In this episode of the Art of Manliness podcast, Dr. Maud Mutus Teroni discusses the difference between acute stress and chronic stress and why acute stress can actually be good for you, while chronic stress can change your brain so you get more stressed out when you experience stress. We discuss how both cortisol and inflammation can be improved in the right amounts and how to deal with chronic stress, and how making time for hobbies can prevent you falling into the stress trap.
00:00:00.000brett mckay here and welcome to another edition of the art of manliness podcast oftentimes our
00:00:12.060ancient brains don't seem well equipped to deal with the speed and complexities of modernity
00:00:16.040the landscape lombards us with perceived threats and problems and we have trouble not ruminating
00:00:19.960on them to navigate this environment while maintaining our composure and sanity we need
00:00:23.720to strengthen our resistance to stress my guest today has written a guidebook on how that's done
00:00:27.700her name is dr mutus teroni and she's a medical doctor who also holds a phd in neuro ophthalmology
00:00:32.740as well as the author of the book stress proof scientific solution to protect your brain and
00:00:36.960body and be more resilient every day today on the show we discuss the difference between acute stress
00:00:41.780and chronic stress and why acute stress can actually be good for you while chronic stress can change
00:00:46.340your brain so you get more stressed out when you experience stress we discuss how both cortisol
00:00:50.440and inflammation can actually be beneficial in the right amounts and how to get them in the right
00:00:54.160doses including the particular type of exercise that will best help you recover from stress and
00:00:58.240the role diet and even tetris yes tetris the game you played on gameboy when you were a kid can help
00:01:02.680manage it we end our conversation discussing how making time for hobbies can prevent you falling
00:01:06.760into the stress trap after the show's over check out our show notes at aom.is stress proof me too
00:01:12.640joins me now via clear cast dot io dr mutus teroni welcome to the show thank you so much for having
00:01:30.180me it's a huge honor to be here so you recently published a book called stress proof it's all about
00:01:35.500managing stress or dealing with stress which is something a lot of people say they got problems
00:01:40.260with these days i'm curious how did you get started down the path of researching and writing about
00:01:45.440stress so there was one big catalyst for my book which was i moved from well i moved countries and
00:01:52.880continents from london to hong kong and i was suddenly surrounded by lots of people amongst whom my husband
00:01:59.920was one who were in very high octane jobs under a lot of pressure and really suffering from the prequel
00:02:08.240to burnout so suffering from stress and given my background as a physician and in neuroscience they
00:02:15.300asked me for advice and despite all i knew i realized i actually knew very little about stress
00:02:23.100i knew very little about what the difference is between good stress and bad stress why stress causes
00:02:28.220harm and what you can do about it so i decided to sit down and go through i had a little bit of time
00:02:34.100so i went through every single paper i could find catalogued in the national library of medicine of
00:02:39.780the united states and i went through about a thousand and i condensed them to just under 600
00:02:46.160and i kind of created a manual that i could just give to to friends to colleagues and i got some good
00:02:52.760feedback from it and that turned into a book so that's how the book appeared so let's talk about
00:02:59.100how so a lot of people are experiencing stress these days what's the typical approach that people take
00:03:04.920when it comes to stress so the typical approach that people take is is usually based on the first
00:03:11.820problem which is that people don't realize where the stress is coming from and people don't realize
00:03:19.760that stress is actually present so for instance most of us recognize stress as the billboard image of
00:03:26.700stress as someone the face of someone who's under a lot of visible emotional pressure but in fact
00:03:32.560chronic stress is much more insidious and much more long-term and acts slowly and it's much more
00:03:38.860difficult to to recognize and more importantly to recognize its source so people tend to resort to
00:03:47.100fixes that they assume will work for them because it's worked for everyone else so there are lots of
00:03:52.960one-size-fits-all approaches and once they try these approaches it becomes apparent that a one-size-fits-all
00:04:00.760doesn't work and i think that that's that's the second problem so the first is recognizing where the
00:04:06.840stress is actually coming from and the fact that it's chronic stress and secondly it's recognizing the
00:04:12.920fact that one person's source of stress is going to be very different to another person so what works
00:04:19.320for person b will not work for person a we'll delve deeper into that so what is the difference between
00:04:25.060acute stress and chronic stress so we all know so i've i've heard some of your brilliant podcast episodes
00:04:33.500before like you i'm a huge admirer of stoic philosophy where a little bit of acute stress or a little bit
00:04:40.120of pressure actually does us good so i was always familiar with that when i entered into my research
00:04:45.820into stress and the the real gray line that is now starting to become clearer is where the distinction
00:04:55.320actually lies between stress being good in short bouts and stress turning bad or causing damage in
00:05:03.160longer bouts so if you just imagine first of all it's taking a step back of what stress actually is
00:05:10.160what actually causes stress and in order to understand that i suggest going right back to
00:05:16.480the research of hans selia who was who's considered the kind of the godfather of stress so back in the
00:05:22.7401930s he was the first one to show that stress actually causes physiological effects measurable effects
00:05:29.260on the body and he first defined stress as and in calling it the general adaptation syndrome
00:05:36.480if we fast forward the past almost you know 80 years or so we've now come to a place where more
00:05:44.580information about about how the brain works is converging on the idea that the brain is constantly
00:05:51.800trying it the brain is in essence a prediction machine and it's trying to create a model of the
00:05:59.260universe and it's trying to use bayesian confirmations so it's trying to create the model
00:06:05.480create a hypothesis make a prediction and then confirm that its prediction is true so it's trying
