Dr Rangan Chatterjee: And I think for anyone listening to this podcast, I really would encourage you to think, when was the last time you did something that you loved, that you did because you wanted to do it, not because you needed to do it, not because you wanted a new post for Instagram, but something that you actually genuinely thought, I'm doing this, I don't care if anyone sees me do this or not, this just makes me feel good. That is a big part of health and that's a big part of lowering your stress levels.
Dr Rupy: Welcome to the Doctor's Kitchen podcast. Today, we're going to be talking with Dr Rangan Chatterjee about how to deal with stress. Make sure you pick up a copy of his book, The Stress Solution, and you can pre-order my book, Eat to Beat Illness, in all good book stores and on Amazon too. Rangan is an NHS GP, is a lifestyle medicine advocate, he's also co-founder of the Prescribing Lifestyle Medicine course, author of The Four Pillar Plan, and host of Feel Better, Live More, the podcast series. If you've ever wondered what stress is, how it can affect your health, or what things you can do to help yourself with stress, you're going to love listening to this pod.
Dr Rangan Chatterjee: Rangan, welcome to the show.
Dr Rupy: Rupy, thanks for having me on.
Dr Rangan Chatterjee: It's a pleasure to have you back. This is the second time you're on the show, and the first time we talked about eat to beat type two diabetes, we talked about sugar control and inflammation, and it was probably one of the most popular shows by far. Lots of people have loads of questions. And now I'm really excited to have you back on because not only are we going to have a great chat about stress, but it's going to be based on this fantastic new book that you've got out, The Stress Solution. Do you want to tell us about a bit about how that came about?
Dr Rupy: Yeah, I think, you know, Rupy, that we are both practising doctors, seeing patients, and I've realised more and more that basically so much of what I see each day is actually driven by stress. And you know, there's a paper from 2013 that says that up to 80% of what a GP sees in primary care on any given day is in some way related to stress, which is a staggering statistic. The World Health Organisation are calling stress the health epidemic of the 21st century, which again is a pretty alarming statement from such a prestigious global organisation. And I've got to say that that really reflects what I see in practice. So every day, like you, I'm seeing problems such as anxiety, inability to concentrate, poor memory, insomnia, a lack of libido, which I'm seeing more and more of, gut problems such as irritable bowel syndrome, even things like obesity, blood pressure, even type two diabetes. All of these things, although many of them seem quite separate, all of them at their root cause have as a key driver, stress. And I don't think we're talking enough about stress because we can't really see it in the same way that we can see our food and our diet or it's something that we kind of know is there. On any given day now, I'm sure I will hear the word I'm stressed on multiple occasions. You catch up with a friend, hey mate, how are you doing? Yeah, not bad, pretty stressed, but things are good. It's common parlance now and I think all of us in the 21st century need some form of stress-busting strategy, whether we think we do or not.
Dr Rangan Chatterjee: Yeah, and I think it's that B word as well. We're all busy, we've all got very active lives and it's almost like a badge of honour to have this busy label as well because it shows to the outer world, you know what, I've got things to do and that makes me, and it kind of validates my existence on the planet. And I think it's really interesting what you picked up on there from the WHO because it really has become one of the commonest cause, or the commonest cause actually of disability in the industrialised world.
Dr Rupy: Yeah, it's mental health problems.
Dr Rangan Chatterjee: It's so common. As I say, if someone's feeling tired, it could be stress-related. If someone has no libido, it could be stress-related. Gut problems, there is almost always a stress-related component to them. Irritable bowel syndrome, for example, which affects up to 20% of the UK population at some point in their lives, which causes a huge amount of disability for people, social embarrassment, physical discomfort. Yes, diet plays a role, no question, but stress plays a key role as well. We know it's a disorder of the gut-brain axis and I cannot get my IBS patients fully better unless I also employ stress management techniques as well as changing their diet. And you know what you're always doing, Rupy, very similar to me is we're trying to inspire people to be proactive about their health, to actually look at their lifestyle. Yes, sure, food, but also their movement, their sleep quality, but also their stress levels. And I'm finding more and more, if I relate this to real-life patients, that often the reason they're unable to sustain behaviour change is because of stress. If someone is trying to give up sugar, which is pretty common, particularly at this time of year, then often the underlying driver behind that is stress. So for a week or two, someone can willpower it. Yeah, I'm quitting sugar. But if you are using sugar as a way of making yourself feel good or de-stressing, when you come back from a busy day, you're tired, and there's that sweet treat there, we all know we crave that, we want that, it makes us feel good in the short term. So I feel that stress is a key driver for long-term behaviour change as well. And I think it's the reason why many of us can't stick to new behaviour habits that we're trying to, because we haven't addressed the underlying driver. And basically, that's why I wrote this book, is to help people first of all identify where stress exists in the modern world, because I think unless you shine a light on something, you're not even empowered to do anything about it. But once you've identified it, then figure out what you can do about it. And it's full, like my first book was, it's full of simple and practical tips for people that they can apply in their everyday life. These aren't tips that I've fabricated in my head. These are tips that real-life patients have told me work, busy people, people with maybe doing two jobs, maybe they're running a business, maybe they've got children, maybe they're go, go, go the whole time. I could say, Rupy, to you here that, hey, you know, if we all did two or three hours of yoga and meditation a day, we'd be less stressed. Well, you know what, I think everyone knows that, but the reality is, who's going to be able to fit that in into their lives? So it's really about breaking stress down, making it actionable for people. And I'm really, really proud of this book. I really hope it has done what I've just said to you.
