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Speaker A: Welcome to the Huberman Lab podcast, where.

Speaker B: We discuss science and science based tools for everyday life. I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine. Today, my guest is Doctor Alyssa Eppel. Doctor Epel is a professor of psychiatry and behavioral sciences at the University of California, San Francisco. She is also the director of the center on Aging, Metabolism, and Emotions. Doctor Epel's laboratory focuses on stress and the many impacts that it has on our brain and body, both negative and positive. For instance, her laboratory has shown that particular forms of stress change our telomeres, which are a component of the genetic machinery of our cells that impacts how quickly our cells and therefore we age. We also discuss exciting work from Doctor Epel's laboratory exploring how stress impacts our behavioral choices, in particular which foods we elect to eat and how we experience those foods. Today, you'll learn how stress, and your interpretation of your stress impacts the different aspects of your biology and psychology. You'll also learn about several important stress interventions that Doctor Epel's laboratory has explored, including meditation and breath work, can profoundly influence the way that stress impacts your brain and body, both for better or for worse. She's also explored how specific dietary interventions, such as omega three fatty acid intake, impact stress and our response to stress. And a key and important feature, I believe, of Doctor Epel's work is how stress and stress interventions vary in their effectiveness depending on whether or not the subjects in her experiments are male versus female and their social status. By the end of today's episode, I assure you, you will have a much more thorough understanding of what stress is and how it changes our biology and psychology, as well as the specific stress interventions that are going to be most optimal for you in reducing the negative effects of stress on the aging process and on negative behavioral choices, and also how to leverage stress in order to maximize the positive effects that stress can have on cellular metabolism, mental health, physical health, and performance. To learn more about the work from Doctor Epel's laboratory, as well as to learn more about her books entitled the Telomere Effect and now, more recently, the stress prescription, you can find links to those in the show. Note captions before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford. It is, however, part of my desire and effort to bring zero cost to consumer information about science and science related tools to the general public. In keeping with that theme, I'd like to thank the sponsors of today's podcast our first sponsor is element. Element is an electrolyte drink with everything you need and nothing you don't. That means plenty of salt, magnesium and potassium, the so called electrolytes, and no sugar. Salt, magnesium and potassium are critical to the function of all the cells in your body, in particular to the function of your nerve cells, also called neurons. In fact, in order for your neurons to function properly, all three electrolytes need to be present in the proper ratios. And we now know that even slight reductions in electrolyte concentrations or dehydration of the body can lead to deficits in cognitive and physical performance. Element contains a science backed electrolyte ratio of 1000 milligrams. That's 1 gram of sodium, 200 milligrams of potassium, and 60 milligrams of magnesium. I typically drink element first thing in the morning when I wake up in order to hydrate my body and make sure I have enough electrolytes. And while I do any kind of physical training and after physical training as well, especially if I've been sweating a lot, if you'd like to try element, you can go to drink element. That's lmnt.com huberman to claim a free element sample pack with your purchase. Again, that's drinkelement lmnt.com Huberman Today's episode is also brought to us by waking up. Waking up is a meditation app that includes hundreds of meditation programs, mindfulness trainings, yoga Nidra sessions, and NSDR non sleep deep rest protocols. I started using the waking up app a few years ago because even though I've been doing regular meditation since my teens and I started doing yoga Nidra about a decade ago, my dad mentioned to me that he had found an.

Speaker A: App turned out to be the waking.

Speaker B: Up app, which could teach you meditations of different durations. And that had a lot of different types of meditations to place the brain and body into different states and that he liked it very much. So I gave the waking up app a try and I too found it to be extremely useful because sometimes I only have a few minutes to meditate, other times I have longer to meditate. And indeed, I love the fact that I can explore different types of meditation to bring about different levels of understanding about consciousness, but also to place my brain and body into lots of different kinds of states depending on which meditation I do. I also love that the waking up app has lots of different types of yoga Nidra sessions. For those of you who don't know, yoga Nidra is a process of lying very still, but keeping an active mind. It's very different than most meditations. And there's excellent scientific data to show that yoga, Nidra, and something similar to it called non sleep, deep rest, or NSDR, can greatly restore levels of cognitive and physical energy, even with just a short ten minute session. If you'd like to try the waking up app, you can go to wakingup.com huberman and access a free 30 day trial. Again, that's wakingup.com huberman to access a.

Speaker A: Free 30 day trial.

Speaker B: And now for my discussion with Doctor Alyssa Epel. Doctor Epel, welcome.

Speaker C: Thank you.

Speaker A: So great to have you here.

Speaker B: We have colleagues in common and topics.

Speaker A: Of interest related to our laboratories in common. So got a lot of questions today. I'd love to just kick off by you explaining a little bit about the different forms of stress we hear stress. Stress is bad. Stress can kill us. No one likes to feel stressed, et cetera. But as you and I both know, that's not the entire picture. So I'd love for you to just educate us a bit on what stress is and what it isn't, where it can be problematic and where perhaps it can even be beneficial.

Speaker C: So as a stress scientist, it is a word I use a lot, but it has to be broken down because it has so many different kind of dimensions and meaning. So there's good and bad stress, there's acute and chronic stress. And technically, it just means anytime we feel overwhelmed that we feel like the demands are too much for our resources. So that's kind of a very technical way to put it. But really, so much of life is about meeting challenges, and we're never going to get rid of different stressful situations in life. If anything, they are increasing. And so it really comes down to not the stressors of what happens to us, but really how we respond, the stress response. So that's a distinction that we're still trying to get the field to talk about stress in a more specific way so that we can think about, well, what situations are in your life. They might be difficult, ongoing situations, like caregiving or work stress, or worrying about health, your own or someone's. And then there's how are you coping with it? So when something happens, we mount a stress response and we recover. And that's beautiful, no harm done. We need that. That's why we're here, still alive. Is that survival response? It's a problem these days of just, we keep it alive in our head. We keep it alive with our thoughts. Our thoughts are the most common form.

Speaker A: Of stress, even though I expected we would get into tools to combat stress a little bit later. Since you have now told us that our thoughts are the biggest sort of propagator of internal stress, what, to your knowledge, is the best way, or what are the best ways for us to manage overthinking and ruminating on stressful topics? Because I certainly experience stress and when I do, I have tools related to breath, work, running, exercise, sleep, non sleep, deep rest. I'm a huge fan of all these sorts of things, but when we succumb to stress and the thinking patterns take over where the gears are turning and they won't stop turning, what does the science tell us about ways to manage those thoughts? Should we work with them in the sense that we try and rationalize or understand the basis of the stress? Or should we try and divert our thinking away? Or is there some other tool that I'm unaware of?

