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Stress affects everyone differently. Returning to The Thorne Podcast is guest Dr. Joel Evans, who answers the question “What is stress?” and explores how different types of stress can help – or harm – the body. In this episode, you’ll discover mind-body practices for stress management.
During this episode you’ll learn about:
Resources to topics mentioned in this episode:
Products mentioned in this episode: Stress Test – an easy at-home health test; Phosphatidylserine (formerly Iso Phos); PharmaGABA; Stress Management Bundle – Stress B-Complex, Stress Balance, PharmaGABA-250
Subscribe to More Content
Subscribe to the show wherever you listen to podcasts so you never miss an episode. You can also learn more about the topics in the episode by checking out the latest news, videos, and stories on Thorne’s Take 5 Daily blog.
During this episode you’ll learn about:
Resources to topics mentioned in this episode:
Products mentioned in this episode: Stress Test – an easy at-home health test; Phosphatidylserine (formerly Iso Phos); PharmaGABA; Stress Management Bundle – Stress B-Complex, Stress Balance, PharmaGABA-250
Subscribe to More Content
Subscribe to the show wherever you listen to podcasts so you never miss an episode. You can also learn more about the topics in the episode by checking out the latest news, videos, and stories on Thorne’s Take 5 Daily blog.
Dr. Robert Rountree – Ad Read
This is The Thorne Podcast, the show that navigates the complex world of wellness and explores the latest science behind diet supplements and lifestyle approaches to good health. I'm Dr. Robert Rountree, Chief Medical Advisor at Thorne and Functional Medicine Doctor. As a reminder, the recommendations made in this podcast are the recommendations of the individuals who expressed them and not the recommendations of Thorne. Statements in this podcast have not been evaluated by the Food and Drug Administration. Any products mentioned are not intended to diagnose, treat, cure or prevent any disease.
Dr. Robert Rountree
Hi everyone, and welcome back to The Thorne Podcast. This week we have a special returning guests, my good friend Dr. Joel Evans, who's a board certified OB-GYN in Connecticut, a functional medicine doctor and educator, and he's a member of the board of directors for the Center for Mind Body Medicine that's doing amazing work around the world. Welcome back to the show, Joel.
Dr. Joel Evans
Great to be here. Dr. Roundtree.
Dr. Robert Rountree
How are you doing?
Dr. Joel Evans
I'm doing really well, I am, thank you so much.
Dr. Robert Rountree
Great. So, Joel, this week we're going to zoom in on a particular aspect of health that affects the entire body and the entire population of the world, but it affects everybody in different ways. We're going to talk about this magic word, stress and levels of stress and what that means exactly. So maybe we can just start by defining what that means. What is what is stress? What does it mean to you? What's your perspective and what does it mean from a medical perspective?
Dr. Joel Evans
You know, that is such an incredible question because we always talk about stress and we don't know how to define it. So basically there's emotional stress and there's physical stress. So physical stress on the body is anything that will cause the body to go out of its state of equilibrium, anything that will cause the body to create a compensatory physiological response. Like if you're in the cold, right, your body has to compensate. So it's that compensation that can be a stresser on the body. Now we may look at the latest science and say, Wow, I thought that being in the cold is a good thing. And the answer is it is a good thing because the response of the body to being in the cold is actually a very good thing, except when you're in the cold for too long and then it becomes problematic. And that's that is actually the same way to look at emotional stress. So emotional stress is something that upsets us real or imagined. So if we are afraid of flying and we sit in our living room and I say, close your eyes and imagine yourself getting on a plane, you'll have that same stress response as if you were getting on a plane in the physical sense, right? So whether it's real getting on the plane or imaginary getting on the plane, so stressors, real or imagined, affect the body in the same way and conversely, positive thoughts. So imagining your being with someone that you love, a child, a romantic partner, causes the body to produce those same molecules of emotion that affect you positively, whether you're with that person or not. So stress, real or imagined, is the same terms of your body's response and positive emotions, real or imagined, are just like cold. Where those reactions on the short term are good because that's what we call fight or flight where you are running from an enemy or you're going to fight an enemy, you need those stress hormones. You need your body to go through that stress response. But it's the prolonged stress response, which is a problem.
Dr. Robert Rountree
Now, I think I hear you saying it isn’t accurate to say there's a negative stress in a positive stress. What's accurate to say is that there's a negative response to stress and a positive response to stress. Am I getting that right, that there's no true like negative stress? Because if you said, well, cold is a stressor that's, you know, really not the issue, it's more like, how long are you in it and how do you perceive it?
Dr. Joel Evans
Exactly. And it's both. It's how long you're in it and how how you perceive it. So you can take the same stressor. I use this example all the time with my patients. Picture two five-year-olds on the beach, a wave comes in and they're both knocked down. One of them gets up laughing and screaming and wants to run back into the water and can't wait for the next wave. The other gets up crying and runs away from the wave. It's the same experience, but a totally different reaction.
Dr. Robert Rountree
And why does that happen? Why do some people and this starts with little kids, right? That they're…
Dr. Joel Evans
Yeah, yeah.
Dr. Robert Rountree
Some kids seem to have that built in. I remember an old study where they would have somebody in a clown suit walk into a preschool and some of the kids would run towards the clown and other would run away from the clown. What? What's going on there?
Dr. Joel Evans
Similar. Similar? Yeah. So we don't have all the answers. But, you know, as an obstetrician, one of the places I go when I'm thinking about early childhood behavior is what we call prenatal programing, or what was that child's experience both in the womb as well as extreme early life. And, you know, there's a whole field there called prenatal psychology, which looks at that. And as far as stress goes, there's actually data and studies and science that shows that if you are in utero and your mom is stressed, that that affects the whole programming of your stress response. And that's really, you know, heavy stuff. I actually spoke at the UN on that topic.
Dr. Robert Rountree
At the United Nations.
Dr. Joel Evans
I did. I did, yeah. Because they were doing a conference on reducing violence. And someone said, I wonder, you know, if there's anything with pregnant women to reduce violence. And they said basically the only one that would know would be me and they called up. And I said, Yeah, I can answer that. Absolutely. And so I spoke about this prenatal psychology, birth-psychology-dot-com is the website that has all this association pre and perinatal psychology and health. I happened to be their medical director. So this is something I'm very interested in.
