WHY YOU'RE ALWAYS TIRED! - It All Begins With Your EVENING ROUTINE | Rangan Chatterjee

my clinical experience and I'd also say life experience has taught me that when you feel tired all the time it affects three key components of your life your health your happiness but also your relationships and what you do well you probably turn to sugar to caffeine to stimulants I think we've all been there before haven't we I mean at some point you've got to ask yourself why what's causing this how long is this going to last what can I do about it you see I've been a medical doctor now for over two decades I've seen this time and time again I've seen the impact it's humming on people's lives when they feel exhausted but have also seen how some really simple changes when implemented regularly can make a huge difference and it doesn't actually take that long now look certainly there are some cases of tiredness that need someone like me or a healthcare professional to help with you know if you've got low iron low B12 sometimes low vitamin D you may benefit from supplementing and very quickly the fatigue is gone sure for some people that helps but for most people for me maybe for you that isn't the cause the cause is actually to do with our lifestyle and in particular it's to do with our evening routine you know there's a lot of talk about morning routines but have you ever thought about your evening routine if you make some simple changes to your evening routine it can have a huge impact on how tired you feel the following day and that's then going to positively impact your health your happiness and your relationships the things I'm about to recommend as part of my five-step action plan are things that I have seen time and time again really really work and they don't actually take that long to kick in the first part of this action plan is to think about the one hour period before bed so why is this important well do you have kids you know I've got kids if I think about my children and what I like to do with them before beds what I don't do is give them a load of sugar put the lights on really bright put the music on super loud really aggressive metal music and then expect them to fall asleep no that would be ridiculous what I do with my children is start to create an environment that's conducive to sleep dim the lights soften my voice read them a story maybe put on some relaxing music basically send their brain and body signals that the day is over and the night and our sleep routine is beginning and I think we all naturally do that with our children but somehow we think as adults we don't need to apply the same rules but we do that is just as important for adults as it is for kids you need to send your body and brain a signal that the day is over and it's time to start winding down now one of the huge issues these days is that we have all these devices let's say you've got a laptop and we often do our work on our laptop and we consume our entertainment on the same laptop often in the same place this is a big problem because your brain is an associative organ your brain starts to associate certain activities with certain environments so for example if you work from home and you do a lot of that work in your bedroom you're doing work calls you're answering emails on your beds well that could be one of the main reasons you struggle to fall asleep at night because your brain has Associated your bed and your bedroom with work not rest and sleep so for some of my patients just the simple Act of working in a different environment where they're sleeping will make a huge difference but it's not just the environment we have to pay attention to it's also the information that's coming into our brains so as I mentioned with my kids we want to change the tone of the information in that one hour before beds but what are you doing in that one hour before beds are you on social media maybe you're on Twitter having an argument are you watching the news they're often negative and divisive news that gets you amped up are you having an argument with your friends or your partner are you discussing financial matters in the evening I mean what signal are you sending your body and brain when you do that think back maybe a couple of hundred thousand years ago what would happen in the evening right it wouldn't be emotional stimulation physical stimulation no it'd become fire time right what happens at campfire time obviously there's a fire but there's singing There's connecting there's intimacy there's storytelling that's how you have evolved that's how I've evolved but somehow in the modern world we think we can override the stuff that's hard wide in us and we can't so what elements from that campfire time can you bring into your life right now and it doesn't have to be complicated I'm not asking you to light a campfire in your garden or in your house I'm simply saying can you change the tone of course there are all kinds of things that you can do in this golden one hour before bed in this campfire time but the reason this is so important if you're feeling tired is that if you properly wind down in that one hour before beds you are hugely increasing the chances that you're going to sleep for longer and your sleep quality is going to be better which in turn is going to mean you have more energy the following day and it's not just more energy you can have more creativity you're going to Crave less unhealthy Foods you're going to be a lot more emotionally stable your focus will be better and you're going to have more empathy there are so many incredible benefits when we start sleeping better yes energy but all these other things as well but it all kind of starts with your evening routine so what are the kinds of things you can do in that golden one hour before bed to give your brain and body a different signal now first of all I would try your best to avoid work can you put some sort of shutter time where you say right after this time I'm not going to do any work emails anymore like if you don't Define that you're gonna really struggle because emails are always coming in now something that a lot of people find useful is an alarm right not a morning alarm to wake up now an evening alarm an evening alarm to say no this is now when my one hour wind down starts so that's something you may want to consider at least initially until you get this ingrained into your life right so let's say you want to be in your bedroom forming a sleep at 10 o'clock maybe you're putting alarm on your phone at nine o'clock and nine o'clock it goes off and you know okay whatever I'm doing I now need to change the signals to my body and brain I now need to show my brain that it's campfire time right so what can you do you can lower the lights we're going to talk about that shortly you can read a book listen to some relaxing music you can run a bath like a hot bath does two things number one it relaxes you right number two what a hot bath does is something very special that really helps you to sleep yes it raises your temperature but within half an hour of coming out off that hot bath your core temperature starts to drop that's a very important signal for your body when your core temperature starts to drop it helps you fall into a deep relaxing slumber right so it's counterintuitive for some people and this is also why some people struggle to sleep because their room is too warm you need that signal of cold at night and a hot bath actually will do that for you there are all kinds of other things you can do the key thing though is you don't want it to be stimulating right you want it to be relaxing it could be playing board games like maybe it's playing chess maybe seeing a jigsaw maybe it's a coloring book which loads of adults love to do these days as a form of mindfulness practice anything it really doesn't matter what you do I'm not trying to be prescriptive I'm trying to give you options so that you can go yeah actually that one's going to work for me to say the key thing is changing the signals that your body and brain are getting sometimes it's worth having a few rules within your households like I put in a rule a few years okay that after 7 30 P.M I do not want to talk about anything intense I don't want to talk about the news I don't want to talk about finances and initially it was a bit challenging because people weren't used to that but I realized particularly after I had children that I need to get to bed in good time when I do that it's going to give me more energy the following day I honestly have found by really focusing on my evening routine it's given me so much energy the following day and the more you get that energy the more it keeps you engaged in sticking to that evening routine so what are those rules for you are you okay with discussing finances at 9 00 pm or are you not like ask yourself and instead of getting heated about it and annoyed if there are people in your life have a conversation with them and say Hey listen I know this is important but honestly for me it doesn't work at this time I think you'd be surprised at how effective that can be a little tip here is don't have that conversation when you're feeling angry or triggered like in the moment yeah another time of day when everyone's feeling calm you say hey look I've realized actually this doesn't work for me can we find another time another thing you can think about at this kind of campfire time is connecting connecting with the people in your life now if you're lucky enough to have a partner or live with a family this could be a great time to you know switch off from work and spend time with them I know for me introducing something that I call a five minute tea ritual was completely game changing a few years ago it's something so so simple my wife and I probably like you are super busy and we'd often find that actually although we were kind of in the same space in the evenings we were kind of lost in our own worlds and I see this time and time again with my patients they say I'm having real problems in my relationship like we never spend any quality time together and often people are to together physically in the same space but emotionally and mentally there were a million miles away because they're both independently stuck on their devices so this tea ritual is a really simple way to change that and what it looks like for me is after my kids are in bed each night before I go onto my device if I do which I try my best not to and before my wife does we have a commitment that we're going to get together for five minutes that's it if you make a commitment to say it's got to be half an hour it's not going to happen but we make a commitment say it's just five minutes and we'll come into the kitchen we'll usually make something like mint tea some sort of non-caffeinated tea and we'll sit there catching up the requirement is just five minutes when we do this regularly our relationship is completely different we're closer there's less niggles there's more intimacy when we think we're too busy let's think about that for a minute too busy for five minutes with your partner crazy isn't it when we think we're too busy for it the niggle snots come in the frustrations there's less closeness less intimacy and I've shared that five-minute tea rituals so many of my patients and one couple in particular I remember came back to me and said that's he ritual has saved our marriage no question so perhaps that's something you want to introduce into your life again we're talking about people feeling tired all the time right and what's so powerful about focusing on your evening routine is that it helps you switch off and it helps you get better quality sleep now one of the reasons I'm so passionate about the one hour before beds is that yes it helps with physical fatigue but it also helps with mental fatigue these things are slightly different and you may not be aware of the subtle difference between the two of them so one of my patients Susan she's about 44 came to see me she said I feel tired all the time a bit of energy to do the things that I want to do is there anything wrong with me doctor so I took a history I examined her I did some blood tests they were all normal nothing I could easily identify then correct as I started to talk to her about her life I remember she said you know but I'm getting enough sleep I go to bed on time like I probably get seven hours of sleep a night I thought blood test normal and she's getting a pretty good amount of sleep each night but when we start to dive in a bit deeper in that one hour before bed she was doing emotionally stimulating activities she was often watching emotionally charged dramas sometimes she'd watch the news sometimes she'd be on social media getting into disagreements and sometimes even arguments so even though she could actually fall the seat quite quickly afterwards the quality of her sleep and the quality of her West wasn't where she wanted it to be when she started to change that one hour before beds things start to change really really quickly so what does she do well she really enjoyed yoga which she hadn't really practiced much for a while and she loved music so we combined the two in the evening and that one hour before bed she's put on some relaxing music in a living room and she do some yoga stretches and yoga moves that she really enjoyed often it would just be 15 minutes or 20 minutes and what she found was that even though she was sleeping for the exact same time because she was switching off for that one hour before bed she felt totally energized refreshed and recharged