Hello everybody. We're happy to have Dr. Aalia Yakub today, welcome. Doctor is from Thrive Global and we're so excited to have you here today. Can you tell us a little bit about first, tell us about where your trainings from, where you're from, how you got interested in this, and then the leap to Thrive Global. Of course, yeah. Thank you so much for having me Bill. I'm really honored and excited to be here. I'll tell you a little bit about myself. As you mentioned, I'm Dr. Aalia Yakub, I'm board-certified in internal medicine. I trained at UCLA and Stanford. In fact, I actually wanted to go into rheumatology which is the practice of treatment of auto-immune disorders, and thought I would be in academics all my life. But living in Silicon Valley really got interested in innovation and figuring out how to do you use technology to allow people to live healthier, happier lives. One of my first jobs after training I was the on-campus physician at the Facebook corporate headquarters where I took care of exclusively people who worked at Facebook and who worked on tech, and what I realized at the time was just how much of a mental health burden they were going through with an intense work environment, lots of anxiety, lots of depression, which we were starting to see back in 2014, 2015, 2016 when I was there. I became really interested in how do we use technology to develop solutions that help us change our behavior that are based on the neuroscience, and also help us access medicine and health care in a better way so that we are more engaged in our health and have a preventative lens with which we look at things rather than just treating things when they happen, when it's too late, but rather how do we prevent things before they happen and so much of that has been about learning about lifestyle and lifestyle medicine and how the things that we do in our day-to-day lives, how we sleep, how we eat, how we move, or a lack of those healthy behaviors leads to the development of chronic diseases. That's a little bit about me and my training. I have worked with lots of startups over the last 10 years, both as a medical founder, an advisor, and in many different capacities and have been able to witness the inception of a lot of really great companies doing incredible work in the space. One of which that I'll highlight is a diabetes company. It's a diabetes platform that is totally telemedicine focus, so you don't have to go in person to see an endocrinologist, and everything is connected through a continuous glucose monitor. You as a diabetic are able to use a continuous glucose monitor. Your glucose values get shot over to your doctor virtually, and everything gets managed remotely, which is incredible for folks who live in rural areas and we're traveling three, four hours to just get to an endocrinologist. In that way I think technology has been really amazing, but I think as we'll discuss in this conversation, there are ways in which technology also leads to chronic stress and leads to other things that are of concern for us. Yeah, absolutely, and just to restate for our audience that members that are not health care providers, when we worked to lower risk for cancer we in turn address so many things like diabetes, like mental stress, and especially, and I love the fact that you as a physician understand some of these things but also you understand what's relevant today. I don't understand how people can take in so much information in one day. If you have an interest, for instance, in the environment, you're bombarded by environmental stories all day long. I mean, how do people start a panic mode with that information overload? I myself have to be very careful because we got tens of thousands of communications a year, and I have to tread lightly. Can you share some insight on that? Yeah, absolutely, and that's something actually that we talk a lot about at Thrive and while we're talking about this maybe I'll just tell you a little bit about Thrive. Thrive Global is a really wonderful company started by Arianna Huffington. It was started back in 2016. It's a behavior change platform, and we have technology products and wellness solutions that we offer to companies to help them unlock human potential of their workforces, but also to end the burnout epidemic, which on top of the pandemic that we're experiencing has been a lot for folks. One thing that you're talking about is the information overload that we all experience given that we have devices that we're carrying around all day, we get notifications, we get news. We're getting all these emails, we're watching the news. It's so much stimulation for the human brain. What we recommend in terms of your personal wellness is to actually set some boundaries. We recommend that you turn off your notifications so that you can focus on your tasks and not get disrupted by some news that shows up on your phone or notification that's disruptive to you. Also, another tip would be to schedule a boundary in the evenings where you stop watching the news, you have a news cutoff. Because what we find is that stimulation from these informational triggers especially in the evening can disrupt people's sleep. People aren't sleeping well because they're triggered by all of these pieces of news, and facts, and things that are coming in randomly, and we don't have control over our head space because of all of these notifications, and stories, and things that crop up into our consciousness. Two small pieces of advice, turn off notifications and try to focus on what you're working on in a non-destructed manner and then set a cutoff time at which you're not reading the news anymore, you're not watching the news anymore, you're not mindlessly consuming social media where that can also happen. You might be scrolling and all of a sudden you see something really terrible happened or some piece of news that really triggers you and puts you in a bad head space. That is always disruptive I think to sleep and to our day, so just being really mindful about what you let into your consciousness is really important. I do want to thank you for that. I do