Hello friends and a very warm welcome to transform express with Dr. Ash. Are you ready to turn stress into your comfort? First third year now, Dr. Ash has worked in education across three continents. India, United Kingdom, and the United States. Each week at the first hand how stress can impact our health or happiness. But here's the excitement. It's here to help you transform your stress into a powerful tool for growth and mobility. Each week, it'll share practical tools and life-changing insights from people, including the boiling frog, to help you manage your stress, find balance, and live a life of purpose. Please join us every Friday at 5 p.m. and let's start turning stress into strength together. Now let's dive into today's episode.
SPEAKER_02Hi, welcome to the Transforming Stress with Dr. Ash podcast. And today I am really delighted to welcome Dr. Adrian Udem. Dr. Adrian Udem is an internal medicine physician and an obesity expert in California, USA. Dr. Udem is an expert, also an expert in mind-body medicine. And I read her book Hungry for More, and it really deeply resonated with me. And Dr. Yodim, thank you so much for joining us today, giving us your valuable time. This is a very common uh scenario we see in our patients, but not only in our patients. I see as healthcare professionals, we have always struggled with food and comfort eating. So I'm very grateful for you to join us. Welcome. Welcome to the Transforming Stress Dr. Ash. Thank you.
SPEAKER_01It's really a pleasure and lovely to be with you.
SPEAKER_02So I would uh start um asking you the question that what was your own personal journey with food and what brought you here with the amazing uh remarkable work you have done in this field?
SPEAKER_01You know, um culturally, food is very much a part of uh my culture and my background. And uh as we had discussed before the recording, uh it is part of celebrations, it is part of sadness, you know, uh even in funerals and the the Shiva that we have a week of mourning, uh how we feed the guests is so much a part of the experience. And you know, there's a different cultural aspect to food in the United States and a different uh environmental aspect as well. And so I think it's very easy to start to view food as not only fuel but comfort, uh, connection, love. Um, you may, you may, it may resonate with you that I had a grandmother whose form of expressing love was by ensuring that we cleaned our plate, you know, and that she fed us to the maximum capacity. And food, of course, also has this very uh physiologic effect on the body, particularly palatable foods, because it does release dopamine, because it does give a feeling of um not only comfort but also pleasure. And so growing up, I think that these messages uh and these factors kind of got mixed up in my head in terms of how and when to use food. And I really struggled for much of my childhood uh until I became a young adult and I was able to start to discern these things. You know, how is food fuel? How is food health? But also um it also is cultural comfort, connection, and all those other things that we discussed.
SPEAKER_02Yes. Uh Dr. Adrian, um like you mentioned about your culture, coming from an Indian culture, food is very deeply linked. Birth, death, marriages, divorce, uh, any kind of event, and you know we have a lot of festivals as well. So you are fed, and sometimes you're fed till you die. I'm just joking. That's my highest sense of humor. So there's a culture of making people eat food, and sometimes it's not the healthiest food because it's a very carb-rich food. Now, the other context is healthcare. Being uh been in the healthcare now for 30 plus years and uh practicing internal medicine physician. I've seen our healthcare professionals once many times they would eat unhealthy food, food which are rich in carbs, and always they're in a rush. Because we we even starting from the residency and then continuing um our busy lives, we are always seems to be in a rush. So those two different contexts are very huge, and there's another context because of this. If you ask me what my number one stress response or coping strategy when I'm dealing with any challenge, I would tell you number one, number two, and number three are all linked to food. So it's that that deeply that that that deeply ingrained in United States, all over the world, Asia, Middle East, we see that obesity is a pandemic. Obesity-related diseases, diabetes, type 2 diabetes, cardiovascular, cerebrovascular disease are all linked to this. So, where do we start? And I really like your approach. Uh uh really uh reading your book, Hunger for More. So I really want your um want your insights to the listeners that where do we start this?
