologic, you know, in that analogous thing that's happening when we're growing from stress? [SPEAKER_00]: And we are rewiring the connections between ourselves.

[SPEAKER_00]: We are taking out the damaged proteins. [SPEAKER_00]: We're repairing the damaged DNA. [SPEAKER_00]: We're increasing our mitochondria, which is giving our body more energy to handle and cope. [SPEAKER_00]: We are physically making ourselves more resistant to disease. [SPEAKER_00]: We're physically making ourselves better able to handle stress. [SPEAKER_00]: We are physically making ourselves slow the rate at which we're aging. [SPEAKER_00]: So to me, this is the key.

[SPEAKER_00]: And when we give into comfort, which I will be the first to say, I do it too. [SPEAKER_00]: We all do it. [SPEAKER_00]: I mean, this is how we're humanly wired. [SPEAKER_00]: wouldn't rather sit on a sofa watch TV and like have some delicious meal delivered at their doorstep. [SPEAKER_00]: Like of course we all want it but we also have to realize that there's a cost associated with it and we don't challenge ourselves.

[SPEAKER_00]: We are not really activating our body's ability to heal. [SPEAKER_00]: We are not allowing our bodies to physically reach that higher level of human potential, we're not allowing ourselves to reach greater possibility and expanding our boundaries and our horizons. [SPEAKER_00]: So, you know, this is a message of not just due hard because it's quote, good for you building grit or [SPEAKER_00]: You know, becoming tough like that may happen, but this is a message of love.

[SPEAKER_00]: This is a message of push yourself in a way that is serving you. [SPEAKER_00]: This is how you are enabling your full potential for growth, your potential for being the person you want to become, for expanding your capability.

[SPEAKER_00]: And I think because we're not realizing that these good stressors have been so gradually removed from the fabric of our lives, we focus so much more on the things that have been introduced by technology, like, you know, during its screens, we know the downside of staring at these screens, we have introduced these processed foods, so we know the downside, what we're discounting is what we've taken away.

[SPEAKER_00]: take an out of our lives and we've taken out the need for high intensity exercise. [SPEAKER_00]: We've taken out the exposure to cold and hot, right? [SPEAKER_00]: We're in indoor air conditioned spaces. [SPEAKER_00]: We've really taken out the need to fast. [SPEAKER_00]: I mean, there's food available, twenty-four-seven and we have food preservation technology. [SPEAKER_00]: You can open your refrigerator.

[SPEAKER_00]: You can open your cupboards and there's always food available. [SPEAKER_00]: And we are also taking away some of the need to do critical thinking, you know, as we rely on, you know, GPS to take us where we want to go, as we rely on chat GPT to just give us the answer.

[SPEAKER_00]: There is that, you know, decrease need to force critical thinking. [SPEAKER_00]: And we need that as a stimulus for growth, like for our brain to create new brain cells to create connections and synapses that help us bring ideas together and become a creative person with better decision-making. [SPEAKER_00]: We need it to regulate our mood. [SPEAKER_00]: So to me, there's this huge downside to leaning into that comfort, at least doing it to an excess.

[SPEAKER_00]: I mean, we're all going to do it. [SPEAKER_00]: But without kind of reintroducing the stressors. [SPEAKER_00]: So what we have to reintroduce deliberately today is what was inherent in the life of our ancestors until about two hundred years ago. [SPEAKER_00]: So for over two million years. [SPEAKER_00]: But we are now deliberately calling stress or good stress was the everyday.

[SPEAKER_00]: Our ancestors didn't have to work at introducing high intensity exercise they had to to survive. [SPEAKER_00]: Our ancestors didn't have to fast. [SPEAKER_00]: They essentially were facing starvation as a biggest threat to their unsurvivable. [SPEAKER_00]: You know, heat and colds mean they lived in impermanent shelters. [SPEAKER_00]: So we are really just saying, what are the components of our ancestors' lives that serve as well?

[SPEAKER_00]: And this is not saying all things that are paleo or hunter-gather and necessarily beneficial because natural selection selects for survival not for health.

