It’s been said that chronic stress is the health epidemic of the 21st century. It can have negative effects on all of us in multiple ways. Elevated cortisol levels can increase our susceptibility to illnesses, sleep deprivation, and can even cause brain shrinkage and memory problems. So what steps can we take to manage stress? Join me as I speak with Dr. Dave Rabin, a Board-Certified Psychiatrist, Neuroscientist, and inventor who studies resilience and the impact of chronic stress in our day-to-day lives. He specializes in treatment-resistant mental illnesses including depression, anxiety, post-traumatic stress disorder (PTSD), psychosomatic disorders, personality disorders, chronic pain disorders, insomnia, and substance abuse disorders using minimal and non-invasive treatment strategies. In this episode, Dr. Dave shares some of his favorite tools to help manage stress and anxiety and explains why not all stress is created equally. He explains the difference between distress and eustress, and provides some tips on how to heal a dysregulated nervous system.
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*Unedited Transcript*
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Jacqueline: [00:00:00] Well, happy Friday. It’s morning for you. Um, Ava was saying that you are in California.
Dr. Dave: Where are you?
Jacqueline: I’m completely opposite side Greenville, South Carolina, but the weather, the weather is equally as nice. At least it has been the past week or so. So I can’t complain.
Dr. Dave: That’s awesome. Yeah. It’s been rainy here.
Jacqueline: Well, I know I’ve heard, I saw it on the news this morning.
Um, well, first of all, Dr. Dave, welcome to the show. I’ve been a longtime fan of your work ever since I first heard about the Apollo wearable. So. I’m really excited to speak with you and really just dive into the world of stress and its impact on our nervous systems, which I know is a topic that you speak very frequently
Dr. Dave: Yeah. Sounds good. I’m so glad you’re enjoying the wearable. Uh, we use it every day. Have you
Jacqueline: Yeah, I need to be more consistent with my usage. My understanding is that the more consistent you are, the better effects it has, but I’m, I’m getting there. Um, but Dr.
Dr. Dave: scheduled it yet?
Jacqueline: [00:01:00] no.
Dr. Dave: you should. That’s the, that’s the best feature. And we can give you access to Smart Vibes, which is the AI that turns on automatically throughout the day and night.
Jacqueline: Interesting.
Dr. Dave: That’s the most exciting new feature. So we’ll definitely make sure to give you access to that after this.
Jacqueline: awesome. I’m very excited. Yeah. I think I have an update available. At least I checked on the app this morning that I have to still still update, but interesting, you know, excited to get into that too. But, um, I’d love to start. So you have quite an interesting background and I love if you could share a bit more about.
Yeah. Your story and how you essentially found yourself in this space.
Dr. Dave: Sure. Um, and thank you so much for having me. Um, I. was when I was a kid I used to have very vivid dreams and I was always interested in How real they felt and and sometimes I would find myself, you know recalling like mentioning things about That my dreams that I thought had happened in real life to other people like hanging out with my [00:02:00] brothers and thinking that they were had some experience with me that I realized they weren’t there for because I dreamt it, um, and that was really interesting.
And so I asked my parents, you know, I was probably like somewhere between four and seven years old. And I, you know, I started to ask my parents, you know, what’s with, what’s these dreams in, you know, are they, you know, what’s going on when we sleep basically. And you know, they just told me that dreams aren’t real.
And like many parents do, you know, to make sure that we don’t believe in our nightmares and things. And, you know, That always never really sat with me completely because I kept having them occasionally and when you have a dream like that You know, it makes you question what’s going on and so I started to, you know, develop this early interest in the meaning of reality and consciousness and Um, the way we use these words to describe like what we, what we see is, you know, real versus whatever else is out there, which could [00:03:00] be equally or more real, you know, unless we investigate it.
So, so that became really interesting to me. And then I realized as I was starting to get out of high school, that Um, that was actually a very challenging field of study at the time. And there were, there were not a lot of opportunities to study consciousness in that kind of way, um, where you actually could make a decent living.
And so I, um, had a lot of advice to go to medical school. And so I, um, started that path. And while in medical school, I was, I was always interested in research. And, and so I was, um, doing research on chronic stress and resilience and Um, how we think about the, uh, the way that stress impacts the body, um, because stress seems to be one of the major things that decreases our lifespan and our health span and makes us feel unwell, um, and it can seems to contribute to a lot of illness.
So, um, at the same time, stress can also help us grow and [00:04:00] becomes better, stronger human beings. Right? So it has these. It has this, this, these two layers that are very interesting that are, I think, not, not fully taught about. And so I was studying that for a long time on the cellular level and understanding how cells deal with stress, which is actually very similar to the way that we deal with stress, um, and impacts because we’re made of cells.
All the ways that stress, uh, impacts our bodies, uh, and then in 2012, I, I learned about, um, I was treating, um, veterans with PTSD and, um, you know, starting to see the growing crisis of mental health and realizing that many of our treatments that were not as, were not that effective to actually, you know, get people with mental health conditions better long term, um, where they weren’t medication dependent for life.
And many of our patients were just not getting better, more than 50 percent in many cases. And so, um, [00:05:00] one of my friends introduced me to the literature that was, uh, in the psychedelic assisted therapy space. And I started to dive into that and realize that, um, that this was some of the. best research I’d ever seen on psychedelic therapy is actually treating or starting to treat mental health conditions by getting to the root source of the problem and When I saw that evidence and how psychedelics seem to be working to get that effect It made me realize that I could actually study consciousness by, um, studying the impact of psychedelic medicine and psychedelic therapy on treating mental illness.
