Mithu Storoni || Stress Proof

Thanks for listening and enjoy the podcast today. It's a great pleasure to chat with Metrio Sterroni mewtwo has a medical degree from the University of Cambridge. During her pH d, she studied pupil lometry, the science of pupil movements, which sparked her curiosity and stress. Meto has since written the book stress Proof, The Scientific Solution to protect your brain and body and be more resilient every day, creating a stress strategy based in over five hundred and fifty sided

published studies. Hey, thanks for chelling with me today, me too, Thank you for having me. It's great to chat with you, and what a fascinating book that you've written and sort of a fastening background that you have. Can you tell me a little bit about your background? In pupilometry in the world is that? And why are the people's fastening

window and distress? Thank you. So I've had a slightly very interesting and tortuous routs to leading up to writing a book, and so I, you know, I was always interested in your science and so on, and then I specially and I'm a doctor, so I qualified, and then I specialized in ophthalmology and then trained in uptomology, and then I did a PhD in europe falmology and part of that was pupilometry. And pupilometry, as you said, is

the study of pupil movements. And the reason why it's so fascinating is because really there are two points in the entire body where the automotic nervous system becomes obvious or measurable to the outside world. And one is something that many of us are familiar with as the heart, which is why all the HRV heart rate variability apps are all kicking off at the moment. And the second point, or i'd say actually they're the first point, are the pupils.

Because the pupils are supplied by both the sympathetic and the person, setting outs of the automotic nervous system. So observing them and observing their movements tells you a wealth of information about what's going on inside the autonomic nervous system and most interestingly for me, what's going on with

regard to stress. That's so fascinating. You know, I wasn't fully aware of the implications of that, but I was aware of some research showing that the more people blink, the faster rate that people blink is might be an indicator of dopamine levels, and that's correlated with creative performance. I don't know if you ever came across that study I have. I have. That's a very very fascinating study.

And since I read that study, actually it's so true because you know, whenever you see people trying really hard to answer a question or to search for an answer within their mind or something, you see them you know, normally maybe they don't blink very often, but you just see their eyelids flutter like crazy, and you think, wow,

that's so much dopamine king you off. So it's absolutely fasci Two people who like are expert meditators or people that are just like super chill, like surfer dudes from California, do they not blink their eyes that much that fast. So the I blink rate isn't something that I've actually studied so much, but I mean, i'd expect if it is, you know, if it does reflect dopamine activity, then I'd

expect it to be quite situational as well. So I suppose, you know, if you're a Californian surfer and you're really determined to get on one particular wave which you keep missing, I guess you know, you probably will have a faster rate of five links compared to someone who's just chilling somewhere with nothing, you know, not really motivated to do anything. That's a really good point. I shouldn't have conflated surfers with meditators. They're not the same people necessarily. So you know,

what do we get wrong about stress? You write in your book that we get some things wrong in our everyday conceptions of the predictors of stress. Could you please talk a little bit about what we get wrong? Sure? So I just wanted to kind of just stepping back into the pupils and that that kind of is the snowball to the avalanche of stress. If I just talk about that a little bit. And I've come to this so if you go all the way back to well, all the way up in the body to the pupils.

The reason white pupils so because you know, we just talked about how interconnected they are with the automotive gnosystem. They're also light the level or they're very tightly connected to the level of the locus erudius, which is a part of the brain that deals with arousal, and that is supposed to be a very central area when it comes to stress perception, stress reactivity, and anxiety reactivity. And

the thing that we tend to get wrong. Well, you see, stress is such a ubiq cuittous word, right, We talk about stress with regard to so many things and so many contexts. And if you read the newspapers or if you read popular press one time, you'll find, oh, stress

is good for you, stress is bad for you. And you know, stress happens, it starts, you know, maybe someone has written it starts somewhere in your adrenal glands and it goes all the way upwards, or it comes from activating them too much or from them being too active. To what we're learning is that actually through the work much of the work in psychology and above everything else is that of cause that stress begins at the level of the brain, and because it begins at the level

of the brain, downstream effects. So when I say the level of the grain, I include within that locus ceruleus and of course the prefrontal and central autonomic network connections, and the downstream effects of that don't just reflect on the hpaxis, so on the chain of organs and on the chain hormonal reactions that we normally associate with stress.

