In this episode, we discuss:
- The relationship between blood sugar and cortisol and their connection to stress and burnout
- When biohacking can be supportive and when it can be problematic, and why it’s important to optimize sleep and recovery
- Steps we can take to manage our stress levels, including building social connection, which is a more crucial component to longevity than not smoking or maintaining a healthy BMI
- The link between emotional health and metabolism, and the roles that stress and trauma play in struggling to lose weight
Hey, everybody, Chris Kresser here. Welcome to another episode of Revolution Health Radio. We’re suffering from an epidemic of burnout, and women are especially affected. According to recent statistics, 45 percent of women suffer from burnout. This, of course, has many different causes, and they can vary from person to person. But they include sleep deprivation, poor nutrition, nutrient deficiency, chronic stress, social disconnection, blood sugar irregularities and metabolic dysfunction, not enough exercise, too much exercise or the wrong type of exercise, overtraining, [and] inappropriate use of biohacking approaches like fasting, cold plunges, sauna, etc. Of course, that’s not a major cause on a population level, but for people who listen to these types of podcasts and who show up in Functional Medicine practices, it can be.
There’s a long list of issues that contribute to [the] burnout and exhaustion that so many people are experiencing, and I was really excited to welcome Dr. Molly Maloof as a guest on the show to discuss this. She has a recent book out called The Spark Factor, where she explores this phenomenon and offers a number of really helpful and insightful strategies on how to recharge your batteries and get fitter, stronger, and build resilience over the course of your lifetime. Dr. Maloof is a physician [who] provides personalized medicine to entrepreneurs, investors, and technology executives. She taught a pioneering course on extending health span in the wellness department of the medical school at Stanford University, and since 2012, she’s worked as an advisor-consultant to more than 50 companies in the digital health, consumer health, and biotech [spaces]. Dr. Maloof is on the frontier of personalized medicine, digital health, biofeedback, psychedelic medicine, and evidence-based wellness products and services. She’s got her hands in a lot of different areas, [is] super knowledgeable on many different topics, and I really enjoyed this conversation because it spanned a range of things that I’ve been interested in for many years—everything from how social isolation is a bigger risk factor for disease and early death than smoking cigarettes and body mass index, which is always surprising when people hear that, [to] how to use continuous glucose monitors and other technology to discover insights about what’s affecting not only your blood sugar but your cortisol levels and sleep. [We also talk about] who should and shouldn’t fast, when fasting can be supportive and when it can be problematic, how to optimize for sleep and recovery instead of just thinking about exercise and training and fitness, blood sugar, [and] metabolic flexibility. It was a pretty wide-ranging conversation, so I think you’re really going to enjoy it. Let’s dive in.
Chris Kresser: Dr. Molly Maloof, welcome to the show.
Molly Maloof: Thanks for having me.
Chris Kresser: Let’s talk about burnout. It is an epidemic. Even anecdotally, I think we can all reflect on, “How are you?” “I’m so busy right now. I’m exhausted. I’m so tired.” This is just regular conversation. But there, of course, are statistics to back it up. Forty-five percent of women [claim] to suffer from burnout. What’s going on here?
Molly Maloof: Sixty-five percent of doctors.
Chris Kresser: Yeah, I’ve talked a lot about clinician burnout on the show.
Molly Maloof: Yeah, it’s a huge issue. I think, first, it’s really important for people to understand where they’re at in the stress response. There’s a lot of people who are in the alarm phase, [where] you’re super tired and also wired all the time, and you’re waking up really early in the morning. These people actually have energy, but they feel like they’re on edge at all times. Burnout is after that high cortisol state has lasted for so long, and you basically are flatlined. Your body’s like, “I need to shut down; I need to heal.” It’s an adaptive response to chronic stress. It’s important to understand that the body isn’t supposed to experience this level of chronic stress, and it’s going to do its very best to adapt to that situation. So what does it do if it can’t keep up with you? It literally turns down your cortisol so that you have to rest. It’s just imperative. Now, a lot of people don’t have the luxury of just taking time off, so you have to do certain things to support the body. In my personal practice, one of my secret weapons of burnout is, first of all, cortisol testing. I like to see where in the cycle they [are] really low. And then [also] blood sugar monitoring. If you wear a blood sugar monitor along with measuring your cortisol and also your [heart rate variability] (HRV), you can see how this is affecting your ability to maintain your blood sugar. Which is actually leading to a lot of the symptomatology of burnout, is blood sugar dysregulation. These people will wake up in the middle of the night, specifically very early in the morning, [and] they wake up really depressed and headachy. You put a blood sugar monitor on these people, [and you’ll see that] they have really low blood sugar, and they can’t maintain their blood sugar because their cortisol is so low.
