480: How To Become Stress-Proof: The Secret To A Stress-Free Life with Dr. Mithu Storoni, MD, PhD

Podcast Transcription: How To Become Stress-Proof: The Secret To A Stress-Free Life with Dr. Mithu Storoni, MD, PhD  

Ted Ryce: Dr. Mithu Storoni, welcome to the Legendary Life podcast! So happy to have you here. We're going to be diving into a subject that is near and dear to your heart as it is to mine, we're going to be talking about your book, Stress Proof. We're going to be talking about why you wrote this book, and really how to help someone become stress-proof in their life, because, I mean, I'm just going to come out and say it, for me, the game of getting in shape and staying in shape and performing at a high level, raising your kids, whatever it is that you want to do, comes down to managing stress.

And you pointed out in your book that those of us today in the modern, digital crazy world that we inhabit—which has been great, you and I connected over Twitter, but we don’t suffer from : “how do we find food? How are we going to eat?” We don't have that experience. We don't have the experience of like: “Oh my gosh, the Winter's coming? Are we going to freeze to death?”

We have: “I don't know if I can pay my 30-year mortgage. My boss is passive aggressive.” We’ve got psychosocial stress, and then add what we've all been through with the pandemic recently. So, it's just a perfect time to have this conversation.

But what I'd like to start with is, can you share a bit about how, you know, you're a doctor, you're an eye doctor, an eye surgeon, and you wrote a book about stress. Can you talk a little bit about your journey there? Why you decided to write this book.

Dr. Mithu Storoni: Thanks, Ted, thank you so much for having me today. It's a pleasure to be here. Yes, so it was a journey for me. And the journey came through very different angles. So, my first angle was subjective. Any junior doctor knows the burden of junior medical training. So, the stress of being a junior doctor, the stress of my early years of my career and so on, was a channel through which I felt stress, in the direct subjective manner.

Second is when you go through a whole journey of medicine, so I went through—so general, then I specialised in ophthalmology eyes surgery. And then I did neuro-ophthalmology, where I began to see patients in a tertiary clinic. I was part of a team in a tertiary clinic, which meant we saw patients who had neurological conditions, which did not have any easy answers, so easy explanations, and they were really at the edge.

And when you see a whole spectrum of such disorders, and especially autoimmune, the whole spectrum of autoimmune conditions that we see in medicine, you realise that there is something more, there is this little shadow or elephant that’s lurking in the background. And the problem is that, at least during my medical training, stress was not really recognized as a culprit, as a topic.

So, whenever patients would come to you, and say, “Well, okay, I've had a relapse.” And you would ask, “Well, did you do anything differently?” And these patients would follow their treatment to the letter. And the only thing that they could flag, that I could flag was they'd gone through a very stressful experience shortly before relasping, or shortly before their symptoms reappeared.

And it's very obvious that stress always played a factor in the background. And so, when I finally got around to it, I had time to sit down, and try to understand it, to make sense of it, and get some papers together to kind of create a manual for it.

Ted Ryce:  Fantastic. And I want to say I'm no stranger to reading about stress, or books about stress. And what I really appreciate about your book, I mean, I think Robert Sapolsky, Zebras Don't Get Ulcers, was a fantastic book.

I think it a lot of things have changed since then, a lot of new breakthroughs in understanding stress, as well as how to manage it, and what might work. And I think you did a great job in your book of tackling all those things, and so it's a really nice, updated version.

Another thing that I really like about your book too, is that you do a great job of riding the line between being very evidence-based using randomised controlled human trials, to backup things where you can, but also being open to the things that may have promised, that don't have a lot of solid evidence.

And I don't know about your experience of the health and fitness industry, but mine is this: we're in this time where people, either they’re too evidence-based so if there's not a randomised control trial, they won't even entertain it. Acupuncture. show me randomised control trials. Meditation. show me randomised control trials. I don't know about the quality of those trials.

And so even if people say…Well, for me, I get acupuncture, I meditate almost daily, and I don't care what the trial say, right? You know what I mean?

And then you have the other side, which are like, people who are saying things like, “Well, what you’ve got to do is you’ve got to go do some grounding, you've got to take off your shoes and walk on.”

And it's, they're all about that, or about maybe the biohacking culture where they're doing all these things. And it's, there's not really much evidence to provide a solid backing for doing them. So, it's really hard to tease out, okay, is it placebo? Is it actually doing something? So, I think you did a great job of writing both, you know, being open minded, but being based in the evidence where you can.

One thing that I want to talk about, though, is something that you brought up, the issue with stress leading to problems, like you mentioned with autoimmune disorders and some other things.

And if you go to the doctor, what typically happens, they talk to you, or at least in the States, right? I know you've been all around, though you're British, but you've lived in Hong Kong, and now you're in Luxembourg. So, you've been all around the world.

But in the States, the way it goes in my experience is you go in, you do an interview, they ask you some questions, and they run some tests, and everything comes back normal. And if there's nothing that fits the book of like, “Oh, well, you need a surgery for this,” or “here's the treatment for this,” then they don't do anything.

