[00:00:00.000] - Dr. Lemanne

Restraint stress is in animal studies is being physically trapped. And what's really interesting in my mind is that females have more response to this stress than do males. And we think that there's an interaction with estrogen. So that plays a role in estrogen-related cancers like breast cancer, endometrial cancer, ovarian cancer. You have found your way to the Lemanne Gordon podcast where Docs Talk Shop. Happy eavesdropping. I'm Dr. Dawn Lemanne. I treat cancer patients.

[00:00:41.940] - Dr. Gordon

I'm Dr. Deborah Gordon. I work with aging patients.

[00:00:45.760] - Dr. Lemanne

We've been in practice a long time.

[00:00:47.440] - Dr. Gordon

A very long time.

[00:00:49.740] - Dr. Lemanne

We learn so much talking to each other.

[00:00:51.850] - Dr. Gordon

We do. What if we let people listen in? 

Today's episode will change how you think about stress. We've all heard that stress is bad, but what if that's only half true? In this episode, Dr. Le Monde and I discuss why short bursts of stress act like a vitamin and why chronic stress quietly rewires your brain, bikes your blood sugar, and helps tumors grow. We talk about the stress you can't see, the kind that shows up in your sleep stages, your heart rate variability, and even your insulin sensitivity before you feel anything. And then it gets personal. Dr. Le Monde shares what her wearable revealed after one emotionally charged conversation. The data shocked her, and she's an oncologist. We cover a biological stress response, especially relevant to women, that speeds up tumor growth. Yes, we have data, and yes, it's disturbing. How to know with real-time data if your chosen meditation practice is actually truly calming your system, or if you'd get more results from switching to another form of meditation, or to nonmeditative breathwork, or to something else entirely. I talk about the overlooked hormone, pregninolone, a stress buffer, brain builder, and myelin sheath maker you've probably never tested.

[00:02:26.620] - Dr. Gordon

Did you know your stressed body will steal this hormone from your brain, leaving it vulnerable to damage from prolonged stress. And that there's something you and your doctor can do about this today without even a prescription. We also tackle what exercise actually lowers Cancer Risk, hint, it's not walking. Why 30 seconds of true exertion may do more to boost your immune system and lower inflammation than hours of long, slow aerobic exercise. And Maybe most importantly, if you're not measuring your sleep and heart rate variability, at least some of the time, data show that you're almost certainly underestimating your own stress levels. We discuss how to fix that. This episode has numbers, hormones, and tools you can use tonight. Let's go. Yes, we both had stressful weeks.

[00:03:26.300] - Dr. Lemanne

Stress is also a vitamin. It Short bursts of stress are good for us. And having to deal with the day to day, I think, keys and locks and buildings are fairly minor stresses. And that everybody has to deal with all the time. And they're not bad for us. But there are certain kinds of stresses that are terribly bad for our general health, and that's chronic stress.

[00:03:59.380] - Dr. Gordon

Yes. Yes. And I would also say that... So say a little bit more about the first part of your statement, which is Stress is a vitamin because it's not in my vitamin drawer. Am I missing a vitamin? Oh, no.

[00:04:15.120] - Dr. Lemanne

It's there. Stress is in your vitamin drawer. It's built into everyday little bursts of stress. And they develop our physical, mental, and emotional strength. They're a little workouts. So I think that that's the way that I think about them. So if you had a normal workout, if you just put somebody in a in a room or, for instance, in a nursing home where there's really not much going on and they don't have to make any important decisions, that leads to a withering of one's personhood, physical, mental, spiritual, everything. We need a little bit of some tasks to do every day.

[00:05:03.240] - Dr. Gordon

And I guess the question is, when do they go from sparks to a lion chasing you down?

[00:05:12.480] - Dr. Lemanne

It's not even the lion chasing you down. That's recoverable as long as you get away from the lion and can go and recover over the next few hours. What seems to be problematic, at least in cancer, and I'll bet you're going to say it's the same in cognitive health, is chronic stress. Stress that's never dealt with, never alleviated, starts to become a constant companion, and that the person has no tools or knowledge or opportunity to actually deal with on a daily basis. So that's the stress that is really toxic.

[00:05:52.200] - Dr. Gordon

And we were in preparation thinking about this. I think of calling something stress when I see the effects of stress. There are definitely things that you do managing patients with life-challenging diseases, and that I do seeing lots of patients or something in a day that some people would find very stressful. And how you define stress is very personal.

[00:06:26.100] - Dr. Lemanne

Oh, well, I knew you were going to say that. And I'm going to tell you that I looked up the definition of uStress, which is good stress or distress, which is- So uStress as in E-U stress, not Y-O-U. Yes, exactly. Thank you. Or distress. So U stress being good stress or distress being bad stress. And so we can actually measure this in the laboratory. So U stress is defined as a transient hypothalamic pituitary axis activation with cortisol surges lasting less than one hour. Okay. And a second part of that definition, a sympathetic nervous system engagement showing an increased in heart rate variability without prolonged catecholamine elevation. So in English.

[00:07:28.690] - Dr. Gordon

Yeah, could you please do that in English.

[00:07:31.520] - Dr. Lemanne

So what this means is that the emotional reactivity comes, it's very powerful, and then it goes within an hour. All right? So the tiger chases you. That's probably going to be over within. Tiger was chasing me. It's going to be over with one way or the other within 30 seconds. Right. Assuming I survive, then I can calm down and recover from that. But distress- Unless it's the 20th Tiger that has chased you and you then...

[00:08:10.770] - Dr. Gordon

So looking into this, I think of not in the laboratory being able to measure these markers, although some of them we do have ready access to, like heart rate variability, of course, in our trackers. But I was looking more at the cognitive or emotional or signs of stress and my favorite one, when you got rid of the lion, but you can't stop thinking about the lion.

[00:08:38.460] - Dr. Lemanne

We're going to get to that. Yeah, that's the bad stress.

[00:08:45.090] - Dr. Gordon

That's the bad stress. That's the distress.