Cortisol is a glucocorticoid. It’s designed to maintain blood sugar. It’s one of the many functions of cortisol. In these individuals, I start Dr. Wilson’s Adrenal Rebuilder if it’s early on in the process, or if it’s established burnout, then I’ll use a little bit of hydrocortisone that’s been prescribed by a compounding pharmacy, 5 milligrams, maybe max 15 milligrams, and use that to sort of restart that cortisol curve. It’s not necessarily common practice. I learned this from a doctor who taught me hormones. But it’s for people who are really burned out and they can’t maintain [their] blood sugar, and they’re waking up in the morning and they’re feeling super headachy. They just feel so exhausted [that] they can barely get out of bed. Sometimes just supporting their systems can really help. But you also have to look at testosterone, estrogen, [and] progesterone, because when a person’s under chronic threat, their [body is] directing resources to survival, not to reproduction. You often see concurrent hypogonadism, or, specifically [in] women, [for whom The Spark Factor] is written, you see a lot of progesterone deficiency in women who are under significant stress and also those who are hitting their late 30s, early 40s, [and are] at the peak of their career. It’s important to recognize that hormonal support can be one of those things that can bridge you through a really tough patch.
The Relationship Between Blood Sugar and Cortisol
Chris Kresser: Let’s talk about blood sugar and cortisol a bit. I’ve talked about this on my show a bunch, but I think it’s really important for people to understand the relationship and [that] there’s a two-way street here. You mentioned [that], in the burnout stage when cortisol is low, people will experience hypoglycemia, maybe during the night. Actually, the main role of cortisol, from an evolutionary perspective, was to maintain blood sugar during periods of food scarcity. Now, in the developed world, that’s not really an issue for most people. But for most of our evolutionary history, starvation and periods of food scarcity were far more common than periods of food abundance. So you’ve got that side of things. Then on the other side of things, and people often will learn this when they wear Levels or do glucometer testing, is [that] if people are still in the phase where they’re getting cortisol spikes in the morning, [they think], “Wait, why is my fasting glucose so high? I’m on a low-carb diet; I’m keto and whatever. But I have these really crazy high spikes of glucose in the morning. What’s going on here?” Very often, that can be the cortisol awakening response, where they get that surge of cortisol in the morning.
Molly Maloof: That happened to me this year, literally, because I was under so much stress from running a company, launching a book, teaching at Stanford, fundraising, [and] moving, all in one year. Sometimes success is actually really stressful, which you don’t realize until it happens to you. I know the Holmes-Rahe rating score, I know that this is a part of life, but I had never really experienced it like this. I was wearing my blood sugar monitor, and I was like, “Oh, I need to cut out coffee because I’m drinking a cup of coffee in the morning, and it is spiking my blood sugar.” People don’t realize that coffee is one of those great tools for alertness, but if you’re under a high-stress state and you’re spiking your cortisol, you’re actually just raising it higher. So I shifted over [and] I detoxed off coffee. I designed a coffee detox [program] for MUD/WTR, so I just did what I designed and I weaned off coffee, started MUD/WTR, started drinking more tea, less caffeine. And it really was one of the main things that helped moderate my cortisol levels pretty significantly.
Biohacking, Hormetic Response, and Sleep
Chris Kresser: That’s a good segue to chat a little bit about hormetic response, because a lot of your work in the book is related to this. There are many interventions that can be beneficial in certain circumstances but harmful in others. And we’re talking about one of them, coffee.
Molly Maloof: Right. Oh yeah, coffee is a healthy tool.
Chris Kresser: Yeah, if you sleep well, you’re rested, you’re in a good spot, [and] you’re not in a burnout stage, [then there’s] no problem with coffee. [There’s also] exercise and fasting or intermittent fasting. These are all things that, when used properly, can be beneficial. But when someone is in a state of exhaustion, they’re no longer hormetic, meaning they no longer lead to a positive adaptation. They just push you deeper into the hole. Let’s talk about that a little bit.
Molly Maloof: I mean, you nailed it with all these things. This is one of the main messages I’m trying to communicate, to women, in particular. And men, too. This book can be read by women or men. But I spent all this time in Silicon Valley working with these male biohackers as clients, and then when I would work with women, they were coming in trying to biohack, [and] they were stopping their periods because they were doing [high-intensity interval training] (HIIT), weightlifting, cold plunge, and [they were] combining all these things, and they weren’t eating enough. Calorie restriction is technically a hormetic stressor. Chronic calorie restriction, combined with excess exercise, combined with not enough recovery—you’re going to turn down your fertility, and you’re going to turn off your hormones. And these are women who [have] very low body fat. Some of them were even bodybuilders. So I learned firsthand that a lot of biohacking doesn’t necessarily work the same for women [and] men. I think for everybody, if you [have] really high cortisol and you’re feeling stressed out, or you [have] really low cortisol and you’re feeling burned out, you do have to be more careful with biohacking, because you’re not going to get the same benefits from these interventions.