in the morning have you ever noticed that have you ever thought about it well what you do just before bed if you're trying to solve problems and go through let's say work emails and beds even if you do fall asleep how do you feel in the morning compared to when you fully switch off I've seen this time and time again with my patients I've experienced it myself now I'm human right sometimes I fall into the Trap I just want to do stuff just before I go to bed but I've learned enough times that if I have a defined one hour switch off before I go to bed every aspect of my life is better yes energy but that has a knock-on effect on my health my happiness and my relationships the second thing I'd like you to focus on as part of this evening routine that's going to give you more energy the following day is exercise now exercise comes in many different forms many different intensities and of course you just heard me share a story one of my patients where by exercising in the evening this was yoga relaxing exercise with music it really helped her to switch off which in turn helped the quality of her sleep but exercise can also be problematic too close to bed for some people and this is something I've experienced myself as well if we exercise too close to bedtime we struggle to fall asleep so many years ago east of love playing squash and I realized if I played squash after work or let's say at 6 6 30 P.M I would really struggle to fall asleep I'd be in bed at half nine or ten I'd feel my heart racing I'd feel myself amped up in my brain it would take me a long time to fall asleep and I learned back then that five o'clock was my cut-off point which of course had its challenges around work but nonetheless I realized that actually if I'm gonna play Squash I have to play earlier and again I've seen this with so many patients they go to the gym after work is that you have you done that do you struggle to find time to move your body so you go after work and I totally understand that but you've got to be aware that on one hand you're exercising to improve your physical and your mental well-being but if that's negatively impacting your sleep you gotta really ask yourself the question is it worth it or could I perhaps exercise at a different part of the day I had this patient a few years ago a 52 year old chap High achieving High performer at work right it's always go go wanted to work out look after himself and he'd go to the gym after work you know when you push it hard on the treadmill with the weights he'd get home he'd eat maybe do a bit more work and he was really struggling with low energy again all this blood tests were normal this wasn't an issue that needed resolving with a supplement or a medication that this was to do with the way he was living his life and as we start to look at his life I suggested to him that maybe he wants to consider a different form of exercise now he was really reluctant but over a period of time I helped him see how it may have been negatively impacting him and he agreed to a trial I said okay try it for two weeks let's just see what happens and again I suggest that he go to a pilates class because he wanted to work on his body he wanted to work on his core he liked to go for long runs at weekends so Pilates really appealed to him he thought I'm still working on myself if I'm still working towards a goal it's just a little bit different and it was incredible within a few days he was starting to fall asleep quicker and he was waking up with more energy and the Beautiful Thing is then it was no longer necessary for me to persuade him he experienced it for himself he said doc I get it I get it he realized that in the evening he can't go intense and again bit by bit he started to change his life and he started finding time earlier in the day to work out move his body does any part of that story resonate with you have you ever experienced that now I want to be really clear exercise in the evening does not affect everyone in the same way some people are completely fine going for a long run in the evening and then falling asleep we're all different we're all unique what we have to do is find the right approach that works for us and the reason I'm making this is to help you realize that your fatigue your low energy that is affecting your health your happiness and your relationships May well be due to what you're doing in the evening and a lot of us simply aren't thinking about that the third thing I want to talk about with respect to your evening routine that I think is going to make a big difference to your energy levels is Foods the first thing when it comes to food I want to ask you how late are you eating what time do you take your very last bite because it's important it's important for all kinds of reasons to make sure you're taking action after watching this video I've created a free guide to help you build healthy habits we can all make short-term change but can those changes become a fundamental part of our life often they don't and that's why in this free guide I share with you the six crucial steps you need to take that really really effective if you want to get hold of that free guide right now all you have to do is click the link in the description box below look I've had the pleasure of speaking to this wonderful scientist Professor Sachin panda on my podcast on two occasions and he's done all kinds of research on something called time restricted eating when we eat all the food that we're gonna eat in a particular eating window and as part of his research a few years ago he realized that a lot of people in the western world are eating food over 15 hours in every 24 hours essentially that means many of us are waking up and eating let's say six in the morning 6 30 in the morning and we're still eating at 9 30 10 o'clock at night in front of the television and the two this was simply not designed to do that I think pretty much all of us need 12 hours without food in any given 24-hour period and let's be really clear here hopefully you're sleeping for seven or eight hours of those 12 hours it's not actually that hard and one of the big things that we see across Society now is people eating later and later into the evening now if you are able to stop eating two or ideally even three hours before bed you may find that your sleep quality is improved and you wake up the following day with more energy one of the key things I learned was that if I eat close to bed the quality and quantity of my sleep drops I was seeing it in my own life that when I ate late just before bed there was a huge impact and what I ate early my sleep was much better and many of my patients reported the same thing back to me and we know from the research that if you can give yourself that gap before bed it can really really help now I understand sometimes they are work pressures you get back late you have to eat late and again a wider point for me is maybe you can't do everything that I'm suggesting that you do for your evening routine you don't have to even just a few of them will start to make a difference you know I get it we've all got busy lives we've all got unique pressures we've got to do what works for us but for some of us this is something that is very very achievable I've got patients who having discovered how important it was for their sleep and death or their energy that they don't eat late they started taking dinner to work with them and often if they would finish work at 9 00 PM they'd often have a break at around 6 6 30 p.m they'd go into the staff room and have dinner at work so that they weren't tempted when they get home okay so that may be something that works for you now if you are at home and you've eaten early I know what it's like you can be tempted right a few things that might help are after dinner you know let's say you have an early dinner well maybe you brushed your teeth straight after dinner simple thing it is so so effective if you brush your teeth after dinner you know you've got that nice refreshed feeling inside your mouth often you're not as tempted to dive into the ice cream or have the sweets or the biscuits another tip that I found helpful with many of my patients and also me in the past I must ads is after putting dinner out on the plate anything left put away in a container and put in the fridge so before you've even started eating you've put the extra food away because how many of us get temp sets we've eaten our first serving we found it tasty and we think oh just a little bit more if the food is already away in the fridge you're putting just a little bit of friction between you and that desired behavior and often that little bit of friction is all you need to introduce to stop you doing it so again give it a try key point though is if you can try not to eat for those two to three hours before bed you may find you're sleeping better and you've got more energy now there's another thing I want to talk about when it comes to food and that's to do with high sugar foods before beds oh I get it sometimes you're not going to stop eating two to three hours before bed sometimes you're gonna be hungry or you're gonna be back late from work and you're gonna want to eat that's okay I get it the question then becomes what are you eating if you are having high sugar foods before bed I'll tell you what sometimes happens people coming to see me all the time struggling with their sleep and one of the complaints you hear is people say oh I woke up at midnight or one in the morning or two in the morning I just woke up and I couldn't get back to sleep now there's many reasons that could cause that but one reason which I don't feel is spoken about enough is to do with what is the last thing you're eating before you go to bed if you have some ice cream let's say what often happens and it depends a little bit on the current state of your health is that your blood sugar will start to rise right and then two three hours later sometimes even three and a half hours later that blood sugar starts to drop really really quickly and when your blood sugar starts to drop quickly that's an alarm sign it's a shock sign to the body and often that jolts you out of a deep sleep I have seen this so many times right that people are waking up in the early hours of the morning because of what they're eating last thing before they go to bed so if you are hungry before bed if you have to eat just before you go to bed for whatever reason for work reasons for personal reasons I'd really encourage you to think about foods that are high in protein or foods that are high in healthy fats like nuts olives maybe something like carrots and hummus something that's not going to spike your blood sugar now although not technically Foods I just want to bring a commonly consumed drink in here and that's coffee or tea or anything containing caffeine right I would definitely say as part of your evening routine probably not a good idea to consume caffeine especially you're feeling tired all the time some people will say I'm okay with an evening cup of tea or coffee and you know most of the research really doesn't support that even if you can fall asleep after an even cup of coffee it looks as though the quality of your sleep still gets affected so I have a rule like a general rule of course not everyone has to follow it but I find most people find improvements in their energy levels if they stick to caffeine in the morning I know this is about an evening routine but I do think it's worth mentioning caffeine because it's something that can really play Havoc with sleep and with energy levels fourth area I really would like you to pay attention to as part of your evening routine which is going to give you more energy the following day is lighting what is the type of light that you've been exposed to in the evening now before we get into lighting I just want to explain about circadian rhythms right your body exists on a daily circadian rhythm right and that's circadian rhythm is set primarily by light and dark now one thing that's happening these days is that we spent a lot of time indoors now again let's just think back back in the day maybe 10 000 years ago 100 000 years ago would be outside a lot we'd be getting a lot of natural light exposure in the day and then the evening it would be dark research has shown that the average person today is exposed to 10 000 times the amount of light at night than they were in the 1800s that's not that long ago in just two or three hundred years we've completely transformed a light environment and not for the better what we really need is more light exposure in the daytime and less light exposure in the evening you see darkness is a signal to our body that it's time to switch off it's time to relax sleep is coming remember what I said earlier what do we do with our kids before beds we don't put the lights on really bright and get them amped up now we soften everything we dim the lights we put on the bedside lamp and reads it's sending the signal to the brain and body there actually it's not daytime anymore it's night time light is a very powerful way in which you can start doing this for yourself how intentional are you with your light use in the evenings see one of the problems these days is in a lot of modern homes we have these bright LED lights right in your kitchen and your bedroom or even in your bathroom you know incredibly many of us we brush our teeth Don't We lasting before we go to bed and we may be relaxing and chilling and have been reading but then to brush your teeth you go into this bathroom with these Bright Lights