Dr Rupy: Yeah, no, I'm super excited. I've just had a first look at it. It's not out yet whilst we're recording, but it will be out on the 27th of December.
Dr Rangan Chatterjee: 27th of December. Yeah, so just after Christmas.
Dr Rupy: Yeah, and there's going to be a lot of promotion around it. I'm sure you're going to see it everywhere, but I think it's going to be one of those books, like very much like your first, that is going to transform lives because you're giving a very simple strategy to how to deal with stress, but also heightening people's awareness of it because I think as you eloquently put at the start, we as GPs see patients every single day who won't recognise that stress is a factor in their symptoms, their physical symptoms sometimes. And unfortunately, we have that very hard job working in the NHS of eight to nine minutes per patient. And whilst we're trying to rule out the red flag symptoms that could be a cancer or something just as severe, we're also trying to figure out, okay, what are the other differentials here? Could it be stress? And it's just something that just takes so much time to weedle out of patients as well because they're not thinking about it. And also, if something is labelled as something to do with your mental health, it's almost seen as, you know, something that shouldn't be there, something that is a fault of them and not society at large or.
Dr Rangan Chatterjee: I think the point that comes to mind there, Rupy, is that it's the way we're living today in modern society which is making stress such a big problem. And I think it's useful right at the start of this conversation to really sort of talk about what the stress response is, because not all stress is bad. A little bit of stress turns us into the best version of ourselves. We need a little bit of stress to function. If you have got a presentation to give or someone's got a work meeting where they've got to present in front of their colleagues, you know what, a little bit of stress helps you perform better. A little bit of stress for your exam will help you pull out information from your brain that you might not have otherwise been able to do without that little bit of stress. But like most things, it's the dose that makes the poison. If that little bit of stress becomes chronic daily unresolved stress, that's when short-term benefit becomes long-term harm. So I'll give you an example. So our stress response is a series of complex biological and physiological changes that happen in our body when we feel under threat. So, you know, two million years ago or something like that, when our stress response was evolving, it was there to keep us safe. So, it's a bit of a cliche, but you know, if we were being attacked by a wild animal, we would want our stress response to kick into gear, and it would do. And in that moment, we would basically divert resource to the areas which are essential for our survival, and we would move resource away from things that are non-essential to survival. So I'll give you an example. So when your stress response kicks in, your blood sugar goes up. Sugar will pour into your bloodstream, which is going to help you run faster. Your blood pressure will go up so that more blood can get to your brain. These are all really, really good things. Your blood will be more prone to clotting, such that if you get attacked and cut or injured by that tiger or that lion, you're not going to bleed to death. These three things are really good things. At the same time, you will switch off things that are non-essential, such as your libido. If you're trying to run away from a tiger, you don't need to be able to chill out and procreate with your partner. So your body switches off attention to that area. If you are running away from a tiger, you don't need to be able to have your digestion working optimally. So I've mentioned, I mean, there are so many things that happen in the body with the stress response. I've mentioned five of them just there. So if we take those and we say, well, what happens when those short-term helpful responses become long-term? We start to understand how stress can become problematic. So, sugar pouring into your blood to help you run faster, brilliant in the short term. If that's happening day in, day out, actually that's going to cause fatigue, weight gain, high blood pressure, and ultimately type two diabetes, all from too much stress. If you are, just to pull it back to your programme, BBC Doctor in the House, I believe you came across one of your early patients, I think in the first season, you did a little bit of lab work with and you found that she had an elevated cortisol response.