want to add that Arianna is really the first person I'd ever heard talk about sleep in the way that she did. It was so important about the restoration of my head space, the care of yourself that isn't always evident that you can see a cut on your finger, you can put a band aid on it. This is something that isn't always evident. Even when we look in the mirror, we don't see that stress physically. But that internal burn is there and we see it and it was actually Arianna that made me very mindful of that and it's role as we've seen from scientists and healthcare providers in managing health and working to lower health risks. I'm super grateful for that platform. I'm also have been lucky enough to be able to blog on that platform and I appreciate that opportunity, and connecting some of these issues to managing our own health and lowering risk for things like diabetes which I love the concept of that company, but we have an opportunity to lower risk in lots of places. Absolutely. It isn't always easy to do especially for people that have a harder time getting access to many things including this broadcast which we're always trying to figure out ways that people can access the help of people like yourself. I just wanted to ask you something that you touched on that I thought was super interesting back to some of the devices in technology that we're using. We have some information actually on how to cut down on the overload, but is there technology out there today that can help us become more present and free us up rather than just not use? Is there other practices, or devices, or technology out there that will help us? Can you share a little bit on that? Yeah, that's a really great question. Based on the latest neuroscience and what we know about the brain and how the brain doesn't do well with uncertainty and just how anxiety can build up, and also how our nervous system works. When we're activated, when we're stressed, our sympathetic nervous system is firing. That's when we're in a fight or flight response, and we want to be in the parasympathetic nervous system activation state. To move from the sympathetic nervous system where we're totally stressed out and overwhelmed to parasympathetic nervous system, one of the greatest tools we have is something very simple. This is really I think an incredible thing for people to practice is deep breathing. In particular there is a type of breathing practice called box breathing which was developed for Navy SEALs because what we found is that Navy SEALs were going out on these incredibly stressful missions. They were doing really difficult work and then coming home to their families. They'd be sitting on the couch and they hear a loud noise on the TV and all of a sudden they would be in that sympathetic activation where they're just activated and stressed again as if they were on a mission, or they might be sleeping at night and have a terrible nightmare and wake up from that and be in that stress state once again. Psychiatrists and psychologists tried all of these different measures on them, and what they found that worked was something called box breathing. What that is basically for those who aren't familiar with that, is you inhale for four seconds; you hold your breath for four seconds, and then you exhale over the course of four seconds and you can count. It's really simple to do and you do this for a couple of cycles. After about 2-3 cycles or one minute of doing this, you'll find that you move from that sympathetic activation to that parasympathetic nervous system where you're calm, you're relaxed. What that does overall is it breaks that cycle of really tight stress happening where if you don't break that cycle, it becomes chronic stress. As you know chronic stress leads to inflammation. It leads to the production of cortisol, and overeating, and making bad food choices, and lots of unhealthy behavior that leads us down that track towards things like cancer, and diabetes, and hypertension, and obesity, and all of the things that we're trying to avoid. Getting back to your question, the strongest best tools that we have are the simplest. They're really our breathing. They are our ability to go out into nature, go for a walk. It's almost like disconnecting from the technology, is our greatest strength and the way that we can counteract all of the stress that we're feeling. Well and just I think simply put, especially with COVID I've noticed so many more hostile people, like I really have to psych myself up to not be reactive, to help others calm down, help them find peace just simply by being kind. Because people are really on high alert in every corner of they lives. I think that your advice on the breathing piece is key. I know if I can just pivot for one second, when I first started Less Cancer and the emails were unstoppable and the website's kept breaking and there was no peace ever. Literally for me to find that box breathing to even talk a lot of focus, a lot of practice and I did things like, go to an acupuncturist, walked every day with a very focus walk and thinking about every time my foot touched the ground. Those habits are not like flipping a switch. I think it wasn't that way for me. It may be for some people that are super disciplined or have that mindset, but for me it really took a practice of saying, you know what? My bucket's not full today, I need some time. It might be a walk or it might be breathing or sometimes I'll be able to go see something or do something that brings my mind totally off of my work. But I think scheduling those breaks, I schedule bike rides now. Today I had a meeting, I had to cut out early because it was going to cut into my bike ride, which was going to cut under this conversation. I really do set the alarm on my phone for things like bike ride, breathing, and maybe are there other tips that way that you might advise that people could do to help give them structure around some of the stress and worry rather than just say, Oh breathe. Are there some other things that we might be able to do? Absolutely. There are so many of them. In fact, our tribe we have something