Cold plunge is a great example. I’m all for cold plunge, [but] I see people going online and they’re doing 10- [or] 20-minute cold plunges. That is not helping you. Maybe if you’re Wim Hof, and you’re genetically superior in this way, you can handle it. But the vast majority of people do not have the capacity to handle that level of stress. I’ve seen people develop real burnout after doing really long cold plunges. And this is a man, actually. So it’s important for people to recognize [that] these are things that make you stronger if you’re already at a baseline state of balance. And they need to be dosed appropriately. Let’s say you’ve got a stress cup, and you’re filling it with day-to-day stress, and you’ve got all your biohacking tools that are adding a little bit of stress, but it makes you stronger. What happens if you get hit with a major life stressor, and you’re still doing all this biohacking? Well, you can overflow the stress cup, and that’s when people start to break down. That’s kind of the big message to people. It’s not that I want you to stop biohacking; it’s not that I don’t want you to fast. It’s that, when you’re really stressed out, fasting is not going to help you as much as eating [at] regular mealtimes and being consistent, [and] sending safety signals to your brain, and really getting that recovery in.
I realized that I was doing a lot of great exercise, but I wasn’t getting enough recovery. And I have this whole living room of biohacking tools. I had to remind myself, “Hey, you’ve got to use these things. They can’t just sit in your room; you’ve got to actually go do them.” Recovery and biohacking recovery is just as important as biohacking strength and all of the bigger challenges that biohacking can do to make you stronger.
Chris Kresser: These are, in my opinion, cultural norms that many people have to overcome. One is that we have not been taught to listen to our bodies and to respect our own bio-individuality. And everything that you’re referring to requires that as a starting place. It requires me to be aware of what’s happening in my life [and] to be aware of what’s happening in my body. I wake up in the morning, [and] maybe I typically intermittent fast, but I wake up feeling jittery and hypoglycemic, and I’ve got a long, stressful day ahead. I’m going to eat breakfast that morning because I’m paying attention and I know that’s going to give me a level of stability and grounding. If I just keep [saying], “I’m a person who intermittent fasts, so every morning, I’m going to skip breakfast,” and you have that [type] of rigid approach, that’s when things [go bad]. You could use any example. “Today, I have an appointment to do a [HIIT] workout at the gym, but I woke up feeling totally exhausted.” What choice do you make in that situation? Do you go and do it anyway because [it’s] Tuesday, and Tuesday is my HIIT day? Or do you back off and listen to what’s going on?
In my practice, I’ve always been trying to help people to, A, just pay attention, first of all, which is the starting point, and then, B, be willing to break the routine if that’s what your body’s telling you to do. Your body is the ultimate arbiter, and that’s way more important than sticking to any kind of fixed schedule.
Molly Maloof: Well, we’re all moving so fast right now, and the world is changing so fast. So [the] first thing is, most people need more self-compassion, because we’re living in a massive change in financial structures, changing political structures, [and] changing climate. There’s war in the Ukraine, [and] there’s threats of war in China. There’s all sorts of things that are changing in the world. We just had a pandemic. We’re entering a major flu season, and Covid’s still here. Let’s get real. There’s a lot of reasons why people are living in a state of threat, let alone the media and the way that they communicate things.
So we have to really start addressing firsthand, “Okay, what are my major sources of stress in my life? And how do I get a handle on these things?” I had to stop reading the news. I was just like, “The news is making me sad and anxious, and I can’t tolerate [it].” I used to wake up in the morning and love [reading] the Wall Street Journal. Then there [was] a moment where I was just like, “What is this doing for my mental health?” And I replaced it with meditation. Obviously, meditation is going to be more nourishing for your brain than reading the newspaper right now, given the way the world’s going.
Chris Kresser: Yeah, it’s remarkable how little you need to [read to] always find out what’s going on. You don’t need to read three newspapers and five substacks and Twitter and everything else. You will know the important things that you need to know even without that. I often recommend the same thing to my patients, and there’s anxiety like, “I want to be an informed citizen.” Yeah, me, too. You will know, one way or the other, what’s going on.