00:06:11.100to constantly predict the universe the environment around us and update its model with every single
00:06:18.140moment of passing time the brain encounters change when it encounters change it has to update its
00:06:26.980calibration or change it will modify its calibration process but in order to be able to do that
00:06:33.500efficiently it needs to know what's about to happen next so one of the triggers of stress is not
00:06:41.020knowing what's about to happen next and so uncertainty as we all know is one of the most potent triggers
00:06:48.280of stress and uncertainty according to some theories lies pretty much behind that it forms the foundation
00:06:56.480of the acute stress response because the stress response is in essence a default kind of a recalibration
00:07:04.840response to cover all bases in the face of uncertainty now that's what acute stress is and we've been
00:07:12.920used to acute stress for years and years our ancestors had it it does us good and we know that for instance in
00:07:19.400acute stress there are certain processes that happen which are actually very beneficial for instance we know
00:07:26.880that neuronal plasticity synaptic plasticity is temporarily increased during acute stress we know
00:07:35.940that during acute stress the brain instigates a mechanism which allows the body to survive no matter what
00:07:44.740the organism so us whatever we face in chronic stress these processes stay turned on because
00:07:53.220one of the ideas that one of the theories is because the brain assumes that the uncertainty it faces
00:07:58.980isn't over and that's one good way of looking at it so any uncertainty that the brain is facing
00:08:04.760remains any threat that the brain is perceiving remains and as a result the stress response stays
00:08:13.000switched on or there is insufficient recovery from a previous stress response when this happens the
00:08:20.220processes that the brain kickstarts during an acute stress response stay turned on and they start going
00:08:27.240awry and that is the distinction between acute and chronic stress so for instance as soon as you
00:08:34.660become acutely stressed motivation rises but in acute in chronic stress we find in both
00:08:42.180human and animal studies that chronic stress relates to a decline in motivation so that pathway goes awry
00:08:50.860acute stress increases plasticity in certain parts of the brain but we know that the effect of
00:08:57.500glucocorticoids or the stress hormones that our body produces becomes different and the difference is
00:09:04.660dose dependent so it becomes different depending on how long it's that the glucocorticoids that the stress
00:09:10.960hormones are produced for and how long they hang around for and how much the stress hormones are
00:09:17.680produced so all of these things change the the same processes that are started in acute stress
00:09:24.260when they become chronic and when they become chronic they start causing harm that was very useful and i'd
00:09:30.940like to delve deeper and more into that what how our brain changes so you you have sections of the book
00:09:35.780where you thoroughly explain like what happens to the brain for example when you experience acute stress
00:09:41.440but then how the brain changes once you experience chronic stress and how those changes in the brain
00:09:49.360can actually increase the chances you'll become more stressed out whenever you experience stress
00:09:55.180again so what parts of our brain changes whenever we experience chronic stress that makes us less resilient
00:10:02.740to stress so one way of thinking about it is stress is not a disease process stress is a state of the brain
00:10:12.500and that's really important distinction because the brain is constantly adapting to whatever is asked of it
00:10:19.580and when the brain faces acute stress it goes into a certain functional configuration so for instance
00:10:28.660your alertness your alertness your arousal is increased your emotional volatility is increased your ability to focus
00:10:37.620on one single thing generally is reduced you become more attentive to everything so these are things that are
00:10:46.020the temporary changes associated with acute stress now because the brain is so plastic and it's so intelligent
00:10:53.140that that intelligence has allowed us to survive until today the plasticity allows the brain to change itself for maximal efficiency
00:11:02.020so if it is constantly in an environment where it needs to remain hypervigilant or it's constantly in an environment
00:11:10.720where its need for attentional focus diminishes the brain almost changes its structure to compensate for that need
00:11:19.540now for a long time most of these studies really came from animal observations because we couldn't look
00:11:26.340well enough into the human brain but actually for the first time in history
00:11:31.140a study published on the Karolinska institute in january 2017
00:11:36.100so just two years ago just over two years ago
00:11:39.060showed that chronic work work stress exposure so occupational stress exposure
00:11:46.900actually causes thinning in parts of the prefrontal cortex which is the part at the front of the brain
00:11:53.220it caused in that particular study caused an increase in volume in parts of the amygdala
00:12:00.020and it caused a decline in volume in a part called the chordate nucleus
00:12:04.180so in this study the researchers took a bunch of people who were exposed to occupational stress
00:12:09.620compared them to controls and that's what they found
00:12:12.020so you can argue that okay that's just an association that's just a parallel change or
00:12:17.780that might be coincidental the researchers then took these same individuals with these you know this
00:12:24.420visible thinning and enlargement and volume in these distinct places and they put these individuals
00:12:30.420through three months of stress management therapy which included cognitive behavioral therapy but did not
00:12:38.900involve any medications and then they measured they looked at their brains again and they found that
00:12:44.500this thinning in the prefrontal cortex parts of the prefrontal cortex was reversed in these individuals
00:12:50.420so that was the first time in history that researchers showed that any thinning or any structural
00:12:58.420changes which were more present in people with stress were reversed when the stress was removed when these
00:13:05.620people were given relief from stress and so that was the first you know an enormous step forward in
00:13:12.420showing that stress isn't just a formless psychological state of mind it actually has implications and these
00:13:20.660implications act on the brain but i think what's important is we cannot say that the stressed that that
00:13:27.300that these you know these this patterns of change in the stressed brain were necessarily pathological or