called micro steps, which are small habit changes that are too small to feel. Just making little tweaks in your daily life that improve your wellness and improve your stress level and improve your ability to cope and be resilient. But that don't take so much out of you that they're impossible to carry on and follow through with day after day. Some examples of these micro steps are, of course, incorporating box breathing. If you can't do that, if that's too much, then do deep breathing and schedule it on your calendar, schedule the walks. I love your idea of scheduling the stuff, putting an alarm, reminding yourself. Much of our behavior is just based on how we're feeling in that moment, what we're used to doing and if we need to remind ourselves to do it differently and keep doing it differently every day, that's okay. Put it on your calendar, put an alarm on your phone, write a note, do whatever it takes to remind yourself. Have an accountability partner whether that's a family member or a loved one or friend that you go on a walk with or a bike ride or whatever it may be it to remind yourself to move your body. Some other little tips and micro steps that people can engage in to decrease their stress and improve their wellness are; with omicron anxiety, people are facing uncertainty in many different ways and many people are stressed. One thing that was really helpful was a scientifically validated practice called affirmations. Affirmations are statements that start with I am or I can. You can say I can do hard things. I am capable of doing this task or I am worthy of x, y, and z thing. Just saying that out loud to yourself really changes something in your mind and in your brain that allows you to overcome whatever challenge you're feeling in that moment and facing. Affirmations are really powerful. Something as simple as drinking a full glass of water when you wake up before you consume anything else is really an incredible practice to help you stay hydrated. We know from the neuroscience that they've done imaging on people's brains and when you're dehydrated, your brain looks shrunken as well and people who are adequately hydrated, their brains look hydrated. Just imagine what type of impact that has. Then lastly, another really quick tip that we focus on a lot is gratitude. Having a simple gratitude practice. I have an alarm for that. Wonderful. I set alarm for that at noon. Not to interrupt you, but that's one of the things, because I believe that's as equally or more so or as important as exercise. It really is a very low lift way to have a huge impact. At UCLA, they studied children's brains and adult brains. They found that when kids had a gratitude practice and they spoke out loud about something that they were grateful for or they wrote it down, if they had a gratitude practice for three days, we saw an increase in the thickness of the gray matter in their brain on functional MRI. In a matter of three days just that small simple gratitude practice actually had an impact on the imaging of the brain. In adults it's super important as well, and there are lots of studies that demonstrate that as well. It's these little small changes that we can make these micro stuffs that we can add to our daily lives that really have a huge impact on how we're feeling, how we interface with the world, and really it combat some of the cognitive and brain font that I think people are collectively feeling right now during the pandemic. Sitting in front of the screen all day. You know this, I know this. Sitting in front of a screen all day I think by 3:00 PM, I'm fried. I need to get outside, I need to stretch my body, I need to move, I need to decompress, and so scheduling breaks, moving your body during the day, and just getting away from the wreck of that computer and thought this without screen. Exam situation is for me because I communicate with my whole body, being soul. It's like talking to a keyhole. I've gotten used to it, but it's a little bit different. I wanted to mention this, I would love to know your idea on this. Before when I would duck out to go ride my bike or duck out to go work out, or duck out to go capture a break, I used to keep it. I never mentioned at anybody, it's how I have a meeting or I have this. Now I own it, I say I'm going for a bike ride. They're like, " Well, wow, we wish we had that luxury," and I was like, "I don't have that luxury. I have to do it so I can keep my work going." Today I took a phone call actually when I was on that bike, I was in my own area and I was on the phone for part of it, and then I had to hang up with them and just say, "Listen, I need this time and I will circle back," so I wonder what you thought about. Yeah, you bring up a really powerful point, I think for folks, especially in leadership positions. When you are open about how you're taking care of yourself and your wellness, the people who worked with you you're giving them permission to do the same. I think we have to change our mindset about this, taking care of yourself is not selfish, it's not a luxury. It's a necessity for us to have a sustainable way to function in the type of world that we're living where there is a lot of uncertainty, where there is a lot of stress, and we have to be able to find ways to build resilience and cope with it. One of those ways is to get outside, and move your body, and take breaks, and stretch and do these things for ourselves. As humans we're not robots. We can't just work all day without a break and then expect that our mind, and our body, and our soul is going to be healthy at the end of the day after those types of days. Especially with like the brain fog becomes of COVID and some of the things we're seeing in our friends, and family, and co-workers. Those people that have had COVID and reported to me, I just can't seem to pull it together. The only thing that I can suggest is that they need more time to reboot, and recoup, and what can they do to fill their bucket, but I do here that a lot of people are really struggling to keep up because a brain fog or because of some of these other symptoms that we hear about