Dr. Robert Rountree
And it's close to your heart.
Dr. Joel Evans
Yes.
Dr. Robert Rountree
And is this something that you would say most obstetricians are aware of now and are talking to their patients about?
Dr. Joel Evans
Sadly, sadly, no. Sadly, no. I would say that most of the dualas and midwives are aware of this, but not the obstetrician.
Dr. Robert Rountree
Oh, so there's a lot of education that needs to be done.
Dr. Joel Evans
Absolutely. Absolutely.
Dr. Robert Rountree
Now, what about a person who says, well, I'm really sensitive to stress, you know, that that little things get me revved up, get me upset easily. What does that mean? And and how do you work with somebody like that?
Dr. Joel Evans
So I say so they come and they describe that. I go, So are you telling me you've got a short fuse?
Dr. Robert Rountree
Well, yeah, absolutely. Yeah, absolutely. Yeah, right. So. So what do you do?
Dr. Joel Evans
Well, so I'm going to tell you something funny about short fuse. There's a lot of reasons for this. I just want to speak to a biological cause first, because I learned about this and I'm like, Wow, this was interesting. And that is that it can be caused by a lithium deficiency.
Dr. Robert Rountree
Oh!
Dr. Joel Evans
Right. Now most people aren't aware that lithium does anything in the body other than it's used for a medication in bipolar disease.
Dr. Robert Rountree
Right, in high doses.
Dr. Joel Evans
Very high doses. So what's interesting about lithium is that there's a baseline deficiency of lithium, which is a mineral in our soil just the erosion that's been happening. But lithium has been known to decrease or improve short fuse forever. So much so that that was originally what was the main, not the main, but an important ingredient of 7UP.
Dr. Robert Rountree
Oh, the soft drink.
Dr. Joel Evans
And that's how it got the name. Seven is the atomic number for lithium.
Dr. Robert Rountree
Oh, I had no idea.
Dr. Joel Evans
So seven up to increase your mood.
Dr. Robert Rountree
Oh, and they put the lithium in it.
Dr. Joel Evans
And they put lithium in it. They don't read that anymore. But that's, that's what they did.
Dr. Robert Rountree
Just like they don't put cocaine in Coca-Cola.
Dr. Joel Evans
Exactly. Medicinal soft drinks back in the day.
Dr. Robert Rountree
Wow.
Dr. Joel Evans
But there was something to that. So the form of lithium you can give now as a supplement. It's called lithium orotate. Yeah. Anyway, I just mention that because a lot of people aren't aware of that. Right? So it's not always is that your mother was stressed when your when you were in utero. Right. So what I always do when someone comes in with a short fuse question is I ask every patient, as best you can imagine, what was your mother's life like while she was pregnant with you?
Dr. Robert Rountree
Yeah. Yep, yep.
Dr. Joel Evans
And you know, I've never gotten ever someone that says I really don't know. And they're like, Oh, it was horrible because and they go through the reasons or it was fine because and etc.. So that's part of this prenatal or perinatal psychology where stress in utero of the mother. Right. Impacts the whole programing of the HPA access.
Dr. Robert Rountree
Yeah. Can you define that? HBA Yeah.
Dr. Joel Evans
Yeah. The hypothalamic pituitary adrenal axis, which is the brain, the hypothalamus and the pituitary gland, and then the adrenal, which sits on top of the kidney, and that's where the stress hormones are produced. So when we say it gets reset, it gets reset for a lower threshold, old meaning for a given stressor. And we can measure stressors and, you know, you can measure stressors by how hard you hit someone's finger or, you know, for a for a baby that's in utero, they do something called buzzing where they actually put a vibrational device on the mother's belly. And the baby responds to that.
Dr. Robert Rountree
By moving around a certain way.
Dr. Joel Evans
Exactly. And the heart rate changes. The heart rate will go up. The baby that's too sensitized, The heart rate stays up longer. It doesn't go to normal. So you have a reprograming of your stress response even while you're in utero. If your mom has been stressed while she's carrying you and that changes, those changes rather continue all the way through adult life and contribute to violence and inability to make friends, etc.. So that's something. And then there's the you then jump to adult life, and this is everyone's common observation is that when you're stressed about something, it's very easy to have a short fuse.
Dr. Robert Rountree
Yeah, yeah, right.
Dr. Joel Evans
You know, so it's a good thing nobody called me while I was preparing for this podcast, but I'd say, no, no, no, no.
Dr. Robert Rountree
But, Joel, what does this do to your body to have this kind of chronic short fuser? What are the implications in terms of health issues?
Dr. Joel Evans
Well, it has a negative impact on every area of the body.
Dr. Robert Rountree
Everything
Dr. Joel Evans
Yes, that's the sad part. And, you know, there are different ways that we analyze how stressed people are. We can check the function as I said, of that adrenal gland that sits on top of the kidneys, which is the main organ for responding to stress. And our adrenal function goes through a continuum where we are over-secreting these stress hormones like cortisol.
Dr. Robert Rountree
Cortisol
Dr. Joel Evans
And like, you know, epinephrine and norepinephrine. So that fight or flight response where our heart rate goes up and blood pressure goes up, etc.. So those are good in the short term and then really, really bad. So if you are staying in that stressed response long term, almost every organ system is negatively impacted. And, you know, I could take you on a tour around what we call the functional medicine matrix and tell you how everything is impacted by stress from your immune system, your ability to detoxify and get rid of toxins, which I know is something near and dear to your heart. But when people are stressed, they don't clear toxins as well. Right? So there's that. But then there's this continuum where if stress goes on for too long, instead of having elevated cortisol, you don't make enough cortisol. And when you've been stressed long enough such that you're not making enough cortisol, there's an increase in all-cause mortality. And if you're diagnosed with breast cancer, there's one study that I love to cite. I hate the findings, but with metastatic breast cancer, if your cortisol is low again, much more likely to die from your breast cancer, which quicker.
Dr. Robert Rountree
So you start out with overdrive to my right and then the gland will burn out and then you stop producing cortisol. And that's even worse.
Dr. Joel Evans
Right.
Dr. Robert Rountree
And that's what you're saying? It predisposes you to chronic disease.