[SPEAKER_00]: It's just saying now that we can understand the effect of these actions on our genome, on ourselves, can we reverse engineer the way we were meant to live? [SPEAKER_00]: And that's really what we're doing by reintegrating these good stressors. [SPEAKER_02]: So I run an article last week about the use of chatGPT on college campuses. [SPEAKER_02]: And the question was, do we need to retool curriculums to make them more challenging? [SPEAKER_02]: And so is that the solution?

[SPEAKER_02]: Is it, do we make things more challenging? [SPEAKER_02]: Or do we go back to the basics like our ancestors? [SPEAKER_00]: You know, I think that, you know, you can make curriculum more challenging. [SPEAKER_00]: You can also [SPEAKER_00]: You know, think some of it is just asking yourself what you want to be able to do to contribute, like what aligns with your belief system.

[SPEAKER_00]: And then I really think that [SPEAKER_00]: In an ideal state, we choose our heart because for me to have that dopamine release, to have the serotonin release, I need to pick something I want to work really hard at that is meaningful to me that aligns with my beliefs as done. [SPEAKER_00]: And those are essentially the good stressors, but it's very motivating because of the biochemistry of the stress response we release when things matter to us.

[SPEAKER_00]: And that is ultimately how we regulate our cortisol or stress response. [SPEAKER_00]: When we have chemicals like dip, and we know our epinephrine and serotonin circulating, we have lower cortisol reactivity. [SPEAKER_00]: we actually mitigate where, you know, how much of a spike we get in cortisol. [SPEAKER_00]: So for me, it's this natural way to become emotionally regulated, but also challenge yourself.

[SPEAKER_00]: So I think because, you know, kids are younger and if you create curricula that, [SPEAKER_00]: Just inculcates this as a practice, I think there's value, but I think as adults, we have to ask ourselves, kind of these bigger questions of, let's look at the stress in our lives, how are we living? [SPEAKER_00]: What is the effect of the choices we are making?

[SPEAKER_00]: And I mean, our thoughts, our beliefs and our mindsets, not just the physical choices we're making, because mindsets also make a huge impact on our health. [SPEAKER_00]: And to really push ourselves in a way that serves us well and in a way that helps us grow and to appreciate that making that investment.

[SPEAKER_00]: Makes us better able to handle not just challenging problem solving questions, but when you are creating this like, yeah, I make the analogy of your brain goes from DSL to like a five G network rate because the connectivity becomes so incredibly enriched. [SPEAKER_00]: You're also building cognitive reserve. [SPEAKER_00]: You are reducing your risk of dementia. [SPEAKER_00]: There's such a benefit above and beyond. [SPEAKER_00]: Oh, I can problem solve on my own.

[SPEAKER_00]: I don't need chat GPT. [SPEAKER_00]: It's I have a brain that is disease resistant. [SPEAKER_00]: I have a brain that also regulates mood. [SPEAKER_00]: It helps me make better decisions in my life.

[SPEAKER_00]: right you can't tell chat GPT you know how should I budget my finances this coming here right like at some point you need good decision making can you ask chat GPT hey I'm having an argument with my significant other what's a good thing for me to say like there's skills that you just inherently have to build and develop and

[SPEAKER_00]: You know, there's really no way around hard like you just have to accept that the gateway to getting to be that person who can, you know, make these decisions, who can handle challenging, you know, emotional situations are conflict well. [SPEAKER_00]: is by just leaning into it, not in a way that creates adversity with like, you know, capital A, you know, but through these micro stressors through small situations.

[SPEAKER_00]: So for kids who are early in school, it could be for a test for a project. [SPEAKER_00]: And over time, it's stress followed by recovery, stress followed by recovery. [SPEAKER_00]: And you are building the muscle of resilience. [SPEAKER_00]: And I think that's really the key, like I think, you know, when people think of growth through adversity, they think of like trauma. [SPEAKER_00]: They think of big. [SPEAKER_00]: And that can actually, you know, harm.