through COVID is there anything you could add to that? Yeah, think it really goes back to some of the things that we talked about, but you're right. In a collective manner most of society is feeling that pandemic fog and that brain fog, and part of that is our response to stress and the way that we're dealing with stress. From a neuroscience perspective the brain fog is part of one of our stress biotypes, and so we've collaborated with Stanford and we have this incredible curriculum called Thriving Mind where we teach people based on the research out of Stanford and from Dr. Leanne Williams there who's in the Department of Psychiatry. We teach people what their stress biotypes may be. For some of us we go into rumination where we start worrying. We start worrying about the future, we start worrying about something that we did that was a mistake and we fixate on that. Another stress biotype is that cognitive fog and the brain part of that we talked about where you're on a screen or you're overly stressed and you're just going through emotions, but at the end of the day you're completely barred. Your emotionally disconnected, it's hard for you to focus, and that's one stress biotype. Another one is where you procrastinate because you're stressed about something that's coming up and you're just into your responses to procrastinate and avoid that task that you're doing. We have a whole curriculum that teaches people about their stress biotype. That is so good to know that universities like Stanford and people such as yourself and thrive are developing, but for the general public out there I cannot encourage them enough to go to thrive. Can you really explain some of the tools that are available on that website either in blogging or could you share something? Yes, I would love to. We do have a really wonderful blog where we post really incredible content that's based in the neuroscience, that's based on the latest trends, what we're seeing in industry, and in the community. Please check it out. Check out our content on there. We do post a lot of tips, a lot of incredible content on our social media. Arianna post a lot on her personal social media, on her LinkedIn, on Instagram as well. Her books by the way are very helpful. Not jump in here but her books have been very helpful to me. Sleep and the Intention of Sleep. She also wrote a book most recently called, Thrive, and it talks about the premise of the company and some of the behavior change science and platform. That's a really incredible book that people can pick up as well that's widely available, it's called Thrive. Lots of resources available online. Absolutely. Then also to the role of some of these things in chronic disease. Can we just review that a little bit. We're talking about stress and bandwidth and staying fresh, not being burned out. Can you tell us the role of stress in chronic disease, how that increases risk for things like diabetes and yes, even cancer? You can share it with me? Absolutely. What we know is that stress is inherent part of our lives, as humans there's no way we can get rid of stress. What we want to do and focus on is not letting our stress that's acute in the moment in the day become cumulative and chronic and happen over the course of time and not get corrected, we want to break that cycle. Stress is inevitable, chronic stress is what we wanted to attack and break down and we don't want our stress to get to that level. Once it gets to the level of chronic stress, what we find is inflammation throughout the body and it impacts every single organ system. What we find is the release of stress hormones, one of which being cortisol, which then leads us to make lots of decisions based on that stress regarding our eating habits and regarding our nutrition. Those decisions that we make when we're stressed, are unhealthy decisions typically. We're acting impulsively, we're making poor food choices and that leads to metabolic syndrome, obesity, hypertension, diabetes. When we're stressed we tend not to move our bodies as much, not exercising and make fitness a priority. All of these things indirectly impact the development of chronic diseases, some of which we talked about, but also lots of cancer. Lots of cancer is related to chronic stress as well and indirectly, a lot of the lifestyle choices we make as a result of stress. If you ask a smoker when do they smoke the most is when they're stressed. They're chain smoking. If you ask an over-eater, when do they eat the most? It's when they're stressed. If you ask anybody, when do you sleep the least? It's when you're stressed. All of these things have a downstream effect on our health that is just tremendous. If we were to really quantify it and qualify it, it would just be absolutely mind blowing. Stepping back and saying, when I'm feeling stressed, I'm going to break that cycle. Here are the strategies that I'm going to use, I'm going to do box breathing, I'm going to go for a walk, I'm going to take things off my plate, I'm going to tell myself really positive affirmations. I'm going to get help if I have anxiety and depression, I'm going to get help with my eating by making small changes. I'm going to try to get more sleep. All of those things cumulatively lead to a healthier you and to less disease burden. One last thing that I want to share on sleep because we didn't talk a lot about sleep. It's something that Arianna really was a pioneer in terms of the sleep revolution in her book and her own personal experience. What we know about sleep is that sleep is like a dishwasher for your brain. When we sleep, we clear out all of these waste proteins that accumulated throughout your normal day. You doing your normal things during your day accumulates waste proteins in your brain and if you sleep and you sleep appropriately with the right amount and with the right quality of sleep, what you get is that your brain is like a dishwasher. It cleans up all of those proteins and your brain is recharged and refreshed after that 7-8 hour period in the morning. If you don't get enough sleep, It's like if you were to open up your dishwasher