Dr Rupy: Yeah, absolutely, Rupy. It was the, I think it might have been the first episode actually of Doctor in the House, which was on in 2015, which for people who want to watch it is actually there on YouTube, so you can actually Google it and find it. But there was a lady there who had really bad menopausal symptoms and she had issues with her weight. She tried everything. She tried changing her diet, every year she'd try a new diet, she would try different workout regime and getting more and more frustrated why A, her hormonal problems were so bad and B, why she couldn't lose weight. And I remember going into her house and I was helping her and her husband and her daughter. And I thought actually the diet's not bad, but we sort of cleaned it up a little bit more. And it was really interesting that her husband on this new food regime was losing weight for fun. Like literally losing weight, no problem, feeling great. And as much as she loved her husband, she was getting more and more frustrated that actually she was unable to actually lose the weight. And it was then I really realised, I don't think your diet is the issue here. I think it's your stress response. She was constantly on the go. You could tell she never switched off in her mind. She was always thinking, always ruminating on things, always worrying about the next thing, go, go, go the whole time. And we know that if chronic stress is associated with weight gain, because when you are, when you're chronically stressed, your body feels as though it's under attack. So because it feels it's under attack, it's going to hold on to things that it deems that it needs. One of those things can be weight. And for her, what was really interesting is when I taught her how to relax and switch off, very quickly, not only did the weight start coming off, but her hormonal symptoms almost went completely. And these were simple things. These were things like, okay, fine, I get your life is stressful. How about in the one hour before bed, we start to come up with a stress management programme. So she would have a bath some nights, she would switch off her phone, she would sometimes do some deep breathing, sometimes do five minutes of meditation, not 20 minutes, not 30 minutes, five minutes. And she would literally create a relaxation regime before she went to bed. And that really changed the rest of her health because suddenly her stress response gets switched off. And her weight starts coming off. Her hormonal symptoms start getting better. And people don't make the association between stress and hormonal problems. But you've got to understand this is that, as you well know, Rupy, that the precursor for most of the hormones in our body is LDL cholesterol. Now, very simplistically, that LDL cholesterol can go down one of two paths. One path can make cortisol, which is our body's primary stress response hormone. But the other path goes to make what we call sex steroid hormones, such as testosterone and oestrogen. Now, if we're not overly stressed and everything is in nice balance, actually, resource gets partitioned off nicely to make the right amounts of cortisol, the right amounts of testosterone, the right amount of oestrogen. That is brilliant. But if we're chronically stressed, our body will divert more attention to making more and more cortisol, which means we've got less resource to make oestrogen and testosterone, which is why I see that stress is a key driver of hormonal problems, whether it's premenstrual symptoms that women are getting in the week before their period, whether it's menopausal symptoms, whether it's guys who are having libido problems and low testosterone. In medicine, we often want to correct the hormone imbalance by giving hormones. Again, that has utility, no question about it. But I'm always thinking about, okay, what can I do that's short-term symptom relief, which has value, but how can I help someone long-term also address the root cause of their problem? And I find more and more that when I address stress with my patients, their hormonal problems over the course of weeks and months start to get better. And it's incredibly rewarding to do that because patients love trying to understand what's the root cause of my problem. Another issue we're seeing a lot now is anxiety. And remember how I said that in the short term, stress is really helpful. So if you're running away from a tiger, your amygdala, which is a part of your emotional brain, goes onto high alert. So you are hypervigilant for all the threats around you. That's great if you're trying to run away from something, you want to be alerted to anything that could be a threat. But if you're hypervigilant day in, day out, that's what we call anxiety. And it's how short-term things are a benefit, long-term things, these things become problematic.
Dr Rupy: Exactly. Yeah. So these essentially, these evolutionary physiological mechanisms that are designed to protect us when they're out of balance have become what we see in modern day as common complaints that we as GPs see, whether that be the blood pressure issues, the inability to maintain proper weight, hormonal issues because of cortisol, cortisol steel as some people might refer to as, or essentially just not utilising the resources of cholesterol, which is the precursor to all of our steroid hormones, as well as anxiety as well. And it's important to say, you know, this is just one perspective and I'm sure there are lots of other reasons as to why people can have blood pressure and cholesterol issues and obesity issues, but it's certainly something that we, I don't think are actually equipped that well from medical school and postgraduate training to deal with because it's seen as something, if it's in the mind, well, that's the psychiatrist's job. And that it kind of goes back to how we silo off different specialities and we kind of rid ourselves of responsibility if we can't really deal with it in that respect. But I think what we're both doing in this respect is we're trying to teach people to become the expert of their own health.
