“Burnout” is a controversial term because there is no medical diagnosis, per se. [...] Burnout is real but has a variable definition; but, most people agree that symptoms of burnout have risen over the years."

Dr. Amy Shah, MD

Dr. Amy Shah is an allergist and immunologist at Valley ENT as well as a speaker and consultant on health and mindset. In March 2021, she published her first book, I'm So Effing Tired: A Proven Plan to Beat Burnout, Boost Your Energy and Reclaim Your Life.

Shortly after starting her wellness practice, Dr. Shah was named one of mindbodygreen's Top 100 Women In Wellness to Watch in 2015. Clinically, she was named in Phoenix Top Doctors magazine in 2017, 2018, and 2019.

We kick off the conversation with the personal experiences that led Dr. Shah to learn all she could about burnout and, later on, offer guidance to others who are suffering through it. She was inspired to do her part in changing the mainstream perception of burnout as a “badge of honor” and steer people away from the glorification of “the grind”.

Listen in as Dr. Shah goes on to discuss the hidden dangers of supplements; why cases of burnout have drastically risen over the past year; the benefits of “circadian fasting”; and how optimizing your gut health, immune health, and hormone health can supercharge your energy levels no matter your age.

 

Follow Dr. Shah @fastingmd

Follow Chase @chase_chewning

 

Key Highlights

  • Dr. Shah shares why she was driven to understand burnout and how it affects mental health and wellness.

  • We’ve all heard of intermittent fasting. Dr. Shah introduces a new concept, “circadian fasting”, that combines the knowledge of circadian rhythms with intermittent fasting.

  • What biomarkers should we look out for when recovering from burnout?

  • Gut health, immune health, and hormone health are central to energy. Dr. Shah explains how to optimize all three.

  • Chase and Dr. Shah describe how their nighttime routines evolved over time and how to get a good night’s sleep.

Powerful Quotes by Dr. Amy Shah

Real change in your life comes from changing your daily habits.

Giving your body food in the middle of the night is like me waking you up and asking you to do a complicated math problem in the middle of the night. You’re going to get it wrong, you’re going to be pissed that I woke you, and the next morning you’re going to feel tired. That’s how our gut bacteria feel when we eat close to bed or late at night.

We’re literally different people at different times of the day because the genes that are turned on during the morning are different from the genes that are turned on during the evening.

Gut health, immune health, and hormone health are all one.

Once you respect your own boundaries and your own time, other people start to respect them, too.

 

Episode resources:


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Interview transcript

Chase: no and continuing in a way that doesn't serve us compounding stress and all these things is really now your specialty. It's kind of what you literally wrote the book about it.

Amy: Yeah. So people who are giving you care are the most burned out of them all. So it's like, how are they going to offer you solutions when they themselves can't get themselves better? Right, like

Chase: So what brought you to this conclusion? What brought you to I need to focus on burnout, and how it's actually affecting people in their health and wellness?

Amy: I mean, I think you and I both know that it's not just this past year that we've felt burnout, I think a lot

Chase: It has been a tipping point for sure.

Amy: Yeah, I think a lot of us have felt it even before well, before the pandemic and I definitely had my crisis. And I could not figure out why I was so tired all the time, why I had GI complaints, why I was feeling anxious, you know, all this stuff, nutritional stuff, bloating. And I felt so stupid, because my labs or my labs were, quote, unquote, normal. And they were like, you're fine. You know, I don't know. You're just getting older. I was a mom, like I had a new practice. And so that was, it was just chalked up to, you know, just accept it. And there's no solutions given at all, no tools, no solutions, no advice. I mean, I knew I wasn't expecting dietary advice. But I was thinking like, maybe there were some things that people can impart on me that was interesting. 

Chase: So you were hoping to find something wrong so you could fix it?

Amy: right. And I see the frustration for so many of us. And I know you're alluding to the fact that you had something similar recently.

Chase: Oh, yeah burnout, for sure.

Amy: So then at that time, I didn't know what that was. And I looked up all my symptoms, because I thought, well, you know, I get why people are frustrated, because there's no real answer. And so there was this, these things about gut health, you know, poor gut, health, leaky gut, whatever. And then there's this whole thing about adrenal fatigue and hormone imbalance. And then there's this whole thing about inflammation and so I kept thinking like, okay, maybe I'm inflamed. No, wait, maybe I have a leaky gut, no way maybe. But I realized that the way energy works is focused on health. It's actually like all interconnected, the gut health is connected to inflammation connected to hormone health, I had no idea. I mean, all these years of schooling, I was a nutrition, nutrition major in college, all these years of schooling, and I had no clue that this was all 100% connected. Inflammation is actually fatigue, like, so when you're inflamed. When we say, you know, inflammation, that's why you feel tired. That's why you're feeling burned out, because there's such a connection between the brain and the body. So when the body feels inflammation, it sends signals to your brain to say, hey, slow down something, she's sick, he's sick, something's wrong, something we can't keep on going with what we're doing and then we have our stress in our lives that are making us more inflamed, impacting our gut. So realize a hormone, the gut and the immune system are completely connected and everything we do around that has to kind of help all three. And so the whole thing about a system like, oh, your adrenals are, you know, burned out that like, that's not even, that's not what's happening. So I realized, like, okay, so then as I started to figure myself out, and it's not rocket science, like some of the things that I talked about are things that you probably intuitively knew help you, you know, how you feel when you get a good night's sleep, I just found that the science behind it, you know, that helps the gut, it helps the inflammation, it helps the hormones, but in intuitively, you knew that. So it's not everything is not like this shocking revelation, but I pared it down to the things that really, were going to make a big difference. And I experimented myself, and then I helped other people with it. And then that's why I wrote the books because, because I thought, okay, if I can pare it down to a few little changes throughout the day, like you're really busy, I'm really busy. I can't be like doing every single wellness trend that's out there a lot. It could be like a full time job, right. And it is some people's full time job. You live in LA, there's people here who literally spend their entire day in their wellness routine.

Chase: I probably spend hours a day. 

Amy: so I was trying to think of like, what's a total of one hour a day, little things that you can do to kind of like change that so that you're one lifting yourself up out of burnout, which is like the first part of it, and then choose like keeping a daily routine so that you don't get into that place again. I put a quote up the other day that said, like, real, if you really want to be burnout, you have to build self-care every day. It's not chocolate, cake massages, and you know, spa day or whatever. Like, you have to build in little parts of your day, every day to prevent the long term burnout. And in our culture right now burnout is a badge of honor, like if you're exhausted, because you're working so hard. Like, that's amazing that, you know, that's great.

Chase: it is glorified it means that you're grinding? 

Amy: Yeah, like the grind is total glorified. But people, I feel like, we can adapt, we can learn this information. Technology is moving so fast, that we have all these tools today that we didn't have 10 years ago. So couldn't we build new tools, 10 years from now that would like learn from this, maybe, you know, we don't need to be looking at screens and doing work, you know, all the way until midnight or 10pm every night, maybe we can change our culture a little bit so that all these things don't emit so much blue light. Because like at night, not only are we not supposed to see blue light, our body's also more sensitive to it because it's like it's sensing whether it should stay up or not. 

Chase: should I stay vigilant or not? Is there a threat? Or is there a reason we need to be up? 

Amy: exactly. And then people who are worried about aging. So if you think about skin, I found this to be fascinating. Skin has a circadian rhythm to like a body clock and so it knows that during the day is probably when you're getting the most sunlight and blue light. So it has a lot of defenses up against aging and discoloration wrinkles. 

Chase: I read this in Matthew Walker's book “Why we Sleep” it has this concept of like all the photoreceptors that our skin actually has, just in the rods and the cones in our eyes. 

Amy: yeah and then so they are really turning like down off the genes the protective genes at night and so when you are seeing a ton of blue light, or your you know, expose to stressors for your skin, you're going to age faster, you're going to get more wrinkles, you're gonna so it's not just about you know, feeling tired. It's about aging in general that you can really change by changing our habits. So I think for me, it was eye opening and I felt like you know, there's so many amazing people in the world who could make changes or make technology or do things that can help us through this

Chase: shout out. Where's Elon Musk? Can we focus on Earth a little bit more? I love space travel. But we got a lot of problems right here.

Amy: yeah, here at home, inside of ourselves. So that was something that I thought was important to share and clarify for people because I think we hear so much information, that it's hard to know what's real, what's not. So I kind of parsed it out. For us to say, Okay, this is where it matters. Let's concentrate on these things. And then, you know, if you have extra time, you can do all this other stuff, right? 

Chase: yeah because we can do all things and I've been guilty of trying to do them all as well. And I would even say kind of in the pursuit of preventing burnout in the pursuit of taking care of yourself it almost induces stress and burnout, because it's like you learns, it's like, trying to drink water out of a fire hydrant, yeah, learn all these things that you can do to improve your health, your wellness, your sleep, your metabolism, immune system, all of these things, and then you try to do them all. And then sometimes it can, you know, work against each other, and just add more stress.

Amy: I didn't know before looking into it, that there are many supplements that actually damage your body and so when people are adding on these things to their wellness regimen, you have to remember that some things cancel each other out. Other things

Chase: decrease or increase bioavailability of nutrients.

Amy: yeah, antioxidants taken by mouth through supplements are actually not good for your body.

Chase: Really? How so? Like they cancel them out or they hurt you actually?

Amy: yeah so we have a very complicated antioxidant balance in our bodies, right? So when you're adding things, it can throw off that balance. You can get more oxidative damage by adding antioxidants on, you know what I mean? It's so wild, like, whenever, when I read those studies, and you know, there's so much controversy about vitamin A and vitamin E, both of which were shown in studies to be dangerous when taken.

Chase: individually, or in excess?

Amy: vitamins A, D, E, and k are fat soluble and so if you take too much, you will store it in your body, and it can be toxic. And so after I read all that I really became a big minimalist on supplements. And I realized, like, these wellness routines that people talk about that have, like, hundreds or like hand fulls.

Chase: you don't want to look at my pantry. I mean, I've got a repertoire of things that I yeah, I choose and select and based on kind of over the years of a lot of self-experimentation. It's like, I need this, and I want that. 

Amy: I have a few that I experiment with but I also remember that these studies are really powerful. And we don't even know that half of it, because most people aren’t doing studies on supplements and we don't really know what happens if you mix all of these things together. And what we do know is our body's super smart, and if it's food based, it's able to kind of parse things out a lot better. So antioxidants from fruit, for example, are really great for you. But if you separate that into a supplement, it can be dangerous.

Chase: I've read so many things on that topic of how in Whole Foods, the way that things are even like just the amylase that your body produces in your mouth to just trigger the initial breakdown of certain starches and sugars and things based on what you see and what is known and that it has had before, like, that's the start of the metabolism. And so then it like from the entry point, based on what it is it is going to have a relation and it's going to have a lot more like basically just things ready to go, that we don't even fully know about, like the way that we absorb things and the way that certain phytochemicals and nutrients interact. There's so many things we can't even tap into to understand all of them yet.

Amy: We don't we don't. And we don't understand how our gut bacteria sort of got back to our urine, the army, right? So the military. So the gut bacteria is literally our military and it determines so much of who passes through, who are we going to attack? What are we going to extract from this

Chase: great analogy?

Amy: And they communicate with our immune system at all times. You know, hey, I need help, come over and help me. And so what's that complex interaction is something we don't understand. That's why people say, Oh, I can't do gluten, but nothing comes up on testing or I can't eat dairy, but nothing comes up on testing. It's because there's such a complex interaction between our gut bacteria and our immune system that we can't understand yet. There's no test for it. And it can change. Because we know that gut bacteria as it changes, it may be tolerating new foods, right? Most, a lot of people will say, they have all these food intolerances, and then once they kind of fix their gut, so that means replace some of that army they will be able to extract the nutrients that they need and not have such a bad reaction to them. So that's the basis of actually my book, the basis of the book is to understand, hey, this army is in constant communication with your own immune system, and your brain and the hormones and so you really want to keep that group intact.

Chase: as like a primary focus? 

Amy: yeah and that's, that's how you're going to get more energy and get out of burnout as on a personal level. Now, burnout is, there's so much brain burnout too you know,

Chase: yeah, I would love if you could, can you kind of really define burnout? What is it from the medical perspective in terms of how it shows up possibly, things people can be on the lookout for? What it looks like, what it feels like?

Amy: Well, burnout is a controversial term, because there's no medical diagnosis, per se,

Chase: you're not like, alright, yeah, burnout. Take two of these. 

Amy: exactly, exactly. It's I mean, fatigue is fatigue is an actual medical diagnosis, there is testing that you would do to rule out medical causes of fatigue, thyroid, B 12, vitamin D, and anyone who is suffering from burnout or fatigue should definitely undergo a battery of tests to make sure that there's not an obvious Oh, it's your iron. You know, it's your it's your B 12 level, like a lot of people who are plant based they deplete their B. and vitamin D, as you know, so much so many of us are low vitamin D,

Chase: it is instrumental in so many things in the body,

Amy: right. So fatigue is a diagnosis and burnouts, main symptom, the prominent symptom is fatigue, but its constant fatigue, 

Chase: it's an inexplicable fatigue 

Amy: exactly, that doesn't go away with a good night's sleep, it is the feeling of depletion. It's a loss of motivation. So a lot of people who feel burnout won't be able to do a good job at work, because they feel not only tired, but almost like the loss of motivation, apprehensive, and a change in mood. And there's a few, you know, there's a few different definitions of burnout, but in general, those are and then there's a whole host of medical symptoms that people will get often, for example, you'll be tired but wired at night.

Chase: Yeah, the mind is just constantly going, going, going. All the things you didn't do.

Amy: Exactly, so tired, but wired, so you get a very sleepless night of rest or don't sleep well. And then you have often GI complaints because our gut is so connected to our mind and so when you were in this fight or flight mode, and you're feeling at the end of that road kind of depleted, you will often have GI complaints, so people will often complain of like constipation, or bloating, or just some GI distress,

Chase: irritability, or general, irritability,

Amy: reflux disease. So that's often a part of burnout as well. So burnout is real, but has a variable definition. But most people will say that symptoms of burnout have risen over the years. In fact, this last year, there's a 33% rise in people who were saying that and before that it was about 69% of women and 50% of men said that they reported feelings of stress, burnout or fatigue beyond the norm. And, you know, there is a differential between women and men. And this seems to be both societal and biological. And this year, obviously, a lot of the stressors came into focus. And what I think happened this year is that the mistakes we make and society just became more blatantly obvious. You know, some, some of the things I talked about in the book is like disruptive circadian rhythm; so that internal clock that we have in our brain and each one of our cells, we need to be listening to that and when we were indoors all the time for, you know, a good part of this year, not seeing natural light, maybe getting a ton of blue light because everybody's like stuck to their TVs 

Chase: reduced physical activity. Gyms were shut down. 

