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

Dr. Rangan Chatterjee 0:00 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 do 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 gonna 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 having on people's lives when they feel exhausted. But I've 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 gonna 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.

Dr. Rangan Chatterjee 2:15 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 bed, 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 the, these devices. Let's say you 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 bed, 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 to 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 wanna change the tone of the information in that one hour before bed. But what are you doing in that one hour before bed? Are you on social media? Maybe you're on Twitter having an argument. Are you watching the news, the 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 be campfire 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 hardwired 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 bed, you are hugely increasing the chances that you're gonna sleep for longer, and your sleep quality is going to be better, which in turn is gonna mean you have more energy the following day. And it's not just more energy. You're gonna have more creativity, you're gonna crave less unhealthy foods, you're gonna be a lot more emotionally stable, your focus will be better, and you're gonna 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 gonna 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. No, 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 wanna consider, at least initially until you get this ingrained into your life. Right? So let's say you wanna be in your bedroom falling asleep at 10:00. Maybe you put an alarm on your phone at 9:00, and 9:00 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 gonna 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 it's doing 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 gonna work for me." As I 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 household. Like, I put in a rule a few years ago that after 7:30 PM, I do not wanna talk about anything intense. I don't wanna talk about the news, I don't wanna 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 gonna 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." And 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. Maybe another time of day when everyone's feeling calm, you say, "Hey, look, I've realized actually that 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. You know, 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 together physically in the same space, but emotionally and mentally they're 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 gonna get together for five minutes. That's it. If you make a commitment to say it's gotta be half an hour, it's not gonna 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, [laughs] 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 niggles start to come in, the frustrations, there's less closeness, less intimacy. And I've shared that five-minute tea ritual with so many of my patients, and one couple in particular I remember came back to me and said, "That tea ritual has saved our marriage, no question." So perhaps that's something you wanna 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 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 bed 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 in to see me and she said, "I feel tired all the time. I don't have energy to do the things that I want to do. Is there anything wrong with me, doctor?" So I took her history, I examined her, I did some blood tests. They were all normal. Nothing I could easily identify and 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 started 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 asleep quite quickly afterwards, the quality of her sleep and the quality of her rest wasn't where she wanted it to be. When she started to change that one hour before bed, things started to change really, really quickly. So what did 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, in that one hour before bed, she'd put on some relaxing music in her living room, and she'd 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? Where what you do just before bed, if you're trying to solve problems and go through, let's say, work emails in bed, 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 of trying 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.

Dr. Rangan Chatterjee 16:59 The second thing I'd like you to focus on as part of this evening routine that's gonna give you more energy the following day is exercise. Now, exercise comes in many different forms and many different intensities. And of course, you just heard me share a story of 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, I used to love playing squash, and I realized if I played squash after work at, let's say at 6:00, 6:30 PM, I would really struggle to fall asleep. I'd be in bed at half 9 or 10, 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 learnt back then that 5:00 was my cutoff 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 wellbeing, but if that's negatively impacting your sleep, you've got to really ask yourself [laughs] 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, go. Wanted to work out, look after himself, and he'd go to the gym after work. You know, when he'd 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 his blood tests were normal. This wasn't an issue that needed resolving with a supplement or a medication. This was to do with the way he was living his life. And as we started 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 suggested 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. 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 and 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 they're 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

Dr. Rangan Chatterjee 21:22 third thing I want to talk about with respect to your evening routine that I think is gonna make a big difference to your energy levels is food. 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 are 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 Satchin 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 going to 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, 6:00 in the morning, 6:30 in the morning, and we're still eating at 9:30, 10:00 at night in front of the television. And the truth is we're 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 when 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 there 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 therefore 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 6:00, 6:30 PM. 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 brush your teeth straight after dinner. It's such a 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 add, 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 tempted? 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. The 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 bed. Now, I get it. Sometimes you're not gonna 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 come in 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 1:00 in the morning or 2:00 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 gonna spike your blood sugar. Now, although not technically food, 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 if 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 evening 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.

