Roadmaps for a long, happy life do not exist without three critical elements: Sex, stress reduction, and a regular mindfulness practice. So say Dr. Britney Blair, Co-Founder and Chief Science Officer of Lover, Dr. George Slavich, Professor, Psychiatry & Biobehavioral Sciences at the University of California, Los Angeles, and Dr. Elissa Epel, Vice Chair, Psychology Research and Community, Department of Psychiatry and Behavioral Sciences at the University of California, San Francisco, who spoke with Dr. Jack Kreindler, CEO of WellFounded, during the DOC 2025 session, “Sex, Stress and Social Nutrition: Get Your Groove On.”
Sex is a non-negotiable ingredient to longevity, according to Dr. Blair, who stumbled into an elective about sexual health in graduate school. With 20 percent of couples not having sex — one of the top three reasons they break up, she says — she believes sex returning to relationships is critical, not only for overall health, but to live longer. “Sex has been linked to decreased risk of anxiety, depression, and chronic disease. It improves our immune system, it’s a great form of exercise, so you live healthier,” she says.
Few would argue that reducing stress is also helpful in living a longer, healthier life. But Dr. George Slavich showed the extent a single ten-minute stressful experience can have on the body, from a systemic inflammatory response that continues — and increases — 65 minutes after the event, to a shift in how our genes react “toward greater inflammation that happens quickly and against reduction and antiviral immunity,” he says. “All these are a result of a ten-minute stressor.”
To Dr. Elissa Epel, however, much of our daily attempts to reduce chronic stress is going into energy for survival. Critical for longevity and to reduce aging is the work towards restoration from oxidative stress, and what she calls “growth maintenance repair,” with her studies looking at Wim Hof breathing, mindful meditation, and high-intensity interval training exercises, among other activities.
“If you have a mind body practice, you’re obviously devoting some gene expression toward more reparation, rejuvenation,” she says.
You can hear more from our compelling panelists on directions we can all take to bring more balance to our lives in our video, or read our lightly edited transcript.
TRANSCRIPT:
Dr. Jack Kreindler
Normally I spend my life in very extreme environments trying to learn what makes people survive and thrive. But I recall a couple of years ago, being at a so-called longevity medicine conference, and the final panel, I was great to be on the stage for, and the last question was amongst these great and the good of the so-called longevity doctor world.
What is your key secret to longevity and of course, there were the peptides and there were the exosomes, and there were the various stacks of, various molecules and things. And, I had a flash of inspiration when I said, well, I’m 50 next year, and I feel great. And I’ve been living on a strict diet of sex, drugs and rock and roll.
But the moment I turned 50, I won the full stack. There is a reason for this. And that is, in fact, that sex, drugs and rock and roll represent three areas which are very hard in our life. To actually inject or buy on Amazon, human contact. Intimate human contact, not necessarily sex itself, although Britney would probably argue otherwise, is extremely important for health and well-being.
The oxytocin pathways tell the cells in your body that they are loved, that you’re that you should be around in the tribe. Drugs, the drive to achieve things, meaningful work, the dopaminergic drive. It doesn’t need to be from cocaine. Not that dopaminergic drive, but finding meaning and purpose. It reminds us that we are useful to the tribe, and we all have anecdotes around people who keep going in order to get to the birthday, or the wedding, or the bar mitzvah or whatever it is.
But the ikigai is a very fundamental part of longevity, and rock and roll does not necessarily need to be, Eric Clapton, but some form of genre of music, dance, immersing yourself in nature. The psychedelic activities that we can partake in. That is the serotonergic pathway, which is very important to happiness. And we all know that people that are miserable either don’t live as long, or if they do, they’re bloody miserable to be around.
So sex, sex, drugs and rock and roll are, broadly speaking, the three categories that we’re going to be talking about today. Jordan’s already introduced the three folk. And as I think is probably appropriate under the Chatham House rules, let’s start with sex.
Dr. Britney Blair
All right. Sex, drugs and rock and roll is a good one to follow. Lunch. So you’re not fading off. Hopefully. Hopefully this will be interesting. So during my first year of graduate school at Stanford, I happened to stumble, literally happened to stumble on a workshop about sexual health. It was an elected. It was not required. During this workshop, I learned that 1 in 2 women and 1 in 3 men have a sexual problem.
My mind was blown. 20% of couples are non sexual, and this is in the top three reasons that people split up. That afternoon I learned all about treatment and how effective it is and I was like, “What in the world are we doing? Why aren’t we starting this conversation? We need to do something about this.” I knew in that moment I had a kind of road to Damascus moment of, this is going to be my life’s work.