And that's what I understand to be called a biomedical model. But what you're talking about is maybe the biopsychosocial model, looking at how stress affects our autonomic nervous system and what that entails.

Can you talk a little bit about that and your view on it, being a doctor, and then also when someone who is struggling with that goes to the doctor, they “Help me,” and the doctors like, “Well, we did the test, and you're fine,” but they know they're not fine. Can you talk about that experience? And maybe what someone can do, they find themselves they're sad.

Dr. Mithu Storoni: So, thank you very much. I think I agree with you that there is a big problem. I go by the words of my mentor at this tertiary clinic where we used to see the patients that no one else could solve. And his golden words were, “The patient is always right.”

And if you if you extrapolate from there, actually, we've come to a situation within science, science has undergone several evolutions through history, and around the 18^th century, 19^th century – I’m talking mainly about Western science—when we decide when we realized how if we reduced large, complex puzzles, we could reduce these puzzles to simplistic pathways, and within a certain framework, these reduced simplistic pathways could actually predict and could very easily define the ways in which systems worked.

And, of course, in science, a degree of reduction is necessary. And the issue that we fell into, is that we assumed that everything can be reduced. And that is how with confirmation bias and propagation, we ended up entering into a system where we operate based on the fact, based on the assumption that almost everything is reducible into simple pathways.

Now, today, we are learning—and of course, it's not just today, it's happened over a while—that actually the human body, the human brain, in fact, all of life, we are not a simple system, we are a complex system. And a complex system means we are made up of pathways, each pathway may not be linear, so when you sum up the pathways to create the complex system, you get a completely unpredictable outcome of the system at large.

We know this with the weather. We can't predict the weather accurately from one day to the next. We can do a sum job of it, but we can't predict… I mean, I can't predict the weather in Hong Kong sitting here, as an example. So, we very gradually are now grasping the idea that actually the brain—well, physiology, the body and the brain are actually complex systems.

And this applies even more to the brain, where we've managed to segment out over the years, parts of it. And we can predict and describe how these parts work in terms of a simplistic linear model. But as soon as you sum the parts together, you start looking at the brain at large, we suddenly run into these glass walls.

So, the reason why the patients that you describe, people whom you describe who come into the clinic with a problem, with something that they are subjectively feeling, but that is not objectively measurable, and both parties part without a clear solution, which is frustrating on both sides. That sort of situation has arisen because of this way in which we generally tend to perceive science.

And just to repeat, it would be an impossible task not to do this, because we have to reduce something to something.

But wh at we must also always remember is that what is not reducible, does exist. And so when a patient comes with a complex problem—and many labels of, for instance, the word psychosomatic, have been used in the past that we are now finding actually measure up to antibody levels that you can measure in someone's blood, they also correlate with other things that we were not able to measure before.

So, our tests are only as good as the tests themselves. So, all of these factors enter into it. And I think they are especially true when it comes to a topic like stress. So, 20 years ago, stress itself, of course, as we know, the research following the war years, especially enhanced and emphasise the importance of stress. But stress has been talked about for even longer.

The reas on why stress has never been factored in to medical conditions or to disease at large is because it's never been measurable. And also, because a large component of it has a subjective element, you cannot measure subjectivity. However, with stress, subjectivity is probably the most important factor of all, because if you look at stress and its effects on disease, its effects on illness, its effects on mental illness, it's almost never the measured levels of cortisol, that are at play, it's always the perceived stress.

Perceived stress correlates with the outcomes of stress, whereas actual measured stress does not. But if we disregard perceived stress as subjective and hence, cannot be measured, we are losing knowledge in a whole wealth of conditions.

So, addressing the last point you raised about what should people do when they go to the doctor and they need to…So, first of all, I think it's important for all sides to realise that any illness, especially your perception, one's experience of an illness of any kind, it can be as simple as a little cold, it can be as complex, as you know, something far more serious, but that perception is yours. And there are elements of it that can be understood by medicine, there are elements of it that are yet to be understood, but that do exist.

So, if your physician just does basic numbers of tests, that gives you assurance that what is being tested is okay.

But there is still this large area which no one has the capacity, perhaps, at this moment, to test, but which exists. And there is some, you know, it may be possible that addressing it in a variety of ways. If it's something like stress, then addressing it in 360-degree way can provide solutions.

Ted Ryce: Yeah, it immediately brings up for me what you say there. I recently did a course in cognitive behavioural therapy to apply it to my coaching clients. And in the stress segment, the person teaching it, who actually interestingly, he's part of the medical school. He's a clinical psychologist, but he works at the medical school, I believe, in University of San Francisco, helping to train physicians on how to use a more psychologically and socially-oriented model when approaching their patients, helping their patients.

So, he mentioned Something about the perceived… So when you say it can't be measured, what you mean is like on a blood test or an imaging, MRI or whatever type of imaging that a medical doctor might use. He recommended the perceived stress assessment— I forget exactly. It's a type of questionnaire, that might be helpful.