And I could actually do what I always wanted to do. Um, and that, and the way to do that was to become a psychiatrist. And so I, um, then went down the psychiatry path and started to work on, um, psychedelic research, but also trying to figure out how psychedelics work so we can replicate some of the benefits with.
Technology and non psychedelic tools like Apollo.[00:06:00]
Jacqueline: Yeah, that’s incredible. You were ahead of the curve before you even knew it, right? Because nowadays, I mean, there’s so much information on the mind body connection, certainly psychedelics. It is all related, and it’s really encouraging to see people stepping back from the conventional approach to things like pills, for example, in treating again, PTSD or depression and really relying on more natural means like touch therapy and, you know, the Apollo wearable.
Um, are you familiar with Dr. Roger McFillin and his
Dr. Dave: No.
Jacqueline: You should check him out. He has a podcast called Radically Genuine. I had him on my show not too long ago, but just from your story, it sounds like you have similar interests. Um, but I, I would love to start with the basics, Dr. Dave. So what is the fundamental definition of stress?
Mm
Dr. Dave: Um, so stress is actually two things. Stress is really just challenge to the body. Um, and the body recognizes stress as inflammation. So that’s [00:07:00] like the chemical signaling pathways that get activated when our bodies are under stress. In our, in our mind it’s just challenge. Um, and challenge can be of two major categories.
One of which is What we call EU stress, which is EU stress, which means good stress, and good stress is stress that is in a safe environment. where we know we’re not under survival threat when we’re experiencing that stress. And that stress challenges us to grow in productive ways without any kind of risk of damage or trauma, um, or minimal risk at least.
And, um, and that is critical for Being a human. We have to have that kind of stress. Um, that includes like things like learning to calm down when you’re a little kid or learning to read or learning how to ride a bike or anything, right? Like all of those things that are very obvious, um, challenges that we face growing up that, [00:08:00] um, allow us then develop new skills like learning how to ride a bike or learning how to read, right?
Or learning how to calm ourselves down. Um, so all of that, um, is the good stress. And then there’s the other side of stress, which is what most of us are experiencing on a chronic daily basis is. distress. And distress is bad stress. It’s stress that, that, you know, make, makes us feel overwhelmed and anxious and having racing thoughts all the time, which increases our heart rate and increases our blood pressure and our breath rate and results in more inflammation in the body.
And over time, that inflammation leads to, you know, build up a Waste product which causes to sell stress and damage and then eventually disease, right? So actually learning what modern neuroscience and psychiatry psychology research shows about how we can learn how to cope with and [00:09:00] and adapt to stress more effectively Which we actually do know how to do like we have done enough scientific research to explain to people How to do this and that a lot of the techniques of breathwork and yoga and meditation, mindfulness, biofeedback, um, getting good night’s sleep and sleep hygiene, right?
All of these things are highly evidence based and retrain the body into how to get into these, um, adapt, maximally adaptable states where we can deal with the stress that’s coming in rather than. Just, and, and turn it into eustress, right? And so, those techniques are really about how to understand how to interpret stress, so that even though it seems overwhelming, it’s not actually going to kill me right now.
It’s just seems like a lot. And then we can turn that into a growth opportunity.
Jacqueline: exactly. I’m so glad you highlighted this. There’s two differences because people I feel like automatically when you say stress, it has a negative connotation. But again, acute stress does help us perform better in certain scenarios, [00:10:00] right? Like if you’re running a race or you’re taking a test, but it truly is that chronic stress that they stay like is the root of all disease.
Because as you said, it does flame the fire for inflammation in the body. Um, so going back to measuring stress. Is there any, I mean, obviously we’ve heard of HRV, but outside of that, what are some other ways to actually measure if our body is in a stressed state? Because certainly that could be subjective too, right?
Someone says they’re stressed, but how do you actually measure that? Interesting.
Dr. Dave: to capture, um, that almost all consumer wearable fitness trackers track nowadays. So HRV is a measure of, you know, vagal tone or your body’s amount of recovery and resilience. Um, and it predicts a lot of things like having a higher HRV means that your chances of getting sick go down, your chances of Achieving peak performance during a stressful [00:11:00] situation are higher.
Consistency of performance is higher. Um, you’re more likely to recover from illness if you get sick and recent studies also shown it predicts long life, long, healthy life, um, health span. Um, so HRV is probably the single best thing that we can track to understand the impact of stress on our bodies. And when our HRV is like, you know, you know, I’m talking like not day to day track day to day tracking with wearable trackers is not as accurate as it could be yet for a lot of reasons.
Um, but you can track HRV week over week, month over month, and then over enough time of baseline data, you can start to understand more. daily trends, but, um, that’s probably the, when it’s low, you know, that’s a sign that we need to take it easy and get more recovery. So that’s a, that’s a, um, really good one, if not the best one.
And then there are other things that are like slightly more invasive or challenging to do [00:12:00] like galvanic skin response to electrodermal activity, which is the measure of the conductance of electricity, electrical microcurrents on the skin, um, that you can measure. through certain wearables, but they have a very short battery life, generally speaking.
And, um, it is, uh, basically when you get stressed out, you sweat a little bit, right? Even, even if you don’t notice it, you’re sweating like a teensy bit more. And so, Yeah, so that that’s part of like the body’s stress response. And so you can measure that change very very quickly But it’s really hard to tell the difference between like stress and anger and frustration and excitement,
Jacqueline: Yeah.