Dr Rangan Chatterjee: Exactly.
Dr Rupy: And once you're able to understand the root cause mechanisms behind why you might be feeling more anxious or why you might not be be able to lose the excess weight, then you can lead a truly helpful lifestyle for yourself and for others around you, but you actually give a lot more control to patients. And I think that's kind of what we want to see in the pursuit of a proactive, healthy population. And I love what you described there actually about almost like a mini retreat in your own house, like having a bath, putting your phone away earlier. And I'm sure we're going to talk about these tips a little bit more, but there's breathing exercises that are accessible to everyone and can have real effects on your physiology.
Dr Rangan Chatterjee: Yeah, absolutely, Rupy. And I just want to sort of re-emphasise what you just said, which is that we're just talking about stress being one component. Of course, diet is important. Of course, movement is, of course, sleep is. I'm not saying that stress is solely responsible, but what I am saying is that it's one of those factors that many of us aren't thinking about. You know, we get to January, everyone's thinking about diet, they're thinking about getting to the gym. Very few people are talking about, I better address my stress levels this year. And that's really my drive behind writing this book was to raise awareness that this is a problem. This affects pretty much everyone. And the reason why I also think that medical school didn't potentially serve us that well for things like dealing with stress is because I'm not sure, you know, I was in medical school between 1995 and 2001, okay? So I'm aging myself now quite a lot. I just, of course, I was younger then, but I don't recall lives being as stressful as they are today. And I do think that technology is a big part of that. This is not an anti-technology piece at all. The book is not anti-technology. I think technology is absolutely fabulous. But I do think that as a society, we haven't quite yet figured out what are the good rules around how we use technology so it really serves us rather than harms us. And you know, one of what I'm trying to do is split this book into, a bit like my first book, The Four Pillar Plan, I took four pillars here, the four big, what I call stress superhighways that exist in the 21st century, and really helped to split the book up into four quarters to make it really easy to understand. And one of the bits I, one of the pillars in this, in this book is relationships. And I think technology really plays a role here because you know, we're told, aren't we, that we're more connected than ever before. And I think that's true in a digital sense. You know, I've got friends all over the globe now that I would never have had in a million years without the advent of social media and technology. I can now talk to my family in Kolkata in India and see them in pretty close to high definition, what they're doing in real time. I mean, that is phenomenal. But electronic communication is not the same as deep human, meaningful interaction. And I think somewhere along the last 5, 10 years, we've really need a reminder of that. I think our relationships are struggling. I think we're not prioritising friendships as much as we used to because we're all so busy. We see on social media what our friends are doing. We see their holiday snaps, we see what they're doing in the house. So on some level, we don't even feel the need to see them in real life and catch up with them.
Dr Rupy: Yeah, I get that a lot actually. I get like my friends who follow me on social media and they're like some of my closest friends from medical school. And when we eventually meet up, it's kind of like, well, I know what you've been doing anyway, and that's why I didn't feel the need to reach out or to like turn up for these meetups and stuff because I kind of know what you're up to. So I didn't feel the need, but actually we are losing that deep meaningful connection.
Dr Rangan Chatterjee: We're missing something and it's integral for our stress levels, for how we feel. You know, on one level, by not prioritising our friendships, we end up putting more pressure on those relationships that are, let's say we have a partner. So I'm married to my wife. So if I don't see my friends, then suddenly there's a huge pressure on my wife to be everything. You know, to be my lover, my best friend, someone who I bring up children with. You know, before they say it takes a village, right? But now we're living these lives where we've moved away from our family and friends, often we've moved away for work. So we're we're sort of living, you know, we're trying to bring up children some of us without any support at all. Often now two parents might be working. We don't have friends nearby and we've literally we're missing out on what all these different people and these different relationships would would nourish us. And I, over the last few years, you know, particularly when I started making TV programmes, I realised that as I was getting busier and busier, I deprioritised my friendships. It's not that I didn't still love my mates to bit and want to see them, but you know, we just didn't put dates in the diary. So, you know, we didn't see each other that often. And it had an impact. And I, you know, over the last two years, we made a vow, you know, some of my good friends, Jeremy, one of them, you know, we made a vow that twice a year, because I don't live near my really, really good friends. You know, my really good uni mates, we all live hundreds of miles away from each other. So for us, a weekly get together is not a possibility. So we say twice a year, we're going to get together for a golf weekend. Now, why is it golf? It's actually nothing to do with golf. Golf is the glue that gets us there. And when we're there, we're just hanging out, interacting. You know, I come back, even if I go into that physically and mentally exhausted, I come back feeling refreshed. I come back and I'm a better father. I come back, I'm a better husband, simply from spending two days with my friends. I mean, that's incredible. So one of my tips is to make sure we have set a date. There's always a date in the diary to see one of your friends in real life.