Amy: gyms were shut down. We were getting no social interactions. And we had no release, right? And then you couldn't sleep at night because you were stressed. And a lot of people were triggered by what's going on? So there are these unconscious pathways that are connected to our HPA axis or our HPA axis is our stress pathway. Hypothalamus pituitary adrenal axis and there's a part of our brain that's, that gets programmed from when we're children to respond to stress. That's why some people who have had a lot of trauma in their life, really had a hard time during the pandemic, because you know, these trauma pathways trigger that cortisol, more so than maybe others.

Chase: I'm so glad you said that right there. And sorry to cut you off, right. That's such an important point. And I'll say personally, that's been an irreplaceable part of my wellness journey. But also for people to realize right now, when they're listening and hearing this, like the things we naturally gravitate towards, or the route that we think we're supposed to take, or maybe even our doctors or providers tell us to take can be beneficial. But there's a lot more going on in the background, and the conscious and the subconscious and just that initial framework and system really, that was wired and built years and years and years decades ago, even for some people say don't discredit that I'm so glad you brought that up.

Amy: I mean, the trauma pathways, not only build our thoughts, but also what we look for, for comfort.

Chase: Exactly. How we cope. Or don’t. 

Amy: Yeah, exactly. Or, you know, what are we reaching for to cope? Because there are a lot of people who need comforting, but they don't know how to get it and so they reach for the easiest tools that they can find to cope and often that's negative coping. So you know, drinking has gone up, you know, usage if there's some food intake can be comforting in a negative way for people like they go back to their you know, what releases dopamine and serotonin 

Chase: they go for the chips or they go for the Oreos? Oh, that's just me. I am a sucker for Oreos. I don't keep them in the house. I'll eat a whole sleeve and won’t even think about it. 

Amy: that is so funny. I don't think I've eaten Oreos, I am a salty person. So definitely during the pandemic, I hadn't eaten, you know, regular chips. I mean, tortilla chips I've had, you know, at a restaurant or whatever. But I would never buy bags of chips and salsa or like potato chips. But I got into all that stuff because I think it was just like we're saying it's a stress. Everybody has subconscious pathways. You know, we all have some, I mean, when you drive to work every day, that's your subconscious pathway driving you because you're thinking about something else. So we have so many of those, and those get triggered. And so what I was trying to do in the book is say, one recognizes that because sometimes you just fall into those habits, and you repeat it every single day. And they're negative habits. And it's just because you've done it since you were a kid or you know, that comforted you as a kid doesn't mean that that's a good thing. 

Chase: or they're seemingly positive. Right? But they're just not leading you to that same positive outcome.

Amy: Yes and then changing I think, real change in your life comes from changing your daily habits, changing little things, understanding the science of why you're doing what you're doing. I think so many people, myself included, think like you too when you start to improve your personal health. Your mental health starts to improve, and you start to see things that are

Chase: a little bit more of the veil lift; what you're doing, what you're not doing. The response that you get.

Amy: I was running like a million miles per hour every single day and I had this huge car accident, which is how I start the book. Because what happened is, I was burned out. I knew I was burned out, but I couldn't stop, right.

Chase: said every person that has been through burnout ever.

Amy: yeah, I was like in the cycle and I had so many things going on and I had a new practice. I had these little kids that were depending on me to pick them up all this you know, do all these things. I had my boards coming up because I had two board certifications. So you have to like certify for both and I was just running on empty and I thought just like we were talking about before that I wasn't trying hard enough if I got enough sleep because if you're sleeping that means you're like not living or not doing a good job, right? And I thought that I didn't have time to do a real workout or something I really wanted to do, I had to do something really quick and intense.

Chase: I am sure no one listening has had any of these justifications running through their head, never.

Amy: right and then you give yourself a lot of guilt for doing anything for yourself, because you want to be working all the time. And so I knew there was something very wrong, but I couldn't put my finger on it. And I didn't know what to do. Because I didn't have any tools, I didn't have the knowledge of like, what I should be doing. And so one day, my partners asked if we could do a last minute meeting at five after clinic and I, and I wanted to say no, but I felt like I had to say yes, and I didn't have the guts to explain, like, I have to go pick up my kids like they're going to

Chase: Maybe you didn't have the gut health.

Amy: Right. Exactly. And I and I didn't have the clarity to know like that I should speak up. Because I thought it would be judging me like I was new, you know. So anyways, I thought, okay, I'm just gonna not like going through the meeting. I just have to get there before six because I think they were getting out at 530. And I thought, okay, if I can get there by six, the center closed at six. So I'd be okay. So we get done. You know, later than I thought really close to six. And I literally ran out of there. And ran to the car. I was rushing to go pick them up. And you know, those little small decisions you make, like, should I make that like and I think about it now, it's so clear in my mind that I was rushing. And I wasn't like

Chase: It's a great example of how even the most seemingly obvious things that of course we could answer in our sleep when under stress it just kind of makes us like, baby deer just stuck in the headlights.

Amy: Totally. So I was making a left, right, what as I was getting to the center, and that I got into a car accident with an oncoming car, who and literally I saw, you know, I was literally spinning. I thought I was spinning for minutes, but I guess it was like seconds because it was a big intersection. And the only thing I remember is I've never seen all the airbags inflate the entire car. Like there were back seat ones front seat ones.

Chase: your car just turned into an airbag? 

Amy: literally, it was an airbag. So it activated all of that stuff. And then all I remember is I got out of the car, and I was bloody there's, you know, the whole windshield was shattered. And I remember thinking like, I don't care, I need to run and go to that center because it's like six and, you know, like, I have to be there and I have to take the kids and they say no you can't go anywhere you are in this huge accident.

Chase: You're bleeding like you need to stay.

Amy: I could barely walk. Anyways, so I had I was on you know, I couldn't do anything for the next week. And it really opened my eyes. I was like, Okay, I need to, I need to make some big changes here. There's no reason for me to feel like I didn't feel almost like a worse version of myself that I didn't want to be like I was cranky, like a virgin. So then that week really helped me kind of refocus. And I started to look into a lot of more of this stuff. And that's where my journey started. And as I started to figure it out myself, I made a ton of mistakes. But as I started to figure it out myself, this is why I mentioned before the wellness, like the energy trifecta, I realized, oh, our gut health is related to our energy, but then our immune health is also related to our energy, and so is our hormone health and if you keep all three systems happy, you will feel good on daily basis. So I learned that and I started to implement things to help all three things every day. And then over time, I refined it, then I tried it on other people

Chase: sounded like you did a great little self-assessment. And paid attention to the variables of what was working what was not.

Amy: and I made a ton of mistakes, because just like a lot of people out there I was tempted by all the shiny objects, oh, take this for adrenal fatigue or, you know, try this diet for and I think that it's kind of like it kind of like steered me the wrong direction. But then when I came back, I was like, Okay, I realized there's no real shortcut to doing the work but here are like some of the things that helped in circadian rhythm. 

Chase: what is the work please? 

Amy: The work is fixing, you know, that gut, that hormone system and the inflammation system, which sounds complicated, but it's literally the same few things like one was living with their circadian rhythms a little bit better. So our society as its belt is completely off from circadian rhythms, like we are programmed to sleep at night and not eat right before bed. And so when I got interested in the science of intermittent fasting, it made so much sense to me. I'm like, yeah, of course, you're not supposed to be eating late at night, and probably, you know, 1000s of years ago, you didn't wake up and have a pop tart, like, as soon as rolled out of bed, right, 

Chase: like, roll out of the cave, and yeah, go find some scraps.

Amy: So it made sense to me that there, there should be a little bit of a break. And then I learned, oh, got health improves from that those bacteria need a break to like, it's I mean, giving your body food in the middle of the night is like waking you up and asking you to do a complicated math problem in the middle of the middle of the night,

Chase: Even in the middle of the night, or you are what about just like late night like a couple hours before bed?

Amy: Yeah, yeah, that's what I mean. That's, the feeling is the same as waking you up in the middle of the night and asking you to do a complicated math problem, you're going to get it wrong, you're going to be pissed that you were woken up, and then the next morning, you're going to feel tired from being woken up at night. And that's how our gut bacteria feel when we eat kind of close to bed or late at night. And so I understood, okay, that makes sense that’s what intermittent fasting can help. But the way I talked about in the book is circadian fasting.

Chase: circadian fasting. I've never heard that. 

Amy: that's a new concept that basically combines the knowledge of circadian rhythms with intermittent fasting. Because

Chase: what does it look like? 

Amy: Yeah, so the Nobel Prize in Medicine in 2017 was on circadian rhythm science and then in 2019, it was on intermittent fasting science, because these are two novel concepts. I mean, they've been around for 1000s of years, but it's like novel

Chase: finally kind of paying attention to them, right. 

Amy: So what we realize is, hey, 80%, up to 80% of our genes work on a circadian pattern. So literally, we're different people at different times of the day, because the genes that are turned on us during the morning are different from the genes that are because, of course, the morning our body wants to focus, our body wants to metabolize. And so the genes for metabolism, focus, energy, or like high, and then two to three hours before bed when our melatonin hits the system it starts the genes that repair and renew. So when we're doing all these things off, eating off schedule, seeing a lot of blue light, not seeing daylight during the day, we're literally shortchanging our repair renewal processes. 

Chase: I actually caught myself on that recently today, I forced myself to take a break, my office downstairs, faces the other side of the house here, I get no sunlight. And I was telling you earlier, I've been kind of going through some burnout. And I've been doing a lot of things to work on that and repair it. And one thing came to mind that came to light today, pun intended. I haven't been getting regular daily sunlight. And it sounds so bad. I live in Southern California where it's sunny all the time. So today, I took about a 25 minute 30 minute break, went up to the roof, took my shirt off, had some shorts on, just got some sunlight, and listened to an audio book. And so it gave me kind of twofold from burnout. It helped me introduce break in a pause and de stress. And it gave me simple, I guess, threefold the sunlight and then I finally got to catch up on an audiobook. So yeah, some kind of like pleasurable thing.

Amy: That is one of the biggest things I actually say is a strategy. So you figured it out yourself. So basically, the multitasking of taking a break, getting the sunlight, and doing some self-reflection is the multitasking way to really get out of burnout. One of the tricks and what I recommend is to do in the morning, like before 10am if you can

Chase: I always strive for my morning routine. Strive for about 10 at least 10 minutes of sunlight first morning, so I get that probably about three to four days a week. I'd say about four days a week.

Amy: And you know, people who don't live in Southern California or Scottsdale or somewhere where their sun is. There are these lamps on Amazon that have 10,000 Lux of light. And remember, you can't be looking through a window, you have to roll down your window, you have to be outside. Windows block out a ton of those locks of light that you need to activate in your red Now that goes straight to your brain and reset all of the circadian pathways. So you really want to be doing some sunlight during the day. A circadian fast overnight. So what that particularly looks like is stop eating two to three hours before bed. So if you were on perfect circadian rhythms, you might stop around seven or eight. 

Chase: that might be difficult my wife is Persian and they like late nights

Amy: I totally get it. Oh, you don't even know I went to India, not this December but 2019 the first time I'd been in 20 years or whatever and I learned that their culture, the way they eat is completely against circadian rhythm. But I convinced some of them to try this. So basically, whatever bedtime is for you work two to three hours before that.

Chase: I like that. Whatever bedtime is for you. So this is just another example for the listeners that you know, this isn't a here's one strategy that you have to follow. But here's a strategy that you can implement into your life.

Amy: Exactly. Yeah. And you know, shift workers of course. Yeah, it's tricky. Yeah, they can't do that. Stop doing you know, your first responder work you can't. So one strategy I tell shift workers like it doesn't matter when you're sleeping but when you are sleeping to stop eating two to three hours before bed, and then you obviously don't eat overnight. And in the morning, you may not want to eat first thing; maybe you go into a fasted workout, get some sunlight, do your morning routine, do some mindfulness or self-care and then you break your fast. So the magic of fasted workouts is that there was a study that came out in the New England Journal of Medicine that detailed the benefits of intermittent fasting and one of them is the metabolic switch. So we preferentially use carbohydrates as fuel and most of us are always just sugar burners unless you're on a Keto plan. But overnight, you deplete your sugar because your brain is still working on repair, renewal processes, whatever. And in the morning, often, you may have some sugar leftover, or your liver had some stored glycogen leftover. So you could do a workout and deplete that glycogen. And once you start to really get low on glycogen, our body makes this cool switch. And that switch to using, you know fatty acids as fuel seems to be the magic switch. And that seems to be what turns on all the beneficial aspects of intermittent fasting. We don't know when that switch happens. And it happens at different times for different people. So if you ate your carb loaded last night, probably not going to make that switch for a few hours, but many hours after your carb load. But if you're someone who keeps a pretty low or a healthy level of carbs and then you fasted from two to three hours before bed, and you get up and you do a fasted workout, you're often going to be in that switch zone, and that is the magic. And so what I say is like, hey, you don't have to be fasting for days. And, you know, even this can happen at 14-15-16 hours and so you're kind of getting all of the benefits of both circadian rhythms and intermittent fasting in one overnight fast. So that's another strategy because there's lots of anti-inflammation that happens when you sync to circadian rhythms and you intermittent fast and remember, inflammation is fatigue and burnout. So if you're doing things that are anti-inflammatory, you're automatically curing that and that's the connection when people are like, wait, what's a food diet? You know, burn out? So you're reducing your inflammation and you're feeling less tired. So that's a second strategy is a circadian fast, the fastest workout, sunlight in the morning self-reflection; self-reflection more because you want to activate your parasympathetic system, your vagus nerve. So a lot of us live in that fight or flight, you know, response and we never counteract it with being parasympathetic.

Chase: You got to have the Yin to the Yang. 

Amy: Exactly. Doesn't have to be one to one. That was what I realized from the get interesting. It doesn't have to be like, okay, six hours I was stressed like now next hours, I should not it’s not like that. You just need brief periods of being parasympathetic.