which basically gives your body a sign and a signal that it's time to be alert right so I know it's hard to be perfect here we're not living in the olden days what I am saying is try and be intentional with the light you have on in the evening what you really want to try and avoid are what we call down lights well it's a light that come from the ceiling if you can't switch them off if you can't dim them if you can and then focus more on lamps lights that are lower in your field of vision right that's going to really really help like there's all kinds of companies now which are making lights that change throughout the day so you have bright lights in the morning and as you get to late afternoon and early evening the the tone starts to change becomes more Amber more red softer if that's I remember when my kids were a lot younger my son would sleep with a nightlight on in his room and he'd always wake up really early and it was a white bright NightLight and my wife and I decided to change it to a red light just a really simple cheap plug-in red lights and remarkably the following day he slept for one hour extra and we saw this happen time and time again it wasn't just a one-off it completely changed how long he slept for and all we changed was the color of this light and there's all kinds of companies which will sell you Amber lights or red lights that if you have the capability you can actually put on in your house in the evenings in my own bedside lamps at home I have got low Lux Amber lights feel the difference you feel calmer and my Sleep Quality is better on the other side of that again these are very cheap very simple to use but they can make a really big difference so I want you as part of your evening routine to be really intentional about the lighting yes for sure as I hinted at earlier try not to be on your screens if you can for one hour before bed even half an hour if that's too much even 10 minutes start small start wherever you're at it really does make a difference for two reasons yes the lights but usually on their screens for being emotionally stimulated right usually not always of course but usually it's not calming the concept we're consuming on there so that's really the reasons why I think if we can avoid screens immediately before beds so much the better now a common question people often ask me is I say what about television what about the blue lights and the brightness from televisions and the truth is is that televisions don't tend to impact our circadian rhythms as much as smartphones or tablets and I think one of the main reasons is is that smartphones and tablets we kind of have really close to our face and close to our eyes whereas televisions at least for most of us I hope tend to be a little bit further away so it has less of an impact ideally I would say go without both if you can but if you can't television is probably better than a smartphone or a tablet now I understand going without screens in the evening is a really really hard some of us find it much harder than others how hard do you think you'd find it have you tried before have you struggled well there's a patient of mine who also was very reluctant to go off her screen in the evening this 35 year old lady called Isabel she came to see me she said doc I'm tired I just don't have energy to do the things that I want to do again everything else seemed fine in her life but her low energy was affecting her ability to interact with her husband and her children and do her hobby so it was really quite a problem now she did struggle with her sleep she tried over-the-counter supplements she tried sleeping pills but nothing seemed to really help and as we got chatting she shared that in the 90 minutes leading up to bed she'd be on her phone doing all kinds of things emails social media you know getting back to WhatsApp messages whatever it might be and she was completely reluctant to change that she said no that's my time I really enjoy it I catch up with life I thought okay well what can we do to help her I encouraged her to go softer with her content not to get into arguments on social media for example but I also said look the light the brightness of this light I don't think is going to help you so I recommended she tries some Amber glasses now she got these Amber glasses and it didn't take long at all for her to feel the benefits she popped them on and she started to yawn she fed back to me that I'm feeling tired earlier right her sleep quality got better immediately she had more energy and the knock-on effects on her life were huge so again there are always compromises we can make and the reason I share that story is you don't necessarily need to be perfect but if you are going to be on that screen maybe this is going to help now there's a part of Isabel's story which I think is really interesting she started to yawn earlier when she put on those Amber glasses and many of us don't realize just how much the light keeps us awake at night many of us think we're night Towers when we're actually not we're just exposing ourselves to so much light that it's pushing our circadian rhythms back so again this may be something you want to experiment with now I will say these glasses don't work for everyone for some people they're fantastic for other people they seem to have very little effects but I definitely think it's worth experimenting with you see one thing that happens in the evening if it truly is dark around us it's an important hormone called melatonin starts psoriasis that's the darkness hormone and melatonin it's one of the hormones that helps you fall asleep well it's really important but in the presence of bright light often our melatonin release gets delayed we're pushing back or circadian rhythm which is why many of us can't fall asleep that's why we feel tired in the day again it comes back to that evening routine so don't worry about being perfect but just be a little bit more intentional about the lighting you use in the evenings I think the impact may surprise you the fifth thing I'd really like you to pay attention to as part of your evening routine which in turn is going to give you more energy which in turn is going to improve every aspect of your life is a reflection activity what do I mean by that well one of the commonest reasons why people struggle to get to sleep is a busy mind worries anxieties things they didn't finish in the day all kinds of things are whirring around our brain which makes it really hard to switch off and get to sleep is this something you've experienced before I mean it's just very common I think we all have that to a certain degree I know the nights before exams I've been lying in bed thinking about things not switching off so it's pretty common I think if we tap into our own experience we'll know that yeah this happens now for some of us it affects us more than others now some of the things I've already mentioned for example that calm one hour before bed are going to help you if you can avoid emotional stimulation finances news kind of really aggressive films or documentaries that's gonna help but even with that sometimes it's still there so some of the things I found helpful in my own life and with my patients are reflection activities to make sure you're taking action after watching this video I have created a free breathing guide that's going to help you reduce stress calm your mind and boost your energy in this guide I share with you six really simple breathing practices that work immediately even just one minute a day will start to make a big difference to receive your free guides all you have to do is click on the link in the description box below so one of the ways you can reflect is with a gratitude practice now there's a lot of Science Now on gratitude it's not just a soft intervention actually it works really really well we know that practicing gratitude can help reduce anxiety reduce stress help you feel calmer improve your sleep even reduce your perception of pain I mean it's incredible it's simple to do it doesn't take long and it's easy so if that's something you want to try it could be as simple as writing down three things you're grateful for in that day okay you can change it up though if that doesn't appeal to you or if you get bored doing that it can be what's one thing I did today for someone else what's one thing someone else did for me today and what have I learned today anything that helps you reflect and turn your attention from the negative to the positive it's going to be really helpful all of us humans have a negativity bias we're hardwired to remember the negative things that have happened that is what has kept us alive for so many thousands of years so you have to intentionally counteract that if you want to thrive and that's why these gratitude exercises are so powerful again there's all manner of grass shoot exercises that you can try and experiment with but I love to keep things simple so give those two exercises a go now I just want to add here if you are going to try this gratitude practices there's a few principles of behavior change that you want to implement to make it more likely you're going to do it and one of the key rules of successful Behavior change is you have to make things easy to do so what might that look like with a gratitude practice well it means that you want to have a journal and a pen or pencil and put it on your bedside table here's the thing if you decide you want to practice gratitudes and you get to bed and you can't see a journal you can't see a pen it's downstairs it's in another room you're introducing a bit of friction you might think ah I'll do it tomorrow and then you know what happens Tomorrow Never Comes it was an idea it was a bit of inspiration and it never actually turned into action so if you're gonna do gratitude make sure you've got a journal or a piece of scrap paper and a pen keep it next to your beds another thing that's often useful for people as part of this kind of reflection at night if you're worrying about all the things you have to do in life or the following day write them down write down home I need to take the kids to sports class I need to go to the post office I got to remember to answer those three emails whatever it might be write it down for some people this is transformative instead of your mind racing you're literally putting these things down onto paper and by doing so you are literally and metaphorically getting these ideas out of your heads and onto paper again no tip works for absolutely everyone but if you struggle with erasing minds and you struggle with thinking about the things that you have to do give it a go another reflection activity that I really like that I've used with many of my patients which really helps them switch off and therefore get better sleep is a two-question reflection right question one what went well today could be anything you know I did well at my job today work went well you know despite feeling tired when I came back from work I still made time to cook a fresh nourishing meal whatever it might be just one question and the second question is what didn't go so well today that I can improve on tomorrow and again it could be anything it could be ah I was really tired today because last night I was really busy all the way up until bed I stayed at watching Netflix for an hour longer than I probably should have done I was tired today so I was craving sugar and caffeine I had no energy maybe my work performance suffered whatever it might be and then you can say okay so tomorrow I want to make sure that I switch off for one hour before beds that I don't stay up that extra hour watching a box set and then I prioritized my sleep again it's a very simple exercise that does two things one it helps you engage positively with your life and behavior changes in a very kind and compassionate way and two I think it's just a beautiful way to switch our mind off and calm us down at the end of the day the other really helpful practice that you can think about just before beds or frankly any time in that one hour golden time period before you go to sleep is your breathing breathing is such an underutilized tool breeding is information right the way you breathe sends signals to your brain so many of us without realizing it changed the way that we breathe there's one study from America that showed that 80 percent of us change the way we breathe when we look at our email inbox it's incredible and if that's you and remember it's 80 of us you're probably not even aware that you're doing it so what happens well when you feel stressed or anxious or you're maybe concentrating on something three things happen you start to breathe more from your chest than your abdomen you start to breathe a little bit quicker and your breathing becomes a bit more shallow so when you start breathing like that you start to send stress signals up to your brain basically that is giving your brain a signal that you're in danger the world around me is not safe and then your brain sends signals back down to your body to breathe even fast as you get locked in this vicious cycle now the great thing is is that you can actually hack that very very quickly if you take control of your breath if you intentionally slow your breath down you can actually start to send calm signals up to your brain which in turn will encourage you to breathe even more slowly so one of the things I love about breathing practices is that they are effective they are simple and they're completely free now there are all kinds of breathing practices out there in fact looking