Dr. Rangan Chatterjee 29:26 The fourth area I really would like you to pay attention to as part of your evening routine, which is gonna give you more energy the following day, is lighting. What is the type of light that you're being 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 circadian rhythm is set primarily by light and dark. Now, one thing that's happening these days is that we spend 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, we'd be outside a lot. We'd be getting a lot of natural light exposure in the day, and in 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 our 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 bed? We don't put the lights on really bright and get them amped up. No, we soften everything. We dim the lights. We put on the bedside lamp and read. It's sending the signal to the brain and body that actually it's not daytime anymore, it's nighttime. 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? You see, one of the problems these days is in a lot of modern homes, we have these bright LED lights, right in your kitchen, in your bedroom, or even in your bathroom. You know, incredibly many of us, we brush our teeth, don't we, last thing 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 wanna try and avoid are what we call down lights, right? So lights that come from the ceiling. If you can, 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 gonna 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. In fact, 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 plugin red light. 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 his 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, and you can 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 ten minutes. Start small. Start wherever you're at. It really does make a difference. For two reasons. Yes, the light, but usually on those screens we're being emotionally stimulated, right? Usually, not always of course, but usually it's not calming, the content we're consuming on there. So that's really the reasons why I think if we can avoid screens immediately before bed, so much the better. Now, a common question people often ask me is they say, "What about television? What about the blue light 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 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 thirty-five-year-old lady called Isabelle, she came to see me. She said, "Doc, I'm tired. I just don't have energy to do the things that I wanna 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 hobbies. 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 here?" 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 gonna help you. So I recommended she try 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 in 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 gonna be on that screen, maybe this is gonna 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 owls 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 wanna 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 effect. 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 is that an important hormone called melatonin starts to rise. That's the darkness hormone, and melatonin is one of the hormones that helps you fall asleep. Right? It's really important. But in the presence of bright light, often our melatonin release gets delayed. We're pushing back our 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 gonna give you more energy, which in turn is gonna improve every aspect of your life, is a

Dr. Rangan Chatterjee 39:09 reflection activity. And 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 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 gonna 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've 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've created a free breathing guide that's gonna 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 guide, 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 wanna 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 is gonna 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 gratitude 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 wanna add here, if you are gonna try those gratitude practices, there's a few principles of behavior change that you wanna implement to make it more likely you're gonna 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 wanna have a journal and a pen or pencil and put it on your bedside table Here's the thing. If you decide you wanna practice gratitude, 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, "Oh, I need to take the kids to sports class. I need to go to the post office. I gotta 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 head and onto paper. Again, no tip works for absolutely everyone, but if you struggle with a racing mind 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 up 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 wanna make sure that I switch off for one hour before bed, that I don't stay up that extra hour watching a box set, and that I prioritize 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

Dr. Rangan Chatterjee 45:41 the day. The other really helpful practice that you can think about just before bed, 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. Breathing is information, right? The way you breathe sends signals to your brain. So many of us, without realizing it, change the way that we breathe. There's one study from America that showed that 80% 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 faster, so 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 their evening routine. It helps them switch off, helps them feel more relaxed, helps improve the quality of their sleep, and that in turn gives them more energy the following day. The first one I wanna share with you is the three pause six. 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 breathing 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 breathe in for three, then you have a little pause, and then you breathe out for six, and you just keep doing that, keep repeating it. And I've tried it before. Once I 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, any time your 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 wanna switch off the stress arm of your nervous system, what we call the sympathetic branch of your nervous system, and you wanna promote the relaxation branch, also known as the parasympathetic branch of your nervous system. And a practice like that three, pause, 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 will take you just one minute. In fact, 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.