Speaker C: Yes, yes, both. And great. I like to bin it in three categories. So one is we. Well, I'll just say, first of all, we have to have some awareness of how our mind works, or we're just like a subject to thinking. Our thoughts are real thinking, that it's helpful to keep ruminating and problem solving, because that's our tendency, is to go toward whatever we think there's threat or risk and to problem solve that. But you could just be stuck there all day in this kind of threat mode or redmine state, and that's just a shame. We don't need to turn on that stress response all the time. But that's where we are as a society. So that's why I wrote the stress prescription. Take any survey, even pre pandemic, and people feel, the majority of people feel an overwhelming amount of stress. So even this past year, 46% of adults report feeling overwhelmed by stress. And then you break it down, you're like, ooh, this is really bad for young adults and women and people of color. And so we have these groups that are targeted for marginalization that are feeling an extremely high amount of stress in most of those subgroups. So bottom yeah.

Speaker A: Wouldn't you argue that most, most everyone is feeling more stressed now? Or is it just. Or what do the data say?

Speaker C: Yeah, so I think that we come with different levels of awareness of our stress. And so when I find someone who really doesn't feel a lot of stress, sometimes I can see right through that and they're just not aware. And sometimes it really is true. They're often in a different stage of life and they control their environment a lot and they've been through a lot. I mean, one of the big patterns in the population levels of stress is that the older people are less stressed, period. If you're over 65, you have been through so much, solved so much. You just have a better perspective on life and on stressors. And then our adults, our young adults have, like, four times the level of stress as our older adults. So we do. We don't have to wait till we get older. But there certainly is true wisdom and resilience that comes with age for many people. Often we're so used to feeling daily stress from our urban and modern life that we don't notice it. We're just used to it. And so we're going through the day with kind of like clenched hands and just, you know, for listeners, just even just taking a check in now and noticing how you might be holding stress in your body, that's a huge clue. It's a huge place where we accumulate tension. So we might not be aware that we're stressed, but we're clenching our hands. And in fact, my taxi driver who drove me here let me know that he's exactly that point, that he doesn't realize he's stressed until he realizes that he's tensing his shoulders and his fists. And so great signal, doing a check in to notice where in our body we're holding stress is step one to releasing it.

Speaker A: So going back to this notion of overthinking, what are the tools that are most efficient for dealing with overthinking or ruminating when people just can't seem to let go of the thing that's the stress or thinking about, not the stress in their body, but the thing that caused the stress, the difficult conversation, the thing that irked them on social media or in their personal life or professional life, or simply out in the world.

Speaker C: So I wish I had one answer, but I'm going to say lots of strategies tackle that. And so in those three bins, one are top down strategies of awareness and things that we can say to ourselves, since our beliefs and mindsets can really help us release stress, view stress more positively. The second bucket is not that the mind changes the body, but the body changes the mind. And those are the set of strategies that you tend to use the most. Right. We're working stress out of the body. We're metabolizing it, we're burning it up, and we get relief. It changes our amygdala activity and moves us to more, an experiential state where we're more in our somatosensory cortex. And then the third bucket is change the scene. Just getting away from all the stress triggers that we have in our office or in the city. And being in an environment that we find calming. It might even just be a corner of the house. But implanting what I call safety signals. We're just these animals that are conditioned to signals, whether we're aware of it or nothing. Having things like comforting pets, pictures, smells, music. Why not? We need those. They help. They add up.

Speaker A: Yeah. I like the idea of having a small physical space. Or I suppose it could be a large physical space. But for most people who don't have the resources, some small, pre designated physical space that represents a safe zone and creating, or I should say, populating that safe zone with things. As you said, as a visual neuroscientist, originally, I guess, now I study stress. But as a visual neuroscientist, we know that photographs are extremely powerful cues for the memory system, especially actual physical photographs. And I believe there is some work on this. That if people keep a photograph of something that draws positive memories, that that photograph actually, they keep it with them. That actually can be a positive cue for alleviating stress and just enhancing mood. This is probably done less so nowadays because everyone keeps things on their phones and it's just kind of a scroll through. But in any event, you know, when we talk about stress, it's clear that there's short term, medium term, long term stress. You studied all these different forms of stress. If you would be so kind as to just give us an overview of the different forms of stress, how we can learn to recognize those. And then I'd love to transition from there into talking about some of the work that you've been doing on stress and stress related eating and stress and how it relates to aging in particular. But before we do that, to make sure everyone's on the same page, if you could just pepper our minds with knowledge about stress in all its beautiful and not so beautiful forms.

Speaker C: So when we think about stress, we usually think feeling stress, reporting stress, and that's important. What our body is doing is also important, and it's not always related to our mind. So measuring levels of the nervous system and how vigilant we are is another way that we can understand stress. And that's particularly important and interesting because that's how stress gets under the skin. And we might not be aware, we might not report stress, but we're still holding tension and being much more sympathetically dominated, meaning that our body is vigilant and scanning for cues, and we don't feel safe, and so we're mobilizing a lot more energy than we need to. Stress is so expensive to the body. The stress response uses a tremendous amount of energy, ATP, that's made by your mitochondria. And if we have that kind of vigilant stress response on all day, we're just going to feel exhausted, and we all feel exhausted at this stage of the kind of long shadow of the pandemic. And it's really no mystery because we're not good at turning the stress response off. And that's what we want to really focus on, is understanding. We need to mount a big stress response to cope with things when we need extra energy, but then we can actually let our body relax and we can turn it off, and that's where the rumination comes and we want to catch ourselves rehearsing and reliving stress or worrying about the next thing, saying, right now I'm safe. And, you know, there's the breathing strategies. I'm right with you. Where those are the most direct and fast path to reducing stress in the body, period.

Speaker A: Yeah. Our colleague David Spiegel, our associate chair of psychiatry at Stanford, and also a colleague of yours as well, has, I think, said it best, which is that breathing is unique among the functions of the brain, because it really originates as a brain function and then extends, of course, to the body in that it represents a bridge between the conscious and the unconscious, because at any given moment, we're breathing, and of course, at any given moment, we can take control of our breathing. There are very few brain circuits that impact the body in that way. I can't suddenly just change my rate of digestion because I decide to. But we can do that with breathing. We will definitely get into some of the work that you've been doing on breath work in particular. I know you have a study that's actually explored the Wim HoF method quite directly, one of the few studies that I'm aware of that's done that. So we'll get to that a little bit later. So you describe stress as a way that the body and mind mobilize energy.