Another thing that came to mind, because I think someone listening might hear you and listen to the perceived stress thing, and think of, “Yeah, that's some nice talk, but that's not really…It's stupid, to be honest.” I think there's a lot of people who would hear that and think that way. In fact, in the past, I might have, but I wanted to share an experience where for the past three years – it actually kind of pre pandemic—I went and had an experience in Southeast Asia that really changed me.

I travelled to a bunch of places, including Hong Kong, by the way, and Bali and Thailand, but the place that changed me the most, was going to Cambodia. And I had a really nice experience at Angkor Wat. But then I came back and kind of forced myself to do the Killing Fields tour. And if you're listening and you don't know what that is, they had a genocide there in the late 70s, I believe, and you see that it's still in living memory of these people, and how it affected them.

And you know, I've been through some things in my life, as we all have. But seeing the way people there dealt with it, it's a great example of what you're talking about with perceived stress. And they really relied on their—in case you don't know, you know, I know you're familiar with that part of the world, me too. But case, someone's listening and they don't really know—there's a Buddhist culture out there. And they're very strong family and friendship ties, they put a lot of value on their relationships with each other. We say we do that in the States, but it's not quite to the same degree. It's really supportive there.

And you see them talk about it in the way they talk about it, and sometimes it's triggering some of the conversations that I've had when they were talking about how people starve to death, or were taken away and killed in one of the killing fields, but it's just, you see how they rely on the religion and their friendships and family relationships. And it just changes their perception of what they've been through, and they're just more okay with it. Do you have anything to say about that or personal experience? What do you think about…?

Dr. Mithu Storoni: This is really important. There are angles to it. The first angle is that if you're perceiving stress, it does not mean that you are weaker than someone else, it's not a weakness of being able to mentally bear it.

And also, that idea actually works into the second factor, which is that if you have a scale of personal life experience, where zero is everything's great, and 10 is what you've just described.

Then, if a colleague or a boss shouts at you one day on the corridor, your perception of that stress with regard to your own personal scale is probably going to be a two or three. But if you've never seen what you've just described, never lived through that horror and your worst experience of feeling threatened is by a colleague on the corridor of your office, then that is your scale number 10.

So, every time someone threatens you, or you feel social stress, you have to give a talk, etc. Your perceived stress level could go right up to eight or nine. But if you had the same environment, as the people you speak about—luckily, most of us don't. But if we did, then our own scales shift.

So, the perception of stress isn't just to do with your own resilience, your own built-in mechanisms, your built-in mechanisms are shaped by your environment, by your daily practices, by what you describe, your social network, your social environment.

So, the important thing here is that someone whose boss is mean one day, actually feels and palpably suffers more stress than someone with exactly the same experience, say from the experience in describing Cambodia. That does not mean that the person who has lived a life that is relatively safe is simply giving in or is simply too sensitive or too soft, it's about how you respond.

And this is also very important because your perception of stress—we call it perceived stress, that actually manifest in extremely measurable ways. And one of the things I've tried to do in my book is, of course, link these together. 25 years ago, when I was in medical school, if you discussed measuring or looking at gut bacteria or giving people faecal transplants to make them feel happier, you would probably have been kicked out of the medical school.

Bu t we now know that just the perception of stress changes your bacterial makeup in the gut. So, your perception of stress—not your actual measured levels, your measured levels may also correlate with that, but they may not. So, while perception of stress is a very vague— is a very sort of subjective label, it has incredibly strong effects. It is significant. And for the individual concerned, it matters.

And I think the last takeaway here is, you know this actually offers an advantage. Because if perceived stress is really the stress that matters, then you can play around with the cues you are giving your brain, with the cues you're exposing to your physiology, to lower the perception of stress, regardless of the stress that is rampant around you.

And when communities go through trauma, and I'm going to bring in another short study, if I may, a recent study that looked at PTSD in US veterans, and compared that PTSD to PTSD suffered by members of a tribe—I’m forgetting which one—a tribe in Africa, who also go through exactly the same degree of trauma.

But there's a key difference between the two. The US soldiers who were studied for the paper, we know their lifestyle, you're aware of their lifestyle, an average lifestyle. If you compare them with African counterparts, they had rituals before they went to war, they had rituals after they came from war, they were valued, they were given prizes consistently reminding them of their value to society, the entire society shared their values that they were going through a noble group goal.

So, all of these things, what were they doing? They were really manipulating and manoeuvring their perception of their reality. So, you can alter your own perception of your reality for measurable outcomes, which can then be physically measured as markers of disease, markers of illness, in the case of PTSD, as brain scan findings. So, all of these things, it being perceived stress actually offers an enormous tool for us to play with.

Ted Ryce: Beautiful example. And I love the talk about the rituals that are designed to improve the warriors, the people who are going off to war, what their perception is of how they're standing and where they are in their tribe and also what they're doing. Yeah, it's a beautiful example. And something I feel, especially…I know, the UK is much older, obviously than the US, former colony, right.