Dr. Rangan Chatterjee 50:35 The conversation around health, I feel, gets overly polarized regarding food and movement. 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 our food choices, often our 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, in the UK, new year, new you, time to get healthy. Right, so what are the two commonest things that I see people doing in my clinic? I wanna reduce sugar, or I wanna reduce my booze. Right? Those are the 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 gonna have it. This year's gonna be different. It's not gonna be like the last few years. This year, I get on top of things. Same with alcohol, you know. I'm now not gonna drink. Yeah, I've, 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 habits start to creep 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- Mm ... it's super obvious to say it, but what they're doing is they're... And I... The reason I'm explaining it is I think people will be listening to this, and somebody there is gonna go, "Uh, yeah, that's me, actually. I do that every January, but I, 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 gonna be very limited in the change they're gonna 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 is 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 turns 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 alcohol on Thursday, affects his sleep, and this pattern 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, Rich, there are multiple things at play here. But in this particular instance, I helped him. We sort of unpacked his 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 you should go to a yoga class right after work. [laughs] Well, yeah, you know. You should... We should swap places, man. [laughs] Yeah. Go. No. In fact, you go to my clinic. Go ahead. No. I'll, I'll come and live in- Come on- ... sunny California ... keep going. Keep going. 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 present, changes his relationship with his wife. He still has a glass of wine on a Wednesday night, but it's one glass. 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 gonna identify in their own life and go, "Yeah, wait a minute. Ah, yeah, this is... That's like a similar pattern for me. Maybe if I can manage my stress in a slightly different way, maybe those knock-on consequences will be different."

Speaker 55:47 Mm-hmm.

Dr. Rangan Chatterjee 55:47 And so, look, these are individual cases, but they apply to all of us i- in many aspects of our life.

Speaker 55:53 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 t- 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?

Dr. Rangan Chatterjee 56:33 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.

Speaker 56:43 Mm.

Dr. Rangan Chatterjee 56:43 You know, doctors over and over again tell me, um, this stuff is all great, Dr. Chatterjee, 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 from my patients. Like, I, I do not say that to boast. I say that because I really think that when you communicate effectively with them, right, people wanna change. People don't wanna come in and not follow your advice. People don't wanna take half a day off work to come and sit in a waiting room, wait for 20 minutes whilst you're running late to come in and see you so that they can ignore your advice. People wanna feel better. I... That is my number one belief in my job, is that people fundamentally want to feel better. They don't really wanna be there, so let me help them feel better.

Speaker 57:33 So what is leading to that idea that patients don't take the doctor's advice? Is it in the delivery, uh, in the w- in the manner in which these practitioners are trying to advise the patients? Like, where is that communication breakdown?

Dr. Rangan Chatterjee 57:48 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 come and 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 would make the case that maybe 30, 40 years ago, that worked super well. Like, if you c- were coming in with an acute problem, like a pneumonia, and, you know, you're coughing, you can't sleep, you've got sweats. "Hey, doctor, 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 gonna 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.

Speaker 58:44 Mm-hmm.

Dr. Rangan Chatterjee 58:45 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 trained 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 will 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, A, 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, type 2 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 tired. 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 to doctors to demonstrate just how different these things can go. So the conventional one is this. Patient comes in, knocks on the door. "Hey, Brian. How you doing?" "Um, yeah, Doc, you know what? I'm feeling knackered. I've got these, uh, blood tests. I wonder if I could get the results." "Yeah, yeah, sure." So without looking at them, looking at the computer, 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 if 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 gonna 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 it'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. We 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 consultation.

Speaker 1:01:32 Mm.

Dr. Rangan Chatterjee 1:01:32 Now, I'm not having a go at the doctor 'cause I do recognize that things are challenging. But what about the same scenario where Brian comes in, you make eye contact with him. You don't look at your computer screen. You have a conversation with him, 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, "Hey, your blood sugar's 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, Doctor, 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, 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?" "Hey, Doc, yeah, if you can let me know what I can do, that would 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 a good result.

Speaker 1:02:48 But this is communication.

Dr. Rangan Chatterjee 1:02:50 Yeah.

Speaker 1:02:51 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, y- you know, to be trained as a, as a doctor. Like, you're gonna be... You're gonna spend your entire career communicating with patients, telling them what to do, what's wrong with them, et cetera. Shouldn't there be a... There's a s- there's a skill to that, right? To do it effectively.

Dr. Rangan Chatterjee 1:03:25 Yeah. You know, one of the things I'd say from certainly when I was going through med school applications, and from what I understand it's not really changed that much, although they have tried to evolve, that is not, uh, anywhere in literally how you are assessed. It is what are your grades, right? What is your interview like? Now, I guess an interview on some level-

Speaker 1:03:45 Mm

Dr. Rangan Chatterjee 1:03:45 ... is, uh, looking at your ability to communicate. I get that. But I think, I think the health 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, than th- the skill set a doctor 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.

