Loneliness Is As Bad As Smoking with Dr. Bryan Walsh and Dr. Mike Nelson, Live From Costa Rica

Today I had a fascinating discussion with Drs. Walsh and Nelson regarding lifestyle.  Did you know that being lonely is as harmful as smoking? We also talked about the importance of life purpose, the damage that unnecessary fear of food can inflict and other important aspects of connection, purpose and happiness.

In This Episode

Episode Intro … 00:00:40
Importance of Optimism … 00:01:25
Having a Purpose … 00:08:35
Finding Your Purpose … 00:15:40
Outlook … 00:18:50
Optimism … 00:21:21
Negativity … 00:22:00
Placebo … 00:26:20
Mindset … 00:34:50
How to Speak to Patients … 00:40:00
Episode Wrap-up … 00:49:40

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Episode Intro

Dr. Michael Ruscio: Hey, everyone. Welcome to Dr. Ruscio Radio. This is Dr. Ruscio. I’m here with Dr. Bryan Walsh and Dr. Mike T. Nelson. We are live from Costa Rica, so you’re probably going to hear a bunch of noise in the background. There are some pretty gnarly bugs that just randomly will peg you right in the face.

Dr. Bryan Walsh: They’re like the size of small birds.

DrMR: It might get a little bit choppy here, but we’re going to do our best. I was prepping for my lecture today while Bryan was lecturing, and you had said some interesting stuff on the importance of optimism, of mindset, of purpose, of friendships on things like all-cause mortality.

Importance of Optimism

And I only caught a couple snippets because I had my head in something else, but it was enough where I was impressed and wanted to kind of pull a little bit deeper on that string.

And I know Mike Nelson’s also done some similar work, so I thought we could have kind of a roundtable here on this topic. Bryan, you want to launch us in, and we can kind of go from there.

DrBW: Sure. I don’t know where to start, but for a long time—and I know that you’ve kind of been in this space too—you start out usually in this medicine, if you will, thinking about physiology and biochemistry and how the gut works and how the liver works and detoxification and all these things.

And I’ve been progressing myself in looking at other aspects. And one of the big aspects is this connectedness. It all started for me is I read a couple of papers by this researcher named Steven Cole, who basically was talking about this conserved transcriptional response to adversity and showing how if people were lonely, if they were socially isolated, then they had a lower immune system function to fight infections and then, simultaneously, had higher baseline inflammation.

When I look around at our society, I think there’s so much lack of connectedness nowadays. There’s so much social isolation. There’s so much loneliness, and there’s so much chronic disease that’s associated with lower natural killer cells and macrophages but higher inflammation that I have to wonder how much that’s impacting this chronic disease that we see today.

That was the foray that got me into even looking into some of these things in the first place because it’s so chronic, it’s so common. And I will say—I always say to people, “What supplement do you give for that?” And is diet going to counterbalance the inflammation that somebody has that they’re feeling lonely. Is there a supplement or do they need to sleep more? And the reality is that none of that will go away until they start to feel less lonely.

There’s a whole bunch of research on this stuff, so this is just the beginning. But that’s what kind of got me into this in the first place.

DrMR: It’s a really interesting point because as you’re saying that I’m thinking that it’s almost as if the situation is we have an environment that is pro-inflammatory, meaning people are Cesarean birth and they’re not breastfed and we know that leads to a malformed immune system and a malformed microbiota. And the microbiota kind of sets the tone for your immune system for your life once it forms in the first two to four years of life. So that may just be compounded by the loneliness that also accompanies this.

So we kind of have an overly hygienic environment and an overly lonely environment, and those things may be working in tandem to really contribute to the disease epidemic that we have. It’s definitely something that in my opinion is hard to treat. We were talking about this earlier today. And I said it’s easy for me to say “go on a gluten-free diet,” and if someone hasn’t done that yet or if someone hasn’t gone on the low FODMAP, they’re going to improve from that.

The cases that are more challenging are the ones that come in and their husband is not not supportive of them. And they feel isolated and they’re withdrawing from social engagements. One of the things I try to impress upon people—but it’s tough and I’m hoping this podcast will help to do that and will hopefully get more and more granular over some details to motivate people—is you’ve got to invest time into your life. Because some of those things, well, any of those things regarding your life, none of us can do for the person. They have to do them.

And I understand sometimes you think that the answer to the problem is figuring out, Well, maybe I’m sulfur-sensitive or maybe it’s a CBS mutation. Yeah, maybe it is. But in my experience—and I’d be curious to what you guys think on this—you have some foundational treatments to go through, a few big pillar diet items. Try paleo, try low FODMAP, try to find out what meal frequency is best for you is a few examples. Get somewhat adequate sleep. Get some exercise.

And if those aren’t getting you where you want to be, I question how much you will get out of these much deeper analyses when under the caveat they’re not feeling fulfilled, they’re not feeling like they have adequate social time or social connectedness. And I would venture a guess if we had a comparative study that were to look at, ok, we’re going to treat your CBS mutation or you’re going to pursue purpose in your life, we would see vastly better results with purpose.

DrBW: I want to hear, Mike, your opinion on this as well.

Dr. Mike T. Nelson: Yeah, of course.

DrBW: Some of the things that I presented today was, first of all, that loneliness in terms of its correlations with mortality is on par with smoking, consuming alcohol, and obesity. Your risk of death…

DrMR: Which is a strong statement.

DrBW: It’s huge.

DrMN: Yeah, that’s massive.

DrMR: That’s a very strong statement.

