Chronic Stress Is Aging Your Body Faster Than Smoking (Here's How To Reverse It) | Dr Elissa Epel

1. RCDr. Rangan Chatterjee0:00

   You've done some research suggesting that chronic stress can age the body by as much as 10 years. That's quite a staggering statistic.

2. EEDr. Elissa Epel0:08

   Yes. So the telomere is this structure made of base pairs. It sits at the ends of chromosomes, and it protects them. So telomeres are one of our many biological clocks, and they do shorten as cells divide over time, but they also shorten based on the level of wear and tear or stress, physiological stress, in a cell. We statistically can say with confidence shorter telomeres predicts more likelihood of early disease, early mortality, slower wound healing. And when we first started studying telomeres, we did this calculation where we know exactly how many base pairs we lose per year, and thus we can quantify how much extra aging or additional base pairs people lose when they're under chronic stress. And that's how we came up with that statistic, that there was 10 additional years of aging in terms of the immune system. But our lifestyle changes actually can boost this protective enzyme that can lengthen telomeres. And so if you study someone over time, you actually see that they're much more dynamic and that nothing is determined or written in stone. And any time in life, any day, we can start to reverse damage and boost all of the restorative enzymes and processes in the cell and lengthen our telomeres.

3. RCDr. Rangan Chatterjee1:47

   Does that therefore mean that if we focus more on relaxation in our lives, and we can of course, uh, elaborate as to what we mean by that, are we therefore then able to slow down the aging process in the same way?

4. EEDr. Elissa Epel2:04

   Absolutely. And it's not just that we're not experiencing stress, but when we put ourselves into a state of rest, and even more so deep rest, now it's time to restore and repair. And so that happens at night when we sleep, and that needs to happen more in the day. I think we've lost the siesta. We've lost a culture where it's okay to lie down in the middle of the day or have leisure time be a regular part of the day. And so we're in a, in a sense, this grind culture is grinding down our telomeres more quickly as well. When we rest, we turn on telomerase, the enzyme that repairs telomeres. We also turn on other restorative mechanisms such as DNA repair mechanisms and the cleanup crew in the cell that cleans up junk, repairs proteins. And we also turn on the anabolic hormones-

5. RCDr. Rangan Chatterjee3:07

   Mm

6. EEDr. Elissa Epel3:07

   ... the, the sex hormones, the, the steroids that actually create growth and maintenance.

7. RCDr. Rangan Chatterjee3:16

   Yeah. If I reflect on my career as a medical doctor, I don't think that stress per se was really on my radar at the start of my career. But I soon started to realize that, wow, unmanaged stress that goes on for a prolonged period of time can have quite devastating effects on human biology. And I guess when I really saw this was with my father, my dad. And to cut a long story short, for 30 years, my dad only slept three nights a week. He was a consultant physician in Manchester Royal Infirmary, but also when he got home in the evening, he would get picked up in a car and be doing a family doctor house calls all night-

8. EEDr. Elissa Epel4:14

   Wow

9. RCDr. Rangan Chatterjee4:14

   ... four nights a week. And I didn't know, you know, Dad got lupus. He had kidney failure. He ultimately died in 2013. I've learnt so much about the impacts of chronic stress since my dad died. I know that his lifestyle ultimately is one of the reasons why he's not here today.

10. EEDr. Elissa Epel4:34

    Mm. Mm-hmm. That's heartbreaking, and, uh, that was his normal default mode. You know, it became what he was used to. If we are living a lifestyle of chronic stress, we tend to become numb to the feelings and thoughts of stress and to the body signals. We don't read them anymore because it's our default mode. And so I think we're, at, as a society in general, living with an epidemic of chronic stress. The baseline level of arousal for people is not, let's say, normal. It's not a resting state. It is a subtle state of chronic stress. And some people, of course, many people feel the thoughts of str- the feelings, the subjective stress, feeling overwhelmed, feeling worried, but other people don't, and yet their body is still under the state of chronic stress, but they're not, uh, they're not denying it. They just don't notice it anymore.

11. RCDr. Rangan Chatterjee5:43

    Yeah.

12. EEDr. Elissa Epel5:43

    They're, they're so used to it. So I think there, there's a, uh, question about, like, what is our true baseline? Are we under chronic stress? We can ask ourselves how stressed we feel, and this is how we measure it in studies, you know, rate on a one through 10 scale. Whether you feel moderately stressed in the middle of five or extremely stressed at 10. But when w- it's day after day, you know, we just adjust our baseline.

13. RCDr. Rangan Chatterjee6:13

    Yeah. One of the things I loved in your book, The Stress Prescription, was the way you describe these different states that we can be in as it relates to stress, red mind, yellow mind, green mind, and blue mind. So perhaps now would be a good time for you to explain, first of all, w- what is stress? What's, what's the point of the stress response, you know? Because it clearly serves a role in our bodies or we wouldn't have it. And then from there, it would be really fun to explore these different mind states because I think it helps us understand where we might be living. And as you say, do many of us even know what it's like to really feel deep relaxation anymore? I think many people just don't, right? So perhaps we can just start with, you know, what is stress, and then move on to these different mind states.