Speaker 1:04:18 Yeah.

Dr. Rangan Chatterjee 1:04:18 You can teach people some skills of how you do that. How do you actively listen? How do you not interrupt the patient's story? You know, basic things that frankly, [laughs] I would argue it's not just about being a doctor. If you want to communicate with your partner-

Speaker 1:04:34 Yeah

Dr. Rangan Chatterjee 1:04:34 ... with your wife, with your children-

Speaker 1:04:35 Mm-hmm, your family. Yeah

Dr. Rangan Chatterjee 1:04:36 ... 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 collective modern lifestyles, well, doesn't it not stand to reason that actually these sort of life skills that we need to be able to communicate effectively are probably top of the tree when it comes to being a doctor?

Speaker 1:04:58 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 and 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?

Dr. Rangan Chatterjee 1:05:31 I mean, Rich, what I'm trying to do to help this problem is, um... 'Cause I was talking about it in the media for years, right? I'm saying, "This is a problem. We need to change this." And I was thinking, "Yeah, but what do you do?" It's all very well 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 show showing that all these chronic lifestyle-driven conditions can absolutely be turned around, or certainly dramatically improved, by making small changes to key areas in your lifestyle." And then I thought with a colleague of mine, Dr. Ian 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 Europe, it's the very first course called Prescribing Lifestyle Medicine that is accredited by the Royal College of GPs. Now, that is important 'cause it gives, it gives a certain gravitas to the course.

Speaker 1:06:22 Yeah, credibility.

Dr. Rangan Chatterjee 1:06:22 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.

Speaker 1:06:36 Mm.

Dr. Rangan Chatterjee 1:06:36 And we have a 95, 95, more than 95% of attendees so far 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 1,000, 1,000 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 in medical school." "Oh, that's fine, but you're never gonna make change like that." And I'm like, "Well, hold on a minute. Five years ago, this course didn't exist. It certainly 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 to say, "Hey look, this c- 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-

Speaker 1:07:58 Mm

Dr. Rangan Chatterjee 1:07:59 ... to come and train the course.

Speaker 1:08:00 Mm-hmm.

Dr. Rangan Chatterjee 1:08:00 Right? So in many ways you're, you're, you're only attracting the people who've got that interest, right?

Speaker 1:08:05 Yeah, but you started, you know, and you gotta fan the flames of positive change.

Dr. Rangan Chatterjee 1:08:09 Yeah.

Speaker 1:08:09 Right? This is, this is forward progress, so.

Dr. Rangan Chatterjee 1:08:12 Yeah.

Speaker 1:08:12 You know?

Dr. Rangan Chatterjee 1:08:12 And so hopefully in five years' time this will be a part of-

Speaker 1:08:14 Right

Dr. Rangan Chatterjee 1:08:15 ... medical school training.

Speaker 1:08:16 Right

Dr. Rangan Chatterjee 1:08:16 Or it'll be compulsory. We can only hope.

Speaker 1:08:19 Right.

Speaker 1:08:20 Well, let's drill down into stress a little bit more deeply. Um, this book opens up with you saying, "Listen, 60 to 80% of the people that come into my office, uh, have some kind of stress related condition." Uh, 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, "Well, we're all stressed. I'm stressed out, I'm anxious" or whatever. But perhaps it might be, um, 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?

Dr. Rangan Chatterjee 1:09:13 I mean, I would agree with you that the term is slightly problematic, I think. We do use it. It is common parlance now. Not a day goes by where you do not hear the term, right?

Speaker 1:09:23 Mm-hmm.

Dr. Rangan Chatterjee 1:09:23 You talk to a buddy you've not spoken to in a while, "Hey mate, how you doing? You all right?" "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-

Speaker 1:09:37 Fun-

Dr. Rangan Chatterjee 1:09:37 ... fundamentally what stress is, because stress is different for every single person, it is a perception. It is a 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%. Between 70 and 90% of all conditions that a primary care doctor sees in any given day is in some way related to stress.

Speaker 1:10:15 That's bananas.