[00:08:46.820] - Dr. Lemanne

And we can measure that, too, and we should. But we don't have to measure it in daily life all the time. But it can be measured. And I think that that's important to point out, that this is not just a subjective feeling wheeeling, woo. These are real bodily physiologic chemical reactions that the body puts out to deal with whatever it thinks is coming along. So yes, prolonged cortisol elaboration, meaning you're under stress for more than 2 hours, starts to affect the way your brain processes everything. So And this is a chemical process. It's not... You feel it. It feels subjective. Like, I don't feel so great. I'm stressed out. And if we looked at your blood and your brain, we'd actually see these changes that are becoming more permanent. And we can also measure... I think I mentioned that the fast, quick stress, the lion, tiger chasing you for 30 seconds, that increases your heart rate variability, which is a good thing. You need to be able to do that. Long term stress actually lowers heart rate Heartrate variability, meaning you're less resilient. And heart rate variability is a measurement that can be taken. And what's interesting about heart rate variability, all these things tie together.

[00:10:10.900] - Dr. Lemanne

We talk a lot about metabolism. But heart rate variability is not only an instantaneous measure of the resilience of your central nervous system, your autonomic nervous system function, heart rate, blood pressure, breathing, those kinds of things. It's also an instantaneous measurement of insulin resistance or sensitivity.

[00:10:31.500] - Dr. Gordon

Oh, wait. I've never heard this.

[00:10:34.300] - Dr. Lemanne

Yes. So at the moment your heart rate variability goes down, at that moment, you become a little bit diabetic.

[00:10:40.680] - Dr. Gordon

As just a little aside, for those who don't know, heart rate variability, your pulse is beating at 64 beats a minute, but the space between the beats varies by milliseconds on a, hopefully at a high rate of variability. And this was first introduced in clinical medicine, by my experience, when we measured fetal satisfaction going through labor, and when a baby going through labor lost heart rate variability on the monitor, we thought they were in distress and Maybe the labor needed to be accelerated. But it's something that you can't take your own pulse and measure for practical purposes. But a lot of our trackers track them, And we want high heart rate variability. And now you're telling... And I just knew it meant you were feeling resilient, but say more about insulin.

[00:11:39.980] - Dr. Lemanne

So all of these systems are related. We wonder why people who have insulin resistance or high blood pressure aren't healthy. Well, their heart rate variability can be the basis of this. So all these systems are connected, I think, is the major point that I would want to make. I like your example of the fetal, how you used that during labor to look at the fetal distress. And they call it fetal distress. Yes. And so that's very, very helpful. In adults or people after birth who are breathing, the heart rate variability is connected to breath. So when you breathe in, your heart rate speeds up. And when you breathe out, immediately, your heart rate slows down. And the bigger the swings between breathing in and breathing out in the heart rate, in general, the healthier the person, the autonomic person.

[00:12:42.410] - Dr. Gordon

Well, that is something you could test yourself, you probably couldn't actually count it, but you could do the famous box breathing, which I've learned recently is not only a widely touted stress reducer, but it's used by populations as disparate as meditators and navy Seals who are using it to steady their hands before firing on their target. I saw that somewhere this week. But where you breathe in slowly for a count of four, hold it for a count of four, breathe out for a count of four, hold it for a count of four. I've never tried to take my pulse while I was doing that.

[00:13:23.170] - Dr. Lemanne

You can put a pulse oximeter on that gives you your pulse, and you'll see the heart rate change with each of the box breath. So as you breathe in, you'll see the heart rate go up. As you hold at the top, you'll see it start to slow. And as you let it out, it'll slow even more. And then at the bottom, it'll be the slowest. And then it'll start to speed up again as you start taking that next breath. So yes, you can use a heart rate monitor to see your heart rate variability. It might be if your general average heart rate is 60, you'll see when you breathe in, it'll go up to 63, As you hold across the top, it'll go 65, 66, and then start coming back down. And then as you breathe out, it'll go way down, maybe down to 59, et cetera. So people can play with that. And that's really important if you're doing some type of stress relief exercise of any sort, like meditating, anything like that, you want to see if it's increasing your heart rate variability. If it's not, you're wasting your time, if that's your goal.

[00:14:26.520] - Dr. Gordon

And tracking it in the moment. In the In the moment. Everybody now we need to have a pulse oximeter at home?

[00:14:34.230] - Dr. Lemanne

Well, they cost about $10. Oh, okay. At any drug store, they're not great. But even better is a heart rate variability device. So Whoopband, HeartMath, OuraRing, all of those will give you at least once daily heart rate variability read out. And the HeartMath will give you a real time so you can see if what you're doing, if you think, Tai chi or meditation, mindfulness or Vipasana, whatever your favorite flavor is, you want to know is If you're doing it for stress relief, if you're doing it for spiritual purposes or something like that, okay, well, this isn't going to measure that. But if you're doing it because your doctor said you need to meditate, you're stressed, you want to know before you invest hours and hours in particular form of meditation, whether it's actually helping you.

[00:15:34.400] - Dr. Gordon

So that's interesting. So I think of HeartMath as measuring. So that's just an app that you hook up your ear, lobe, pulse.

[00:15:45.860] - Dr. Lemanne

It has an oximeter clip, yes, that you put on your earlobe, and it syncs to your phone, and it doesn't actually give you numbers, but it gives you a rate, and it also coaches you.

[00:15:58.040] - Dr. Gordon

It says, Oh, you're doing a very good job. It does, yes. Could you bring your focus back to what we're doing here, please? I like HeartMath coaching. Have you ever done any of these devices and then a before and after of the intervention that you're trying?

[00:16:20.160] - Dr. Lemanne

Yeah, I've used heart math and even just a pulse oximeter when I'm bored to try out several different meditative and breathing techniques to see which ones actually increase my heart rate variability. And for me, three, four, seven breathing is more effective than box breathing, and it's more effective than mindfulness meditation or mantra meditation. Those are some of the things I've experimented with. But everyone's nervous system is different, and it's important, in my opinion, to track and test what works for you if your goal is to use a meditative technique or a breathing technique to balance your nervous system. Or else you're just relying on hearsay. And I've seen people at meetings over these things almost come to blows over three, four, seven versus box breathing. Just please people just put on an oximeter and see which one is working.