So the downstream actions of that actually reflect or extend into things such as our metabolism, so things like incident resistance, things like our cardiovascular system through inflammation and through other things, our cardiovascular reactivity. So know how quickly our blood pressurizes men will become angry, and also our baseline blood pressure that's indicative of chronic stress, and of course through things

like through our circadian rhythm. Again, the pupil is connecting all of this because of course the light that determines our data night rhythm is served by the same receptor that serves the pupil or NFE response. So you know that's it's another great focal point for that. But you know, through that chronic stress can just manifest in the way your day night rhythm, your circadian rhythm becomes anomalist, becomes abnormal, And all of these can happen independent of someone feeling

acutely stressed all at the time. So, in that sense, stress is not just you know, the standard billboard image of someone looking and feeling frustrated. When we talk about stress or chronic stress in a bad way, we're talking about lots and lots of different effects that will begin at the level of the brain but can actually manifest in different people in completely apparently unrelated ways. So why does your accent call me down? Well, clearly something to

do with association. Oh boy. Yeah, I did live in England for quite some time and I found it pretty calming. I found the people pretty awesome over there. Yeah, I think that I find the opposite because I think that the pace and the energy and the motivation and the drive of New York and of America in general, I love that and it's a great antidote. I think that we're a bit slower, a bit more relaxed. But your energy is just amazing in this country. Well, thank you.

I'll take credit for the energy of my country. So you mentioned a lot of kind of buzzwords today. One in particular that you mentioned is inflammation. And everybody is everybody and their mother and grandmother and great grandmother is talking about information because it seems to be the source of so many issues. It's fascinating that stress is related.

Now are you mentioning just correlations or do we really is the science really at that stage where we have causal understanding of stress causing information as opposed to I mean it's bidirectional, right, like if you have like a wiki gut, for instance, that can actually cause stress, just as stress can cause a leaky gut. Am I right, correct, correct, So yes, it's biodirectional. And in answer to your previous question, in animal studies, we are now getting empirical data causal data.

In humans, it's obviously ethically much more difficult to test, but in humans we are seeing certain things. For instance, we are noticing that certain types of clinical depression, which are refractory to normal depressive treatment, normal antidepressant treatment, actually

respond to anti inflammatory treatment. Now that's not saying that all cases of depression are happening because of inflammation, but inflammation does play a role and plays a role that's large enough to alleviate the symptoms with the use of anti inflammatory medication. So that's one example of a huge

human correlation. And of course you mentioned leaky gut, so that's actually a fantastic area of study of inflammation because it fuses so many arms of human metabolism, so from things like diabetes and insignet resistance to of course generalized inflammation. And it also brings into it this whole new world that we've just discovered of the guts microbiota, because all of these things ensure so the gut microbiotop player role and of course the integrity of the interstinal walls and

the mucus lay that's just within it. They all influence the immune cells because a large part of our immune system recites along our gut. So that's a great focal point bringing all of those together. And in terms of the cause and effect relationships, again in animal studies, these

have got great, you know, cause effect data. In humans, we are getting a little the picture is a little murkier again because of ethical constraints, but we are getting clear examples of if you introduce endotoxins, or if you look at situations where you're getting endotoxemia or you're getting you're looking at situations where you're inducing inflammation in a human being that is manifesting at the level of the brain as stress. So for instance, you know, we know,

we've known for a long time. Just to give you a picture of inflammation and its effect on the mind and mood and so on, we've known for a long time that, for instance, interferre on alpha is a treatment is one as a treatment option in certain diseases, including in things like hepatitis, see in certain types of cancers and so on. And when you're giving interferre and alpha treatment, one of the side effects is anger, is impulsivity and frustration,

a change in mood. And you know, that's a brilliant cause and effects demonstration where you're increasing levels of interferent alpha in the bloodstream and you're immediately seeing a manifestation in the patient smood, and that's a very clear human picture. So we also have that at the level of endotoxins and endotoxemia. So we're getting a patchier but again a cause an effect picture, but a more pation in the human world. But it is improving by the day. Studies

are accumulating so rapidly. A lot of people attempt to take probiotics to help their weakly gut. What are your thoughts on probiotics supplements. So in terms of the scientific realm, there is no doubt we know now beyond a doubt that you know, we are all before we discovered or we were aware of the existence of the richness of this huge population of microbes living within us. There are many aspects of life, of physiology, of disease, or even

off mind of mental disorders, which were inexplicable. We couldn't connect the dots, and as soon as you bring the microbiota into it, suddenly you get so many answers. And you know, one great example is that we have, you know, the micro biota are like a garden that we all grow. We all have different species, we all have different plants, different shrubs, and it is a vibrant ecosystem which, because of diversity, it adapts and it changes in response to change,