00:13:34.020were necessarily harmful you could argue that they were as i just mentioned adaptive changes
00:13:40.820so if you place the brain in a chronically stressed environment the parts of the brain that are used more in effect
00:13:49.540become show show change and the parts of the brain that are used less also show
00:13:54.740change so that's kind of what's happening when you when we see plastic changes in the brain in response to chronic stress
00:14:02.020but the problem with those changes it is adaptive but in a way it's maladaptive because that prefrontal cortex
00:14:08.020comes in handy for solving problems right so if you're that's if that's diminished it makes it harder to solve
00:14:14.900the problem that might be causing you chronic stress that's absolutely right so the the important thing is
00:14:22.420is the context of these changes so in a day-to-day in a in a healthy environment that we live in today these changes so shrinkage of the prefrontal cortex
00:14:34.420can indeed suggest that there is diminished prefrontal activity and we need the prefrontal cortex for as you say these higher mental functions
00:14:44.100and to support what you just said a second study more recent studies showed that even in people who are not stressed who are not complaining of stress
00:14:53.620around young to middle age young men and women have been shown in one study to have thinning in the prefrontal cortex
00:15:03.380which was associated with higher levels of circulating cortisol the stress hormone
00:15:10.820and this thinning was associated with poorer working memory even at the a young and middle age when these people did not complain of stress
00:15:20.600and did not complain of memory disorders well the other kind of nefarious thing about stress in the modern age is
00:15:28.580okay i think we all understand that you know when you exercise or lift weights or run you experience stress
00:15:34.920or if you see something dangerous happening you experience stress and you you can see how
00:15:40.580having that stress response would be useful in a situation where say there's an accident and a car accident
00:15:47.620you know stress hormones kick in and helps you deal with the situation the problem with a lot of stress today
00:15:54.020is that uncertainty that's in our brain and it's like we're just sort of kind of coming up with it in our head
00:15:59.960right it's like you're at work and there's nothing really like physically stressful happening to you
00:16:04.820there's no you know barking there's no lions chasing you at the office hopefully but it's this more cognitive type of stress
00:16:12.900like you're just imagining bad things happening to you so it's like the brain is actually our because we're so good
00:16:20.100at thinking about the future and coming with different situations like we actually we're too smart for our own good
00:16:26.100in a way that's right and actually one of the biggest advances in stress and and what the you know what
00:16:34.660the most recent data shows is that perceived stress is the primary driver of chronic stress
00:16:41.820so and perceived stress depends on your own perception and your own perception is going to be
00:16:49.820different from the perception of someone else so the perception of the world around you the perception
00:16:56.700of a stress as of a stressor as being a stressor the perception of whether or not you can cope
00:17:03.540with a certain stressor all depends on how on on the mechanisms and on the patterns of thought and
00:17:12.100patterns of behavior and patterns of reaction that your own brain carries out so it is possible to
00:17:19.160modulate the perception of stress and we're finding that certain soft factors which are almost surprising
00:17:28.420in a way can actually modulate the perception of stress and reduce the chronic stress burden so one
00:17:34.020example which i absolutely love which i quote in my book is we base that you know we just talked about
00:17:40.200how the brain creates a model of the world from the cues it's receiving in the environment around it
00:17:45.560and this model of the world forms the basis for whether or not the brain gauges the presence of
00:17:52.940uncertainty now different people will form a different model of reality of the same reality and the reason
00:18:01.060why this difference exists is because different people attend to different cues as william james famously
00:18:08.640said my experience is what i choose to attend to so everyone's experience is different and hence the stress
00:18:16.600triggers and the stress interpretations will be different in each case so this example that i quote in my book
00:18:24.980is the following if you have a stress reaction to anything a psychological stress reaction say an
00:18:32.120argument with your with a colleague with a loved one an altercation with your boss your perception of
00:18:37.860that stress reaction will not correspond to reality and one of the most intriguing things that
00:18:46.260recent stress research has revealed is this extraordinary relationship between rumination and
00:18:55.260chronic stress so going back to the scene where you're having an altercation with your boss so you
00:19:03.280enter the office and just say on a monday morning at 10 o'clock you enter your boss's office and you get
00:19:09.860three minutes of criticism you have an altercation your boss shouts at you for three minutes
00:19:16.020at the end of those three minutes you open the door and you leave the room now your boss knows
00:19:22.800your stressful experience has only lasted three minutes and it's over you know you've left the
00:19:28.960room and your stressful experience is over but does the brain know does your brain know that your
00:19:34.880stressful experience is over your brain is using cues to create an image of reality so if after the
00:19:43.420stressful experience your brain replace the scene repeatedly as you leave the room as you close the
00:19:50.360door as you return to your desk your brain perceives that the experience is still going on so it's all your
00:19:57.960memory of the event is almost acting like an internal cue to distort your perception of reality and make
00:20:05.980that perception of stress last longer so if you have five such episodes of stress triggered by not just
00:20:15.340an altercation with your boss but just say you know getting stuck in traffic or a miscommunication with
00:20:21.160a friend or an argument misunderstanding with a stranger if you have five such episodes during the day
00:20:27.140and you ruminate after each one you will perceive let's just say you ruminate for 45 minutes or an hour
00:20:35.380in your head that stressful experience has suddenly expanded in size when you come home at the end of
00:20:43.480the day rather than having had just 15 minutes of stress you may well imagine your brain may well