DrBW: That’s not just from one paper. There’s a few papers that say that. And then you could put on top of that, you were saying that we can’t do it for people, but what we can do is bring light to the fact that somebody might be lonely. Then the big question is, what really is loneliness?

What I presented today is loneliness has nothing to do if you’re shy. It has nothing to do with your introverted or extroverted. It has nothing to do if you’re optimistic or pessimistic. What it is is your lack of social connection, if you are lonely and you don’t feel connected to others.

And where I think we screw this up is people have to admit to themselves if they really are lonely. You can have 1000 or 2000 or 5000 Facebook friends but not feel connected to any of them. We’re more connected technically to people, but we lack…

DrMN: The superficial level.

DrBW: It’s a very superficial level.

DrMR: And you look at some of the research—and this is something that I put in the book to drive this point—they’ve shown that time on the internet and specifically social media time is a negative corollary to happiness.

DrMN: Totally. Yeah.

DrMR: Yeah, you can have all these Facebook friends, but if you don’t have that feeling of connectedness with an actual, physical person, then you are probably going to make yourself feel worse rather than feel better.

DrBW: And you said pursue purpose and it’s funny because this is another piece I talked about, and, Mike, you can jump in on any of this stuff. But typically, when you pursue a thing and you don’t achieve it, if you pursue happiness, you’re saying “I am not happy.” The pursuit of it doesn’t often lead to necessarily happiness. And to even pursue a purpose.

And just to jump to some of these studies. So loneliness is on par with smoking, alcohol consumption, obesity, on mortality. So then the question is and for yourself, like, if you were lonely, how do you become not lonely?

DrMR: Yes.

DrBW: You go and you find a friend?

DrMR: That is the question.

DrBW: How hard is that? I cannot find a good friend very easily in my life. But it turns out that also according to the literature then, the thing that trumps loneliness every single time—or living life in a eudaimonic way, which is living life for a bigger purpose other than yourself, which is to say to have a purpose.

So what’s really cool about this is you can be lonely, but if you have a purpose, then it doesn’t increase your risk of mortality. It basically wipes out that loneliness piece, and that’s huge. So if posed with the option of find a friend and don’t feel lonely anymore…

DrMR: Or find a purpose.

DrBW: Or find a purpose. I think that ladder is so much easier to do.

Having a Purpose

DrMR: There’s two things I want to tack on that because that’s brilliant. There’s a quote—I believe it’s by Nietzsche—that says, “For he who has a big enough why, they can overcome almost any how.” And also, in my reflections and I’ve spoken about this on the podcast before, I think there’s a strong utilitarian aspect of friendship. You were talking about earlier today when you’re a young, single guy, you have a bunch of young, single guy friends because everyone’s trying to find a girl. So it works out.

I’ve watched this. As I’ve transitioned from in my 20s into my 30s, then the single guys keep hanging out with the single guys and the guys who get married hang out with the married guys and the guys who have kids are more prone to hang out with other guys who have kids. At first—I was also saying this earlier today—I was a little bit disappointed in humanity, meaning the only reason me and you are friends is because we need each other for something.

But then I realized it probably comes back to this fundamental concept of efficiency, where the minimal foraging theory. We hunted animals with more fat because there were more calories per kill. So I think there’s always this gearing toward efficiency, and that was probably why there is this hardwired utilitarian aspect of friendship that we’re born with. So if you can find a purpose, you’ll probably find other people who are aiming at that same purpose. And then you have a utility partner, going toward your respective purposes. So I think you might get two birds with one stone with pursuing purpose.

DrBW: Indeed. And purpose can also change throughout somebody’s life, when you think about it.

DrMR: Sure. And we were talking about something else in terms of a purpose. I think religion is something that could be helpful for a lot of people, and I was raised Catholic—not to get too far off topic here. But I was raised Catholic, and for many years of my life in my adolescence and in early adulthood, I kind of felt a pulling away from religion. And I went through the standard criticisms of Catholicism and Christianity.

But then I started learning more about how much good it can do for people. And that’s a whole other conversation that I’m not sure that I’m prepared to have, but I’ve been reading some of the work of Jordan Peterson. And I’ve been finding a lot of his work very insightful. So religion could be one. I’m not saying you have to do that.

DrBW: Well, no, and there’s papers on religion and church attendance and purpose.

DrMR: Or even spirituality or even we were talking about charity, doing something good for people. And so, I think there are maybe easier ways than like you said what about like a Meetup group in a facetious way.

Maybe a Meetup group isn’t the best…

DrBW: It could work.

DrMN: It’s not that crazy of an idea.

DrBW: No, but how easy does that work. How often do people go to a Meetup and find that person that gives that connected feeling?

DrMN: But I think it goes back to what you were saying about purpose and even like all of us just ending up here. And we can all probably speak to this. As we’ve figured out what we wanted to do with our careers, which has kind of changed, you end up meeting other like-minded people along the way.

And I think part of it is just convincing people to take an unknown action. Go to that conference.

DrMR: Get involved.

DrMN: Meet somebody, get involved, find a church group, whatever it is. Not necessarily because, like you were saying, “I’m going to make myself be happy.” It’s like maybe this is the direction I want to go with my life. Maybe this is my purpose, so I’m going to take this action and this action and this action. If I enjoy fitness, maybe I’ll go to a conference with fitness just for a day. Or maybe I’ll be able to come down here for a week or two weeks and hang out with other likeminded people.

Every time that I’ve done that myself I know that, oh, wow, you find other people who are much to my surprise similar to me. Of course, they’re probably similar to you if you’re in the same position, doing similar things. But I think it becomes very easy just to kind of live in your own little universe without that kind of human connection that you’re all kind of moving in that same direction and purpose.