[00:17:17.020] - Dr. Gordon

Well, a little bit you can tell, too. I mean, one of the... So three, four, seven, if I'm right, you inhale for three, you hold it for four, you exhale for seven, and you turn around and inhale again. That's correct. So for For me, I feel pretty regularly suffocated if I try to do that. And so I'm probably doing something wrong. But when I do box breathing, I get in the rhythm of it pretty quickly.

[00:17:44.740] - Dr. Lemanne

Yeah, see, I'm the opposite. Box breathing, I feel like I'm about to die on that bottom part of the box where you hold after you've exhaled. That doesn't work well for me. It's really stressful. So yes, everybody is different and you I really, really want to... I think we talked about medicine 3. 0 last time. I think medicine 4. 0 is where everybody is really showing themselves whether something that they're doing, some intervention that they're putting effort, money, time into, is actually doing anything rather than just somebody read them a textbook, said, this worked once upon a time for somebody else. Why don't you do it and buy? See you around. So I'm really sounding like a broken record. Isn't that an old analogy? So nobody knows.

[00:18:42.200] - Dr. Gordon

A broken what? Yeah.

[00:18:45.420] - Dr. Lemanne

In the old days, if you had a scratch on your round record that would be played with a needle and would spin under the needle to make the sound, the recording, come out. If you scratch that record, the record would just Repeat, repeat, repeat, repeat. So that's what a broken record is for our younger audience. Most of our audience is going to know what that means. But yeah, I think that those things are really interesting.

[00:19:14.680] - Dr. Gordon

So can you give me some insight as to how, as a cancer doctor, this appears in your practice, in your counseling, in your analysis of what's going on with patients?

[00:19:29.540] - Dr. Lemanne

Well, Yeah, I think I can. But should I give a little background? Sure. First? Okay, because I think this is really interesting, and it is sciency, but bear with me. So There's been some recent flurries of publications on pancreatic cancer, which is just one type of cancer. But it has analogies to other types of cancer that are similar in that there are what we call adenocarcinomas or cancers that arise in glandular epithelium. And so breast cancer, prostate cancer, certain types of uterine cancer, ovarian cancer, those are very similar in some ways. And chronic stress, chronic stress caused by things like social isolation, especially in women. And what's called restraint stress, especially in women, we think, increases the rate of growth of pancreatic tumor.

[00:20:42.180] - Dr. Gordon

What do you mean, restraint stress?

[00:20:44.360] - Dr. Lemanne

So restraint stress is in animal studies is being physically trapped. And so the animals aren't harmed. They're put in little... These are mice or rats. They're put in little glass tubes with air holes so they see in and out of them, but they can't turn around very easily. And they can't get out, and they're still in their little cage, and they can see their litter mates out there free. And it's just done for 2-3 hours a day, all right? Or just an hour a day. It's not done for very long. Well, let me take that back. So you can Do a long session, up to 12 hours to see how that works. But repeated just daily short sessions for a couple of weeks actually increases the rate of cancer growth in these animals. And what's really interesting in my mind is that females have more response to this stress than do males. And we think that there's an interaction with estrogen. So that plays a role in estrogen-related cancers like breast cancer, endometrial cancer, ovarian cancer. So in humans, restrain- Good, you're not going to put me in a glass, too. No, restraint stress, hospitalization or limited mobility.

[00:22:20.300] - Dr. Lemanne

If you're in the hospital, you're probably stuck in a bed somewhere. Nursing homes, okay? Other incarceration, jails, things like that. High pressure jobs where you could go out the door, but you don't because there's some other competing need there, but that have repetitive demands that are difficult to meet. So you don't feel successful at meeting them. So that causes chronic failure, in other words, is a type of restraint stress.

[00:22:51.080] - Dr. Gordon

So these are external restraints rather than a woman walking around always being polite and restraining herself from- Oh, no, no, no.

[00:23:00.420] - Dr. Lemanne

So that's exactly, I think that's the exact, you know, restraint stress. If you feel you can't leave for some reason, then you have to be nice. And there's no consistent benefit or reward that at least your lizard brain sees. You get your paycheck or whatever, but there's no escape from the repeated failures. So caregiving, caregiver burnout, doctors, nurses, other health care workers, people who care for in a less structured way for ill relatives, those kinds of things. All of those are restraint stress. Financial stress is a type of restraint stress. You can't escape from it. And so I think the fact that this was that female rodents had an amplified response to that is really interesting. So the female brain is apparently, particularly sensitive to this stress.

[00:24:12.580] - Dr. Gordon

And it promotes the growth of these adenocarcinomas, particularly in the pancreas?

[00:24:22.410] - Dr. Lemanne

Well, the studies were done in the pancreas that I'm referring to. There are some other studies done about 20 years ago in ovarian cancer done at MD Anderson by a brilliant oncologic gynecologist named Anil Sud, and he's still practicing and still researching. But he defined the restraint stress and its effect on ovarian cancer in animals, and then did some clinical studies that show that this transferred to humans. So it's very interesting findings.

[00:25:00.000] - Dr. Gordon

So I'm thinking of all the different settings in our world that contribute to a sense of restraint and victims of injustice that aren't individual, but they have no way of escaping. If there's a prejudiced against women, you and I are both going to be affected by that, or people of color, that you're just going to be affected by these externally imposed restraints. It's that you have no hope of finding... There's no remedy for it except relieving your own stress that is naturally going to arise in response to it.

[00:25:41.850] - Dr. Lemanne

Well, there are... Yes, so the world is unfair.

[00:25:47.460] - Dr. Gordon

Damn.