them up can start to get overwhelming so let me share with you some of my favorite ones that I've used I've seen my patients use that really help them as part of that evening routine it helps them switch off helps them feel more relaxed helps improve the quality of their sleep and that instant gives them more energy the following day the first one I want to share with you is the three pause sex this is a breathing practice I actually first learned from the human performance expert Brian McKenzie who I spoke to on my podcast and he shared with me in conversations we've had how powerful this reading practice is and it's really simple basically you breathe in for three again ideally you do this in and out through your nose but I know not everyone can do that at least initially so if you can't do that at the moment that's fine do it through your mouth or do it in through your nose and out through your mouth whatever you find achievable at the moment but breathing for three then you have a little pause and then you breathe out for sex you just keep doing that keep repeating it and I've tried it before once actually fell asleep without even realizing it I've shared it with many of my patients they found it really really effective again it's very simple now an important thing to help you understand is that when you're breathing anytime you're out breath is longer than your in-breath you start to switch off the stress part of your nervous system and activate the relaxation part of your nervous system and that's really what you're looking for as part of your evening routine you know you want to switch off the stress arm of your nervous system what we call the sympathetic branch of your nervous system and you want to promote the relaxation Branch also known as the parasympathetic branch of your nervous system and a practice like that three poor six will do that another practice that I really like is what I call the three four five breath when you breathe in for three you hold for four and you breathe out for five again one of those will take you 12 seconds five of them I'll take you just one minute but you could try that right now and you will feel a difference immediately I know how debilitating it is when you have no energy to do the things that you want to in your life but I also know that if you start implementing some of the things that I've just been through and integrate them into your evening routine you're gonna feel calmer you're gonna start sleeping better and you're gonna have much more energy do not worry about doing all of them at once pick one thing right start there start small bring it into your life then add another one and very very quickly you'll find your energy levels transformed the conversation around health I feel gets overly polarized regarding food and movements now I am not for one minute saying that these things are not important but I think there is far too much focus on them personally at the expense of other factors and here's the funny thing about stress right and this is what I really figured out as I was unpacking the book and writing it often are food choices often are movement habits often why we do certain things is because of the stresses in our life so what happens in January every January in the US and the UK New Year New Year time to get healthy right so what are the two commonest things that I see people doing in my clinic I want to reduce sugar or I want to reduce my booze right those are two commonest things so what is the pattern that I see is this for a week for two weeks maybe for three weeks willpower gets them through it's like yeah getting sugar out the house I'm not going to have it this year is going to be different it's not going to be like the last few years this year I get on top of things same with alcohol you know I'm now not going to drink yeah I've I've overdone it over Christmas and New Year that's it now I'm in I'm sorting my life out one week two week three weeks then those helmets start to quit back in and my view on that is in a lot of cases it's because the sugar or the alcohol was serving a role in someone's life of course uh of course I know it's super obvious to say it but what they're doing is that and the reason I'm explaining is I think people will be listening to this and somebody there is going to go yeah that's me actually I do that every January but I can never get past January the 14th and if you are using sugar or if you're using alcohol or if you're using anything to soothe the stresses in your life I think many people are going to be very limited in the change they're going to make unless they address the underlying stresses address the underlying stresses then you no longer need to engage in the same behavior I'll give you another example I had a patient who was a I can't remember his job he was sort of some sort of managerial position in a company and he came to see me for you know a whole variety of different reasons the point was is that when we looked at his lifestyle it was quite clear to me what was happening so he would drink a lot of alcohol and it was affecting his relationship it was affecting the um his sleep it was affecting his performance right but he wouldn't you know he wouldn't drink every day but what would happen when you looked at his week as he would start drinking on a Wednesday so what happens when you unpack his life Wednesday just after lunch he has to present a team meeting he finds it incredibly stressful so by the end of Wednesday's work he is super amped up he goes straight home and he wants to unwind so he opens a bottle of wine has a glass one glass turns into two two cents into three and before you know it Wednesday he has a whole bottle of wine therefore doesn't sleep well wakes up tired feeling a bit angsty needs more caffeine to get him through by default of that happening he's quite anxious throughout the day feeling stressed throughout the day because he's drinking caffeine all the way into the afternoon you know he then drinks more at home on Thursday affects her sleep and this passing continues whereby come Friday it's two bottles of wine come Saturday it's two bottles of wine and Sunday he spends just recovering for the week ahead now what did I do of course as you well know which there are multiple things at play here but in this particular instance I helped him we sort of unpacked this week and I helped to say hey look you know what it seems that on Wednesdays things start to go wrong so is there something else that we can maybe think about doing to de-stress and he said well you know we looked at a few options there was a yoga class I was just gonna say yoga class right after okay you should we should swap places man in fact you guys are my go ahead I'll come and live in uh study California so what happens next is that he goes okay fine so Wednesday straight after work before going home what does he do he goes to yoga now he was a little resistant but again he was seeking help so he came to see me so he goes to yoga within weeks everything changes when he comes back he reports what happens on a Wednesday now he relieves that stress at yoga he goes home feeling calm feeling presents changes his relationship with his wife he still has a glass of wine on a Wednesday night but it's one class doesn't affect his sleep as much he feels good on Thursday again he'll have a glass of wine on the Thursday not the whole bottle and you know ultimately over the course of a few weeks it completely transformed things so that was the trigger point for him in the week so I hope that people listen to this someone's going to identify in their own life and go wait a minute yeah this is that's like a similar person for me maybe if I can manage my stress in a slightly different way maybe those knock-on consequences will be different and so look these are individual cases but they apply to all of us in many aspects of our life yeah I think basically what you're doing is you're telescoping up on the on the on the whole situation and trying to get at the root causes of of these things so that the solutions that you're implementing are taking into consideration the downstream impacts of these Behavior so instead of just saying well don't drink a bottle of wine you're looking at what is causing the person to make that choice in the first place and then you see the Domino impact either way either positive or negative to what happens to that which I think is I mean that's that's the way to address these things you know this has come from experience because what what is all public health messaging it's you know eat less of this move more you know you're drinking too much alcohol you know doctors over and over again tell me um this stuff is all great dots charity but um you know patients just don't do what we tell them to do I would argue that that phrasing in itself needs shifting I gen generally get really good compliance with my patients like I do not say that's a boast I say that because I really think that when you communicate effectively with them right people want to change people don't want to come in and not follow your advice people don't want to take half a day off work to come and sit in a wasting room wait for 20 minutes whilst you're running late to come in and see you so that they can ignore your advice people want to feel better I that is my number one belief in my job is that people fundamentally want to feel better they don't really want to be there so let me help them feel better so what is leading to that idea that patients don't take the doctor's advice is it in the delivery uh in the in the manner in which these practitioners are trying to advise the patients like where is that communication breakdown look I think conventionally if we look back over the last 30 40 years there has been a certain tradition in medicine this very paternalistic relationship that I have a problem I can tell the doctor he's gonna he or she is gonna figure out what the problem is give me a diagnosis and then give me some form of prescription usually a pill to take to get rid of it and again I will make the case that maybe 30 40 years ago that works super well like if you can we're coming in with an acute problem like a pneumonia and you know you're coughing you can't sleep you've got sweats hey don't to help me you know they listen they might take some tests hey you have got pneumonia that's the overgrowth of this bug I've got a pill for you that is going to kill that bug and you will be better right that approach has worked and still does work of course there are unintended consequences of that in the example I gave but that approach I think does work and the whole medical system as you've alluded to already is set up around that model we are not set up a to look for root causes people online will say yeah we are this is all nonsense you know all doctors look for the root cause I'm sorry but I disagree because I know what our training is and we're not really trying to look at it because I don't think we had to in the past so a I don't think we're trained to do it B I don't think the system is set up in a way that allows us to do it and look if you are a busy tired stressed out doctor and you have like in the UK a NHS GP we'll see between 30 and 50 patients a day right I get it right you're sitting there you've got five people waiting outside the easiest thing in the world is to give a prescription because you can get that done quickly and run on time and start to build through your backlog but also I think the way we're taught and the way often in that rushed setting that we deliver this information is I think it's I think it's destined to fail like if you have a patient right who comes in terms of diabetes is the obvious example to use right the patient's in front of you and um you've got their tests right let's say they're coming in for some blood tests they're trying to figure out what's wrong with them why they're so tight you run some blood tests and they've got um type 2 diabetes but they don't know this so I actually do this at role play at the end of the course that I teach the doctors to demonstrate just how different these things can go so the convention one is this patient comes in knots on the door hey Brian how you doing um yeah doc you know what I'm feeling knackered I've got these blood tests I wonder if I could get the results yeah yeah sure so without looking at them looking at the computer so looking at the screen going yeah you know you have got something called type 2 diabetes right that's a chronic illness um it's a bit of a problem because we don't get on top of it it may lead to heart attacks it may lead to uh amputations in your leg it's the commonest cause of blindness in this country so we really need to get on top of it now the good news is we've caught it I've got some drugs for you we're going to start you today on Metformin normally within a couple of years we need to add a second drug um sometimes we then have to go to insulin which are injections but don't worry we've got it all under control I'll get you seeing the diabetes nurse and we'll get this stuff licked okay Brian's in shock as he gets up and walks out the door and he's like hey but also Brian you know if you can lose a bit of weight and go to the gym that would help as well okay so Brian walks out yes you've given lifestyle advice but what does he take away he takes away that oh well 99 of that conversation was that we didn't mention lifestyle I mentioned this drug and that they've got this under control for me cool but I can keep going doing what I'm doing if you