Then fast forward to year three of grad school. I was asked to take a rotation in a sleep clinic. And I thought, sleep. Don’t you just put your head on a pillow, close your eyes and go to sleep. Turns out millions and millions of millions of people, suffer greatly from sleep problems. So I was hooked.
Treatments also very effective. I spent way too many years of training, to get boarded in both sleep and sexual medicine. Which brings us to today. This is a lightning talk. So we’re just going to stick to sex. When I talk about sex, I’m going to talk a little bit about sexual frequency, but also sexual satisfaction.
We’re going to do a real cursory run through here. We are saturated and inundated with sex in our media. 85% of movies, 70% of TV shows. A recent study, asking adolescents about sexual content in social media, 50% of them said all of the social media that they consume contained sexual content. So it is everywhere, all the time, and yet it’s still considered a taboo topic. So I said 1 in 2 women and 1 in 3 men. That’s 130 million people in the United States that have a sexual complaint or a sexual problem. How often are we talking about that? Never. The reasons for this are varied. We don’t have time to get into it. But there are less than a thousand board certified sex therapist in this country.
In the US, less than 25% of therapists, including couples therapist, get any training in sexual health. Just astonishing. Physicians aren’t much better. The average medical school 3 to 10 hours of sex education. And that includes contraception, STIs and reproductive health, which is why we see only 2% of medical charts. Your primary care office has anything to do with sexual health.
For only 40% or less than 40% of people talk about sex with their partner. Which is a problem given that every relationship we can’t say a whole lot of every and all, in the world of research. But this I can say with definitive certainty, every relationship at some point is going to have to navigate desire discrepancy. This is where one partner has a higher sexual desire than the other partner. For some relationships, this is stable. Over time, these roles higher desire, lower desire, for other relationships, it can flip and flop depending on stress and kids and all the things that life throws at us. But every relationship has to navigate this at some point. If we’re not talking about it. This lack of communication comes at our peril, right? Top three reasons that people split up.
And oftentimes with partners, oftentimes with the higher the higher sex drive partner, they may feel kind of unwanted insecure rejected. And your lowered is our partner may feel nagged or put upon or like something’s inherently wrong with them. And it’s a very difficult thing to navigate in relationship if we’re not having any communication about it. So sex actually is linked to not only health, but living longer.
A fascinating study published in 2020 looking at adults aged 20 to 59, over 12,000 adults, they found that sex twice weekly reduced your mortality risk by half and cut cancer risk by 69%. I promise I did not make that start up. And now is to twice per week compared to folks having sex once per month or less.
Right. So this before you say, well, there’s more frequent sex group there gets healthier. This was after controlling for all the big things that we look at. So smoking, alcohol, nutrition, exercise, heart health BMI. Yeah. The findings were still interestingly those the lower sex frequency, lower sexual frequency was related to all cause cardiovascular disease and all cause mortality. So there’s something going on here. We also will live healthier. Sex has been linked to decreased risk of anxiety, depression, chronic disease. It improves our immune system. It’s a great form of exercise. So you live healthier. In a recent study looking at sexual activity during Covid, they found that folks who were sexually active, nobody was very sexually active during Covid.That was a very unsexy time. But those who were sexually active were less likely to experience depression, anxiety, and stress.
Folks who were having sex regularly report overall higher quality of life and greater relationship satisfaction. We see this again and again, across many different studies. In fact, over 80% of people report that sexual satisfaction is crucial to the maintenance of a relationship. And that’s men and women.
So how do we solve the problem? First, we have to start the conversation. So there’s a popular model called the Implicit model. And without going into too much detail about that, it’s been studied since the 70s. And basically what they found is 80% of people report an improvement just with permission, having a conversation, limited information and specific suggestions. Only about 15% of people need intensive therapy. So when I was first coming out of fellowship, with sleep, fellowship and giving talks on sleep and talking about how important sleep was, it felt like at the time we had this kind of cultural mindset of, I’ll sleep when I’m dead. And I used to tell people it’s going to happen sooner rather than later with that mindset.
I don’t know about you guys, but it does feel like after the last decade, there’s been a real shift. We’re really talking about sleep more, reprioritizing it more. And so my hope is that we start to prioritize this aspect of our health. We have a market size of 130 million people. And I really feel like I hope that this is the next kind of frontier. Right.
Dr. Kreindler
Thank you. Really. Okay, so the next next up is, George, who is, an expert in what happens when the rock and roll is no longer there and there’s too much stress. Over to you, George.
Dr. George Slavich
I was told this was on stress, drugs and rock and roll, so I may be on the wrong side. Thank you so much. So I fully realized that I just have the privilege to spend eight minutes on the stage here with you and any one of you could be up here doing the same thing. So thank you for your time. I’m a clinical psychologist by training, and I’m primarily interested in how it is that experiences of stress get represented in the brain and how the brain then regulates peripheral physiology.