00:20:50.040perceive that it has had five hours of stress during the day and this habit of dwelling on something
00:20:57.400is a very interesting one because it has such a simple solution so the moment you you're out of a
00:21:05.240stressful situation if you do something as simple as distracting yourself so completely that your mind
00:21:11.700doesn't wander so ideally in an immersive activity that alone will rapidly bring down your stress response
00:21:19.180and treating rumination has been shown to treat had to reduce a high blood pressure in people suffering
00:21:26.820from chronic stress induced hypertension so that's how powerful this tiny little habit shift is
00:21:32.800and it's even more powerful because it shows you that at times of stress you can't tell your mind what
00:21:40.080to think but you can tell it what to do so manipulating your thoughts through your behavior changes your
00:21:47.260perception of the environment and hence can impact your chronic stress burden all right there's a lot
00:21:53.140to unpack there all right but for now let's talk about some of the seven stress agents you highlight
00:21:57.520in your book the first one you talk about is that our brain goes on emotional high alert when we get
00:22:02.820stressed and that can cause us to overreact to things and make the problem worse so what are some
00:22:07.300things that we can do some research back tactics to mitigate that state of emotional sensitivity
00:22:12.140we experience whenever we get stressed so i talk about the seven agents of stress as you as you say
00:22:18.480and the seven agents of stress are really the seven things that the brain seven processes that the brain
00:22:24.260kicks off as soon as we become acutely stressed and there are actually more than seven but these seven
00:22:31.500have been mostly most studied so my first one is generalized arousal including emotional reactivity
00:22:39.680and emotional reactivity is a very interesting very interesting element of stress because as soon as we
00:22:47.060become acutely stressed we become emotionally reactive but at the same time an inability to regulate
00:22:54.680emotions increases our vulnerability to stress and the trick is here to we know about it as emotional
00:23:03.520intelligence but the trick is here to kind of play with attention regulation self-control self-regulation
00:23:11.440to regulate your emotions so what do i mean by that so in a good healthy functional brain in a good you
00:23:18.920know healthy person living a nice balanced life you're and i'm being very generic here but you're you're
00:23:27.260usually engaged in what we call goal directed activity which means your prefrontal cortex
00:23:33.260guides kind of coordinates the rest of your brain like an orchestra like a conductor coordinating an
00:23:39.440orchestra and guides your brain towards a goal that you have chosen and when your prefrontal cortex is in
00:23:49.740that goal directed mode different parts of your brain different departments of your brain are up
00:23:55.320regulated and different departments of your brain are down regulated and in order to achieve that goal
00:24:01.720and to carry your brain towards that goal your prefrontal cortex does what is called self-regulation
00:24:09.500or rather you carry out self-regulation self-regulation basically means coordinating your brain to serve the
00:24:17.560goal and it has elements of self-control because when you're you know if you are writing an article
00:24:24.420writing a piece for a deadline any distraction is bad so every time you have loud noise behind you
00:24:31.620or you're tempted to go for a walk or to just go out and get you know do something that's anything
00:24:37.760that's better than writing whatever you're writing those those temptations those distractions are muted
00:24:44.460by a prefrontal cortex when it is carrying out good self-regulation and if you have better self-control
00:24:52.400you will also resist those temptations more similarly when you are working towards a goal
00:24:59.660your emotions need to be regulated you don't want to pay heed to any emotions that are not relevant to
00:25:07.440you or don't serve your purpose at that moment and your prefrontal cortex along with other regions so
00:25:13.980it's not just a you know a single kind of this is a very reductionist kind of way in which i'm
00:25:18.580describing it it's actually much more coordinated process but your prefrontal cortex sits at its
00:25:24.720center in this regard so your prefrontal cortex regulates your emotional reactivity and regulates
00:25:30.540your emotional appraisal of things so that your emotions don't react inappropriately while you're
00:25:36.760serving that goal now because self-control forms part of that self-regulation it's it's logical that
00:25:45.140improving your self-control can improve your emotion regulation and there are studies that confirm this
00:25:54.440the area of research is still very early but it is progressing so there are a few studies for instance that
00:26:01.460show that attentional control training that increases self-control will also help mute emotion
00:26:08.760kind of distracting emotional thoughts there are also studies on using neurofeedback techniques
00:26:16.860where you learn to mute your emotional reactivity by reducing your overall arousal by using breathing
00:26:26.580techniques by using other kind of physical techniques to keep your brain in a state of
00:26:34.620good self-regulation so your emotions don't surface so self-control training attentional control training
00:26:42.060neurofeedback training and within that i also mentioned yoga which can be used kind of as a tool
00:26:47.560of neurofeedback involving self-control all of these things improve your state of self-regulation
00:26:55.020and hence harness any inappropriate emotional reactivity we're gonna take a quick break for a word from our
00:27:02.220sponsors and now back to the show is this where stoicism would come in as well or maybe cognitive
00:27:09.720behavioral therapy where you you learn or you tell your brain okay it's just an emotion just because i'm
00:27:16.040feeling this doesn't mean it's necessarily so yes so cognitive behavioral therapy is definitely part of it
00:27:22.860cognitive reappraisal has been shown to be effective you mentioned stoicism and i think that the
00:27:31.440the essence here is that you need to balance two things the first thing is that when your brain is
00:27:38.520with your mind or your brain is emotionally reactive it's very difficult to reason with the emotions
00:27:44.440when beyond a certain threshold so very early on in the in the process so when your your brain is
00:27:53.920becoming more and more aroused or alert and it's just about to descend into stress