DrBW: Well, as you were saying this too I was thinking back to—it’s an interesting time I think in human history where, as I was talking during the presentation today, we don’t have an embedded purpose when we’re born. In previous communities, there was a farmer, and there was the doctor. And there was the accountant. And there was the person that fixed or repaired the houses or the clothes men or whatever it was, and that was their purpose. And the community benefited by how well you did your job. And there was no question as to what your purpose was, and then your offspring probably were going to inherit your purpose. And so, it was their purpose from early on.

So we’re in this weird time now when we don’t have community in the same way that we used to, and we have to search for it. What is your purpose? I don’t think anybody in human history ever had to ask themselves, What’s my purpose? And now, we’re posed with this “you don’t have a purpose,” so we need to figure that out.

DrMR: It’s kind of the gift of the wonderful society we live in where it’s a paradox of choice.

DrBW: Or a curse.

DrMR: Yeah.

DrBW: Or a curse because if you don’t have one and if you don’t have a purpose and we live in this disconnected society and you’re feeling lonely, again, getting back to…

DrMR: A double negative there.

DrBW: So low natural killer cells and low macrophages may make you more prone to infections, but that’s also what you see in cancer, including like that higher baseline inflammation. So how much is not having a purpose, not living for yourself therefore and then not for the community? Feeling lonely because we’re all disconnected and nobody really has your back the way that they used to not that long ago, and then how much is that contributing to today’s chronic disease, for example.

So it’s a unique time that we even have the option of even asking what our purpose is and the confusion around that. So anyhow.

Sponsored Resources

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Finding Your Purpose

DrMR: I think there’s a lot to be said about how to find your purpose, of course, but a couple of things that come to my mind as being helpful. One, I do think you need to get to a certain level of biological health. I think you have to quiet your mind of all the poisonous thoughts that can be triggered by having an unhealthy physiology.

If you’re eating inflammatory foods that don’t agree with you, you’re going to have depressive thoughts. We know that for a fact. So how likely are you to find your purpose if your head is clouded with depressive thoughts? Probably difficult. So taking some fundamental steps, simple steps, toward biological health gets you one step closer.

Another step that I think can be helpful is having quiet time to just listen to that inner voice. And then the third I think is just reading—there’s a grasshopper just landed above…

DrBW: There’s a massive grasshopper.

DrMR: That thing has got to be a good four inches. Wow. It’s like we’re in Jurassic World. So having some quiet time I think is good so you introspect a little bit and actually listen to yourself. And then, exposing yourself to all different types of information. That could be reading articles or talking with different people just to see what kind of stuff resonates with you or just taking, quite simply, stock of what you currently do. What do you like? What do you read about? What do you do? And that may give you some indications as to what your purpose is.

Sometimes I think, and this is what happened with me actually, I wanted to go into law. But I was always the guy making workout programs and dietary plans for my friends just because I really enjoyed it. And then one day I was like, Oh, maybe I could do this for a living.

So sometimes it’s right there in front of you. You just have to take a moment to kind of connect the dots.

DrBW: And you’re argumentative and you like to debate, so that’s going to…

DrMR: Very argumentative. Yeah. That’s the Italian in me.

DrBW: So the counterview of that is there was a study that I presented today that said that people that had a purposeful engagement in life lived, on average, 14 years more than people that didn’t.

DrMR: Makes sense.

DrBW: And then, the question that arises from that is it simply having a purpose or is it having a purpose that is what generates people wanting to exercise, wanting to eat well? And while I agree—I’m not disagreeing with you.

DrMR: Yeah, I see what you’re saying though.

DrBW: If you eat a non-inflammatory diet to not cloud our thinking and our judgment so that we can choose a better purpose and we can live that purpose, if one has a purpose in the first place, I don’t think that you like those inflammatory foods. And I think you like to get up in the morning and you like to eat healthy because it makes you healthier and you like to exercise because then you can go for your purpose better.

DrMR: It comes back to the Nietzsche quote from earlier.

DrBW: Yeah. Well, as with most things, I don’t think there’s one answer. I think that they both feed into each other. But I would like to see something that shows that when somebody develops a purpose, they then develop healthier lifestyles as a consequence of that versus—and I think this is possible too—healthier consequences may lead to less clouded thinking, which then leads to living a life with more of a purpose.

DrMR: Sure. I think they can both definitely feed in. It’s not to say you have to start on one end of the spectrum or the other.

DrBW: Just do both.

Outlook

DrMR: So you were also mentioning some stuff on outlook, which I found interesting. Why don’t you talk about some of that? And then I had a few questions as a follow up.

DrBW: There’s a whole variety of stuff on this which I find fascinating. There was one paper that I presented that showed that pessimism was correlated with shorter telomere length and higher interleukin-6. I joked around saying I didn’t know if they were pessimistic that they had short telomeres and they were angry because of that or vice versa.

But what was interesting is optimism wasn’t associated with longer telomere length. It was just pessimism was shorter.

DrMN: I found that part fascinating.

DrBW: And then it starts to get into this part when—and I don’t want to get too deep into this. But the whole positive psychology has been…

DrMR: There’s a difference between—not to cut you off—but a difference between positive thinking and being optimistic, it seems.

DrBW: And there was another paper that I had mentioned too. There’s something called dispositional optimism or pessimism and then situation-specific optimism or pessimism. So dispositional is sort of someone’s constitution. They’re just kind of a person that thinks good things are going to happen eventually.