Dr. Dave: They’re they look very similar to on this
Jacqueline: Even, yeah, that’s a great point. And even too, I mean, folks who use continuous glucose monitors, right? Like similar situation, you could be excited. In talking to someone or, you know, giving a presentation and you’ll see your your blood sugar spikes, right? That’s not necessarily a bad spike. It’s [00:13:00] just the nature of the situation that you’re in Um, so being able to identify the differences is really important But when we do find ourselves in an acute stressful state, we just got some news that we didn’t want to hear You know life happens.
What are some of the best tools to help us calm down?
Dr. Dave: think that the tools I would put into kind of like Um, the tools are mostly like in a category of if you think about stress as, um, or, or having like a stressful event happen, um, be a situate, you know, a situation where we are like kind of feeling out of control. In those moments, um, because something just happened to us, right?
Um, which is often how we feel. Um, which kind of puts us into a victim mindset of being out of control. Um, the best way, the best things that we can do for ourselves in those moments are to [00:14:00] do everything we can to restore our sense of control and our awareness of what we have control over at any moment.
So those things are breathing, movement, singing, and intentional listening. So like putting on a song that you like, um, or, um, or intentional touch, soothing touch, getting a hug from a loved one, holding somebody’s hand, giving yourself a hug, you know, putting your hands on your, on your chest, right? Like, so, so those are the four things that we can have, that we as humans have control over in any moment.
That can rapidly take control over and by, uh, give remind ourselves that we’re in control by focusing our attention rather on, rather than focusing our attention on the thing that we’re out of control of, we bring our attention back to the things we are in control of. And so you can move, you can breathe, [00:15:00] um, and you can do, and you can, you know, touch, you can touch yourself and apply soothing touch to yourself and you can just.
Listen to what’s going on around you in any moment or produce song in any moment, right? So that those are these critical, you know core techniques from you know, ancient medicine that are still relevant today I
Jacqueline: they’re so simple too, right? Like people don’t, I think nowadays it’s funny. It’s, it’s truly the simple things that are the most effective. Um, and I’ve, I particularly use the deep breathing for myself as well as like cognitive reframing to the point where I’ll actually talk to myself aloud if my mind starts to race and actually, you know, bring myself back to the present moment and again, reframe the situation.
Um, but going back to the breathing. Is there a certain breathing pattern, in your opinion, that’s more helpful than others? I mean, there’s so many out there. I was listening to a recent podcast with Huberman, and he basically was saying how the double inhale and long exhale is especially great because it’s more [00:16:00] effective at ridding your body of carbon dioxide, which relaxes the body very quickly.
What are your thoughts on that,
Dr. Dave: think that while the theory of that may be true the that breathing technique is At least from what I’m familiar with is more Uh, consistent with an activating, uh, breathwork. So um, you know, we do that kind of breathing technique and holotropic breathwork and other breathwork that is like very activating to the body.
Um, it probably, yeah, like it probably would calm some people down. Um, what we find, and I think what the biofeedback literature shows is that, um, The most common basic breathwork, which is really, really simple, which is nice that it’s simple, is to breathe in for five seconds.[00:17:00]
Jacqueline: hmm.
Dr. Dave: breathe out for five seconds and then just gradually just try to fill your lungs a little bit more every, you know, every minute or so.
And then gradually, like, let, try to empty them out a little more with each, with each, you know, breath, but really aiming for like five to seven seconds per breath, um, to start. And in what biofeedback shows is that if you do that for 90 seconds, 95 percent of healthy people will start to, will enter into a high heart rate variability, increased vagal tone state that results in decreased racing thoughts, decreased stress, decreased anxiety, improved mood in a lot of cases.
And then when you, you know, it takes like five minutes for people who are more, who are like diagnosed with a mental illness usually to get to that state. But still it’s five minutes, right? And it’s so simple. Um, but I think the challenge with a lot of these things is that when we’re under stress, we forget to do them,
Jacqueline: Exactly.[00:18:00]
Dr. Dave: And so that was a big, a big, uh, impetus for why we Developed Apollo was because if you could have something on you, you can just, you know, tap two buttons and turn it on when you’re in a stressful situation, or you can schedule it to turn on and it anticipates your stressful situation, um, then, you know, you’re going to be in a state of more calm and ease and.
And, uh, evenness, and you can restore, and it reminds you to do the techniques, you know, it reminds you to come back into your body. Um, that’s, that’s like, it’s nice to have another tool, you know, in addition to these old things that, that work, but we just don’t tend to do.
Jacqueline: Exactly. And I am just curious, Dr. Dave, have you seen in research the use of breathwork being effective in terms of like, as like a preventative measure? So you just said before like, we tend to forget the simple things when we’re in a panic moment. So have you found that people who actively practice, you know, some type of breathwork [00:19:00] routine on a daily basis may have more?
I guess resilience when faced with those stressful situations.
Dr. Dave: Yeah, I mean, I think the best evidence comes from like the 70 years of biofeedback research. And biofeedback is the, is the real first, from what I know, like quantified science of breathing, where you connect somebody to a heart rate monitor and a respiratory monitor and then you show them their respiratory and heart rate patterns on a screen.
And they’re told to basically like sync the patterns. And, um, that syncing happens between 5 and 7 breaths per minute. And that’s when vagal tone starts to go up and heart rate variability starts to go up and people start to feel like more quiet mind, more calm, more settled. Um, and the body calms down.
And so, from those studies which are extensive, um, I think it’s pretty, it’s pretty, uh, undeniable that [00:20:00] breath practice will improve your overall resilience, you know, cause it’s improving heart rate variability. So heart rate variability is the best measure of resilience and your ability to adapt to stress.