SPEAKER_01I don't think that the carbohydrates is in of itself problematic. Because to your point, this is uh, you know, it is part of the main staple of food uh in many cultures, in many places in the world. And 20, 30 years ago, these cultures uh and these communities didn't suffer from obesity because the food actually took a special place and time. There is something sacred about eating. Families would pause, they would sit at the table, they would make time not only for the consumption, but also for the preparation of food. Now, fast forward to present day, as you mentioned, time is a critical factor because when we try and find the fastest, most satiating food, and it is consumed in a way that is not mindful, then we are not able to follow our hunger cues. We are not able to give the time and the attention necessary to make the correct choices. And so the time scarcity, I think, becomes a significant point at which that relationship with food breaks down. Now, add on top of that an increasingly stressed environment, whether that is familial situations, uh complicated work situations, political turmoil, uh financial uncertainty, all of these things that we are experiencing at what it seems an escalating rate. I mean, I know that my family who had to leave Iran, um, undoubtedly they were in a stressed state, right? But it feels as though right now our stressors are kind of uh compounding one on top of the other, which takes even more away from that mindfulness, that awareness of how we are using food. And I think it's kind of this conglomerate of issues uh that makes food a prime way in which we use it to our detriment as opposed to using it as a nutrient. And I mean nutrition not only in terms of food nutrition, but how we are using food to nourish ourselves when it comes to being with family, when it comes to being with community. These things don't have to be mutually exclusive. We can see food as a uh way of connecting with each other and yet not use it as an emotional tool.
SPEAKER_02Yes, absolutely, but yet what is happening now in the cultures, now even in the restaurants, when you see people will be on their mobile phones, and even in families, uh they are distracted when they are when they are eating. Something as fundamental as that has been so much affected. And we used to read when we studied physiology that how the entire system works, right? From the time when you think about food and uh you start with taking the ingest taking the food, the saliva is coming, then the gastric uses, the whole body is ready for holistic processing of the entire process, but because of our busyness distractability, it has been so much affected. One of my friends, he is a consultant gastroenterologist, and he says in his clinic, in his gastroenterology clinic, eighty percent of the patients are with irritable bowel syndrome. And that is uh evidence that how the stress affects the entire entire gut. Now, Dr. Adrian, I wanted to ask you something. I was reading your book, uh Hunger for More, and it was one thing I really resonated, and I found it very deeply striking that it's not just only the physical hunger, it's mainly emotional hunger, spiritual hunger. So definitely would like you to speak on that, because that is that is where I believe the root cause. And unless and until one works on the root cause, you can do anything. You're not going to go very far. What do you, first of all, would you agree with what I'm saying?
SPEAKER_01There's actually physiology, uh, biology, and neurochemistry to support that. So our hunger is managed by a whole host of hormones that are released by the gut, released by fat cells, uh, short and long-term satiety signals that inform the brain of our hunger or our satiety. And we know that when people experience stress, when they experience difficult emotions, that those hunger hormones will go up. Ghrelin, for example, which is a hormone that's released by the stomach, will go up in times of distress even when we have been fed. So there is a very clear and concrete correlation between stress, distress, and a physical hunger, a physical signal to consume food. And I have found in my work nearly 20 years with patients that that um emotional drive or that distress oftentimes comes from an unmet or unrecognized spiritual need. When we neglect our basic psychological needs, it causes a distress, a discomfort that we then go and soothe with either food or drinking, smoking, overworking. These are all the same. The difference is that some of these coping mechanisms are more socially accepted, right? An overworker or a people pleaser is not going to get um, no one is gonna say no, right? No one is going to um perhaps shame that individual. But of course, when it comes to food or alcohol, it's a maladaptive process, not only physically and physiologically, but also culturally. At the root of it, though, it is the same, the same hunger. And so in my book, Hungry for More, uh, I go through maybe 30 emotional or spiritual hungers. I talk about the stories and the science behind how these spiritual hungers then uh prompt us to soothe with food. And they are things like uh a hunger for self-love, for self-compassion, for autonomy, for boundaries. And when these needs, these essential needs go unmet, then we turn to food to soothe. You mentioned earlier uh physicians, um, high achieving professionals are set up for this because on so many levels they are working towards achievement, working towards success. They're highly driven towards that. And in that striving for success, we tend to neglect our personal mental, emotional needs, and that will work to a certain extent. But at some point, that hunger is going to want to be met, it is going to want to be addressed with something that is actually scratching the itch, with a solution that is actually addressing the underlying hunger, the root cause, as you say.