and it digests our food. One of the many things we're observing in general are you know, people seem these days to become more intolerant to certain things than they used to in the past. And you know, various other little relationships that we couldn't really explain before, especially with relation to in student resistance or besity, diabetes, even hypertension. So the studies on probiotics so far, where you're adding certain species of bacteria and seeing a result, the best

empirical evidence has emerged so far in animal studies. Again, it's difficult for ethical reasons to do them so rigorously in humans, but the animal studies are really quite striking because you're finding that certain species of bacteria have almost remarkable effects from influencing vitamin levels, influencing mineral levels within our system two of course, you know, influencing immunity, influencing mood,

influencing stress reactivity. Now, there have been a handful of randomized control trials, small ones carried out in humans using probiotics, and many of them have used fermented milk drinks with certain probotic species added to them, and they have shown some very very promising, almost striking results within as short a time as something like four weeks or six weeks

or eight weeks. I think my general view is that there is still a very large amount of knowledge that we have yet together with regard to probiotics, But what is true what all the studies point to other following Number one, diversity is really important. Number two, the probotics that seem to be most effective if you're taking provotic supplements are ones that have more than one species incorporated within them. So instead of taking just one bacteria, whatever

supplement you're taking should have quite a few. And of course the third is the numbers, because by the time you're taking the probiotic, you don't know where the bacteria are ending up or if indeed they're actually surviving all the way down. So I think there is still a

lot to know. But you know, one of my favorite examples of its effectiveness actually come from Elis Mitchikov, who of course discovered a very long time ago that you know, when he himself observed that people were living for a very long time in a certain area of Eastern Europe where there wasn't very much money, people didn't have very much food. Life was hard, but people ate your bit

and that let them live very long lives. And you know, if you go anecdotally, there is a lot of data around about priortic food and linking provitic food longevity and health and so on. So really summing all of this up, I think there are an area of great promise, but really there is still a lot we don't know. But diversity lots of different types of bacteria are probably the most important areas to emphasize. Can it be harmful? Can such? Oh? Yes,

it can indeed be harmful. So if you're getting your provatics from food in general, I've not come across any studies that show food to be harmful per se, but there are certainly case reports and case series out there where if you're in an immunocompromise state and you're taking a single species bacteria, and many of these studies case reports have come actually from pediatric populations, are from children,

from young people. Then, in an immunocompromise state, if you introduce one bacteria, you're tipping the bank of the ecosystem. And if you're tipping the balance of the ecosystem, which way you're tipping it is something you don't have any control over. So you're relying on a good immune system to control your ecosystem so that the bad bacteria are

not amplified when the balance is tipped. So if you're taking probotic supplements, there is definitely a ditch which is amplifi if you are in an immunocompromise state, but in general for healthy population, you know, taking probotic food or fermented milk. I've not come across any study for that that has made sense. Totally fascinating. Cool. Well, let's move

on to talking about some other things. You know, your work talks not just about stress, being about resiliency and what we can do to strengthen our emotional regulation muscles. Can you give some of our listeners some tips for how can we increase our emotional regulation when we feel like we're just about to explode? Certainly, so you have things that you can do in the long term that

improve your your self regulation skills. And of course I've listened to your wonderful podcast so far as well discussing this the great work of Bao Mixt and so on. But you know, yourself regulatory skills are of course something that you have to work on, that you have to train, and you can train. It's very easy to train if you want to. And on top of that, in the moment that if you're facing a stressful situation, then there's

certain things of course that you can do. So you know, as a psychologist, you'll be familiar with the perils of rumination. So the moment, Yeah, so the moment you go through a stressful response, and it's it's common sense, but so that many of us still fall into the trap of you go through something stressful and what do you do. You sit down, you relax, or you call a fend, you talk about it, and you dwell and you replay

and you replay the event in your head. So if you do nothing else but just moment of stress response is over, engage your mind into something else, Immerse yourself into something so deeply that your mind can't wonder. So whether that's a game, whether that's a task, whether that's something you have to do, you know, an errand you have to do, that's fine. So never ever ruminate the

moment of stress responses over. That's golden rule one. And I'd say probably for me personally, that's probably the most important intervention to do because if you can cut short your stress response, at that point, your HPA access activity, so your quarter's all release. The release if all your stress moments is curtailed and given how you know, according to this theory of alistatic load of the theory of chronic stress. The little it's all the little events that

add up. So if each little event is made as short as possible, then even if you have twenty during your day, you are far more resilient in that you return to baseline, your sympathetic and parasympathetic balance is quickly restored.