And the example I use is there was a paper on recently married couples. The ones that had more dispositional optimism tended to be able to work through their problems more. And the people that had specific optimism, like about their marriage, didn’t. Life sucks, but our marriage is going to work. So it was different.

DrMR: So situational optimism is just you’re not necessarily a happy person but you’re just trying to apply happiness to a certain situation.

DrBW: I see that as the people that aren’t happy but are trying to be happy. There’s people that everybody…

DrMN: Feels like it’s forced.

DrBW: Right. Like, oh, everything’s going to work out. But you can just feel they don’t feel that way. And you guys have known people that are just truly optimistic. They just really believe that everything kind of works out. But then there’s some really interesting things that are coming out now about negative thinking and how negative thinking and pessimistic thinking might actually be beneficial because it can actually prepare you for the worst-case scenario. Rather than thinking that everything’s rainbow and butterflies and unicorns.

Optimism

DrMR: And then you talked about stoic philosophy which is something I’ve bridged on briefly in the podcast. And I think stoic philosophy—so for the audience, stoic philosophy, one of the things that struck me about the philosophy of stoicism was that they would practice having nothing. There are stories about old stoics in Greece that would spend a day… And I apologize for the background noise, guys. They would spend a day dressed in rags to appreciate the clothes that they had. Or they would visualize the worst things in their lives that were possible, worst-case scenario, to make them appreciative of what they do have.

So it was almost like a re-sensitizing themselves to appreciate what they have. Whereas, our society is so hedonistic. All you see is the millionaire on Instagram taking photos in his jets or the wannabe Instagram model taking pictures. She took 18,000 pictures and found the one that looked really awesome and applied 18 filters and edited it and then posted it. And you look at that on your way quickly from picking up your kids, saying to yourself, “God, I look like a slob compared to this person.”

So there’s always this stimulus of you not appreciating what you have because of the society that we live in. So that’s what really struck me about some of the appeal of stoic philosophy.

Negativity

DrBW: And they would actually contemplate death which we… Why are people afraid of aging? Everybody’s afraid of dying. They were not. In fact, they would approach death, and they would use that in order to have a better perspective on life which was interesting.

So there’s a lot of interesting stuff coming out now about the benefits of negative thinking. And we’re so against that.

DrMR: So let’s clarify negative thinking a little bit.

DrBW: Well, pessimistic.

DrMR: Does the research clarify between kind of what I just mentioned which might be portrayed as a negative visualization between people who are just globally pessimistic?

DrBW: Yeah. No, no, no. So that too. So you can have a dispositional pessimist or you can have a situational kind of pessimist.

What it seems that the research suggests is to be specific in the pessimism. To not think that everything’s just going to fail but literally think of the worst-case scenario and be very specific with it. So when you do that, then what you’re doing is planning for the worst, and if it doesn’t happen, then it’s good.

DrMR: Yes.

DrBW: And also, if it does happen, you’re prepared for it. And I used a funny example. There was this paper looking at people that had been through tornados. The more optimistic ones thought they would get through another tornado; the ones that were pessimistic or didn’t get through it, they were better prepared for possibly another one.

DrMR: Sure.

DrBW: So the thought is now is to if you’re going to think that, A, it’s not bad to think of a worst-case scenario. And B, if you do, be specific about it so it’s more of a planning mechanism than it is, “Eh, nothing is going to work out.”

DrMR: I took a tool very early in my life from Bryan Tracy. His recommendation was when you’re confronted with a very difficult situation, oftentimes you may be feeling more fearful than you need to because you haven’t actually taken the time to consider, ok, if the worst possible thing happens to me right now, how bad would that actually be?

And there’s been a couple of times in my life where it was very, very challenging for some of the things professionally that have been taxing, both financially and logistically and from a time perspective. And there’s the risk when you’re building something from scratch of failing.

And I thought through, Ok, what would happen if I did fail? And I thought through it and I actually realized, it wouldn’t actually be that bad. I’d still be alive. I’d still have a place to live. I’d still have some fallback options. So I was less fearful because I actually identified, ok, worst-case happens, here’s what I would do. It’s actually not that bad, and now I’m not actually that fearful because it’s not an unknown. It’s known now, and it’s not as bad as I thought it was. So I think that’s a very good exercise.

DrBW: The next part of it is that when you realize that that’s the worst than can happen is it’s actually not that bad.

DrMN: Do you think part of that pessimism though is increasing the body’s ability to survive? So if we say that physiology is primarily survival-based, the body will do whatever it can to survive, that running those “pessimistic scenarios” is actually enhancing the body’s ability to survive because you can then prepare for those specific situations.

DrBW: That’s a fantastic question. You could answer that in different systems. So you could answer that in like the sympathetic or the HPA axis, the stress system, or you could answer that from an immune system perspective. And I wouldn’t be surprised if it did.

Everybody uses the word hormesis now. It’s almost like in mild doses it’d be like a hormetic stress to prepare you better for survival. That’s a great question. I haven’t seen any answers on that, but that’s a great question.

DrMN: Yeah.

DrMR: So we’ve hit a couple big ones: mindset, purpose. What have we missed because I didn’t hear everything? So is there anything we haven’t bridged on.

DrBW: I’d like to hear Mike talk more. I’m happy to say more but go for it.

DrMN: Oh, I was just saying your thoughts you had on the placebo effect too because if you go back and say that what is the role of even just the mind. Because similar to you guys, I spend a lot of time studying physiology. When I started working with clients, I realized it was more their mindset than it was their physiology as the rate limiter.

So I went back and started taking classes on neurobiology instead of psychology. But the stuff you presented on like the maid study where they told them that this was good for their health. And then the group that they told that actually saw better health outcomes.