Dr. Rangan Chatterjee 1:10:16 That is bananas, but I'm gonna 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 predator is attacking or approaching. We get scared. In an instant, our stress response kicks into gear. So what happens then? Well, a 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, uh, through some of them. Your blood sugar starts to rise. Great. That means you're gonna deliver more glucose to your brain. That is fantastic in that, in that, uh, 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 hypervigilant 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 predator, you're not gonna bleed to death. Your blood's gonna clot. It's gonna 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 predators, 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, um, 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're having to do all the childcare ourselves and 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 that are so helpful to us in the short term, they start to become 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, uh, health is dominated by diet and movement. 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 of type 2 diabetes into remission. Yes, I change their diet for sure, but when the diet plateaued, the way I got their blood sugar lower was by addressing their stress levels.

Speaker 1:13:07 Mm.

Dr. Rangan Chatterjee 1:13:07 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. Great 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 hypervigilant 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 amygdala to go on high alert. You want to be hypervigilant to all the threats around you. If that's happening day in, day out to your life, that's what we call anxiety.

Speaker 1:13:55 Mm.

Dr. Rangan Chatterjee 1:13:56 Right? So suddenly, this very complex mechanism, when you simplify it right 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's 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 2 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.

Speaker 1:14:48 Right.

Dr. Rangan Chatterjee 1:14:48 So your body switches it off, right?

Speaker 1:14:50 Yeah.

Dr. Rangan Chatterjee 1:14:50 It, it, it, it al- 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, why poor concentration, why insomnia, why low libido, why hormonal problems, why obesity, why type 2 diabetes can all have stress as a key player. Gut problems, right? Last, uh, Mintel survey in the UK showed us that 80% of UK adults have complained of some form of GI problem in any given year. Right? Now, food, of course, is a factor, but I would argue that stress is a bigger factor, because what happens, a- again, just like libido, if you're running away from a lion, you don't need to be able to digest food. It just gets switched off, just like that. And I tell you, o- 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, that they are reacting. They 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 some of 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 gotta 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-

Speaker 1:16:43 Mm

Dr. Rangan Chatterjee 1:16:43 ... when they change their state before they eat, which literally was mind-blowing to me. 'Cause those patients in the past, I had asked them to remove that food for a period of time. So it is so, so powerful. And I, and I, I kind of reflect on the F- the French when I think about this, because there is this, this whole French paradox, right? You've, you've heard of this, right? It's-

Speaker 1:17:03 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, their mealtimes are, are, are sacred and elongated compared to, you know, what we do here in America.

Dr. Rangan Chatterjee 1:17:23 S- same in the UK.

Speaker 1:17:24 Yeah.

Dr. Rangan Chatterjee 1:17:24 Look, I've, 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 on 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 gonna have a different impact on their body. It's gonna do, it's gonna do something different. If you prioritize a 90-minute lunch break where, "Hey, you know what? It's lunchtime. We're not doing that call. We're closing the computer. We're sitting down. We're chilling, and we are now gonna have lunchtime," right? Of course, when you understand the stress response, it is gonna do something different. And I actually had an interview with a French journalist last week, 'cause my, uh, this is, my, 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 go on?" She goes, "Yeah. By and large, it is still what goes on."

Speaker 1:18:22 Mm.

Dr. Rangan Chatterjee 1:18:22 Now, in some of the heavily urbanized places like Paris, in 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.

Speaker 1:18:36 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?

Dr. Rangan Chatterjee 1:18:53 Yeah. Well, first of all, I'm not saying, uh, true allergy, and we've got to be very careful that we distinguish allergy from intolerance. That's a very different-

Speaker 1:19:01 Mm-hmm

Dr. Rangan Chatterjee 1:19:01 ... biological mechanism. So you know, I think it's important just to clarify that. If you have a true allergy, that when you eat a food, you get, um, you know, you get, uh, 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, um, your microbiome. Your stress levels do. That has been shown time and time again. Um, your digestive enzymes. So in order to digest food, whatever it 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, it can affect multiple different organ systems. It can affect various different things in your gut. 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. They will often have, uh, they have to go to the toilet 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 her. She didn't like the way that they made her feel, so she ends up at my door. I start trying to help her. Now, granted, I did start with diet. 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. Thought, "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 then she plateaus. She comes in to see me. I hadn't seen her maybe in six months, and I'm talking to her, and she's like, "Dr. Chaz, you've got to do something. Um, what else do I need to, you know, do? What, what do I need to add into my diet? What do I need to cut out?" She was talking really fast. Um, and I started to, started to unpick her life a little bit, and it was really clear to me, I was just trying, 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 self. And there was many things to do, but the, 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 diet. 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 levels in your life are playing a role here, and I wonder if we could try something there." Now, she was resistant, 'cause 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 wanna 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, I want you to do 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%.