14. EEDr. Elissa Epel7:07

    Yes, that sounds great. I really like the mind states because it opens the door to us having a labeling system, pretty simple label system of four mind states, and checking in with our body and seeing where we're at, and that's step one. If we can turn on the light of awareness, we can then measure, manage, monitor, and reduce stress, and that sounds like a lot of work, but we can do that within minutes. So the beauty of feelings of stress is that they are absolutely malleable, and we can change our physiological stress as well as our emotional stress within five minutes. So these subtle, s- small changes every day that you talk about a lot and, and many of your speakers are really the medicine. They are critical for us to bringing down our elevated, excessively elevated, unnecessary feelings of stress so that we can actually really tap into deeper living. So that's where the mind states come in. The first mind state is... Well, sorry, you asked me what is stress. W- we are all experts on stress because we live with so much stress. We know what we do to manage it. We all wanna manage it better. You can't get rid of it. It is the fundamental survival neurobiological and body wiring that keeps us able to adapt to the ever-changing environment. So we n- we need to be flexible and responsive, and that is beautiful and healthy. So the stress response in a young, healthy organism is a low baseline, a really high peak response, and a quick shutoff. That dynamic, flexible, let's mobilize energy when we need it, and then let's recover when we don't need it, and that shutoff, of course, is hard when we carry mental stress. Um, so the acute stress response is beautiful and necessary, and that's how we adapt so beautifully to demands. And, uh, shifting up and down is so important, but we lose that ability to, to quickly downshift. And when we're under chronic stress, we can't even upregulate the stress response normally. We get a blunted stress response. So acute stress is a different animal. And let's talk about normal daily acute stress. It is our friend. It is our body being excited and responsive and enabling us to really a- adapt flexibly to demands and perform well. So that's the red mind state, is that acute stress, um, that's healthy, and we have it every day. Now, when we, of course, are having that too much or we're in these situations where we just can't let down, um, we are under chronic stress. And of course, that's, as you've described in your book, where the wear and tear on biology, on telomeres and every other regulatory system happens. When we can downshift from this acute stress response, we get into yellow mind state, and that's where the majority of time is spent for most of us living in an urban, stressful environment. The yellow mind state is pervasive, moderate, sometimes invisible cognitive load. So this is a subtle chronic stress state that we're used to. That's the one we don't notice. And so shifting out of yellow mind state to a healthy, acute stressor like exercise or down to relaxation is really important, thinking about moving our stress response system. I call that stress fitness. We wanna move flexibly through the day. We don't wanna stay in yellow mind. Of course, we don't wanna stay in an acute stress response either. The stress response is extremely expensive energetically. It uses up so much ATP or en- energy, and so it's exhausting. By the end of the day, if we've had a lot of these w- peak red mind states, we will inevitably feel exhausted and depleted, and that's why it's so important to have these, these breaks during the day and getting out of red and yellow mind. Green mind is a state of relaxation. We love to call it green mind to remind us that nature attunes us toward, uh, automatic or, or let's say, passive relaxation, that we don't have to work hard to have our body let down the stress response and release when we are in a natural environment, and we feel safe. And then the blue mind state is the state of deep rest, and I really think that there's magic to blue mind states. Biologically, this is when we release the most powerful healing mechanisms in our cells, and this is also the state that we get the least. So if you look at your typical week, Rangan, how much do you spend in blue mind states during the day?

15. RCDr. Rangan Chatterjee12:37

    Well, I'll tell you the sort of things I do each day. You can tell me if any of these are blue mind. I have a little morning routine, and the first thing I do in that morning routine is I meditate for usually 10 minutes, sometimes 15 minutes. I will usually have two to three walks throughout the day. Sometimes they're only 15 minutes, but it's just my way of, you know, managing my blood sugar and managing my stress load and that kind of stuff. And I will not work in the evenings barring exceptional circumstances. So that's maybe given you a flavor of the kind-

16. EEDr. Elissa Epel13:08

    Yeah

17. RCDr. Rangan Chatterjee13:08

    ... of things I do, but I don't know how much of that would be blue mind versus green mind.