00:27:59.840if you tackle that your brain when it's at that point when your arousal levels your alert levels are
00:28:08.880really really high but you haven't quite kicked off your hormonal response to stress if you tackle it at
00:28:16.180that point you can kind of reason with your brain and draw back you can have greater control over your
00:28:24.120your stress reactivity and draw back but once it goes over the hill and it descends into a stress
00:28:31.700response it's difficult to logic to use logic with your brain and at that point you have to use things
00:28:38.260which target your the nerve network that's responsible for your stress reaction so your autonomic
00:28:43.840nervous system because targeting the nerve network doesn't involve you having to reason with your mind so in
00:28:50.440the middle of a stress reaction you can't reason so you have to use different techniques and what
00:28:56.360will those techniques be so one of the the really you know interesting areas here is we know that in
00:29:03.560order to stem a stress reaction so we know that chronic stress relates to perceived stress and perceived
00:29:11.180stress relates to things like rumination things like how quickly you recover after each stress response
00:29:18.140now we know that increasing the the gradient so making you making your your stress response shorter
00:29:25.900recovering your normal functioning state of your autonomic nervous system all of these things reduce the
00:29:33.720burden of that particular stress episode so they reduce the perception of stress during that time so
00:29:40.020things that target autonomic flexibility or things that improve autonomic flexibility have a role to play
00:29:47.120in mitigating your stress response so one study i can think of straight away that i think i've quoted also in
00:29:54.060my book is you know even a single bout of something that trains your your autonomic reactivity so for instance
00:30:03.120we know that certain types of yoga done in very certain ways can train your autonomic reactivity but it doesn't
00:30:09.920just have to be yoga by extension it can in theory be anything else that trains your autonomic reactivity
00:30:15.200one session of yoga reduces the impact of a psychosocial stress response immediately after
00:30:23.380the yoga session so in the study i'm talking about this is actually a recent study they some researchers
00:30:30.520just gave a bunch of people a lesson on yoga through a video and immediately after that the
00:30:38.300volunteers were subjected to psychological stress they measured cortisol and they measured markers of
00:30:46.700the autonomic nervous system the nerve network involved in stress throughout the stress response
00:30:52.520and afterwards and they found that compared to controls though compared to the control condition
00:30:58.440yoga reduced stress reactivity and it increased recovery after stress so in very general terms what this means is
00:31:07.620that anything that improves your autonomic reactivity improves flexibility of your autonomic nervous system
00:31:15.560will enable you to recover faster from stress in the situation where you can't reason with
00:31:23.280yourself to recover so you need your autonomic nervous system to stay flexible at all times so improving
00:31:29.380flexibility is key to stress recovery and i'm going to bring something else here in here which is very
00:31:35.880interesting um the stress response really has two parts it has the nerve part which is the autonomic nervous
00:31:42.060system and it has the hormonal part which we abbreviate to the hpa axis now we all use cortisol as a marker of
00:31:50.200stress we call it the stress hormone and we think that lots of cortisol equates to lots of stress but actually
00:31:55.780there is a dissociation because you can have too much cortisol or too little cortisol what many of the stress
00:32:02.440studies have ignored for a long time is that your autonomic nerve network is key not just in your stress
00:32:09.400reactivity but also in your well-being and in in people who suffer from chronic stress the flexibility of your
00:32:16.680autonomic nervous system becomes limited it becomes smaller so people with chronic stress don't show the
00:32:26.540autonomic nerve response to acute stress as much as they should and again it's not necessarily the absolute
00:32:35.880state of your hormones and of your nerve network that's that's you know that's contributing to chronic
00:32:43.840stress it's the flexibility of it so things that improve the flexibility will help that so besides yoga
00:32:50.600you talk about in your book that breathing techniques can help improve that flexibility too
00:32:54.880so i want to go back to that idea you mentioned earlier about rumination because that's a part of
00:33:00.080that so we might experience a stressful situation with our boss it only lasted three minutes but the
00:33:04.860thing that can amplify the the effect of the stress is us thinking about it over and over again our mind
00:33:11.320can't differentiate between like something actually happening to you and like just you thinking about in
00:33:16.820your head and you mentioned you can distract yourself from that using different tactics how can you
00:33:23.280distract yourself from ruminating so you don't experience that stress over and over again so you need to
00:33:29.600have an activity that is so interesting and so engaging that your mind does not have the chance to
00:33:37.480wander that's the key so that activity can be anything it can be playing a game on your phone
00:33:44.540there are studies that show tetris has this effect so i mentioned tetris for instance in the book
00:33:50.260but it doesn't have to be tetris it can be any any activity or game that engages you to the extent
00:33:56.680that your mind can't wander because if your mind can't wander it can't replay the scene and if it
00:34:01.820can't replay the scene you can't imagine the scene is happening so i mean i think that maybe so it's a
00:34:08.800distraction i think that's why some people when they get stressed out they do unhealthy things like
00:34:12.820they shop or they eat or do things like that because it's a distraction but playing tetris that's not
00:34:20.060going to hurt your your waistline or your pocketbook that's right i mean one of the one of the problems
00:34:27.180with stress with with acute with what we do immediately following stress which kind of leads into its some of
00:34:33.440its negative maladaptive consequences is we deal with stress in inappropriate ways and having strategies
00:34:42.260out there that you can resort to or having backup strategies on your phone is a very helpful way of
00:34:48.380preventing you from resorting to distraction techniques through inappropriate ways so another example for
00:34:55.500instance is alcohol many people use alcohol to unwind after stress and there is there is you know this is