Speaker 1:22:44 Mm.

Dr. Rangan Chatterjee 1:22:44 Now, she still has Crohn's disease. She still has symptoms. It's just significantly better. I said, "What have you been doing?" Said, "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." Said, "Okay, great. What else do you do?" "Doc, I've always wanted to do salsa dancing. Always. I've never done it, but you've given me the kick, so every Thursday night I go to a salsa class." Now, this was just a month, Rich, but I've, I have followed her up, 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've 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-

Speaker 1:23:31 Mm

Dr. Rangan Chatterjee 1:23:32 ... now that she's started to lower her stress levels. So when you ask the 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 gonna 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?" 'Cause you need awareness. Once you know where it lives, you know what? Pick one of the simple things.

Speaker 1:24:18 Mm-hmm.

Dr. Rangan Chatterjee 1:24:18 Try it for seven days and see if you feel different. That is all I ask from someone.

Speaker 1:24:23 Yeah. 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-

Dr. Rangan Chatterjee 1:24:55 Yeah [laughs]

Speaker 1:24:55 ... 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, um, sort of provoked through memory-

Dr. Rangan Chatterjee 1:25:39 Yeah

Speaker 1:25:39 ... or some experience that you have throughout the day that reminds you of it.

Dr. Rangan Chatterjee 1:25:42 Yeah. You know-

Dr. Rangan Chatterjee 1:25:44 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 stresses? 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-

Speaker 1:26:08 Mm-hmm

Dr. Rangan Chatterjee 1:26:08 ... 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 doses. And I, 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, contact me 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 var- 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 bit, 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 of door, before we've walked out of the door in the morning. So what is the conventional... Not the conventional. What is a common scenario these days? Okay, work's 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 gonna 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. Micro-stress dose 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've got a few more minutes. You press snooze. At 6:36, boom. Alarm hits again. Micro-stress dose number two. Then you think, "You know what? I, yeah, I, I better 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 was three work emails yesterday. I didn't get round to doing them. I've got to do that today. MSD, micro-stress dose number three. Then you quickly go on to social media. Ugh, 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 gonna keep sort of laboring the points.

Speaker 1:28:59 Mm-hmm.

Dr. Rangan Chatterjee 1:28:59 But you can very easily see how before you've 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 gonna 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, that they are accessible to everyone. You know what? You can apply these tools to make yourself more resilient-

Speaker 1:29:52 Mm-hmm

Dr. Rangan Chatterjee 1:29:52 ... to the stress. So let's say you've got a stressful life. If you're going out of the 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 sort, 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-

Speaker 1:30:41 Right

Dr. Rangan Chatterjee 1:30:41 ... better than without. So it really, I, I really do believe that this is a book for everyone, whether you have macro-stress doses, 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 down, where people will think, "You know what? Yeah, you know what? Maybe I can do that. I think I can do that."

Speaker 1:31:03 Mm-hmm. 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. I mean, it's about the solutions, right? And some of these are, are very easy to implement into your life, like go for a walk, turn your phone off, go to bed early. Like, you know, re- 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, the, uh, Okinawans call ikigai, which you talk about in the book. And that's a journey, right? So how do you help... I mean, and I think that's fundamental, right? If you don't have purpose, then everything else is sort of a, a house of cards.

Dr. Rangan Chatterjee 1:32:12 Well, that, that, that-

Speaker 1:32:12 But that's the hardest one

Dr. Rangan Chatterjee 1:32:13 ... 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, it just is. We all know that. It, 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, probably not.

Speaker 1:32:38 And feeling bad about the fact that you don't know what your purpose is is an added stress on top of that.

Dr. Rangan Chatterjee 1:32:42 Absolutely. So let me clarify my view on this.