Dr Rupy: I love what you said there actually about how in the past it would have taken a whole community, a whole tribe of people to be your best friend, to be the somebody who provides, to be someone who can provide emotional support and connection and all the rest of it, whereas now we're actually quite siloed off. Because I like to take the evolutionary perspective when it comes to looking at our physiology and our mental health as well, because I think where before we would have had tribes of people for support and food and everything else, where the core purpose would have been procreation and food and gathering food. Whereas now we have a lot more other sorts of responsibilities and things that might not even be responsibilities for general living. We live in a mass media society that is driven by consumerism, that is driven by things like social media, but also the need to look like someone or the need to have something to generate respect from your from your peers and from your your social groups. Whereas in reality, we've kind of lost our true sense of purpose. And I think a lot of us, and we were talking about this before actually on the pod, trying to figure out your why, trying to figure out your purpose is something that not a lot of people put that much effort into. And I think when you do discover it, and I'm still in the process of finding my why, a lot of things would click into place and the need for things that would essentially bury that hole in your in your being would be filled.
Dr Rangan Chatterjee: The opening pillar in my book is on purpose. There's a whole quarter of the book is on purpose because I haven't seen the book yet, so that came out of nowhere. But that's great. Because I realised as I was writing it that you can do everything else I'm asking you to do. You can see your friends regularly, you can eat a healthy diet, prioritise your sleep, work out regularly, you know, and a whole host of other things. But if you don't have a reason to get up each morning, if you don't connect with that, I think on one level, your life is going to be inherently stressful. And I see it, I see it in myself a few years ago. I see it in so many of my patients that once they can start connecting with their why and that purpose, I think their lives automatically become less stressful. And one thing I'm really super proud of that I put in the book is a new framework that I've come up with. So you, like me, have heard of Ikigai, this whole Japanese idea of how we can find our purpose. You know, and it's, you know, my understanding of it, there's four things, you know, can you do something that you're good at, that brings you joy, that the world needs, and that you can make money from. You know, and if you can tick all those four, you've found your Ikigai. I'm not Japanese, but that's my understanding from all the reading I've done on Ikigai. Now, I love that and I really resonate with it, but I've got to say for a lot of my patients, that's going to feel unachievable. I just can't find my thing that's going to tick all those four boxes.
Dr Rupy: I can't imagine having this conversation in an NHS GP appointment either. Like in eight minutes, can you imagine? Like, you know, what do you do that the world needs and yeah, yeah, totally.
Dr Rangan Chatterjee: You could try. I'd be running late even more late than I already do. But so I thought, okay, how can I simplify this? Because there's a lot of really nice ideas in that. And I've come up with a framework called LIVE, which is love, intention, vision, and engagement. And I explain in detail, you know, how we can apply that in the book. But I'm really proud of it because I think it makes Ikigai achievable. It makes it actionable. It means you can get various aspects from different aspects in your life. You don't have to get it from your job. You can, you might hate your job, but recognise that actually it pays the bills, it allows you to put food on the table. So you can actually maybe engage in a passion in some other part of your life than being your work. Of course, in a dream world, we'd all do things that we love, but for many people, it's simply not practical.
Dr Rupy: Yeah, and it's really good that you say that actually, because I was, I was abroad with a friend of mine as part of this NHS delegation for the clinical entrepreneurship programme. He's a dentist and I was talking about some days in general practice, I find it really hard to tolerate the stresses and I really do feel like I don't enjoy my job. I don't have the same vigour and zest as I did when I first qualified. And he was like, it's just all about perspective. He runs three dental practices. He has to deal with a lot of bureaucracy, but he told me this trick that he does where he just looks at all the positive things out of that day, just taking out the positives and focusing on those. And actually, it's just all about your perspective. It's not about the fact that you resent your job. It's not about the fact that you wish you were doing something else. You can actually pull a lot of positives out of what you're doing right now.
Dr Rangan Chatterjee: Yeah, absolutely. Well, you know, you do your daily gratitude exercise on Instagram, which is not dissimilar, is it? It's about focusing, it's about reframing. And yes, you might have had a what on the on the surface might be a crappy day, a lot of stressful things happened, you didn't get everything you needed to do, but just by doing that gratitude, you suddenly reframe your day and focus on the positives. And you know, because you came and stayed at my house with Drew, you know what I do every day with with my wife and the kids. And you played it with us actually, and it's still something that, you know, even yesterday, I can remember sitting at the dinner table yesterday.