Speaker C: Yeah, and I didn't quite answer your question. So there's that acute stress response when everything, every hormone and cell in our body is having a stress response, and that is allowing us to reorient, focus, problem solve. It's really beautiful how much we can increase our capacity to do things during stress, and then if it lasts minutes or hours, we eventually recover. And that is what happens all day in small, you know, to small extents with daily stressors, we don't necessarily get so threatened that we release a lot of cortisol, but our nervous system is going up and down all day. Then there are, then there's kind of moderate stress events that maybe take days or months to cope with. And what's important there is that noticing, like right now, am I really coping acutely with something, or can I restore? So that kind of daily restoration is very important. And then there are chronically stressful situations that go on for years. Many of us, not all of us, but many of us have those in our life. These are situations, I'll just use caregiving as an example that we can't change. We can't change other people. We can't change certain situations or resources, and we can be thinking about them chronically, problem solving, trying to wish things were different. Or we can use acceptance, radical acceptance strategies and other strategies to live well with them. And so that's a really important strategy for people who feel like their life is going to be stressful forever because of x or y. That's not true. You have a harder life, you're going to do more coping, but you can actually be dealing with uncontrollable chronic stress in ways that it's not going to take that toll on your body. I mean, I study chronic stress and how it accelerates cell aging, and I can tell you there's so much variance between people. People are so different. So among caregivers, some of them look as biologically young or younger than our controls, people with no identifiable, big, tough situation in their life.

Speaker A: I love to hear about the lack of inevitability around aging and stress. I realize that there's a big landscape of discussion around aging and stress for us to cover. But since you brought it up in one of your papers, there's a beautiful graph. And since a lot of people are listening, not watching, and we don't use visual diagrams for that reason, I'll try and explain this as best I can. You distinguish between optimal aging, typical aging, and accelerated aging. I think everyone I can imagine would want optimal aging, right? Certainly not accelerated aging. And what's interesting about this graph in your paper is that while, of course, it appears that toxic stress, chronically unmitigated stress that makes us feel like we are at the world's mercy or the other people's mercy, will accelerate aging. Turns out that underexposure to stress leads to more rapid aging than what you describe as ideal amounts of stress. In other words, that no stress is not the answer. Rather, to have some stress is ideal if you want to have so called optimal aging, can you explain a little bit about the mechanisms behind that? Maybe this is a good opportunity also to tell us about your telomere work. The questions are, how does one measure optimal versus accelerated aging? Why would it be that some stress is better than no stress when it comes to aging? Ideally.

Speaker C: So having no stress means we're not really living like, we're not engaging in the gifts of life, which are inevitably have some challenge and risk. And let me give you an example. One study took elderly people who retired, and they society kind of labels them as you're kind of done with your meaningful work in life, and you are pretty much not able to contribute to society. I mean, there's so many negative stereotypes that people then kind of embody and then live. And this program brought them to work in schools and tutor young at risk students. And what happened to them is they went from feeling maybe safe and understressed to feeling challenged, but generative. They were feeling more purpose. They were feeling like they were growing, and they were feeling like their day had more meaning. They had more relationships. They had these caring relationships with the students. The students had all sorts of issues and troubles, drugs and maybe not having lunch, poverty. And so they felt the stress of that. But they also saw how much they could help with their support and their tutoring. And in this study, they took images of the hippocampus. And those who engaged in the program, particularly the men, actually had growth of their hippocampus during this program. So at any stage in life, we can be growing and challenging ourselves, even in our much later years and growing our brain. And you know, more than anyone, like, what does that hippocampal growth mean for their wellbeing and their cognitive function?

Speaker A: Yeah, it's interesting, that hippocampus, of course, a brain area involved in formation and recall of memories, mostly formation of memories. It's super interesting because it's so plastic, it's so amenable to the addition of new memories. I think the most striking study, to me is the one, and I should point out that most of the data say that the addition of new neurons is not the main reason for improvements in memory, but it is one of them. But Rusty Gage down at the Salk Institute did a study in, I think, the early two thousands where they took terminally ill people, and these people agreed to have their bodies injected with a dye that would label new neurons. And then after they died. Their brains were processed, and they didn't die from the dye injection, by the way, folks. They died from other causes. They were terminally ill. And what they discovered was that even internally ill, or, and some of these people were quite old, those people were still generating new neurons, especially in the context of still trying to learn and acquire new information. So, of course they're dead, so they can't apply that information after that. But of course, none of us can. Right? None of the information that.

Speaker C: Why nothing up to when you die, right? Absolutely. So one other example of this, my colleague, Dave Almeida, he measures daily stressful events in huge national populations, and a small percentage of people report no stressors. And so you wonder, like, what's happening? Are they not engaging in life? Are they really not having stressors? It looks like they are. It's not just that they're not getting stressed by things, they're not. They're not really going out and doing much. What he found is that their level of memory and cognition, their cognitive health, was significantly lower. You can imagine the hippocampal, the lack of those neuroprogenitor cells, they're just not being stimulated.

Speaker A: It's super interesting. I wasn't aware of that result, so I appreciate you sharing it. I almost have to wonder if it's like exercise, where so many people, I think now everybody hopefully understands that exercise is going to lower blood pressure, reduce resting heart rate, improve musculoskeletal function and bone density, all that stuff. But that if you took a snapshot of the bodily response during exercise, blood pressure is way, way up, heart rate is way, way up, stress hormones are way up, cortisol is through the roof during a hard workout immediately afterwards. And yet that sets in motion a series of adaptations that brings you to a better place most of the time. I almost wonder if stress is the same. Is there any evidence that short bouts of stress, provided that they're managed well, meaning that we don't spend the next 24, 48 hours ruminating on the stressor, but that we're able to move through the stressor and resolve it in some way that that's actually beneficial for us because of the mobilization of energy stores and maybe, maybe even changing our threshold for reacting to stressors in the future?

Speaker C: It's a great question, and it's one that I have been chewing on for a while, because we know, as you said, that physical stressors, when they're short and repeated, like high intensity interval training, they are promoting not just aerobic fitness, but stress fitness. People feel less rumination, less depression, less anxiety. So they're kind of tuning up the nervous system. What about psychological stressors? And we know two things. So one is, I do think that there is a level of engagement with moderate stressors, that when we are used to them, we get fit and our stress resilience builds, meaning we're less threatened by them. So let me go deep into that. Two people can approach the exact same stressor, and one person is having a pretty overreactive stress response where they basically are feeling their survival is threatened. So it's high cortisol, high vasoconstriction, and blood pressure goes up equally in both. But the person who's feeling super threatened, either their survival or their social survival, their ego, their blood pressure went up because of the vasoconstriction. The other person who is viewing the same stressor as I can do this. This is a great challenge and opportunity. I have what it takes. Those types of thoughts generate a different hemodynamic response, which is actually more cardiac output, blood pressure is going up, but in this healthier way, more oxygenation to the brain, better problem solving, they're able to maintain this positive outlook. We've measured this threat challenge response in many lab studies, and we know lots of things. If you're having more of the challenge response at the end of it, you're less inflamed. So just in the lab, within an hour or two, we see that they didn't trigger all that pro inflammatory response, and their telomeres tend to be longer, which is a measure we can talk more about. But basically it looks like they have a slower speed of aging.