And I feel like in the US, we really…One of the great things about the US is we're kind of unbound by tradition. That's my feeling and perception. We’re unbound by tradition. I don't know where my great, great, great… I assume they're British, I don't know for sure. We just don't have that connection. The people that I've talked to, only people who have immigrated, they have a connection to their past, their ancestry, if you will.

And it's good because we can look at the world through fresh eyes. But the con, I feel, is that it's like all these, like from my experience in Southeast Asia, they have a very deep connection with their ancestry. In Thailand, they have these spirit houses where they give offerings to the spirits that have passed, the spirits of their family. In Malaysia, the Hungry Ghost Festival, all these things that they do.

And it's like, we don't do any of that. It's just kind of making it up as we go along. And we just don't have these. We don't have rituals that we do. Yeah, it's just fascinating what you're talking about.

Mithu, unless you have something to add there, I do want to address the other aside that I've found where you so eloquently put forth the person who's getting super triggered by their boss having a bad day, because it's kind of like the most stress they've ever experienced, based on their perception.

And then sometimes I deal with people who are under a lot of stress but they're like, “No, no, it's not stress. It's just, I mean, I can't sleep at night, I feel like I'm walking on eggshells with everybody, like I'm just about to explode. But no, I'm not. I'm not stressed.”

I mean, that's like baby, like wimp—that's just a wimpy sort of thing to view, like, “Oh, I'm stressed out, I just need to suck it up, and push forward.” Can you talk a little bit about how you view that particular perception and your thoughts about it?

Dr. Mithu Storoni: Sure. Yes, unfortunately, that used to be the norm much more thankfully, than it is today. The problem with our world at large, and perhaps some of this might change after the pandemic, I don't know, but the problem has always been that stress was viewed as a mental reaction to the burden that life is giving you.

And the problem with that view, and to corroborate that, if you were to just type in “stress” into Google, at least, you know, until recently, you get a picture of someone with smoke coming out of their ears and just looking at angry and looking taut and strained and so on.

Today, we are learning—and this is what I've tried to do also in my book—is that you could be suffering from chronic stress, not the acute bouts, when the acute becomes chronic, you could be suffering from chronic stress, and looking at you and your own perception of yourself might not give you any red flags.

So, you could just be keeping calm and carrying on and keeping balanced for your colleagues, for your family, for your loved ones to see. But in fact, because stress and perceived stress, not just the stress that you can measure, doesn't just rest in your brain or rest in your perception, in the parts of your brain that deals with perception. Chronic stress goes through your brain and acts out through at least seven pathways.

And someone who is keeping a lid on how they're feeling or not recognising that they are putting themselves into stress, could suddenly one day find themselves developing insulin resistance through no fault of their own. They're doing exactly what they've always done. They're exercising, eating right, doing everything right. For some reason, their blood sugar, their insulin blood sugar relationship dynamics have just suddenly gone haywire.

For another person, they could suddenly also, in addition to that, be developing hypertension, high blood pressure, or developing, putting on weight. For another person, they could suddenly have gut disorders. And you could have – and of course, we know that over several years’ time people could possibly develop the risk—we must still call it a risk, we cannot still call it a cause, but there is a strong risk of developing things like depression.

Now, this is the problem, if  you view stress as just a mental reaction and your instinct is just to toughen up and bear it, you are not eliminating the effects of that perceived stress. That perceived stress is acting on every single organ system in the body. And just to quickly go through this, the moment we get stressed—and I actually didn't know this until I wrote the book myself—but the moment we get stressed, at least seven processes take place across your brain and body.

Some of them, most of us will have heard about. So, we know that there is an immediate neural response, autonomic response. We know that is followed almost immediately by a hormonal response. Your cortisol levels peak about 20 minutes afterwards, I'm talking about the acute stress response. What is also true is at that moment that you're acutely stressed, your blood sugar's go up, they raise up.

At that moment that you're acutely stressed, there is a burst of synaptic plasticity, in a particular, within your brain. If you were a mouse, you'd have a burst of new neurons being born. There are many other things. So, there's a sympathetic drive, also causes a rise in the heart rate and high blood pressure. We know about all of this, but we also know that at that moment, there is a surge of inflammation.

So, if you were to take a blood test, you'd find raised inflammatory markers at that precise point.

And we also know that if all of these short-term processes, if you imagine them like an accelerator pedal on a car that you're driving into the highway, you want to speed up so you press on your accelerator—Of course, if you don't have an automatic car, I know many people do these days—but you press on your accelerator. But if you keep your foot pressed on the pedal, your engine starts burning out.

Com ing back to stress, an acute short burst of stress, all of these processes keep you alive, they ensured the survival of our ancestors when they were running away from predators, but all of these pathways, they are nonlinear. So, the effect they have in the short term is different to the effect they have in the long term. In the short term, they cause good. In the long term, kept turned on, they cause harm. Short burst of inflammation is great. Chronic inflammation, we know leads to a plethora of disease.