that sounds like I'm I'm making this up but that's an extreme example I can guarantee you that is how some of these consultations go down there'll be people listening to this who have been in that conversation now I'm not having to go with the dot set because I do recognize that things are challenging but what about the same scenario where Brian comes in you make eye contact with them you don't look at your computer screen you have a conversation with them find out what he's concerned about and then you say hey look something actually has come up Brian um do you know anything about blood sugar well a little bit you explain how your blood sugar is a little bit higher than we would ideally want now it's actually gone into the range of something that we call type 2 diabetes do you know what that is no adults who I don't know what that is okay look it's a condition that actually it doesn't develop overnight you have not just got this in the last week or the last few months this has been going on in your body for maybe five years maybe even 10 years this has been building up now look there are a couple of options yeah there are some drugs that we we sometimes need to use but if you're open to this I can help you look at your lifestyle and try and figure out with you what are the various factors that may have led to this are you interested yeah doc yeah if you can let me know what I can do That'll be amazing and if you go down that road and you spend the time connecting and spend the time explaining to them what they can do and what they feel is achievable I think even within 10 minutes you can get good results but this is communication yeah right so why aren't medical schools training doctors to better communicate with patients particularly if compliance is an issue it seems like that should be part and parcel of what it means you know to be trained as a doctor like you're going to be you're going to spend your entire career communicating with patients telling them what to do what's wrong with them Etc shouldn't there be a there's a there's a skill to that right to do it effectively yeah you know one of the things I'd say from certainly when I was going through a med school applications and from what I understand it's not really changed that much although they have tried to evolve that is not anywhere in literally how you are assessed it is one of your grades right what is your interview right now I guess an interview on some level is uh looking at your ability to communicate I get that but I think I think the whole landscape has changed what we needed in doctors 30 years ago is frankly not what we need in the bulk of our doctors today it has moved on and therefore the skill set that a doctor requires in the 21st century is fundamentally different in my eyes and the skill set a dots are needed in the 20th century so it is about saying yes we should be assessing it I think that's important but also we should be looking at can we train it like I think you probably can train it you can teach people some skills of how you do it how do you actively listen how do you not interrupt the patient story you know basic things that frankly I would argue it's not just about being a doctor if you want to communicate with your partner with your wife with your children right it's the same skill set so given that most of what we now see as doctors is driven by Collective modern Lifestyles I say 80 is driven by collecting modern Lifestyles well does it not stand to reason that actually these sort of with life skills that we need to be able to communicate effectively are probably top of the tree when it comes to being a dancer yeah well I think it is changing slowly we're seeing the the growth and the Advent of functional medicine and uh you know there are more and more people like yourselves who who understand this and are and are stepping into a new way of practicing medicine so I'm hopeful in that regard but it does seem like there needs to be some systemic changes in updating the education and also the continuing education right I mean you have to do all this continuing education all the time like couldn't that be built into that as well I mean Rich what I'm trying to do to help this problem is um because I was talking about it in the media for years so I'm saying this is a problem and we need to change this and I was thinking yeah but what do you do it's already about talking about it but then what is the solution I thought you know I've I've hopefully inspired millions of people with my TV showing that all these chronic lifestyle driven conditions can absolutely be turned around and certainly dramatically improved by making small changes to key areas in your lifestyle and then I thought with a colleague of mine drain panja we were like do you know what should we just set up a course should we just create one and we did it and we we've created the first in the UK and Euro it's the very first course called prescribing lifestyle medicine that is accredited by the Royal College of GPS now that is important because it gives it gives us a gravitas to the course it gives it a stamp of approval that people may not otherwise give it and it was very hard to get accreditation we had to jump through a lot of Hoops we probably had to compromise various aspects of the course that we ideally wanted but nonetheless we've done it and we have a 95 95 more than 95 of attendees so far I think it's the best course they attended highly recommend it to their colleagues and we have not just had Primary Care practitioners we've had consultant cardiologists come psychiatrists nurses pharmacists because this is a problem that is systemic in medicine now we probably trained nearly a thousand a thousand Healthcare professionals so far in the past 18 months and we've got big plans on how to expand that now people always say you know what it's like you do anything and there's the naysayers it's like oh that's fine but it should be compulsory medical school oh that's fine but you're never going to make change like that and I'm like well hold on a minute five years ago this course didn't exist as soon didn't have any credibility this year we've got a fully accredited course where people can come and get their CPD points that is progress at every single event we invite some medical students for free to come they come give us feedback we are talking to medical schools this is how change happens I'm not saying we'll get there right I don't know if we'll get there but this is my effort to try and contribute to this process and say Hey look this this course is fantastic um please come if you're interested but you know here's the problem Rich we're still relying on a doctor who has an interest who is prepared to give up a Saturday and pay the money to come and train the course right so in many ways you're you're only attracting the people who've got that interest right yeah but you started you know and you got to Fan the Flames of positive change yeah right this is this is forward progress so yeah and so hopefully in five years time this will be a part of medical school training right or it will be compulsory we can only hope right well let's drill down into stress a little bit more deeply this book opens up with you saying listen 60 to 80 percent of the people that come into my office uh have some kind of stress related condition the World Health Organization has has qualified stress as the epidemic of the 21st century like this is something that we really need to look at um stringently and figure out protocols for redressing and I feel like the word stress is used very cavalierly like wow we're all stressed I'm stressed out I'm anxious or whatever but perhaps it might be beneficial to like Define the term like when we say stress like what do we actually mean and what is happening biologically physiologically in the body when we are under this form of duress I mean I would agree with you that the term is slightly problematic I think we do use it there's common parlance now not a day goes by where you do not hear the term right you talk to a buddy you're not spoken two in a while hey mate how you doing you're yeah yeah mate I'm okay I'm not too bad a little bit busy a little bit stressed but I'm okay it's it's become that normal and so I guess taking that 30 000 foot view fundamentally what stress is because stress is different for every single person it is a perception it is perception when your body feels that it's under threat that it is in danger that fundamentally is what I think stress is now how do you explain that because that statistic you mentioned and it comes from the Journal of the American Medical Association 2013 there was a paper where they did a little study and they said that up to it's actually 70 to 90 percent between 70 and 90 of all conditions that a primary care doctor sees in any given day is in some way related to stress that's bananas that is bananas butts I'm going to explain why I think it is quite easy to understand when you understand what the stress response is so let's go back again two million years right two three whatever we go back a couple of million years ago and understand how our stress response evolved so we were again in our hunter-gatherer Community getting on with our business doing what we need to do and a wild producer is attacking or approaching we get scared in an instant our stress response kicks into gear so what happens then well the series of physiological changes start to take place that are designed to keep us safe so I can't list them all but let's go through it through some of them your blood sugar starts to rise great that means you're going to deliver more glucose to your brain that is fantastic in that in that threat scenario your blood pressure starts to go up so you can deliver more oxygen to your brain your amygdala that's the emotional part of your brain right that becomes hyperreactive so you are literally hyper vigilant for all the threats around you your blood starts to become more prone to clotting so that if you were to get attacked by that lion and that predecessor you're not going to bleed to death your blood's gonna clot that's going to keep you safe these are very very smart complex mechanisms that are designed to keep us safe the problem is quite simply is that now in the 21st century many of us are having our stress responses activated not to Wild practices but to our daily lives to our email inboxes to our to-do lists to the fact that we've got competing demands at work to the fact that two parents are working and someone's trying to rush home to pick up the kids the fact that actually we're living separate from our family so we'll have to do all the child care ourselves we don't have grandparents around us to the fact that we may have elderly parents now we're looking after as well as looking after a young family for many of us that is activating our stress response so what happens well those mechanisms are so helpful to us in the short term it starts looking problematic blood sugar going up is fine for 30 minutes if your blood sugar is going up day in Day Out well that leads to fatigue obesity high blood pressure and ultimately type 2 diabetes just from being stressed and I go back to saying what I said before what the whole conversation around health is dominated by diet and movements talk about type 2 diabetes it's all about which dietary tribe you subscribe to I can tell you that stress is a very very key player when it comes to your blood sugar and I have put many cases to talk to diabetes since remission yes I changed a diet for sure but when the diet plateaus the way I got the blood sugar lower was by addressing their stress levels so blood sugar problem helpful in the short term harmful in the long term blood pressure again same thing great if you're running away from a tiger create if you're in your spinning class in the gym it's an appropriate response to that stressor but if that's happening to your email inbox that's a problem what about your emotional brain right the amygdala I just said when you are trying to escape a predator you become hyper Vigilant to all the threats around you that is appropriate if you go to Downtown LA tonight and it is dark and you are walking down a dark Street and you think somebody is following you you know what you want your amygdalas to go on high alert you want to be hyper Vigilant to all the threats around you if that's happening day in day out to your life that's what we call anxiety right so suddenly this very complex mechanism when you simplify it white down we can start to see why up to 90 of what I see as a doctor is in some way related to stress but what about the things that it switches off right we've spoken a bit about relationships so libido is a big problem these days I've been practicing for nearly 20 years I'm seeing more cases of low libido now than I've ever seen not a week goes by where I don't see a young male in their 20s complaining of low libido this was not happening even five years ago certainly in my practice there are many factors to consider but stress is probably the biggest in my view again go back two million years you are running away from a threat in that moment you need to prioritize survival you do not need to be able to chill out and procreate with your partner right so your body switches are off right it it it all it almost sounds overly simplistic but I love Simplicity because when you understand it simply you start to realize hey I understand now why anxiety why low memory by poor concentration why insomnia while low libido why hormonal