00:35:04.280again a very maladaptive practice because not only does excessive alcohol use harm the very same parts of
00:35:12.340the brain that you need to stay well to maintain a healthy stress reactivity but chronic stress kind
00:35:20.740of acts in synergy with alcohol to cause cognitive damage so alcohol is one way people try to to relax from
00:35:30.300stress but again playing tetris is yeah it's far safer uh so you mentioned hormones um and we think
00:35:37.540cortisol is bad uh but it's it's useful there's a purpose there but too much of it can be a bad thing
00:35:43.440and so it's not so much the the stress hormone itself that's a problem it's a it's an imbalance of
00:35:48.480these stress hormones so are there things we can do if we are experiencing chronic stress or even acute
00:35:54.820stress so that those hormones or they help us more than they hurt us is i guess what i'm trying to ask
00:36:00.040cortisol is actually very very interesting because you know we we as you say we associate cortisol as
00:36:08.480being bad so we say oh this raises our cortisol so it's a bad thing or stress we measure stress using
00:36:16.060cortisol and hence cortisol is a bad thing but actually cortisol has got a very interesting effect
00:36:20.880because cortisol as anyone with asthma or with eczema will know cortisol actually has an anti-inflammatory
00:36:28.200effect cortisol is we don't know why we have evolved to have the stress response that we have but one
00:36:36.320theory is that cortisol is is produced at the end or towards the the second half of the stress response
00:36:43.360and the first half of the stress response increases inflammation whereas the second half of the latter
00:36:49.720part we don't know where the distinction is between the first and second by the way but
00:36:53.480essentially the latter part of this of the stress response kind of acts to restore us back to our
00:36:59.260healthy form back to our normal form and so cortisol actually has an anti-inflammatory effect
00:37:04.820in short bursts but what's so interesting with cortisol and actually with pretty much all the hormones
00:37:11.940involved in the stress reaction as you say is that all of these in all of these cases the dose makes the
00:37:19.240poison so while short sweet bursts of cortisol can have an anti-inflammatory effect excessive amounts of
00:37:27.840cortisol increases inflammation and another thing i'd love to kind of bring in here is the relationship
00:37:36.900between growing new brain cells and synaptic plasticity acute bouts of stress actually increase
00:37:47.520plasticity in mouse studies not in human studies they've been shown to increase the birth of brain
00:37:52.180cells but essentially they increase synaptic plasticity in the hippocampus and possibly in parts
00:38:00.280of the prefrontal cortex now what's really interesting is bdnf is a kind of a growth a nerve growth factor
00:38:08.660nerve growth a synaptic plasticity elixir is one way of looking at it and bdnf production
00:38:15.760bdnf is produced during acute stress and bdnf production actually correlates with cortisol so if
00:38:24.320you have a really big bout of cortisol released during acute stress you have it corresponds to a good
00:38:32.040amount of bdnf production as well but the cortisol has to decline very fast for the bdnf effect
00:38:40.880to be at its peak as regards of what we can do to reduce cortisol well the the idea isn't necessarily
00:38:47.480to reduce cortisol but it's to cut short its production after stress in fact we want to produce
00:38:53.780good amounts of cortisol during a stress reaction and chronic stress is is associated in some cases with
00:39:01.300less cortisol production during the acute stress reaction so what we want to do is cut it short we want
00:39:08.880to produce a good amount but we want to cut it short and things we can do to cut it short are as
00:39:14.300follows so one example i've given in the book is exercise but again like with all the other things
00:39:20.720the dose makes the poison so there is evidence that one study that i've quoted shows that the dose of
00:39:27.600exercise can make a difference to what it does to cortisol levels now you know as per nietzsche's
00:39:35.920philosophy um a little bit of stress is good for us and we think that's kind of how exercise works
00:39:42.580exercise is a stressor and little bits of exercise or regular little bits of exercise do us a great deal
00:39:50.320of good now in the context of cortisol we know that in the study i've quoted they measured the intensity
00:39:58.720of exercise as per vo2 measurements and low intensity exercise so in that study people who exercised at
00:40:08.740intensities at or less than 40 vo2 max for those people 30 minutes of exercise actually reduced cortisol
00:40:19.460circulating cortisol levels in their blood whereas exercise at 60 or 80 vo2 max level increased levels
00:40:30.300of cortisol so following immediately following a stress reaction when you want to bring down your
00:40:36.740cortisol levels as quickly as possible low intensity longer duration exercise is a is one very good idea
00:40:45.500so that's one example let's talk about inflammation because that's another stress agent and inflammation
00:40:51.760is one of those other things that have gotten a bad rap we think that oh all inflammation is bad but
00:40:57.200inflammation can be useful for example after you lift weights i know your muscles experience
00:41:02.900inflammation and you actually need that inflammation for your muscles to get stronger or to adapt
00:41:07.500so i guess there's a point where too much inflammation can actually be a bad thing right so it's sort of
00:41:13.940same thing with cortisol right so inflammation is essential for our survival the the role of
00:41:21.200inflammation within an acute stress response is in case there are any bugs entering us entering our bodies
00:41:27.560through our wounds we want there to be a or we have any cuts we want to have inflammation to protect
00:41:34.680ourselves so it's a defense mechanism now when it comes to stress and inflammation there are some very
00:41:41.740very very interesting threads so one interesting thread i'll i'll bring in here is recent evidence that
00:41:50.260this is deviating from stress a little bit but recent evidence that in certain conditions in certain
00:41:56.800settings of depression which can be a long-term sequelae of chronic stress in certain cases of depression
00:42:06.580anti-inflammatories seem to be more effective than standard antidepressant medications now that's not
00:42:15.280saying all depression is caused by inflammation at all it's not even saying that all depression cases need
00:42:21.480to be treated by anti-inflammatories but it shows you how inflammation and disease of the brain that