Dr Rupy: Just for the listeners, what the game that we play is something you did to make someone else happy.
Dr Rangan Chatterjee: Yeah, so there's four of us in the family and we have to go around and we all have to answer these three questions. What did I do today to make somebody else happy? What did somebody else do today to make me happy? And what have I learned today? And you know, I thought this is going to be a great game for my kids. It's going to really help bring them up the right way. But you know what? I find it so incredibly helpful for myself. And what happens is that, you know, if anyone is listening to this who's got a family and got young kids, or even if you don't actually, it really doesn't matter. It's such a beautiful game to play. And people can be quite busy and stressed coming into dinner, but instantaneously, what happens, multiple things happen. The whole tone of our dinner changes. We start to find out things about each other that there's no way we would have found out without this game. The kids start to bring up things that they would never have told me about their school day because they're trying to answer these questions. And they then also learn things from mummy and daddy about the things that we found hard, but how we overcame that, or what we've done today to help somebody else, or what we've learned today. And you know, I love trying to teach them that every day is a school day. You're always learning. You know, it doesn't matter if you're a kid, doesn't matter if you're an adult, you're always learning something. But it's just a simple thing that people can do. But I think what you said and what your colleague said, it is about really identifying why we're doing what we're doing. And I think that's probably the most impactful stress reduction measure there is out of anything. But that's also one of the hardest things for some people as well.
Dr Rupy: And it's not something that you can just prescribe or something that we can just talk about and you figure out in a couple of weeks. It's a constant ongoing process as I've found, where you're questioning and you're just asking different things of yourself, like the game. The fact that the kids are asking themselves or you're asking these questions to the to the kids and the adults, it gets them to think in a different way. It creates those different neural connections. It rewires your brain. And on a physiological level as well.
Dr Rangan Chatterjee: It really does. Yeah.
Dr Rupy: And I think it's that whole process that will allow us to overcome stress and actually be more aware of where stress might be having an impact.
Dr Rangan Chatterjee: Yeah, and I think the big point there for me from what you said is that our brain is constantly adapting to the information we feed it. It's always changing. It's just adapting to make itself more efficient at what's going on. So if you feed it stressful information every day and how bad things are and how negative things are, it's a feed-forward cycle and you become better and better at doing that. If you feed it gratitude every day, if you feel it positive, if you feed it positive emotions every day, your brain starts to think, hey, the world's a pretty cool place. You know, I'm not under attack. Therefore, I don't need to engage my whole repertoire of stress response systems because things are pretty good. And it's, you know, literally bit by bit that we can rewire our brains. And and, you know, that is in in in its essence, I think how you de-stress your life.
Dr Rupy: Absolutely. Yeah. It brings me back to this book that I've mentioned a couple of times in the pod called The Telomere Effect, which is written by Elizabeth Blackburn and Alyssa Epel, and they're Nobel laureates for their discovery of telomerase, which is the enzyme responsible for the telomeres, which are the repeating bits of genetic material on the end of your chromosomes. And I thought this book was going to be all about longevity, supplements, diet, and exercise regimes to improve your lifespan. And I would say 70, 75% of that book was about mindfulness, and it was about how what you feed your brain, what environments you put your your body in, but also your mental environment as well, can lead to incredible health outcomes, reduce your chances of mortality from all different causes of disease as well. And I think that is just another way of looking, another perspective of looking at how stress can positively or negatively impact your well-being.