Speaker A: That is super interesting. You call this a stress challenge response.

Speaker C: So we could call this kind of a, to be really simplistic, two types of psychological stress response. Feeling threatened like you're going to fail, you're embarrassed. You know, that social pain response we know, well, that feels terrible, but that also that huge stress response, when we, you know, we feel it in our stomach, our heart is pounding. It's just an over exaggerated response. That response biologically is different, and the thoughts that go with it are different, and we recover a lot slower. And then there's the challenge response, which is this. It's more of that kind of activated excited response. And the beauty is that there are lots of studies out there done by emotions and social psychologists that tilt people toward the challenge response. We can actually promote that challenge response. And so when you asked about, like, is it good to have a repeated stress response? Yes, if it's manageable, right then we're kind of building the muscle of stress resilience.

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Speaker A: What are the sorts of things that people I can do in order, including me, I should say can do in order to wage that challenge response? Is this purely based on mindset? Like, instead of saying, why me? Why this, why now? I can't believe this is happening. Is it a mental pivot to, okay, this is a great opportunity for growth? I don't know how I'm gonna manage this, but I'll manage this. You know, you wanna stop me, you gotta kill me type of, type of mindset is that the switch that then the body follows? Cause this is an interesting instance where the most, all the stress mitigation work that my lab does is focus on using the body to control the mind. But here we're talking about the mind controlling the body first and then the body following suit, which I find equally fascinating. So are there some specific mental scripts that people follow, and are we all able to follow those scripts?

Speaker C: Yes, to some extent we control the script. We can use that script to prepare ourselves going into a stressful situation. And we can use it at any point during the stressor. So some of us are just wired to have a big threat response, period. Maybe it's, you know, it's epigenetics we've inherited. Maybe it's early trauma that has shaped us to be, have this exaggerated emotional response. And yes, we and others have found that trauma sensitizes our emotional stress response so that we are feeling more threatened. But that's okay, because that's the part we can't control. And we just have to have a lot of self compassion and awareness that this is what I do. My body reacts like this. But what happens next? That's when we can start to use those statements. Self comforting, self compassion, distancing. There's all sorts of statements that allow us to then recover more quickly.

Speaker A: So when we want to shift from a threatened response to a kind of challenge response, are there any data that dictate whether or not we should keep those statements in our head, write them down, say them out loud? I guess what I'm trying to do here is trying to get to a little bit more of the meat of the actionable, since a lot of our listeners, I think, will be, as I am, very excited about the idea that a mere shift in our mentality about stress can give us the opposite outcome. Before, you were talking about vasoconstriction and inflammation and all these bad things to put it lightly. And then in the challenge response to stress, getting the exact opposite, more vasodilation, more resources used, and more positive effects on the brain and body. So what are some, if you can recall from the papers. If not, that's fine. But I'm just curious what those specific tools might be.

Speaker C: Every statement you said, Andrew is good. It's a good one. The whole trick here is that people need to find the strength statements, the stress shields, I call them, that fit them, that feels right, and that they believe. And so I list a bunch of options in chapter three, which is called be the lion instead of the gazelle. So the lion and gazelle are both high blood pressure, high stress, and the lion's chasing the gazelle. But the gazelle's having this total threat vasoconstriction response because she might die. Lion might get dinner, right? So it's needing to mount the stress response because it's so excited to get the tasty dinner for the next few days. And so the lion is having that challenge response, and so we can remind ourselves, be the lion. It's not that we're always lion or gazelle. We get to shape that. And so some of those statements are, well, let's say right when we're going into it. List your resources. Why have you ever dealt with any situation like this? Remind yourself of past successes. Remind yourself of someone you can call or text or feel supported by. Remind yourself that this outcome is not going to affect your life in ten years or five years. That's a distancing kind of perspective taking. So there's all these strategies, and you got to use what works for you, telling yourself, I got this, I can do it, I can get through through it. I have what it takes. Those are all good shields. And another set is some of us feel really stressed out by stress. Once we feel our heart racing, that leads to, oh, no, this is bad for me. And so rather than getting stressed by stress, we actually want to remind ourselves that this stress response is empowering. This is going to help me cope. My body is excited. My body is doing just what it should right now. So that reframing. In studies by Wendy Mendez and others, my colleagues who do this reappraisal research, they have basically trained people to view stress as positive. During the stressful situations in the lab, people do better, they perform better, they feel more positive emotion, they problem solve better, they recover more quickly. So, pretty powerful stuff.

Speaker A: Yeah, that is powerful stuff. I'm wondering if we can talk about the relationship between stress and eating. And I think that's also a great opportunity for us to talk about the opioid system. A lot of people are familiar with the so called opioid epidemic and opioid crisis. Sadly, far too many people are dying of fentanyl overdoses. And we all know about the oxygen epidemic and all these people addicted to opioids. And that's not really what this is about. What we're about to talk about is the fact that we have an opioid system within us, that is, neurons and other cell types that can reduce, excuse me, can release substances into our brain and body that make us feel less pain and make us feel sedated, but at a healthy level. Right? And yet there are a lot of things besides drugs that can activate this opioid system. I think sex activates the endogenous opioid system. As far as I last read, there was a paper out recently, but also food can do it, and again, to healthy levels, provided the context is healthy, of course. What is the relationship between stress and eating and eating and the opioid system?

Speaker C: Stress and eating is an interesting one. So most people, when they feel stressed or, you know, I'm just gonna ask you, do you eat more or less when you're stressed?

Speaker A: Less, definitely. I feel like I can go two, three days without food when I'm really stressed. But I came up in a profession where, sadly for me, all nighters were part of the regular until pretty recently, a couple years ago, when I just called an end to that. And no, it wasn't just because of procrastination. It was just work overload. I can go a long period of time without eating, although I love to eat. So I do point out that I do love to eat.

Speaker C: And what does the body feel like when you're in that stress state when you're not even hungry? You're kind of shut down in your.

Speaker A: Digestion, that I have enough energy from my neural resources, from adrenaline. And generally those periods of time when I'm not hungry coincide with a hyper focus on the stressor, the deadline, whatever it is in life, that that needs tending, too. And food just doesn't appeal to me as much. It doesn't taste as good, and it's not as enticing.

Speaker C: Yeah. So we think that your type of body temperament is high, sympathetic, and so when you have a big stress response, your digestion is pretty much shut down. Like, it would be the opposite. Eating would be the opposite of what your body's telling you to do.