Molly Maloof: Yeah. The thing is, we’re told that stress is the thing that kills, but no one tells us how to handle it. What do we do when we get stressed out? What are we supposed to do? I think because people are moving so quickly in their lives, they don’t often pause and reflect on what’s really going on and how they’re living, and how they can change how they’re living. Some of my favorite stress-relieving tools are things like acupressure mats, biomats, [pulsed electro-magnetic field] (PEMF) mats, [and] sauna mats. I have all the mats in my living room. I invite friends over to hang out and, instead of drinking, we [lie down] and we do recovery practices. I want to popularize cuddling and hanging out with your friends and doing biohacks and giving each other Theragun massages. That should be how we socialize more often, [rather] than just thinking we have to go to every party and to every event when, for a lot of people, that’s really stressful, given how many options we have.
It’s also key to understand that if you do exercise, you have to recover, too. You need to bake recovery into your day and not just your exercise. That’s something I think a lot of people miss, specifically people who don’t have a lot of time on their hands. They’re doing the exercise, but they’re not doing the recovery properly. I think more people need to be thinking about, “Okay, when am I going to take my next vacation?” A lot of people skip vacations. They just don’t go. They just work through them. We feel so proud of ourselves for, “I haven’t taken a vacation in this long.” I don’t look at that as a thing to be proud of. Everybody needs time to recover and time to reflect. If you don’t occasionally retreat, or what I call advance, you often miss an opportunity to take a step back from your life and really look at how you’re living and say, “Well, what do I want to do different[ly] next year?” I’m going to Puerto Rico to see some friends and to do some work, but I’m also thinking about what happens later on and what [I’m] going to do during that week to plan for 2023. What am I going to do to sit down [and] really think through what I want this next year to look like? How do I want it to look different than this year?
Chris Kresser: Yeah, I think there’s a lot of cultural norms and attitudes there, as well, that make it difficult. There’s the sort of “I’ll sleep when I’m dead” mentality. Of course, we know that you’ll die a lot sooner if you don’t sleep.
Molly Maloof: Oh, my God, I had a conversation yesterday with a woman who [is a] world-class scientist [and] inventor. She goes, “I only need to sleep three to four hours a night.” I’m like, “I’m sorry, no.” And she’s like, “No?” I’m like, “Yeah, no. That is absolutely not true.”
Chris Kresser: Yeah. I mean, Matt Walker will tell you there is some variation individually, but there’s nobody that I know of that’s three to four hours a night. Here’s the interesting thing about that, which I’m sure you know. Studies have shown that after the first night or two of impaired sleep, you notice that your function is impacted the next day. But after a few nights of sleep deprivation, this sort of delusion comes over people where they’re no longer aware that their function is impacted by their sleep deprivation. So you get that phenomenon where people are like, “I sleep three to four hours a night, and I’m fine,” but if you did some kind of objective test of their motor function or any other way of measuring the impact of sleep deprivation, they would perform poorly, for sure.
Molly Maloof: That’s what I’m saying. That’s the thing. The lymphatic system turns on, opens up, and starts removing garbage from your brain overnight. That’s a really important time for your body to repair itself and clean out the garbage. You should be fasting overnight. That’s a really important time for you to activate ketosis. If you do a reasonable 14-hour fast, you’re going to have a little bit of ketones produced, and that’s neuroprotective. On top of that, we naturally live in accordance [with] sleep-wake cycles. Light-dark cycles are part of the design of existence. It’s not like you can just ignore that and pretend like that doesn’t matter. [Andrew] Huberman talks constantly about how morning light changes his entire day, but it’s just as important at night to have a really dark room, because even just a little bit of light pollution can really affect your sleep quality.
So these are very simple things that people can do. Prioritizing sleep is really key for optimal health, because it’s when we recharge our batteries. There’s a lot of gene transcription during the night. There’s potentially even more at night than during the day, they say. It’s interesting to think about the night as a very productive time and not this thing that we have to do. I used to think that when I was younger. I was like, “I wish I didn’t have to sleep. I wish I could just keep working all night long.” And then the first thing I biohacked was my sleep, and it was game changing for my mental health, my focus, my attention, [and] my mood. Yet it’s still overlooked by so many people.