Dr. Joel Evans
Exactly. But you know, what happens is the high cortisol predisposes you to chronic disease, too. And then you've had that predisposition. And then as it gets lower and lower and lower, that chronic disease that was started by the elevation continues, gets worse, then you die.
Dr. Robert Rountree
Wow. Now, I imagine this is a scenario you've seen, but I I've certainly had people in my office that were totally revved up and they're complaining about something that seems stress related, like having chronic migraine headaches or chronic neck tension or they're they can't sleep, they're wired, but they're tired, why? And and I hint that maybe stress plays a role and the person, you know, has a short fuse in their response? No, absolutely not. There's no way stress could be involved. Have you ever seen people like this? Yeah, They're exuding stress.
Dr. Joel Evans
Yeah. It's lack of self awareness, we call it.
Dr. Robert Rountree
Yeah. And then you suggest you dare to make the suggestion that maybe you need to calm down or do something differently. And there's resistance. So you think people get stuck in a in a mode where they're either unwilling or afraid to acknowledge that the stress is going on?
Dr. Joel Evans
I think that's certainly one way to look at it. So that's absolutely true. And then there are other additional factors, meaning people that are exposed to chronic stress and may not even be totally aware of it. Right. So they may have issues in their romantic relationship, issues with it with children and issues at work, financial pressures, etc.. They have some awareness of it, but don't realize how it's really impacting them much more than they realize or will care to admit. So that's one thing. And then the second thing is that there may be stressors that they're aware of that can't be changed. You know, we look at social determinants of health, so being, you know, living through the experience of racism, living through poverty, etc., you know, trying to sleep when there's gunshots outside of your bedroom, you know, these are all stressors that can't be changed or are very difficult to change. So there's, you know, people in denial. There's people that don't have awareness, and then there's people that have situations that are incredibly stressful that they can't change. However, the silver lining here is that these mind body interventions work for all three groups, right? And so this way, if you say, well, you know, you have someone who clearly is speaking quickly and clearly has a short fuse and tells you that they're not stressed. Yeah, you know, I'm you know, I'm sure that there's something going on that you'll notice physiologically either their heart rate's elevated, you know, the respiratory rate is elevated, their blood pressure is elevated. And you say, okay, you say to yourself, I'm not going to challenge them about their short fuse, because that went nowhere. But I'm going to tell them that their heart rate's up. And so then I'll say, you know, your heart rate's up. I think one of the ways to reduce this heart rate for you would be a mind body intervention, right? So you find a way to give the recommendation in a way that they don't feel challenged or defensive. Right? This works for things as simple as, you know, I'm stressed because I have a presentation all the way to what's going on in Ukraine. Right? You mentioned done with Center for Mind Body Medicine. We just did a major teaching program. We sent 15 faculty members to Ukraine and taught 150 mental health practitioners in Ukraine how to use these techniques in wartime with their patients. And I led one of those groups virtually, you know, last summer, just these techniques focusing on your breath. And we can go through these in detail if you like, but these techniques and there are so many of them really can work no matter what the circumstance.
Dr. Robert Rountree
You know, one thing I've got to say, having listened to our mutual friend James Gordon talk about these techniques is I thought it was going to be something really elaborate. And then when he explained it, I realized it's it's really not complicated at all. It's belly breathing, you know? Yeah, it's slow, deep breath, you know, using a mantra, you know, relaxation response. So people sometimes have the idea, oh, I need to do, you know, stress reduction. That's going to be complicated.
Dr. Joel Evans
right?
Dr. Robert Rountree
And it's not complicated.
Dr. Joel Evans
Right. It is so easy. It's so easy. And one of the things that very interesting, as you know, is spirituality. And there's a continuum between mind, body and spirituality. So what my body does is it gives you techniques to change your physiology. What spirituality does, it gives you a perspective so you become less reactive to those circumstances. And then when you combine your decreased reactivity with the technique, that's the one-two punch to keep your physiology stable.
Dr. Robert Rountree
So is it fair to say that you believe the brain can be reprogramed?
Dr. Joel Evans
Absolutely.
Dr. Robert Rountree
And that's what neuroplasticity is all about.
Dr. Joel Evans
Yes. And that's that science is there.
Dr. Robert Rountree
It's never too late. Never, never, ever. Great. Well, we'll be right back after a short break to answer some questions from our listeners. So hang in there and we'll talk shortly.
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Dr. Robert Rountree
And we're back. So now it's time to answer some questions that have come in from the community. Our first question this week comes from a listener who asked why does stress cause weight gain? What a great question.
Dr. Joel Evans
There's a couple of mechanisms for this. The obvious one is stress causes us to eat differently. So they actually had a commission, a study to say that when people are stressed, they eat differently and they eat foods that have more calories. So therefore that contributes to weight gain. And they also eat more processed foods which have more chemicals in them. And when you have more of these toxic chemicals or preservatives that will also increase weight gain. So that's the obvious thing, is we eat differently. We also eat foods that create inflammation and that causes weight gain without looking at what we eat. Terms of the physiology of stress. Cortisol, which is the hormone that we produce under… under stress, causes us to gain weight around the middle. That's the the main reason for weight gain. And so we can measure this actually, usually it's best done through saliva with a four point cortisol curve or adrenal stress index, adrenal stress profile, where you see where your cortisol is throughout the day. And, you know, sometimes we find cortisol can be very low, which is we talked about that burnout. We can find that cortisol can be elevated. Some people that can't sleep at night, for example, have elevated cortisol in the evenings. And that's almost like a reverse because the cortisol supposed to be elevated in the morning. So what we would do for that would be a supplement like Phosphatidylserine, for example, which can reduce cortisol.
Dr. Robert Rountree
Well, I think you're you're actually answering the next question, which is what hormone is responsible for stress? Is it just one? And are there ways to turn it down?
Dr. Joel Evans
So it's pretty much, you know, cortisol and epinephrine and norepinephrine. So I wouldn't say they're responsible for stress. Stress causes them to increase. Right. And the hormones don't cause the stress. The stress causes the hormones. You know, the ways to turn it down are primarily like I just said, with the phosphatidylserine. That's really what you can do in terms of a supplement. Then in terms of lifestyle, it's about normal exercise, it's about sleep, it's about eating in a healthy way because you don't want to have sugar spikes, you don't want to be, you know, too much sugar, too little sugar. Healthy fats, omega threes are so important. And then there's, you know, mind body interventions and mind body interventions really make your body less reactive to stress. So when you, let's say, meditate, blood pressure goes down, your heart rate goes down and chemicals in your body change when you're meditating, and then when you stop meditating, you'll go back to normal. But after you've been meditating for a while, your body's changes persist even when you're not meditating. So those benefits continue, even when you're not actually practicing the meditation technique. And you will also react in a in a less reactive way. And so that's the benefit of doing these and practicing these techniques long term.