SPEAKER_02So the underlying unmet needs it is important that we have we reflect about what I mean, first we diagnose that the overeating, whether it is comfort eating, whether it is overweight, whether it is obesity, it is important to have a more holistic, comprehensive approach. And that is the only way that we can have any long-term solutions and strategy, I would say, rather rather strategy which is sustainable. So I read in your um or heard on your podcast about the fuel approach. So tell us the about the acronym FUELEL and how how now we have made the diagnosis, now we realize that okay, I'm in a situation which is not fulfilling my needs, I'm at a workplace which is not I'm not living to my highest values, or I have some relationships which are not serving me, I make that diagnosis. Now, what framework or strategy we should follow to manage this problem?
SPEAKER_01Right, and I just want to make the point that this is a universal hunger is universal. Whether individuals are overweight or not, we all as humans experience emotional, spiritual hungers, and so you don't have to be overweight in order to pause to have that reflection, to have that awareness, to try and discern what direction is my life going in, and where are those places in which I could address a need that is not being fulfilled. And so, yes, I have created this acronym FUEL. So FUEL stands for F for nourishing food, U for uh unwinding with uh movement and rest, E engaging with nature, and L is to lean into contemplation or contemplative practices. And if we can start with that last one, the contemplative practices, I think that really is the starting point. Because if I'm telling you that uh distress or stress literally will cause rise to hunger hormones and that you feel a physiologic response or physiologic drive to eat when you're under distress, the question then becomes: how are we to discern this physical sensation from emotional hunger, right? Uh, if they are manifesting in the same way physiologically. And so it does require us to pause to create space between the trigger, which is that desire to consume, and the response, which is that habitual, you know, grabbing of whatever it is that we are consuming. Finding that pause in between the trigger and the response is the way in which we can discern what is it that's going on right now? What is it that I am truly hungry for? And I'll hear very common anecdotes from my patients. For example, uh individual comes to sit at her his or her desk, has already consumed food, and finds herself wanting to head into the pantry. It can be something as trivial as clutter in the office. You know, having clutter around you, it's distressing. Uh, you don't know where to start, or you don't want to deal with it. And so an escape for that is to get up and go and distract yourself with food. Or you've been at your desk for an entire day, you haven't gotten up to breathe the fresh air, or give yourself respite, or connect with another human being. And these are the hungers that then make you want to consume food. Or it's the end of the night and you're in bed and you feel like you want to go down to the kitchen and grab something, even though you've had dinner. What is going on in that moment? Maybe it is hunger for connection. You see your partner sleeping next to you, and it dawns on you that you haven't spent any meaningful time connecting with that person. Or it can be something very concrete like hunger for sleep. You're on the TV or on your phone when you really should be going to bed. And in fact, we know that sleep deprivation, as little as two nights of sleep deprivation, increases hunger hormones, increases the desire for highly palatable foods, and also increases insulin resistance. So these things are very much intertwined, and sometimes they can be really significant spiritual or emotional needs, or they can be seemingly trivial physiological needs, like the need for sleep that is going unmet.
SPEAKER_02Very true. And earlier, what you mentioned stressors, like micro-stressors in the environment. So hunger is giving you a cue that there is some level of misalignment somewhere. And I really like that in the in the fuel, the last thing is is leaning into your own awareness is a starting point, is like what's what's going on here. That I've just had my dinner and a big dinner, and one hour one hour later, I'm revisiting the refrigerator to check in. So, what's going on? No, very, very insightful and painfully true at at many times, I I would say. So thank you for sharing uh those amazing insights, Dr. Adrian. Now, one thing we are seeing very commonly these days, you know, we are in a fast fix, quick fix culture these days. Uh, no wonder the start smartphones are making us dumb. That I'm hearing a lot of people you patients using Ozempic, patients asking for OZIMPIC, and a lot of colleagues I I I'm seeing now uh using it uh if they are overweight. So definitely I want to ask from the expert is what uh what are your views about OZIMPIC?