And I want to just share a few main messages about that. In the short time that I have here, there’s good news and bad news about why you’re going to die. The good news is that about 120 years ago, you’re much more likely to die from communicable diseases such as pneumonia and influenza. Those have gone down as environments around us have become more sanitary, as you all know.
But the downside is that we’re all much more likely to die of chronic diseases of aging that are driven by stress and stress related lifestyle factors that increase inflammation throughout the body, cause oxidative stress, and cause cells in our body and our organs to break down. Now, of course, it’s the case that a lot of lifestyle factors are contributing to these chronic diseases of aging, sleep, diet, physical activity, etc. but what I want to make the argument here is that stress is one of the biggest killers in the room, and unfortunately, the one that we wear is a badge of honor the most and therefore, pay the least attention to in clinical care. So adverse childhood experiences which you may have heard of are things like early life abuse, neglect, maltreatment in early life, divorce, unpredictable households. The data here are showing the association between experiencing four or more adverse childhood experiences relative to zero adverse childhood experiences, being implicated in the nine of the ten top leading causes of death in the United States today.
Just so you know, about 20% of individuals in the United States have four or more Aces, and about 62% of individuals in the United States have at least one ace. These are, very common experiences that we’re talking about. Increasing risk for heart disease, 2.1 fold, increase Alzheimer’s disease and memory impairment, 4.9. Kidney disease, 1.7. Chronic liver disease 2.4. So very strong associations between stress and nine of the ten leading causes of death in the United States today, if you look at stress, related proportional attributable fractions, namely the proportion of that, of those health problems attributable to stress, you see a very similar picture of 40% of cases of depression attributable to stress aces, 20% of cardiovascular disease.
The economic costs in California alone top $110 billion per year. In a recent health care, economic analysis, there are lots of different, types of stress, food insecurity, caregiving, stress, which Alissa studied for many years. Incarceration, isolation. I’m here to tell you just a few data points about the impact of social stressors like social evaluation, rejection and exclusion on the brain and the immune system to make the point that we should really, as a society, be focused on reducing sources of social stress and promoting so sources of social safety, belonging, connection and inclusion.
So how have we studied this in the lab? Well, all kinds of interesting ways. I’ll just give you one example of a study. Although we’ve done this with very different methods in this particular study we had 40 52 well-characterized adolescent females, 12 to 16 years old. Psychiatrically healthy. They come in for a first session where we interviewed them about their goals, plans and aspirations for the future, what they want to be when they bring up what their household is like, etc. we video record them and audio record them. We have that on video. Then we bring them into the next session, which is about one week later, which is an fMRI session. We introduce them to somebody else who they think is part of the study, but who’s actually a Confederate. We flipped the proverbial coin, and the participant is always the person who goes into the fMRI scanner.
Okay, what do they think is happening in that fMRI scanner? They believe they are led to believe that the person, the other person is part of the study is watching the video that we recorded of them, and judging how the participant is coming across and seeing in real time the evaluation of the other person, what they think the person is coming across in the interview.
If you’re the participant in this study, you put on fMRI safe goggles, you go into the fMRI scanner, and this is what you see through the fMRI safe goggles a matrix of words, all personal attributes, one third positive, one third negative and one third neutral, ostensibly relating to how the other person feels like you’re coming across.
One word is clicked on about every 10s so the other person thinks that you’re interesting. That’s great. But then of course, the other shoe always drops and the other person now thinks that you’re coming across as insecure. So they think that these, assessments are being done in real time. Actually, what we did was just pre-record a PowerPoint video.
Every participant has seen this video that is very believable. And it induces, a stress response, which I’ll show in a minute. Okay. What is that stress response. So we found that fMRI safe needles. We installed an in-dwelling catheter in the non-dominant arm and enables us to get, blood samples before, immediately after and 65 minutes after the stressor.
So this, for me, is one of the biggest AHA’s. Think for a moment in the past day or week or month, the number of times that you’ve been stressed out for only ten minutes, a ten minute stressor of social evaluation, laying flat on the scanner where you can’t run or go anywhere significantly induces a systemic inflammatory response, shown here, by three key inflammatory cytokines that initiate the inflammatory cascade interleukin one beta, interleukin six, and tumor necrosis factor alpha.
That’s the first ten minute stressor inducing a systemic inflammatory response. What’s the second one? 65 minute, 65 minutes after the stressor, the group average is still increasing. So in inducing a group wide inflammatory response that does not come down to baseline for most people, even 65 minutes after the onset of the stressor. If you look at the level of the human genome, you see very compelling results as well.