Speaker A: I should. I'm just going to. Forgive me for interrupting. For those of you hearing sympathetic, and we're not talking about sympathy. We're talking about the sympathetic arm of the autonomic nervous system, which is the so called fight or flight arm, as opposed to the parasympathetic. In any event, sorry to interrupt, but want to make sure that sometimes people hear sympathy and then they think, emotional sympathy. I like to think I have that too, but. Okay, so I tend to lean more towards the sympathetic, meaning more alertness, arousal on the seesaw of the autonomic nervous system.

Speaker C: And I'm a high sympathetic reactor. I lose weight when I go through, like, writing my dissertation. I looked like a skeleton at the end. But that's not what most people complain about. It's not weight loss. Most people complain about overeating or binge eating when they're emotional, when they're stressed. And so that's the more common pattern. And that looks different both in the brain and biologically. And so what it looks like is that the stress response is driving cravings and also, let's say, high insulin or an insulin resistant state. What goes along with that is tending to be overweight or have obesity, whether it's through conditioning or genetics, having that larger body with a big stress eating temperament, that is a challenge in life. And I've been, you know, I've worked with people with different eating conditions, eating disorders, binge eating. And it is a. What's hard about it is, number one, it's very common and normative to just feel like you can't feel satiated. So it's this compulsive eating tendency that stress brings you to. And so, so what it means, we measure this. It's very easy to measure. It means that people feel like they can't control their eating. They don't get full, they think about food a lot. And so stress kind of exacerbates that tendency. And that is a, you know, it's a common phenotype, like, we've studied it, and maybe 50% of people with obesity have that. Do lean people have that? Some. Not many, like less than 20%. But what they also have is this tremendous, what we call dietary strain or control over their eating. So they are able to not overeat, even though they're thinking about food a lot. So that explains that unusual body of someone who's really more still has those compulsive traits. So why does this matter? This makes it really hard to eat well, because when you're stressed, you're craving the comfort food, the high fat, high sugar, high salt, depending on your temperament. And that means with repeated bouts of stress, you're just going to be gaining weight, and particularly in the intra abdominal area. That's what we've seen. We've seen it cross sectionally, we've seen it in rat studies, in my studies, and now we've seen it in people, and many for about ten years, I studied this, and the question was, is what's happening in people? The same thing that's happening in mice. If you stress them out and you give them oreos, the mice develop binge eating, they get really compulsive and they get this terrible metabolic health profile, metabolic syndrome, where their round their belly fat basically expands like a cushion. And that's because that's this really good immediate source of energy during stress. So we're really well wired to, if our body thinks we're under chronic stress, we're going to store stress, fat or abdominal fat. So we can just mobilize that in a second. The second question we've asked is, can you reverse that with different interventions? Can you block the compulsive eating? I can tell you what we found there. But the opioid system that you mentioned is certainly involved in studies with people, lean people, and people with obesity. My colleague Rajita Sinha at Yale has basically found that when you stress them out, people with obesity are having a different reward response. And the more insulin resistant they are, the more their reward center lights up during stress.

Speaker A: And what's causal there? Like, what's the chicken? What's the egg? Because I can imagine these were people that at one time were not obese who got stressed. The opioid system reacted in a particularly potent way to food, and they were able to clamp their stress, and so then they become binge eaters in the context of stress. And that leads to insulin insensitivity.

Speaker C: Exactly.

Speaker A: I could also imagine that they were insulin insensitive. Therefore, they need to eat more in order to feel good of an increase in satiety, as we know this now, based on brain and body mechanisms. And then that set off a cascade of things leading to obesity. Not that it necessarily matters, but what's causal? Do we know if it's.

Speaker C: Oh, I think it really does matter. I think there's been a mistake of kind of confounding all obesity with food addiction and. And metabolic disease, and it's completely heterogeneous. So I think it's the developmental path that you're describing, which is that there's a tendency toward having a bigger reward response and hunger during stress. So it becomes a way of coping, a lifestyle, and that is a pathway toward obesity. And so some obese people have a dysregulated stress response, but not all of them. I mean, it really is a certain type of person. So that's why we target people with cravings in all of our intervention studies. Now we want to know who has more of the compulsive eating type because they need a different set of skills to cope with stress and to lose weight, if that's their goal.

Speaker A: There's a drug I'm sure you're familiar with, naltrexone, which can block the opioid receptor. It's used to block the opioid receptor in the context of different types of addiction. Have people tried to use naltrexone in the context of binge eating? And does it help people lose weight because it presumably reduces some of the rewarding properties of food?

Speaker C: That's one of the very few drug combinations that has been used for binge eating. So it was a combination of naltrexone and wellbutrin. And I'm not sure at this moment how much that's favored for binge eating, but certainly the early trials showed that it really does damp down on the compulsive.

Speaker A: Interesting. So is that a commonly prescribed kit of drugs now for obesity? I know there's a lot of excitement nowadays about these semaglutide analogs, because they do seem very effective in blocking hunger, especially in type two diabetics. I don't know if you're familiar with, but there's sort of all the rage, mostly because people saw the before and after photos of Elon. He had his shirt off on a boat, and there were some not so nice comments made about him. And then I. Sometime later, he was quite a bit lighter, and he announced that he had been taking one of these semaglutide agonists.

Speaker C: Yeah, I really hope that we come up with safe and effective drugs. And one thing to think about is that the challenge that we all have, particularly if we're prone to obesity, is the toxic food environment, and particularly the refined sugar. And regardless of what we're on, metformin. Metformin or one of these drugs, we override it with our diet. And really, the improved nutrition is the only way to solve it as a public health problem. I mean, the drug companies are saying everyone should be, you know, everyone with a certain BMI should be on one of these new drugs, and it's just rubbish, and it's not going to lead to long term health.

Speaker A: Well, I know you have a colleague there at UCSF, Doctor Robert Lustig, who's been talking about sugars and hidden sugars for years, and the problems with that. We don't want to demonize sugar as the only cause of the obesity epidemic, but it's certainly one of them. At least that's my belief, according to the data.

Speaker C: Yes. And Rob is the biggest proponent of helping people understand the big problem. And the root is in the processed food and the sugar, and that the drugs don't touch, that we override effects of any drugs with our diet. And so it's been a losing battle, really, because of the force of big food and big pharma. So let me go back to the compulsive eating. So there are some clues about how to break that cycle. So one is, in our weight loss trials or our healthy, mindful eating trials, we find that mindful eating is not going to cause a lot of weight loss, period. But the people who benefit most from learning this kind of calm self regulation, where you check in with your hunger, you slow down, you increase your awareness of your body. So interoceptive awareness, that type of skill is really critical for people with compulsive eating. And so in our trials, we find that if they, people with compulsive eating, if they get that, if they get randomized to the mindful eating, they do better in terms of their insulin resistance and their glucose and their long term weight loss. That's one good clue. Another is the positive stress pathway. Looks important for breaking the compulsive eating cycle. High intensity interval training, or maybe some of these other ways that we've been talking about to increase the bodily stress in these short term ways to metabolize stress in our body can help with the cravings.