Dr. Robert Rountree
So that segues into the next question, are there natural foods or medicines? And they say besides marijuana foods or medicines that can help reduce stress. And I think there's maybe opposite to that too is like are there things that increase stress?
Dr. Joel Evans
Right. So basically the thing that I'm using, you know, a lot is, you know, CBD, usually in the form of hemp oil that really takes the edge off.
Dr. Robert Rountree
Without making people feel stupid or high or anything like that.
Dr. Joel Evans
Yeah, exactly. And it's legal and all that sort of stuff. So I really love that. That's actually a go to for me. There are other things like, you know, Valerian, for example, and different supplement companies make different blends. But in general, I think the hemp oil is a nice go to and seems to work the best in my practice.
Dr. Robert Rountree
One thing I would throw in that I've had a lot of experience with is GABA, or PharmaGABA, which is a natural source of GABA. GABA is the same chemical made in the brain that produces a calming effect. So drugs like thallium and bind to the GABA receptor. And I've actually been quite impressed at how taking something like that orally can help a person calm down without making them loopy.
Dr. Joel Evans
Yeah, GABA is great. I'm a big fan of GABA for me and I don't know if this is true for you, Bob, but the way I decide if I'm going to go to GABA as a first choice or CBD is if someone says they're feeling a bit agitated or anxious. So if they use the word anxiety or agitation, I'll go to the GABA. If they'll just say I'm feeling a little stressed, I'll go to the Hemp. But there's also no reason we can't do them together.
Dr. Robert Rountree
Well, this person says, I've tried meditation and yoga for stress, but I can't get into it. I have some mobility issues. So what do you tell a person? And I'm trying to meditate. I can't do it.
Dr. Joel Evans
So, you know, there's so many different types of meditation patterns, right? I think that, you know, when you look at some of these ancient yogic texts, they talk about hundreds of different meditations.
Dr. Robert Rountree
Hundreds of techniques.
Dr. Joel Evans
Hundreds. Yes. Yes. You know, there's a meditation for when you're in an oxcart, for example, you know, there are concentrated meditations, there are active meditations, there are awareness meditations. Those are the big three. So when you're doing a concentrated meditation, you're trying to concentrate on something. And what that does is it takes your attention away from whatever the troubling thought is so you can concentrate on staring at a candle. You can concentrate on looking at a photograph of something that has a positive connotation to you. You can concentrate on your breath, you know, you can concentrate on anything. And you don't have to sit there for 40 minutes and concentrate. Right? You start with just a couple of minutes, right? 60 seconds even to start. Then there's an awareness type of meditation where you're just aware and you say, You know what, I'm on this walk now. I feel the wind on my face. I hear the sounds of the birds, Oh, now I hear a car. So you just have this inner dialog of everything you're experiencing, and that takes your mind off of your thoughts, of your troubling thoughts. And then there's the active meditation, which is anything that takes your mind off of the passage of time, right? So what I was doing, surgery, surgery was a meditation for me. I could just do an operation and then I'd look at the clock and two or 3 hours had gone by.
Dr. Robert Rountree
Oh, wow.
Dr. Joel Evans
Right. Dancing is a meditation now for this person that's mobility impaired. Clearly, they can't be dancing, but maybe they can do drumming, right? Banging on a drum or practicing an instrument. Those can be meditations. Saying a word, you know, like peace, either silently or out loud. Peace, love, something, you know, that you have meaning to or words that you don't know what they mean. And this comes from different spiritual traditions. Those are called mantras where they're supposed vibrational or energetic properties to saying the word. And you don't need to know what the word means. The best example of that is the expression ohm, which they do before and after yoga classes usually, and that supposedly has very healing and therapeutic properties.
Dr. Robert Rountree
You know, I had to teacher years ago who was talking about this and said by way of framing, you all got to breathe, right? You got to breathe anyway. So what happens if you just focus on your breath and slow it down and become aware of it? And I think the point was, a lot of times people have the idea, Oh, you're telling me I need to meditate? That means I got to get on that za-zen cushion and I've got to sit there for 3 hours without moving, you know, or somebody's going to wrap me on the back. So they have this idea that it's just kind of structured activity as opposed to what you're saying, which is there's all kinds of ways that we can do that. And it's more of the state getting into a meditative state. That's the issue, which I think has got to. I mean, the next question is, are there other ways of reducing stress tips for meditation not so dull. I think we've already kind of addressed that is like, well, it doesn't have to be dull. I mean, would you agree with that?
Dr. Joel Evans
Oh, it absolutely. Not only it shouldn't be dull, it really shouldn't be dull. Right? So just like we say with exercise, you need to find something you like or it won't be as effective. The same is true for your mind-body technique unless you enjoy it. Then there's no reason to do it. So find something that you like.
Dr. Robert Rountree
And then just crank up the volume, do more, find something you like and just do more of it. And I got to say, for me, even though I do a sitting meditation every day, that the deep meditation for me is going for a walk in the woods, which I try to do every week, get out into the deep forest and really bring in the chemicals from those trees and the mosses and the lichens and all that stuff in the air. It's like.
Dr. Joel Evans
That's beautiful, that's perfect.
Dr. Robert Rountree
Does it for me. So find what you like and tune in to that and just do more of it.
Dr. Joel Evans
Absolutely. Absolutely.
Dr. Robert Rountree
This has been an amazing discussion. So, folks, that's all the time we have for this week. Dr. Joel Evans, thanks again so much for coming on the podcast. If people want to follow more of your work or specifically if they want to find out more about this mind body work that you mentioned, how would they do that?
Dr. Joel Evans
Yeah, just just go straight to CMBM.org, Center for Mind-Body Medicine. But it's just the website is C-M-B-M, Charlie, Mary, Bravo, Mary-dot-org. You'll find the great work they do there.