Chase: That's been a big realization as of late for me is that to come back to homeostasis at this level to come back to just feeling your sense of normalcy. It actually doesn't take a whole, whole lot. Yeah, even just introducing a few deep national breaths, out to the nostrils. I recently wrapped up James Nestor’s “breath”. The power of activating the parasympathetic nervous system through just selective actual breathing is incredible. So that's often another lie I think we tell ourselves in the burnout is that I don't have the time to go do all these spas and relaxation or meditations like it actually can compound with just a few deep breaths, few small practices every day

Amy: 100%. That's exactly what I said in the book. I said, you just need two minutes a day, one minute in the morning, one minute in the evening to do that counteract a parasympathetic exactly what you said, breath work, it can be humming

Chase:  we'll take a two minute break now for everybody to join together. 

Amy: Yeah, I know, I've seen that before, where people like to do it together. It's really easy. And you can do it. And it makes such a huge difference it does. And then, you know, and then one of the other things I talk about is really taking a little stock of where your energy is going. So I think a lot of burnout is also thought processes, like who is taking your energy? Who are you giving your energy freely to? And how can you edit your life so that you're eating the foods, doing the things and hanging out with the people who are bringing you joy and energy? And how can you block yourself from the people who are constantly taking it away?

Chase: That's a huge point. Burnout. It sounds ironic. I'm burnt out of energy and burnt out of motivation. I'm depleted. But you're saying it's actually there are things there are people a thing, a person that is just constantly taking the energy?

Amy: And often it's like a colleague, or someone you see often a friend or a family member. And what I realized if you really take note of what it is that is repeating your energy, and what it is that is constantly depleting your energy, you get a lot more clarity. And for me, I realized I was doing things on a daily basis that were constantly depleting me and I was hanging out or interacting with people that were constantly draining me. And so I really started to edit my life, I started to say, I'm too busy to hang out or talk or engage with the drainer. Then I purposely started to do activities out which were like to fill your cup. Yeah, like, you know, the one minute twice a day it was great in the beginning when I was just getting out of burnout. But then I realized, wow, this whole nature thing is like, really amazing. And I love how I feel. I feel really good after I spend some time outside. And there's a study that came out that said 120 minutes in nature is like really what you need a week to get optimal health. Right? So I was thinking about it. And I like calculated. I was like, okay, 120 minutes, not so hard. Two hours a week. And you space it out through the whole week. And so I started to add in those things. And one of the biggest things I did, which you I'm curious to see what your thoughts are, okay, I used to do these really heavy, intense workouts, and I would skimp on sleep, I'd wake up at five. And I do these, like CrossFit type workouts. And what I realized after doing my research is that I was actually contributing to the problem. I was doing too many hormetic stressors, too much of a stress load on me, because those work, those kinds of stressors are supposed to be intermittent and heavy, not constant and not taking, not after you've had a bad night of sleep. So of course, I wasn't seeing results because I was throwing cortisol in my system after the workout.

Chase: throwing salt in the wound.

Amy: Exactly. So I changed a few more. I did a little more yoga. I did a lot and I did this yoga that was super athletic. Like I you know, I think a lot of people think oh, like, I'm never going to do yoga. I never did. I hated yoga. But I picked one that was very athletic. It was all about gymnastics and balancing. And so it kind of, you know that type A personality kind of can come through so well. And then I really toned down on the CrossFit type stuff, because at that time, that was like the big trend and I would wake up super early to do that. But I realized it was just short changing myself and you know all the other things that was happening because I was stressed at work, then I would be stressed at home that I was skimp on my sleep and then I would go to the stressful workout and then I'd expect to see results. 

Chase: which is where so many people go I know I've heard it. I've heard it in my coaching practice before and I damn sure hear from people now. It's like, I'm so tired. I'm so stressed. Let me just go. Let me just go move some bunch of weights, which can be great. Like it's good you time. And honestly, it's something that I love as well. But when you really, really think about it, like what are you doing? You're overloading your system. Again, you're taxing your system systems in a way that now like, it's your choice, all these other things may just be happening because the life around you, you may have some control over things. Maybe not. But then you take all that. And your body finally gets some you time. And what do you do? Do you go beat it up again?

Amy: You know about Blue Zones? Right?

Chase: Yeah. Dave?

Amy: Yeah. Dan Buettner. So if you look at the centenarians around the world, they're not going to CrossFit or like a high intensity gym.

Chase: They're walking and drinking wine with their best friend. That's what they're doing. 

Amy: so there's this exercise called NEAT exercise, non-exercise activity, thermogenesis, that's super important. And so even if you've done your workout for the day, you really need to do more NEAT exercise. So it's like walking from your car to you know,

Chase: people vastly under estimating the power of walking. It's profound.

Amy: When I, the things that I recommend is when you're really burned out, you really want to pull back on this intensity, and the type of exercise that stresses you out, and you usually know where you are everybody's different, right? Somewhat stressful to you maybe, you know, fine for me, or vice versa. So pull back and maybe do a little more walking, a little more nature time, a little more mindfulness, whatever, before you kind of add it back in and just like you said, our bodies are so resilient. Just two weeks absolutely no pulling back a little bit, you're gonna feel like a million bucks, good sleep, pull back your workout, start getting nature time, start eating better. And your bacteria actually in your gut can replace itself in three days, you can have a whole different, new you.

Chase: Yeah, I was gonna say what are some of the medical medically oriented positive effects of when we're on the comeback from this burnout? What can we actually expect in terms of biomarkers in terms of you know, anything?

Amy: So there's a biomarker for inflammation called CRP, C reactive protein, and high sensitivity of c reactive protein is a marker of inflammation in our body. And you can look at homocysteine levels that are also a marker. There's ferritin, which is also a marker of inflammation. Now, these are really nonspecific. And so some people will be very burned out, and they won't have high levels, and other people, because there are so many markers of inflammation. So those are just three that people can look at, in the beginning of their journey. And then like, follow them down. A lot of people will see, oh, wow, my levels, my CRP levels have gone down, or the biggest change, you can see is that your digestion is better. Your mood is better. Your sleep is better. So I have kind of check-ins in the book, because even in 2021, we still don't have a good panel that you can say, hey, Chase, you feel like crap and then there are a few things that you can check. But most, a lot of people will, you know, be quote unquote, normal. And so there's not a great blood test for all this. So one of the best things you can do is, how's your energy? How's your mood? How's your sleep? And how do you know overall well-being is like a big marker for how you're doing? So you know you're burned out? Like you're talking about your own stuff. I'd love to hear about it because I workshop it through. Sure. Most people know when they're approaching that. Sometimes you're not willing to stop and listen, but you kind of know when we're getting there because it's not something that gets better with just a one night of sleep. Something that is a little worse than a daily fatigue. So are you what are you doing for you?

Chase: I'm probably going on about I would say week three of like working through it and improving for sure. Um, for me it was showing up. It was well first of all, this is just a great marker for I get like we're saying before what the body remembers. It's like, for some reason, I couldn't quite put my finger on it, but it just felt like, like I felt this way before, but I don't really know what exactly I'm feeling. I just, it's like the spider sense. It was just my body's like, hey, something's something familiar here that we don't actually like. And so then, you know, thankfully now years later, I've kind of gone through processes to kind of like pay attention, biofeedback, energy levels, productivity, all these things and it just felt like it felt very begrudging. It felt like I was just showing up for the sake of showing up, I felt very kind of disconnected and unmotivated from a lot of the work that I do. And, you know, I've been doing the work that I love that I choose to do for many years. And I'm very grateful for that. But even at that point, I felt disconnected. Yeah, I felt like I

Amy: I liked that word disconnected, that's probably a nice way to talk about it.

Chase: And that's really what I've come to realize, you know, now, a couple of weeks later, it was like, I have my just unmotivated, and my lazy and retired. But it was just a disconnection. And so I kind of just took an analysis of like, what are all the things that I'm doing? And I do a lot of things like taking care of myself, my mind, body, spirit is very important to me. So if I'm doing all the things that I know that I like and work for me, what am I missing my forgetting something and or, like, let me just look at the whole. So I realized that I've just been going hard for the last like two ever since we moved to LA really the last like two, two and a half years, I have been performing at a level that a I had to just the nature of my household and the world and my type of work. And but then B it was like, I know why I'm doing what I'm doing. But the way that I go about it, it's just no longer serving me. And so it was kind of like a come to Jesus moment, I guess of, of like the physical state, but then also kind of like, I guess, the spiritual state, but just like my purpose for everything, like how I go about it, and like not wanting to just feel like I'm spinning my wheels. And so I turned off social media for a couple of days. And my wife and I took a quick little trip up to Santa Barbara, we just disconnected for like a weekend. That's kind of always my go to I go, I go to nature, once a year for my birthday actually do a bit I just go like my friends and I my wife, we get a big cabin, or we went to Jackson Hole Wyoming last year, we just get away. And so I realized that I may be needed to do that sooner this year. So I disconnected. I got back in sunlight, got back in nature, and kind of introduced a lot more sense of calm. And after that one weekend, like we're saying, I've been going for two and a half years hard. That one weekend was a very great reset for me. And it was like the hard kind of positive shock to the system that I needed. So now like two or three weeks later, I've just been taking it easier, a little bit more. I took a week off of my show. I hadn't taken a week off for the podcast in 4 years. And so after that, like it was a very great reset. And it showed me a lot of things where I was pushing too hard, where I could pull back a little bit. And just I'm still working through it for some reason. There are still just certain things I feel. It's just like a feeling. You know, I can't I can't put a biomarker on and I can't put a label on it. But my body is just like, Hey, we got some work to do.

Amy: Yeah, I think the nature thing is huge. The sleep thing is huge. And the self-reflection thing is huge. And then we didn't mention but I think food is a huge part of it. So I think what happens is,

Chase: I've been vastly under consuming calories. So that's my go to I again, I was so caught up in the work and go, go, go. I actually, for the first time in a long time I've gone back to tracking my calories. And for the first couple of days, I would just log my norm. And I would barely be getting like 1400 1600 calories. That's way too little for me. So now I'm finally back up to my norm which is like between 22 and 2400 for maintenance. But now it's no wonder Chase, you haven't been giving your body the nutrients it needs.

Amy: you know, I heard one of the other doctors saying that we're overfed, but like, you know what? 

Chase: overfed and undernourished.

Amy: Yeah, exactly. And underpowered as well because, you know, we're eating a lot of things that don't have any kind of nutrient value to us and even those of us who are, quote unquote, eating healthy. So when I went through my journey and when, after that car accident, when I really looked at my diet, and I consider myself super healthy, but I was eating very little fiber. So if, like I had, you know, my, I really didn't have much vegetables at all, and really no natural fiber in my diet, and I was thinking to myself, I Thought I was doing all these healthy things like I have like a protein bar, and then I have coffee. And then I'd have you know, all these things.

Chase: This is a double board certified medical doctor.

Amy: I was in a rush. And I would do the protein bar during work.

Chase: I was going for convenience as well, way more than I should have. Even in my mind, I was like, well, these are healthy snacks. This is a healthy protein snack, protein shake this that whatever. 

Amy: exactly. And that's when I looked into it. I was like, wow, I'm getting, I'm eating a lot of sugar that was hidden and a lot of these bars and shakes and, you know, convenient foods that are healthy.

Chase: But it also goes to the whole burnout thing, like we want something a quick fix, like, our body's gonna be craving something, right? We crave something like that.

Amy: And I had no idea that you could eat vegetables, like breakfast, lunch and dinner. I want to get like six to eight servings a day, I'm gonna have to incorporate it into like, every part of my day. So I really started to change, I realized that there's that army, that bacterial army that you're trying to grow, that's their food, they actually don't eat other food. That's, that's what they eat. And so if you're not eating enough fiber, which 95% of people are not 95? You are really shortchanging your entire health

Chase: and enough fiber being what? Are we still in like the 25 to 30 grams a day?

Amy: So most people are eating 15 or less grams, we're supposed to be in the 25 to 40 grams. But really, for optimal health, we want to be the 60 to 80 gram mark, if you look at you know, when they did hunter gatherer studies, they were probably over 100 grams a day, probably 120. And they found that the prebiotic fibers are what was feeding their bacteria, they had more bacteria, and they had more diverse bacteria. And we know that our gut, the more diverse, and the more army and the more diverse it is, the better it is. So the better we feel.

Chase: a mutual friend, Sean Stephenson actually that's one of the key things we talked about on when he came on the show a couple months ago when he was talking about his book Eat Smarter, and the fascinating old science and knew that we're finding the correlation between the diversity and your gut health, how it is directly correlated to and now we're even seeing causation to mental health, to brain fatigue to immune system, because what, like 70 plus percent of your immune system lies within that gut. When we're talking gut health, we're really talking immune health.

Amy: it is; gut health and immune health and hormone health are all one. There is even particular bacteria that they've seen, that's associated with good mood and well-being like facilitar, bacterium or whatever. And you can boost that with prebiotics, basically, fiber inulin fiber from foods. So when I learned that, I was like, wow, what that's an easy fix. I mean, that doesn't require supplements. It's not like you don't have to buy anything. Really just go to the grocery store. 

Chase: turns out mom had it right the whole time.

Amy: seriously. So and I, you know, people always put fruits and vegetables into one category. So I was eating a ton of fruit, like every day, but I didn't realize that that was not a substitute, like zero vegetables and offer it's not a good idea. In fact, it should be the opposite. You should be doing tons of vegetables. And fruit as needed.

Chase: To pick one more majority, I would go with vegetables.

Amy: 100%. Right. So then once you rebuild that gut, you start to feel better. And like you said, it's such a mental connection that you start to think better. And you know, not only is your immune system and your gut, you have a lot of serotonin in your gut, your neurotransmitters are in your gut, and they're communicating with your brain and saying, Hey, I feel better, I'm eating better. I'm less inflamed. And so things become clearer to you as well. So that's why so many people have these like epiphanies when they start because they're like, hey, I hate my job, you know, like, this relationship sucks, or like, I'm not doing what I really want to do my life or whatever it is, that becomes a little more clear. And that's really how you get out of burnout, right? Re-find your purpose, connect with people who replete you, do the daily habits that are going to give you those mini self-care and do a lot of self-reflection and really try to piece that out. And like you said, centenarians in those Blue Zones have figured out it's a you know, hanging out with your friends, community walking, nature, sleep and good food. You know, those are kind of like the basic aspects of it

Chase: My favorites are the I forget the group and I think it's Japan. The Okinawa women that just like they outlive everybody. They have a tribe together community. And they all say like good Sake. Italy it is good wine.