problems why obesity why type 2 diabetes can all have stress as a key player got problems right last mintel survey in the UK showed us that 80 percent of Yuca adults have complained of some form of GI problem in any given year why now food of course is a fancy but I would argue that stress is a bigger Factor because what happens again just like libido if you're running away from a lion you don't need to be able to digest food it should get Switched Off just like that and I tell you one thing that I've discovered in my practice for maybe the last two two and a half years a lot of people feel that they are reacting to certain foods and and I say that they are reacting there are intolerant to certain foods and I have gone through many years asking people to maybe avoid certain foods for a short period of time as a trial then reintroduce and see what happens but what I've discovered since I've really dialed into stress is sometimes people are actually not reacting to the food they're reacting to the fact that they're eating in a stressed out state so when I teach them on my patients breathing techniques and I say look you really need to have some sort of switch off between your work and your eating I am not casting judgment on anyone I also often will buy my healthy organic whole food lunch and I'll still be working and doing my emails whilst doing it right but you've got to understand you might be eating the right thing but if you're not eating it in the right way there could be a consequence and some of these patients no longer react to those Foods when they change their state before they eat which literally was mind-blowing to me because those patients in the past I had us into remove that food for a period of time so it is so so powerful and I I kind of reflect on the French when I think about this because there is this this whole French paradox right you've heard of this right it's right well they they eat all these crazy foods and uh and they don't have the Obesity problems and the chronic disease problems that we have and so why is that is it their de-stressed lifestyle they take you know ex you know their meal times are are are sacred and elongated compared to you know what we do here in America same in the UK look I I've recently been thinking about this a lot because there are multiple theories why the French paradox exists but with the knowledge I now have a stress I would have to say that there's a very powerful case to be made that actually the way they are eating means that actually their food is going to have a different impact on their body it's going to do it's going to do something different if you prioritize a 90-minute lunch break where hey you know what it's lunch time we're not doing that call we're closing the computer we're sitting down we're chilling and we are now going to have lunch time right of course when you understand the stress response it is going to do something different and I actually had an interview with a French journalist last week because my uh it's because my my first book has just come out in France and I asked her at the end of that interview I said hey look can I ask you is does that still go on I've spent a lot of time in France for skiing for sure but I was saying does that still conscious Yeah by and large it is still what goes on now in some of that heavily urbanized places like Paris and some of the companies where there's a lot of international people working there it is starting to get eroded away which kind of makes sense but I don't know I find it so interesting well I get the the the idea that when you're in a stressed state it restricts blood flow to your digestive system but what is the impact on the microbiome or why would that lead to some kind of allergic reaction to a certain kind of food yeah well first of all I'm not saying uh true allergy we've got to be very careful that we distinguish allergy from intolerance that's a very different biological mechanism so you know I think it's important just to clarify that if you have a true allergy that when you eat some food you get um you know you get red cheeks and your lips start to swell I'm not saying in that instant but I think some of these milder intolerances or not so mild many things happen your microbiome changes with stress it's not just food that impacts your microbiome your stress levels you that has been shown time and time again um your digestive enzymes so in order to digest food whatever is you're eating you need the presence of certain digestive enzymes to digest that food if you are switching off as a very Broad and non-precise term your digestion the levels of digestive enzymes go down so it can affect multiple different organ systems it can affect various different things in your guts I have found over and over again now not only for intolerances that with gut problems I am more and more focusing on the stress around how they eat and I'm getting great results from doing it I had a patient right who had Crohn's disease right so Crohn's disease for people who don't know is one of the inflammatory bowel diseases people often have severe stomach cramps that will often have uh they have to go to toilets maybe up to 15 20 times a day there'll be blood there very very physically unpleasant socially unpleasant a few years ago I had a patient who was under the gastroenterologists um she had tried the various drugs they didn't work that well for she didn't like the way that they made her feel so she ends up at my door I suck trying to help her now granted I did start with diets I thought okay let's see if we can change some things let's see what happens and we got a bit of an improvement for sure and she was feeling motivated and inspired that okay this is great you know I'm finally getting some control over this condition then I don't see her for a little while and she plateaus she comes in to see me I haven't seen her maybe in six months and I'm talking to her and she's like that's Jazz you've got to do something um what else do I need to you know do what do I need to add to my dad what do I need to cut out looking really fast um and I started to start to unpick her life a little bit and it was really clear to me I was just trying to picking up on this this sense of background anxiety she was rushing around she was like many of the female patients I see in my practice they were so caring they were nurturing she was looking after her husband she was looking after the kids everything she did in her life was for somebody else and she was not doing anything for herself and there was many things to do but the first thing I started off with her was with I said look I know you want me to give you some more advice on your diets I know you might want me to refer you to a nutrition professional maybe to go deep into this but just hear me out I think that's not the lever to turn at the moment I think the background stress that was in your life are playing a role here and I wonder if we could try something better she was resistant because in her head it was all about diet so she wanted more dietary advice and I said look all I want you to do is I want to take I want you to take a bit of time for yourself every day just 15 minutes right so this is not deep breathing before a meal this is just saying look do something for yourself 15 minutes a day and if you can once a week on which is something that you're really really passionate about that you've always wanted to do and you've never done anyway so we also did what's called an msq a medical symptom questionnaire so I scored the level of her symptoms she goes away a month later she comes back she feels like a different person her symptoms have gone down by 50 50 now she still has Crohn's disease she still has symptoms it's just significantly better I said what have you been doing so well you know what every morning when I drop the kids at school I now park the car leave my phone in the car and I go for a walk in the local park for 15 minutes okay great what else do you do doc I've always wanted to do salsa dancing always I've never done it but you give me the cake so every Thursday night I go to a salsa class now this was just a month rich but I have followed out so I've seen what's consequently happened what does this tell you this tells you that there are multiple facets going on in everybody's life that can impact every organ system in the body I have not got rid of her condition she still has Crohn's disease but it is a damn sight easier on her and easier to manage now that she started to lower her stress level so when you ask a question what is stress well her stress right wasn't too many emails necessarily her stress was the fact that she didn't have enough passion in her life that she didn't do anything for her that made her feel complete that nourished her and so when you ask the question what is stress it's going to be different for different people and that is fundamentally what I try to do with this book is as completely as possible simplify the topic but then have these four concrete areas so I want the reader to be able to identify where does stress live in my life because you need awareness once you know where it lives you know what pick one of the simple things try for seven days and see if you feel different that is all I ask from someone I mean what's interesting about that example that you just gave is that the stress in that woman's life wasn't some external pressure it was an absence of something in her life right which is not how we really think of stress it was the fact that she didn't have something that was causing her that kind of duress that was contributing to her to her symptoms um and and it is interesting to kind of deconstruct stress and look at the different um faces that it has and you talk about this in the book you talk about like the MSDS the the micro stress doses that we get throughout the day it's not it's not that stress is inherently bad it's The Chronic stress or the repetitive nature of these little micro doses of stress that we're getting all day long throughout our day within moments of waking up in the morning that culminate in this chronic stress condition that's creating all of these problems but that's also very different from this thing that you call the adverse childhood experience like the ace which is essentially the idea that we've all experienced traumas in our life some more severe than others whether it's a childhood trauma or some experience that you had that even though it was in the past it still rears its head and contributes to your to your stress condition when it's sort of provoked through memory or some experience that you have throughout the day that reminds you of it yeah you know this is one of the challenges when I sat down to write this thing it was how do you explain what stress is and how do you also differentiate these different kinds of stressors like you mentioned adverse childhood experiences these are you know really significant and traumatic things that happen you know when you're a kid whether it's abuse whether it's maybe you know not having parents you know being an orphan all kinds of things that we know impact all of your life outcomes and I was trying to figure out how can you describe this and then I came up with this concept of micro stress Doses and macro stress statuses and I'm so pleased that this has taken off and like lots of people now use that in their classes lots of yoga instructors uh constantly on Instagram and say hey look I'm using this as a way of describing to people the difference and I think it's a very useful way of looking at your own life so a micro stress dose is a little dose of stress that in isolation you can easily handle but when they mount up one on top of the other they start to add up and they can start to become problematic so we have all got what I call our own personal stress threshold and it will probably vary throughout various different days of the week depending on what we've got going on depending on how well we've slept how many balls we're juggling but we have this stress threshold so let's say you wake up in the morning and you're feeling calm you can start accumulating micro stress doses bit by bits and the more of them you accumulate the closer you get to your own stress threshold when you get to your stress threshold that is when things start to go wrong that is when you have an unreasonable reaction to an email that you've received that is when you have an argument with your partner that is when you scream at your kids when they haven't actually done anything because you have passed your threshold and I make the case that many of us have had 10 to 15 hits of micro stress before we've walked out our door before we've walked out the door in the morning so what is the conventional not the commercial what is a common scenario these days okay work stressful come back I'm knackered I want to unwind I don't want to go to bed because then it all starts tomorrow so I'm going to stay up late on Netflix unwinding and and numbing what is going on in my life so I go to bed late right I set my alarm for 6 30 in the morning because I've got work the next day okay so you're in a deep sleep and at 6 30 your alarm goes off boom microstress day is number one because waking you jolting you from a deep sleep is a stressor on the body you look at the time you look at which will be on your phone you look at it you know what I I've got a few more minutes you press snooze at 6 36 boom alarm hits again micro stress says number two then you think you know what yeah I I better had to