So we applied, a transcriptional wide, profiling. So this is looking at gene expression across 30,000 transcripts and a result of this ten minute social evaluation stressor leads that, greater than two fold change in more than 1500 genes. The main finding been significant increase in genes that support the inflammatory pathway and significant downregulation in gene sets that are involved in antiviral immunity.
So if you’ve ever been stressed out and you feel like you have pain sensitivity, and then 2 or 3 days later you get sick, this is the mechanistic basis for what’s happening, shift toward greater inflammation that happens quickly and against reduction and antiviral immunity. All these are all a result of a ten minute stressor. If you look into the brain, what are the sites, the primary brain sites of neural activity, you see this social pain, social evaluation, social rejection, stressor activity in the same neural regions in the human brain that would be activated if you expose somebody to physical pain.
If you put somebody in that fMRI scanner with a heat pad on their leg, you engage those Antilles anterior cingulate cortex, amygdala, bilateral and teller insula. If you socially reject them in the scanner, you get the same primary sites of neural activation and in fact, activity in those brain regions, when people are being rejected versus included strongly is a strong neural predictor of the extent to which they mount an inflammatory response to acute social stress.
We have a neural signature in the brain that can predict individual differences in peripheral inflammatory response to social stress. What’s the pivot here? Is any of this science being taught in medical schools. So we sought to do an analysis of that question. We asked U.S. News and World Report tell us the top 50 primary care-focused medical schools in the United States today.
We downloaded all course descriptions and course syllabi, and we looked for these keywords social determinants of health, health disparities, health equity, resilience, life stress, toxic stress, bio psychosocial biobehavioral. The results are dismal. So if you think that your kids are going to have primary care physicians that will be more knowledgeable around stress, health and resilience than your than were own providers, we’re going to fall short.
We need much more education in around stress, health and resilience. In medical school education than we have today. I have 30s left, five seconds left, ten year mission number one, teach the science of stress, health and resilience to every interested health care provider in the world. Number two, embed psychosocial resilience training in every interested campus company and community in the world. And number three, launch an institute to transform the science of resilience into new programs, products, partnerships and possibilities. And guess what? We have a site for that. This is a 130 acre site that’s 12 minutes from the Presidio in San Francisco, a short, jaunt down the road here, in strawberry. We have 200,000ft² that will be devoted just to social health and resilience, a lot of capacity here.
We’re just starting a welcome center that been developed. 40 faculty offices, 27 classrooms, a culinary center, art and events center, all to basically give a brick and mortar location for social health and resilience that really deserves. You can think of this should be if we can create it, if the people in this room can stand this up, a, MIT or a, a Caltech for Social Health and Resilience, let’s do it.
So if you if you are a scientist or an educator, a creative, a culinary expert, a health care provider, a strategic partner, a philanthropist, or a good human being, come and change the world. Let’s figure how to do it together.
Dr. Kreindler
Thank you George. And next up, Elissa. Thank you.
Dr. Elissa Epel
Okay, a little height adjustment. Thank you. Brian. George. It’s very exciting. I’m going to touch upon solutogenesis mechanisms healing. But first we have to go to the dark side and talk about stress. I am excited to share what I think is really the edge of the next generation of understanding the fundamental basis of not just disease, but also healing and, healthy longevity. And that is energy, energy, science, energy, bioenergetics and mitochondria. So that will be a theme. Let me just start by asking, you to think back to a typical work week. Work day, busy and, high paced. How much energy do you have at the end of the day? How tired do you feel at the end of the day?
If you feel the impact, raise your hand. If you feel like you want to lie down, that might be some of us. You don’t have to raise your hand, but you might have even experienced like hitting the wall, feeling exhaustion. That’s clearly energy imbalance. We need to make more mitochondria than we are burning. When we don’t, we become, under a state of mitochondrial stress and strain. That creates cytokines, inflammation like GDF 15. The basis of healing in every cell is, of course, the energy source of mitochondria. So what does feeling tired, exhausted have to do with healthy longevity or healthspan? This is also a result of chronic stress.
I don’t have time to go into the spiritual crisis, but I believe that we are in an intersection of a spiritual crisis, a bio energetic crisis, and the health endemic that we all know well. The interrelated set of chronic diseases and mental, conditions that that arise together. So I’m going to just address how has stress changed now?
What is the energetic cost of different types of stress if they’re really different? And can we reverse stress effects through manipulating allostatic states to extremes to very high and to very low? What do I mean by that? Mounting a stress response. All we have to do is create stress, but it happens at every single level within the cell.