Dr. Robert Rountree
Terrific. Excellent. As always. Thanks, everyone, for listening. Until next time!
Dr. Robert Rountree Outro
Thanks for listening to The Thorne Podcast. Make sure to never miss an episode by subscribing to the show on your podcast app of choice. If you've got a health or wellness question you'd like answered, simply follow our Instagram and shoot a message to @ThorneHealth. You can also learn more about the topics we discussed by visiting Thorne.com and checking out the latest news videos and stories on Thorne's Take 5 Daily blog. Once again, thanks for tuning in and don't forget to join us next time for another episode of The Thorne Podcast.
Dr. Robert Rountree – Ad Read
This is The Thorne Podcast, the show that navigates the complex world of wellness and explores the latest science behind diet supplements and lifestyle approaches to good health. I'm Dr. Robert Rountree, Chief Medical Advisor at Thorne and Functional Medicine Doctor. As a reminder, the recommendations made in this podcast are the recommendations of the individuals who expressed them and not the recommendations of Thorne. Statements in this podcast have not been evaluated by the Food and Drug Administration. Any products mentioned are not intended to diagnose, treat, cure or prevent any disease.
Dr. Robert Rountree
Hi everyone, and welcome back to The Thorne Podcast. This week we have a special returning guests, my good friend Dr. Joel Evans, who's a board certified OB-GYN in Connecticut, a functional medicine doctor and educator, and he's a member of the board of directors for the Center for Mind Body Medicine that's doing amazing work around the world. Welcome back to the show, Joel.
Dr. Joel Evans
Great to be here. Dr. Roundtree.
Dr. Robert Rountree
How are you doing?
Dr. Joel Evans
I'm doing really well, I am, thank you so much.
Dr. Robert Rountree
Great. So, Joel, this week we're going to zoom in on a particular aspect of health that affects the entire body and the entire population of the world, but it affects everybody in different ways. We're going to talk about this magic word, stress and levels of stress and what that means exactly. So maybe we can just start by defining what that means. What is what is stress? What does it mean to you? What's your perspective and what does it mean from a medical perspective?
Dr. Joel Evans
You know, that is such an incredible question because we always talk about stress and we don't know how to define it. So basically there's emotional stress and there's physical stress. So physical stress on the body is anything that will cause the body to go out of its state of equilibrium, anything that will cause the body to create a compensatory physiological response. Like if you're in the cold, right, your body has to compensate. So it's that compensation that can be a stresser on the body. Now we may look at the latest science and say, Wow, I thought that being in the cold is a good thing. And the answer is it is a good thing because the response of the body to being in the cold is actually a very good thing, except when you're in the cold for too long and then it becomes problematic. And that's that is actually the same way to look at emotional stress. So emotional stress is something that upsets us real or imagined. So if we are afraid of flying and we sit in our living room and I say, close your eyes and imagine yourself getting on a plane, you'll have that same stress response as if you were getting on a plane in the physical sense, right? So whether it's real getting on the plane or imaginary getting on the plane, so stressors, real or imagined, affect the body in the same way and conversely, positive thoughts. So imagining your being with someone that you love, a child, a romantic partner, causes the body to produce those same molecules of emotion that affect you positively, whether you're with that person or not. So stress, real or imagined, is the same terms of your body's response and positive emotions, real or imagined, are just like cold. Where those reactions on the short term are good because that's what we call fight or flight where you are running from an enemy or you're going to fight an enemy, you need those stress hormones. You need your body to go through that stress response. But it's the prolonged stress response, which is a problem.
Dr. Robert Rountree
Now, I think I hear you saying it isn’t accurate to say there's a negative stress in a positive stress. What's accurate to say is that there's a negative response to stress and a positive response to stress. Am I getting that right, that there's no true like negative stress? Because if you said, well, cold is a stressor that's, you know, really not the issue, it's more like, how long are you in it and how do you perceive it?
Dr. Joel Evans
Exactly. And it's both. It's how long you're in it and how how you perceive it. So you can take the same stressor. I use this example all the time with my patients. Picture two five-year-olds on the beach, a wave comes in and they're both knocked down. One of them gets up laughing and screaming and wants to run back into the water and can't wait for the next wave. The other gets up crying and runs away from the wave. It's the same experience, but a totally different reaction.
Dr. Robert Rountree
And why does that happen? Why do some people and this starts with little kids, right? That they're…
Dr. Joel Evans
Yeah, yeah.
Dr. Robert Rountree
Some kids seem to have that built in. I remember an old study where they would have somebody in a clown suit walk into a preschool and some of the kids would run towards the clown and other would run away from the clown. What? What's going on there?
Dr. Joel Evans
Similar. Similar? Yeah. So we don't have all the answers. But, you know, as an obstetrician, one of the places I go when I'm thinking about early childhood behavior is what we call prenatal programing, or what was that child's experience both in the womb as well as extreme early life. And, you know, there's a whole field there called prenatal psychology, which looks at that. And as far as stress goes, there's actually data and studies and science that shows that if you are in utero and your mom is stressed, that that affects the whole programming of your stress response. And that's really, you know, heavy stuff. I actually spoke at the UN on that topic.
Dr. Robert Rountree
At the United Nations.
Dr. Joel Evans
I did. I did, yeah. Because they were doing a conference on reducing violence. And someone said, I wonder, you know, if there's anything with pregnant women to reduce violence. And they said basically the only one that would know would be me and they called up. And I said, Yeah, I can answer that. Absolutely. And so I spoke about this prenatal psychology, birth-psychology-dot-com is the website that has all this association pre and perinatal psychology and health. I happened to be their medical director. So this is something I'm very interested in.
Dr. Robert Rountree
And it's close to your heart.
Dr. Joel Evans
Yes.
Dr. Robert Rountree
And is this something that you would say most obstetricians are aware of now and are talking to their patients about?
Dr. Joel Evans
Sadly, sadly, no. Sadly, no. I would say that most of the dualas and midwives are aware of this, but not the obstetrician.
Dr. Robert Rountree
Oh, so there's a lot of education that needs to be done.
Dr. Joel Evans
Absolutely. Absolutely.
Dr. Robert Rountree
Now, what about a person who says, well, I'm really sensitive to stress, you know, that that little things get me revved up, get me upset easily. What does that mean? And and how do you work with somebody like that?