[00:25:49.420] - Dr. Lemanne

And if you're born female and you have a certain hormonal makeup, you're going to feel stress more than if you're born male, perhaps. But there are some things that can be done. So there's some really powerful things. So probably the most powerful one is exercise. So regular exercise has been shown to decrease the risk of cancer. And I think also cognitive issues as well. Absolutely. And this is one of the reasons why. So daily exercise is important. And the exercise has to be at least once a week. It has to be hard, not just going for a stroll. So for maximum benefit. So you want to get some high intensity interval training. I think we've talked about that in the past, and that resets that stress response. So that's probably one of the most important things. I think the most important thing is sleep. So making sure that sleep is intact in terms of all four stages and that it's long enough is imperative. We can't get beyond our our stress responses if we haven't slept well.

[00:27:03.060] - Dr. Gordon

And for most of your adults, what's the length of sleep that you recommend they have?

[00:27:08.790] - Dr. Lemanne

I don't recommend. I measure it. So I've been lately just requiring that my patients measure their sleep. And we use wearables like Whoop and Aura. We can use the Why Things mattress. It goes pad, it goes under the sheet. It's a strip that will give us some information on how well You're actually sleeping. Different people need different amounts. And the amount of time in bed actually makes a little difference between people. It may make a big difference within a person's sleep. So some people, like I, will need sometimes nine and a half or 10 hours in bed to get my eight hours of actual sleep. And some people will need only seven hours of sleep, and we can tell what they need by measuring, too, and can get that in seven hours and one minute in bed. They're such efficient sleepers. Tests to be men.

[00:28:08.930] - Dr. Gordon

Yes, but that concerns me. That means they've fallen asleep within one minute of putting their head on the pillow And to me, that's a red flag for sleep apnea.

[00:28:18.840] - Dr. Lemanne

Possibly, but we can actually see that, too, with these wearables. So Wup, and some of these other devices will tell us a little bit about sleep apnea. The Whoop band is as compared. It's not inferior to a full hospital polysumnography test. Wow. Yeah. So yes, so we just measure. We see if there's sleep apnea, and we don't have to put them in the hospital, send them to the hospital for several thousand dollars sleep test. We just put these devices on them and there we go.

[00:28:53.460] - Dr. Gordon

And for our listeners who don't... I have an Aura ring and I know it's... I do like and it measures oxygenation, but I know it would miss episodes of apnea. I mean, that's been identified that it is not good for measuring apnea as WUP must be. But now for most people, if you have any significant sleep complaint that your physician can write about, respiratory therapy companies will mail you out a simple device you put on your wrist and you're going to get a home sleep apnea test, which is far more appropriate.

[00:29:32.780] - Dr. Lemanne

It is, isn't it?

[00:29:33.730] - Dr. Gordon

Yes. This is the information you actually want, not how well you slept in a hospital, but how well you slept and what your oxygen went down to. And it doesn't do anything about brain waves, and it doesn't measure sleep stages, which are your Whoop Ring and Myora Ring do, which is- So sleep stages are imperative for...

[00:29:57.510] - Dr. Lemanne

If you don't have slow wave sleep, If you don't have at least 90 minutes, 2 hours per night is better. If you don't have that, you're at risk for immune suppression that leads to cancer and all the other things that come along with that. And we will measure it in your heart rate variability. Sleep, which means that your insulin sensitivity is off.

[00:30:19.140] - Dr. Gordon

So when you say slow wave sleep, that is deep sleep.

[00:30:22.960] - Dr. Lemanne

Deep sleep, yes. And then there's rem sleep. You want at least 90 minutes of that, preferably 2 hours. So you want about 4 hours of these very deep sleep stages. And I have a lot of patients who say, I sleep good, I sleep well. I have eight hours of sleep. And we put on the measurement and they have 10 minutes of deep sleep per night. I'm seeing patients who are ill. They have cancer. That's why they come to me. But that's one of the reasons that they have cancer is because they are not getting into those steep stages of sleep. And stress can prevent you. If you're ruminating at night from stress, that's going to prevent you from getting into those steep stages of sleep. What can stop the rumination? Hard exercise. And for some people, for many people, breathing exercises, aka meditation. But again, only if they're actually effective for that particular patient.

[00:31:23.820] - Dr. Gordon

A couple of other practical tips that are more on the easy side of this. Both Both of the ones you're suggesting are highly important and I think valuable for multiple reasons. But destressers that I like, and this is a passive one, is forest bathing. If you live anywhere near a forest and you walk in the forest, it can be written as a prescription in Japan, and it's getting acceptance here as a reliable means of... You shouldn't be on your phone and listening to a conversation and also reading a book while you're doing it, but just walking through a forest is a practical way of destressing. And the one that comes up a lot in Our cognitive work. So background. Do you remember in medical school, this is the only time I heard this word prior to doing brain work, the pregnina loan steal?

[00:32:28.860] - Dr. Lemanne

I don't. Tell about that.

[00:32:30.460] - Dr. Gordon

So we learned in medical school, I'm told, and the name did seem familiar, but I couldn't really remember when I learned it, about something called the pregnina loan steal. So in a time of stress, your body needs to come up with a lot of cortisol. And if for any reason it's making protracted, excessive amounts of cortisol, whether it's prolonged stress or Cushing's disease, you need to scavenge raw materials from various places, and one of them is your store of pregninolone. The problem with that- Do you want to tell our audience what is pregninolone?

[00:33:11.580] - Dr. Lemanne

Right.

[00:33:12.560] - Dr. Gordon

Pregninolone is the hormone you've never heard of. Our bodies, one of the reasons we have cholesterol in our bodies is to make hormones. And the first hormone that we make from cholesterol is pregninolone. It is a highly important organ hormone that is primarily of use in the brain, where it acts as myelin on the nerve sheaths of the brain and enables-Wait, what?

[00:33:44.380] - Dr. Lemanne

It actually lies down on the nerve sheath?