[SPEAKER_00]: All of these good stressors need to be in this mild moderate range, fresh to grow from them, and that's such a key concept. [SPEAKER_00]: You don't want too much stress that can harm. [SPEAKER_00]: We're also learning too little stress. [SPEAKER_00]: It's just as harmful as too much. [SPEAKER_00]: And unfortunately, I think we're veering in that direction.

[SPEAKER_00]: What we all should seek is this just right amount, the school deluxe amount, which is just a little bit past our comfort zone, but not to the point of overwhelm. [SPEAKER_00]: And the key part is that when we're in the stress mode, [SPEAKER_00]: Our cells in our bodies are creating pathways to become more stress resistant. [SPEAKER_00]: They kind of hunker down and they function in a way that builds housekeeping and kind of cleans up the internal environment in our body.

[SPEAKER_00]: But it's in the recovery that we actually grow. [SPEAKER_00]: It's in the recovery that we create these stronger connections in the brain. [SPEAKER_00]: It's in the recovery that the stem cells differentiate, for example, into neurons or brain cells. [SPEAKER_00]: And we have to strategically plan for the recovery so that we get the growth from experiences, the hardship. [SPEAKER_02]: Sitting in discomfort is a big part of sobriety, right?

[SPEAKER_02]: And it is uncomfortable getting sober. [SPEAKER_02]: And now I think I understand why, right? [SPEAKER_02]: We're trying to increase the sensitivity of our dopamine receptors. [SPEAKER_02]: And so I have been telling people now, I'm wondering if I'm wrong, that look, you're doing something really hard.

[SPEAKER_02]: This is not the time to go vegan, start working out like crazy. [SPEAKER_02]: Like let's focus on one uncomfortable thing at a time. [SPEAKER_02]: And my other advice, and I do this myself is if I'm having a really bad day and the only thing I can do that day is stay sober. [SPEAKER_02]: That's okay. [SPEAKER_02]: Like I can watch Netflix any ice cream. [SPEAKER_02]: It does that kind of go against the idea of building resilience. [SPEAKER_02]: Am I giving people bad advice?

[SPEAKER_00]: No, you're giving them great advice. [SPEAKER_00]: So this is such a key part because [SPEAKER_00]: You're really asking, can you stack good stress, right? [SPEAKER_00]: Like, can you stack doing one hard thing, emotional physical, say, high intensity workout plus all the ways that we can stress our bodies? [SPEAKER_00]: And you want to be in this mile to moderate range of stress. [SPEAKER_00]: And if doing the, I'm just not, you know, just today's hard is just being sober.

[SPEAKER_00]: That is already for a person who is best in sobriety. [SPEAKER_00]: Like you're already at that mild to moderate amount of stress. [SPEAKER_00]: Doing more than that can really push the kind of beyond that sweet spot of that Goldilocks zone. [SPEAKER_00]: I think over time you can, right? [SPEAKER_00]: Because as you build the muscle of becoming sober and it is less emotionally, mentally, physically taxing and your body is becoming stronger and more resilient.

[SPEAKER_00]: Then you can add the good stressors, et cetera, and experience the same pleasure. [SPEAKER_00]: But you're then substituting the healthy habits and getting that dopamine so that you don't crave the alcohol and that you're finding other ways to give yourself the pleasure. [SPEAKER_00]: But I think this is just such a key thing because [SPEAKER_00]: When we're saying, go past your comfort zone, the key is, it's what is hard for you.

[SPEAKER_00]: And that's going to be different for you than it is for me than it is for the next person, right? [SPEAKER_00]: There's so much bio-individuality, and it also depends on where you are in a daily state of recovery, right, if you don't sleep well the night before. [SPEAKER_00]: you're already entering the next day in a less resilient state. [SPEAKER_00]: So the amount of stress you can handle the next day is less.

[SPEAKER_00]: So if that date, you can go through a night of sleep deprivation and stay sober the next day. [SPEAKER_00]: You've already done something that would be harder to you that day than it was after a day that you slept well.