Short term rise in cortisol is great. Chronic cortisol leads to all sorts of disorders and dynamic relationships, disordered dynamic relationships. All of these, and the same with plasticity. Short term, you get a rise in plasticity. But if you keep the stress reaction going long term, plasticity actually goes down.

So, if you are keeping the stress that you're experiencing, bottled up, so it accumulates and it becomes chronic, you're not going to be able to see the sugar levels flying in your blood unless you stringently measure, you're not going to be able to see your own blood pressure fluctuations minutely throughout the day, you're not going to be able to see your cortisol, you're not going to be able to measure the levels of inflammation within you.

But one day, they will manifest as an illness. And at that point, you will have to start treating the illness. Whereas, if you very early on recognise the signs of acute stress turning chronic, and you take action, you could prevent, or at least reduce the risk of many of these things happening.

Ted Ryce: Yeah, makes me think of what so many people complain of with, “Oh, I’ve got to get the kids ready, the kids aren't doing what they're supposed to be doing,” or relationships that have a lot of stress due to poor communication, or whatever the route might be, or job stress, really interesting.

I don't know about where you are, but in the United States, I read the American Psychological Association survey on stress, and they were saying how there's been a shift. Usually, it's like money, career and family, right? That are the big: “I can't pay my bills, I didn’t pay them, work…My family, I love them, but I want to kill them sometimes.”

And now there's been a shift to national level issues in the United States, people say “the future of…” and this is on both sides of the political spectrum. I'm not personally a very, I'm not really into – I probably fall in somewhere in the centre. But just so people know. But regardless of what political affiliation people were, they said the future of the country is a big issue.

And I don't want to get into a political discussion here, but I think the important point, and I'm open to whatever you want to add to this, you know, it's stressing out about these things where you can vote every four years in the United States for whoever you want as President, you can do certain things and show up.

But we're in a world right now where you can constantly get triggered by viral videos, sometimes taken out of context of the statistical incidence of how often something might happen. And certainly, I think we're at the point where we've started this conversation again in the United States, where we're looking into these things to try to figure it out.

But I wouldn't want anyone, regardless of their political affiliation, burning out along the way, especially because one of the things that happens with stress, something you talk about in your book, is that the seed of our goal setting, our logical decision making is our prefrontal cortex, and stress knocks that out.

So, if you want to solve the world's problems, or maybe just your own, that thing needs to work. And if you're constantly getting triggered because you're on social media and someone says something you don't like, or shares a video that's very triggering, you know, it happens to most of us, at least if you have a social media account, or five, but you can just end up in this state.

And I feel like you could make an argument for it in that, “Well, I need to know what's going on, this is important, addressing racism or inequality or politicians who are disingenuous,” and all that stuff is important. But you’ve got to keep your head about you or more specifically, your prefrontal cortex working properly if you want to live your life or have any type of positive effect on yourself, on your family, community, the world. What are your thoughts on that?

Dr. Mithu Storoni: I think you're really correct. And I think that the problem does not just exist in America, in the United States, it exists everywhere. And I've been thinking a lot about this since moving here to Luxembourg in Europe, because hundreds of years ago, if you say your ancestors came from Europe somewhere or the UK or somewhere, your ancestors…Let’s just imagine you had ancestors in the middle of German Village, okay? And let's just say the village was very small.

Now, in those days, if you lived in the little village, you saw the news, because it happened in front of you, you did not care about anything that did not happen within your tiny, little village. If something came from the next village, that was a big deal, that was far away, it took us such a long time to get there. Before bicycles were invented, it took us even longer. Okay, so the sphere of control.

So, I'm going to bring into this two ideas: one is uncertainty and the other is information. I think that really applies to this time. Now, Claude Shannon, who's the father of information theory, he's the reason why we have so much digital data right now. He’s an amazing, amazing scientist, American, he said, “Information is the resolution of uncertainty.” But today, we're actually flipping it on our heads.

Going back to that little German village, it doesn't have to be a German village, it can be anywhere in the world. But just to imagine it, you know, the little beautiful houses and so on. In those days, we would seek information to resolve an uncertainty or various uncertainties happening within our immediate sphere. And we could see the sphere, we could smell it, we could hear it, we could touch it, we could participate within it.

As soon as information became digital, and Marshall McLuhan has written a lot about this in his work on understanding media, as soon as it became digital, we started being given information and data from places and faraway events over which we had no control.

So, in that little village, you had control, because you're a citizen of that village, you have power in that village, you had control, so you're only concerned with what happened there. But today, we are getting information, which we did not ask for, from miles and miles away. And that information triggers something inside us, which says, “Oh, look, there is uncertainty lurking all the way there that you had no idea about.”

Now you have an idea of uncertainty by getting information. And the reason why in this case, information is bringing uncertainty is because you can't do anything about it. It's so beyond your sphere of control.