So, you know, we’re, we, I think, you know, it goes, I think. Yeah, absolutely. You know, breath is preventative and it can be used to treat and address stress in the moment. It’s like probably our single most powerful tool that we never learned to use.
Jacqueline: Yeah, no, absolutely. I’m going to self experiment in the sense of being more consistent with using my Apollo every day and really creating a breathwork routine that I can stick to again, even if it is only five minutes or so, um, because interestingly, again, we all have a story. Those of us in the health space.
And I found out not too long ago, and I’m not really surprised to hear it, that I have a dysregulated nervous system. And we obviously know that chronic stress is Can impact our [00:21:00] nervous system. So I’d like to start first by asking you, what are some of the common causes of a dysregulated nervous system?
Dr. Dave: Well, chronic stress is probably the number one cause. Um, and, and to your, but, and, and just to answer or to comment on something you said earlier about, um, doing more breathwork and doing more Apollo or using more your Apollo and more of a schedule. One of the nice things is you can do them together because Apollo works by delivering the vibrations, the sound wave vibrations to your body at that five to seven breaths per minute rate.
And that’s how it works. So if you just breathe with your Apollo. Vibrations when you’re using it, it will, you know, it will train you even faster how to breathe with that natural rate, um, or that resting rate. So that’s that’s, so that’s part of how it works. But yeah, I think that the things that cause the most disrupted, um, nervous system or dysregulated nervous system, [00:22:00] which, you know, is actually really common, I think probably most humans in the Western world right now have a dysregulated nervous system because we’re not sleeping and S and not getting good, deep restful sleep is.
a major contributor to chronic stress because that’s when we get like 80 to 90 percent of our recovery. So we’re, you know, in deep sleep, you’re getting your physical recovery for the most part in your REM sleep, you’re getting your mental emotional recovery. And so, and memory reconsolidation. So if you don’t have those happening as much as they should, because you’re not getting that good deep restful sleep, then you’re going to be more tired and more stressed out during the day.
And that’s, and you’re not going to deal with stress as well, and your HRV is going to be lower. Um, so, so I think, you know, those are the most common causes of, of nervous system dysregulation.
Jacqueline: Yeah. It’s funny. I just got an aura ring and your comment before about how like how technology today isn’t necessarily super accurate in [00:23:00] terms of tracking on a daily basis, but we can get insights from more of like the weekly patterns yesterday for the first time I looked and it was like your body has been in a stressed state for 80 percent of the day and I was just working like I wasn’t doing anything necessarily out of the ordinary.
So. I just thought that was interesting. And I mean, I think it still has to get used to my body. I literally got it a week ago, but it’s definitely interesting to, to see some of those insights.
Dr. Dave: Yeah, um, do you find them helpful?
Jacqueline: I do. I mean, interestingly, my sleep seems to be, be pretty solid and I don’t, like, I, I actually sleep, I’m embarrassed to say, like, over nine hours a night, which is, I mean, I mean, yeah, I, I guess it is, but I don’t know. I feel like I could probably get away with less, but maybe I’m one of those people that just needs the extra sleep.
But, uh, no, it’s interesting. I like learning, you know. I mean, I think sometimes too much information isn’t too great. Um, like if you have a bad night of sleep and you see it in the morning on your aura ring and right away like puts [00:24:00] you in that mentality of, oh, no, it’s going to be a horrible day, not going to be able to focus.
Um, but I think, you know, knowledge is power again. It depends how you use it. Um. But something interesting to you touched on before, Dr. Dave. So like the vagal toning practices, obviously there’s so much literature on the vagus nerve, right? And vagus nerve stimulation for, you know, improving a dysregulated nervous system.
One of my questions to you is what are your thoughts on hormetic stressors, particularly for someone who already has a dysregulated nervous system? So things like, you know, cold water immersion that obviously shock your body, right? You would think that that’s not great for a dysregulated nervous system, but there’s a lot of research that actually has shown that it interestingly is.
So, what are your thoughts on that?
Dr. Dave: Uh, yeah, I mean, I think it’s It depends on the situation, right? So if you’re, um, I think in general, the way to look at, [00:25:00] at hormetic stressors, which is a great word, um, is to think about, you know, what we were talking about earlier about creating situations of you stress so that we can improve our ability to grow and become more adaptive, resilient human beings.
So. If you know that you’re safe and you go into a cold plunge sauna situation, right, then and you, you do it safely, um, or with, you know, some guidance or whatever, then you can train that trains your body to be able to be more tolerant of not just hot and cold stress, but stress in general, just by doing that.
Um, however, the caveat is that there are certain times, certain, you know, it’s different for men and women about what. Uh, times of the month are good to, uh, hot, cold plunge. Uh, so for instance, for women, you know, this isn’t taught, um, or explained very well, but you know, it [00:26:00] seems like during the luteal phase, uh, of the menstrual cycle is not a good time to cold plunge because, um, it can, you know, for whatever reason it can, you know, impair your immune system and people get sick more often than it’s not.
Not good to do not to put your body under that kind of stress during that time
Jacqueline: Right.
Dr. Dave: if you’re like about to get a cold or you’re feeling under the weather or you’re you know feeling physically dysregulated And uncomfortable because you might be getting sick or something like that. That’s also probably not a good time to do hot and cold So there’s you know, but but for you know a mental emotional stress Um, I think, you know, sauna cold plunge can actually be really helpful because it’s just like, just like exercise is helpful, right?