[SPEAKER_00]: So it's a [SPEAKER_00]: different level of how much is going to get you past your comfort zone person to person and even within the same person different day to day depending on these other factors that help you nurture yourself and become more capable of kind of getting through that day. [SPEAKER_00]: So, no, I think you're spot on. [SPEAKER_00]: Think of all of this like growing a muscle. [SPEAKER_00]: You gotta start at five pounds and then the five pounds gets easy.

[SPEAKER_00]: You get to ten pounds and you build that resilience and then you can get to the bigger weights. [SPEAKER_00]: But if you start trying to do too much like, hey, today I'm not gonna drink. [SPEAKER_00]: This is really hard. [SPEAKER_00]: I don't feel all that great and I'm going to go and do this really high intensity workout and I'm just going to change my diet and I'm going to do all this.

[SPEAKER_00]: Like it's you're trying to lift fifty pounds on your first trip to the gym and you're going to damage your muscle, right? [SPEAKER_00]: So you kind of want to stay in this slow but gradual incremental way of getting to where you want to be. [SPEAKER_02]: Yeah, that makes sense. [SPEAKER_02]: Okay, I'm glad I'm not steering people in the wrong direction.

[SPEAKER_02]: Yeah, no. [SPEAKER_02]: If you have time, I would love to talk about something I'm super passionate about, which is a plant-based diet.

[SPEAKER_02]: I would love to. [SPEAKER_02]: Okay, what led you to write? [SPEAKER_02]: Plantology. [SPEAKER_00]: What led me to write that is in what I do in internal medicine, the biggest thing that brings people in the door, the biggest types of diseases that we're managing your chronic disease. [SPEAKER_00]: I play pressure high cholesterol diabetes, dementia, cancer, obesity, anxiety, depression, polycystic ovarian syndrome, and the longest of things that are chronic disease.

[SPEAKER_00]: and diet and food choices that we make are arguably the biggest lover of whether there's diseases developed, how we manage them with the minimum reliance on medication and potentially even reverse them. [SPEAKER_00]: And within that space of food as medicine, there are literally thousands of clinical studies looking at how we can stop these disease processes.

[SPEAKER_00]: They share common pathways, things like inflammation, oxidative, stress, alterations in the gut microbiome, cellular changes. [SPEAKER_00]: Like we were talking about DNA damage, et cetera. [SPEAKER_00]: And when you look at where that science takes you, the power of plants is a really big piece of how do we get people to not be one of these statistics in terms of chronic disease and the rampant increase?

[SPEAKER_00]: How do we get people to be in that healthier state and even reverse or disease? [SPEAKER_00]: Really not become dependent on medication, right? [SPEAKER_00]: Because there's such a... [SPEAKER_00]: logarithmic increase in our alliance on medication. [SPEAKER_00]: So, plants became such a centerpiece in that conversation. [SPEAKER_00]: And, you know, to go from the knowledge sharing with patients to then the how-to is a different skill set.

[SPEAKER_00]: And, you know, we had created a teaching kitchen at my institution where [SPEAKER_00]: We literally were bringing people to the table and giving them ways to prepare food, right? [SPEAKER_00]: It's one thing to say go eat plants. [SPEAKER_00]: It's a whole different thing to say, what do you do with quinoa, right? [SPEAKER_00]: Or what do you do with this vegetable to make it tasty?

[SPEAKER_00]: So the cookbook really became this evolution from just taking all the knowledge and scientific information out there and then combining it with the frequently asked questions and the how-to of now. [SPEAKER_00]: How do I, you know, get the plant foods that I need in a given day that nourish my body? [SPEAKER_00]: But how do I make it delicious? [SPEAKER_00]: And I think, you know, we started off doing this. [SPEAKER_00]: I read it with the dietitian.