And that has implications and so many other things. So, for instance, studies have shown and I've quoted in my book the fact that again these are mouse studies, but if you take a mouse and you expose the mouse distress, and in the studies I've quoted it's really injury related stress. Then if you can curtail that stress response as soon as possible, you reduce cracks forming in the mouse's intestines.

You know, there are studies freends and also in humans that things like public speaking, speaking in public in need causes immediate cracks in your intestinmon lightning. So if you can curtail your stress response, these cracks don't form, or they heal faster. So you have so many downward repercussions of cutting a stress response short. And you know, then of course there is the question of cortisol because cortisol is of course it's not a hum for hormone. We

need cortiso. It saves our lives, but it's a marker for an extended or extensive HP access to reactivity. And also too much court style is what causes the harm. So just that one little step of the moment your stress response is over, stop your brain from thinking you're

still experiencing it by thinking about something completely different. I think that's really interesting and speaks to the power of meditation and other sort of stress techniques where you really retrain your attention or you strengthen your muscle to be able to control your attention. But sometimes meditation doesn't work, and you talk about that in your book, Can you please talk about what sort of goes wrong in some

of these stressed techniques. So, I mean, if you look at the spectrum of chronic stress, the really good way of looking at it is what happens in acute stress. So we all know that acute stress is not harmful. It's an evolutionary mechanism we have. It's allowed us to survive, and short bouts of stress is good for us. You know, they are all good for us. What actually happens during

an acute stress response isn't just what you're feeling. You're actually having more than seven processes taking place inside your brain and your body. So the moment you become acutely stressed, for instance, you become momentarily insulin resistant. Your body clocks are suddenly more vulnerable to change, You become acutely inflame. No, no, no, they are all good because imagine they're about mauled by

a lion. So just imagine you know, it's now several thousand years ago, and you're gone, You've spotted something you really like in the wilderness, you really like to have for dinner, and you're running after it, and then a lion comes after you instead, and it is about to, you know, maybe attack you, physically harm you. So you want to be inflamed because then any germs entering in your body, you want to be insulin resistant. Because the selfish brain is the reason why we have the rest

of the body. Our body is there to serve the brain. So at moments of acute stress, you want all the blood sugar you have to be there available to the brain should it need any more energy. That's why the rest of the body becomes insulin resistance, no glucose can enter muscle or your liver, so that it's all there to enter into your brain. So all of these are evolutionary mechanisms there to serve us, to help us survive, and all of them stop the moment you're about of

acute stress is over. So when it comes to chronic stress, what actually happens is it's almost as if these processes go awry. So you have insulin resistance, which isn't instantaneous, it becomes chronic. You have information which isn't instantaneous, it becomes chronic chronic. You have HVA access reactivity, which either becomes excessive or too little. So all of these seven agents go awarde. They just go completely on their like

seven secret agents who then turn rogue. Then, and when that happens, it happens to different people in different ways. So one person might be affected more by instain resistance, and another person might be affected more by a disordered emotional regulation, while a third person might be affected more with disordered circadian rhythms. And really it's in that context that not every stressed solution that's out there will work

equally well for everyone. So for example, if you're a pilot working long haul, or you're a shift worker, then doing something like mindfulness meditation won't be as effective for you as really focusing on getting your daylight, your darkness intervals, normalizing your melatonin production, and timing your heat, your light, your exercise exposure to the time of day. That will reduce your HPA, access reactivity or activity much more and make you feel harmer and better and reduce levels of

chronic stress. So that's one way in which things like meditation might not work equally for everyone, and it can do everyone a little bit of good, but it won't be as potent an anti stress formula for say a shift worker. Then it would be safe for someone, say a nurse who works on a very say an oncology ward or a pain management war, where you're seeing a

lot of emotional trauma and emotional emotionally taxing situations. In that situation, something like focused attention meditation would probably be far better than another intervention. What do you think about open monitoring meditation, which has been shown to be related

to creativity, So that's an interesting one. I think every kind of meditation has its place and has its benefits, and I think that when it comes to open monitoring meditation, one of the research areas I've come across, one of the studies that you've i'm sure read as well, is independent of creativity. So just in the sense of making

people calmer, is it can unmask anxiety. So I know, one randomized control trial that was carried out on school children on a mindfulness program showed that after I think it was eight weeks of practicing mindfulness meditation, anxiety levels are actually raised in the male members of the volunteers, So there is that aspect of it. So in terms of stress, I think focused attention meditation is more logical because it trains your attentional focus, which of course you