Dr Rangan Chatterjee: Yeah, absolutely. And I was sort of just flicking through my book as you said that because I actually talk about them in my telomere section in this book on page 159. And actually, you know, because their book is really good. And it's, it is incredible how much stress and mindfulness really does actually play a key role in the quality of our lives, the quality of our health. And I really do feel we've got to broaden the conversation around our lifestyles to be much more than just food and movement. As important as they are, they're not everything. And we're missing big pieces of the picture when we don't talk about things like stress and mindfulness. And it's a huge, huge thing. I will say on purpose that I genuinely do believe that it is possible with this live framework to start finding your true purpose. It's a journey to do that, but there's some very, it's very tangible, it's very actionable steps on how you do it. And actually, a thought just came to mind. I had this patient recently, this, he's a 50-year-old chap, he's a businessman, and he came to see me, general practice, and you know what, he worked hard, he was making pretty reasonable, you know, income. On the, on the outside, things look fine. He had a, you know, he could afford to feed himself and his family, they would go on a couple of holidays each year. But what was really interesting is that he didn't feel so good. He felt a bit low some of the time, a bit lacklustre. He didn't know where he was going in his life. He thought he might be a little bit depressed. And he came in to see me, we did the blood tests, nothing came up on them at all. I had a look at him and examined him. I thought, there's nothing really that I can hang this on. So I started inquiring more about his life. And I realised that he actually did nothing for him. He didn't do nothing that he loves in his entire week. Everything was just obligation. He would go to work, he would work hard, he was competent at his job, but he didn't particularly enjoy his job. He'd come home, he'd see his kids, he'd do things with them at the weekend, but he didn't seem to gain pleasure in anything that he was doing. I'm sure you will recognise this from many patients that you see. And on chatting to him, I started talking to him about hobbies, hobbies that he might have used to have engaged in. And he said, yeah, I used to love train sets. As a kid, I was obsessed with them. I said, well, you know what, I think you are literally, you've got a pleasure deficiency in your life. And I think that would be really helpful for you. He goes, really, a toy train set? I said, yeah, why don't you start? So anyway, to cut a long story short, he started to do that. He gets, he gets a train set, he starts playing with it in the attic. And I actually didn't know what had happened to him because I saw him once more, then I didn't see him again. But I once bumped into his wife in the car park. And she goes, you know what, you've completely changed his life. He's like a different person. So what happened is, basically, by engaging in that one thing, so a passion for him, he started becoming obsessed. He started buying magazines for this hobby. He started looking on eBay for collector's items, right? Suddenly, he gets his pleasure dose most days, but certainly every week. Then he finds more enjoyment out of his job because he's not quite as stressful all the time. So he feels, he gets pleasure in his life, he feels less stressed, he doesn't feel down as much, he feels better about himself. He gets more enjoyment out of his job, he gets more enjoyment out of his relationships, just from changing that one thing. And it's not, this is not quite purpose, but I would argue it is. I think doing things that you love is part of the umbrella of purpose. And so much of what we do these days is what we have to do rather than what we want to do. And I think for anyone listening to this podcast, I really would encourage you to think, when was the last time you did something that you loved, that you did because you wanted to do it, not because you needed to do it, not because you wanted a new post for Instagram, but something that you actually genuinely thought, I'm doing this, I don't care if anyone sees me do this or not, this just makes me feel good. That is a big part of health and that's a big part of lowering your stress levels.
Dr Rupy: Absolutely. And I think there will be a lot of people that will resonate with the, the example that you've just made there about how you're doing things out of regimen and you're doing things out of obligation of doing things, whether it be your job, whether it be your responsibilities, whether it be your family life. When's the last time you've actually done something for yourself? And I'm actually thinking, I mean, I have a stress reduction sort of a couple of minutes that I do every day because I've recognised that in myself, especially over the last couple of years with doing the whole social media thing and the book thing, you realise that you're indebted to so many other responsibilities that you put on yourself, and it's not that you don't enjoy them, but still you need to make that time for yourself, particularly if you have a lot of people that are dependent on you as well.
Dr Rangan Chatterjee: You need to guard your digital borders. You need, I think, that as you say, it's not that you don't enjoy it, it's just it can become overwhelming. Overwhelm is the new, it's basically, I think, in a nutshell, why we're so stressed these days. And I've got this concept in the book, which I really, I think really helps people understand stress. It's this whole idea of micro-stress doses versus macro-stress doses. So, micro-stress doses are these little hits that we get each day, these little bullets of stress that we're getting that in isolation aren't actually that much, but you add them up on top of each other and they become huge. So, for example, I think we've all got a personal stress threshold. And this changes from day to day depending on what's going on in our lives. Now, the more micro-stress doses, what I call MSDs in the book, the closer we're starting to get to our stress threshold. The nearer we are, the more reactive we are to things, the more irrational we become, the