[SPEAKER_00]: I work with at work. [SPEAKER_00]: And, you know, we were doing this one on one in repeating the same things over and over. [SPEAKER_00]: And that's when you know, you need to write it in a book. [SPEAKER_02]: and understand that. [SPEAKER_02]: So when, so you were talking about the idea of like, yeah, we don't, not everyone knows how to make a zucchini taste good. [SPEAKER_02]: It's easy to throw a steak on a grill and make a taste good without any herbs, spices.

[SPEAKER_02]: So how do you talk to people about making slow, sustainable changes and how does, how does the book simplify that, the switch to a plant forward lifestyle? [SPEAKER_00]: I think it's really the way I view all of this equation of good stress bad stress. [SPEAKER_00]: If you focus on adding in the things that you should be getting and less focused on what you should not be eating. [SPEAKER_00]: That switch becomes easier and easier.

[SPEAKER_00]: So, for example, if a patient of mine goes to a restaurant or even prepares dinner at home, the kind of standard way food is presented is, for example, here's some of me order chicken at a restaurant. [SPEAKER_00]: You get this big slab of whether it's a steak or chicken that's the equivalent of about five servings because a serving is a deck of cards, right? [SPEAKER_00]: So it's this steak or chicken with a little side salad.

[SPEAKER_00]: So I just start telling people to just flip it a little bit. [SPEAKER_00]: make it salad with a little side chicken or with a little side meat, right?

[SPEAKER_00]: Because it's still the same food but you're changing that balance of getting more of the healthy plant-based foods that you need and less of the other things that come with some of the animal products and serving again is a deck of cards if a person wants to get the protein [SPEAKER_00]: You can do that with a smaller amount of food. [SPEAKER_00]: I mean, you can just a chicken breast as plenty, but we're usually given at least two in an entree.

[SPEAKER_00]: And so sometimes it's just as simple as just take what you're eating and just flip the ratio. [SPEAKER_00]: And that's a really simple way to start. [SPEAKER_00]: Or just focus on adding one more fruit and vegetable. [SPEAKER_00]: And that fills you up and you just have less room for dessert or processed food or whatever else that you would be filling yourself up with.

[SPEAKER_00]: So focus on what to add and naturally just becomes easier to have a healthier plate that has less processed food on it. [SPEAKER_02]: What do you say to people [SPEAKER_02]: who say what's so much easier when I'm on my way home from work to pick up the ninety-nine cent meal at McDonald's instead of one of the grocery store picking up couscous and broccoli and chickpeas and the herbs and the spices needed to cook them so they taste good.

[SPEAKER_02]: What how do you explain that paradox? [SPEAKER_02]: Like how can you bridge that gap? [SPEAKER_00]: Yeah, and I mean, again, we're all in this kind of situation together because I work full time and where there's a minute to be saved, like by Gali, I want to save it. [SPEAKER_00]: So I understand it, but it's back to our conversation about comfort convenience versus what our bodies need to thrive, right? [SPEAKER_00]: So we're kind of leaning into that comfort, but it's at a cost.

[SPEAKER_00]: And I think seeing things more as a long term as opposed to short term decision may not be the thing you want to do when you're tired and driving home from work but

[SPEAKER_00]: I think if you do step back and maybe meal plan and tell yourself, look, one or two days a week, these are my long days at work, these are the more, you know, I'm just gonna do that, but maybe when you're not in that point of fatigue, you can maybe spend a Sunday afternoon doing some meal planning and just giving yourself those days, but also planning to have these nutritious meals that pack in a lot more vitamins and

[SPEAKER_00]: nutrients so that you can nourish your body but think of this as an act of self-love and short-term decision may be may feel good in that moment but it's at a cost I mean at some point it will lead to disease and [SPEAKER_00]: living with a chronic disease. [SPEAKER_00]: I mean, it's, it's really a trade off. [SPEAKER_00]: Like, is that worth it for the comfort convenience pleasure? [SPEAKER_00]: I mean, these foods are tasty when you kept on eating.