Amy: Yeah, exactly. So alcohol is a big part of an anti-inflammatory diet. The only thing is, is that in our culture, we take this little thing and we run with it. So if you think about what the anti-inflammatory levels are, it's three to five drinks a week for a woman. And it's like five to seven for males. Most people are doing way over that on a weekly basis. And so if you cannot control yourself around alcohol, because oh, a little bit, it's good but a lot is better than that's not the strategy for you. You have lots of other anti-inflammatory strategies. But I do think that it can be really helpful for people who are like, oh, yeah, I can incorporate three to five drinks a week for me that is easy. 

Chase: It goes back to what you're saying in the beginning, when, especially when we're facing stress and in burnout, we tend to reach for things that we may already be doing in a healthy way. But we push the envelope. You know, the coping mechanism becomes tainted a little bit.

Amy: like with coffee and what I say is that caffeine is like stealing from your energy bank. You have to pay it back. You're not, it's not free energy. And people don't like when I tell them that they're like, wait, it's not? No, you have to put that energy back through either sleep or rest or recovery. And if you don't, you will crash. And that's why so many of us overdo it on the caffeine, and then you have a super big crash in the afternoon. And that, you know, that's a sign that you need to kind of get off that caffeine.

Chase: that was another thing I did. And I've always been very conscious over the last several years I've been very conscious of not only caffeine, and like total milligrams, but my caffeine cut off time. So I actually the past  like two weeks I've realized I'd gotten a little high caffeine high for me had been, like 350 milligrams, maybe a day. Well, actually would have to two, but I know the exact dosage. I use, like a couple different specialty coffees. They're healthy coffee. Yeah, they're really good. So I actually would then decrease my servings to 250. I decreased by about 100 milligrams per day. And my caffeine cut off time was usually two o'clock. But when I really looked back, again, I was logging things. Now I could see it was actually pushing between two and three ish. So that extra hour could have been directly correlated to you know, reduce recovery, sleep quality time. So I cut back 100 milligrams. Now my max is 250. And I have a hard like, absolutely not past two o'clock. Honestly, I'm sure I'm shooting for more for noon. 

Amy: It's my, like, I can have something at lunch. And that's it. That's kind of like my cut off. I'm like, and it depends on how you metabolize caffeine. I'm a slow coffee metabolizer. So if I have something in the afternoon, I will definitely have a poor night as well. So it just, it does depend on the person, but you will know, I mean, you probably know that if you consume caffeine late in the afternoon, you're gonna feel it, you won't be able to fall asleep. The other thing I talked about is high quality sleep. So I think I severely under because of all these years of training and so much sleep loss, that I kind of lost respect for sleep, like I love sleep, but I thought, oh, I can't sleep. I'm not that's not productive. 

Chase: That's not grinding. 

Amy: Yeah. And then I realized, like, oh, all this. All the things that you want in your body, and in your mind, and your brain and your gut, happen during sleep. And so I started to really guard my sleep and clean up by sleep routine. And like you said, caffeine, it was the blue light exposure. It was the working all the way through until bedtime. It was, you know, not realizing that if you have ambient light in your room that's actually disturbing your sleep. So they did this interesting study with two groups of overweight women, because they knew that blue light has some implications on weight. They weren't sure. They had these women sleeping rooms, one with ambient light in the room, kind of like a nightlight. And then the other ones were in a blackout room. And they found a significant difference in weight loss with same calories consumed. I mean, if that's not enough for someone you know who's trying to be fit and healthy to actually make it a blackout room, or you can wear a face mask and make

Chase: I use a face mask for sure.

Amy: I totally look like a crazy person especially when I travel because it's like earplugs and the face mask because I realized that if you protect the quality of your sleep, you're just a different person the next day and you're building up that gut bacteria, you're helping your immune system, you're helping your hormones, and all of the things you want, both externally and internally are working the way that you want. And I just feel like I'm a better person, I get work done. So I started to protect my sleep. Like it was like the most important thing. And it's funny because you know, even now, I think that they say you're supposed to sleep at the same time every day. And obviously, on weekends before the pandemic, we could never do that. So I made a rule, I wouldn't go more than two, I try not to go more than two hours past my bedtime. And most nights, even on the weekends, and then you're not so hung over or like sleep hungover it feels so horrible the next day. So protecting your sleep became one of the big tenants, for me, that helped me through my burnout. And I tell people, like you'll have to sleep a little bit extra, when you're trying to get over, I'm sure you've felt this in the last couple of weeks when you've worked on it. It's not enough to sleep your usual seven hours a day.

Chase: I've been going over probably, I'd say 45 minutes to sometimes an hour and a half and I don't set alarms, I go to bed at the same time I wake up the same time that my natural rise time last month ish has been about 45 minutes to an hour and a half more than usual.

Amy: Yeah. And it's nice, because you really do need that time when you're recovering from that you need that extra time to recover. So don't feel guilty. And I think that's one of the biggest things that I have to tell you and other people like, I think that we all give ourselves so much guilt for taking a break.

Chase: yeah, that's I was gonna say that's got to be another component to this is that you try to take care of yourself. But then you feel bad about doing that. Yeah. Because you think it's creeping into all these other responsibilities. 

Amy: we feel so guilty for ever taking time for ourselves. I mean, I've had people say to me, oh, it must be nice to you know, sleep, work out now, you know, kind of implying that it was selfish or that it was must be nice all these things and what I said is that actually protects me from being able to protect me from burnout. And it helps me do more during the day and last longer, without, you know, feeling burnt out. So I think for me, I realized I'm allowed I'm, I'm giving myself permission to get sunlight every day to get a workout in every day to sleep every day to eat good food every day. That is not a luxury that is part of self-preservation. I think we've lost that in our culture, I think we kind of feel like all of these things are like, nice to haves. But it's you must have that. And you know, there are things we can do in the future. Like I said, the technology can change, we can have different barriers. So in my world, sometimes you're getting a lot of emails, tons of activating things late at night and so one of the things I've decided is I don't make any phone calls or any activating conversations or like stressful events, like two, three hours with somebody that's gonna demand more of your time and energy. I try not to do any meetings like late like, we used to do practice meetings now at like 8pm or 9pm. And I don't do that anymore, because then it's like just riling you up, and then you can't sleep, and you have the higher anxiety levels, and your body's basically getting mixed signals like, Hey, I thought it was like time to go to sleep. And like, now you're doing all this stuff that's keeping you awake

Chase: yeah, it doesn't know how to properly respond when it needs to.

Amy: Yeah, so then, I started to turn off all of my devices, I still have my phone with the blue light blocker. And but I don't respond to any like emails, I don't do any major phone calls or meetings or anything, two to three hours and that's a really nice way to block your mental space. And I really have a strong nighttime routine just as strong as my daytime routine. And these are all little sounds like a lot but literally ends up being just minutes a truly extra. That's basically how that's what I talked about in the book.

Chase: Amazing. Well, we definitely gonna have all the book information listed down in the show notes for everybody. I've thoroughly enjoyed this conversation and kind of getting towards the end. I have a one other question I want to ask you before I final question. So we've been talking about a lot of different ways to work through well, to understand it, to address it, to pay attention to it, how it's probably showing up in our lives. What we can do to address it and work through it. What's waiting for us on the other side of burnout, like once we actually kind of take control back of our life and reintroduce some things that get us through this burnout like what can we expect to like to get back into our life?

Amy: I think the biggest thing I noticed a change is my energy levels I had stained and high energy. I think we all want that, right, want to be able to do the things that we love, and we want to do with full energy, you will have energy like you haven't had since you were a kid. That's how I describe it to people, I think I thought, okay, getting older is also energy depleting but I didn't realize that just like muscle, you can build muscle at any age, you can actually build your gut health, your immune health, your hormone health, you can be energetic at any age. I also think it really brought out in me my purpose. And so then once you know your purpose you can draw clear boundaries, 

Chase: that is a whole other source of type of energy. 

Amy: so once you realize what you really want in life and what you're going for, then the boundaries become a little more attainable, because that you can say, Well, you know, what I'm going to not do or interact with, or I'm really going to protect this passion and build some boundaries. And I think building boundaries is so empowering, because you're saying, Hey, I love this energy, and I love what I'm doing as my life's work and once you figure out the people and the pieces, then you protect that at all costs. And that means, you know, maybe that means not doing the eight o'clock meetings ever. Maybe that means not answering everybody's text right away. Maybe that means, you know, putting no notifications on your phone, and just, you know, whatever it is, those are my boundaries. You know what I mean? Whatever it is those are mine. But make sure you have boundaries. Because once you respect your own self and your own time, people start to respect that too. There'll be like, oh, yeah, I don't call Chase after 8pm. Because I know he's not gonna pick up until the next morning. You know, like, that's, that's what I'm talking about.

Chase: Yeah, I've even had to have some moments with my own family member like, why don't you answer your phone? Why can’t I reach you? I don't turn my phone on until like, X amount of time after I wake up. I don't, I can turn it off X amount of time before I go to bed. You know, what if it's an emergency? Well,

Amy: figure it out.

Chase: thankfully, you know, do not disturb on the phones. Now, it's like, if you try to call somebody, I think three times in a row, it'll actually go through. So there are ways even in the modern world to set boundaries, but still be there for the people 

Amy: I had a strategy. Well, we stopped this strategy. But my strategy was that I had a landline but nobody knew the number except for a few key people and so I would be okay, I've disconnected from my phone. But I knew that if there was an emergency, we could use that. But now we have that do not disturb thing that you can you can do. And you can selectively deselect, you know, my kids calling?

Chase: I need some people to come through.

Amy: Yeah, exactly. So for me, putting up boundaries has been so empowering. Because once you really do realize what is repleting you and what is draining you, then you start to put up those boundaries. And then you feel so much better. Because you're like, Oh, I should have done this years ago, like I should have said, you know, I'm not going to, you know, do this thing. And be okay with it. It's not like, yeah, you don't have to be in the popular crowd, you can say whatever you want to say. And as long as not hurting someone else you're good you know,

Chase: one thing I heard in there that I love is that it can come across in people and we talked on that talks about that earlier, as well. And all the things we've been talking about of biofeedback of paying attention to what's showing up in your body and your mind, like, also look for that in people take an evaluation analysis of the people that are just energy suckers, and never energy givers. And it's a very, very hard thing to go through. I've been through it so many times. And honestly, it just turns into people coming and going out of your life. And at the end of the day, you have to recognize you have to do that, because those behaviors aren't going to go anywhere.

Amy: Yeah, no, you have to you have to take those energy suckers. If you can't take them out of your life I say just stop giving them your energy. You don't have to engage.

Chase: it doesn't have to be a harsh cut off kind of thing. 

Amy: it can be that they wouldn't even know the difference. Because they might just see you in passing now and you're just too busy to you know, maybe you're not organizing things with them. But you are reaching out to someone who is giving you energy and I think that that naturally kind of happens sometimes. But if you're deliberate about it, you really can do great things and you know energies is such a thing that if you give up off really good energy, you will attract more people with really, absolutely, yeah. And then you can kind of engage more with those people and engage less with the people who obviously don't give you good energy, and then you don't have to give energy back to them. So that's the energy tactic. 

Chase: that reminds me this tactic I would use to use a lot in practice of when people are embarking on like their health and wellness journey, especially in the beginning, a common misconception is all the things I have to give up. All the things that I can't do, that I can't eat, or the places I can't go. And that is just a mindset shift that we would work on a lot. And I still try to work on that through the content in my own life is no just focus on what you can do. Focus on the people that light you up, focus on the people that you light up, focus on the things, the practices, the modalities that just give you back something, some kind of ROI and just lean into that. And like, just follow that mentality and the things you're doing, the places you're going the people in your lives, things are eating, like you will also just wake up and realize like, wow, I'm, I'm getting it all back. Because I've been giving only to people places and things that deserve it.

Amy: it's so empowering. So that's, that's really the key is, is finding out what things can replete you and what things and people are depleting you and kind of doing an edit.

Chase: yeah, that's, that's a whole I feel like I have a whole other conversation on like the people in the community aspect. That's been that's been, especially what the whole world has been going through this last year, that detachment and lack of community for so many people has just, I mean, now we're literally feeling it a year later of having such, like, harsh lines in the sand of how often we see people when we see them where we see them. It's just been like, now we're really we were reaping what we sowed.

Chase: it's terrible. I mean, there are people who haven't seen anyone for a full year. It's so sad for our elders and children. It's, it's, it's just sad all around. And everyone, you know, can argue about, you know, what we did wrong. And what we did, we can all say that we all suffered from the disconnect that we had this year. That's why I started to really realize, oh, there's so much value in the actual energy exchange in person energy. And that we really underestimate that when we you know, this year, we weren't able to do that. We realized now what we were missing, you know,

Chase: which is why I'm so grateful you are here in person. I appreciate appreciated and enjoyed your energy and your expertise today. And so the final question I ask everybody on my show is ever forward; to live a live a life ever forward and I have like this philosophy of taking awareness, a heightened sense of attention, awareness to our fitness or nutrition or mindset, all the things that just make us and what we can fine tune and what we can keep and what we can maybe get rid of just take a step, take the step, take any step to just move forward. How do you interpret that? What does that mean to you? How can what you're doing in this whole work of burnout help us do that?

Amy: I think the whole conversation we had was really how to move yourself forward, how to move our society forward. If we understand these things, then we can build systems, we can build technology, we can build network, I mean, we can really change how we build the next, say 20 years of our lives forward by learning all this and incorporating it and making it tangible tools for people. Maybe, you know, not everyone can get natural light, but maybe they can, you know, have these light lamps and in the winter months, and maybe, you know, we emphasize nature time more on for everyone. And maybe we deemphasize working late at night or eating late at night and change our culture a little bit. So yeah, moving forward as individuals act as a collective society by doing some of these things, especially the circadian rhythm synching is something that I think that can change a lot of people's lives.

Chase: I agree. Very well said. I always tell my guests there's never a right or wrong answer. It's just, I love it right? After we have our conversation, and then you know, I share a little bit of the philosophy of my own and in the show, you know, I'm always grateful for the answer that I get. So it help. Well, where can people learn more about you? Where can they get the book? If they want to go somewhere right now connect with you where are they going?

Amy: there a few places. So on social media, I'm at fasting, MD, on Instagram. I'm at Amy Shah, MD on Twitter and Facebook. The book is that I'm so effingtired.com

Chase: I love the title by the way.

Amy: Amymdwellness.com is my personal website.

Chase: Okay, amazing. Well, thank you so much.