get up now so you grab your phone whilst you're sort of stretching in bed let me just look at my email oh man there's three work emails yesterday I didn't get router doing them I've got to do that today MSD my question is number three then you quickly go on to social media oh you know what someone's been mean to me on my last post MSD number four then you realize oh my god I've been in bed for 20 minutes I'm running late now I really need to get a move on and I'm not going to keep sort of laboring the points but you can very easily see how before you even leave the house in the morning you've picked up 15 MSDS and what does that mean that means you are closer to your threshold which means it's going to take less little hits of micro stress in the day to tip you over this is why I'm so passionate about having some downtime having some space in the morning to insulate yourself make you more resilient it's not just about reducing the stress in our life where we can I get some people live difficult lives some people don't earn much money they're working two jobs that is fundamentally stressful but if you can adopt some of these techniques and pretty much every single tip in the book is free and I'm super passionate about that but they are accessible to everyone you know what you can apply these tools to make yourself more resilient to the stress so let's say you've got a stressful life if you're going out of a house with only two micro stress doses as opposed to 15 you've got a much bigger buffer before you start to have problems and so I think that's a useful analogy I will say though even if you have had a macro stress dose one of these big hits of stress like you know like trauma of some sorts like physical abuse and I say this with the utmost respect of course that needs processing that needs probably to see a professional and actually untangle that but if you talk to psychologists if you talk to therapists they will tell you that it is even more important in those situations that you apply these principles because they will help keep you at a level that hopefully you can manage things a bit better than without so it really I I really do believe that this is a book for everyone whether you have macro stressors as micro stress doses whether you have too much stress in your life or whether you have not enough passion because these are Universal themes and I do think I have simplified it right now where people will think you know what yeah you know what maybe I can't do that I think I can do that yeah I think that uh I think you're absolutely right and what I like about the book is that it's it's very practical and solution I mean it's it's called the stress solution it's about the solutions right and some of these are are very easy to implement in your life like go for a walk turn your phone off go to bed early like you know very very like simple implementable tools morning routine whatever that may look like for you meditation mindfulness practices some of them are a little bit more ephemeral I mean your first bucket here is purpose and you know that's a that's a harder thing to kind of figure out for yourself everybody has their own relationship to purpose and you know I feel like there's a lot of people who live their lives relatively untethered and don't have a sense of purpose or what you know we both know the the okinawans call it guy which you talk about in the book and that's a journey right so how do you help I mean I think that's fundamental right if you don't have purpose then everything else is sort of a a house of cards well that that's the hardest one that's the hardest one that's why I started the book with it because it's the hardest and I think it's the most important because fundamentally a life lacking meaning and purpose is inherently a stressful life right it just is we all know that it the research backs it up not having a sense of meaning and purpose in your life is associated with much worse Health outcomes of course do we need science to tell us that no I'm feeling bad about the fact that you don't know what your purpose is is an added stress absolutely so let me clarify my view on this so I thought okay this is all about practical Solutions I like you love that Japanese concept of ikigai right I do I came across it I think on a Facebook post a few years ago and I was you know one of my it's a Dan buettner thing from Blue zones I didn't come across it with me actually he he helped kind of Usher it in because Okinawa is one of the blue zones and and their relationship with purpose which they call ikigai is fundamental to their longevity and happiness for sure and so one of my Facebook friends uh so if you're watching the video that was inverted Commerce friends um and to be fair I'm being slightly um you know I'm sort of trying to make a point which is probably not the best way of doing it but um I saw this post and she put this thing up about it he kind of saw these four circles and the middle area was shaded where these four things intersect you know icky Guy is when you find something in your life to do something that you love something that you're good at something that the world needs as something that pays you money and I read it and I think I read this pretty soon after my dad died which is very significant moment clearly for me and I remember reading that and I thought I like that and see a bit of icky guy in my life you know I want that and I started to reflect on it I think about it I thought I thought well this could be useful for some of my patients so I started to talk about this idea with my patients and I found many of them found it quite stressful to think about it how can I find one thing in my life that gives me this sense of icky guy that's just too stressful you know I'm I'm working to pay the bills and to meet the mortgage payments and to put food on my plate I feel ashamed that you can't master that and and what's super interesting to me is in January when I when the book came out in the UK and I was on my tour I was in London and I spoke about this and at the end people it was a q a and this Japanese student in London put her hand up you know so she she asks a question she says Chelsea I just want to add to this that I have grown up in Japan and I have heard about this concept of ikigai and I found it super stressful my whole life as I have to live up to this esteemed idea that is embedded in my culture and I find it stressful and I can't do it so that was super interesting I heard that from my patients I also heard it from a Japanese student in London so I'm not I I sort of pay homage to this in the book but then I come up with what I call the live framework I've come up created a framework that I think and I've seen very very practical for people of how they start to find meaning and purpose in their life because I get it you listen to this podcast on a train and you're thinking yeah meeting a purpose it's all very well for you two to talk about that you know what your life is different from mine so it's a very simple framework L is For Love I is for intention V is for vision e is for engagement now we don't necessarily need to unpack the whole thing but the point about it is you don't need to get all of these from one aspect in your life you can get them from different aspects in your life but it's a simple way to start moving you towards finding your meaning and purpose so what is the first L the first L is love it's about passion right so research shows us but regularly doing things that you love helps to make you more resilient to stress and I'm saying that resilience is super important but at the same time being stressed out day in day out makes it harder to experience pleasure in day-to-day things so one of the prescriptions I give people and I don't particularly like the term prescription but one of the recommendations I make is to have a daily dose of pleasure you can live just for five minutes now again just to bring this to life I had a patient 52 year old chat or maybe 53 you know early 50s chap CFO off a local Plastics Company right again comes in to see me he's worried daughter do I have depression what's going on I struggle to motivate myself sometimes I can't concentrate at work I feel quite indifferent about my relationships you know what is going on so as always I try and unpack different aspects of their life so do you like your job yeah not really you know it's so so I have to do it and I've got a family I need to provide for them I said okay fine how's your relationship with your wife you know what so so you know I don't really see her that much it's fine um do you um do you have any hobbies no time for hobbies that late I said okay what about weekends weekends I've got to do the household chores I've got to take the kids to their classes I don't have time for hobbies so the prescription I gave him the recommendation I made some at the end of doing this and again so that I don't get not that it matters if I get criticized but just so people understand I did do the safety nursing that has required of me I didn't feel he was an active suicide risk I didn't do all these sort of various things that I have to do as a doctor I did check but ultimately what I felt was he didn't have any passion in his life right and I said look did I know you don't do any hobbies now did you ever have a hobby well yeah I guess you know when I was a kid when I was a teenager I loved playing with train sets I said okay great do you have a train set at home I've got one at home it's in my attic I've not seen it for years I said okay look what I would love you to do when you go home tonight is to get your train set hands and you've got a smirk on your face right yeah I get it hey I have no judgment on people's Hobbies I had a train set when I was a kid well I thought you were I thought you were smoking on the fat butt the dot he came in to see me with a with a problem he was concerned about and my prescription was to get at is trying I know I'm with you on that okay you're with me on that okay so so he again he agrees to go and do this so he goes away I don't see him then it is not uncommon in general Practice in the UK for you not to be able to follow up every single patient you just simply cannot do that so I got on with my job I was you know doing my thing three months later I finished my morning clinic and then we have something called home visits in the UK where you know normally after your morning Clinic you will then have a list from reception of people who are maybe elderly and firm who can't get out of the practice and you go and visit them at home to look after them so I was I went to the car park it's going to do my home visits and I bumped into his wife and I said hey hey look um you know how's your husband getting on he said that's chassis I feel like I've got the the guy I married back again he comes home from work he's straight onto his train set he's on eBay all the time trying to buy collector's items and he's he and he's subscribed to this monthly collectors magazine now she's wearing his conductor hat the house hey but she's happy but I still haven't seen him right again roughly three months later I'm just going through my clinic as usual and I see his name pop up and he has had some blood tests at a well-man check and he's coming in to see me to go through them welcoming in and before we go into the book results I say hey look how are you getting on he says doc I feel like a different person life is great I said my mood's better I've got energy I said okay cool you know how's your job job I love it I'm really getting a lot out of my job now how's your relationship with your wife really really good I feel really close to her so just like that case I don't know how long we've been chatting for maybe an hour ago just like that uh story about the kids who was feeling low and who had a friendship deficiency did this guy have a mental health problem sure I think he had symptoms that would be consistent I could have made I could have labeled him and given him a diagnosis right and of course sometimes that may be appropriate although I have issues with labels because I think what that does to people that's a separate story or did this chap really have a deficiency of passion in his life and the remarkable thing for me is when that passion deficiency gets corrected not only does he feel better in himself but everything else in his life starts to come back online the job that he couldn't stand before now he enjoys the relationship that was a bit tired and he felt a bit indifferent about now he's feeling closer to his wife and you know this is why I'm trying to make the case that this this live framework is applicable it is achievable if you are listening to this and you want more meaning and purpose and you don't know where to start I challenge you when was the last time you did something you love right if you haven't done it recently scheduler in your diary it doesn't need to be fancy it doesn't need to be swim run like we did at the start right for many of my patients I say give yourself five minutes a day for a daily dose of pleasure that could be going for a walk that could be reading a book listening to a podcast it could even be coming home from work going onto YouTube finding your favorite comedian and laughing for five minutes so when we say meaning and purpose is unattainable for many people I disagree because if you start with small small steps I mean you could call them hacks I know you're not a huge fan of the hacking worlds and I wouldn't call them hacking in the same sense