[SPEAKER_00]: And, and so I think, you know, you just have to, [SPEAKER_00]: Think of it in a moment when you're not depleted, tired, and just so content to take the path of least resistance. [SPEAKER_00]: You have to make these decisions when your body has more resources to really think about what your long-term goals are. [SPEAKER_00]: And having said that, I don't really think it has to be hard to create these delicious meals at home.

[SPEAKER_00]: If you do a little bit of meal planning, you can first of all use what I call shortcuts. [SPEAKER_00]: Like, I have tons of frozen fruits in my freezer, so they're always ready to go for a quick smoothie. [SPEAKER_00]: I keep frozen vegetables. [SPEAKER_00]: I buy a lot of chopped vegetables because I don't have [SPEAKER_00]: time to chop them. [SPEAKER_00]: You know, so now you can get lettuce that's already chopped and ready to go.

[SPEAKER_00]: You can get cauliflower broccoli already chopped and ready to go. [SPEAKER_00]: If I'm making whole grains, I make more and kind of batch cook. [SPEAKER_00]: So I'll reserve [SPEAKER_00]: You know, some for later meals that week or put some in my freezer for later use. [SPEAKER_00]: So very quickly, I can just kind of put all the stuff together instead of doing everything from scratch with every meal because like that's not very realistic.

[SPEAKER_00]: And then the sauce and my goodness, the sauce is like that literally is the secret sauce right? [SPEAKER_00]: To making a meal delicious and sometimes you can batch a couple like homemade salad dressings you make a lot and you already have it in your fridge. [SPEAKER_00]: You can make like a certain teriyaki sauce or favorite sauce that is a healthy sauce.

[SPEAKER_00]: Once you make a big batch of it, it's good for quite a while in your fridge, so to me that batching really saves time. [SPEAKER_00]: So there are ways to do this that I would argue like I'm at a point now, I've been doing this long enough that sitting in the drive through takes more time than preparing that meal at home. [SPEAKER_00]: because we're a family of five.

[SPEAKER_00]: So for us, like ordering five things, it's not even ninety-nine cents if you've gone through a drive through recently, it is not cheap anymore.

[SPEAKER_00]: It is actually so much cheaper for us to make a meal from a grocery store, not to mention the health benefits, and it is a time saver. [SPEAKER_00]: So, you know, I can cook up, I've got my gosh beans and lentils literally at a fraction of the price of a drive through right now. [SPEAKER_02]: I agree. [SPEAKER_02]: I have a ton of vegetables in the freezer. [SPEAKER_02]: I have a ton of sauces. [SPEAKER_02]: Yeah, I totally agree.

[SPEAKER_02]: What are some other common misconceptions about plant-based diets? [SPEAKER_02]: And we were talking right before we started recording about how people give me a lot of feedback about how much protein I must be getting. [SPEAKER_00]: You know, I mean, there are probably a number of things.

[SPEAKER_00]: I mean, the protein is one that comes up a lot in terms of can you get enough from a plant-based diet and can you trigger enough muscle proteins synthesis because of the amino acid profile being different than in plant-based foods, compared to animal-based foods. [SPEAKER_00]: You know, for a lot of those types of questions, you always have to ask yourself, what is the outcome measure you're looking at?

[SPEAKER_00]: For example, in any clinical study, how are you evaluating the word quality of a protein product, right? [SPEAKER_00]: So right now, quality is largely based on the amino acid profile and proteins digestibility. [SPEAKER_00]: I eat how much you can absorb in your body. [SPEAKER_00]: And if you use those as a metric, well, animal-based products give you the amino acids in the proportion that you need from any single food and they're more digestible, however, what?

[SPEAKER_00]: A lot of those studies, you know, may or may not be looking at or what you should be looking at in a study is what is the difference between, for example, a mixed meal if you're doing not just one plant food like rarely are you just going to have [SPEAKER_00]: Can you offer dinner or are you just going to have soy? [SPEAKER_00]: You're going to create this mixed plate with some green, some amount of protein, some amount of like vegetables with carbs in them.