Harnessing your spark is the key to reaching your physical, mental, and spiritual potential. In The Spark Factor, Dr. Molly Maloof offers lifestyle changes that target the unique biology of women and provide immediate and long-term benefits. #chriskresser #sparkfactor #biohacking
Stress Management and the Importance of Social Connection
Chris Kresser: Absolutely. Let’s talk a little bit about sleep and how stress and stress management relates to sleep. A common pattern I see is people running around like chickens with their heads cut off all day long and then getting to the point where they finally decide to go to sleep and expecting to just be able to get in bed and sleep deeply throughout the night. Of course, that doesn’t work at all. If you’re triggering cortisol and adrenaline all throughout the day and you’re on that hyper-alert mode, then when it comes time to sleep, your sleep is going to be really disrupted. So I often hear from patients, “I’d love to try to get to bed earlier, but I can’t because I’m so wired at night. I don’t feel tired [enough] to fall asleep, or when I do fall asleep, I wake up frequently throughout the night or I’m restless or whatever.” I know in your book, you talk a lot about the importance of stress management and different ways to monitor stress and how to approach that. Let’s dive into that a bit.
Molly Maloof: Yeah, there’s a lot of obvious things that we need to do. We all know that there [are] major life stressors, and that’s part of being human. But there’s this theory called the Generalized Unsafety Theory of Stress, GUTS theory, and when I learned about this theory, it made a lot of sense to me, because there’s a lot of hidden stressors in our lives. In between these big life stressors, there can be a lot of minor stressors in our environment, and also within our social networks and our bodies, that can contribute to our cumulative allostatic load. Our allostatic load is basically the total amount of stress that you have in your life at one moment. Over time, you can develop allostatic overload, and that’s when you start really seeing the negative effects of stress on the body, where you get mental health disturbances, you get impaired immunity, and you [are] generally feeling exhausted.
One thing people need to know about the nervous system is that when you’re in a safe environment, surrounded by people who make you feel safe, your brain turns off unsafety signaling. But if you’re isolated and you’re alone, and you don’t have a strong social network, you are, by nature, turning on the stress signal to protect [yourself], because being alone in primitive times would have signaled to the brain that it was unsafe. We actually developed loneliness as a primitive pain signal to bring you closer to your tribe. That’s what loneliness’ purpose was, from an evolutionary biology standpoint. So we talk about this loneliness epidemic, but it’s [really] an epidemic of disconnection and of people not having a strong tribe like they used to. More and more people describe having few to no friends. More and more people describe being isolated. That is extraordinarily detrimental to health, and something that I really want to promote—this importance of connection as a path to greater health. Because it turns out that the greatest factor in long-term health and happiness is close personal relationships. Yet, I wasn’t taught that in medical school at all. In fact, it was kind of glossed over. So that’s one facet of unsafety, is a disconnected social network.
Another one is, very simply [and] interestingly, low cardiorespiratory fitness. VO2 max is one of the best markers of longevity and yet, most people you talk to do not get the recommended amount of exercise per day. As a result, they have low cardiorespiratory fitness. By the way, aside from the Midwest, every single aspect of the country has experienced a natural disaster in the last few years. And if you’re [in] a national disaster, you need to be able to get out of danger. Yet, if you have low cardiorespiratory fitness, you can’t run away easily. This is one of the reasons why low cardiorespiratory fitness contributes to generalized unsafety. It also contributes to lower oxygen, [and] if you have low oxygen-carrying capacity, you don’t have high-functioning mitochondrial health. It’s a marker of how well your batteries are working. It’s how easily your body can assimilate oxygen and burn fuel.
Now interestingly, [and] I didn’t really encounter this until I lived in the Bay Area, but the decibel level of your environment affects your signaling of safety or unsafety and your general level of stress. Having lived in a big city before and now living in Austin, I live in a really quiet neighborhood, but I used to live in a very loud part of San Francisco. Over the pandemic, I started living in different locations, and I discovered that the decibel level of my environment really did affect my overall mental health and mental well-being. So I recommend everybody download a decibel meter and look up their decibel level to find out exactly how loud it is where they live. It can make a big difference in how you feel day-to-day. [The] same thing goes with visibility. Let’s say there’s a forest fire and you can’t see very far. Well, low visibility is also sensed as generalized unsafety. These are all really interesting ways to think through what some aspects of stress [are] that we may not be looking at but that could contribute to our overall health and well-being day-to-day.
Chris Kresser: Yeah, I think that’s really important. It’s looking through the ancestral evolutionary lens. What is our natural environment as a species? [It’s] looking at our current environment and seeing where those areas of mismatch are. It would have been highly unusual for us, for most of our evolutionary history, to live where there’s a lot of really loud noises. Especially unnatural loud noises. The same thing with [having] our visual field obstructed or to be in a situation where, like you pointed out earlier, we’re under constant chronic stress. Acute stress was always part of life, and chronic stress to some degree. But we weren’t sitting around worrying about our 401(k) plans and all of the new types of modern stress that we have now. Our bodies are just not wired for that.