Placebo

We were talking afterwards too about like placebo effect, so people who will come up to me and they’ll be like, “Ah, that all mental mumbo-jumbo doesn’t mean anything.” I’m like, “Well, do you believe in the placebo effect?” “Well, of course. Everyone believes in the placebo effect.” I’m like, “Well, that’s what we’ve known of data for a long time, showing how powerful the mind is.”

And even the placebo effect can be different in different parts of the world. It can be different parts of the country. So it’s not this sort of static thing per se. And then if you agree with that, then like what you were presenting is how far can we extend that. It’s pretty far with the studies on visualization of performance. The one study you have, there’s the same study showing free throws.

DrBW: Oh, yeah. That one.

DrMN: Which was a classic study. Basically, the group that did the visualization of it did almost as good as the group who did the actual practice of it. So I just find that that is a good argument to get people on board that the mind really is that powerful. We do have actual hard scientific data to show that, and then it’s like how far does that extend?

DrBW: Two of the studies that you didn’t see, one of them… like the free throw one, this was just mindboggling. To say what you were saying, Mike Nelson, is what are the possibilities? And I don’t even think we know.

DrMN: No.

DrBW: So one of the studies was they took these college freshmen, essentially. They split them into three groups. They had each do this hip flexor test to see how strong they were in this one hip flexor exercise. So they had a control group for two weeks that did nothing. They had a group that came in five days a week, did four sets of eight reps of this exercise, 60 second rest. And then the other group was a visualization group.

And this is where I think we totally screw up visualization because we hear like, “Visualize yourself in the perfect body or visualize yourself in the perfect…” You know what the visualization group did? They had to visualize five days a week doing four sets of eight reps with a 60 second rest in between and every day to visualize adding five pounds to the exercise.

And after two weeks, the people that performed the exercise had a 28% increase in strength. And after two weeks, the people that visualized it had a 24% increase in strength which is unbelieve when you think about that. And then you start to think, well, Can I visualize my way into a stronger deadlift? And to a degree, I think that you can if you are specific about it.

DrMR: I wonder why that’s why many of the educators that talk about goal-setting talk about the goal has to be incredibly specific.

DrMN: It’s the principle, right?

DrMR: Yeah.

DrMN: Just like we got patients—

DrMR: Yeah, so I wonder why they say you can’t just visualize you’re rich and successful. It has to be visualize you’re driving. You just left…

I’ll share one of the visualizations I had when I was in high school. I always wanted to public speak. That was always something that I enjoyed, and when you’re in high school, some of these priorities aren’t maybe the best. But I always envisioned myself driving in a convertible, like a nice convertible sports car along a coastal road after leaving a lecture with my wife.

And that was just something I just always held. And I haven’t gotten there yet.

DrBW: Which part? You’re close.

DrMR: I feel like I’m making strides. But the point is that was a very appealing visualization to me because I could almost feel it and taste it.

DrBW: And experience it. You’ll appreciate this one too. So you may have heard this. They got a little bit of attention. What they do is they took type 2 diabetics, and they put them into—there was three different rooms. And they asked them to play the computer. And they had a clock next to the computers, and they’re supposed to play computer games.

But so that they paid attention to the time, they were supposed to switch the game they were playing every 15 minutes. So what they did was is each—and this is incredible because here we are talking about lifestyle, diet, supplements to help regulate glucose regulation. In each of these rooms, they were each in there for 90 minutes, playing video games.

In one of the rooms, the clock was fast. So it appeared as though they were in there for only 45. They thought they were in there for 45 minutes. They were in there for 90. There was the middle group that was in there for 90, and they thought they were there for 90. And then the other group that the clock was slow, they were in there for 90 minutes, but they thought they were there for 180 minutes.

DrMR: Or they were in there for 180 and they thought they were in there for 90?

DrBW: No, no, no.

DrMN: The clock was fast. So it was telling them they were in there for 180.

DrBW: They thought they were in there for a certain amount of minutes. And so what they found was—and the graph was an incredibly statistically significant difference in their fasting glucose level in just the perception of their time if that makes sense.

DrMR: Wow. Yeah.

DrBW: I’ll show you the graph after we’re done with this, but it was profound. Their fasting glucose was predicated on how much their perception of time that they thought they were in the room. And here we are, “Well, you’ve got to take berberine. Don’t take metformin. You’ve got to do this kind of exercise. You’ve got to eat this diet.”

Then you see a study like that and what that should do is not say any answers but rather like what are we doing with these people? What is the role of perception when it comes to their fasting glucose? And how could you have three groups of diabetics who were all in the room the exact same period of time, but they came out and they measured their glucose and it was vastly different.

DrMR: And this is a little bit different, but I think it piggybacks and builds on that concept. This is one of the reasons why I’ve been a strong advocate of not scaring people about a given lab marker. And I actually take the opposite approach where I actually—I don’t want to say I downplay. I think I’m actually very accurate.

So we’ll see an MCV elevated occasionally or we’ll see mild SIBO. And sometimes patients come in and, “Oh, I saw I have SIBO.” And they’re so nervous. And when I explain to them, “You know what? This is such a minor elevation I don’t even really consider this SIBO.” The amount of relief that you see expressed on their face is amazing.

So this is why, for all the healthcare practitioners listening, I think you’re really doing people a disservice when you try to use lab markers to fear people into compliance. I think it does more damage than it does good. And I understand the rationale. I think that comes from a good place, but I think you have to be very careful.