need in order to rescue yourself from a stress response. Now, with regard to creativity, that's a really interesting one also because of the work that well, the pieces that you've written on this as well, because monitoring meditation is clearly has a place, and also with the discovery of the DMN of default mote network, it has tremendous potential in a huge place in creativity. And I think what I found really interesting is the most recent study on this

that shows you need a little bit of both. You need to focus almost on mind wander and wander at the same time in order to really tap into your creative juices. I think you wrote about this in a Scientific American piece a while ago, but a paper recently came out confirming this. So I think that the problem with regard to stress is many people who are very

highly strong who tend to ruminate a lot. If they are placed in a situation where they're monitoring their thoughts without controlling them or without pushing them away, and they have a tendency towards negative rumination, then that can pull them into negative rumination and might increase their anxiety levels. That said, if you're doing it in the contextop creativity, the effect of that is completely different. That's such a great,

great point. It just reminds me, you know, reminds me of that recent model by Jessica Andrews, Hannah and colleagues on spontaneous cognition interacting with with controlled cognition. You know, if you kind of have both, like rumination, you're kind of out of control in your in the cognitions you don't want to have. But creativity seems to be this

beautiful combination of controlled chaos. That's right. And I think that one of the things that really I find so intriguing is that Kazuhiguru Son, who won the Nobel Prize for Literature last year, he gave an interview in one of the papers in Britain where he described doing just this. So he described how when he wrote, I think he decided he was going to write Remains of the Day, and he had a plot or he was thinking about it. He had a plot and so on, and then he

just left it. He just went off and he just put his brain into you know, information absorbing murd or whatever. And then he came back and then he decided, Okay, I'm going to write Mains of the Day. Within I think it was a four week period, and what he did was he shut himself into his room and he focused, but he let his mind wander, and he focused on letting his mind wander. So it's almost as you just described.

He ruminated and he kept focusing on what he ruminated through or toward, and at the end of the four weeks he had the novel. And I thought, that's a fantastic demonstration of this phenomenon. Oh, that's a great example, and it's just so fascinating. Our brain is so fascinating. Oh boy, okay, well I want to you know, I could talk to you all day as you know. Let

me ask you one more question. Why have certain phmasco companies abandoned its efforts to find a cure for Alzheimer's while interventions such as the mind diet and cognitive training programs and games online are becoming more and more popular. What's going on there? So I think that we're going through a really exciting time in brain research where we are discovering that many of these processes, many of the brain not just degenerative processes, but just situations where the

brain is not behaving optimally. So situations that are not you know, an acute injury or an acute lesion in the brain. We're finding that much of the cause behind it is really the brain's own plasticity. So as an example, in chronic stress, we know that if you, animal studies

show this very clearly. But now we're getting some inkling of this also through human studies, because you know, just I think it was January twenty seventeen when the Carolinsk Institute published a study of work exhaustion showing that work exhaustion played a probable causal role in causing shrinkage of parts of the prefuntal cortex in humans, which is a really really exciting observation. But I think what is actually going on here is, for instance, in chronic stress, chronic

stress is not a disease. It's the brain changing itself in response to what is being demanded of it, and the consequences of those changes are pathological. So as the prefuntal cortex remodels itself, as you have deficiency or change in synaptic plasticity in favoring emotional reactivity working against prefrontal control, you're having an almost remodeling process going on in the

brain that's initiated and propagated by the brain itself. So in order to undo that process and to go back to baseline, you can't just treat a single molecular pathway. You have to deal with the cues that the brain

responds to in the environment. And the example of Phiser and Alzheimer's research is a brilliant one because what we're finding is I mean in dimension in Alzheimer's disease, it's still a slightly foggier picture but we are finding that lifestyle interventions, especially when carried out in a multifaceted way, seem to have certainly, in some cases almost astounding results in producing change, positive changes that no drug and no

single treatment pathway can produce. It's almost you are giving the brain a set of cues and the brain is doing the work by itself. And that's why things like diet we just mentioned the mind diet for instance, which is shown to have again positive effects on the brain.

But things like diet, things like cognitive training, things like working with the brain to give the brain cues from the outside so that the brain can remodel itself in the way that you want it to, is a far more potent and powerful and actually obviously much safer way of doing things, especially in a non pathological context then using a drug, using a neotropic, stimulating one single pathway

and so on. So that's a really really exciting time that we're passing through, the fact that we're able to see this in action, to see the early results of this coming through. Well, thank you so much for imparting your obvious depth of wisdom on this podcast and your unique ability and vantage point from your unique background of medical training as well as psychological training. So thank you for chatting with me today. You know I'm a big fan of yours. Thank you so much having you Scott.

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