Speaker A: So what would that look like in the context of, let's say somebody has the opposite phenotype to me, they get stressed and they find themselves reaching for snack food, or that they simply can't reach satiety. They just want to eat and eat and eat. What are some of the, aside from naltrexone and wellbutrin and some of these prescription approaches? Because I always say, while I value, certainly value prescription drugs in certain contexts, I always feel like behavior should come first do's and don'ts, then nutrition, then supplementation, and then if and only if it's still needed, prescription drugs. But that's just my bias. Based on my observation.

Speaker C: Pretty reasonable.

Speaker A: I like to think so. It also is a, it starts at a zero cost endeavor. I mean, behaviors require time, but it certainly includes everybody, not just those that have insurance or that live in a particular region of the US or the world. So anyway, that's my bias. And at least for the time being, I'm sticking with it. It's the basis of a lot of what we talk about on this podcast. But nonetheless, if somebody is finding themselves in that category of binge eating, or heading towards binge eating, or using food to comfort or alleviate stress, how should they intervene in their own thoughts and behavior?

Speaker C: We talked about the bins, top down strategies, changing the body, changing the scene. We need all of those. I mean, the compulsive drive to eat is one of our strongest impulses if we've developed that pathway. And so we train people, for example, in mindful awareness of separating out emotions from hunger, so they get really wrapped up together. So just labeling how you're feeling, labeling your hunger from one to ten, and figuring out, am I really hungry? Or is it boredom that helps people? And if you do that check in right before you eat, that helps the most so that's the top down mindful check in. The other thing we help people do is, like, ride the craving, surf the urge. So we deal a lot with soda drinkers, and it is addictive. And there is nothing worse than drinking sugared soda for our body. So we help people by having them watch their craving pass and knowing that it's a matter of time that they can surf the urge without jumping to consuming. And so that practice helps some people, especially with practice, the push ups, the taking a walk, the changing the scene, getting away from food is always going to be a huge, strong strategy if you can get yourself away from it. The problem is, as you know, is that the cravings get you to the buffet, they drive you to the soda, et cetera. And so just creating safe environments, both at home and in the workplace where you don't have soda, is really important. So we tried that at UCSF, my colleagues and I, including Rob Lustig, the anti sugar doctor, we just saw the absurdity of being a medical center. People come with these chronic diseases, and what are they served in the cafeteria or even at their bedside?

Speaker A: Sugared coke in the hospital.

Speaker C: In the hospital. And so my colleague Laura Schmidt, who's partly responsible for the soda tax, she rallied the all the we went top down to administration, but bottom up to vendors, got rid of all the soda in all of our hospitals and campuses. And we found two things. Number one, people who were heavy drinkers lost weight in the most important place.

Speaker A: Their waste heavy soda drinkers.

Speaker C: So when we took it out of the workplace, they actually their health improved. And number two, those with compulsive eating, they score high on our little scale for reward based drive. It didn't help them. So then we randomized half of them to get some extra boost. We call it motivational interviewing where we're really supporting them more and helping them think of goals like being with their grandchildren, not getting diabetes. And that little bit of support helped them tremendously. And so now we're trying to roll that out in a big controlled trial. At least 100 hospitals have adopted the stop selling sugary drinks because people don't want to be sick, but they can't help it if they have the reward drive and if they have the compulsivity, and it's right there at work, we're just working against health.

Speaker A: That's super interesting. I think that for most of us, we think about soda as the kind of thing that maybe we have every once in a while, or that we drank more when we were kids. I seem to have lost my appetite for soda.

Speaker C: Some point, you just know too much.

Speaker A: Teen years, maybe, or just at some point, I started to feel like there were better alternatives and, you know.

Speaker C: Like what? Well, okay, well, people want ideas.

Speaker B: Yeah, well, full confession.

Speaker A: I mean, okay. Most of my non water beverage consumption is going to be either coffee, usually black coffee, or nowadays, I sometimes will throw some ketones in there, not because I'm on a ketogenic diet, but for I do feel like it makes my level of focus and cognition pouring in this morning. Yeah, I do use it before podcasts, and we're prepping for podcasts. There are good data showing that we can all utilize ketones as a brain fuel, even if we're not on ketogenic diet. That's clear to me, based on my experience and the data as I see them and understand them. Or yerba mate tea, which is just a caffeinated tea from South America, which I like very much. However, I am guilty of drinking the occasional diet soda every once in a while, and I know that some of my audience will just gasp, how could I do that? But we're talking about the occasional Diet Coke.

Speaker C: Diet soda.

Speaker A: The occasional Diet Coke, mostly because I don't like the taste of sugary soda, and I actually really like the taste of diet soda. Aspartame is a particularly rewarding taste for me. Um, and as a consequence, I try and avoid drinking it more than I might have a can of Diet Coke once a month maximum, usually on a plane or something like that. So that's the extent of it. But if I have the choice between a really great coffee and a soda, it's going to be coffee or yerba mate and a soda, it's gonna be yerba mate, um, or food and soda. I'm gonna eat instead. And so that's me. But I do recall, you know, as a teenager, soda was kind of a default. You just kind of, like, go to the soda fountain and fill the drink. It felt like such a rewarding thing. And I think the reason we're drilling into this more deeply is it sounds to me, based on what you said earlier in my read of the literature, also brings me the idea that drinking sugar in the form of liquid is one of the worst things that we can do in terms of our bodily regulation of insulin and glucose. It's. I don't want to use the words empty calories, because that's kind of a loaded phrase, but it is essentially empty calories. It doesn't.

Speaker C: Well, it's harmful calories. They're not empty.

Speaker A: Yeah, I mean, there are no amino acids in there, there are no essential fatty acids, and there aren't many carbohydrates that you can really utilize for, um, long term bouts of mental or physical work. So. So what do you view soda as one of the, um, the worst, certainly not the best, but one of the worst culprits out there. I mean, it is really prominent, especially nowadays. Also, we should include energy drinks. A lot of kids, especially males, by the way. It's, it's almost, this is crazy. It's almost 95% of energy drink consumption is males.

Speaker C: Interesting.