So it’s, you’re putting your body when you’re exercising and you’re doing something that’s elevating your heart rate, um, to a, to a high level, um, because you’re really exerting yourself. Even if it’s just for like five or 10 minutes, you know, every couple of days you’re training your [00:27:00] body to not only let out physical tension through movement.
But you’re also training your body to learn how to tolerate discomfort and stress more effectively. And so then over time, that has an effect that’s more powerful than antidepressants.
Jacqueline: Yeah, it’s crazy to say, but I think I’ve become addicted to cold showers. I have to do it at least, I mean, I find that’s better than my morning cup of coffee, quite honestly. Um, but speaking of coffee, what’s the relationship between caffeine and HRV?
Dr. Dave: Um, I think the studies are still out on that. I don’t, I don’t think we necessarily know that there is a significant impact on HRV from drinking coffee. I think, you know, every, everything can be done in excess. If you’ll drink too much, uh, you know, it probably would have a, a negative effect because if you drink too much coffee or caffeine in general, um, or any [00:28:00] stimulant for that matter, including amphetamines like Adderall or Ritalin or anything like that, um, or cocaine, you will mess up your sleep.
And if you mess up your sleep, your HRV goes down. Sleep is the number one reason why our HRV recovers. So if we’re not getting good deep restful sleep, like I said earlier, you’re not going to have improvements to your recovery that are reflected in your measurements of your HRV. So I think that’s, so, so, you know, indirectly, if you’re messing up your sleep, you will have HRV drops and you will be less recovered during the day.
Jacqueline: that makes sense. And I guess that’s more also like of an individual approach in terms of figuring out like how how one person metabolizes caffeine over another, right? We’re all different. Um, and I am curious to Dr. Dave, what are your thoughts on nootropics? So I feel like this area just exploded in the past like year or two.
I mean, I get approached on like a weekly basis from a new nootropic company every week. [00:29:00] I still have mixed thoughts on it. What is what is your take on that?
Dr. Dave: So nootropic is like, is a general term that refers to, for the most part, like, um, a supplement, nutritional supplement that improves cognition, memory, like things about how our brains work, um, and function. Um, and you could even put improving energy as part of that, right? There’s, uh, so. nootropics include a lot of different kinds of, um, supplements.
It’s not like it’s hard, you can’t really say like the whole category is either good or bad. Um, there’s lots of good ones and there’s lots of ones where you’re, you know, you’re not, you’re not sure like what’s in them or what the quality of the ingredients is. And And, you know, I think a lot of, a lot of people, you know, there’s a big desire in a culture that prioritizes and rewards productivity so much to take things or do whatever you need to do to get an [00:30:00] edge to be more productive, right?
Like that’s, that’s just kind of like what we incentivize in our society. So yeah. I, you know, that’s, I think that has a big impact on the way that tropics have been embraced in the market because everybody’s trying to get an edge and, um, ideally without a prescription. Right? So, but I think you have to be a little bit careful because there’s a lot of, there’s a lot of ingredients in these things that have not been tested in any way.
They’re not regulated by the FDA. Um, and, you know, we don’t know what the side effects are. Some, a lot of them, you know, have stuff in them that is not intentionally made to cause you anxiety. But if you have anxiety at all, a little bit, and then you take something that is more activating to you in a, in a way that’s stronger than you thought, like that can introduce a lot more anxiety for people.
Um, yeah,
Jacqueline: I won’t divulge the company name, but I did try them for the first time. I don’t know, a month or so ago before a podcast episode [00:31:00] thinking this will give me that focus boost that I need while like blunting, like the effects of caffeine, like the jitters and whatnot that we all don’t really want after drinking too much coffee.
But Dr. Dave, I felt. I felt horrible. Like I, I, like I, I don’t even know how to describe it. Like, and I’ve, I’ve never done, done drugs in my life, but I just felt like I was on something for like a solid two days and I couldn’t focus. Um, like my vision was blurry. I just, I, I felt like, it was like an out of body experience.
Um, so that’s why I, I just wanted, uh, your thoughts on that. Cause I did not have a good reaction.
Dr. Dave: there’s lots of good, there’s lots of good stuff out there. I would check out Sean Wells. Um, and the supplements that he has collaborated on because he is a expert formulator. Um, and, you know, really knows his stuff around, um, nootropics and supplement formulation. So he works, he’s worked on a lot of stuff, um, out there and, you know, I think we [00:32:00] don’t think about cannabis, uh, cannabinoids this way, but cannabinoids are, that are, that are legal, like, um, CBD, CVDA, um, especially like full spectrum stuff where you have like other avenues and terpenes in there.
Those can also be nootropic. Um, adaptogenic mushrooms, uh, there’s a lot of mushroom supplements that can be nootropic, um, that improve memory, cognition, um, emotion regulation, um, adaptability, right? These are all part of the same story.
Jacqueline: Yeah, interesting. I am a fan of like L theanine, ashwagandha, gaba, like I take those occasionally, um, but yeah, the whole combination of 20 plus substances scares me a bit, uh, but I will look into, look into him. Um, but going back to our nervous system, so another, I guess, area that I’ve always been interested in is, Well, first of all, neuroplasticity, right?
Like the brain’s ability to continually change and improve and make new neural connections. And as I was thinking of that, I started [00:33:00] thinking about the nervous system. And I guess my question to you is Are our nervous systems, like, neuroplastic in the sense of being able to, like, change, I guess, like, quickly over time?
And I guess that stems from one of my, like, first questions is, how much control do we really have over our nervous systems? And I’ve read. So many studies right on the infant mother connection and how the mindset and stressors of a pregnant woman Will have a significant impact on the developing nervous system of the child Right.