SPEAKER_01Right. I I and I think it's important to start by differentiating prevention from treatment. There are many things that we can do. In order to prevent excess weight gain and clinical obesity. However, once an individual is obese, there obesity is a disease. Back in 2006, the American Medical Association coined it as a disease. The reason why this is important is because it brings awareness to the fact that once someone has achieved excess weight and maintained it for a given period of time, the physiology of the body changes to support that excess weight. When we try and lose weight, there are many counter-regulatory mechanisms that occur to cause weight regain. So, for example, we know that even 5 to 10% loss of body weight will increase hunger hormones, not just immediately after the calorie restriction, but even a year later. We know that metabolism drops, even if you lose weight in quote, the right way, because the body perceives calorie restriction as a threat. If you think about how our bodies have been made, how it has evolved back to hunting and gathering, if there was insufficient food or food scarcity, that was a threat to survival. And so the body has created all of these ways to trigger the human to seek a higher caloric intake in a setting of food scarcity or food restriction. This is very real. And so to just tell people, oh, you need to diet and exercise, and to not recognize the very physiologic change that happens in the body is really to do a disservice to the patient. And so I do support the use, I'm very grateful for the advent of GLP1 analogs. GLP1 is a hormone that we all release in the body when we consume food. GLP1s do a couple things. Number one, it informs the pancreas that food has been received and causes a surge of insulin to meet that need. And that is why GLP1 analog under the name of Ozempic in the United States is FDA approved for the treatment of type 2 diabetes. GLP1 will also signal to the brain that food has been released or received rather, and it will result in a reduction of the food or the hunger signal in the hypothalamus of the brain. So it is addressing that, again, very physiologic counter-regulatory happenings in the body when people gain weight. So I am in favor of using these drugs in the right time and in the right way. But of course, I also understand the underlying emotional and spiritual component. And in fact, when we use GLP1s, another benefit of these drugs is that it turns off or dials back food noise. That is the compulsion to consume. And I find that when that food noise is actually dialed back, then people have a different relationship. They can actually take the time to understand their hunger in a way that they were unable before because they were being bombarded by the compulsion to eat.
SPEAKER_02So it can it can give them greater insights about their own triggers, so to say, and that can perpetuate a more virtuous cycle if they bring that awareness and then they take that holistic approach along with along with the GLP1 inhibitors.
SPEAKER_01Right. And so I tell people, you know, that yes, the GLP1 analogs are so effective for many, not everybody, 20% of people are actually non-responders, so it's important to say that. You know, the studies show, for example, when it comes to exercise, exercise is not a critical contributor to weight loss. You cannot outrun a poor diet. But what I think exercise does is actually it offers a spiritual solution because when you move your body, you offer yourself a way to metabolize your discomfort, your distress, so that you then don't need to go and rely on an external substance to soothe. And in fact, studies show that when we engage in vigorous intensity activity, so that's the exercise that makes you sweat, it makes you huff and puff, it makes you uncomfortable, that the ability to tolerate that physical stress or distress makes us better able to tolerate psychological distress as well. And so you can see there's actually this spiritual component to physical activity that allows us to tolerate psychological distress in a better way.
SPEAKER_02Absolutely. Absolutely. I can completely relate to it. More recently, just around a month earlier, I did the London Marathon. In just three months, I lost five kilograms or so. I don't know how much it's going to be in pounds. Uh around that. And now embarrassingly so, in the last four weeks, it's been a very stressful three, four weeks as well. I see that I'm getting back. So earlier, what you said, Dr. Ariane, that when somebody is taking GLP analogs, it is important now to take that opportunity to understand our own patterns and triggers. Do you think it would be helpful to work with maybe a psychotherapist, maybe a mindfulness teacher? Because many times we are inside our head, we might not be able to understand our own triggers. Working with somebody as a coach, mindfulness expert, spiritual teacher, psychotherapist might help us. Do you think there is a place for that that we can suggest to our listeners and patients to have a very multidisciplinary approach to the management of overweight and obesity?