And the instant nature of electric media, of connectivity, of digital communication, and the cheap way in which we throw information around is actually creating more uncertainty within us. Because we are being shown, we are being highlighted, elements of uncertainty, beyond our spheres of control. And in some ways, this does also apply to the pandemic, because for some people, they're able to control what is immediately around them, their own health, the health of their loved ones, the health of their community. That's all you can do when, you know, the height of this pandemic.

But if you're then constantly shown pictures of the worst-case scenarios taking place on the other side of the world, you're seeing those pictures, you're sensing uncertainty, hence, you're feeling fear, but you can't do anything about it because those parts of the world are beyond your reach and beyond your control.

So, I think this is really a problem that we all have across the world. And, of course, as you mentioned earlier, we are communicating because of digital communication. And I'm a big fan, I'm a big admirer and a big proponent of technology and the way we're all progressing, but I think the flip side of it needs to be appreciated, especially when it comes to mental distress because this brings another angle to it.

At the moment, we are experiencing the world through our imagination for a large part of the time, we're not seeing events happen, where we are watching little snippets of it and we're having to fill in the gaps in our heads. So, we are creating a virtual, extensive, detailed world that is spanning the entire earth. And now, thanks to Jeff Bezos and others, also extending beyond the earth into the universe.

So, we are creating a virtual world, which means that we are holding all this data, all this information within our imagination. And this is very dangerous, because perceived uncertainty, if you add a little bit of the spice of uncertainty into your imagination, your imagination runs wild. I mean, the film industry has capitalised on this for decades.

So, we're living a virtual world, thanks to a virtual way of life. We're experiencing things through our imagination, and the uncertainty that the information is bringing us, we cannot resolve. And hence, our imagination is turning that into fear, into a sense of constant, relentless fear and paranoia, thanks to this digital media, instant communication and constant flow of information.

So, I think this is a problem. And you described the United States, I think it is a problem that extends elsewhere and where you will not find it is where people are engaged in their communities, they're doing, they're active, they're seeing, they're touching other people's hands, holding hands, doing things with their hands, as opposed to doing things virtually.

So,  where people are really detached from a virtual existence, at that moment, you feel a greater sphere of control, you feel more agency, over your surroundings, and there is a very strong link between agency and stress. Because if you feel you're an agent of your surroundings, of your world, you feel parts of the world are under control.

And if you can predict what lies immediately around you, you're predicting threat, and hence, you know there is no threat, your stress activators, the stress triggers will no longer trigger stress, you will calm down. So, creating an island of certainty, when we're in this virtual world is of incredible importance. And we can do that in many ways.

So, disengagement from the virtual world is probably the first step. And I think most people are aware now having screen free time and so on. But being aware of how much salient information and data is coming our way, how much of that we can actually do anything about and hence, is relevant. Making that distinction is very important in this setting.

Ted Ryce: Great. And I do want to transition into, what can we do about it, right? How do we become, in the title of your book, stress proof? And so, you just kind of laid down the foundation there. But I want to say one thing very quick. I'm in Florianopolis, Brazil, it's incredibly beautiful here. And I do a lot of my work online, and I post on social media, more than I really need to, for business reasons.

And sometimes you go there with a purpose of posting or maybe getting back to someone, and all of a sudden, you get sucked into the algorithm, you read something and then you click on another thing, and you go down this rabbit hole and 20 minutes have gone by where you’re reading something that kind of stresses you out a little bit. And then I walk outside and maybe take a trip. People are walking around here. And Brazil has got a lot of political turmoil going on here.

Don't need to really get into that, you can Google it—or please don't Google it, actually, you don't need to stress yourself out about what's going on in Brazil, so don't Google it.

But yeah, you can go out to the beach right here. I mean, there's some beautiful places in nature. Nature is something that, as you mentioned in your book, and has been researched, can lower your stress levels.

So, you see these beautiful vistas or views. I did a hike to this beautiful, beautiful view. And it was just incredible. The whole day, my phone didn't work because there was no service there. And so, I could take photos or little videos and I did a lot of them. But I never like checked or got back to people or got all my email. And so, I had some disengagement there.

And also, I had some engagement with the people I was with and also with nature, climbing and getting exercise, getting some sunlight. And yeah, let's help people…What would you say besides that disengagement?

I know we don't have a lot of time left here. But what can we do to present a kind of a hierarchy of like, okay, we'll do this first, and maybe one or two other things that you think can really move the needle for someone with changing that perceived stress?

Dr. Mithu Storoni: So, one thing I'd say is, first of all, try and identify where your stress triggers are coming from. So, in my book, I talk about seven pathways. Some people are going to be more likely to be vulnerable to one than the other. So that's, I'd say, the first step. So, for instance, if you are someone who has a great life, perfect life, but you work night shifts, now working night shifts, alone, regardless of anything else, acts as a chronic stressor.