in the middle of a cycle and your dishes are still dirty. What we're finding when it comes to dementia and Alzheimer's down the road, is that you have a higher risk of those things if you have chronic sleep issues, if you're not sleeping well. Interesting. [inaudible] how so many of the things that we can do to prevent and lower risk. It is really interesting and that things are not happenstance. People would say to me, wow, you've been so fortunate to be able to take care of yourself or aren't you lucky, or aren't this. But it hasn't always been that way certainly for a whole host of reasons. And I understand that for other people, lots of different people their access issues like wow, I wish I could get a rest. Wow, I wish I could do this or wow, I wish I could go to a doctor. There are a lot of people that don't have some of these things and I always think it's important to share this information with everyone. When people have a tough time, as you suggested earlier, there are small steps that people can do. They can take five minutes in their car, on a bench, to just breathe, to just stop themselves. That's something, with practice, people can do. There are smaller versions where we can chip away the work at some of these sayings, these changes that don't necessarily happen as a soundbite or a flip of a switch. They really require work and so when we talk about these things, I'm always mindful of those that have problems with access, and I think, today, you've given us a lot of tools for a lot of different people to dip in, to reach in, and understand things that they might be able to do to lower their stress. I don't know if we've discussed this before, but when COVID hit, I had been locked up in my office for weeks. I bought the last bicycle in the shop in my town, which I'm not sure who it's for, but it's a pale blue, aqua V Frames bike, and it was an e-bike. It was more money, and I haven't ridden a bike since 1973, maybe. So I got the bike, I jumped on it, and I never stopped riding. I lost tons of weight and rode over 4,000 miles. Wow. Super lucky to have that opportunity to buy a bike, and I really devoted time into the practice of riding the bike, setting the alarm, and I still do that today. If any of that helps, anybody who's listening today, we all have issues with stress. We all have pile-ups, and we know that the stress can make us chronically ill and in some cases, much worse. I just wanted to share that. Absolutely. Thank you so much for sharing that. I think there is so much to be inspired by in your story, and so much of what we're talking about today is not intention. None of us are ever going to be in a perfect state where we're exercising perfectly, we're eating perfectly, we're performing perfectly at work, we're doing a perfect job at being a parent or a sibling or a child, or whatever our roles are in life, but what we can do is commit to being better and better every day. That's something that's very tangible. That's something you can wrap your head around. So if you just commit to, "I'm going to be better tomorrow than I am today and the day after, I'm going to be a little bit better. In a week, in two weeks, in a month, you're going to be a different person. You're going to be completely transformed. Right. On the road anyway. I think it's okay to be a little bit lazy and take shortcuts. It doesn't necessarily have to be a big deal. I have a jack of cards, the jack, the card playing in my wallet. Somebody said, "Why do you keep it there?" and I said, "Because somebody, a few years ago, asked me to pray for their son, Jack." I'm not very religious, but I keep that jack of hearts actually in my wallet because when I come across it, I think about that young man, and I think about how he's doing. So I do have little reminders of my life for things that are helpful to me and helpful to others. In that case, it's a jack of hearts in my wallet, but I think there are other things we can do, like setting the phone or thinking about one of the small changes that I made and I think could be helpful for others. How we start our day, think in your head how you want to start your day. Do you want to start it running for the train, or do you want to start it calm and happy? Do you want something healthy that's going to make you feel better when you eat in the morning? You're not just grabbing a cup of coffee and a piece of burnt toast and flooring it it to your next meeting? I think some of those little minor reminders to yourself like, "How am I going to spend my morning?" and not just reacting to fire drills. I think so much of our habits are about the fire drills in our lives. Absolutely. I think living your life with intention is a great starting point to infuse intention into the things that you do. Right. Well, you are so helpful to so many people, and I'm very grateful, personally, to you and all the work you do for others. I'm grateful for Thrive and Arianna and some of the tools. Some of the things, like Sleep, that she's brought out into public spaces. Now Sleep is part of our conversation. It's part of our landscape because of her, and we know that when things become part of our landscape, they take on normalcy, and that's when we see change. When I first wanted to do something on cancer prevention 20 years ago, nobody put those two words together. They weren't in the same book, much less the same paragraph, certainly not side-by-side. It just wasn't happening and now, people look for ways to lower the risks. We are so grateful to people such as yourself, and I appreciate all the time you gave to us today. Thank you so much, and thank you for all the incredible work that you do with Less Cancer and on National Cancer Prevention Day. This is so incredibly important, I think, to people just empowering them with education and knowledge because knowledge is power. Once they have the knowledge, they can choose what to do with it. If they want to act on it, they can change their lives. It can be transformative. Thank you so much. Really appreciate this conversation, Bill. Thank you so much for your good work, and thanks for all you do.