Dr. Joel Evans
So I say so they come and they describe that. I go, So are you telling me you've got a short fuse?
Dr. Robert Rountree
Well, yeah, absolutely. Yeah, absolutely. Yeah, right. So. So what do you do?
Dr. Joel Evans
Well, so I'm going to tell you something funny about short fuse. There's a lot of reasons for this. I just want to speak to a biological cause first, because I learned about this and I'm like, Wow, this was interesting. And that is that it can be caused by a lithium deficiency.
Dr. Robert Rountree
Oh!
Dr. Joel Evans
Right. Now most people aren't aware that lithium does anything in the body other than it's used for a medication in bipolar disease.
Dr. Robert Rountree
Right, in high doses.
Dr. Joel Evans
Very high doses. So what's interesting about lithium is that there's a baseline deficiency of lithium, which is a mineral in our soil just the erosion that's been happening. But lithium has been known to decrease or improve short fuse forever. So much so that that was originally what was the main, not the main, but an important ingredient of 7UP.
Dr. Robert Rountree
Oh, the soft drink.
Dr. Joel Evans
And that's how it got the name. Seven is the atomic number for lithium.
Dr. Robert Rountree
Oh, I had no idea.
Dr. Joel Evans
So seven up to increase your mood.
Dr. Robert Rountree
Oh, and they put the lithium in it.
Dr. Joel Evans
And they put lithium in it. They don't read that anymore. But that's, that's what they did.
Dr. Robert Rountree
Just like they don't put cocaine in Coca-Cola.
Dr. Joel Evans
Exactly. Medicinal soft drinks back in the day.
Dr. Robert Rountree
Wow.
Dr. Joel Evans
But there was something to that. So the form of lithium you can give now as a supplement. It's called lithium orotate. Yeah. Anyway, I just mention that because a lot of people aren't aware of that. Right? So it's not always is that your mother was stressed when your when you were in utero. Right. So what I always do when someone comes in with a short fuse question is I ask every patient, as best you can imagine, what was your mother's life like while she was pregnant with you?
Dr. Robert Rountree
Yeah. Yep, yep.
Dr. Joel Evans
And you know, I've never gotten ever someone that says I really don't know. And they're like, Oh, it was horrible because and they go through the reasons or it was fine because and etc.. So that's part of this prenatal or perinatal psychology where stress in utero of the mother. Right. Impacts the whole programing of the HPA access.
Dr. Robert Rountree
Yeah. Can you define that? HBA Yeah.
Dr. Joel Evans
Yeah. The hypothalamic pituitary adrenal axis, which is the brain, the hypothalamus and the pituitary gland, and then the adrenal, which sits on top of the kidney, and that's where the stress hormones are produced. So when we say it gets reset, it gets reset for a lower threshold, old meaning for a given stressor. And we can measure stressors and, you know, you can measure stressors by how hard you hit someone's finger or, you know, for a for a baby that's in utero, they do something called buzzing where they actually put a vibrational device on the mother's belly. And the baby responds to that.
Dr. Robert Rountree
By moving around a certain way.
Dr. Joel Evans
Exactly. And the heart rate changes. The heart rate will go up. The baby that's too sensitized, The heart rate stays up longer. It doesn't go to normal. So you have a reprograming of your stress response even while you're in utero. If your mom has been stressed while she's carrying you and that changes, those changes rather continue all the way through adult life and contribute to violence and inability to make friends, etc.. So that's something. And then there's the you then jump to adult life, and this is everyone's common observation is that when you're stressed about something, it's very easy to have a short fuse.
Dr. Robert Rountree
Yeah, yeah, right.
Dr. Joel Evans
You know, so it's a good thing nobody called me while I was preparing for this podcast, but I'd say, no, no, no, no.
Dr. Robert Rountree
But, Joel, what does this do to your body to have this kind of chronic short fuser? What are the implications in terms of health issues?
Dr. Joel Evans
Well, it has a negative impact on every area of the body.
Dr. Robert Rountree
Everything
Dr. Joel Evans
Yes, that's the sad part. And, you know, there are different ways that we analyze how stressed people are. We can check the function as I said, of that adrenal gland that sits on top of the kidneys, which is the main organ for responding to stress. And our adrenal function goes through a continuum where we are over-secreting these stress hormones like cortisol.
Dr. Robert Rountree
Cortisol
Dr. Joel Evans
And like, you know, epinephrine and norepinephrine. So that fight or flight response where our heart rate goes up and blood pressure goes up, etc.. So those are good in the short term and then really, really bad. So if you are staying in that stressed response long term, almost every organ system is negatively impacted. And, you know, I could take you on a tour around what we call the functional medicine matrix and tell you how everything is impacted by stress from your immune system, your ability to detoxify and get rid of toxins, which I know is something near and dear to your heart. But when people are stressed, they don't clear toxins as well. Right? So there's that. But then there's this continuum where if stress goes on for too long, instead of having elevated cortisol, you don't make enough cortisol. And when you've been stressed long enough such that you're not making enough cortisol, there's an increase in all-cause mortality. And if you're diagnosed with breast cancer, there's one study that I love to cite. I hate the findings, but with metastatic breast cancer, if your cortisol is low again, much more likely to die from your breast cancer, which quicker.
Dr. Robert Rountree
So you start out with overdrive to my right and then the gland will burn out and then you stop producing cortisol. And that's even worse.
Dr. Joel Evans
Right.
Dr. Robert Rountree
And that's what you're saying? It predisposes you to chronic disease.
Dr. Joel Evans
Exactly. But you know, what happens is the high cortisol predisposes you to chronic disease, too. And then you've had that predisposition. And then as it gets lower and lower and lower, that chronic disease that was started by the elevation continues, gets worse, then you die.
Dr. Robert Rountree
Wow. Now, I imagine this is a scenario you've seen, but I I've certainly had people in my office that were totally revved up and they're complaining about something that seems stress related, like having chronic migraine headaches or chronic neck tension or they're they can't sleep, they're wired, but they're tired, why? And and I hint that maybe stress plays a role and the person, you know, has a short fuse in their response? No, absolutely not. There's no way stress could be involved. Have you ever seen people like this? Yeah, They're exuding stress.