Amy: Thank you so much for having me.

EFR 462: Scientific Ways to Beat Burnout, Boost Energy, Reclaim Your Life and Stop Being So Effing Tired with Dr. Amy Shah, MD

Dr. Amy Shah is an allergist and immunologist at Valley ENT as well as a speaker and consultant on health and mindset. In March 2021, she published her first book, I'm So Effing Tired: A Proven Plan to Beat Burnout, Boost Your Energy and Reclaim Your Life.

Shortly after starting her wellness practice, Dr. Shah was named one of mindbodygreen's Top 100 Women In Wellness to Watch in 2015. Clinically, she was named in Phoenix Top Doctors magazine in 2017, 2018, and 2019.

We kick off the conversation with the personal experiences that led Dr. Shah to learn all she could about burnout and, later on, offer guidance to others who are suffering through it. She was inspired to do her part in changing the mainstream perception of burnout as a “badge of honor” and steer people away from the glorification of “the grind”.

Listen in as Dr. Shah goes on to discuss the hidden dangers of supplements; why cases of burnout have drastically risen over the past year; the benefits of “circadian fasting”; and how optimizing your gut health, immune health, and hormone health can supercharge your energy levels no matter your age.

 

Follow Dr. Shah @fastingmd

Follow Chase @chase_chewning

 

Key Highlights

  • Dr. Shah shares why she was driven to understand burnout and how it affects mental health and wellness.

  • We’ve all heard of intermittent fasting. Dr. Shah introduces a new concept, “circadian fasting”, that combines the knowledge of circadian rhythms with intermittent fasting.

  • What biomarkers should we look out for when recovering from burnout?

  • Gut health, immune health, and hormone health are central to energy. Dr. Shah explains how to optimize all three.

  • Chase and Dr. Shah describe how their nighttime routines evolved over time and how to get a good night’s sleep.

Powerful Quotes by Dr. Amy Shah

Real change in your life comes from changing your daily habits.

Giving your body food in the middle of the night is like me waking you up and asking you to do a complicated math problem in the middle of the night. You’re going to get it wrong, you’re going to be pissed that I woke you, and the next morning you’re going to feel tired. That’s how our gut bacteria feel when we eat close to bed or late at night.

We’re literally different people at different times of the day because the genes that are turned on during the morning are different from the genes that are turned on during the evening.

Gut health, immune health, and hormone health are all one.

Once you respect your own boundaries and your own time, other people start to respect them, too.

 

Episode resources:


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Interview transcript

Chase: no and continuing in a way that doesn't serve us compounding stress and all these things is really now your specialty. It's kind of what you literally wrote the book about it.

Amy: Yeah. So people who are giving you care are the most burned out of them all. So it's like, how are they going to offer you solutions when they themselves can't get themselves better? Right, like

Chase: So what brought you to this conclusion? What brought you to I need to focus on burnout, and how it's actually affecting people in their health and wellness?

Amy: I mean, I think you and I both know that it's not just this past year that we've felt burnout, I think a lot

Chase: It has been a tipping point for sure.

Amy: Yeah, I think a lot of us have felt it even before well, before the pandemic and I definitely had my crisis. And I could not figure out why I was so tired all the time, why I had GI complaints, why I was feeling anxious, you know, all this stuff, nutritional stuff, bloating. And I felt so stupid, because my labs or my labs were, quote, unquote, normal. And they were like, you're fine. You know, I don't know. You're just getting older. I was a mom, like I had a new practice. And so that was, it was just chalked up to, you know, just accept it. And there's no solutions given at all, no tools, no solutions, no advice. I mean, I knew I wasn't expecting dietary advice. But I was thinking like, maybe there were some things that people can impart on me that was interesting. 

Chase: So you were hoping to find something wrong so you could fix it?

Amy: right. And I see the frustration for so many of us. And I know you're alluding to the fact that you had something similar recently.

Chase: Oh, yeah burnout, for sure.

Amy: So then at that time, I didn't know what that was. And I looked up all my symptoms, because I thought, well, you know, I get why people are frustrated, because there's no real answer. And so there was this, these things about gut health, you know, poor gut, health, leaky gut, whatever. And then there's this whole thing about adrenal fatigue and hormone imbalance. And then there's this whole thing about inflammation and so I kept thinking like, okay, maybe I'm inflamed. No, wait, maybe I have a leaky gut, no way maybe. But I realized that the way energy works is focused on health. It's actually like all interconnected, the gut health is connected to inflammation connected to hormone health, I had no idea. I mean, all these years of schooling, I was a nutrition, nutrition major in college, all these years of schooling, and I had no clue that this was all 100% connected. Inflammation is actually fatigue, like, so when you're inflamed. When we say, you know, inflammation, that's why you feel tired. That's why you're feeling burned out, because there's such a connection between the brain and the body. So when the body feels inflammation, it sends signals to your brain to say, hey, slow down something, she's sick, he's sick, something's wrong, something we can't keep on going with what we're doing and then we have our stress in our lives that are making us more inflamed, impacting our gut. So realize a hormone, the gut and the immune system are completely connected and everything we do around that has to kind of help all three. And so the whole thing about a system like, oh, your adrenals are, you know, burned out that like, that's not even, that's not what's happening. So I realized, like, okay, so then as I started to figure myself out, and it's not rocket science, like some of the things that I talked about are things that you probably intuitively knew help you, you know, how you feel when you get a good night's sleep, I just found that the science behind it, you know, that helps the gut, it helps the inflammation, it helps the hormones, but in intuitively, you knew that. So it's not everything is not like this shocking revelation, but I pared it down to the things that really, were going to make a big difference. And I experimented myself, and then I helped other people with it. And then that's why I wrote the books because, because I thought, okay, if I can pare it down to a few little changes throughout the day, like you're really busy, I'm really busy. I can't be like doing every single wellness trend that's out there a lot. It could be like a full time job, right. And it is some people's full time job. You live in LA, there's people here who literally spend their entire day in their wellness routine.

Chase: I probably spend hours a day. 

Amy: so I was trying to think of like, what's a total of one hour a day, little things that you can do to kind of like change that so that you're one lifting yourself up out of burnout, which is like the first part of it, and then choose like keeping a daily routine so that you don't get into that place again. I put a quote up the other day that said, like, real, if you really want to be burnout, you have to build self-care every day. It's not chocolate, cake massages, and you know, spa day or whatever. Like, you have to build in little parts of your day, every day to prevent the long term burnout. And in our culture right now burnout is a badge of honor, like if you're exhausted, because you're working so hard. Like, that's amazing that, you know, that's great.

Chase: it is glorified it means that you're grinding? 

Amy: Yeah, like the grind is total glorified. But people, I feel like, we can adapt, we can learn this information. Technology is moving so fast, that we have all these tools today that we didn't have 10 years ago. So couldn't we build new tools, 10 years from now that would like learn from this, maybe, you know, we don't need to be looking at screens and doing work, you know, all the way until midnight or 10pm every night, maybe we can change our culture a little bit so that all these things don't emit so much blue light. Because like at night, not only are we not supposed to see blue light, our body's also more sensitive to it because it's like it's sensing whether it should stay up or not. 

Chase: should I stay vigilant or not? Is there a threat? Or is there a reason we need to be up? 

Amy: exactly. And then people who are worried about aging. So if you think about skin, I found this to be fascinating. Skin has a circadian rhythm to like a body clock and so it knows that during the day is probably when you're getting the most sunlight and blue light. So it has a lot of defenses up against aging and discoloration wrinkles. 

Chase: I read this in Matthew Walker's book “Why we Sleep” it has this concept of like all the photoreceptors that our skin actually has, just in the rods and the cones in our eyes. 

Amy: yeah and then so they are really turning like down off the genes the protective genes at night and so when you are seeing a ton of blue light, or your you know, expose to stressors for your skin, you're going to age faster, you're going to get more wrinkles, you're gonna so it's not just about you know, feeling tired. It's about aging in general that you can really change by changing our habits. So I think for me, it was eye opening and I felt like you know, there's so many amazing people in the world who could make changes or make technology or do things that can help us through this

Chase: shout out. Where's Elon Musk? Can we focus on Earth a little bit more? I love space travel. But we got a lot of problems right here.

Amy: yeah, here at home, inside of ourselves. So that was something that I thought was important to share and clarify for people because I think we hear so much information, that it's hard to know what's real, what's not. So I kind of parsed it out. For us to say, Okay, this is where it matters. Let's concentrate on these things. And then, you know, if you have extra time, you can do all this other stuff, right? 

Chase: yeah because we can do all things and I've been guilty of trying to do them all as well. And I would even say kind of in the pursuit of preventing burnout in the pursuit of taking care of yourself it almost induces stress and burnout, because it's like you learns, it's like, trying to drink water out of a fire hydrant, yeah, learn all these things that you can do to improve your health, your wellness, your sleep, your metabolism, immune system, all of these things, and then you try to do them all. And then sometimes it can, you know, work against each other, and just add more stress.

Amy: I didn't know before looking into it, that there are many supplements that actually damage your body and so when people are adding on these things to their wellness regimen, you have to remember that some things cancel each other out. Other things

Chase: decrease or increase bioavailability of nutrients.

Amy: yeah, antioxidants taken by mouth through supplements are actually not good for your body.

Chase: Really? How so? Like they cancel them out or they hurt you actually?

Amy: yeah so we have a very complicated antioxidant balance in our bodies, right? So when you're adding things, it can throw off that balance. You can get more oxidative damage by adding antioxidants on, you know what I mean? It's so wild, like, whenever, when I read those studies, and you know, there's so much controversy about vitamin A and vitamin E, both of which were shown in studies to be dangerous when taken.

Chase: individually, or in excess?

Amy: vitamins A, D, E, and k are fat soluble and so if you take too much, you will store it in your body, and it can be toxic. And so after I read all that I really became a big minimalist on supplements. And I realized, like, these wellness routines that people talk about that have, like, hundreds or like hand fulls.

Chase: you don't want to look at my pantry. I mean, I've got a repertoire of things that I yeah, I choose and select and based on kind of over the years of a lot of self-experimentation. It's like, I need this, and I want that. 

Amy: I have a few that I experiment with but I also remember that these studies are really powerful. And we don't even know that half of it, because most people aren’t doing studies on supplements and we don't really know what happens if you mix all of these things together. And what we do know is our body's super smart, and if it's food based, it's able to kind of parse things out a lot better. So antioxidants from fruit, for example, are really great for you. But if you separate that into a supplement, it can be dangerous.

Chase: I've read so many things on that topic of how in Whole Foods, the way that things are even like just the amylase that your body produces in your mouth to just trigger the initial breakdown of certain starches and sugars and things based on what you see and what is known and that it has had before, like, that's the start of the metabolism. And so then it like from the entry point, based on what it is it is going to have a relation and it's going to have a lot more like basically just things ready to go, that we don't even fully know about, like the way that we absorb things and the way that certain phytochemicals and nutrients interact. There's so many things we can't even tap into to understand all of them yet.

Amy: We don't we don't. And we don't understand how our gut bacteria sort of got back to our urine, the army, right? So the military. So the gut bacteria is literally our military and it determines so much of who passes through, who are we going to attack? What are we going to extract from this

Chase: great analogy?

Amy: And they communicate with our immune system at all times. You know, hey, I need help, come over and help me. And so what's that complex interaction is something we don't understand. That's why people say, Oh, I can't do gluten, but nothing comes up on testing or I can't eat dairy, but nothing comes up on testing. It's because there's such a complex interaction between our gut bacteria and our immune system that we can't understand yet. There's no test for it. And it can change. Because we know that gut bacteria as it changes, it may be tolerating new foods, right? Most, a lot of people will say, they have all these food intolerances, and then once they kind of fix their gut, so that means replace some of that army they will be able to extract the nutrients that they need and not have such a bad reaction to them. So that's the basis of actually my book, the basis of the book is to understand, hey, this army is in constant communication with your own immune system, and your brain and the hormones and so you really want to keep that group intact.

Chase: as like a primary focus? 

Amy: yeah and that's, that's how you're going to get more energy and get out of burnout as on a personal level. Now, burnout is, there's so much brain burnout too you know,

Chase: yeah, I would love if you could, can you kind of really define burnout? What is it from the medical perspective in terms of how it shows up possibly, things people can be on the lookout for? What it looks like, what it feels like?

Amy: Well, burnout is a controversial term, because there's no medical diagnosis, per se,

Chase: you're not like, alright, yeah, burnout. Take two of these. 

Amy: exactly, exactly. It's I mean, fatigue is fatigue is an actual medical diagnosis, there is testing that you would do to rule out medical causes of fatigue, thyroid, B 12, vitamin D, and anyone who is suffering from burnout or fatigue should definitely undergo a battery of tests to make sure that there's not an obvious Oh, it's your iron. You know, it's your it's your B 12 level, like a lot of people who are plant based they deplete their B. and vitamin D, as you know, so much so many of us are low vitamin D,

Chase: it is instrumental in so many things in the body,

Amy: right. So fatigue is a diagnosis and burnouts, main symptom, the prominent symptom is fatigue, but its constant fatigue, 

Chase: it's an inexplicable fatigue 

Amy: exactly, that doesn't go away with a good night's sleep, it is the feeling of depletion. It's a loss of motivation. So a lot of people who feel burnout won't be able to do a good job at work, because they feel not only tired, but almost like the loss of motivation, apprehensive, and a change in mood. And there's a few, you know, there's a few different definitions of burnout, but in general, those are and then there's a whole host of medical symptoms that people will get often, for example, you'll be tired but wired at night.

Chase: Yeah, the mind is just constantly going, going, going. All the things you didn't do.

Amy: Exactly, so tired, but wired, so you get a very sleepless night of rest or don't sleep well. And then you have often GI complaints because our gut is so connected to our mind and so when you were in this fight or flight mode, and you're feeling at the end of that road kind of depleted, you will often have GI complaints, so people will often complain of like constipation, or bloating, or just some GI distress,

Chase: irritability, or general, irritability,

Amy: reflux disease. So that's often a part of burnout as well. So burnout is real, but has a variable definition. But most people will say that symptoms of burnout have risen over the years. In fact, this last year, there's a 33% rise in people who were saying that and before that it was about 69% of women and 50% of men said that they reported feelings of stress, burnout or fatigue beyond the norm. And, you know, there is a differential between women and men. And this seems to be both societal and biological. And this year, obviously, a lot of the stressors came into focus. And what I think happened this year is that the mistakes we make and society just became more blatantly obvious. You know, some, some of the things I talked about in the book is like disruptive circadian rhythm; so that internal clock that we have in our brain and each one of our cells, we need to be listening to that and when we were indoors all the time for, you know, a good part of this year, not seeing natural light, maybe getting a ton of blue light because everybody's like stuck to their TVs 

Chase: reduced physical activity. Gyms were shut down. 

