Control Stress for Healthy Eating, Metabolism & Aging | Dr. Elissa Epel

Andrew Huberman introduces Dr. Elissa Epel as a professor of psychiatry and behavioral sciences at the University of California, San Francisco, and director of the Center on Aging, Metabolism, and Emotions (AME). He describes her laboratory as studying stress and its negative and positive effects on brain and body. One example is work showing that particular forms of stress change telomeres, which he describes as a component of the cell's genetic machinery that affects how quickly cells, and therefore people, age. He also previews her research on how stress shapes behavioral choices, in particular which foods people choose to eat and how they experience those foods.

The introduction lists the interventions her lab has explored: meditation and breath work, and dietary interventions such as omega-3 fatty acid intake. Huberman points to one feature of her work in particular: the effectiveness of stress and of stress interventions varies with whether subjects are male or female and with their social status. He also names her books, The Telomere Effect and the more recent The Stress Prescription. The transcript carries a note that it may not be in its final form and may be updated.

Huberman opens by pushing back on the popular view that stress is simply bad and can kill us, and asks Epel what stress is, where it causes problems and where it may help. Epel says the word has to be broken down because it has many dimensions: good and bad stress, acute and chronic stress. Her technical definition is any time we feel overwhelmed, when demands feel like too much for our resources. She argues that stressful situations will not disappear from life and may be increasing, so what matters most is how we respond.

She separates the situations in a person's life, which may be difficult and ongoing, such as caregiving, work stress or worry about one's own or someone else's health, from how that person copes. Mounting a stress response and then recovering is, in her account, healthy and necessary for survival. The modern problem is that we keep the response going mentally after the event.

We keep it alive with our thoughts. Our thoughts are the most common form of stress.

Huberman lists the tools he already uses, including breath work, running, exercise, sleep and Non-Sleep Deep Rest, and asks what the science says about handling looping, ruminative thoughts. Should people reason through the source of the stress or divert their attention? Epel answers "Yes, both." Her starting point is awareness of how the mind works. Without it, she says, we treat our thoughts as real and assume that continued rumination and problem solving help, because our tendency is to move toward perceived threat and try to solve it. That can leave us stuck all day in what she calls a threat mode or "red mind state." She says this society-wide pattern is why she wrote The Stress Prescription.

She cites survey data. Even before the pandemic, most people reported an overwhelming amount of stress, and in the past year 46% of adults reported feeling overwhelmed by stress. In her account, the burden is especially high for young adults, women and people of color, groups she describes as targeted for marginalization.

When Huberman asks whether almost everyone is now more stressed, Epel answers indirectly. People differ in how aware they are of their own stress. Some people who report little stress are simply unaware of it, while others genuinely have little, often because of their stage of life, a high degree of control over their environment and a lot of past experience. One of the largest population-level patterns, she says, is that people over 65 are less stressed, and young adults report about four times the stress of older adults. She credits age with real wisdom and resilience for many people, and adds that we do not have to wait until we are older to gain them.

Epel offers the body as a practical sign of hidden stress. People get so used to daily urban stress that they stop noticing it and go through the day with clenched hands. Her taxi driver that day told her that he does not realize he is stressed until he notices he is tensing his shoulders and fists. She presents a check-in on where the body is holding tension as step one toward releasing it.

Pressed again on overthinking about the source of stress, such as a difficult conversation or something irritating on social media, Epel says she has no single answer and sorts strategies into three groups.

Top-down strategies: awareness, and things we say to ourselves, since beliefs and mindsets can help us release stress and view it more positively. Body-to-mind strategies: working stress out of the body, "metabolizing it" and "burning it up." She says these change amygdala activity and shift people into a more experiential state centered in the somatosensory cortex. She notes these are the strategies Huberman uses most. Changing the scene: leaving the stress triggers of the office or city for a calming environment, even just a corner of the house, and installing what she calls "safety signals," such as comforting pets, pictures, smells and music. Her reasoning is that we are animals conditioned to signals whether or not we are aware of them.

Huberman builds on the third group, suggesting a small, predesignated physical space as a safe zone for people without many resources. Drawing on his background as a visual neuroscientist, he says photographs, especially physical ones, are powerful memory cues. He believes some research shows that carrying a photograph tied to positive memories can help relieve stress and lift mood. He adds that this is probably done less now that people keep images on their phones. He does not name the work he is recalling.

Asked for an overview of the forms of stress, Epel first separates stress as people feel and report it from what the body is doing. The two are not always linked. Measuring the nervous system and how vigilant a person is offers another view, and she calls it especially important because "that's how stress gets under the skin." A person may hold tension and be "much more sympathetically dominated," with the body scanning for cues and not feeling safe, and so mobilize far more energy than needed.

And stress is so expensive to the body. The stress response uses a tremendous amount of energy, ATP, that's made by your mitochondria.

Epel argues that keeping a vigilant response on all day leads to exhaustion. She ties widespread exhaustion during "the long shadow of the pandemic" to people being poor at switching the response off. Her proposed focus is to mount a large response when extra energy is needed and then let the body relax. This is also where rumination enters: people should catch themselves rehearsing or reliving stress, or worrying about the next thing, and tell themselves they are safe right now. She calls breathing strategies the most direct and fastest path to reducing stress in the body.

Huberman adds a framing he attributes to their colleague David Spiegel, associate chair of psychiatry at Stanford. Breathing is unusual among brain-driven functions because it bridges the conscious and the unconscious: it runs automatically, yet we can take control of it at any moment, unlike digestion. He previews a study of Epel's that examined the Wim Hof Method directly, which he calls one of the few he knows of, and sums up her view of stress as the way body and mind mobilize energy.

Epel then lays out a timescale. In an acute stress response, every hormone and cell is engaged, which lets us reorient, focus and solve problems, and if it lasts minutes or hours we eventually recover. Smaller versions of this happen all day. Daily stressors usually do not make us threatened enough to release a lot of cortisol, but the nervous system rises and falls throughout the day.

Moderately stressful events may take days or months to cope with. For these, she stresses noticing whether one is coping acutely in a given moment or can restore, and she treats daily restoration as very important. Chronically stressful situations can last years. Her example is caregiving, where the person cannot change other people, certain situations or resources. One can think about such situations constantly and wish they were different, or use acceptance, including "radical acceptance," and other strategies to live well with them. She rejects the idea that such people are bound to be stressed forever. A harder life means more coping, she says, but uncontrollable chronic stress can be handled in ways that do not take the same toll on the body.

Her evidence comes from her own research on chronic stress and accelerated cell aging. She reports large differences between individuals: some caregivers look as biologically young as, or younger than, controls with no identifiable major hardship.