[SPEAKER_00]: But when you look at mixed meal studies, I mean, no acid profile. [SPEAKER_00]: is such that you do get the muscle protein synthesis, and then you're also need to ask yourself, are you looking at short-term like what happens immediately after a meal versus longer-term studies on muscle protein synthesis of studies that have looked over a week, what happens, and then even better studies that are looking at muscle mass.

[SPEAKER_00]: I mean right, ultimately, the outcome you want to look at is lean muscle mass. [SPEAKER_00]: And when you look at mixed meals versus purely derived from animal products, lean muscle mass. [SPEAKER_00]: I mean, you can get the same amount from plant-based meals. [SPEAKER_00]: You do have to be very intentional and thoughtful about getting kind of the limiting amino acids have to complement each other so a lot of times it's like games plus greens to get complementary amino acids.

[SPEAKER_00]: So there is a little bit more thought that may have to go into meal planning, but it's certainly doable for people who choose to. [SPEAKER_00]: And at the end of the day, even if a person prefers animal proteins, [SPEAKER_00]: There's a benefit to just adding the plant food.

[SPEAKER_00]: To me, this is where I feel there's a lot of argument where there doesn't need to be. [SPEAKER_00]: It's not necessarily one versus the other. [SPEAKER_00]: Do you have to be either vegan or carnivore, likely, or at these two extremes of kind of argument [SPEAKER_00]: And when you look at studies like the global burden of disease study, which is one of the largest epidemiologic studies looking at food and death in worldwide globally.

[SPEAKER_00]: So it was a study that looked at a hundred and ninety-five countries over twenty-seven years, looking at the link between food and mortality and food and morbidity. [SPEAKER_00]: One out of five deaths globally are attributed to food. [SPEAKER_00]: The real headline though of that study is that what we are getting too much of or what is often vilified, for example, sugar-sweetened beverages get vilified.

[SPEAKER_00]: If you look at the deaths attributed to that compared to the deaths attributed to not getting enough whole grains, not getting enough fruits and vegetables, not getting enough of different plant categories, [SPEAKER_00]: There's an, like, a thirty fold, more magnitude of acetitute, but a little to not getting enough whole grains than to getting too much, like sugar sweetened beverages.

[SPEAKER_00]: And so, whatever your baseline diet, even if, like, your, your boyfriend prefers chicken, okay, great. [SPEAKER_00]: Can we add enough of these plant categories? [SPEAKER_00]: Because you are going to get more of a health benefit from getting enough of these plant foods than worrying so much in arguing about doing need to be removing, you know, these certain foods that get debated and sometimes vilified.

[SPEAKER_00]: Right now, only one out of five people in this country are getting the recommended fruits and vegetables. [SPEAKER_00]: I'm sorry, only one out of ten is getting the five recommended fruits and vegetables a day. [SPEAKER_00]: So ten percent. [SPEAKER_00]: And if we just got the five recommended fruits and vegetables a day, risk of cancers reduced by fifty percent. [SPEAKER_00]: I mean, the numbers are staggering. [SPEAKER_00]: Of how much we can move the needle.

[SPEAKER_00]: So I feel that when we talk about plant food, the misconceptions are that when we say the word plant based, it's plant exclusive and it's not.

[SPEAKER_00]: It's just saying that this is a diet defined by adding quality food to your diet. [SPEAKER_00]: That gives you the nutrients you need for a long healthy life. [SPEAKER_00]: But it's not plant exclusive. [SPEAKER_00]: And I also generally like to move away from labels. [SPEAKER_00]: There's also labels that maybe terms like, you can vegan. [SPEAKER_00]: So you can have a healthy vegan diet and unhealthy vegan diet.

[SPEAKER_00]: You can have [SPEAKER_00]: You know, different, whatever your dietary preferences is really, I want more of a focus on the quality of the food, right? [SPEAKER_00]: Because you can have processed food instead of vegan diet and advice for us with any dietary plan. [SPEAKER_00]: It's not even so much the labels, but just stepping back and saying, am I giving myself the foods that nourish my body?

