Episode 70: Stress is killing me!

Welcome to Wisdom from the Aerial View, the podcast for those who seek to find meaning and purpose in their lives and to have less stress. Hello, Dr. Klein. How are you today?

I'm very good. Good morning and good to see you.

Good to see you. I threw the word stress in there because these are stressful times and they're always stressful times. But I read a study that I really want to talk about today, particularly with you as a physician. It was a study about how stress prematurely ends black lives. And it says nearly half of the mortality gap between black and white adults can be traced to the cumulative toll of a lifetime of stress and heightened inflammation. a study came out and it goes on to say that over the course of the study 25% of black participants died compared with about 12% of white participants. Meaning that black participants were more likely to die at younger ages. Researchers found that 49.3% of this gap was explained by stress and inflammation. I found that astounding and I wanted to talk to you as a physician about stress and inflammation in our lives. Let's talk about that if you don't mind.

You know, I'm laughing because as many of our listeners know, you don't really give me a heads up about what we're going to talk about. And so I didn't so about a minute before we started, you told me we were going to talk about stress, but you didn't tell me we were going to talk about the gap in lifespan between black individuals and non-black individuals. due to stress. I mean I so you know

yeah that's a little bit of a more particular specific thing but so we'll we will of course generalize from that as we always do but

yeah and I guess the reason that I guess the reason I brought that up not to put you on the spot but it just it struck me because I know that you spend a lot of time in your practice with many many African-American black Americans and I know that I'm spending a lot of my time in the anti-hunger world with with minority populations and I it always amazes me that, you know, we have people in buckets, which is fortunate or unfortunate, but but this one just it's troublesome. I think the broader issue of stress and what stress can do to our bodies and how it's really robbing us of life. So, we can generalize it.

You know, I don't know. Where was that study done? Do you know? Do you have that handy? You can look it up. I'm just curious because I want to I want to know how they figured out that 49.3% was through stress.

Yeah, I know. I know. That's that sounds basically like they pulled that one out of thin air because I'll tell you

it was published in JAMA Network Open. Okay.

So it's a Journal of the American Medical Association. So you know I don't know.

Okay. So the reason I say that is because

I'm sorry I get you prof This is done by a professor of psychological and brain sciences at Washington University in St. Louis.

Okay. So obviously a very a very good place. Yeah. I'm just curious, maybe after after we're done today, you can send me the link and I'll I'll look it up. But you know, the problem with a lot of these studies, especially when you come up with something like the 49.3% is due to stress, is that there's so many variables.

Yes.

In in in the human condition, there you can't, you know, in a typical controlled experiment, right? You want to change only one variable. Keep everything else the same between two groups. And the only thing you change was, you know, whether you clip your nails on Thursdays, right? And that's why, you know, clipping your nails on Thursdays is associated with blah blah blah. Yeah.

Once you if you but it's very very hard to do that in humans because a we're all different. There's so many things we don't know. There's so many variables. It's really hard to pin it down. Now, I can tell you we know for sure that hypertension, diabetes are much more common in in black populations. And these are since since cardiovascular disease is the number one cause of death in the United States among all almost all groups then you know it's not then you can that's that's a well-known statistic but the rest of them are hard. So we I think we should be we'd probably be better served today just talking about since you wanted to talk about stress sort of generalizing it and talk about what it does and how to prevent it because really that's what people care about, right?

Absolutely. Absolutely. In fact, can I one quick thing? I did a little bit of research too and because of the whole stress notion and one of the things the Cleveland Clinic does is what stress can do to your body. They talk about the the 10 areas that stress really impacts our lives. Muscles and joints, heart and lungs, skin and hair, gut, shoulders, head and jaw, immune system, reproductive health, sleep, weight gain, and mental health. My goodness. Let's talk. Yeah. Well, what else is there? No, but as a physician, you've got you've seen it all, haven't you?