00:42:29.960relate to the stress pathways have a relationship with regard to stress the acute inflammation we get
00:42:37.460in stress does us no harm and in fact the rise in inflammatory markers so we know that there is a rise
00:42:45.200for instance in one cytokine which is inflammatory marker rather than an actual instigative inflammation
00:42:50.900called interleukin 6 the the temporary rise in these things is fine because they decline in chronic stress
00:42:59.600these inflammatory markers these cytokines and other inflammatory markers they persist and as stress
00:43:09.320becomes more chronic we there is evidence that people with chronic stress have very low levels of chronic
00:43:17.460inflammation and as you say again with regard to inflammation like with regard to cortisol the dose
00:43:27.020makes the poison where there is an element of chronic inflammation that chronic inflammation can have
00:43:34.420repercussions on communication within the brain and on disease processes affecting the body and that's where
00:43:42.820chronic stress we think relates or translates into some of its manifestations so for instance one very
00:43:51.220interesting study is the discovery of inflammatory of markers of inflammation within the reward pathways of the
00:44:00.960brain which in animal studies correlate with the kind of the decline in the ability to feel pleasure
00:44:10.380that accompanies chronic stress when i talked about the psychiatric conditions
00:44:16.800mental illness conditions such as depression that can be treated with anti-inflammatories
00:44:22.360we know that certain cases of of these conditions so certain cases of of depression
00:44:28.920show evidence of low-level inflammation peripheral inflammation so if you test their blood you find evidence of
00:44:37.220inflammatory markers and it's these patients who do who benefit the most from anti-inflammatory therapy
00:44:45.220so inflammation has again a very nuanced relationship short bouts are good but when they become chronic their effects change
00:44:53.520i've noticed i don't know this is related maybe it could be just coincidental but i when i've gotten like a sinus infection
00:45:01.520and i've gone in to get a an anti-inflammatory shot i feel great right away but then i also i'm just like super motivated
00:45:08.400like i just like want to get a lot of work done and it happens very quickly i wonder if there's something
00:45:14.320like there's a connection there somehow so with regard to cortisone there are several possible explanations for that
00:45:22.040but one of them relates to what i just mentioned about the animal studies where inflammatory markers in the brain
00:45:29.900in certain parts of the brain the reward pathways in the brain correlated with the inability to feel pleasure
00:45:35.660and be motivated so removing these so so achieving a state where there are no inflammatory markers in that part of the brain
00:45:43.080was associated with feeling more motivated towards pleasure so this could relate to to your own experience of this
00:45:50.880the evolutionary kind of mechanism or theory behind this is that if you have inflammation
00:45:57.760in in yourself you want to sit there and you want to heal the wound before exposing yourself to uncertainty
00:46:04.640through exploration which is why which is what motivate motivation invites us to do motivation increases
00:46:12.320our need our desire our want of exploration so it's a kind of trade-off that when you're in danger
00:46:20.120you repair and heal yourself and then when you're better and you're well equipped to deal with any
00:46:24.800dangers that's lurking behind uncertainty you have your motivation back so what are things people can do
00:46:31.440to keep inflammation in check is it a matter of exercising diet things like that yes so coming back
00:46:39.140to acute stress and inflammation actually one of the really kind of intriguing things that tends to happen
00:46:43.740with acute stress is you know acute stress is a state where because you are running a default program
00:46:50.920your your brain has putting in a default mechanism that puts you in a state to deal with absolutely
00:46:56.480anything and to optimize your chances of survival your brain becomes king so all the nutritional aspects
00:47:04.820energy aspects all other aspects are there to serve your brain so during acute stress there is evidence
00:47:12.460that our intestines become the intestinal wall lining becomes a little bit broken or a little bit
00:47:20.340kind of compromised and when the intestinal lining loses its kind of intact surface not only do things that
00:47:31.340we that are good for us leak into our bodies from the gut but also pathogenic bacteria also leak in to the
00:47:40.560blood from the gut and also other fragments of these microorganisms that trigger inflammation
00:47:45.620so one of the routes through which stress or acute stress increases inflammation may be through
00:47:53.620increasing gut permeability so for instance the stress of speaking in public has been shown to increase
00:47:59.820intestinal permeability now in chronic stress we know for instance that micro microbial flora
00:48:10.220act as gatekeepers essentially um keeping the lining of the gut intact and they are they have a really
00:48:19.380important function because if you think about it your intestinal lining your gut lining is where your
00:48:25.380environment becomes you it's where you meet your environment and so you have lots of things lots of
00:48:33.760elements passing through there which could be harmful but they are dangerously close to your body so you
00:48:39.740have a very large immune presence that's along your intestine along your digestive tract and there is a lot of
00:48:47.540cross-talk between the bacteria in your intestinal tract and these immune agents and some of these immune
00:48:55.900agents are responsible for telling your body that this is safe and this is not safe and hence triggering an
00:49:02.760immune reaction so some of the ways in which you can keep your inflammation low one strategy which is very
00:49:10.260simple is to adopt an anti-inflammatory a diet which reduces the inflammatory burden on your body
00:49:17.460yeah some of the foods you listed as or nutrients that you list as anti-inflammatory are dietary fiber
00:49:24.220which a lot of people don't get enough of beta carotene you get that in sweet potatoes and carrots
00:49:29.240turmeric is another one but you got a whole list there in your book that people can check out
00:49:33.880so yes so choosing your food carefully is one way of reducing inflammation other environmental effects
00:49:40.180of course treating the other pathways is important as well and also with regard to choosing your food
00:49:47.180carefully and with regard to these microorganisms manning your intestinal lining gut bacteria may well play a