Amy: gyms were shut down. We were getting no social interactions. And we had no release, right? And then you couldn't sleep at night because you were stressed. And a lot of people were triggered by what's going on? So there are these unconscious pathways that are connected to our HPA axis or our HPA axis is our stress pathway. Hypothalamus pituitary adrenal axis and there's a part of our brain that's, that gets programmed from when we're children to respond to stress. That's why some people who have had a lot of trauma in their life, really had a hard time during the pandemic, because you know, these trauma pathways trigger that cortisol, more so than maybe others.

Chase: I'm so glad you said that right there. And sorry to cut you off, right. That's such an important point. And I'll say personally, that's been an irreplaceable part of my wellness journey. But also for people to realize right now, when they're listening and hearing this, like the things we naturally gravitate towards, or the route that we think we're supposed to take, or maybe even our doctors or providers tell us to take can be beneficial. But there's a lot more going on in the background, and the conscious and the subconscious and just that initial framework and system really, that was wired and built years and years and years decades ago, even for some people say don't discredit that I'm so glad you brought that up.

Amy: I mean, the trauma pathways, not only build our thoughts, but also what we look for, for comfort.

Chase: Exactly. How we cope. Or don’t. 

Amy: Yeah, exactly. Or, you know, what are we reaching for to cope? Because there are a lot of people who need comforting, but they don't know how to get it and so they reach for the easiest tools that they can find to cope and often that's negative coping. So you know, drinking has gone up, you know, usage if there's some food intake can be comforting in a negative way for people like they go back to their you know, what releases dopamine and serotonin 

Chase: they go for the chips or they go for the Oreos? Oh, that's just me. I am a sucker for Oreos. I don't keep them in the house. I'll eat a whole sleeve and won’t even think about it. 

Amy: that is so funny. I don't think I've eaten Oreos, I am a salty person. So definitely during the pandemic, I hadn't eaten, you know, regular chips. I mean, tortilla chips I've had, you know, at a restaurant or whatever. But I would never buy bags of chips and salsa or like potato chips. But I got into all that stuff because I think it was just like we're saying it's a stress. Everybody has subconscious pathways. You know, we all have some, I mean, when you drive to work every day, that's your subconscious pathway driving you because you're thinking about something else. So we have so many of those, and those get triggered. And so what I was trying to do in the book is say, one recognizes that because sometimes you just fall into those habits, and you repeat it every single day. And they're negative habits. And it's just because you've done it since you were a kid or you know, that comforted you as a kid doesn't mean that that's a good thing. 

Chase: or they're seemingly positive. Right? But they're just not leading you to that same positive outcome.

Amy: Yes and then changing I think, real change in your life comes from changing your daily habits, changing little things, understanding the science of why you're doing what you're doing. I think so many people, myself included, think like you too when you start to improve your personal health. Your mental health starts to improve, and you start to see things that are

Chase: a little bit more of the veil lift; what you're doing, what you're not doing. The response that you get.

Amy: I was running like a million miles per hour every single day and I had this huge car accident, which is how I start the book. Because what happened is, I was burned out. I knew I was burned out, but I couldn't stop, right.

Chase: said every person that has been through burnout ever.

Amy: yeah, I was like in the cycle and I had so many things going on and I had a new practice. I had these little kids that were depending on me to pick them up all this you know, do all these things. I had my boards coming up because I had two board certifications. So you have to like certify for both and I was just running on empty and I thought just like we were talking about before that I wasn't trying hard enough if I got enough sleep because if you're sleeping that means you're like not living or not doing a good job, right? And I thought that I didn't have time to do a real workout or something I really wanted to do, I had to do something really quick and intense.

Chase: I am sure no one listening has had any of these justifications running through their head, never.

Amy: right and then you give yourself a lot of guilt for doing anything for yourself, because you want to be working all the time. And so I knew there was something very wrong, but I couldn't put my finger on it. And I didn't know what to do. Because I didn't have any tools, I didn't have the knowledge of like, what I should be doing. And so one day, my partners asked if we could do a last minute meeting at five after clinic and I, and I wanted to say no, but I felt like I had to say yes, and I didn't have the guts to explain, like, I have to go pick up my kids like they're going to

Chase: Maybe you didn't have the gut health.

Amy: Right. Exactly. And I and I didn't have the clarity to know like that I should speak up. Because I thought it would be judging me like I was new, you know. So anyways, I thought, okay, I'm just gonna not like going through the meeting. I just have to get there before six because I think they were getting out at 530. And I thought, okay, if I can get there by six, the center closed at six. So I'd be okay. So we get done. You know, later than I thought really close to six. And I literally ran out of there. And ran to the car. I was rushing to go pick them up. And you know, those little small decisions you make, like, should I make that like and I think about it now, it's so clear in my mind that I was rushing. And I wasn't like

Chase: It's a great example of how even the most seemingly obvious things that of course we could answer in our sleep when under stress it just kind of makes us like, baby deer just stuck in the headlights.

Amy: Totally. So I was making a left, right, what as I was getting to the center, and that I got into a car accident with an oncoming car, who and literally I saw, you know, I was literally spinning. I thought I was spinning for minutes, but I guess it was like seconds because it was a big intersection. And the only thing I remember is I've never seen all the airbags inflate the entire car. Like there were back seat ones front seat ones.

Chase: your car just turned into an airbag? 

Amy: literally, it was an airbag. So it activated all of that stuff. And then all I remember is I got out of the car, and I was bloody there's, you know, the whole windshield was shattered. And I remember thinking like, I don't care, I need to run and go to that center because it's like six and, you know, like, I have to be there and I have to take the kids and they say no you can't go anywhere you are in this huge accident.

Chase: You're bleeding like you need to stay.

Amy: I could barely walk. Anyways, so I had I was on you know, I couldn't do anything for the next week. And it really opened my eyes. I was like, Okay, I need to, I need to make some big changes here. There's no reason for me to feel like I didn't feel almost like a worse version of myself that I didn't want to be like I was cranky, like a virgin. So then that week really helped me kind of refocus. And I started to look into a lot of more of this stuff. And that's where my journey started. And as I started to figure it out myself, I made a ton of mistakes. But as I started to figure it out myself, this is why I mentioned before the wellness, like the energy trifecta, I realized, oh, our gut health is related to our energy, but then our immune health is also related to our energy, and so is our hormone health and if you keep all three systems happy, you will feel good on daily basis. So I learned that and I started to implement things to help all three things every day. And then over time, I refined it, then I tried it on other people

Chase: sounded like you did a great little self-assessment. And paid attention to the variables of what was working what was not.

Amy: and I made a ton of mistakes, because just like a lot of people out there I was tempted by all the shiny objects, oh, take this for adrenal fatigue or, you know, try this diet for and I think that it's kind of like it kind of like steered me the wrong direction. But then when I came back, I was like, Okay, I realized there's no real shortcut to doing the work but here are like some of the things that helped in circadian rhythm. 

Chase: what is the work please? 

Amy: The work is fixing, you know, that gut, that hormone system and the inflammation system, which sounds complicated, but it's literally the same few things like one was living with their circadian rhythms a little bit better. So our society as its belt is completely off from circadian rhythms, like we are programmed to sleep at night and not eat right before bed. And so when I got interested in the science of intermittent fasting, it made so much sense to me. I'm like, yeah, of course, you're not supposed to be eating late at night, and probably, you know, 1000s of years ago, you didn't wake up and have a pop tart, like, as soon as rolled out of bed, right, 

Chase: like, roll out of the cave, and yeah, go find some scraps.

Amy: So it made sense to me that there, there should be a little bit of a break. And then I learned, oh, got health improves from that those bacteria need a break to like, it's I mean, giving your body food in the middle of the night is like waking you up and asking you to do a complicated math problem in the middle of the middle of the night,

Chase: Even in the middle of the night, or you are what about just like late night like a couple hours before bed?

Amy: Yeah, yeah, that's what I mean. That's, the feeling is the same as waking you up in the middle of the night and asking you to do a complicated math problem, you're going to get it wrong, you're going to be pissed that you were woken up, and then the next morning, you're going to feel tired from being woken up at night. And that's how our gut bacteria feel when we eat kind of close to bed or late at night. And so I understood, okay, that makes sense that’s what intermittent fasting can help. But the way I talked about in the book is circadian fasting.

Chase: circadian fasting. I've never heard that. 

Amy: that's a new concept that basically combines the knowledge of circadian rhythms with intermittent fasting. Because

Chase: what does it look like? 

Amy: Yeah, so the Nobel Prize in Medicine in 2017 was on circadian rhythm science and then in 2019, it was on intermittent fasting science, because these are two novel concepts. I mean, they've been around for 1000s of years, but it's like novel

Chase: finally kind of paying attention to them, right. 

Amy: So what we realize is, hey, 80%, up to 80% of our genes work on a circadian pattern. So literally, we're different people at different times of the day, because the genes that are turned on us during the morning are different from the genes that are because, of course, the morning our body wants to focus, our body wants to metabolize. And so the genes for metabolism, focus, energy, or like high, and then two to three hours before bed when our melatonin hits the system it starts the genes that repair and renew. So when we're doing all these things off, eating off schedule, seeing a lot of blue light, not seeing daylight during the day, we're literally shortchanging our repair renewal processes. 

Chase: I actually caught myself on that recently today, I forced myself to take a break, my office downstairs, faces the other side of the house here, I get no sunlight. And I was telling you earlier, I've been kind of going through some burnout. And I've been doing a lot of things to work on that and repair it. And one thing came to mind that came to light today, pun intended. I haven't been getting regular daily sunlight. And it sounds so bad. I live in Southern California where it's sunny all the time. So today, I took about a 25 minute 30 minute break, went up to the roof, took my shirt off, had some shorts on, just got some sunlight, and listened to an audio book. And so it gave me kind of twofold from burnout. It helped me introduce break in a pause and de stress. And it gave me simple, I guess, threefold the sunlight and then I finally got to catch up on an audiobook. So yeah, some kind of like pleasurable thing.

Amy: That is one of the biggest things I actually say is a strategy. So you figured it out yourself. So basically, the multitasking of taking a break, getting the sunlight, and doing some self-reflection is the multitasking way to really get out of burnout. One of the tricks and what I recommend is to do in the morning, like before 10am if you can

Chase: I always strive for my morning routine. Strive for about 10 at least 10 minutes of sunlight first morning, so I get that probably about three to four days a week. I'd say about four days a week.

Amy: And you know, people who don't live in Southern California or Scottsdale or somewhere where their sun is. There are these lamps on Amazon that have 10,000 Lux of light. And remember, you can't be looking through a window, you have to roll down your window, you have to be outside. Windows block out a ton of those locks of light that you need to activate in your red Now that goes straight to your brain and reset all of the circadian pathways. So you really want to be doing some sunlight during the day. A circadian fast overnight. So what that particularly looks like is stop eating two to three hours before bed. So if you were on perfect circadian rhythms, you might stop around seven or eight. 

Chase: that might be difficult my wife is Persian and they like late nights

Amy: I totally get it. Oh, you don't even know I went to India, not this December but 2019 the first time I'd been in 20 years or whatever and I learned that their culture, the way they eat is completely against circadian rhythm. But I convinced some of them to try this. So basically, whatever bedtime is for you work two to three hours before that.

Chase: I like that. Whatever bedtime is for you. So this is just another example for the listeners that you know, this isn't a here's one strategy that you have to follow. But here's a strategy that you can implement into your life.

Amy: Exactly. Yeah. And you know, shift workers of course. Yeah, it's tricky. Yeah, they can't do that. Stop doing you know, your first responder work you can't. So one strategy I tell shift workers like it doesn't matter when you're sleeping but when you are sleeping to stop eating two to three hours before bed, and then you obviously don't eat overnight. And in the morning, you may not want to eat first thing; maybe you go into a fasted workout, get some sunlight, do your morning routine, do some mindfulness or self-care and then you break your fast. So the magic of fasted workouts is that there was a study that came out in the New England Journal of Medicine that detailed the benefits of intermittent fasting and one of them is the metabolic switch. So we preferentially use carbohydrates as fuel and most of us are always just sugar burners unless you're on a Keto plan. But overnight, you deplete your sugar because your brain is still working on repair, renewal processes, whatever. And in the morning, often, you may have some sugar leftover, or your liver had some stored glycogen leftover. So you could do a workout and deplete that glycogen. And once you start to really get low on glycogen, our body makes this cool switch. And that switch to using, you know fatty acids as fuel seems to be the magic switch. And that seems to be what turns on all the beneficial aspects of intermittent fasting. We don't know when that switch happens. And it happens at different times for different people. So if you ate your carb loaded last night, probably not going to make that switch for a few hours, but many hours after your carb load. But if you're someone who keeps a pretty low or a healthy level of carbs and then you fasted from two to three hours before bed, and you get up and you do a fasted workout, you're often going to be in that switch zone, and that is the magic. And so what I say is like, hey, you don't have to be fasting for days. And, you know, even this can happen at 14-15-16 hours and so you're kind of getting all of the benefits of both circadian rhythms and intermittent fasting in one overnight fast. So that's another strategy because there's lots of anti-inflammation that happens when you sync to circadian rhythms and you intermittent fast and remember, inflammation is fatigue and burnout. So if you're doing things that are anti-inflammatory, you're automatically curing that and that's the connection when people are like, wait, what's a food diet? You know, burn out? So you're reducing your inflammation and you're feeling less tired. So that's a second strategy is a circadian fast, the fastest workout, sunlight in the morning self-reflection; self-reflection more because you want to activate your parasympathetic system, your vagus nerve. So a lot of us live in that fight or flight, you know, response and we never counteract it with being parasympathetic.

Chase: You got to have the Yin to the Yang. 

Amy: Exactly. Doesn't have to be one to one. That was what I realized from the get interesting. It doesn't have to be like, okay, six hours I was stressed like now next hours, I should not it’s not like that. You just need brief periods of being parasympathetic.