Yeah. You know, the problem is,

you know, stress, we all know that stress is not good for us. Now, even if we can't pin, you know, pin it to one of those 12 systems or whatever you just mentioned, right? Everybody knows that you can feel it. Stress is palpable. You when you're really stressed, I'll give you an example. So for me personally, I can tell you that when I have a stressful situation or something that's really upsetting to me, I often would feel it in my chest. Now I wasn't having a heart attack. I knew that. But I felt it. And when the incident was over, the stress did that discomfort didn't vanish. It would hang around for hours really. And that's how I personally would manifest it. I used to joke around thinking, I wonder what I wonder what's going on in my heart at the moment. But clearly it has major effects on various systems in our body. We feel it. We don't have to have a hundred studies to figure that out. Everybody knows it, right? But it's really very difficult to parse it in terms of what is it about the stress or what type of stress. There's so many different factors involved. For instance, if you're having an argument with a loved one, that's a particular kind of stress. is are you going to have the same physiological sequelae from that as you would if you were in the military in a war zone? They're both stressful. Are the are the actions and results the same? So these are the things that are very hard to pin down, but we know for sure that less stress is is better.

And so really what we really want to talk about I think is how the heck do we manage stress? So, it doesn't matter whether you're in a I don't want to be glib here, but it obviously I don't I was gonna It doesn't matter whether you're in a war zone and having an argument with a with a loved one, but of course, they're not the same. So, but but the effects could be similar. You could walk away that that sense of that the physical manifestation of the anxiety can be similar. You know, PTSD very always in the news, a really a big deal. in fact there was a there's a golfer his name is Gary Woodland who about three years ago was diagnosed with a brain tumor. they say it was benign. I guess it's probably a meningioma or something like that. But brain benign brain tumors are not like benign skin tumors. You know that they're space occupying lesions in your brain and your brain is encased by a very firm thing called your skull. So you don't you can have a benign tumor that's growing and it can cause a lot wreak a lot of havoc and sometimes they're not the easiest things to remove. But fortunately they he had surgery. The lesion was removed. I remember reading that he didn't get all of it. And so you can leave little bits of these things behind. They'll grow over many many years or come back, but it could be a long time. But the point of the story is not that he had a brain tumor and recovered, which was great. The the story is that he developed PTSD as if he had been in a war. So his PTSD is manifested by a lot of paranoia. In other words, he's he's he's fearful all the time. This is a a professional golfer, very accomplished, big guy, and yet he's super fearful. In fact, when he plays golf, he came back to the PGA tour, the professional golf tour, and has been playing, and he's actually won a tournament last week or two weeks ago, few weeks ago, but he's fear is that somebody's going to walk up behind him. He's petrified. So, they have to keep people away from him. I mean, a lot of times they the person carrying the score not the score card, but that little thing that they hold up with the scores on it for that particular group,

they often walk they walk with the golfers and he was af he got very upset because one of them was a little too close.

So, here's a guy who wasn't in a war,

had a brain tumor, but as a sequelae of this surgery and his and his brain tumor developed PTSD and his his reactions to normal events is out of proportion. It's irrational and and that's a lot of what stress is. Sometimes it's a rational response, but a lot of times it's an irrational response to what the fear danger is. If you see a lion running at you in the savannah and your heart rate goes up, you have that fight-or-flight instinct mostly. I wouldn't fight. I'd fight. But but that's real. That's a very appropriate response, right, to an to a situation. But sometimes our responses are not appropriate for the situation. They're out of they're out of out of proportion. So you may get into a been in a social situation especially if you're younger and you for some reason believe that the person with whom you're talking the group within you're in is is thinking about you or commenting you or looking at you in a certain way or judging you and they may not be doing that at all but you get this sense that they are. Your heart rate goes up. You start to sweat. You get all the typical reactions of of a of a fight-or-flight reaction. stress and it turns out they weren't talking about you at all. Had nothing to do with you. Nobody was even thinking about you at that point. So that's an inappropriate response to a situation. And most of what we have in our lives ranges from is not the lion chasing you, but this kind of out of proportion reaction to what's going on. And the good news about that is that's manageable. That we can fix. That at least we can certainly help it. we can't you know unless we have a gun or some a very fast vehicle we can't do much about the lion chasing us but we can do something about these these responses that we have in our everyday life that are not lions chasing us but they still cause the same reactions there still fight-or-flight reactions anxiety heart rate goes up sweating sense of foreboding you know this is what stress is and when that happens the hormones in your body go crazy cortisol released from the adrenal cortex the the surface of the adrenal gland, you know, very big anxiety produced release which also has a lot of negative effects on your body. So when we say stress causes negative effects on your body, it's because it's mediated by certain things usually these these hormones that circulate. So it's not just like oh stress causes heart disease.