SPEAKER_01Yeah, absolutely. Uh, you know, build your army. You know, bring in the people and the resources that will support you in this endeavor. And I also want to say that this we often take this approach to weight loss as like a negative thing, you know. Um, we view our hunger with shame or negativity. And I really want to reframe that because your hunger is an opportunity, it is an opportunity to understand where we've missed the mark, to acknowledge our unmet needs, and to meet that need. And when we do so, we have this again opportunity to live a more fulfilling life. So instead of suppressing the hunger, shaming the hunger, brushing it under the rug, no, bring it up, acknowledge it, be respectful of it, and know that it is an opportunity to really um understand where it is that you could be nourishing yourself in a more holistic way. And when we do that, uh our relationships improve, our work situations improve, the opportunities that we offer ourselves uh improve, and in that way we we give ourselves a chance to live a more fulfilled uh and satiated life. And so I think this is actually a very beautiful process. And if we can hold that mindset uh of self-awareness, of self-acceptance, and by the way, positive self-acceptance is also associated and correlated with successful habit change, so it's not just the nicer way of dealing with ourselves in our hunger, but it is actually the more effective way as well. Absolutely, absolutely.
SPEAKER_02So I think you've beautifully articulated everything. And for my listeners, I'm just going to summarize in just a few lines and please correct me if I'm wrong. The first thing is that when you are dealing with a situation of overweight or obesity, it's important to have a compassionate approach, understanding what are the triggers which is causing it, understanding our own relationship to food. And the second part is the management. When we are managing managing it, I love your fuel approach. And we discussed the role of Ozempic and the GLP1 analogs. But finally, what you just said was so powerful, and it's really stayed with me, and I read in your book also. Embrace embrace your hunger. See what the messages messages it is, messages it is bringing to us, and how we can trans transform it. And that way, not only we will be fully able to utilize that and transform our own health and our own relationship to our uh food.
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SPEAKER_02Adrian, it's been a really beautiful session with you. I know it's busy, I know it's it was early in California. You gave uh gave us your valuable time. Would you like to share one final message before we close with the listeners?
SPEAKER_01Yes, I would, and thank you for giving me this opportunity to speak to you and to your community. I think it's important to understand that this is an evolution, this is not a one-and-done process. Oftentimes patients will say, Oh, you know, I why am I here again? I lost the weight and I regained the weight, or I address this uh emotional loss or the grief and now it's come back again. When will I ever rid myself of this? And you know, it is not, we don't rid ourselves, we don't surgically excise, you know, our humanity. It is part of our evolution to recognize that our hunger, as we grow and evolve, the hunger will grow and evolve as well. We may be met with certain hungers in our youth, and these will transform in different ways and with different triggers as we get older. And again, that just speaks to our personal growth and it speaks to our humanity. And so I would love to leave people again with this compassionate uh message that if you can meet yourself with self-acceptance and self-compassion, it truly is an opportunity to uh bring yourself to a more fulfilling place in your life.
SPEAKER_02Thank you so much. Thank you so much. And I would uh definitely uh recommend the book. Uh recommend your book. And if uh the listeners want to follow you on social media, I see you've got a very uh you have got a LinkedIn presence, any other place where they can follow you?
SPEAKER_01Yes, I am on LinkedIn, uh Dr. Adrian Udeem, as well as on Instagram. Uh at same Dr. Adrian Udim. I have a podcast called Health Byte, a newsletter uh in which I explore these relationships very holistically. As you mentioned, I am an obesity medicine specialist, and that is what I do in my clinical practice. But my content is really about the emotional and spiritual journey of being human.
SPEAKER_02Thank you so much, Dr. Adrian. I have learned a lot and I'm going to apply a lot of these things to myself. Uh, we have to, in the healthcare, I think we have to sometimes undo a lot of habits which we have picked up during the journey. So I'm very grateful for you joining. Thank you so much. And uh thank you so much for joining me at the Transforming Stress with Dr. Ash. And until we meet again. Thank you so much.
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