Chase: That's been a big realization as of late for me is that to come back to homeostasis at this level to come back to just feeling your sense of normalcy. It actually doesn't take a whole, whole lot. Yeah, even just introducing a few deep national breaths, out to the nostrils. I recently wrapped up James Nestor’s “breath”. The power of activating the parasympathetic nervous system through just selective actual breathing is incredible. So that's often another lie I think we tell ourselves in the burnout is that I don't have the time to go do all these spas and relaxation or meditations like it actually can compound with just a few deep breaths, few small practices every day

Amy: 100%. That's exactly what I said in the book. I said, you just need two minutes a day, one minute in the morning, one minute in the evening to do that counteract a parasympathetic exactly what you said, breath work, it can be humming

Chase:  we'll take a two minute break now for everybody to join together. 

Amy: Yeah, I know, I've seen that before, where people like to do it together. It's really easy. And you can do it. And it makes such a huge difference it does. And then, you know, and then one of the other things I talk about is really taking a little stock of where your energy is going. So I think a lot of burnout is also thought processes, like who is taking your energy? Who are you giving your energy freely to? And how can you edit your life so that you're eating the foods, doing the things and hanging out with the people who are bringing you joy and energy? And how can you block yourself from the people who are constantly taking it away?

Chase: That's a huge point. Burnout. It sounds ironic. I'm burnt out of energy and burnt out of motivation. I'm depleted. But you're saying it's actually there are things there are people a thing, a person that is just constantly taking the energy?

Amy: And often it's like a colleague, or someone you see often a friend or a family member. And what I realized if you really take note of what it is that is repeating your energy, and what it is that is constantly depleting your energy, you get a lot more clarity. And for me, I realized I was doing things on a daily basis that were constantly depleting me and I was hanging out or interacting with people that were constantly draining me. And so I really started to edit my life, I started to say, I'm too busy to hang out or talk or engage with the drainer. Then I purposely started to do activities out which were like to fill your cup. Yeah, like, you know, the one minute twice a day it was great in the beginning when I was just getting out of burnout. But then I realized, wow, this whole nature thing is like, really amazing. And I love how I feel. I feel really good after I spend some time outside. And there's a study that came out that said 120 minutes in nature is like really what you need a week to get optimal health. Right? So I was thinking about it. And I like calculated. I was like, okay, 120 minutes, not so hard. Two hours a week. And you space it out through the whole week. And so I started to add in those things. And one of the biggest things I did, which you I'm curious to see what your thoughts are, okay, I used to do these really heavy, intense workouts, and I would skimp on sleep, I'd wake up at five. And I do these, like CrossFit type workouts. And what I realized after doing my research is that I was actually contributing to the problem. I was doing too many hormetic stressors, too much of a stress load on me, because those work, those kinds of stressors are supposed to be intermittent and heavy, not constant and not taking, not after you've had a bad night of sleep. So of course, I wasn't seeing results because I was throwing cortisol in my system after the workout.

Chase: throwing salt in the wound.

Amy: Exactly. So I changed a few more. I did a little more yoga. I did a lot and I did this yoga that was super athletic. Like I you know, I think a lot of people think oh, like, I'm never going to do yoga. I never did. I hated yoga. But I picked one that was very athletic. It was all about gymnastics and balancing. And so it kind of, you know that type A personality kind of can come through so well. And then I really toned down on the CrossFit type stuff, because at that time, that was like the big trend and I would wake up super early to do that. But I realized it was just short changing myself and you know all the other things that was happening because I was stressed at work, then I would be stressed at home that I was skimp on my sleep and then I would go to the stressful workout and then I'd expect to see results. 

Chase: which is where so many people go I know I've heard it. I've heard it in my coaching practice before and I damn sure hear from people now. It's like, I'm so tired. I'm so stressed. Let me just go. Let me just go move some bunch of weights, which can be great. Like it's good you time. And honestly, it's something that I love as well. But when you really, really think about it, like what are you doing? You're overloading your system. Again, you're taxing your system systems in a way that now like, it's your choice, all these other things may just be happening because the life around you, you may have some control over things. Maybe not. But then you take all that. And your body finally gets some you time. And what do you do? Do you go beat it up again?

Amy: You know about Blue Zones? Right?

Chase: Yeah. Dave?

Amy: Yeah. Dan Buettner. So if you look at the centenarians around the world, they're not going to CrossFit or like a high intensity gym.

Chase: They're walking and drinking wine with their best friend. That's what they're doing. 

Amy: so there's this exercise called NEAT exercise, non-exercise activity, thermogenesis, that's super important. And so even if you've done your workout for the day, you really need to do more NEAT exercise. So it's like walking from your car to you know,

Chase: people vastly under estimating the power of walking. It's profound.

Amy: When I, the things that I recommend is when you're really burned out, you really want to pull back on this intensity, and the type of exercise that stresses you out, and you usually know where you are everybody's different, right? Somewhat stressful to you maybe, you know, fine for me, or vice versa. So pull back and maybe do a little more walking, a little more nature time, a little more mindfulness, whatever, before you kind of add it back in and just like you said, our bodies are so resilient. Just two weeks absolutely no pulling back a little bit, you're gonna feel like a million bucks, good sleep, pull back your workout, start getting nature time, start eating better. And your bacteria actually in your gut can replace itself in three days, you can have a whole different, new you.

Chase: Yeah, I was gonna say what are some of the medical medically oriented positive effects of when we're on the comeback from this burnout? What can we actually expect in terms of biomarkers in terms of you know, anything?

Amy: So there's a biomarker for inflammation called CRP, C reactive protein, and high sensitivity of c reactive protein is a marker of inflammation in our body. And you can look at homocysteine levels that are also a marker. There's ferritin, which is also a marker of inflammation. Now, these are really nonspecific. And so some people will be very burned out, and they won't have high levels, and other people, because there are so many markers of inflammation. So those are just three that people can look at, in the beginning of their journey. And then like, follow them down. A lot of people will see, oh, wow, my levels, my CRP levels have gone down, or the biggest change, you can see is that your digestion is better. Your mood is better. Your sleep is better. So I have kind of check-ins in the book, because even in 2021, we still don't have a good panel that you can say, hey, Chase, you feel like crap and then there are a few things that you can check. But most, a lot of people will, you know, be quote unquote, normal. And so there's not a great blood test for all this. So one of the best things you can do is, how's your energy? How's your mood? How's your sleep? And how do you know overall well-being is like a big marker for how you're doing? So you know you're burned out? Like you're talking about your own stuff. I'd love to hear about it because I workshop it through. Sure. Most people know when they're approaching that. Sometimes you're not willing to stop and listen, but you kind of know when we're getting there because it's not something that gets better with just a one night of sleep. Something that is a little worse than a daily fatigue. So are you what are you doing for you?

Chase: I'm probably going on about I would say week three of like working through it and improving for sure. Um, for me it was showing up. It was well first of all, this is just a great marker for I get like we're saying before what the body remembers. It's like, for some reason, I couldn't quite put my finger on it, but it just felt like, like I felt this way before, but I don't really know what exactly I'm feeling. I just, it's like the spider sense. It was just my body's like, hey, something's something familiar here that we don't actually like. And so then, you know, thankfully now years later, I've kind of gone through processes to kind of like pay attention, biofeedback, energy levels, productivity, all these things and it just felt like it felt very begrudging. It felt like I was just showing up for the sake of showing up, I felt very kind of disconnected and unmotivated from a lot of the work that I do. And, you know, I've been doing the work that I love that I choose to do for many years. And I'm very grateful for that. But even at that point, I felt disconnected. Yeah, I felt like I

Amy: I liked that word disconnected, that's probably a nice way to talk about it.

Chase: And that's really what I've come to realize, you know, now, a couple of weeks later, it was like, I have my just unmotivated, and my lazy and retired. But it was just a disconnection. And so I kind of just took an analysis of like, what are all the things that I'm doing? And I do a lot of things like taking care of myself, my mind, body, spirit is very important to me. So if I'm doing all the things that I know that I like and work for me, what am I missing my forgetting something and or, like, let me just look at the whole. So I realized that I've just been going hard for the last like two ever since we moved to LA really the last like two, two and a half years, I have been performing at a level that a I had to just the nature of my household and the world and my type of work. And but then B it was like, I know why I'm doing what I'm doing. But the way that I go about it, it's just no longer serving me. And so it was kind of like a come to Jesus moment, I guess of, of like the physical state, but then also kind of like, I guess, the spiritual state, but just like my purpose for everything, like how I go about it, and like not wanting to just feel like I'm spinning my wheels. And so I turned off social media for a couple of days. And my wife and I took a quick little trip up to Santa Barbara, we just disconnected for like a weekend. That's kind of always my go to I go, I go to nature, once a year for my birthday actually do a bit I just go like my friends and I my wife, we get a big cabin, or we went to Jackson Hole Wyoming last year, we just get away. And so I realized that I may be needed to do that sooner this year. So I disconnected. I got back in sunlight, got back in nature, and kind of introduced a lot more sense of calm. And after that one weekend, like we're saying, I've been going for two and a half years hard. That one weekend was a very great reset for me. And it was like the hard kind of positive shock to the system that I needed. So now like two or three weeks later, I've just been taking it easier, a little bit more. I took a week off of my show. I hadn't taken a week off for the podcast in 4 years. And so after that, like it was a very great reset. And it showed me a lot of things where I was pushing too hard, where I could pull back a little bit. And just I'm still working through it for some reason. There are still just certain things I feel. It's just like a feeling. You know, I can't I can't put a biomarker on and I can't put a label on it. But my body is just like, Hey, we got some work to do.

Amy: Yeah, I think the nature thing is huge. The sleep thing is huge. And the self-reflection thing is huge. And then we didn't mention but I think food is a huge part of it. So I think what happens is,

Chase: I've been vastly under consuming calories. So that's my go to I again, I was so caught up in the work and go, go, go. I actually, for the first time in a long time I've gone back to tracking my calories. And for the first couple of days, I would just log my norm. And I would barely be getting like 1400 1600 calories. That's way too little for me. So now I'm finally back up to my norm which is like between 22 and 2400 for maintenance. But now it's no wonder Chase, you haven't been giving your body the nutrients it needs.

Amy: you know, I heard one of the other doctors saying that we're overfed, but like, you know what? 

Chase: overfed and undernourished.

Amy: Yeah, exactly. And underpowered as well because, you know, we're eating a lot of things that don't have any kind of nutrient value to us and even those of us who are, quote unquote, eating healthy. So when I went through my journey and when, after that car accident, when I really looked at my diet, and I consider myself super healthy, but I was eating very little fiber. So if, like I had, you know, my, I really didn't have much vegetables at all, and really no natural fiber in my diet, and I was thinking to myself, I Thought I was doing all these healthy things like I have like a protein bar, and then I have coffee. And then I'd have you know, all these things.

Chase: This is a double board certified medical doctor.

Amy: I was in a rush. And I would do the protein bar during work.

Chase: I was going for convenience as well, way more than I should have. Even in my mind, I was like, well, these are healthy snacks. This is a healthy protein snack, protein shake this that whatever. 

Amy: exactly. And that's when I looked into it. I was like, wow, I'm getting, I'm eating a lot of sugar that was hidden and a lot of these bars and shakes and, you know, convenient foods that are healthy.

Chase: But it also goes to the whole burnout thing, like we want something a quick fix, like, our body's gonna be craving something, right? We crave something like that.

Amy: And I had no idea that you could eat vegetables, like breakfast, lunch and dinner. I want to get like six to eight servings a day, I'm gonna have to incorporate it into like, every part of my day. So I really started to change, I realized that there's that army, that bacterial army that you're trying to grow, that's their food, they actually don't eat other food. That's, that's what they eat. And so if you're not eating enough fiber, which 95% of people are not 95? You are really shortchanging your entire health

Chase: and enough fiber being what? Are we still in like the 25 to 30 grams a day?

Amy: So most people are eating 15 or less grams, we're supposed to be in the 25 to 40 grams. But really, for optimal health, we want to be the 60 to 80 gram mark, if you look at you know, when they did hunter gatherer studies, they were probably over 100 grams a day, probably 120. And they found that the prebiotic fibers are what was feeding their bacteria, they had more bacteria, and they had more diverse bacteria. And we know that our gut, the more diverse, and the more army and the more diverse it is, the better it is. So the better we feel.

Chase: a mutual friend, Sean Stephenson actually that's one of the key things we talked about on when he came on the show a couple months ago when he was talking about his book Eat Smarter, and the fascinating old science and knew that we're finding the correlation between the diversity and your gut health, how it is directly correlated to and now we're even seeing causation to mental health, to brain fatigue to immune system, because what, like 70 plus percent of your immune system lies within that gut. When we're talking gut health, we're really talking immune health.

Amy: it is; gut health and immune health and hormone health are all one. There is even particular bacteria that they've seen, that's associated with good mood and well-being like facilitar, bacterium or whatever. And you can boost that with prebiotics, basically, fiber inulin fiber from foods. So when I learned that, I was like, wow, what that's an easy fix. I mean, that doesn't require supplements. It's not like you don't have to buy anything. Really just go to the grocery store. 

Chase: turns out mom had it right the whole time.

Amy: seriously. So and I, you know, people always put fruits and vegetables into one category. So I was eating a ton of fruit, like every day, but I didn't realize that that was not a substitute, like zero vegetables and offer it's not a good idea. In fact, it should be the opposite. You should be doing tons of vegetables. And fruit as needed.

Chase: To pick one more majority, I would go with vegetables.

Amy: 100%. Right. So then once you rebuild that gut, you start to feel better. And like you said, it's such a mental connection that you start to think better. And you know, not only is your immune system and your gut, you have a lot of serotonin in your gut, your neurotransmitters are in your gut, and they're communicating with your brain and saying, Hey, I feel better, I'm eating better. I'm less inflamed. And so things become clearer to you as well. So that's why so many people have these like epiphanies when they start because they're like, hey, I hate my job, you know, like, this relationship sucks, or like, I'm not doing what I really want to do my life or whatever it is, that becomes a little more clear. And that's really how you get out of burnout, right? Re-find your purpose, connect with people who replete you, do the daily habits that are going to give you those mini self-care and do a lot of self-reflection and really try to piece that out. And like you said, centenarians in those Blue Zones have figured out it's a you know, hanging out with your friends, community walking, nature, sleep and good food. You know, those are kind of like the basic aspects of it

Chase: My favorites are the I forget the group and I think it's Japan. The Okinawa women that just like they outlive everybody. They have a tribe together community. And they all say like good Sake. Italy it is good wine.