Speaker A: And I don't know what is. Maybe it's the packaging or how the marketing has been pitched, but by the way, as soon as I say that, someone will be in the YouTube comments telling me that that's completely false, but we can point you to the data. So what are your thoughts on sugary drinks and what that's doing? Do you think this is a reaction to how much stress people are experiencing? Is this like people's attempt to, to inoculate their stress? Or is it simply that it tastes good and it's easy to consume and it's relatively inexpensive?

Speaker C: People have not, and we have not really studied the sugary drinks in the same way we have studied the comfort food and the binge eating. And so my guess is that it is part of a stress response. But even more than that, it's part of the hedonic cycle. So when you get the sugar, especially if it's packed with caffeine, that's going to be a more addictive drink. You get this really feel good response right away, and then you get the low and it's the hedonic withdrawal, which is this. You actually feel bad when it's been a while since you've had it. And so then it drives the compulsivity. You want it again because you want to, not because you want to feel good. You want to get rid of feeling badger. So that's what happens with both food addiction and we think that happens with sugary drinks. Now, let me tell you that when you asked, is a sugary drink one of the worst things we can do for our health? Yes, because sugary food doesn't go to our brain as quickly as a liquid sugar, a sugary drink. So think about cocaine and crack. Crack goes to the brain immediately and it's that much more addictive. That's how we think of liquid sugar.

Speaker A: The view on sugar, I think, is starting to change. And I think in the years to come, provided folks like you and Doctor Lustig continue to be vocal about it, which I hope you will. I think it's going to shift things quite a bit. I look at it a little bit like trans fats. When I was growing up, people ate margarine and now trans fats are banned in many cities. It's kind of incredible how these things have changed over time, and it requires an effort, not just on social media, but podcasts and I think also lobbying our politicians, really getting them to understand just how pernicious this stuff is.

Speaker C: There's a lot of social norms that go into what's good for all of us as a group or community, and what's personal choice. It's very fiery. I've heard a colleague talking about how bringing junk food or soda to work is like passive smoking. You're like, you're bringing something in that's going to pollute other people's health and you shouldn't do it. So that's much more edgy and people will fight them on that. But the basic reality is, yeah, we're going to eat the donuts if they're in front of us. And so it is much more considerate to bring a bowl of fruit.

Speaker A: I do love a good donut.

Speaker C: Oh, me too.

Speaker A: Cue to a certain circuit in my brain. I'm glad you brought up smoking. I don't want to take us off topic, but as long as we're venturing into these general, or I should say more general and yet really important themes around public health and food, I learned something interesting about smoking and why so few people now smoke. I always thought that the campaigns around smoking and how terrible it is for us, showing pictures of lungs that are caked with all this tar and cancer and all this stuff was the effective message. But what I learned was that one of the most effective messaging systems in the battle against smoking was to get young people to stop smoking, not by telling them it was bad for them, but by showing them videos of these rich men sitting around tables cackling about the fact that they're making so much money on the health problems of other people because of smoking. In other words, what they did is they made being a non smoker anti establishment. And so I find it very interesting. Anytime there's something like soda or highly processed foods that are so woven into the establishment, it seems like we can tell people until we're blue in the face about all the health concerns with these things. Sugar is bad and this is bad. Highly processed food is bad. Some people might change their behavior. But it seems like for the younger generation, the thing that's most effective is to activate their sense of rebellion. This has been true for probably hundreds of thousands of years, but it's certainly true in the last hundred years. And let them see that there is a very strong big food, sometimes big pharma, but certainly big food system that is working against them, and that in order to take control of their health, actually, we want to activate their sense of rebellion so that they're like, no, I'm going to take excellent care of myself. I'm not going to fall victim to this monetary scheme. I'm not pointing to any conspiracy. I mean, this has been seen with smoking. This has been seen with a number of different pharmaceuticals. Again, not all pharmaceuticals are bad. This is true of a number of different aspects of kind of big marketing.

Speaker C: Absolutely. It's like pull the blinders off, let people know that we're vulnerable to all the marketing and that there really are suppression of data behind a lot of it. So it's happening with eating disorders, too. Eric Stice, who's at Stanford with you, has been using this method, we call it dissonance, showing people with eating disorders how the food industry has been manipulative and has tried to design foods for addiction for the highest bang for the buck with dopamine, et cetera. And so that has helped reduce eating disorders in these studies, and it has even helped reduce reward drive. Isn't that amazing that the dissonance could do that?

Speaker A: So interesting. Yeah, I think what it's telling us is that few things are as strong as the know. I won't. I refuse to in response, in terms of changing behavior, especially when there's something to push against. So it's not just a battle with ourselves. I want the soda, but I'm not going to drink it. It becomes a well, I want it, but I want it because you are making me think I want it. I don't actually want that. So I don't know, maybe this is getting me back into my teenage mindset. But I think a sense of rebellion provided in the direction of health one's own health and the health of others, of course, can be a positive thing.

Speaker C: We do that with the mindful eating. We have them bring in the junkiest processed food they can think of, like a Twinkie, and eat that really slowly and mindfully. And few people finish it. They're like, that actually wasn't nearly as good as the picture of it and the idea of it. And so it's like that reward predictive error that you've talked about. Wherever they think the brain is driving them to have it because of the advertising and their expectation that they'll feel good. But if they're really paying attention, it's a very disappointing experience. Versus we also have people savor a piece of good chocolate, whichever they like, milk or dark. And that experience teaches them to eat slowly and really enjoy small amounts of rewarding food so that they're nothing. They don't need to feel full and binge.

Speaker A: Oh, so interesting. Dark or milk chocolate?

Speaker C: Dark. Yeah, likewise.

Speaker A: I actually like the hundred percent chocolate. There's one brand of venezuelan chocolate that's 100%, which sound. It might sound awful, but it's actually quite good. I think that was the first time I could actually taste the real elements of chocolate.

Speaker C: Interesting. Yeah. That is not rewarding. This is way too bitter for me. I need the mouthfeel, you know, give me some fat in it.

Speaker A: Oh, my. Well, yeah, it's hard to find, but it's out there. So while we're talking about stress eating, obesity, and here, we've also broadened the discussion to include different generations. We're talking about teens and adults. I'd love for you to share with us your findings around this study that you did of pregnant women and how stress and pregnancy and different patterns of eating and physiological changes that people experience during pregnancy. Could you share with us what those findings were? Because I think those are relevant not just to people who are pregnant or planning to become pregnant, but to everybody, because I think they shed light on how we manage stress and sometimes how we fail to manage stress.