[00:33:47.540] - Dr. Gordon

No, it produces myelin. Produces myelin, okay. In the nervous system, which is different from systemic myelin. But you can't neurotransmit through adjacent nerves unless they have a little bit of a coating on them. And it's a myelin-like sheath that's made by pregnina lone. It also is why if you measure progesterone, it's a precursor to progesterone. Even men have progesterone because they make some of it from pregninolone. And it's a excellent destressing hormone. So one of the The routine labs we do when I'm evaluating a cognitive patient is their pregnina loan level. And a normal level is something like 80 to 200. And I see people where it's immeasurably low or a little bit low. And if it's a little bit low, almost always they can describe some preceding stress. We can replace the pregnina loan. It's an over-the-counter supplement, but it is a hormone. For most people, makes them sleepy. I have one woman that wakes her up, so she takes it in the morning. And for many people, they can take it for a while and it helps calm down what was ever upsetting their body, and they don't need to keep taking it forever.

[00:35:17.280] - Dr. Gordon

But for many people, it helps improve their sleep. And it with... Of course, besides the blood drawing queen, I'm the supplement queen. There's a lot of supplements that can help combat cortisol's overreaching effects on our nervous system. But pregnina alone is a good supplement to think about if your doctor measures your pregnina loan levels and they're low.

[00:35:44.680] - Dr. Lemanne

Oh, That's really helpful to know. So there's something to measure in a blood test. And does the blood test... Are we talking about then if it's low, that suggests chronic stress rather than just an acute stress episode?

[00:36:01.850] - Dr. Gordon

Yes. And I measure cortisol at the same time, most cases.

[00:36:08.380] - Dr. Lemanne

Do you measure it at a certain time of day?

[00:36:10.040] - Dr. Gordon

Yes, I like to measure it in the fasting morning state, a fasted morning state. And they give a range, which is something like it's like 8 to 22 or something like that. And if somebody's stress level on that whatever scale, and then we can get more precise measurements with saliva or urine over multiple samples over 24 hours. But just a blood sampling in the morning is going to tell me if their level is twice what it should be or at the totally low end of normal. Have you ever noticed, this is a totally separate topic, all the glands that produce hormones in your body, conventional medicine acknowledges that sometimes those glands don't make enough, and sometimes they decide to replace them, like thyroid, and sometimes they decide, I don't know, it's up to you or not, estrogen. But when your adrenal gland doesn't make enough cortisol, that is not considered... It has to be pretty much absent, which is called Addison's disease, before conventional medicine says, Do you know that cortisol level that's always at five? That's on the low side. Maybe we should replace it.

[00:37:27.760] - Dr. Lemanne

So that's not That's a result of not looking at the entire day's waves of cortisol elaboration.

[00:37:38.270] - Dr. Gordon

Is that fair to say? I think it's that. And so in alternative medicine, there has been a syndrome that's been called adrenal fatigue. And conventional medicine has puffed up its chest and prided itself on the fact of there is no such thing as adrenal fatigue. Well, what happens when you measure somebody's blood and urine cortisol levels, and they're at the lowest end of normal, not even going through their normal circadian rhythms all the time. They're not putting out enough cortisol. Why is a question, but it's not uncommon to have that after prolonged stress and trying to boost it up a little bit with supplements or herbs, sometimes can really restore it and sometimes Sometimes I actually replace it with very low amounts of cortisol. But the whole cortisol system is fascinating to me. I'm seeing through a glass darkly. Isn't that something biblical? That's very biblical. Or poetic or something. It's biblical.

[00:38:48.840] - Dr. Lemanne

It was Saint Paul in the New Testament. But yeah, I don't think he was talking about cortisol.

[00:38:55.980] - Dr. Gordon

But I think it's a fascinating complex subject that has been minimized pretty much by conventional medicine. Oh, your cortisol is low. Well, you know why?

[00:39:05.060] - Dr. Lemanne

Because they're not measuring it.

[00:39:07.000] - Dr. Gordon

But even if they did.

[00:39:09.020] - Dr. Lemanne

No, I mean, well, no. If we could measure cortisol 24 hours, have it just like we have a continuous glucose monitor. In a continuous cortisol monitor, we would see which patients have the appropriate diurnal elabor of cortisol and which ones are flat. We would just see it and then we could fix it. So that's another Another measurement issue. But that's going to be changed. We're going to have whole labs. Instead of just continuous glucose monitoring, we're going to be able soon to monitor anything we want through interstitially placed devices like We measure continuous glucose right now.

[00:39:47.480] - Dr. Gordon

What are you most looking forward to?

[00:39:49.070] - Dr. Lemanne

Insulin. Without missing a beat. I've been pretty excited about sleep now that we can measure sleep very specifically. That's been really helpful.

[00:40:00.000] - Dr. Gordon

That's a good idea to get a pulse oximeter. I'm going to pick one of those up and look at it because I do believe that... I think the Oura Ring is- I have like 20 of them in my office.

[00:40:11.540] - Dr. Lemanne

Just stop by.

[00:40:12.340] - Dr. Gordon

I'll stop by because we're in the same building now. That's right. And pick one up and borrow it. But I think the Oura Ring is great for sleep onset, sleep stages, but I don't think it's good for sleep apnea. And I would just like to see the compare a pulse oximeter to the heart rate variability.

[00:40:35.520] - Dr. Lemanne

Yeah, you can actually see your heart rate variability. When I was bored in school in fifth grade, I would just take my pulse with my fingertips on my wrist and look at the big... You know how schools had those big clocks with the big second hand? And I could change my pulse rate with breathing intervals right there. And that was much more interesting than whatever the teacher was saying.

[00:41:03.180] - Dr. Gordon

He was talking about.

[00:41:04.880] - Dr. Lemanne

Well, I have a supplement that will help with stress. At least it did in the animals with pancreatic cancer that were under stress. And that's physetin. Oh, yeah, physetin.

[00:41:16.920] - Dr. Gordon

Our old friend.