Within our systems, within our psychological perceptions. And we can harness that stress and use this for healthy longevity. And of course, the question has been, why don’t we do it? Exercise as an example. We know that’s a positive for stress. That’s a discussion I hope that we’ll have. Here’s just a sampling of stress is a bit different these days. We have, for example, technology stress information onslaught, cognitive load. We have existential stress from the ecological crisis that often comes along with, lack and purpose and meaning, moral distress from being part of or seeing our values violated. Uncertainty stress, which I will say that we all we’re in the matrix of uncertainty, stress with change, with political change, etc. all on top of the usual personal daily drama that humans have always had financial survival, self-care, relationships, social stress.
It’s a lot what we do know from several decades of research is that chronic stress accelerates the hallmarks of aging biological aging at the cellular level, as does depression. You see inflammation, epigenetic clocks and telomeres, the protective caps at the ends of chromosomes. What’s new here is that we also now have shown in humans that might that chronic stress impairs mitochondrial enzymes. Let me just show you an example of this study. This is in collaboration with Martin Picard, the, mitochondrial psychobiologist. We’ve been studying caregivers and have shown several years ago that chronic stress impairs the bioenergetics capacity of mitochondria to such an extent that some of our participants under chronic stress looked as impaired as people with mitochondrial disorders.
If you’re wondering if chronic stress should be on the map for what you address for medical education, is it clinically significant enough? I think of it as an umbrella that is, of course, affecting mental health. We know that it affects physical health, but it also shapes every health behavior. We have sleep, etc.. So in this diagram, you can see we’ve followed people longitudinally and have found that not just that chronic stress is related to illness. Shortening a signature effect. I wrote a book about that with, Nobel laureate Liz Blackburn. Dean Ornish is going to talk about some of that telomere work, but that this is through a pathway. We think of mitochondrial impairment. Starting off, if you have poor capacity, you’re more likely to have dampened telomerase, the protective enzyme, and rapid telomere shortening over the next year.
Sex probably takes a lot of energy stress probably takes more energy over a day than anything else we do. Especially if we’re kind of having chronic, vague, pervasive uncertainty stress. So we all know what that looks like when we, you know, we take care of our phone pretty well. But by the end of the day, if we feel like that, we really haven’t recharged and it’s really not hi tech, I’m going to talk about lying down and rest.
It’s very low tech and we know what it does to our stress and immune gene expression. It absolutely slows it down and amps up all of the gene expression for repair for maintenance. We call this set of genes growth maintenance and repair. And so typically we’re going to put energy into survival stress. A lot of ATP is going to go toward that.
We have our basic vital functions. And then maybe if we’re lucky we get that much growth maintenance repair. When we think about aging, the daily damage that we need to repair from oxidative stress, we must have that daily repair. That is what is going to slow aging. So if someone is under chronic stress, they’re using their limited energy budget for survival, less for maintenance and repair.
And then here’s what’s interesting. Here’s what I want to pay attention to is that big blue box. Where is that in your day? How much time are you spending in true relaxation or restoration or how many times a week? So if you have a mind body practice, you’re obviously, devoting some gene expression toward more toward reparation, rejuvenation.
But also when we have acute or positive stress, we are turning on recovery and repair during that period. So there are several ways to turn on GMR. I like to think of how we want to not live in that subtle, pervasive chronic stress mode where our battery is leaky, the yellow mind state. But we want to be living in our allostatic extremes that is, acute bursts of controllable, healthy stress and recovery, or more green and blue mind states, relaxation or deep rest.
I actually lead retreats called Deep Rest where people have new experiences relaxing like they didn’t know they could, and resetting. And I also use, unnamed biosensor rings that help us understand how much people are responding to our different interventions. And we have really been interested in what is the different biological mechanisms to inform stress and deep rest.
We’ve been doing some studies on this with my colleagues, Wendy Mendez, Eric Prather and other colleagues. And we’re testing high arousal like HIT, high intensity interval training, Wim Hof breathing versus the restorative activities, slow breathing, which changes everything within seconds. And as well as mindfulness meditation. I heard someone say earlier, that we all know that lifestyle doesn’t change. I don’t think you were saying we should give up, but, I will say that, we need to talk about this because you can change stress within minutes. And we have many validated ways to do that. We also can do better at lifestyle change. We know that it changes.
So what did we find? We’re starting to publish some of our findings. All of these interventions improve vitality and, reduce depression equally, pretty much a big chunk. If you’re going to spend ten minutes a day on these within three weeks, you might have a reduction of almost 20% in depressive symptoms if you do it right. This is all about adherence.
In our well-controlled studies, we get phenomenal adherence because we’re texting them every day. We know, with time stamps if they’re doing their practices. So we believe that these are working through very different systems. We can move people in these allostatic systems. And that is the extent of allostatic change is related to the extent of recovery from depression.