So, acknowledging the fact that this is not going away [and] most people can’t just snap their fingers and get rid of all of this stress, to me, [it’s really] about stress management [and] reducing the stress that you can avoid. For example, if there’s someone in your life who’s [a] constant battery and energy drain, and they’re not a family member or someone that you can’t avoid, that’s a good example of where you could make a choice and reduce stress, right?
Molly Maloof: Yeah. There’s people [who] you need to block. There’s people [who] are energy vampires [who] will drain your energy and are toxic to your health. So you’ve got to pay attention to that. But also, concurrently, I just had lunch earlier today with some really wonderful women who I just met, new friends, and I left feeling so filled up, so energized, so connected, [and] so safe. And these are very new friends. I only met them each once before, and we got really vulnerable with each other. We shared with each other our biggest challenges in the last year. These [were] real challenges by people, real conflicts at work, real conflicts with partners, real conflicts with exes, and just real things that were affecting us. And it felt so good to hear from these really successful women that I’m not alone. They are really successful women [who] have problems similar to mine, and I didn’t feel alone in my problems. I felt very much like, “I can handle this. I’ve got people who have my back.”
To me, building social connection is this massively under-appreciated frontier of health that can really transform your life. What does that mean? That means a lot of people struggle with social skills. A lot of people don’t know how to make friends and don’t know how to reach out to people and say, “Hey, I’d really like to have lunch with you. Let’s go do this.” Some people are really socially awkward or socially anxious. Some people just feel really uncomfortable with social interaction, especially after three years of a major pandemic. But it’s important for us to get over those hurdles and reach out to people, and go to social events and meet people, and make new friends, and nurture those relationships, and deepen those relationships and expand those relationships. We’re designed to connect. When you connect with people, you share information and resources, and that enhances your survival. That enhances your chances of accumulating more resources, accumulating more friends, accumulating more connection, [and] feeling a sense of love and safety through oxytocin, which is nature’s medicine and implicated in the placebo response [and] in a variety of other things. The expectation of feeling good is what causes a placebo to work. Oxytocin is also naturally a mitoprotective, [meaning] it protects the mitochondria. It’s an antioxidant, it’s anti-inflammatory, it’s cardio-protective, it improves heart health. And yet, we’re not taught about how to boost oxytocin in medical school. It’s not part of your education.
It’s so important that we spend time with people we love and trust, and we build those relationships through having meals with others, through going to social events, through organizing things for people around us, [and] through sharing. Sharing and acts of service. It’s not just for your partner; it’s for others. Doing things to help others is very nourishing to your own nervous system, as well. So it’s just stuff that I had to learn. I’m actually publishing a paper with some students at Harvard on the relationship between metabolic health and mental health and this common pathway of connection versus social isolation. It’s just so obvious after the pandemic that we all miss this major problem. If you isolate animals in labs, they develop depression, they develop [post-traumatic stress disorder] (PTSD), [and] they develop anxiety. Humans are no different.
Chris Kresser: Absolutely. You referred before to some of the research on social isolation as being the major factor for longevity. One of my favorite studies is the one that found that lack of social connections is a bigger risk factor for early death than smoking 15 cigarettes a day. Which just blew my mind when I read it and blows everyone’s mind, I think, when they hear about it. We didn’t have to think about this 200 years ago and before that, because we just lived in close-knit tribal groups [in] most places [around] the world. And even in the industrializing world at that point, most people had multi-generational homes. Grandma and grandpa were there, and the parents and the kids, and the neighborhoods and communities were tighter. We didn’t have these isolated nuclear family living situations that we have today. Like you said, there’s a growing number of people who don’t even have one person that they can confide in and really connect with.
Molly Maloof: I mean, that’s so unnatural.
Chris Kresser: It’s very unnatural and very harmful.
Molly Maloof: It’s so harmful. It’s not just smoking; social disconnection is a greater risk factor for disease and mortality than sedentary behavior and obesity.
Chris Kresser: BMI, yeah.
Molly Maloof: So [if] it’s like smoking, sedentary behavior, [and] obesity, where’s the public health campaign for social disconnection? Can we talk about that? The government tells us we need to exercise [and] we need to eat five [food groups] a day. It doesn’t tell us we need to connect with people. It tells us to isolate. How does that make sense? How does that make any sense?
Chris Kresser: It’s a big problem, and we’ve had a lot of people on the show to talk about it from a number of different perspectives. Certainly, the digital technologies that we have are amazing at connecting people who wouldn’t otherwise be connected, and there’s a lot of pluses there, but it doesn’t substitute for real in-person, human, authentic connection. It doesn’t produce oxytocin in the [same] way. Just as a single example, it doesn’t produce oxytocin in that way, and we know about the physiological benefits of that.