[00:41:17.960] - Dr. Lemanne

Our old friend. And we're not clear on what dosing of physetin is optimal for this application. But I like to use the once, the dose that was tested at the Mayo Clinic, which was basically for about an average weight person, 150 pound person, it was 1,500 milligrams a day, two days in a row. So two consecutive days in a row, once a month. And so that's Saturday and Sunday. On Saturday, you take 1,500 milligrams of physetin. On Sunday, you take 1,500 milligrams of phycetin. And then you don't do it again for 28 days. So that's a pulsed dosing. And the idea in the Mayo Clinic studies was to improve removal of senescent or aging zombie cells. But I think that that's probably... It seems to be a really safe amount, and it may be helpful. I think that the dosing very much needs to be refined. What I tell patients is, do not take physitin or quercitin every day. So laboratory animals who are given these types of substances every day, day in, day out, tend to not live as long. We don't understand that, but it's probably not good to remove too many senescent cells.

[00:42:35.310] - Dr. Lemanne

If most of your cells are senescent, that's all you've got. So there's some care that needs to be taken there. More is not better. So you definitely want to talk to your own health care practitioner and make sure that they understand that, too, in my opinion. But phyzotin, I think it seems to have been helpful in these studies, so I think it might be interesting in this regard for people under chronic stress.

[00:43:01.480] - Dr. Gordon

Because of that, I'm going to have to look into phycetin and cognition. I know Life extension had a really great overall article about fécitin some time ago, and they're usually pretty good about updating things, but so is my artificial intelligence good at helping me find what fécitin these days has to do with cognition. Because when we were looking at it before, we were talking about it's benefit for longevity or now in this case, more specifically affecting stress. That's great. And it's not a pervasively available supplement, but it's not difficult to find. And I'd say the same thing with pregnine alone, because it's a hormone, not all supplement stores will carry it. I think one of our local stores will and one won't. You shouldn't be able to buy hormones over the counter. And I don't completely disagree I agree with that. But I wanted to... If somebody doesn't have a wearable device and they're not in a psychologically aware, self-reflecting point of view, I think it's very easy for people to underestimate the amount of stress that they're in, they're undergoing, the degree of their stress, and particularly when it comes to cognition, because it's a little bit imparing your ability to self-reflect on the stress that's imparing your ability to reflect.

[00:44:41.620] - Dr. Lemanne

Oh, I agree so much. You know what? That's me. I have noticed that... And I didn't know this until I really started paying attention to my Whoop band and my H My heart rate variability and recovery scores. If I had an unpleasant interaction with someone that I cared about, the next day my sleep was disrupted and my heart rate variability was down. And I would not have predicted that. I would have told you, I'm tough. I don't... That doesn't... Those kinds of things don't bother me at all. They bother me a lot. It's scary, and it's very, very clear. And I am one of the people that could not see that without my wearable. And now I do. It's taught me what to look for. But I still rely on it, though. I don't often know if something's going to be super stressful. Like, oh, that was a weird interaction. Did that really bother me? But the next morning, I will see whether it did or not. Very clearly, And I was really surprised because I take exquisite care of myself. I mean, I exercise, I sleep, I try to eat well, all of the things.

[00:46:08.990] - Dr. Lemanne

And I had neglected the emotional/stress part of things. And now I pay attention.

[00:46:19.210] - Dr. Gordon

I think people can definitely swing to one extreme or the other and obliterating the presence of the opposite pole. I What I found interesting because when I'm treating a cognitive patient, I'm measuring their cortisol, I'm asking about their sleep, I'm measuring their pregnant alone, and I'm making assumptions that they should do some meditation, brain relaxing activity.

[00:46:51.110] - Dr. Lemanne

I think relaxating should be a word. It really should. If preventative, which also implies the the word preventation. It used to be preventive medicine, and now it's preventative. But there is no preventation. But maybe there should be.

[00:47:07.340] - Dr. Gordon

Maybe there should be. I actually like preventive because preventative just seems to- There's an extra syllabus in there. A little extra syllabus, but yes. So the thing- Relaxation. Relaxation. And relaxation-ing is a little bit better even than relaxing because it sounds like you're developing a skill. So we are going to coin that term relaxating. I like it. Yes, Yeah. And I know that stress impairs cognition, but there's an emerging science of trying to specify in what ways, and Particularly for people who don't have wearables. I think it would be useful to... They've narrowed it down to five ways that your cognitive skills can be impacted by stress. And some of them are obvious, like forgetfulness. If you have forgetfulness, you know that it's more than usual. You know something's going on. You may not think it's stress. So you may worry that, Oh, my God, I'm getting Alzheimer's disease. And you might be, but more likely, if you don't pay attention to it, you will get Alzheimer's disease. But it might just be that you're stressed right now. What are you stressed about? That's why you're forgetful. The other one that I think is interesting, and they have a special term for it, which I can never...

[00:48:31.860] - Dr. Gordon

It doesn't seem like English. It's unconstructive, repetitive thinking or something like that.

[00:48:39.580] - Dr. Lemanne

A rumination.

[00:48:40.860] - Dr. Gordon

Yes, rumination and rigid thinking. It's so like You can only think about that's going to bed and mulling over the bad exchange you had with somebody over the phone or something like that. But it's also, no, I only do things this way, and I'm not going to think a different way of doing it. That's just the way I do it. It's the way I've always done it. So rigidity. Rigidity. Difficulty with concentration. And while there is an emerging recognition of attention deficit issues in older people. It's not just an elementary school boys problem. But any difficulty with concentration, where your attention is wandering, particularly when it's something important going on, think about whether you're stressed, and that's why you don't have the neurotransmitters available that you need for sustained attention. I guess I combined actually two of them because this unconstructive, repetitive thought is actually separate from rigid thinking, even though I think of them in the same way, you're stuck in your tracks. You can be stuck in your more in your life, or you can be stuck in your tracks in your thoughts and doing it over and over again. And then poor judgment, and thankfully, you or I never demonstrate this, being more impulsive than usual or simply failing to think decisions through people with this poor judgment are also, and this is very interesting, less likely, and this was in a particular study from about five years ago, six years ago, Participants in the stress group, they put people under stress in particular ways and did all this thinking, categorizing, subsequently, they were less likely to take action in moral dilemmas than the participants in the control group.