Well the next question is how does stress cause heart disease? It's release of these inflammatory, we mentioned inflammation, these inflammatory hormones that then stimulate our incredibly intricate immune system to release things that are supposed to only be released when there's a real threat like an like a virus or a bacteria or something like that. But the immune system goes crazy. So a great example is COVID. So what happened in CO the reason people were dying in by in droves in the beginning of COVID was because the COVID virus the corona virus was instigating a severe inflammatory response in lots of parts of our bodies but predominantly in our lungs and you might remember in the beginning there was this whole thing about respirators. We need respirators and

you know Trump had these had these factories all flipped from making refrigerators to making respirators. Right. Yes.

And of course, how many respirators do we end up using? Hardly any. Why? Because we realize that don't put somebody on a respirator. Don't put in a CO person on a respirator until the last possible moment because a it's hard to get them off and b they don't need it. We're getting fooled by the inflammatory response. That's not the proper treatment. So, the proper treatment early on was steroids, big doses of steroids because they're anti-inflammatory. and then down the road, we had other medications that we could use other treatments. So, so here we saw an inappropriate we saw a reaction of our immune system that we that was so out of proportion in a sense that it was the inflammatory reaction that was killing people. The virus was initiated the inflammatory reaction. So we talk about stress. Stress initiates the release of these hormones, the initiation of the cascade of the immune system that attacks all those part all those parts of the body that the you just mentioned that all those from the Cleveland Clinic that all those body systems that are affected because these inflammatory reactions these hormones that are flying around go everywhere, right? They don't just go to one place and pretty much every system is affected one way or another. So the bottom line is stress is bad. It create it can often initiate this cascade of of our immune system and these circulating hormones that do that and before you know it you're a mess,

right?

And and the reason I really wanted to talk about stress today and I that study is the one that tweaked my interest is that we talk about on this show all every week about adding u meaning and purpose in our lives and avoiding stress. I mean can we have both? Can we have a lead a stressful life and yet a you know a purposeful life? And if so, how do we minimize one and maximize the other? How in fact do we minimize stress? Can we get to the aerial view? Do we need the aerial view to help us minimize or even negate stress? And how do we get there?

Well, I was going to say the answer to your question is two words. It's the aerial view. Okay, that's,

you know, so people who've been listening for a while know that I always talk about my wife and her incredible ability to deal with the world in a very dispassionate way. So, she's not she's not a dispassionate person, but she is able to to view things in a dispassionate way to be that objective observer many times. It's instinctual to her. It's it's how it's how she's she's grown up. and so things that would make me go crazy did never made her go crazy. Right? And so once you see that somebody can do this, then you become it becomes the light should go on in your head that unless this person is from Krypton, then then pretty much there's a way to learn how to do this. And of course that's what the aerial view is. It's this way to to to look at all situations and avoid that what I talked about earlier, this inappropriate or out of proportion reaction to a situation.

Well, as as a matter of fact, we're going to have your wife on the show one of these days because I want to talk to her very specifically. How was she born that way? I mean, now the difference between her and us, she's a southerner. We're northerners. Not only are we northerners, we're New Yorkers and we're all crazy in New York because we that's we, you know, you

It's our specialty.

It is. That's what we do. We we majored in that. We're pretty good at it. But I'm really wondering if if the demographics actually play have any influence on this at all, where we're from, the kinds of upbringings we've all had. I mean, does it all play into the fabric that make us who we are? The bigger picture of who in fact we are, where we're from, who raised us, what were the things that we did as children that other children don't do? I mean, I'm seriously wondering about that. I know, for example, I have a friend who's from the south. She was a from she's a Georgian and to her it's just normal to walk around as a kid shoeless, barefoot. Well, you and I didn't do that. I don't know. Did it make a difference? I don't know. I have no idea.