If you’re indoctrinating them into thinking that there’s something really wrong with them, that’s going to have negative consequences because of the mind-body influence, as we’re discussing here.

DrBW: And if you believe a thing, if what you believe can influence your biology…

DrMR: Exactly.

DrBW: And there were other studies that I presented. If you want to speak to that Greatland one and the shake one or the functional hypothalamic amenorrhea, but there are papers now that are showing that what you believe can alter…

DrMR: What is.

DrBW: Hormones. Biomarkers and these different things. That’s so powerful so that if you’re feeding patients fear-based stuff, what is that doing to them when they’re presented with some of these things?

Dr. Ruscio Resources

Hey, everyone, this is Dr. Ruscio. I quickly wanted to fill you in on the three main resources that are available to you in case you need help or would like to learn more. Of course, I see patients both via telemedicine, via Skype, and also at my physical practice in Walnut Creek, California.

There is of course my book, Healthy Gut Healthy You, which gives you what I think is one of the best self-help protocols for optimizing you gut health and of course understanding why your gut is so important and so massively impactful on your overall health.

And then finally, if you are a clinician trying to learn more about my functional medicine approach, there is The Future of Functional Medicine Review, which is a monthly newsletter. Which is a training tool to help sharpen clinical skills. All of the information for all three of these is available at the URL  drruscio.com/resources. And in case you are on the go, that link is available in the description on all of your podcast players. Okay, back to the show.

Mindset

DrMN: Maybe to go back to their mindset. If you have someone who walks in who is like, “I just can’t lose fat.” Or, “I’m convinced I have SIBO,” or whatever. It’s like, “Ok, so you’re already convinced that you’re not going to be successful. What do you want me to do?” Do you known what I mean?

In the past, I would’ve just, “Ah, yeah. Whatever. That’s all physiology. It’s all calories in, calories out.”

DrBW: Running tests. Right.

DrMN: But I’ve found that those people are the same ones who at some point will kind of self-sabotage themselves too because at their core they believe that they are not successful. And one of the sort of tricky things I’ve done in the past is they would come in and I would ask them about their history. And of course, usually if they find you, they haven’t been successful.

So they would say, “Well, what do you do?” I said, “I’ve got all this weird stuff in the garage. We’ve got tires and kettlebells and all this stuff.” And they’re, “Oh, well, that’s nothing like all the machine-training and all the stuff I’ve done before.” And I would tell them, “No, this is much better. This will work much better for you.” And is it kind of a lie? Yeah. Could they get a better result if they did other things? Sure.

But what I wanted to do is to set them up and say, “This is so different that you don’t carry all those other past failures with you beyond this point.”

DrBW: True.

DrMR: Yeah. That’s right.

DrMN: I don’t want all of that baggage. I want them to think that, yes, this is different. This is why we do things different. “Oh, that other stuff didn’t work for you? That’s ok. Don’t worry about it. Just do this and go forward.” Because I don’t want them to kind of carry that same mindset into everything that I’m doing.

Quick story on that. The other part I had is whenever they would leave my whole goal was obviously get a training effect, but I wanted them to feel better than when they came in. So I’m like if I can just make them feel better each time, I’m doing progress and overload and all that stuff.

So I had a guy once who came over. Drives all the way across town. This was when I was in my garage, training people. Opens my front door. Passes out on my floor. And he’s like in the fetal position, going, “Ugh, my stomach hurts.” And I’m like, “Dude, why the hell did you drive across town to come to my place? Do we need to get you to the ER, number one?” He’s like, “I’ll be fine.”

So we do some light warmups, do some things, training, and he ended up doing pretty good. And he actually ended up setting a PR on the bench press.

DrMR: Wow.

DrMN: I asked him, I said, “Why did you drive all the way over here? You could’ve called and said, ‘I can’t make it. I’m not feeling good.’ It wouldn’t been a huge deal.” And he’s like, “Well, cause I know when I leave I’ll feel better.” And he didn’t even really know what he was saying.

DrBW: Right. That’s powerful too.

DrMN: But it was unconsciously sort of programmed in him that every time he went there, he felt better when he left. So just get there and you’ll feel better.

DrBW: No matter.

DrMN: Yeah, association.

DrBW: That’s powerful too.

DrMR: And so, I just want to reiterate this one more time because I just think it’s so important. Sorry to be beating a dead horse here, but this is why I think it’s so important for healthcare providers not to fear people. And if anything, to give them maybe a shade more optimistic of a prognosis than you may even think that they have.

I’m not saying to do that, but I’m saying we can make an argument for that based upon what some of this research is showing is that you’re going to impose on them a set of beliefs around whatever you’re doing. And if you give them, “SIBO, it’s a chronic condition. You’re going to have to be really serious. It’s going to be a long haul,” I would venture to guess if we had a study looking at that prognosis by the practitioner compared to a, “You know, SIBO…”

And this is actually what I tell patients because I actually believe this to be true in my own experience. “SIBO’s actually not as bad as it’s made out to be on the internet.” This is a conversation I have with patients all the time. I am probably inadvertently biasing them or placebo-ing them in a positive way.

DrMN: Of course.

DrBW: True.

DrMN: But your job is to get a result too. I’ve gotten this argument with researchers time and time again. It’s like would I as a practitioner bias someone into a placebo to enhance their response? My answer as a researcher would be no, I’m doing everything I possibly can to get rid of the placebo because I want to see if there’s a “true effect.”

As a clinician, yeah, I would do that all day, every day. And that really upsets people. But it’s a different outcome. In some way, I know I’m kind of doing it on purpose. But they’re paying for a result. As long as they’re getting the result in a safe and positive way, I’m ok with it.