18. EEDr. Elissa Epel13:13

    Right. It's a beautiful, um, rhythm of the day, and you're integrating so many of the, the critical microinterventions in that day. What I really do think of the window right after we wake up and before we go to bed as these critical periods where we really impact our stress response system. In the morning, we prime it for the day. We're either building in a resilient, a cushion of resilience for the day with some practices that set our nervous system up for lower reactivity and more stability and equanimity. And at the end of the day, we're priming our nervous system for allowing us to release and restore, releasing unconscious stress during the night. So it's amazing with these wearables how we can see how we hold onto stress during the night in our nervous system. We've been looking at that in some of our studies. How much does our, our vagal tone, our heart rate variability respond to the deepest stage of sleep? How low can it get, and what practices promote that? So well, daily slow breathing, for example, we have found is, is very important for allowing us to reach more deep rest states during the night. So very short periods of slow breathing during the day when we respond with more vagal tone during the night, this is incredibly helpful for relieving depressive symptoms and boosting our mood. Um, we- that's one of the, the analyses we're currently working on. But to back to your question, what, what are these mind states, and how do they map onto your day? So in the, uh, starting off with these practices that allow us to look into the mind with awareness, mindfulness, mindful movement. So body practices are just as effective as, um, let's say, psychological or cognitive practices. They, um... I would say g- green mind states when we're attuned and in flow would be the common theme in your practices. And the deep rest that, that we were trying to define, I really reserve that for lying down practices that are passive when we literally allow ourselves to release and let go and not exert effort. So that would be something like yoga nidra, visualization, listen to music, lying and resting. Resting, not ruminating. Um, something that allows, uh, our body to truly have a break. And of course, there are flow states when we're engaged in hobbies or being in nature that are, that are, let's say, light blue mind states, where we're not necess- We're still active, but we are, our body's getting signals we're safe right now.

19. RCDr. Rangan Chatterjee16:17

    Yeah.

20. EEDr. Elissa Epel16:17

    It's, uh, t- time to relax. It's okay to relax right now. And our cells are getting physiological signals that we don't need to be creating proteins to, uh, fight viruses, you know, to keep our immunity up and to keep our stress response up, and that's the exact profile of what our cell's doing or the, the proteins that we make that we see during a meditation retreat. So in meditation retreats, when we look at gene expression, we see that the body shifts toward, uh, during a multi-day meditation retreat, so a week or less, the body shifts into creating more proteins for cell restoration like telomerase and mitochondrial function and less of the proteins that are toward building up immunity and mounting the stress response. So we get that shift toward what we call growth maintenance and repair genes or the healing process when we rest. And if we're ripping ourselves off of relaxation and we're not getting deep rest, we are aging faster.

21. RCDr. Rangan Chatterjee17:38

    Yeah. So one thing, Elissa, I'd noticed over the years is sometimes patients would say, "I slept for seven or eight hours last night," but if they didn't switch off before bed, they woke up feeling exhausted. So that could have been that they were keeping their mind active in some way, stimulated. It could be they were doing some work emails before bed, or it could be a variety of different things. First of all, I'd love your comments on that, and secondly, would you say that just before we go to bed, it would be a good idea for us to try and get to that deep restorative blue mind state a, a, almost like a daily habit?

22. EEDr. Elissa Epel18:28

    I think it's a brilliant place to intervene. It's, as you said, it's the bookend that we control right before bed. It is the ability to allow our nervous system to descend into a relaxed state before sleep will directly affect our sleep physiology to be more restorative.

23. RCDr. Rangan Chatterjee18:53

    Hmm.

24. EEDr. Elissa Epel18:54

    So some people think, "You know, my, my head hits the pillow, I fall asleep right away. I don't need to relax before sleep." The bottom line is a lot of that's your homeostatic drive for sleep because you have a sleep debt, right? So you don't have trouble getting into sleep, you probably underslept. But what is your nervous system saying to you while you sleep? It may be saying, "Well, I need to stay vigilant, and I need to continue problem-solving, and there's still, um, a lot of work to be done, and so we need energy. We need to be burning ATP instead of, of restoring and creating it." So we can measure that now with these wearables. It's quite remarkable. When we can l- create a decrease in our arousal from, from our more yellow mind state before sleep, we are allowing our parasympathetic nervous system to get a head start on reaching its nadir, its lowest level of arousal. That happens during deep sleep. And so during sleep in general, we wanna have this release of stress. This is when we reset our metabolism. We, we develop more insulin sensitivity. We get out of that insulin-resistant or pre-diabetic state that we might have been in from stress. We reset. Um, it's also when growth hormone and anabolic hormones that restore and promote growth-

25. RCDr. Rangan Chatterjee20:33

    Mm-hmm

26. EEDr. Elissa Epel20:33

    ... depending on what stage of our life. When we're younger, promoting growth; when we're older, repairing and restoring. So these, only, uh, some of them, like growth hormone as adults, mostly appear during the night and not during the day. So we just wanna protect that restorative period. It's precious. I think some of us are just worse sleepers in general, and so we need to work a little bit harder. But I guess my point is chronic stress can, as, as we were talking about at the beginning, reset baselines. It can rewire things so that our body is now, even in its rest state, still in a somewhat chronically stressed state, and that will... We'll see that in our sleep. We'll see that in our food choices-

27. RCDr. Rangan Chatterjee21:16

    Yeah

28. EEDr. Elissa Epel21:17

    ... um, even in our ability to, like, really connect and relax when we're in social-

29. RCDr. Rangan Chatterjee21:22

    Yeah

30. EEDr. Elissa Epel21:22

    ... situations and relating to other people.

Episode duration: 1:19:18