00:49:55.740role in inflammation so again many of these studies are association studies we're only just getting the
00:50:03.360the the kind of early prospective randomized trials on this but there is evidence of bacteria playing a
00:50:13.820role for instance i mean a study came out i think just a few days ago which has shown that certain
00:50:19.980combinations of bacteria in the intestinal lining through their crosstalk with the immune regulators
00:50:26.300that line the intestinal lining regulate our immune response so all of these kind of weigh in to the food
00:50:33.600you're eating your gut bacteria anything that promotes or prevents them in my book i mentioned you know
00:50:39.980elements of food such as emulsifies which have been shown to have a negative effect on your gut bacterial
00:50:44.980on your bacterial flora in the gut so this is one very very potent way of reducing inflammation
00:50:52.360another way of reducing inflammation is of course recovering as quickly as possible after each stress
00:50:57.860response so that the inflammatory state in which the stress response puts you is very very temporary and
00:51:06.260short all right so uh eat your yogurt get that good bacteria get your fiber just eat a healthy diet and
00:51:12.820you'll probably be get your bases covered for the most part right so let's talk about one more so
00:51:17.720one more agent of stress that you've mentioned throughout this conversation is this idea that
00:51:22.380stress acutely can actually increases motivation but when experienced chronically we can become
00:51:29.560depressed and unmotivated so how do you get out of a stress-induced slump because that's because
00:51:36.020it's hard because all these things we've been talking about these tactics you can use
00:51:39.560to alleviate chronic stress well you're not feeling motivated to do them because like all this chronic
00:51:46.180stress has left you unmotivated to do anything so how do you bootstrap your way out of out of that
00:51:51.580unmotivation so you can do these things that can solve your problem that you have so it's very easy to
00:51:59.300stress acts as a very as a vicious circle because when you start feeling encumbered by stress
00:52:06.340you start doing less and less and you start doing different things with the time you have free
00:52:13.160and one of the dangers of that is you start shaving things off your day or off your life
00:52:19.460which actually have some very potent benefits so one of the things i recommend is reintroducing
00:52:26.080or making sure you never leave behind things in your day or in your in your week that give you
00:52:34.500pleasure and there are two other angles to this the first angle is one of the the sources of stress
00:52:41.280or the two of the sources of stress are uncertainty and a sense of a lack of control so a lack of a locus
00:52:47.920of control of being in kind of an agent of your environment being in command of your environment
00:52:53.660being able to make things happen around you and people with low levels of this sense of control
00:53:03.200and low levels of a sense of certainty so people who think the world around them is uncertain and
00:53:09.060feel they have no control over it have been shown to have more potent stress reactions so when you're
00:53:16.980in this downward slump of depression or down not necessarily of depression of chronic stress
00:53:21.800then one of the the really kind of beneficial ways of lifting yourself up again is convincing
00:53:29.980yourself of your sense of control convincing yourself of certainty in your environment and
00:53:36.620controllability and also essentially kind of feeling in command of your environment and a great way to do
00:53:44.560that is by taking part in a challenge so you know you will have heard many people are aware that there
00:53:53.360is something called active coping in which when you're feeling stressed by something doing something
00:53:59.100makes you feel better and that something that you do doesn't necessarily have to be directly related
00:54:05.660to the stressor so many people for instance take up training they train more when they go through stress
00:54:12.340I've had patients where when the patient is ill with some kind of very bad illness their carer or their
00:54:21.200loved one spends the time alone at home building putting new shelves up in a room or redoing you know
00:54:28.420redoing the garage or doing something like that so active coping is really important to bring your
00:54:33.400controllability back your sense of controllability taking part in a challenge and overcoming that challenge
00:54:39.080again reinstates your sense of agency reinstates the fact the sense that you can make things happen you
00:54:47.880are in control of your life and being better today than you were yesterday is another element of growth
00:54:56.580which again has been shown to improve stress resilience and again challenge taking part in the
00:55:03.820challenge of taking part in a kind of an incremental growth related challenge incremental improvement
00:55:09.240related challenge is another great way to kind of bring yourself back out of that slump so it sounds
00:55:16.320like get a hobby is like an easy way and you might think well I don't have time for hobby I've got too
00:55:21.700much going on you're saying it sounds like what you're saying here is like you actually don't have time
00:55:26.760not to do a hobby or do something that's going to give you pleasure because that's actually going to help
00:55:31.560you it's going to carry over to other aspects of your life well me too there's a lot more we could
00:55:36.960talk about but where can people go to learn more about the book and your work so I have a website my
00:55:42.560name meto steroni.com www.meto steroni.com so that has links to the book and links to me and it has a
00:55:50.960contact form as well if anyone wants to get in touch with me and I'm also on twitter on at steroni
00:55:56.040meto and I also have a facebook and instagram presence with dr meto steroni well dr meto
00:56:02.420steroni thanks for your time it's been a pleasure thank you so much for having me my guest today is
00:56:06.580dr meto steroni she's the author of the book stress proof it's available on amazon.com and bookstores
00:56:11.260everywhere you can find out more information about our work at our website meto steroni.com
00:56:15.500also check out our show notes at aom.is stress proof where you can find links to resources
00:56:19.900where you delve deeper into this topic well that wraps up another edition of the aom podcast
00:56:30.960check out our website at artofmanliness.com where you find our podcast archives there's over 500
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00:57:16.260reminding you not only to listen to the a1 podcast but put what you've heard into action