DrMR: I use this example with gluten-digesting enzymes. I think most of the data on gluten-digesting enzymes is pretty weak.

DrBW: It’s horrible.

DrMR: I’m being kind.

DrBW: I’ve seen it. It’s horrible.

DrMR: I made the comment that, ok, this is an expensive placebo. This is not a placebo I can justify. Because if you’re taking a couple of those with every meal, every day for a month…

DrBW: That adds up.

DrMR: You could be +$150 a month easy. So in my mind, that’s not the best way to use a placebo because it’s harmful financially. But if we have a positive placebo where you’re giving a perhaps overly favorable prognosis or just an honestly optimistic prognosis, then you’re using the placebo effect in a responsible way, in my mind.

DrBW: I presented this other bit too, and I want to see where this fits into the placebo part. There was this really interesting paper. It’s called “Self-Rated Health.” And this is something that really spoke to me when I found this because the people that come to me, they don’t think they’re healthy. They feel like crap. They’re tired all the time and all these different things.

How to Speak to Patients

But what it found was—this is awesome stuff—is that somebody’s self-rated health had a stronger impact on mortality than the biomarkers that they were measuring, things like cholesterol and some of these other things. So then, if you look at it from a clinical perspective, you’re speaking about this fear-mongering, for example. Mike, you were talking about the placebo effect and the benefit in a positive placebo effect.

So then I’m inserting this in here because as a clinician I wonder if—like you’re talking about not fearing people, but saying, “Maybe your SIBO…” and empowering them is to help them think and realize that maybe they’re not as unhealthy as they think they are by listening, no offense to you, but all these podcasts that say, “Here’s what you should be doing.”

DrMR: Sure. Totally get it.

DrBW: “Here’s how healthy you should be.” Some of the podcasts—and again, I realize we’re on one right now—is basically like an intellectual Facebook in a sense where you hear all these healthy people and all these healthy things that you should be doing. And it’s kind of overwhelming. So they feel not healthy because they hear all these healthy things that they should be doing.

So I just wonder if as a clinician what we could be doing is showing people that maybe they’re actually healthier than they realize, like your mild SIBO is not a concern, like the example that you were using or like the placebo effect that you’re trying to use.

That paper I was referencing was actually—they looked at 27 other papers in sort of a systematic review. That was a greater predictor of mortality than were biomarkers that we’re measuring. And I think that that’s huge. And so, should we be running these markers and trying to fix them and trying to convince them that they’re sick or not sick? Or should we be trying to show them, “You know what…”

DrMR: Well, it makes me feel good about what I’ve been doing because I think I’ve been utilizing that principle unintentionally.

DrBW: Right. And I heard that. Yeah.

DrMR: As I have dove, diven… Getting kind of tired here.

DrBW: Dived in.

DrMR: Yeah, dived into the research, I’ve realized that a lot of these markers that people fret about are meaningless.

DrBW: Right.

DrMN: Yeah, really.

DrMR: People come in and they’re so afraid. And I go, “Listen. You don’t have to worry about that.”

DrBW: Totally.

DrMR: And I’m actually being evidence-based, but I think what that’s doing is it’s helping get people a higher level of self-perceived health.

DrBW: Like, “Oh, so I’m not going to die?”

DrMR: Yeah.

DrBW: “Oh, so I’m healthy? So what I’m doing is ok.” It is ok. You’re doing fine.

DrMR: It really turns a lot of the functional medicine model on its head. Some of it. But I do think that… And I was having this conversation with someone else, a guy from the UK. I forget his name now, but a sharp guy. And he was having the conversation about how he’s found that as he’s been in practice longer he’s doing less.

DrBW: That was Jaime. Yeah.

DrMR: Jaime. I wonder if, and I think, that the field of functional medicine is just like a new practitioner who’s now becoming more experienced and realizing they can do less testing but get better results. I think that’s where the field is going as the field matures.

DrBW: That’s totally the journey. I don’t know if you started out that way, but that’s the same journey.

DrMR: More testing to less testing?

DrBW: You learn about all these tests. You start running all these tests, and then you realize that it doesn’t necessarily change your protocols and what you do with somebody. So then you go back to just the basic tests and you really stop running all the tests because you find that they’re not validated. They’re not useful. It doesn’t change your protocol that much, so why spend $500 on the lab.

DrMR: Exactly.

DrMN: I think that principle applies to almost everything. So I think about how—you guys are doing exercise too—I cued people when I first started exercising. Oh my god, I want to like… It was horrible and atrocious. I would give them a five-minute lecture before I had them even squat. I was basically just verbally vomiting on them all the time.

But over time, you get less and less and less. And now it’s like, eh, couple words here and there while they’re doing it. Ok, here’s your explanation. Here’s your one thing to work on. And I keep thinking in my head, Ok, can I use less words and get the same result or better result?

And what I’ve found is less is actually more. So when I’m teaching students, I’m trying to get them to be like, ok, what is like the most important thing they need to hear right now. “Oh, this, this, and that.” No, no. You’ve got one thing. You can talk to them again later but trying to think that process through.

DrBW: Have your programs gotten easier too, like less complicated?

DrMN: The biggest complaint I get from clients is that… I literally had this complaint a couple of weeks ago. A client says, “Oh, I’m doing good. I’m losing weight. Everything feels good. Stress is much better. And my complaint is it feels too easy.” And I’m like, “Whoa, wait a minute. So you’re doing everything. You feel like you’re not doing quite enough. You’re getting the result you want, and it feels to easy. Why is that a bad thing? That’s kind of the goal, right?”