Dr. Joel Evans
Yeah. It's lack of self awareness, we call it.
Dr. Robert Rountree
Yeah. And then you suggest you dare to make the suggestion that maybe you need to calm down or do something differently. And there's resistance. So you think people get stuck in a in a mode where they're either unwilling or afraid to acknowledge that the stress is going on?
Dr. Joel Evans
I think that's certainly one way to look at it. So that's absolutely true. And then there are other additional factors, meaning people that are exposed to chronic stress and may not even be totally aware of it. Right. So they may have issues in their romantic relationship, issues with it with children and issues at work, financial pressures, etc.. They have some awareness of it, but don't realize how it's really impacting them much more than they realize or will care to admit. So that's one thing. And then the second thing is that there may be stressors that they're aware of that can't be changed. You know, we look at social determinants of health, so being, you know, living through the experience of racism, living through poverty, etc., you know, trying to sleep when there's gunshots outside of your bedroom, you know, these are all stressors that can't be changed or are very difficult to change. So there's, you know, people in denial. There's people that don't have awareness, and then there's people that have situations that are incredibly stressful that they can't change. However, the silver lining here is that these mind body interventions work for all three groups, right? And so this way, if you say, well, you know, you have someone who clearly is speaking quickly and clearly has a short fuse and tells you that they're not stressed. Yeah, you know, I'm you know, I'm sure that there's something going on that you'll notice physiologically either their heart rate's elevated, you know, the respiratory rate is elevated, their blood pressure is elevated. And you say, okay, you say to yourself, I'm not going to challenge them about their short fuse, because that went nowhere. But I'm going to tell them that their heart rate's up. And so then I'll say, you know, your heart rate's up. I think one of the ways to reduce this heart rate for you would be a mind body intervention, right? So you find a way to give the recommendation in a way that they don't feel challenged or defensive. Right? This works for things as simple as, you know, I'm stressed because I have a presentation all the way to what's going on in Ukraine. Right? You mentioned done with Center for Mind Body Medicine. We just did a major teaching program. We sent 15 faculty members to Ukraine and taught 150 mental health practitioners in Ukraine how to use these techniques in wartime with their patients. And I led one of those groups virtually, you know, last summer, just these techniques focusing on your breath. And we can go through these in detail if you like, but these techniques and there are so many of them really can work no matter what the circumstance.
Dr. Robert Rountree
You know, one thing I've got to say, having listened to our mutual friend James Gordon talk about these techniques is I thought it was going to be something really elaborate. And then when he explained it, I realized it's it's really not complicated at all. It's belly breathing, you know? Yeah, it's slow, deep breath, you know, using a mantra, you know, relaxation response. So people sometimes have the idea, oh, I need to do, you know, stress reduction. That's going to be complicated.
Dr. Joel Evans
right?
Dr. Robert Rountree
And it's not complicated.
Dr. Joel Evans
Right. It is so easy. It's so easy. And one of the things that very interesting, as you know, is spirituality. And there's a continuum between mind, body and spirituality. So what my body does is it gives you techniques to change your physiology. What spirituality does, it gives you a perspective so you become less reactive to those circumstances. And then when you combine your decreased reactivity with the technique, that's the one-two punch to keep your physiology stable.
Dr. Robert Rountree
So is it fair to say that you believe the brain can be reprogramed?
Dr. Joel Evans
Absolutely.
Dr. Robert Rountree
And that's what neuroplasticity is all about.
Dr. Joel Evans
Yes. And that's that science is there.
Dr. Robert Rountree
It's never too late. Never, never, ever. Great. Well, we'll be right back after a short break to answer some questions from our listeners. So hang in there and we'll talk shortly.
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Dr. Robert Rountree
And we're back. So now it's time to answer some questions that have come in from the community. Our first question this week comes from a listener who asked why does stress cause weight gain? What a great question.
Dr. Joel Evans
There's a couple of mechanisms for this. The obvious one is stress causes us to eat differently. So they actually had a commission, a study to say that when people are stressed, they eat differently and they eat foods that have more calories. So therefore that contributes to weight gain. And they also eat more processed foods which have more chemicals in them. And when you have more of these toxic chemicals or preservatives that will also increase weight gain. So that's the obvious thing, is we eat differently. We also eat foods that create inflammation and that causes weight gain without looking at what we eat. Terms of the physiology of stress. Cortisol, which is the hormone that we produce under… under stress, causes us to gain weight around the middle. That's the the main reason for weight gain. And so we can measure this actually, usually it's best done through saliva with a four point cortisol curve or adrenal stress index, adrenal stress profile, where you see where your cortisol is throughout the day. And, you know, sometimes we find cortisol can be very low, which is we talked about that burnout. We can find that cortisol can be elevated. Some people that can't sleep at night, for example, have elevated cortisol in the evenings. And that's almost like a reverse because the cortisol supposed to be elevated in the morning. So what we would do for that would be a supplement like Phosphatidylserine, for example, which can reduce cortisol.
Dr. Robert Rountree
Well, I think you're you're actually answering the next question, which is what hormone is responsible for stress? Is it just one? And are there ways to turn it down?
Dr. Joel Evans
So it's pretty much, you know, cortisol and epinephrine and norepinephrine. So I wouldn't say they're responsible for stress. Stress causes them to increase. Right. And the hormones don't cause the stress. The stress causes the hormones. You know, the ways to turn it down are primarily like I just said, with the phosphatidylserine. That's really what you can do in terms of a supplement. Then in terms of lifestyle, it's about normal exercise, it's about sleep, it's about eating in a healthy way because you don't want to have sugar spikes, you don't want to be, you know, too much sugar, too little sugar. Healthy fats, omega threes are so important. And then there's, you know, mind body interventions and mind body interventions really make your body less reactive to stress. So when you, let's say, meditate, blood pressure goes down, your heart rate goes down and chemicals in your body change when you're meditating, and then when you stop meditating, you'll go back to normal. But after you've been meditating for a while, your body's changes persist even when you're not meditating. So those benefits continue, even when you're not actually practicing the meditation technique. And you will also react in a in a less reactive way. And so that's the benefit of doing these and practicing these techniques long term.
Dr. Robert Rountree
So that segues into the next question, are there natural foods or medicines? And they say besides marijuana foods or medicines that can help reduce stress. And I think there's maybe opposite to that too is like are there things that increase stress?