Another example, you might have everything perfect in your life, but your diet may be incredibly inflammatory. And there is a very strong proven link between inflammation and chronic stress. So, look at an area where you think you need to work on. So, I say that on a very general level, but on a very more specific level, the strategy I use in my book is to flip things on its head.

So, we know that if you are under chronic stress, that chronic stress is causing harmful changes, or is likely to cause harmful changes in the body through seven pathways. Not everyone will experience the changes in the same way, some people will be affected by some pathways more than others.

But if you look at those seven pathways and you start pre-emptively, making every pathway as solid as possible, doing everything you can to create a boundary in that pathway so stress cannot affect you down that zone, then you will be creating a bolster against stress, no matter which route is acted on.

So again, as an example, one of the routes through which stress acts is through inflammation. There is plenty of data. So, imagine you're living a life, you can't handle this, the psychosocial stress that you're getting, or your diet is very inflamed, you're getting stressed, you can't escape from it.

So, a very simple thing you can do is you can probably manage the food you're eating, you can decide what you will eat, even if you can't manage it, per se. So, look at what you're eating. And I've given a full index of anti-inflammatory foods and the anti-inflammatory index, which has been studied and published, change your diet and make it as anti-inflammatory as possible.

And one of the simplest ways to do it, as a one step process, is add probiotic food to your diet as much as possible, that immediately bolsters one physiological pathway that stress might be affected by. I'll give you another example. If you're someone who works in a stressful environment, where there's a lot of psychological stress.

So, you're being affected by the way people are behaving towards you, you're constantly having run ins with people, you are having bad customers down the line, etc, angry customers down the line. So that's the pathway you need to address. And a very quick hack in that pathway is, remember that the trick, perceived stress is the main thing.

So let me tell you a little example, give you a little example. Imagine you walk in to your colleague boss' office, boss wants to see you, you walk into their office—this is the pre pandemic day when you didn't work from home—just imagine you walked into their office. And in that office, your boss rips your head off for five minutes, telling you are terrible, what you've done is terrible, etc, etc. It lasts five minutes.

After five minutes, you open the door, and you leave. Now that episode of stress has lasted five minutes, but what do you do afterwards? Chances are, you will go by the usual wisdom. And you might go back to your chair and just say, “Ah, I just need five minutes just to recover from that.” And you might just take 10 minutes out, grab a cup of coffee and just sit down and relax. That is where during that10 minutes, your mind…

Now, let's just come back to that scene. When you open the door and you leave your boss's office, you know you've left the room, your boss knows you've left the room, but does your brain know you've left the room? It does not.

So, when you leave the room and your brain is empty, your mind is empty, you're sitting down on that chair taking a bit of time out, your mind immediately does what it deems most urgent, which is, it replays what just happened over and over again because it has nothing else to do.

And as it replays the experience while the memory is still fresh, the stress pathways which were already active, continued to remain active. In fact, as it replays it in stunning technicolour of your imagination, the memory of that stressful experience becomes even more vivid if you thought you were being attacked by one lion, in your imagination, that's turned to 10 lions.

And so, as you sit there and ruminate, not only does your stress response stay active, so your physiological stressful experience has lasted well beyond that five minutes. If you ruminate for another hour, it will have lasted a whole hour. According to your imagination as well, the impact of that stress, of that experience or what you perceive as reality in that stressful experience will also have been wildly exaggerated.

Now imagine you have five such experiences throughout the day, that amounts to about 25 minutes of stress, which, you know, give or take, maybe we can handle. But now imagine you ruminate for one hour after each of those stressful experiences, that amounts to five hours of perceived stress. And that perceived stress has translated into your physiological experience or reaction to stress.

So, your cortisol levels will have stayed elevated, your autonomic nervous system will have stayed active. So, you will have experienced five hours of stress in your reality.

So, a simple thing you can do if you are constantly exposed to emotional triggers like this, is the moments or stressful experiences over, do something incredibly immersive and intense. So that that five-minute episode is cut short at the five-minute boundary. If you want, you can go back to it afterwards. But in your brain’s perception of reality, you will only have experienced that stress for five minutes.

So, this is how if you're someone who thinks your stress is entering through a psychosocial route, this is another little hack you can incorporate into your life. And there are also general stressor hacks.

So, we know that in animal models, chronic stress causes shrinkage in some parts of the brain. We also know that exercise increases or reverses or prevents this shrinkage. we know from animal studies, putting them through chronic stress, and then putting them through chronic stress whilst also making them run on treadmills.

So, you can do this as an antidote. So, in my book, I talk about hundreds of small strategies, and not all the strategies will work for you as an individual. But if you can identify roughly which area you are most likely to be exposed to and work on those tips, you can bolster the harmful processes of stress, even if you're not actively aware of them.

Ted Ryce: Yeah, so in short, buy the book and listen to it, it’s really good, or read it, if that's your style, but you talk about so many ways to deal with it. We we've covered just a few here. And I really love your delivery. And like I mentioned earlier, I really think this is a very modern and practical version of what Robert Sapolsky did, you know, with “Why Zebras Don't Get Ulcers”.