Speaker 1:32:45 [laughs]

Dr. Rangan Chatterjee 1:32:45 So I thought, "Okay, this is all about practical solutions."

Speaker 1:32:49 Mm-hmm.

Dr. Rangan Chatterjee 1:32:50 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-

Speaker 1:32:58 It's a Dan Buettner thing from Blue Zones.

Dr. Rangan Chatterjee 1:33:00 I think I came across it with Dan, actually.

Speaker 1:33:02 I mean, he, 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.

Dr. Rangan Chatterjee 1:33:12 For sure. And so one of my Facebook friends, uh, [laughs] so if you're watching the video, that was inverted commas friends. Um, and to be fair, I'm being slightly, um, you know, I, I'm, 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 ikigai, and I saw these four circles, and the middle area was shaded where these four things intersect.

Speaker 1:33:35 Mm-hmm.

Dr. Rangan Chatterjee 1:33:35 You know, ikigai is when you find something in your life to do, something that you love, something that you're good at, uh, something that the world needs, and something that pays you money. And I read it, and I think I read this probably soon after my dad died, which is a very significant moment clearly for me. And I remember reading that and I thought, "I like that. You know, I fancy a bit of ikigai in my life, you know? I want that." And I started to reflect on it. I think about it. And then 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. How can I find one thing in my life that gives me this sense of ikigai? 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.

Speaker 1:34:24 And you feel ashamed that you can't-

Dr. Rangan Chatterjee 1:34:25 Yeah

Speaker 1:34:25 ... master that.

Dr. Rangan Chatterjee 1:34:26 And I, and what was super interesting for 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... There was a Q&A, and this Japanese student in London put her hand up. You know, so she, uh, she asks a question. She says, "Dr. Chatterjee, 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 have 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, 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. 'Cause I get it. You're listening to this podcast on a train and you're thinking, "Yeah, meaning and 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 that 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, r- 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 have just for five minutes. Now, again, just to bring this to life, I had a patient, 52-year-old chap, or maybe 53. You know, early 50s chap, CFO of a local plastics company, right? Again, comes in to see me. He's worried. "Doctor, 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 lives. I said, "Do you like your job?" "Yeah, not really. You know, it's so-so. I have to do it. You know, 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?" "Doc, I don't have time for hobbies. I'm busy. [laughs] I get back 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 to him at the end of doing this, and again, so that I don't get... [laughs] Not that it matters if I get criticized, but just so people understand, I did do the safety netting that is 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 that 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 out." Now, you've got a smirk on your face, right? [laughs]

Speaker 1:38:18 [laughs] Yeah.

Dr. Rangan Chatterjee 1:38:20 I get it.

Speaker 1:38:21 Hey, I have no judgment on people's hobbies.

Dr. Rangan Chatterjee 1:38:23 [laughs]

Speaker 1:38:23 I had a train set when I was a kid.

Dr. Rangan Chatterjee 1:38:25 Well, I thought you were, I thought you were smirking at the fact that the doc- he came in to see me with a, with a problem he was concerned about, and my prescription was to get out his train set.

Speaker 1:38:32 Oh, no, I'm with you on that. I'm with you on that.

Dr. Rangan Chatterjee 1:38:34 Okay, you're with me on that.

Speaker 1:38:35 Yeah, yeah.

Dr. Rangan Chatterjee 1:38:35 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-

Speaker 1:38:43 Mm

Dr. Rangan Chatterjee 1:38:43 ... 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, infirm, who can't get out to the practice, and you go and visit them at home to look after them. So I was... I went to the car park to go and 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?" She said, "Dr. Chatterjee, I feel like I've got the, the, the guy I married back again."

Speaker 1:39:20 Mm.

Dr. Rangan Chatterjee 1:39:21 "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 sus- he- and he's subscribed to this monthly collector's magazine now."

Speaker 1:39:31 [laughs]

Dr. Rangan Chatterjee 1:39:32 Right? So she's happy.

Speaker 1:39:33 He's wearing his conductor hat-

Dr. Rangan Chatterjee 1:39:35 Yeah [laughs]

Speaker 1:39:35 ... in the house.

Dr. Rangan Chatterjee 1:39:35 Hey, but she's happy. But I still hadn't seen him, right?