Yeah. Well, for sure those things you mentioned play a role. So, you're up. Who brought you know that? Yes. So, in the old days, community was a really big deal. So because we live in most of us I would say most of us but but the concentration in in cities has obviously increased continually over the last hund and something years or more. and so when we're in smaller communities, community made a difference. You and I grew up in a community which was a suburb from of New York like literally a 100 yards out of New York City technical New York City boundaries. But we grew up where we all the families knew each other. if if your mother told me not to do something, I was going to listen to her and vice versa. so we had that sense of community. We grew up with a certain set of values and standards that everybody accepted. We all were playing by the same set of rules. This is what's appropriate. This is what's not appropriate. This is what you can do. This is what you can't do. We listen to authority and authority meant not just our parents but any adult in the community. So we had that standard. So that's lacking completely now. That's a problem. But but get to answer your question. Yes, these things definitely are very important. The fact that we grew up that way was a big advantage in in many ways. Now, so yet so my wife, the fact that she grew up with this lack of anxiety, well, where did she get it from? Two places. She got it from her mother and she got it from the community because the her mother, they went to church every Sunday. And there was a certain way to to look at the world, how to treat each other and so on. And her mother had I didn't know her mother long enough to know if she had if she had the exact same capabilities as as my wife did. But that's what she gets from. But here's the great news. Here is the really good news, right? That we're not stuck. None of us is stuck. So if we grew up in these crazy neurotic situations where Right. You know what I'm talking about.

I do. Yeah. you we live you can look back and go I don't have to repeat that I don't have to do that there were certain things about our community that I thought were fantastic let's replicate those and there are certain things we look at and we go no we don't want to do that's crazy right and everybody can do that but how do you how do you do that people go well that's easy to say but how do you do it aerial view that's how you do it you have to become the disinterested observer you have to detach you have to look at the at at the world from afar you have to incorporate the ideas that all history repeats itself, that all human interactions repeat themselves. There are no new stories in the world. Nothing you're experiencing has not been experienced by millions of other people. This is something I thought about since I was relatively young. we've all been in situations where we're very embarrassed by something that was going on, right? And you just felt, "Oh my god, I'm just I'm the worst. It's only me. Everybody else in the planet is just fine and it's just me, right?" And of course that's a ridiculous idea because not only has has the experience you're feeling at that time be experienced by many others at the exact same moment there are probably a million people on the planet having the exact same reaction you are you are these are there are no unique reactions. So when you understand these things, you understand how how how the world is put together that stories repeat there are no new stories that civilizations repeat the stories that humans repeat the stories and that you able to disassociate from what's happening in the street view and just look at it from afar. You realize that none of these things are all that important in the sense that I don't want to minimize the what happens in life but life is temporary. It is always going to be temporary. The single greatest clue of all is death. Right? You cannot we we take things seriously as we should, but we take them a little too seriously as if we've talked about this before. As if we do everything right that somehow we win the game and live forever or this whole idea of winning the game. There's no such thing, right? You're you're here to experience life for a purpose to prepare yourself. That's it. You need to make that evolution from selfish to selfless, from inward focus to outward focus. That's why you're here, right? Focus on that. The other things are are common to all humans. you. They are unavoidable, but you don't have to in incorporate them into your into your psyche and let them ruin you and ruin your life and make you super stressed.

So, let's talk about Mark. If we're in the middle of a situation that really has us totally stressed, whatever it is, whatever it is, what does one do? How does one pull back and say, "Wait a minute. Wait a minute. Let's be outwardly focused. Not you." How does one do that physically, mentally, and emotionally? How do you pull yourself out of the muck of anxiety, of stress?