[00:50:50.080] - Dr. Gordon

So all the politicians that you're not happy about because they're not taking action in moral dilemmas, just for a random possibility of an example, might be really because they're stressed.

[00:51:02.600] - Dr. Lemanne

Oh, that's generous. Yeah.

[00:51:04.820] - Dr. Gordon

Rather than stupid. Okay. Maybe we'll have to take that part out.

[00:51:08.840] - Dr. Lemanne

Or bribed.

[00:51:10.440] - Dr. Gordon

I love this term Unconstructive, repetitive thought, because it's not... Unconstructive sounds a little bit to me like you are literally deconstructing your mind. You are literally destroying your mind by having these repetitive thoughts. And it's worries that run and conversations that should just be left behind. And we should do our box breathing and forest bathing.

[00:51:42.380] - Dr. Lemanne

And high intensity interval training.

[00:51:44.950] - Dr. Gordon

Absolutely.

[00:51:45.880] - Dr. Lemanne

Absolutely. I think that's one of the most powerful. Going back to the tiger, what happens when an animal is chased by a tiger? They run. High intensity interval right there. It's not long. It's probably 30 seconds. That's how long I can run fast. And that 30 seconds actually decreases the risk of cancer. So people who do that daily, just 30 second exercise snacks at high intensity, though, not just going for a little strole, but getting into a high heart rate exercise situation, just do that once or twice a day. You can measure the decrease in their risk of cancer. And it's not... And again, I really want to emphasize to people that it is not a walk. We are talking about hard exercise, and that's the difference between recovering from stress and not recovering from stress. So if you run from a tiger, you have this instant H-I-I-T, high intensity interval training episode right then and there, and that's part of the recovery. If you have a stressful episode and you're sitting in your office or in your house on the phone, having some bad interaction with somebody, you are not able to process that, all the stress hormones that come out.

[00:53:11.300] - Dr. Lemanne

It's the exercise that does it. So that's where exercise really shines in terms of overall health, reduces stress, processes the stress hormones. Actually, there was an Israeli study that showed that high-intensity exercise actually starves cancers of energy, and they start to die.

[00:53:35.120] - Dr. Gordon

So part of my cognitive recommendations to people, also my recommendations to people who are overweight or insulin resistant or addressing this underlying... And with cognitive impairment, there's the additional problem of trying to recruit additional muscle cells and brain cells. But for all these paradigms, they're dealing with insulin resistance. And my advice has been typically, so it's a little bit different paradigm, and I want to know if these two are equal or different in some way. I suggest people to go as hard and fast as they can, and better they do 15 seconds hard and fast than 30, a slower rate that they can keep up with for 30. So number one, I try to get them to do 30, but longer is not better and shorter is good enough if that's all all out, that if they're going to do a second session, they need to recover all the way before they do that second session. So it's also hard and fast. Easiest if you're on some device that measures it, like a rowing machine. Ideally, they do half a dozen on a given day. And ideally, and this is really the heart of my question to you on this point, they don't do it every day.

[00:54:54.340] - Dr. Lemanne

Yes, that's so important. I have patients, if they're over 50, they do it once a week because they need that time to recover.

[00:55:01.730] - Dr. Gordon

There are patients under 50?

[00:55:05.020] - Dr. Lemanne

And those patients, between 30 and 50, they can do it twice a week. And under 30, they can do it three times a week. But again, that has to do with recovery. And you definitely want to get in. You want to get past the... So there's sprint interval training, which is like 10 seconds or so, and that uses the creatine phosphate system. And that's a little bit different. You want to get into the anaerobic portion, which comes between... It comes more like at 30 seconds, where you've used up all the creatine phosphate system and you're now starting to produce lactic acid. You want to get into that part of things. So that takes at least 30 seconds. And It's very hard. The sprint interval training, 10 seconds, anybody can do that. It doesn't even feel hard. You can sprint for 10 seconds and you don't feel like you've done a whole lot. And so you do have to get into a little bit harder. There are several different protocols. There's one called the Windgate Protocol, which is an exercise, a stationary bicycle, 30 seconds against resistance. There's the Norwegian 4 by 4 protocol, where you're going for four minutes on a treadmill that's slanted uphill as hard as you can.

[00:56:16.560] - Dr. Lemanne

That's a little bit longer, followed by four minutes rest. That's a hard one. But the idea is that you really want to get into those really deep anaerobic states just for a little bit. And that's where the magic is. So I We have some statistics here. So doing this, I think it was for six weeks. So comparing people who are doing this high intensity interval training versus long, slow distance, like walking three or four miles an hour. The increase in VOT2 with H-I-I-T was the increase with long, slow distance over that time was they increased by 1. 2 milliliters per kilogram per minute, which is just the units for that particular measurement. But with HIIT, not 1. 2, 4. 9, almost five times as much. I It's a huge difference. So natural killer cell activity was changed. None, not at all, with long, slow distance walking. And natural killer cell activity, we've talked about that before, that's what kills cancer cells. But with And by IT, the natural killer cell activity went up 38 %. And then IL-6, interleukin 6, which is an inflammatory hormone, it's not all bad. It's part of the growth hormone pathway.

[00:57:43.780] - Dr. Lemanne

But you often have too much in a cancer situation. So that went down 12 % with long, slow distance.

[00:57:50.400] - Dr. Gordon

And in brain situations, too, particularly there are certain genetic variants where IL-6 co-conspires with APOE4 in a bad way. Yeah, so that's another reason for the...

[00:58:02.500] - Dr. Lemanne

But the IL-6 went down 12 % with long, slow distance, and it went down 42 % with the HIT, three and a half times as much. So I just want people to understand. The exercise recommendations that are put out by governments, including ours, are put there because if you look at the meeting notes, they say, nobody's going to do this. We have to make it super, super easy. We know this doesn't really work very well. But if we tell people to do these really hard things, they just won't and they won't do anything. So we've just got to say they should walk 30 minutes a day. Well, I guess walking 30 minutes a day, it's barely better than nothing, but it's not really optimal. If you really want to be in good shape and really lower your risk of these terrible conditions substantially.