[SPEAKER_00]: And then making sure that you are getting an adequate amount of those foods and plant chemicals, fiber, there are all critical pieces of that, you know, question, and you can only get fiber from plant-based foods. [SPEAKER_00]: Animals foods don't have fiber. [SPEAKER_00]: You can only get fiber chemicals from plant-based foods. [SPEAKER_00]: have plant chemicals in animal foods.

[SPEAKER_00]: So you know, I wish we had less debate over that piece and more about, hey, we are falling so far short of what our bodies need and can we just fill that gap? [SPEAKER_02]: Yeah, that makes sense. [SPEAKER_02]: We were talking about this article that I read in S. Squire by Zachary Pack, who eats a carnivore diet, which I think is equally as restrictive as people think of he can diet it. [SPEAKER_02]: So that's interesting.

[SPEAKER_02]: So as we wrap up, can you tell us a little bit about Emory, the lifestyle medicine and wellness and what you have going on now? [SPEAKER_00]: Yeah, so my bigger mission is to implement changes in a health system where we can create more of a focus on prevention. [SPEAKER_00]: And that's really what we try and do.

[SPEAKER_00]: within the structure of a health system, you know, everyone's been to a doctor where you get, you know, maybe fifteen, twenty, sometimes a little bit longer, in terms of how much time how many minutes you have with a doctor, and the work of prevention simply can't be done with these episodic encounters, and they're very far on view and between, you know, if I do a six month follow-up for someone with diabetes, what happens between those visits, right?

[SPEAKER_00]: And so the mission of creating something within a health system that's lifestyle, medicine, based is what happens in between office visits, right? [SPEAKER_00]: And can we create structuring guidance to help people? [SPEAKER_00]: So one of the programs we did, like I mentioned, is we created a teaching kitchen, initially we did it as a clinical trial. [SPEAKER_00]: where we measured outcomes over a year of doing an intensive lifestyle change and then offered it virtually.

[SPEAKER_00]: So now we also have it available as an online course. [SPEAKER_00]: So we're trying to make this type of information accessible, affordable and [SPEAKER_00]: really mainstream and healthcare. [SPEAKER_00]: Now I feel like there's such a divide between you go to the doctor when you're sick and if you want to pursue health, you go outside the healthcare system and I feel that we, you know, as academic centers, we should be leading in this space.

[SPEAKER_00]: We should be filling this gap that is just currently created by how health delivery systems and just functions. [SPEAKER_00]: So [SPEAKER_00]: So that is kind of my bigger mission. [SPEAKER_00]: We have a lot of educational content. [SPEAKER_00]: Like I also have a podcast that is just focused on just whole health and lifestyle interventions. [SPEAKER_00]: And we're really just trying to support people in a way that helps them meet their goals.

[SPEAKER_00]: But that is an adjunct to the episodic visits that we also do in primary care. [SPEAKER_02]: Well, I, for one, am waiting for you to change health care, because I think your idea sounds great. [SPEAKER_02]: And we will link to any socials you have, your books, and where people can find you. [SPEAKER_02]: Thank you so much, Dr. Berkowitz, for coming on. [SPEAKER_02]: I know our listeners learned so much from this episode. [SPEAKER_00]: Well, thank you so much.

[SPEAKER_00]: It's such a pleasure to be able to talk to you and share this with your community. [SPEAKER_00]: So thank you. [SPEAKER_02]: Thanks and thank you for listening to sisters in sobriety and we will see you next week. [SPEAKER_02]: This was Sister Zoom's sobriety. [SPEAKER_02]: Thank you for listening and being with us today. [SPEAKER_02]: If you want to learn more about sobriety and meet your community, find us at sistersinsubriety.substack.com.

[SPEAKER_02]: Our few is Sister in sobriety, then reach out on social media. [SPEAKER_02]: We'd love to hear from you. [SPEAKER_02]: If you're feeling generous, leave us five stars in a review and follow us wherever you listen. [SPEAKER_02]: You'll never miss an episode. [SPEAKER_02]: Until next time,