You have to adopt a philosophy that is not easy to accept. And I cannot tell you how many people close to me think kind of smile at me and go, "Oh, yeah, that forget. I'm not doing that. That's wrong. Can't you have to you have to tone you have to you have to look at everything in life and give it a little less value than you think it should have because it sounds terrible. It sounds callous. It sounds insane. Actually, it sounds insane that things are not that big a deal. You go, "What are you talking about? We're in the middle of wars around the country. We're in the middle of you've dealt with hunger and loneliness and homelessness and blah, all these things, right? Illness, you know, these things. How can you not get upset about these things? It's not that you can appreciate them, you can deal with them, you can accept them, but you don't have to get upset about them because they were always going to happen. All these things were always going to happen. Not only because all of history is written, because all of time exists, but also because that's what happens to human beings. It's the same story again and again and again. When you realize this, when you're in the aerial view and you go, "Oh my god, the story we're seeing now in our politics, on our environment, and everything. It's all happened before. Some of it's happened 100 years before. Some of it's happened 10,000 years before. Some of it's happened four million years ago, right? We talk about you know you know the extinction of species. 99.9% of all species that have existed on this planet are extinct. Nothing's new. There are no new stories. You have to be able to extract yourself intermittently to see okay I'm just part of this story right now. I have I it's happened before to everybody. It will happen again. Do not take it too seriously. Deal with it the best you can. You're gonna cry. You're gonna feel sad. You're gonna feel pain. But then you pull back and you go, I need to keep this in perspective. I can't let this destroy me. This is just a life is temporary. I'm here for a reason. I need to do the best I can. That's it. This is why we talked about grief a couple of weeks ago. Don't linger in grief. Grief should be short. Memories should be long. We I my my wife and I pulled into the garage last night after going out for dinner and I said, "Oh, we got to let the dog out." And of course, my dog has been gone for almost six years, you know. So, she laughed, you know, but we miss him. We think about him. He's super sweet dog. I know you lost your dog, right? So, but and so for a second I'm sad. And then I realized, no, no, no. Two things. One is he's still alive in all the moments of his life and we're still together in all those moments. They're still actively happening. This is a fact. This is Einstein's relativity. We've talked about it a million times in the jukebox of time. Number one. Number two is that's life. You know, I look in the mirror, I don't look like I looked 40 years ago, right? That's life. It's a very interesting phenomenon. Why is that? Why why do we age? What's what what's all about? Because it's all part of our story. It's all part of our journey. Nothing is permanent. I shouldn't say that. All time is permanent, but our lives evolve. We change pages. So, understand what you what life is. It's not it's it's this is going to sound terrible. we give it more value than we should. In other words, we're here for a reason. It's temporary. Understand that good things will happen, bad things will happen. We'll love the good things, we'll hate the bad things, but they don't have to stress you out because they were always going to happen. It's always going to be part of life. And just move on. You don't need to focus on the on the stressful parts. Accept them. Absorb them. That's the best way I would say to absorb the impact. Let it hit you and then absorb. If you going to let the dog out, if you were going to let the Did that did the memory of the dog come back to you in a positive way? So, I that's kind of an interesting concept. I have it all the time. I still see the little guy. I still see him sitting here. Not here. I wish you were here. He's not here. U but it's still comes back to me all the time. And is that what you're talking about?

Well, let's talk to you about this for your dog. Let's digress for a sec because it's really very valuable to a lot of people. So, you see your dog. You say your dog's not here. Wrong.

He's here.

Your dog is sitting in that space but not at that particular time.

So there there are four coordinates, right? There are four coordinates. There are three dimensions of space, right? Length, width, and height. Right.

Right. So in the length, width, and height, you're pointing to a place on your floor that your dog always sat. Right.

Yes.