[00:58:58.300] - Dr. Gordon

Okay, so I'm going to ask you then another... And what we're leaving aside, and we just don't can't... Amazingly, we can't cover everything today, but this topic could cover everything. We're not really adding in resistance training conversation. But in your ideal world, Somebody who's older than 50 who wants to optimize their high intensity intervals safely on a given day, they have to find some exercise they can do. I cannot run uphill until my knees magically transform themselves into new knees, but I can work on a bicycle or on the rowing machine. How hard does somebody work themselves out in If they're over 50? How long they try and sustain it for? And how many times that day are they trying to do it in your protocol?

[00:59:54.310] - Dr. Lemanne

Sure. So they do it once a week. And so the Norwegian 4 by 4 is four 4 minute intervals at 85 to 90 % of your maximum heart rate. And Whoopband, I think, or a Ring and Fitbit, some of the more advanced Fitbit models will tell you this. Whoopband is now giving your VO2 max, the estimation Actually. And that is where you get the optimal tumor suppressive effects. Okay. And so that would be the four by four protocol, four minutes on, Four minutes off.

[01:00:30.700] - Dr. Gordon

How many times?

[01:00:31.640] - Dr. Lemanne

Four times. Okay. Yeah, once a week is plenty to start with. And you definitely want to check with your doctor before you start this. All right. This is a hard exercise program, and it's supposed to be hard. And it doesn't get easier because as you get more fit, you still stay at your 85 to 95 % maximum heart rate. So your heart rate moves up, you don't stay at the same level of exercise. So it never gets easier. It is tough. But, boy, you will be much more fit than you do long, slow distance until the cows come home. And you'll notice it in your brain. I notice it after a nice H-I-I-T bout. My thinking is clear, my emotions are calm. I'm not ruminating or deconstructive or nonconstructive, repetitive thinking, which I call rumination. And life is better. So, yeah, and I feel proud of myself. I think all of those things are helpful. Well, that's where I would start. Again, though, with your own physicians, okay, they need to check your heart and make sure all your limbs work right. And definitely, you can use any modality you'd like within reason. I tell people, do not use a road bike.

[01:01:50.070] - Dr. Lemanne

Do not go out on a street and do this. Okay? You'll kill yourself. I tell people not, if they're not professional athletes or near that, do not use a treadmill, because Because if you fall, if you're at your maximum and you get tired or misstep or something, if you fall, you will break your jaw. So there's so many broken jaws we see from treadmill accidents. Oh, seriously? I didn't know that. Yeah. You'll have your jaw wired shut for six weeks. You do not want to do that besides getting a concussion. So do not do this on a treadmill. Do not do it on a road bike. If you're a really good swimmer, you can do it in the pool, but that's a little bit iffy. Again, I'd want to be sure you're measuring then. You need your loop band on to make sure you're getting into that 85, 95 % heart rate max, because you may not be with swimming, because there's no gravity involved. But a lot of people can get there with swimming. A stationary bicycle is excellent. A rowing machine is good if you have good technique, which you do, being a competitive rower.

[01:02:49.920] - Dr. Lemanne

Running up a hill is nice, even for people with bad knees, possibly because it's running downhill where you get the stress. So if you have a steep hill, So you're not going very fast. And if you fall, you're not falling very far. The hill is steep enough. No.

[01:03:05.480] - Dr. Gordon

If I was going to run any direction, I would choose uphill.

[01:03:08.560] - Dr. Lemanne

And then you just walk back down the hill and walk around at the bottom until it's time for your next running back up. Running uphill is better for a 30-second interval workout, which is called the Windgate. It's usually done on a stationary bicycle, but that's another topic.

[01:03:24.520] - Dr. Gordon

Yeah. A lot to say about stress. And I feel like my stress level has gone up during this conversation, and it feels like it's floating back down to normal now.

[01:03:38.760] - Dr. Lemanne

I think I'm going to have to go to the gym after this.

[01:03:41.280] - Dr. Gordon

I'm going to go bathe in the forest. Oh, okay. Which you do, too, at your home. But it's to each her own, there are many ways to do this.

[01:03:53.180] - Dr. Lemanne

And some are better than others. Measure.

[01:03:56.160] - Dr. Gordon

Measure. And they're individually better than others. Exactly.

[01:04:00.000] - Dr. Lemanne

So what works for you is what you want to do. But don't overlook. It looks like the most powerful ones are sleep, number one, and number two, high intensity interval training for dealing with chronic stress and moving it into the acute stress category, which is good for you.

[01:04:21.620] - Dr. Gordon

Yes. And some form of my box breathing, your box breathing, other people's meditation, something that is mind, body. Try them out and see which ones work. Yeah. Great talking to you.

[01:04:38.360] - Dr. Lemanne

Oh, always. Stop by and pick up one of our extra pulse oximeters.

[01:04:43.020] - Dr. Gordon

I definitely will do that. See you there. All right.

[01:04:46.560] - Dr. Lemanne

Bye-bye. Bye-bye.

[01:04:49.500] - Dr. Gordon

You have been listening to the Le Monde Gordon podcast, where Docs Talk shop.

[01:04:55.460] - Dr. Lemanne

For podcast transcripts, episode notes and links, and more. Please visit the podcast website at docs talkshop.

[01:05:04.460] - Dr. Gordon

Com.

[01:05:04.980] - Dr. Lemanne

Happy eavesdropping. Everything presented in this podcast is for educational and informational purposes only and should not be construed as medical advice. No doctor-patient relationship is established or implied. If you have a health or a medical concern, see a qualified professional promptly.

[01:05:31.640] - Dr. Gordon

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[01:05:43.800] - Dr. Lemanne

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[01:05:58.220] - Dr. Gordon

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[01:06:05.090] - Dr. Lemanne

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[01:06:21.550] - Dr. Gordon

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