Speaker C: Yeah. So with overweight and obesity, we know we can't just change calories. It's just not going to work. The next stressful event is going to come along and people will go back to what their brain is driving them to do, is to binge on comfort food. And so we've done these interventions with men and women that show that we can help them regulate using some of these mindful eating strategies. Checking in. We wanted to do this with pregnant women because when you have excess weight and you're pregnant, you're really vulnerable to gaining excessive weight during pregnancy, which is not healthy for the mom or the offspring. So we did this study. It took us probably ten years total to get the grant and recruit groups of ten women who are pregnant in the same stage and give them this training in mindful eating, mindful nutrition, stress reduction. And then my colleague Nikki Bush has been following the babies for. I think it's been almost ten years since then. And here's what we found. First of all, we couldn't stop excess weight gain. The women in the control group gained, about 60% of them gained excess weight during pregnancy. And same with our mindful group. So maybe it's the end of story. You'd stop there and say, it fails, don't do it. There have been so many beautiful developments in the women who got the training that we just keep. Are being shocked by how impactful this stress reduction training was. It was just two months of their life. But pregnancy is a very critical period when these women were changing their habits and they were very motivated to help their baby. So here's what we found. Within that first month of the intervention, they all got this oral glucose tolerance test. So they got a blood test to see how well their body was metabolizing food sugar. And so it's like a pre diabetes test. And what we found was that twice as many women in the no treatment control group had impaired glucose tolerance during pregnancy. It's a common high risk. And half that many women had this in the mindfulness group. So by reducing stress, they improved their insulin sensitivity during pregnancy. So imagine what that's doing to the baby, too. Then the babies have come out with less obesity, less illnesses in their first year of life, and more of this kind of healthy stress response when they've been stressed out in the lab study. And so then eight years later, we looked at the mental health of the mom right after the intervention, eight weeks later, everyone in our mindfulness stress direction group felt great. They felt less depressed, they had less stress and less anxiety. That's what you'd expect, right? I mean, they'd just gone to a weekly class. They got all the support, but eight years later, they still showed improved mental health. Every year that we measured them, they still looked better. So it's probably one of the longest studies looking at long term effects of a mindfulness training. And I don't think it was a coincidence that was during pregnancy. I think this is a very important time to have these skills. And being in a group adds that social support piece that we know is powerful.

Speaker A: It's an incredible result. Could you share with us what the mindfulness intervention was and when it was initiated, when it was stopped? So we're talking about ten minutes a day of meditation, as many details as you can possibly give us, because I know, even though I don't think I'll ever be pregnant, I don't plan on it.

Speaker C: You never know.

Speaker A: Well, yeah. High zero, minus one probability. In my mind. But anyway, maybe other people have other ideas for me, but zero minus one.

Speaker B: Probability in my mind.

Speaker A: And yet I'm very interested in this mindfulness intervention because it sounds like a very potent one, so much so that it's having a multi generational impact. So how many minutes a day? How many days per week?

Speaker C: We had them. They met once a week. They had little reminder cards. I mean, we need all the reminders we can, you know, post its on the fridge, timers in our phone to do this mindful check in. And so they were during the week doing this check in, and it was simply a mindful check in, closing their eyes and feeling their body, feeling their labeling their emotions. So it was mindful breathing, and then it was some movement, and we taught them prenatal yoga. But really, any mind body movement, people like different things. There's qigong, there's even just slow walking would have worked. So it was mindful check in. Breathe. Move my body. That's what the reminder card said. So close your eyes and look inside. Do slow breathing. They also put their hands on their belly, and so they felt that they were taking care of their baby, and then more movement. So they did increase their walking. And the mindful check ins are, as we were talking about at the very beginning, I would say necessary, but not sufficient. We've got to stop during the day and check in and look inside. If we're not aware of where our mind is, we are just subject to the believing the stressful thoughts, thinking that we need to keep ruminating. They're sticky thoughts. The mindful check in is really important. And then I think the breathing, as we've talked about, is probably the more direct way that they're influencing the prenatal environment, the uterine environment, to reduce the stress that the baby's being exposed to. And the movement refocuses us from our mind and our ruminative thoughts to the experiences, to what we feel in the body. There's even been a study that showed that overweight people with a lot of cravings, if they do the body scan, that's simply focusing on the body from the head to the toe, you know, just reminding ourselves to focus on each part of the body, breathe into it, release tension. Very basic and simple. The body scan significantly reduced cravings. I mean, to me, that's really hard to reduce cravings. So, like, just that refocusing on the body took away stress, anxiety, self referential thoughts, that kind of our favorite topic. Thinking about ourself, thinking negative thoughts about ourself. To relaxing, feeling, ease, feeling well, being.

Speaker A: I can't help but ask about what that body scan might have been doing at a little bit more of a mechanistic level. Some of the listeners might be familiar with these terms, but some won't. So I'll just briefly define them. We can perceive things in terms of exteroception or basically paying attention to and focusing on things beyond the confines of our skin or interoception. I realize, you know, all this, but.

Speaker C: For their sake, no one really understands interoception. Go for it.

Speaker A: So an interoception, essentially the sensory. The sensory innervation of the. Of the internal organs of our own skin. That includes proprioception, which is our knowledge or our sense of where our limbs are, where we are relative to gravity, all that stuff. And it raises this body scan result. That is, the fact that a brief body scan can reduce cravings raises this question in my mind. Which is craving a heightened sense of interoception or heightened sense of exteroception? I could think of one form of craving where, for instance, the donut, again, donuts for me, is in front of me, and I'm thinking that I want that. And so I'm almost in complete extraoception, but I'm tethered to it, like my internal world is tethered to the doughnut. It's almost like the doughnut is in control of me briefly, and then I eat it.

Speaker C: But it's hijacked your prefrontal cortex.

Speaker A: It's hijacked everything. Yeah. And then if I do a body scan. So I'm putting myself in this experiment in a kind of hypothetical scenario, I'm putting myself into this experiment. I do a body scan, which, without question, is shifting me more towards interoception. I'm focusing on my skin, my heart rate, all these things, interoception. So I could see how that would draw my attention off of the external stimulus and reduce craving. And that makes me wonder whether or not craving is a form of extroception, where our interoception is just exquisitely locked to extroception. And if so, because I do think this is a remarkable result, it is very hard to stop cravings. I mean, we had a guest on here, a former colleague of mine at Stanford, who's now the chair of neurosurgery at UPenn School of Medicine, which is Casey Halpern. I mean, they literally drill down through the skull of people who have binge eating disorder and start stimulating different brain areas, because these people are so out of control in terms of their binge eating. I mean, that's the kind of intervention that is considered necessary for a lot of folks who binge eat. So here you're telling me a body scan in some individuals can reduce that, and I have to wonder whether or not it's somehow breaking that extraoceptive tether. Anyway, I'm speculating here, but I'd love your thoughts on craving and binging and breaking binging. Do you think that there are behavioral interventions that could be layered on top of body scans? Should we all be doing body scans routinely?