So those three coordinates are still there. The only coordinate that has changed is the time coordinate. That's the fourth coordinate. So if I say to you, you and I going to have lunch next week and I say to you, we're going to go to this restaurant and you can go into Waze or Apple Maps and it'll give you a coordinates. You go to this place, right? And that's great. And you go, "Well, that doesn't help me, Mark." I go, "Why? I just gave you the coordinates of where we're going. I gave you the restaurant. You looked it up. You have the coordinates. How does this not help? You didn't tell me what time." Okay. So, exactly. So, you could go there today or tomorrow. I won't be there. Right. And you go there every day. Go, where is he? He told me he told me he's going to be there, but I didn't give you the fourth coordinate of time. So, the only thing missing with your dog and my dog and all the people we've lost in our life is that one coordinate of time. And if we go back through the jukebox of time to that any of those particular moments, those T's that stands for time of when our dog was there and we looked at that spot, there'd be there, right? The only thing that's changed is time. This is very important. Since all moments in the jukebox of time exist forever, you don't really ever lose anybody. It's impossible to lose anybody. That's a big source of stress, right? I lost my father, lost my mother, lost my wife, god forbid, I lost my child, I lost my dog. That's not a small thing, by the way. Anybody who's had a dog and lost a dog knows losing a dog is just like losing a person in a lot of ways. The emotions are very similar. So, we've lost parents. You and I have lost four parents be between us, you know, and we've lost dogs and we've lost aunts and uncles and cousins. I've lost c we've lost all these people, right? No, we haven't lost. They just that let the coordinate of time that T is different now but they're still there in all those coordinates that all those T's when we were together they never go away. That's how the jukebox of time works. So this is a great way to relieve that particular type of stress. The stress of loss there is no such thing. You're not they're not with you right now, but they were with you all those other times. You have to look at your life as if you're in the jukebox of time on all your records that you're on. The first record the day you're born. the last record, the day you leave this earth. That's your lifespan. You're on all those records. They're playing forever. They never stop. You're always together. So that singular source of stress of loss, we can eliminate. We can eliminate it because it's untrue. It's an illusion. And I'm not making this up. It is an illusion. We didn't we never lose anybody. We're still with those people or with those animals. We're still together in those other moments. So So if we just focus on that one source of stress, which is huge for many people,

yes,

that's defeatable. easily defeatable once you understand how the world works.

I'll be right back because the dog that isn't here just wet on the floor. So, I'll be right back. I gota, you know,

that's great.

I w I wish I could get there. I wish I could.

You can. It's practice in it. It's practice. That's all it is. You have to first understand that this is true and accurate. That all this is true and accurate. It's not some, you know, I'm not standing on a pulpit saying, you know, telling you that the flying saucers will come save us and take us away to a utopia. I'm telling you something that's physics. That's just the way it is, right? And so once you accept that, do you we we do live in an illusion in a lot of ways. We misunderstand so many things about how our world works. And when we understand that it can be extremely comforting. So, you know, I know we're getting to the end, but there's two things I would like you to take away here from this quick discussion of stress. One is that try to make things less important than they seem because they all are because they're all transient. You're going to move through your book of your life and one day you're going to get to the last record. No matter who you are, no matter what you do, no matter what you've accomplished, no matter how wealthy you are, it doesn't matter. You're going to get to the end, right? So appreciate that. This is all temporary. So no matter what happens, absorb it. Look at it as part of the story of your life. We've talked about each page of our life being our novels. Just absorb it as a part of the story of your life, as if you are the protagonist in a story. And then become the disinterested observer and observe it. Remove yourself from it. Look at it from afar. watch and go, it's too bad that happened. I feel bad for the protagonist, but the protagonist will go on. Life will go on and the protagonist still needs still has the same mission to prepare for what comes next. To become a person of substance, to evolve from selfish to selfless, from inward focus to outward focus. If you if you focus on those things during times of stress, it relieves it. It diminishes it. It's it's hard to make it go away completely, but we'll be all be happy if we can diminish our stress, for sure. And that's the way to do it. And practice makes perfect in this case. The more you do it, the easier it gets. I promise.

Well, those are great final words. And and it leads me to a conversation that we're going to have next in our next podcast and that's about optimism because you're a very optimistic person and that's the one thing that one of the things that I love the most about you. Anyway, we have run out of time. I thank you. You gave us the last word. Those are good words. words are hard to live by, but words that we need to start thinking about living by because then we can all be better off. So with that, I will say thank you for this conversation and peace and we'll see you next time and we're going to talk about optimism versus

Thank you. Thank you everybody for listening. We'll see you next time. Peace.