DrBW: Right.

DrMN: She’s like, “Well, it’s always felt really hard before.” I’m like, “Oh, it’s not supposed to be really hard. Yeah, some stuff will be hard.” But even just like periodization and all that, it’s like, “Yeah, just change the volume, add some density, move some stuff around.” They look at it and they go, “Oh, this is like really basic.” I’m like, “Yeah, it kind of is. Unique exercises different angles, that kind of stuff.”

DrBW: Basic’s good, man.

DrMN: You don’t need like the 17 ways to do the secret Russian bear periodization technique over the next four months.

DrBW: But I love that one.

DrMN: I know it’s your favorite but…

DrMR: I was laughing as you said it because it reminds me of a conversation I have so often in the clinic. And I share this. If any of my patients are listening, you’ll probably laugh when you hear it. And if you’re not a patient, I would offer this to you to help you on your own journey.

People want to get into all these details, and I’ve learned to just tell them, “I appreciate the questions you’re asking, and I’m not trying to dodge your questions. But let’s give this process a few weeks. And what I’m expecting to happen is a lot of your symptoms are going to go away. So you’re going to care a lot less about all these things.”

And I’ve learned that, A, a lot of those things don’t matter. “But what about leaky gut? But what about vinculin antibodies? And what about this?” “Listen. Let’s just get started with the process I know that works. We’ll personalize it to you along the way. And what’s probably going to happen is you’re going to feel a lot better, and you’re going to care about these things less.”

So I don’t engage in all those questions because we’re going down a rabbit hole of trying to convince them of how sick they are because of the pathway that they think they have wrong or just entertaining them in this overthinking about their health which they shouldn’t be. I think, by doing that, what you’re actually doing is you’re taking the worry off of them. And I tell patients, “Listen. I’ll worry on your behalf.”

DrBW: Nice.

DrMR: “I’ll worry on your behalf. Let me worry about everything. You just live your life and…”

DrBW: That’s great.

DrMR: And I think by doing that you take a lot off someone’s plate mentally which, as we’re discussing, sounds like it adds up in a multitude of ways.

DrBW: That’s what Ben, he has on his website. If you’re obsessing about your health, that’s not health. If you’re worrying about it, that’s not health. I love those “what about” questions.

DrMR: This is on Ben House’s website? Ben who?

DrBW: House. Yeah. His quote is “If you’re obsessing about health, then it’s not health.”

DrMR: I agree.

DrBW: I think that that’s true. And obsessing about health is doing what you just said is asking the “what abouts.” What about this supplement? Or what about this? What about this thing I read on this website? What about…? No, stop with the what abouts. It’s not what about this; it’s stop worrying.

DrMN: I have a little rule that with clients if it’s a question about specifically what they need to do, I’ll gladly answer it. If it’s another question, I’ll probably answer it, but you better keep doing what you’re supposed to be doing. The second you stop doing what you’re doing and start asking questions…

DrMR: Right. You’ll sabotage the process.

DrMN: You need to start doing again. Once you’ve been doing again, you can come back and ask more questions about that.

DrBW: A seasoned practitioner.

DrMN: Otherwise, they’ll get off this or that and they’re so far down in the rabbit hole in the woods. And I said, “How’d the training go yesterday?” “Oh, dude. I didn’t train.” I’m like, “Well, why didn’t you train?” “Oh, this or that and that came up.” Just they’re completely out in left field.

DrMR: Well said.

DrMN: It’s like, argh, reel the fish back in again.

DrMR: The way that I explain that to patients is right now we’re running a mini experiment. We’re asking your body this question, and we want to see how your body responds.

DrMN: Yes.

DrMR: If it’s a three-week experiment, if when you get a week in you read something on the internet and you question it and you stop the experiment and start doing something else, when you report back to me we’ve gotten nowhere. We’ve gotten no data. We haven’t answered the question.

So I understand it’s challenging because something seems compelling when you read it, but you’ve got to stay the course, answer the experiment, and we can use that data constructively going forward.

DrMN: And I’ll even tell clients the same thing that no one in their right mind’s going to give you the perfect training and nutrition program out of the gate. It’s not going to happen.

DrBW: True.

DrMN: And the stuff that I start with is kind of more basic because I know if this works, then you’re good. If that doesn’t work and you did it at 90% compliance and we know compliance is not the issue, then I automatically know what direction you need to go because we have the data. So you don’t have to worry if it doesn’t work for you. Most of the time it’s going to be pretty damn close.

But in the case that it’s not, you still made some progress. And now we know exactly what to do with you.

DrMR: With a good provider, they’re probably saying, if it doesn’t work I know the next thing that I do is either B or C.

DrMN: Right. Same thing.

DrMR: Exactly.

DrBW: Yeah, well said.

Episode Wrap-Up

DrMR: What do you think, guys? Is that a wrap?

DrMN: Yeah, that was good.

DrMR: About 47 minutes in.

DrBW: Yeah, man.

DrMN: Yeah, it was fun.

DrMR: Cool.

DrMN: Toad’s going to take you out.

DrMR: You guys want to tell people where they can track you guys down if they wanted to connect with you.

DrBW: Go for it.

DrMN: Yeah, this is Dr. Mike T. Nelson. You can just go to MikeTNelson.com. You can also find me on FlexDiet.com.

DrBW: This is Dr. Bryan Walsh. You just go to DrWalsh.com. That’ll be a good place to find me.

DrMR: All right, guys. Well, thanks a lot. Let’s get to bed and avoid toads.

DrMN: Yeah, thank you.

DrBW: Avoid the bugs.