Molly Maloof: Totally.
How These Factors Affect Your Metabolic Health
Chris Kresser: Let’s shift gears and talk a little bit about, because I know it’s a big interest of yours, metabolic health. In particular, we can tie together some of the things we’ve already been talking about, which are stress and social connection and emotional health, and metabolic health. Let’s use an example [of] a woman who is overweight. She’s trying to lose weight, but she’s burning the candle at both ends, [is] super stressed out, not sleeping very well, socially isolated in an unhappy marriage, [and] doesn’t have a lot of friends. What can we predict is going to happen with her weight loss efforts?
Molly Maloof: Oh, she will not be losing weight. It’s just not going to happen. And the thing is, it’s okay because it’s an adaptive response. It may hurt [in] the moment to feel like, “Gosh, everything I’m doing, I’m trying so hard, but I can’t lose that pound.” Well, it’s because your nervous system is literally under threat. The thing that people need to realize is that mitochondria are not just power plants. They’re not just taking in substrate, burning oxygen, and building [adenosine triphosphate] (ATP). They’re not just power plants. They’re also batteries and capacitors. They make charge in the electrochemical gradient, but they also deploy charge quickly, [and] where that charge goes is determined by the signals that the mitochondria get and the cell gets to determine where they need to direct the resources. So if you’re under threat, are you going to try to reproduce? No. You’re not going to focus on fertility; you’re not going to focus on letting go of calories. You’re going to hold on to every single calorie you’ve got because you don’t know if tomorrow is a famine. What if there’s no food around tomorrow? You’ve got to hold on to those calories.
Thyroid dysfunction is so common in this country, and obviously, Hashimoto’s [disease] is one cause, but there’s also a lot of subclinical hypothyroidism, and I think a lot of it is largely due to the amount of stress people are under. A body under this much stress is like, “I’m going to turn down that thermostat [and] save some energy. Why would I want to burn all this energy? I need to keep this energy around.” What I’ve learned in my career is that we need to stop looking at so many things as problems and diseases, and start looking at more things as adaptations. If you look at the body as always trying to protect you and keep you alive and keep you safe, then a lot of what we consider to be negative effects of stress are actually adaptive responses to stress. And they suck. I’m not saying it’s fun to not lose weight. But I am saying that if you understand the cause, then the focus needs to be directed differently.
During the pandemic, I gained 10 pounds. I was beating myself up [and] I was like, “Man, I just can’t lose this weight. What am I going to do?” Then there was a moment that I just remembered [and] it hit me. It was like, “Wait, you know this. You know you can’t lose weight because the world’s turned upside down. And once you get feeling safe and secure again, the weight’s just going to come off.” I did get vaccinated because I wanted to start traveling to see my friends. I had been isolated long enough, and I was like, “I want to go see my friends. I’m willing to get vaccinated to go see them.” And in three months, I lost all the weight. The moment I felt safe and connected, the weight just started melting off, and it was like, “Oh, obviously, this makes sense.” My diet didn’t change. It was my stress levels that changed; it was my body’s signals that were sent that changed. The world was different.
Chris Kresser: We could go back to when we were talking about cortisol and how, if someone’s really stressed out, then they’re going to [have] spikes of cortisol in the morning, which will spike glucose, which has a whole range of metabolic effects. We also know that cortisol can cause weight loss resistance, because when you have high cortisol for a long period of time, it blunts the receptors. You essentially get cortisol resistance, [and] you don’t get the impact of that anymore. There’s a whole cascade of things that we don’t need to go into, but [there’s a] very close relationship between what’s going on in life and the decisions that the body is making about weight regulation. This is a really interesting conversation for me, because I have [had] lots of people in my practice over the years, both men and women, with weight loss resistance who are doing all the right things, eating a clean, healthy diet, exercising, etc., but the needle is not moving. I think this is unexplored territory for a lot of people. “Wait, just having more social connection [is] going to move the needle in terms of weight loss?”
Molly Maloof: I do want to add another really important topic that is so under-discussed in health and so unbelievably important, and that’s the role of trauma in our history and also attachment dysfunction with our childhood. Adverse childhood experiences, unresolved trauma, PTSD, insecure attachment, a lot of these are facets of what we traditionally call psychology. And/or, if you were physically abused or sexually abused. What people don’t realize is that these experiences can change your nervous system. They can wire your nervous system to be more hypervigilant to threat. As a result, what would typically cause one person to feel [like], “Okay, so that thing at work, not that big of a deal,” another person would completely overreact and be like, “Oh, my God. What the hell?” Typically, people who are overreacting are people who have experienced trauma in their past, or maybe they had adverse childhood experiences, or they have something unresolved in their history with their parents, and there’s this programming that gets activated from negative experiences, specifically what I would call social injury. Sometimes social injury is big and it’s a serious trauma, like you were physically abused or your mother was abused by an alcoholic husband, or you saw some really bad stuff as a kid, or you were neglected, or your parents had mental health dysfunction. That imprints on you that the world isn’t safe and that you’re not safe. And if you don’t feel safe in the world, then you grow up thinking, “I’ve got to be so vigilant to whatever’s around me, because I don’t know if something dangerous is coming.”