I have, of course, after hearing Brit have to show you that we also have, looked at chronic stress at sex as a buffer to chronic stress effects. We find that sexually active couples have longer telomeres. They also have less of the pre-diabetes that we tend to see with caregiving. So we know that some cellular sources of exhaustion, inflammation, mitochondrial, depletion, we also know how to create vitality. We have control. And the question is really how can we use technology. And, you know, not just individual interventions but more social environmental interventions to really increase our health span. And I’ll end with that. And, I have free chapters of both Telomere Effect and Stress Perception on my website, right there. And feel free to join me in a few weeks lying down and learning some some new allostatic states.
Dr. Kreindler
Thank you. Fabulous. Before putting out to, the crowd, I’ve got a couple. I’ve got a couple of questions. Why is it worth us studying all this? If we know that this really intuitively without the science, we know this is damaging us. Stress. Why bother studying it so deeply with so much money after so many years? If society just isn’t prepared to do anything about it?
I’m going to put this to George, by the way, these questions are slightly planted because I did ask everyone what’s the what? The question you really don’t want to be asked.
Dr. Slavich
I will say that the question for all of us is to stress confer more of an advantage or disadvantage. In an exciting place like the Bay Area or maybe another major metropolitan areas, pre-pandemic people were very happy to run themselves ragged, and it felt like there was more upside than downside.
I feel like there has been a cultural awakening. At least there was right after the pandemic, where many of us who otherwise were thriving felt it sometimes difficult to just get through daily tasks. And I feel like we’re now getting back to the point where we are willing to run our lives at all costs and defer the problems down the line again.
That’s very much, I think, a cultural conversation in a lot of other countries, European countries are willing to have prioritized their health, immediate health, much more on the balance and engage in deep rest as a daily practice. We were also, I just a few minutes ago when the pandemic made it much more difficult to function. But I think it’s a matter of cultural will.
Dr. Kreindler
We’re getting there perhaps.
Dr. Slavich
I would say that if our health care providers are not asking about stress in the clinic, they should be the first ones, I think, to put that on the map. So we need we need stakeholders to talk about it in a serious way, including our own providers.
Dr. Kreindler
How good are we as a profession? I mean, we talk about stress with physicians. We know how bad it is, but we don’t exactly walk the talk. This is seems to be a major issue, I think. I can’t think of a single successful medical practice that doesn’t operate in the red line of bioenergetics deficit. Elisa, what can we do to increase the power of the light side in medicine, in our interactions with our colleagues?
Dr. Epel
Do you have to start a concierge practice to feel some relief? This question of, well, first of all, yes, it is true that everyone here most likely suffers to some extent with imbalance of giving, striving, trying. There’s also there’s also different stages of life. And so I really have someone who just assumes everyone’s under stress. It’s really not true that it’s everyone. There are very, wise and generative stages of life that might develop in our later years. Don’t wait until then. I mean, it’s such a sad when then you also try to regain your health when it’s too late. Some of the wisdom that comes with that is that you shift your priorities and you are prioritizing the richness of life, relationships and what we call in, expansive emotions.
We can talk about stress and disease all day. But once we can minimize stress and allow ourselves to get out of this threat, mind state, this hostage brain, we open up a way of being that is really what life’s all about, which is joy, connection. Compassion is like, those are just purpose. Those are just two rare in extended states. We all experience them for little bits here and there, but we can actually live more that way. One of the things that we’re doing in with young adults is actually talking to them in this. I run a class at all ten UC systems. That is about purpose, that is asking them how they want to spend their life.
Yes, there is, ecological crisis and other crises, but that this is really up to them to feel empowered and live the way they want and actually working together, they can have a more meaningful and purposeful life. Every one of you have probably done that in some way. But there’s no map for it. And our youth are really quite lost right now. That’s part of our spiritual crisis.
Dr. Kreindler
Britney, every year we get an appraisal, in the British medical system, they ask you about well-being, and they ask you about things like, how are you getting enough sleep? You know what my next question is going to be? I very much doubt that we’re close to my appraiser asking me, am I getting enough sex?
But it does seem to be something which is very important. You mentioned that the desire discrepancy is one of the biggest causes of breakup problems. Does that increase or decrease over time in a relationship? And if it does increase overall and it is increasing in society, why aren’t we talking about it more?
Dr. Blair
Don’t get me started on the last part. Well, we’re not talking about this. It all just blows my mind on the daily. So I don’t know why we’re not talking about it. I have a lot of theories, some data. I think desire discrepancy is a tricky one. I think in our society, people choose, most people choose, monogamy, the dynamic of their relationship for many really valid reasons.