Speaker 1:39:38 Uh-huh.

Dr. Rangan Chatterjee 1:39:39 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. Welcome him in, and before we go into the blood 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. 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 kid who was feeling low and who had a, 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 'cause 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?

Speaker 1:40:45 Mm.

Dr. Rangan Chatterjee 1:40:45 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 f- 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, schedule it 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-

Speaker 1:41:58 Mm-hmm

Dr. Rangan Chatterjee 1:41:58 ... the hacking world. And I, 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 his ikigai, right? This chap I just spoke about, he's not quit his job-

Speaker 1:42:37 Mm

Dr. Rangan Chatterjee 1:42:37 ... 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.

Speaker 1:43:01 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 of 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 m- nomad or, like, making these massive, you know, seismic shifts in your life. Um, but... And, and, and that may be the ultimate trajectory if you keep pulling on that thread. Like, maybe that train guy is gonna reinvent himself and become some kind of, you know, like, toy train entrepreneur. Who knows? But more likely than not, it, 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 a, 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 seeded.

Dr. Rangan Chatterjee 1:44:23 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 wellbeing. 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-

Speaker 1:45:09 Mm

Dr. Rangan Chatterjee 1:45:09 ... 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.

Speaker 1:45:45 Mm-hmm.

Speaker 1:45:47 So we are headed into, uh, holiday season, the most stressful time of the year. By the time this podcast comes out, we'll, we'll be, you know, more in the thick of it. 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, the minefields of the holiday season.

Dr. Rangan Chatterjee 1:46:24 Yeah, sure. You're right. It is, it is all over the world, I think. Well, certainly in, 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, the thing that is rising to the surface in 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 dose, and you will go over, and it will lead to family arguments. It will lead to a row 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 routine has three Ms, the way I see it. Mindfulness, movement, and mindset. So if you want a morning routine, you don't know where to start, think about those three Ms. 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 pushups. 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, "Doc, these morning routines, they sound great. I'm too busy. I've got to get the kids ready. I, 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 Ms down. First then, mindfulness. She does deep breathing for one minute when she gets up, right? She does a breath that I've taught her that I, I really like called the three, four, five breath. When she breathes in for three-

Speaker 1:49:13 Mm

Dr. Rangan Chatterjee 1:49:13 ... she holds for 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 does she do? For her next two minutes, she does some sun salutations that she learned in a yoga class. Just two minutes. Then what she does, she reads a book that she likes. She keeps a, uh, 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 eczema's gone down dramatically since she started doing this morning routine. When you understand the physiology, of course that makes sense. Stress ultimately impacts the immune system. Eczema actually at its core is a slight, uh, 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. Oh, man, I just wanna 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 lunchtime. Put your phone down, go outside for 10 minutes, and you will start to burn off that stress in your body. But 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, 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, [laughs] 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, 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 cliché. It is the biggest cliché, just breathe. If people understood what breathing actually does on a fundamental physiological level, we would all be practicing it 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, but your breathing will change. Mm. You, you will start to breathe more from your chest than your diaphragm. You'll breathe quicker. Your breaths 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. Mm. You will, you will be less reactive. Alcohol, right? I get it. It's the time of year where people like to drink. Fine. I, I recognize that. That is something people associate with that time of year. Just be mindful of the fact that alcohol will trash your sleep, right? There's no other way of saying it. Alcohol trashes 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 at your diary and go, "You know what? Do I need to go to- Mm ... every single social engagement, or can I go... 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 night." 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 [laughs] when, when you talk to them sober will tell you, and I appreciate, you know, I, I appreciate that everyone's different on this, but for most people, the enjoyment comes from that first drink. For, I shouldn't say for most, for many people- Mm-hmm ... right? There's kind of diminishing returns after that. I mean, you may have a different perspective on this. I'm sort of, um- Yeah, [laughs] I have a, I have a whole other thing on that, but go ahead. No. Okay. I- Yeah, yeah ... okay. I'm gonna say some people- Right ... right, they will find that actually their enjoyment comes from that first drink. Mm-hmm. 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... And I've never really thought about this. I've never really been asked this, but what happens 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 gonna be after that morning routine