more little things start to bother us. And once we cross that threshold, literally, we just can't cope with life. You know, that's burnout, that is argument with your work colleagues, that's an irrational response to someone who has commented on your social media post, right? And so it's kind of, it's about saying, okay, well, these are the MSDs that are hitting you in your everyday life. I can't remove them all, but I can give you a strategy to help deal with it. And those MSDs could be something like this. This is typical now. You're lying in bed, you are, you know, in a deep sleep, and at 6:30, your alarm clock blares. Okay, MSD number one, the alarm clock's blared, it's jolted you from a deep sleep. You look at your phone, because most people have their alarm on their phone now, and you're like, oh, I've got three text messages. Okay, so you just read your text messages. Then a notification pops in from the gas, so that's MSD two. Then you get a notification saying you've not paid your gas bill or your credit card bill, MSD number three. You think, oh, I'll just quickly get ahead of the day, I'll go on my emails. And I know you're nodding your head there because I know what this feels like as well, and I'm not perfect by any stretch of the imagination. You look at your work emails that have come through and you think, oh, I've not done that, I didn't finish that off yesterday, I've got to do that today, MSD four. Because you spent 20 minutes in bed, you're like, oh, I really am running late now. So that creates a stress, MSD number five. You go there, you put your toast on, but you were shaving at the same time, so your toast burnt, MSD seven. Then you spill the coffee, MSD eight. If you've got kids, you're also stressed out that you're not getting them out of the door on time, and they're going to be late, you're going to be late for work. Before you've even left the house, you may well have had nine or 10 MSD hits, these little micro-stress doses, which means you are much closer to your personal stress threshold than you would have been without them, which means it takes less and less stresses in the day to tip you over. And that's what I really feel, I'm sort of passionate that the morning time, if I'd say the start and the end of the day are really key parts of the day to help guard you from stress. I'm a huge fan of morning routines. And I think, you know, in my book I talk about the three Ms of a morning routine. These are things that I think a morning routine should incorporate. Meditation, movement, and mindset. And that can take five minutes, it can take an hour. And this can be personalised to depend on, you know, literally what else is going on in your life. You know, and I do have young kids as well, so I will challenge people and say, you can't do with young kids.
Dr Rupy: You can't do the meditation with young kids.
Dr Rangan Chatterjee: It can be done. And I'm currently, literally almost two months into sticking to this. I've been very sporadic in how well I can stick to a routine. You know, I'll meditate for, let's say, a week, and then I'll fall off the wagon. I'll do my morning routine for 10 days, and then I'll be, you know, I'll stop doing it. But I literally am, you know, on my Calm app, which I can show you now, I'm on like, I think a 46-day streak at the moment.
Dr Rupy: Great.
Dr Rangan Chatterjee: Which is great because it also engages me because I don't want to, I don't want that to go back to zero anymore either. I'm like, no, I kind of like that. Can I get to 50? Can I get to 60? But I'm telling you, I do the three Ms every morning and it's just changed my life. I'm so much less stressed because I just feel that I start the day as far away from my personal stress threshold as I could. So I'll tell you what I do. I get up, I literally will come downstairs and this is what I'm currently doing. I do switch it up from day to day. I'll literally put my headphones in and I'll do 10 minutes on the Calm meditation app. So that's my first M done, that's my meditation. Then I'll do five to 10 minutes of movement. So this will be some hip stretches, some ankle mobility, I might do some press-ups, I might do some yoga moves, anything that I'm feeling like on that day. I don't have a set regime. Sometimes it's only five minutes. Now, normally my daughter or my kids are not up, but sometimes they come in during the movement bit and I don't mind that because then, you know what, they start doing it with me, which I think that's great. But then the third piece is mindset. And I think this is a really important part of a morning routine. It's something to really work on your mind and putting you in a positive frame of mind. This could be, you know, reading an uplifting book for five minutes, listening to some uplifting music if you want. But what I do, and I do this with my daughter a lot who's just turned six.
Dr Rupy: Yeah.
Dr Rangan Chatterjee: But we do affirmations together. So affirmations are short, powerful statements that are in the present tense that can really help feed your brain information that everything is okay. And the one I'm currently doing with my daughter is we hold hands together. I'll do this by myself, but if she's there as well, I like to include her in this and say, I'm happy, I'm calm, I'm stress-free. I'm happy, I'm calm, I'm stress-free. And I literally try and embody that as I'm saying it. And I'll tell you, we do that for two minutes, I feel really calm and positive. My daughter's smiling, she feels great. And she says, you know, it sounds a little bit cheesy, right? But I'm like a different person when I do this. And you know, my kids have noticed over the last two months, I'm less reactive. My wife has noticed, I'm calmer. And I would put a lot of this down to my morning routine.
Dr Rupy: That was part one of my fascinating conversation with Dr Rangan about how to deal with stress. You can catch Dr Rangan at Dr Chatterjee on Instagram, and I'll put the links to his socials on my website, thedoctorskitchen.com. You can listen to his podcast, Feel Better, Live More, on iTunes and all podcast players. Make sure you're subscribed to the Doctor's Kitchen podcast so you don't miss episode two, which is absolutely fascinating, all about stress and how to deal with it. See you next time.