That’s not necessarily our natural human state. So unfortunately, because we don’t have the communication, I think that people expect sexual desire just to be the same kind of lusty feeling you felt the first few months you were going out with your partner for six months, or, if you’re really lucky, the first year or two. In the reality is, for all humans, men and women, that just changes for the vast majority of us, that spontaneous, kind of lusty, feeling for our partner goes away. It’s often replaced by a responsive desire. So the sexual desire is still there. We’re still sexual beings. It’s just that we’re not, hardwired. We are hardwired for novelty. In the absence of novelty, I think we have to accept that a lot of times it’s responsive desires, agreeing to prioritize this aspect of your health, just like you do exercise.
To me it’s more fun and it’s a 2 in 1. It’s also exercise. And you prioritize sleep. You know, you prioritize your diet. I mean, everyone in this room, we’re health nuts and we care a lot about these things. Why? This is the one aspect of our health that we’re not prioritizing is, baffling to me. I hope to change that.
Dr. Kreindler
That is your life mission. Okay, let’s take it to the floor. Mr. Verdin, professor Eric Verdin, I just got to go to the, You’ve got to go there. Might you’ve got to do some exercise. Yeah, it’s good for your pelvic floor. Eric.
Dr. Verdin
Thanks for this, incredible panel. I just wanted to ask you a question regarding the stress in the context of longevity. Space, quite often is is talked about in at the same time as home basis. That is a series of, external modification that induce a perturbation in the system, which, tends to homeostasis, can change and actually elicit a response, which actually makes you stronger once the same stress comes back and we think about this in terms of fasting, in terms of exercise, in terms of a whole series of modifications. I was wondering this. The same thing happened in terms of and here we heard mostly about sort of social stress and, psychological stress. Is there such a thing? So the stress and or misses is thought to be one of the mechanisms by which many interventions that we use in aging space cold plunge. So all of this. There’s the same thing happens in terms of psychological stress. And along with this, my understanding is also stress is a highly subjective variable. That is, you can be the CEO of an enterprise with 40,000 employees and actually function at a high level and not be stressed. Or you could be working with an abusive boss and actually be extremely stressed. How could you merge these two questions in terms of our medical stress question?
Dr. Epel
Because, I was under time stress, so I didn’t get to actually label what we were studying, but we are trying to study different forms of mimetic stress. The short term physiological stress to our body, repeated manageable is probably the most accessible way to reduce stress for most people. We try head down, top down. We try sitting meditation. It’s all good. But if you, without much training, people can reduce stress quite quickly with more medic stressors. We are testing in this, stress incubator, the Wim Hof. Breathing is a form of emetic stress. It’s breath holding, hyperventilation, breath holding. And also some there’s some, deep rest to it to at least the way I do it.
So this has been studied many times and can promote an anti-inflammatory state. And that’s what we have found with our gene expression data that we’ve been analyzing, that this, three weeks of this breathing can trigger a reduction in NF kappa B and an increase in half, as you would expect, because there is hypoxic stress every day.
We’ve studied cold exposure. We’re now going to combine more the hypothermia and the cold exposure. We know we need both, right. We need, not just different types of stress, but we also need both the depressed and the hermetic short term stressors. So I’m interested in any suggestions for what we study in our stress incubator. We’re just so lucky to be able to study stress resilience really up close. So we stress people out before and at the end. Peak recovery. And looking both at blood as well as the nervous system with biosensor rings, etc.. So we’re all set to look at new hermetic stressors. I am always on the lookout. Besides, you know, temperature, breathing, the caloric restriction, of course, is, a whole other field come driving some people to the South Pole with me.
Dr. Kreindler
That was you usually get quite a big hormone extraction. In fact, we did we did find in that research that, despite the extreme physiological and psychological stress, the people who had the shortest spikes in stress hormones were the ones that were talking to each other a lot, which is interesting. They weren’t having sex.
Dr. Epel
That’s amazing. That’s super interesting. So before I forget, please join me tomorrow morning at seven for Wim Hof breathing. If you’re interested, we’re going to practice it in the Barrel Room.
Dr. Kreindler
Okay. We got it seven or something. We got time for an extra. We got a couple here
Question from Audience
Thank you. Rob Saper, Cleveland Clinic. This question for you in a wellness long gravity or primary care clinical context, what is the best way, either in history taking or instruments to ask someone about their sexual satisfaction?
Dr. Blair
I think doing just that. Any concerns about your sex life, what we find in there in the data, like overwhelmingly patients want us to ask overwhelmingly, and clinicians often don’t ask because they’re afraid they’re going to embarrass the patient. We ask about everything. Why are we not asking you about this? And I think what you’ll find is that the fellows I’ve trained is oftentimes people won’t say anything initially, and then they’ll come back for a follow up visit. I’ll be like, so you know, and if I had a nickel for everyone who made an appointment with me under the guise of sleep, and then I know within like a minute and a half. What do we what are we going to talk about? Because you’re not here for sleep. So I think it’s just a matter of starting the conversation and raising awareness.