If you talk to people who struggle [with] obesity, the first thing I like to talk to them [about] is, “Tell me about your trauma. Tell me about your childhood. Tell me about your relationship with your parents.” You’ve really got to ask people what’s underneath this. [The] same thing goes [for] people who are anorexic or [have] other eating disorders. Almost inevitably [in] people with eating disorders, there was something under the surface with their family or their upbringing that didn’t get fully resolved. The way I describe this is, [and] this is Dan Siegel’s work, but when you have traumatic events in life, it forms an implicit memory, and that implicit memory is in the present moment. This is where PTSD shows up from really traumatic things. If something was experienced under significant levels of stress hormones, the nervous system will sense that [it] is still present in the reality of your life. So anything that comes up that reminds you of that experience will be felt as though it’s in the present moment, right now. When people do work on their trauma and you actually integrate your trauma, integration is literally the process of taking those reactive implicit memories that are still being experienced as [the] present moment’s fear, and saying, “That goes into explicit memory, that goes into long-term memory.”
But one of the problems with stress and acute stress is that it can impair this memory transmission from implicit to explicit memory. It doesn’t get put into long-term memory, so you’re constantly reliving the same experience over and over again, with everyone that you experience. Anyone [who] triggers you or anyone [who] reminds you of that parent [who] hurt you in that way, you’re reliving that again in your relationships, and you’re reliving that again in your life. This is a thing that I started discovering when I started working in the field of psychedelic medicine and I was really trying to ask myself, “What is integration? What does that mean?” I had to study so many different psychologists to finally come up with an actual answer that felt scientific to me. And it was like, “Oh, so a lot of people are struggling [with] mental health issues.” But when people get talk therapy, oftentimes, you’re just reliving those experiences all over again and it’s not actually moving you. I feel like it’s consolidating those memories further where they were placed. What we need to do, and what the hope is from modern psychiatry, is that there [are] new techniques of healing trauma and there [are] new techniques with pharmaceuticals, and electroceuticals even, where we can change the way that our brain perceives threat and we can start to relearn these experiences as though they’re no longer unsafe.
I’m not saying I have it all figured out. But I am saying that there’s room for recognizing that you can’t separate the mental and the physical. You just can’t. They’re not separable. Your consciousness is in every single cell of your body. You can’t just say that the consciousness is in the mind. It’s everywhere. And it’s energy flow, I believe. I believe that mitochondria are conscious, and I believe that your cells are conscious, and I believe that amalgamation of you is this whole massive processing system of energy flow throughout your body. So why would you be able to separate the mind from the body? Clearly, when you have gut dysfunction, it creates inflammation that affects the brain. But when you have brain dysfunction, that obviously can affect your physiology. If you’re stressed out because of psychosocial issues in your life, it’s going to affect your digestion. There’s this bidirectional relationship that you can’t just cut in half. They’re connected. That’s why I think people who struggle with weight loss resistance often need to really deal with the psychology of their weight and even the spiritual path of, “Well, what am I doing? How is this serving me? And how do I actually change who I see myself as in this world, so I can let go of that person who I was and become a new person today?”
Chris Kresser: Lots of food for thought, and I think people are going to get a ton out of this podcast. Thank you so much for joining me, Dr. Maloof.
Molly Maloof: Chris, thank you so much for having me.
Chris Kresser: The amazing book, The Spark Factor: The Secret to Supercharging Energy, Becoming Resilient, and Feeling Better Than Ever is coming out January 31, 2023. Where can people learn more about the book and your work?
Molly Maloof: Go to my website www.DrMolly.co. My Instagram is @DrMolly.co. My Twitter and LinkedIn are @MollyMaloofMD. I’d love to have you support the book. We’ve got a pre-sale campaign going on until January 31 with lots of cool things. I designed a course at Stanford that I’ve converted into an online course, and that’s highly discounted during the pre-sale period. So [I] would love for people to take that, as well.
Chris Kresser: Great. Well, thanks, everyone, for listening. Send your questions to ChrisKresser.com/podcastquestion. We’ll see you next time.
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