I'd call them you want to get to a certain destination the destination seems too far away so let's look at a signpost that's nearby let's just break this down make it super super simple do something for five minutes a day that you enjoy do that consistently week after week and you will start to find other things in your life that will bring you closer to meaning and purpose that's just the L right but I'm super passionate that we can all Find meaning and purpose of course it's harder this guy didn't find a zooky guy right this chap I just spoke about he's not quite his job and is now living on a beach and um living his kind of um this romantic idea of what a beautiful life looks like no he's just found passion in his life and suddenly his day-to-day life that was monotonous before suddenly is vibrant and I'm so passionate about this Rich because it's not as hard as we think it is take small small steps small steps are everything I mean I think what happens is people I mean it goes back to what we were talking about earlier but people see read hear this message uh follow your passion and it does have that shame provoking you know unintended consequence to it um and it just seems overwhelming and intimidating because that gets associated with quitting your job or you know sort of you know being a digital Nomad or like making these massive you know seismic shifts in your life but and and and that may be the ultimate trajectory if you keep pulling on that thread like maybe that train guy is going to reinvent himself and become some kind of you know like toy train entrepreneur who knows but more likely than not it is just having the wherewithal to set aside a little bit of time to take a tiny step to like Embrace some aspect of of what you love I mean that's how it started with me like I just I went back to the swimming pool and jumped in the water you know it was nothing more than that and it's led to me sitting here with you in in a manner I could have never predicted in a million years but the tiny First Step that seems meaningless and unconnected to uh ephemeral Concepts like ikigai and passion is where all of these things are seated yeah for sure and you know this is such a fundamentally important Point not only under the umbrella term of stress just for just our overall well-being you know how we feel about ourselves it's very hard to do that without passion it's very hard to do that unless there is some overarching objective or Direction in your life where you are going and I get it many people don't feel that they can have it this is why I drill down I think so hard how do you make this achievable how do you bring these kind of really lofty Concepts and ideals how do you bring them right down to something that someone who's working in a council flat who's working two jobs who feels that there is no way out to something that they can apply and you know I know this stuff works because I've been using these tips with real people busy people with busy lives and you pointed it out that's it it's not about necessarily that first step of course that's very important but who knows what that guy will be doing in five years he's he's now on the road to that destination well there is no destination but he's on that road on that Journey towards meaning and purpose and it starts with those small steps [Music] so we are headed into uh holiday season the most stressful time of the year by the time this podcast comes out we'll be you know more in the thick of the um this is this is the moment where stress Peaks people are with their relatives they're in high stress situations there's a lot of pressure to show up for other people and it pushes people over the edge so I think it would be really helpful and instructive to kind of provide some guidance for how people can better navigate the minefields of the holiday season yeah for sure you're right it is it is all over the world I think well certainly in in the countries in which we live it's it's a Time fraught with problems um pressures external pressures things that we feel that we have to do there are so many things that we can do but the the thing that is rising to the surface of me now is think about downtime right we need downtime we thrive on downtime our brains thrive on downtime you simply cannot get up go on your phone consume watch what the world is giving you reacting go to after work drinks go to all these family engagements come back lie in bed consume more you simply just cannot do that without there being a consequence you will be accumulating micro stress dose after micro stress test and you will go over and it will lead to family arguments it will lead to a round with your partner it will lead to you getting uh stressed out at work and falling out with your boss it is all the consequence of that framework of micro stress Doses and where is your stress threshold you need to minimize the micro stress Doses and you need to take active steps to increase your resilience so well let's call it simple you mentioned a morning routine right I'm a huge fan of morning routines and the framework I create for people is a morning machine has three M's and the way I see it mindfulness movements and mindsets so if you want a morning routine you don't know where to start think about those three M's now you can personalize them to your own life if you have got an hour in the morning great if you've got five minutes you can still do it in five minutes mindfulness that could be meditation it could be breathing um you know whatever you want can be mindfulness whatever appeals to you movement anything you want do some push-ups do some yoga stretches and then mindset mindset is do something to put you in a positive frame of mind that can be reading a book that you enjoy that makes you feel good it could be doing some affirmations like I often do with my daughter now to really be clear on this I have a patient in particular who says these morning routines they sound great I'm too busy I've got to get the kids ready I don't have time for this she now I have persuaded her to try it and she now sticks religiously to her five minute morning routine right so my own routine tends to be about half an hour I have that luxury now I didn't always but hers is five minutes so what does she do let's break those three M's down first and mindfulness she does deep breathing for one minute when she gets up right she she does a breath I've taught her that I really like all the three four five breath when she breathes in for three she holds her four and she breathes out for five now that is one breath in the book there is a whole breathing menu with six different breaths if you don't like that one don't do it choose one that you do like so that's her one minute of breathing then what did she do for her next two minutes she does some sun salutations but she learned in her yoga class just two minutes then what she does she reads a book that she likes she keeps she keeps five books there and she picks one she reads a few pages just the act of having five minutes to herself in that morning actually transforms the rest of her day she this particular patient had really bad eczema her asthma has gone down dramatically since she started doing this morning with saying when you understand the physiology of course that makes sense stress ultimately impacts the immune system eczema actually at its core is a slight dysfunction of certain parts of the immune system therefore if you can impact the immune system you stand a chance that you actually might be able to reduce your eczema not in every case but in this case so have some time to yourself really be mindful of that and if you find a morning routine helpful start there now the next thing I'd probably say to people is think about how much you've moved right yes we know physical activity is important but fundamentally if we go back to too many years ago when we think about our stress response what is the stress response designed to do it is priming us for physical activity nowadays the stresses are coming in such a way like you know we're sitting on our butts at our desk and our email inbox is stressing us out or the fact that actually oh man I am exhausted today but everyone at work's going out tonight and then my sister's flying into town tonight man I just want to go to sleep right so I would say have you moved enough just ask yourself have you moved if you haven't just make it a priority every day to do something even if it's a 10 minute walk at lunch time put your phone down go outside for 10 minutes and you will start to burn off that stress in your body those are two simple things right when you're traveling if you're traveling to go and see your family right and this applies not in the holiday season as well the people are traveling to work and they're getting stressed out use that travel time to really to really look after your mental health right don't put the news on don't listen to what Trump has just tweeted right own your mental space own what's going on in there use that time to listen to relaxing music listen to an inspiring podcast pull up the calm meditation app on your phone and put your headphones in and meditate for 10 minutes I am not asking you to do three hours of yoga every day even though that will help you right I'm asking you to just think about have I given myself a bit of time today if you are getting stressed out at a party at your family are there your mother is stressing you out right your mother-in-law let's say you know or whatever check in with your breath it's a cliche it is the biggest cliche just breathe if people understood what breathing actually does on a fundamental physiological level we would all be practicing every day breathing is information for your body when you're feeling stressed when you've got deadlines that you're working away for you will not realize that your breathing will change you you'll start to breathe more from your chest than your diaphragm you'll breathe quicker your breasts will be more shallow and what does that do that sends messages to your brain that I am in danger that there is a problem and that gets you in a vicious Loop where you start to breathe faster now the great news about that is is that you can very easily change that situation if you consciously change your breathing you can change your physiology so if that's happening you're at a party uh whatever there's a work do you know what maybe go to the restroom or go go outside and just for two minutes breathe do the three four five breath if you don't like that one do a box breath where you breathe in for four hold for four breathe out for four hold for four I guarantee if you do that for one minute or two minutes you will feel calmer and the way you deal with that situation will absolutely it will change you will you will be less reactive alcohol right I get it it's a time of year where people like to drink fine I recognize that that is something people associate with that time of year just be mindful of the facts that alcohol will trash your sleep right there's no other way of saying alcohol trash is our Sleep Quality if you've been out for a few nights on the bounce and you're tired you know what learn to say no just just look it down and go you know what do I need to go to every single social engagement or can I get you know I've gone to two this week maybe I'll just stay in one night and you know I'll reset my stress threshold by having an early night and going to bed and then maybe I'll go out tomorrow nights if you're out drinking maybe can you just reduce it a little bit you know if you like to have a glass of wine when you're out fine most people who drink when you talk to them sober will tell you and I appreciate you know I appreciate that everyone's different on this but for most people the enjoyment comes from that first drink I shouldn't say for most for many people right there's kind of diminishing returns after that I mean you may have a different perspective on there so I'm sort of yeah I have a I have a whole other thing on that but go ahead okay okay I'm gonna say some people right right they will find that actually their enjoyment comes from that first drink that just little feeling of unwind from the day you know maybe have that first drink enjoy yourself stay out and then I don't know don't go don't go overboard because what happens in holiday season I don't ever really thought about this not really been asked this but once in holiday season is fundamentally your micro stress doses add up there are more micro stress doses in your life so you are operating near to your stress threshold much more than you ordinarily would so anything that pulls you away from that is important if you now want to switch your attention to the morning click here where I walk you through how to create the perfect morning routine to help you with your health and happiness you've actually made yourself more resilient you've moved yourself the other way you've actually lengthened the distance between where you currently are and your stress threshold and where you're going to be after that morning routine

Channel: Dr Rangan Chatterjee

Views: 379,534

Keywords: the4pillarplan, thestresssolution, feelbetterin5, wellness, drchatterjee, feelbetterlivemore, ranganchatterjee, 4pillars, drchatterjee podcast, health tips, nutrition tips, health hacks, live longer, age in reverse, self help, self improvement, self development, personal development, motivation, inspiration, health interview

Id: IAgj3DLN8p8

Length: 115min 44sec (6944 seconds)

Published: Fri Dec 09 2022