Dr. Kreindler
Thank you. Quick. We’re going to be quick questions and quick answers now because there’s a lot of people standing, not a lot of time.
Question from Audience
Hi. I’m AJ I’m an internal medicine physician. I think a lot about that tactical part of how to reduce stress with my patients. I think about kind of daily things you can do, whether it’s laying down weekly or whether it’s meditative psychotherapy. And then there’s kind of bursts of energy, like you said, a retreat. I am wondering if you have any thoughts on how the what the right balance of those is or are there there are there some that we think is more effective than others, or is it, you know, patient and kind of phenotype dependent?
Dr. Slavich
I’ll just say there really quickly, there are multiple pathways for stress reduction. There is cognitive behavioral therapy, cognitive restructuring. You know, oftentimes especially when we’re emotional, we have appraisals that are more negative than what’s warranted based on the evidence. That’s one pathway. There’s mindfulness meditation, which, if we’re anxious, we may have neurotic or negative thoughts about the future or the past, even though the present is fine. So mindfulness meditation has a way of bringing us to the present, where we’re not ruminating or separating about those negative things. There’s also my mindset interventions that basically research by Allie Crum at Stanford and others have shown that if you go into a stressful situation and you view it as a challenge to overcome rather than as a barrier to success, your physiology is completely different.
Learning how to come into challenge to stressful situations, to do your best to practice what you’ve learned can also have a huge, physiological benefit.
Dr. Blair
Masturbation. Yep. Solo or partner sex is a great stress reliever and fun.
Dr. Kreindler
There you have it. We’ve got time for probably, quickly, 2 to 3. Let’s see if we can get through them.
Question from Audience
Hi, I’m David Spiegel from Stanford. Thanks for these three terrific talks. I’m trying to find common ground among rather diverse, means of handling stress. And it strikes me, given what you talked about in terms of, you know, adverse childhood experiences, that the real dimension, as I think of it, is, is helplessness versus control versus, having the ability to manage your body, your body’s response to whatever the stressors are. It’s helplessness versus agency. And I wonder if you could comment on that from the perspective of your different recommendations for stress management.
Dr. Epel
David, thank you for bringing up that absolutely fundamental conceptual basis of stress. It’s so important to feel you have some control or if you don’t have control, to completely give up control and try to, you know, work on more acceptance based strategies. Just down to the fundamental neuroscience of how emotions are made, it’s very empowering to recognize and realize that it’s our interpretation that is going to make something traumatic or not. You can develop a trauma response to a childhood adversity. Later when you hear that it’s traumatic and you hear that you should be that you were violated when maybe you didn’t have that appraisal of it at all. So it’s very much, socially constructed and based on our, our meaning and interpretation.
I want to, you know, in terms of diversity of stressors, stress reduction, using the body in a controllable way. So when you’re trying cold exposure or trying to relax into it and know that you control the actual seconds or minutes, and so that you’re not also triggering psychological stress of, cortisol. And ideas of this is bad for me rather than my body loves this.
Dr. Slavich
I have a strong feeling about this. We developed something called Social Safety theory. And we basically asked the question, what does cytokines care about in the environment? I think cytokines care about the potential presence of physical danger, because if you have physical danger in the environment, then you may have physical wounding to the body. So there’s an advantage to the immune system mounting a prepotent response of cell mobilization in advance of physical wounding naturally occurring.
The most effective way to do that is for the brain to scan the social environment for cues of potential threat and to mount that pre potent, immunological response before physical wounding actually occurs, so that immune cells are already in the compartments and they can accelerate wound healing and recovery. So I think that’s why social exclusion and rejection and conflict are particularly deleterious.Things like intimacy and social connection are particularly beneficial.
Dr. Kreindler
Britney, any anything to add? We probably run out of time. Otherwise you get the final word.
Dr. Blair
I get the final word. Just having the conversation, I kind of go back to whatever it is, right? Whether you’re having a stress trigger, I feel like there’s so much that we kind of keep held inside. I think there’s a toxicity to that. So I think being able to kind of, I don’t know, turn outward.
Dr. Kreindler
Before my telomeres for shorten, I am going to turn the stress of the clock there. I’m just going to say, amongst all of the brilliant science and the biology and, the molecular pathways and the genes that we will hear about. Please, please don’t forget about the longevity that you gain and the health that you gain from meaningful connection, from reducing stress in yourself and in your work, in losing yourself in nature, in music and in other things. The sex, drugs, rock and roll, the oxytocin, the dopamine, the serotonin. Not things that you can buy from a longevity doctor.
So please remember that amongst all the other secrets to longevity, please join me in thanking Britney and George and Elissa. Thank you very, very much.