Amy: Yeah, exactly. So alcohol is a big part of an anti-inflammatory diet. The only thing is, is that in our culture, we take this little thing and we run with it. So if you think about what the anti-inflammatory levels are, it's three to five drinks a week for a woman. And it's like five to seven for males. Most people are doing way over that on a weekly basis. And so if you cannot control yourself around alcohol, because oh, a little bit, it's good but a lot is better than that's not the strategy for you. You have lots of other anti-inflammatory strategies. But I do think that it can be really helpful for people who are like, oh, yeah, I can incorporate three to five drinks a week for me that is easy. 

Chase: It goes back to what you're saying in the beginning, when, especially when we're facing stress and in burnout, we tend to reach for things that we may already be doing in a healthy way. But we push the envelope. You know, the coping mechanism becomes tainted a little bit.

Amy: like with coffee and what I say is that caffeine is like stealing from your energy bank. You have to pay it back. You're not, it's not free energy. And people don't like when I tell them that they're like, wait, it's not? No, you have to put that energy back through either sleep or rest or recovery. And if you don't, you will crash. And that's why so many of us overdo it on the caffeine, and then you have a super big crash in the afternoon. And that, you know, that's a sign that you need to kind of get off that caffeine.

Chase: that was another thing I did. And I've always been very conscious over the last several years I've been very conscious of not only caffeine, and like total milligrams, but my caffeine cut off time. So I actually the past  like two weeks I've realized I'd gotten a little high caffeine high for me had been, like 350 milligrams, maybe a day. Well, actually would have to two, but I know the exact dosage. I use, like a couple different specialty coffees. They're healthy coffee. Yeah, they're really good. So I actually would then decrease my servings to 250. I decreased by about 100 milligrams per day. And my caffeine cut off time was usually two o'clock. But when I really looked back, again, I was logging things. Now I could see it was actually pushing between two and three ish. So that extra hour could have been directly correlated to you know, reduce recovery, sleep quality time. So I cut back 100 milligrams. Now my max is 250. And I have a hard like, absolutely not past two o'clock. Honestly, I'm sure I'm shooting for more for noon. 

Amy: It's my, like, I can have something at lunch. And that's it. That's kind of like my cut off. I'm like, and it depends on how you metabolize caffeine. I'm a slow coffee metabolizer. So if I have something in the afternoon, I will definitely have a poor night as well. So it just, it does depend on the person, but you will know, I mean, you probably know that if you consume caffeine late in the afternoon, you're gonna feel it, you won't be able to fall asleep. The other thing I talked about is high quality sleep. So I think I severely under because of all these years of training and so much sleep loss, that I kind of lost respect for sleep, like I love sleep, but I thought, oh, I can't sleep. I'm not that's not productive. 

Chase: That's not grinding. 

Amy: Yeah. And then I realized, like, oh, all this. All the things that you want in your body, and in your mind, and your brain and your gut, happen during sleep. And so I started to really guard my sleep and clean up by sleep routine. And like you said, caffeine, it was the blue light exposure. It was the working all the way through until bedtime. It was, you know, not realizing that if you have ambient light in your room that's actually disturbing your sleep. So they did this interesting study with two groups of overweight women, because they knew that blue light has some implications on weight. They weren't sure. They had these women sleeping rooms, one with ambient light in the room, kind of like a nightlight. And then the other ones were in a blackout room. And they found a significant difference in weight loss with same calories consumed. I mean, if that's not enough for someone you know who's trying to be fit and healthy to actually make it a blackout room, or you can wear a face mask and make

Chase: I use a face mask for sure.

Amy: I totally look like a crazy person especially when I travel because it's like earplugs and the face mask because I realized that if you protect the quality of your sleep, you're just a different person the next day and you're building up that gut bacteria, you're helping your immune system, you're helping your hormones, and all of the things you want, both externally and internally are working the way that you want. And I just feel like I'm a better person, I get work done. So I started to protect my sleep. Like it was like the most important thing. And it's funny because you know, even now, I think that they say you're supposed to sleep at the same time every day. And obviously, on weekends before the pandemic, we could never do that. So I made a rule, I wouldn't go more than two, I try not to go more than two hours past my bedtime. And most nights, even on the weekends, and then you're not so hung over or like sleep hungover it feels so horrible the next day. So protecting your sleep became one of the big tenants, for me, that helped me through my burnout. And I tell people, like you'll have to sleep a little bit extra, when you're trying to get over, I'm sure you've felt this in the last couple of weeks when you've worked on it. It's not enough to sleep your usual seven hours a day.

Chase: I've been going over probably, I'd say 45 minutes to sometimes an hour and a half and I don't set alarms, I go to bed at the same time I wake up the same time that my natural rise time last month ish has been about 45 minutes to an hour and a half more than usual.

Amy: Yeah. And it's nice, because you really do need that time when you're recovering from that you need that extra time to recover. So don't feel guilty. And I think that's one of the biggest things that I have to tell you and other people like, I think that we all give ourselves so much guilt for taking a break.

Chase: yeah, that's I was gonna say that's got to be another component to this is that you try to take care of yourself. But then you feel bad about doing that. Yeah. Because you think it's creeping into all these other responsibilities. 

Amy: we feel so guilty for ever taking time for ourselves. I mean, I've had people say to me, oh, it must be nice to you know, sleep, work out now, you know, kind of implying that it was selfish or that it was must be nice all these things and what I said is that actually protects me from being able to protect me from burnout. And it helps me do more during the day and last longer, without, you know, feeling burnt out. So I think for me, I realized I'm allowed I'm, I'm giving myself permission to get sunlight every day to get a workout in every day to sleep every day to eat good food every day. That is not a luxury that is part of self-preservation. I think we've lost that in our culture, I think we kind of feel like all of these things are like, nice to haves. But it's you must have that. And you know, there are things we can do in the future. Like I said, the technology can change, we can have different barriers. So in my world, sometimes you're getting a lot of emails, tons of activating things late at night and so one of the things I've decided is I don't make any phone calls or any activating conversations or like stressful events, like two, three hours with somebody that's gonna demand more of your time and energy. I try not to do any meetings like late like, we used to do practice meetings now at like 8pm or 9pm. And I don't do that anymore, because then it's like just riling you up, and then you can't sleep, and you have the higher anxiety levels, and your body's basically getting mixed signals like, Hey, I thought it was like time to go to sleep. And like, now you're doing all this stuff that's keeping you awake

Chase: yeah, it doesn't know how to properly respond when it needs to.

Amy: Yeah, so then, I started to turn off all of my devices, I still have my phone with the blue light blocker. And but I don't respond to any like emails, I don't do any major phone calls or meetings or anything, two to three hours and that's a really nice way to block your mental space. And I really have a strong nighttime routine just as strong as my daytime routine. And these are all little sounds like a lot but literally ends up being just minutes a truly extra. That's basically how that's what I talked about in the book.

Chase: Amazing. Well, we definitely gonna have all the book information listed down in the show notes for everybody. I've thoroughly enjoyed this conversation and kind of getting towards the end. I have a one other question I want to ask you before I final question. So we've been talking about a lot of different ways to work through well, to understand it, to address it, to pay attention to it, how it's probably showing up in our lives. What we can do to address it and work through it. What's waiting for us on the other side of burnout, like once we actually kind of take control back of our life and reintroduce some things that get us through this burnout like what can we expect to like to get back into our life?

Amy: I think the biggest thing I noticed a change is my energy levels I had stained and high energy. I think we all want that, right, want to be able to do the things that we love, and we want to do with full energy, you will have energy like you haven't had since you were a kid. That's how I describe it to people, I think I thought, okay, getting older is also energy depleting but I didn't realize that just like muscle, you can build muscle at any age, you can actually build your gut health, your immune health, your hormone health, you can be energetic at any age. I also think it really brought out in me my purpose. And so then once you know your purpose you can draw clear boundaries, 

Chase: that is a whole other source of type of energy. 

Amy: so once you realize what you really want in life and what you're going for, then the boundaries become a little more attainable, because that you can say, Well, you know, what I'm going to not do or interact with, or I'm really going to protect this passion and build some boundaries. And I think building boundaries is so empowering, because you're saying, Hey, I love this energy, and I love what I'm doing as my life's work and once you figure out the people and the pieces, then you protect that at all costs. And that means, you know, maybe that means not doing the eight o'clock meetings ever. Maybe that means not answering everybody's text right away. Maybe that means, you know, putting no notifications on your phone, and just, you know, whatever it is, those are my boundaries. You know what I mean? Whatever it is those are mine. But make sure you have boundaries. Because once you respect your own self and your own time, people start to respect that too. There'll be like, oh, yeah, I don't call Chase after 8pm. Because I know he's not gonna pick up until the next morning. You know, like, that's, that's what I'm talking about.

Chase: Yeah, I've even had to have some moments with my own family member like, why don't you answer your phone? Why can’t I reach you? I don't turn my phone on until like, X amount of time after I wake up. I don't, I can turn it off X amount of time before I go to bed. You know, what if it's an emergency? Well,

Amy: figure it out.

Chase: thankfully, you know, do not disturb on the phones. Now, it's like, if you try to call somebody, I think three times in a row, it'll actually go through. So there are ways even in the modern world to set boundaries, but still be there for the people 

Amy: I had a strategy. Well, we stopped this strategy. But my strategy was that I had a landline but nobody knew the number except for a few key people and so I would be okay, I've disconnected from my phone. But I knew that if there was an emergency, we could use that. But now we have that do not disturb thing that you can you can do. And you can selectively deselect, you know, my kids calling?

Chase: I need some people to come through.

Amy: Yeah, exactly. So for me, putting up boundaries has been so empowering. Because once you really do realize what is repleting you and what is draining you, then you start to put up those boundaries. And then you feel so much better. Because you're like, Oh, I should have done this years ago, like I should have said, you know, I'm not going to, you know, do this thing. And be okay with it. It's not like, yeah, you don't have to be in the popular crowd, you can say whatever you want to say. And as long as not hurting someone else you're good you know,

Chase: one thing I heard in there that I love is that it can come across in people and we talked on that talks about that earlier, as well. And all the things we've been talking about of biofeedback of paying attention to what's showing up in your body and your mind, like, also look for that in people take an evaluation analysis of the people that are just energy suckers, and never energy givers. And it's a very, very hard thing to go through. I've been through it so many times. And honestly, it just turns into people coming and going out of your life. And at the end of the day, you have to recognize you have to do that, because those behaviors aren't going to go anywhere.

Amy: Yeah, no, you have to you have to take those energy suckers. If you can't take them out of your life I say just stop giving them your energy. You don't have to engage.

Chase: it doesn't have to be a harsh cut off kind of thing. 

Amy: it can be that they wouldn't even know the difference. Because they might just see you in passing now and you're just too busy to you know, maybe you're not organizing things with them. But you are reaching out to someone who is giving you energy and I think that that naturally kind of happens sometimes. But if you're deliberate about it, you really can do great things and you know energies is such a thing that if you give up off really good energy, you will attract more people with really, absolutely, yeah. And then you can kind of engage more with those people and engage less with the people who obviously don't give you good energy, and then you don't have to give energy back to them. So that's the energy tactic. 

Chase: that reminds me this tactic I would use to use a lot in practice of when people are embarking on like their health and wellness journey, especially in the beginning, a common misconception is all the things I have to give up. All the things that I can't do, that I can't eat, or the places I can't go. And that is just a mindset shift that we would work on a lot. And I still try to work on that through the content in my own life is no just focus on what you can do. Focus on the people that light you up, focus on the people that you light up, focus on the things, the practices, the modalities that just give you back something, some kind of ROI and just lean into that. And like, just follow that mentality and the things you're doing, the places you're going the people in your lives, things are eating, like you will also just wake up and realize like, wow, I'm, I'm getting it all back. Because I've been giving only to people places and things that deserve it.

Amy: it's so empowering. So that's, that's really the key is, is finding out what things can replete you and what things and people are depleting you and kind of doing an edit.

Chase: yeah, that's, that's a whole I feel like I have a whole other conversation on like the people in the community aspect. That's been that's been, especially what the whole world has been going through this last year, that detachment and lack of community for so many people has just, I mean, now we're literally feeling it a year later of having such, like, harsh lines in the sand of how often we see people when we see them where we see them. It's just been like, now we're really we were reaping what we sowed.

Chase: it's terrible. I mean, there are people who haven't seen anyone for a full year. It's so sad for our elders and children. It's, it's, it's just sad all around. And everyone, you know, can argue about, you know, what we did wrong. And what we did, we can all say that we all suffered from the disconnect that we had this year. That's why I started to really realize, oh, there's so much value in the actual energy exchange in person energy. And that we really underestimate that when we you know, this year, we weren't able to do that. We realized now what we were missing, you know,

Chase: which is why I'm so grateful you are here in person. I appreciate appreciated and enjoyed your energy and your expertise today. And so the final question I ask everybody on my show is ever forward; to live a live a life ever forward and I have like this philosophy of taking awareness, a heightened sense of attention, awareness to our fitness or nutrition or mindset, all the things that just make us and what we can fine tune and what we can keep and what we can maybe get rid of just take a step, take the step, take any step to just move forward. How do you interpret that? What does that mean to you? How can what you're doing in this whole work of burnout help us do that?

Amy: I think the whole conversation we had was really how to move yourself forward, how to move our society forward. If we understand these things, then we can build systems, we can build technology, we can build network, I mean, we can really change how we build the next, say 20 years of our lives forward by learning all this and incorporating it and making it tangible tools for people. Maybe, you know, not everyone can get natural light, but maybe they can, you know, have these light lamps and in the winter months, and maybe, you know, we emphasize nature time more on for everyone. And maybe we deemphasize working late at night or eating late at night and change our culture a little bit. So yeah, moving forward as individuals act as a collective society by doing some of these things, especially the circadian rhythm synching is something that I think that can change a lot of people's lives.

Chase: I agree. Very well said. I always tell my guests there's never a right or wrong answer. It's just, I love it right? After we have our conversation, and then you know, I share a little bit of the philosophy of my own and in the show, you know, I'm always grateful for the answer that I get. So it help. Well, where can people learn more about you? Where can they get the book? If they want to go somewhere right now connect with you where are they going?

Amy: there a few places. So on social media, I'm at fasting, MD, on Instagram. I'm at Amy Shah, MD on Twitter and Facebook. The book is that I'm so effingtired.com

Chase: I love the title by the way.

Amy: Amymdwellness.com is my personal website.

Chase: Okay, amazing. Well, thank you so much.

Amy: Thank you so much for having me.