So when it comes to a dysregulated nervous system Is it really possible to completely bring that back into balance? Like if there were so many things outside of our control before we were even born. Does that make sense?
Dr. Dave: Yeah. Um, everything is retrainable. The brain is infinitely neuroplastic and neuroplasticity, it just means learning [00:34:00] potential. Neuroplasticity and learning are really like the same thing. Neuroplasticity is like what happens on a cellular level, but learning is what happens on a neurocognitive level. Um, so that is, that is always happening and it’s happening at different rates at different times in our lives.
Like when we’re newborns and we’re young, it happens faster in different ways. But when we But it continues throughout our entire lives You know, my, my mid 70s father just taught himself how to play jazz piano, you know, and like
Jacqueline: That’s impressive.
Dr. Dave: impressive. And anything, so anything’s possible, you know, you just have to put your mind to it.
And, you know, I think that we can retrain, like the data, the data is showing that, you know, we can retrain old thought loops, just by self inquiry, non judgmental self inquiry, right? which is like what therapy teaches us how to do and by learning how to do somatic [00:35:00] techniques that calm the body that make non judgmental self inquiry easier and less uncomfortable and resilience techniques that make it less uncomfortable, right?
Because the whole goal is to look inside ourselves. It’s like the whole mental health, mental health, emotional health, healing process that is the journey of life that we’re all on, right? We all have our own somewhere in that journey that we are. Um, and it’s a very personal journey and it really like what we teach people how to do in therapy is really how to, you know, non critically, non judgmentally.
look inside themselves and create time and space to do that where they can, you know, actually connect with the vulnerable parts of themselves and, you know, show those parts a little love and remind those parts that they’re accepted and that they’re part of the me experience in this life, even though they might’ve been.
led to feel badly about themselves, or I might’ve been led to feel badly about them at some point in my life, right? Because somebody [00:36:00] bullied me or treated me badly or whatever, told me not to sing because my voice sucked or whatever, right? And then all of a sudden you decide, well, I’m not, you know, there’s something wrong with my voice, right?
It means there might be something wrong with me. And then it starts these, uh, thought Loops.
Jacqueline: yeah. That’s so interesting, too. And, I mean, can you also, I guess, bust the myth of How do I say this? So my mom, for example, she’s, she, she said she’s a worrier, right? And I’m always like, mom, you need to change the way you view worry and anxiety and her excuses. You know, like my, my family consists of warriors, right?
It’s genetic. Is there a genetic component to that, to our disposition for anxiety and worry? And if so, like what percentage would you give that to or give to that?
Dr. Dave: Um, we, it is, it’s mostly not genetic. Um, the,[00:37:00]
Jacqueline: uh, kinetic, is the same
Dr. Dave: the most of what we experience, the, what, what genetics are is what’s in our DNA. And that’s what’s in every cell of our entire body. Our DNA is basically. in the same. So, um, that the, what’s genetic is what comes from our mother and father. That’s the predisposition to Certain things, meaning the likelihood of certain, certain things happening to us in terms of the way that we respond, our bodies and our minds kind of respond, react to stress, but what is not what what it’s been found is that when you look across like mental health conditions, for instance, genetics play a very small role.
So, most people, you, you know, having a family history of depression, um, is more likely that you had the environmental [00:38:00] impact being raised by somebody with depression that increased your likelihood of depression more so than, um, something being wrong with your DNA and you were just born with depression.
Did you have, possibly have an increased likelihood of, of responding to stress with depressed symptoms? because of the history of what was passed down on our DNA and our epigenetic code, which is on top of the DNA. Sure. That’s absolutely possible. And that does play a role. Um, but the environment seems to play a much bigger role, which is good news because that means that we can modify the outcome.
Jacqueline: Yeah, it’s very empowering epigenetics. I mean, we could have a whole episode just dedicated to that topic because it’s incredibly fascinating. Um, and as I had mentioned earlier, I had Dr. McPhillan on the show not too long ago. And one thing we touched on to that I was news to me is that depression is not actually like really related to serotonin.
Like serotonin does not have any [00:39:00] impact on quote unquote depression and all these SSRIs that are Sadly prescribed, they do more damage than good, um, so much to the point where like he actually refers to modern psychiatry as essentially drug dealing. So I am curious, how do you approach the use of medications versus like more therapeutic interventions which it seems that you’re a big fan of in treating patients with stress and anxiety?
I
Dr. Dave: as doctors, which is, you know, focus on using the least risky intervention first. And then worked your way up as needed. Right. So, you know, I think it’s important to note that that anti like modern antidepressants like SSRIs are not all bad.
They’re actually have a lot of uses and their primary use is stabilization. So. When we’re, you know, working with patients who are extremely, extremely depressed or anxious and really struggling, [00:40:00] um, SSRIs help to actually reduce the thresh, the um, the wind, what we might call like the window of emotion. So if you think about normally you can feel from extreme joy all the way up here to like extreme despair all the way down here.
SSRIs do this. Or this. So that your, your extremes, you can’t feel as much of the extremes, but your, uh, you can’t feel as much of the negative, but the downside is you also don’t feel as much of the positive, which is what causes the side effects that a lot of people report, right? And so, so the main goal of SSRIs is to stabilize people enough to be able to get them into the psychotherapeutic process so that they can actually start to work on some of the stuff that’s causing their depression or their anxiety.
Does that make sense?