And I love what you what you're mentioning here because I was kind of stressed out. I mean my life is… I've been through a lot of my past but it's pretty good now but still dealing with some things, and I went kite surfing and the water, it's the opposite seasons right now so I'm in the middle of winter in Brazil, worse places to be for sure in the middle of winter, but it's still quite cold for me being from Miami.

And went kite surfing, got in the water, immediately was like forgetting about everything else, and then trying to control this kite and not get slammed, which I was unsuccessful at doing the first few times, getting dragged into the water with the strongest. I mean, I wasn't thinking about anything else, except just like, “Oh, please don't drag me into the water again.” And like you mentioned, it can be a very immersive and perhaps an intense experience and you just can't think of anything else.

My dad, as I mentioned on the podcast before, my dad died last year in October, and one of the things I did—I mean, it was his time, right? It was old age, not COVID—and one of the things I did afterwards was I went to Universal Studios, Florida, because you can't be sad on a roller coaster. It's impossible.

If it's a strong enough experience, you're like, “Oh, my life, oh, my dad, oohhh!” and that experience, it just gets you present gets you into the moment. And I was even with someone and she had said, “Do you think we should go? Do you think we'll be able to have a good time?”

And I think that what you said is true, when you talked about the intensity of the experience, you don't get to control that. If it's intense enough, it controls you, it elicits that stress response, actually, right, in a different way. And just gets you into the moment.

So, when you're going down that drop on a roller coaster, you just can't help but to be present and to be scared about the experience, you know, or excited, however you want to characterise it.

So, it's such a great… I love that one in particular, because it's something that I personally used. And I think it's something that everybody can do. And if they're not currently doing something in their life that really is a bit intense or immersive or some combination of both, there's probably a lack there.

You know, and you talk about flow states, I don't want to go into it right now, we’ve got to do a follow up, you and I, and talk again, but just was just an incredible conversation. And if you're listening right now, get her book, read it. We're all suffering from more stress than we realise.

And we could all handle our stress better, in a way that gives us a better quality of life, gives us a better experience of life, and allows us to perform at a higher level, whether you're trying to be an amazing parent, an amazing entrepreneur, whatever it is that you aspire to be.

Getting better at health, right, you can't eat the right things because you're so stressed, you want to go to the sugary instant gratification, hyper palatable foods because you're so stressed, this will help you do everything, whatever it is that you want to do, whatever your goals are.

Any final, anything that you want to add or final takeaway or bit of advice you'd like to give?

Dr. Mithu Storoni: Really the whole pandemic experience, it has been a very strange experience, because it's a shared experience of distress. Different people will have experienced it to different degrees and to different levels.

And I think one of the real take home messages is the fact that life can really send you anything around the corner. I mean, what we've gone through in different countries has been unimaginable in the past. Of course, perhaps not quite as an unimaginable as for people of Cambodia that you described, and for people in certain other parts of the world.

So, stress is something that it also has a benefit, because it's part of our lives, we can have unexpected events at any time. And the take home message here is stress isn't all bad. It's only bad if it becomes chronic. When we get into the state of acute stress and especially just before we actually enter into acute stress, so when we become incredibly alert and vigilant, our brains actually become more open to learning, they become more open to being moulded to new rules to new way of life, to a new terrain.

So, the whole experience of stress, we shouldn't fear it. The only thing we should do is we should prevent it from becoming chronic. I think that would be the most important takeaway message.

Ted Ryce: Mithu, thank you so much for today. And like I said, we’ve got to get you back on the show. If you're listening right now, go get Stress Proof. It's a much deeper dive than what we went into here. And again, talks about a lot of strategies; some that maybe you don't resonate with, some that you can plug and play into your life right away and try out and benefit from it.

And you can get that—I mean, I downloaded it on Audible so you can get it from Amazon or wherever you buy books from. And, Mithu, is there anywhere else that you'd like people to connect with you.

Dr. Mithu Storoni: I have a website which is www.mithustoroni.com and I'm also on Twitter, which is how we connected. My Twitter handle is @Storonimithu, and it's on Twitter that I'm most active. I also have a Facebook and Instagram page, both as my name. And yeah, I'd love to hear from you. I'm also on LinkedIn. So please do get in touch.

Ted Ryce: We'll have all those links on the show notes for this episode so you can get them there. But just in case if you want her name again, it's M-I-T-H-U S-T-O-R-O-N-I. And you can find that mithustoroni.com, her Twitter is the same name. So, all those places, they'll be linked up in the show notes.

Mithu, thank you so much. It was incredible to talk with you after listening to your book. And again, if you're listening right now, just go get the book. It's required. It's like, should be one of the handbooks you get when you're born. Go do that now, go start to handle your stress. Mithu, thank you so much, and looking forward to having you back on the show again soon.

Dr. Mithu Storoni: Thank you so much for having me. It's been a pleasure.