Dr. Joel Evans
Right. So basically the thing that I'm using, you know, a lot is, you know, CBD, usually in the form of hemp oil that really takes the edge off.
Dr. Robert Rountree
Without making people feel stupid or high or anything like that.
Dr. Joel Evans
Yeah, exactly. And it's legal and all that sort of stuff. So I really love that. That's actually a go to for me. There are other things like, you know, Valerian, for example, and different supplement companies make different blends. But in general, I think the hemp oil is a nice go to and seems to work the best in my practice.
Dr. Robert Rountree
One thing I would throw in that I've had a lot of experience with is GABA, or PharmaGABA, which is a natural source of GABA. GABA is the same chemical made in the brain that produces a calming effect. So drugs like thallium and bind to the GABA receptor. And I've actually been quite impressed at how taking something like that orally can help a person calm down without making them loopy.
Dr. Joel Evans
Yeah, GABA is great. I'm a big fan of GABA for me and I don't know if this is true for you, Bob, but the way I decide if I'm going to go to GABA as a first choice or CBD is if someone says they're feeling a bit agitated or anxious. So if they use the word anxiety or agitation, I'll go to the GABA. If they'll just say I'm feeling a little stressed, I'll go to the Hemp. But there's also no reason we can't do them together.
Dr. Robert Rountree
Well, this person says, I've tried meditation and yoga for stress, but I can't get into it. I have some mobility issues. So what do you tell a person? And I'm trying to meditate. I can't do it.
Dr. Joel Evans
So, you know, there's so many different types of meditation patterns, right? I think that, you know, when you look at some of these ancient yogic texts, they talk about hundreds of different meditations.
Dr. Robert Rountree
Hundreds of techniques.
Dr. Joel Evans
Hundreds. Yes. Yes. You know, there's a meditation for when you're in an oxcart, for example, you know, there are concentrated meditations, there are active meditations, there are awareness meditations. Those are the big three. So when you're doing a concentrated meditation, you're trying to concentrate on something. And what that does is it takes your attention away from whatever the troubling thought is so you can concentrate on staring at a candle. You can concentrate on looking at a photograph of something that has a positive connotation to you. You can concentrate on your breath, you know, you can concentrate on anything. And you don't have to sit there for 40 minutes and concentrate. Right? You start with just a couple of minutes, right? 60 seconds even to start. Then there's an awareness type of meditation where you're just aware and you say, You know what, I'm on this walk now. I feel the wind on my face. I hear the sounds of the birds, Oh, now I hear a car. So you just have this inner dialog of everything you're experiencing, and that takes your mind off of your thoughts, of your troubling thoughts. And then there's the active meditation, which is anything that takes your mind off of the passage of time, right? So what I was doing, surgery, surgery was a meditation for me. I could just do an operation and then I'd look at the clock and two or 3 hours had gone by.
Dr. Robert Rountree
Oh, wow.
Dr. Joel Evans
Right. Dancing is a meditation now for this person that's mobility impaired. Clearly, they can't be dancing, but maybe they can do drumming, right? Banging on a drum or practicing an instrument. Those can be meditations. Saying a word, you know, like peace, either silently or out loud. Peace, love, something, you know, that you have meaning to or words that you don't know what they mean. And this comes from different spiritual traditions. Those are called mantras where they're supposed vibrational or energetic properties to saying the word. And you don't need to know what the word means. The best example of that is the expression ohm, which they do before and after yoga classes usually, and that supposedly has very healing and therapeutic properties.
Dr. Robert Rountree
You know, I had to teacher years ago who was talking about this and said by way of framing, you all got to breathe, right? You got to breathe anyway. So what happens if you just focus on your breath and slow it down and become aware of it? And I think the point was, a lot of times people have the idea, Oh, you're telling me I need to meditate? That means I got to get on that za-zen cushion and I've got to sit there for 3 hours without moving, you know, or somebody's going to wrap me on the back. So they have this idea that it's just kind of structured activity as opposed to what you're saying, which is there's all kinds of ways that we can do that. And it's more of the state getting into a meditative state. That's the issue, which I think has got to. I mean, the next question is, are there other ways of reducing stress tips for meditation not so dull. I think we've already kind of addressed that is like, well, it doesn't have to be dull. I mean, would you agree with that?
Dr. Joel Evans
Oh, it absolutely. Not only it shouldn't be dull, it really shouldn't be dull. Right? So just like we say with exercise, you need to find something you like or it won't be as effective. The same is true for your mind-body technique unless you enjoy it. Then there's no reason to do it. So find something that you like.
Dr. Robert Rountree
And then just crank up the volume, do more, find something you like and just do more of it. And I got to say, for me, even though I do a sitting meditation every day, that the deep meditation for me is going for a walk in the woods, which I try to do every week, get out into the deep forest and really bring in the chemicals from those trees and the mosses and the lichens and all that stuff in the air. It's like.
Dr. Joel Evans
That's beautiful, that's perfect.
Dr. Robert Rountree
Does it for me. So find what you like and tune in to that and just do more of it.
Dr. Joel Evans
Absolutely. Absolutely.
Dr. Robert Rountree
This has been an amazing discussion. So, folks, that's all the time we have for this week. Dr. Joel Evans, thanks again so much for coming on the podcast. If people want to follow more of your work or specifically if they want to find out more about this mind body work that you mentioned, how would they do that?
Dr. Joel Evans
Yeah, just just go straight to CMBM.org, Center for Mind-Body Medicine. But it's just the website is C-M-B-M, Charlie, Mary, Bravo, Mary-dot-org. You'll find the great work they do there.
Dr. Robert Rountree
Terrific. Excellent. As always. Thanks, everyone, for listening. Until next time!
Dr. Robert Rountree Outro
Thanks for listening to The Thorne Podcast. Make sure to never miss an episode by subscribing to the show on your podcast app of choice. If you've got a health or wellness question you'd like answered, simply follow our Instagram and shoot a message to @ThorneHealth. You can also learn more about the topics we discussed by visiting Thorne.com and checking out the latest news videos and stories on Thorne's Take 5 Daily blog. Once again, thanks for tuning in and don't forget to join us next time for another episode of The Thorne Podcast.
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