Jacqueline: What does that look like from a timing perspective? Like, would you say six months on an SSRI would be, I [00:41:00] guess, a quote unquote safe time? I mean, I’m sure it depends on the individual and the situation, but in general, like, at what point do you not necessarily want patients to be on an SSRI in terms of timing?
Like, how long?
Dr. Dave: I mean, it’s, it’s more about, so I don’t, you know, we don’t typically start with SSRIs as the first option anymore in most, many of the integrated psychiatry practices. So we’ll, we do like a psychotherapy dominant practice, we optimize supplementation protocols, um, we optimize your medications in terms of other medications you’re taking.
And then we focus a lot on psychotherapy techniques that combine some supplements and plant medicine with technology that can make a dent. That’s as. big or bigger in most cases than traditional antidepressant therapy. And then if that for some reason doesn’t work and we have to move towards prescription therapy, which would, could include ketamine assisted therapy, we’ll usually do that and focus [00:42:00] on the things that have the medications that have the least side effects for that person.
Um, And just gradually again, like work our way up and usually people by the time we get to ketamine therapy before we’ve gotten to SSRIs, people typically respond have responded significantly and they’re feeling a lot better. Um, and that has way fewer side effects then. Um, many other prescription antidepressant or anti anxiety medications, but I think it’s important to note that, um, that it’s not about like duration of time.
There’s no like fixed duration of time that anybody’s on an SSRI medication like Zoloft or Prozac. It’s more about what is the impact of their lives when they’re taking it compared to when they’re not taking it. Like some people, a lot of, you know, there are a lot of people out there who have such a tremendous benefit from taking their SSRI that they can actually work and.
and play and function and do all the things they need to do to be a happy human being, that as soon as you take that away, [00:43:00] for, you know, for a number of different reasons, including that they haven’t mastered, they don’t have other tools that are different or to take the place of the SSRI. And they also haven’t probably yet mastered the therapy techniques that therapy is trying to teach them to self regulate and, and, and really, you know, optimize resilience to stress, um, that You know, it can, it’s, so that’s, so we want them to basically learn that stuff.
And so once, you know, however long they need to take the medication, basically, in short, however long they need to take the medication to learn the techniques on their own, um, about how to manage their own stress without the drug, um, that’s how long they take it. And that’s typically how we do it, or I mean, hopefully, you know, they don’t have side effects during the time they’re taking out a lot of people don’t as long as you get the dosing.
Right. But, um, you know, it’s just very personalized.
Jacqueline: Yeah, it’s so interesting and not to get into a, not to go down a rabbit hole, but [00:44:00] would you say that, I mean, placebo response plays a pretty big part in that, right? And again, one study that I came across from Dr. McPhillan is, like a study by Joanna Moncrief, which was basically this umbrella study. I’m sure you’ve heard of it that essentially just like reviewed as a large umbrella study that showed there is no convincing evidence that depression was associated with serotonin.
So knowing that, looking at all these patients on SSRIs, like how, how can you deduce that, like they’ve improved aside from just the placebo effect.
Dr. Dave: So, well, that’s, that’s so, so that study was a very important study, um, that is probably one of the largest, most conclusive studies that we have showing that, Okay. Depression is not a, is not mean that you have, there’s not enough evidence to support the theory that depression means you have a serotonin imbalance in your brain.
It doesn’t [00:45:00] mean that serotonin is not important and involved in depression, because it is. It’s very important, but, um, and most other mental illnesses and brain functioning. So it’s like a really, really important molecule. So it. It is involved, but we, it’s not, the reason why we get depressed is not because we have a genetic serotonin imbalance in our brain.
We’re born with it. And that means that we can, again, that’s like good news, right? That means that what we do matters, right? The activities we do, the way we change our behavior, the way we think about ourselves, all of that actually has just as much of an impact on the serotonin functioning of our brains as taking a medication.
So, like, a lot of the studies have shown that exercise, I think this study showed also, that exercise was one of the most likely things to make depression better reliably. Right? And that depression is actually most commonly associated with trauma. Past, past life, [00:46:00] you know, difficult, challenging past life events that, uh, people associate with trauma, right?
So that would, is much more consistent with what we see in the clinic and when we’re working with our patients about like what is causing depression than the idea of the serotonin imbalance hypothesis, which many of us haven’t actually believed for a very long time. Um, but that’s what was taught. So, um, so yeah, so that’s, that’s good news.
That means we actually have a say in the outcome.
Jacqueline: Yeah, interesting. Yeah, that’s, yeah, again, that could be a whole other topic area for another episode. Um, but one thing too, you touched on Dr. Dave is nutrition and, you know, the treatment of depression in your patients. Can you maybe just highlight at a very high level, what, what an optimal diet for someone who suffers from severe anxiety and depression?
What might that look like?
Dr. Dave: So. You know, it actually starts more simply than you might think, uh, but it really [00:47:00] just starts with, you know, if, if we look at modern neuroscience theory, right, the depression and anxiety, which are often mostly, most often rooted in past traumatic events, trauma being a, uh, like a learned fear response in the body, right?
That creates inflammation. And then that inflammation sticks around. And so we want to help solve the problem. We want to remove things from the diet to start that cause inflammation. Right. So for a lot of people, it’s dairy, number one, especially cow dairy, which is more inflammatory than any other dairy, um, and then, um, removing simple sugars and, um, especially like processed food, fake sugars, um, you know, and, and things that [00:48:00] are like high fructose corn syrup, right.
Just getting all of that stuff out of the diet, which is actually easier than most people realize. Um,
Jacqueline: It really is. What about gluten?
Dr. Dave: Gluten is actually okay for most people. We don’t usually remove that on round one. If we, you know, you do multiple rounds of this. So, you know, the first round is remove all the stuff that impacts everybody, you know, and include, which means also replacing food you’re eating that has pesticides and herbicides and fungicides on it because it’s not organic with organic food, right?
And that’s also a big part of, of this initial like first round nutrition process, uh, optimization. And then if they’re still having a lot of inflammation afterwards, we often will remove gluten as well. Um, or at least most gluten. Um, and there’s other things that we. can do for diet also, which includes like just making sure you have a balanced diet, right?
If you have a balanced diet, you don’t actually need to take that many [00:49:00] supplements because you’re getting most of your nutrients from your diet. So supplementation becomes something that isn’t as required with like vitamins and minerals and things like that. Um, it’s when people don’t have a balanced diet or they’re eating a lot of processed food that doesn’t have a lot of like high nourishment content.
That are nurturing content that then that, you know, those people are much more in need of supplementation. And so that well balanced diet optimization is a big part of it. And then we also make sure that we figure out, okay, this person might be needing a little extra iron. They’re not getting that. They might need a little extra vitamin D.
They’re not getting enough sun. They might need some calcium and some magnesium because of the age that they’re in. And you know, they might, you know, they might have an increased risk of osteoporosis. And of course that has issue, you know, impact on the body and, and mental health and things like that through calcium, too much calcium.
yada, yada, yada, right? So that’s kind of how we, how we start and continue to work with the nutritional evaluation.
Jacqueline: I love [00:50:00] that and I think the beauty with that approach is that it also supports balanced blood sugar levels throughout the day, right? And as you’re very aware, there’s so much literature on blood sugar spikes with hormone imbalance, depression, you know, ADHD, the whole, the whole slew of, you know, all of those.
So that’s very, very important.
Dr. Dave: Can I mention something about that real quick?
Jacqueline: Yeah,
Dr. Dave: So I think it’s important to note that your blood sugar spiking is not always a bad thing. We’re supposed to have some spikes throughout the day, right? So if you think about All of this. It’s like the key word is moderation. The key word is balance. Right? So we’re gonna have spikes.
Like you said earlier, if you’re just looking at blood sugar and blood sugar spikes, you can’t tell the difference between stress and excitement. Right? Just like when you’re looking at sweat on your skin. So the body is supposed to have certain Um, Uh, times during the day where we have spikes and certain times where we go lower, like [00:51:00] when we’re in deep and REM sleep.
And um, that’s when our gluconeogenesis system turns on where our liver starts actually pumping like glucose back out into the blood. Um, and we have a certain rhythm of blood glucose, which is impacted by meals. So it’s not always bad to have your blood glucose spike, but we want to keep your blood glucose in a balanced range over time.
So you’re not having too many of those spikes or too many high periods where it goes high and stays high because that are unnecessary or induced by diet because that or behavior that is, you know, like too much, way too much stress, then that is a sign that, you know, maybe there’s some more optimization stuff that we can do to help.
Jacqueline: Exactly, yeah. I’m so glad you touched on that too, because I feel like, I mean, I experienced this firsthand. When I got a CGM, I would be anal at looking at spikes. And if I had like a cup of blueberries, I’m like, Oh my gosh, I can never eat blueberries anymore because my blood sugar spiked. When in reality, that’s the farthest thing from the truth.
[00:52:00] But I kind of went more based on symptoms, right? So if I had a whole bag of like plantain chips in the afternoon, and then an hour later, I needed to take a nap. I recognize that that may have been an unhealthy spike, right? So it’s all about the context. Um, very, very important. Yeah. Well, Dr. Dave, I do want to be conscious of your time.
This has been such a wonderful conversation. Where can listeners find you?
Dr. Dave: Uh, thank you so much for having me, uh, first off. And, uh, you could find me on socials at, uh, Instagram and Twitter at Dr. David Rabin. Um, and you can find me on my website at drdave. io. Um, and if you want to hear more about, um, my work in the psychedelic space, you can check out the Psychedelic Report, which is your bi weekly psychedelic news on Spotify and the internet.
Apple, uh, podcast and for more on consciousness and how your brain works, check out your brain explained.
Jacqueline: Wonderful. I could just spend days going through all of your research and still not even skim the surface. But I’d love to have you back on [00:53:00] to discuss one of those topics. Um, thank you so much again for all the wonderful work that you’re doing in this space. And my last question for you is, what does being well and strong mean to you?
Dr. Dave: Uh, I think being well and strong means being graceful. You know, it’s just like being able to kind of just flow with life and not put up too much resistance or just acknowledge when we’re like resisting what’s happening and we’re putting up, you know, putting, putting up um, and just, you know, being just kind of at ease and You know, in, in the flow of life, right?
I think this is like what Bruce Lee taught, which is like, be like water, right? Like it’s, it’s about, um, just going with it gracefully, not, not fighting all the time. The fighting is actually what causes the pushing back on is actually what causes a lot of stress for us. And that’s something that we have control over.
And so [00:54:00] doing these techniques, including using Apollo, it just helps like. remind us that we have control over that and that we are doing that, um, even though we might not realize it.
Jacqueline: I love that. Yeah, I came across a quote the other day. I can’t remember who said it, but exactly, essentially what you said, resistance to what is, is what creates the stress and the depression in our lives. Um, so I couldn’t agree more. Well, Dr. Dave, this has been so fun. Thank you again for your time. And I’m super excited to share this with listeners.
Dr. Dave: it’s my pleasure. Thanks for having me.
Jacqueline: Awesome.
