Why Living Indoors Is Making You Sick, Tired, and Burned Out | Dr. John La Puma - EP 776

32:01I have to tell you, you and I are both lucky that we live by the coast. And one of my favorite things to do is, and we're in prime boating season now, is to get on the golf when I can. And And I have to tell you, if I can just get out one day a week, oh my gosh, does it have a huge impact on me mentally and how recharged I feel for the next week. It is such, and I'm a water sign as well, but man, it certainly impacts me in so many positive ways. And I notice, and I try every single day to do a walk in nature for about an hour. And I tend to do it, which leads into your first outdoor prescription.

32:46I do it first thing in the morning because I like to start it in the dark, but then have this transition to morning light. Because I know if I bookend my day for circadian rhythm, it has had such a profound difference in how soundly I sleep. So what is this importance for listeners of meeting the morning sun? Man, you're a model, John. I love that. So it's about deep sleep. One of the reasons you sleep so well, I think, is that your sleep is restorative. And you only get that if you get deep sleep or non-REM sleep, and you only get adequate deep and non-REM sleep. Same thing. in the first half of the night, in the first two or three cycles of deep sleep.

33:34And those of us who are interested in tracking and IM get a read about deep sleep and REM sleep, both of which are restorative cycles. But what happens in the morning is if you get out within 60 minutes, as you do, of the sun rising, that's the time where the back of your eye, the retinal receptors are the most receptive to the bright blue wavelengths of morning light. You want those because it both makes you feel more awake. It gives you a big cortisol activation response of up to 100 % so you have a brightness on the inside. And I call this daytime before screen time, by the way. And secondly, what it does is set your melatonin for that evening so that you can release it that evening if you don't stop it with screens before bed.

34:27And I'll talk about that screened curfew as well. And thirdly, it gives you during deep sleep, the glymphatic system or the brain cleaning system. And when you stop the cleaning, the trash piles up, right? But that happens in the brain too. The glymphatic system is the brain's cleaning system. It was discovered in 2013. The Nobel Prize was given for it in 2017. The brain actually shrinks a little bit, up to 40%. during deep sleep. And the spinal fluid, CSF, washes over your brain and takes out the beta amyloid and tau, which are proteins that accumulate during Alzheimer's disease. So other good things happen during deep sleep too.

35:12Your muscles repair from strain during the day and you build bone. Especially important, this is the only time that you build bone during the day. A women who are affected by osteoporosis lose bone is resorbed throughout the day, but they can build bone during deep sleep. But again, only set with morning light, best within an hour, 10 minutes bright light, better, cloudy days count, sunglasses don't count, don't wear sunglasses, doesn't work through a window, you block out the wavelengths. So deep sleep is the benefit of morning light, plus the big cortisol activation response. And as you point out, the effects on sleep, if I had one thing to do for America's sleep, this would be it.

36:04It's not, by the way, more sleeping pills. Zolpidem, and the end knocks you out. Excellent. I've prescribed it many times, but that's before I knew, before most of us knew that it also suppresses deep sleep. And it's not the right medicine, that class of medicine, not the right medicines. If you need a sleeping pill, melatonin is better, but melatonin is not really a sleeping pill in the same way. You can't take it 20 minutes before bed and expect it to put you to sleep. It needs three hours. And also people take too much of it. Take five milligrams or 10 milligrams, it actually works the opposite way.

36:49For many people, it doesn't improve sleep at that dosage or quality of sleep. So you need really tiny doses, tenth of a milligram, three-tenths of a milligram, at most half a milligram. And so what you're doing is a model. That's fantastic. And if I could have read, written that in indoor epidemic, get out during dark walk and see the sunrise, I would have, it's even better than what I wrote. I love it. And your second prescription I've already mentioned when I was talking about getting on the boat on the weekend, because this all is immersing yourself in this feeling of awe. And one of the most interesting things I found is, not familiar, I'm not sure if you're familiar with Dacher Keltner and his work at UC Berkeley.

37:39It was so interesting to me that awe is produced even more frequently by acts of kindness and witnessing either others perform them or us doing them ourselves. But this whole awe that you talk about, whether it's walking in a nature park, going out on a boat like I do, just getting exposure to the horizon, these different things, it certainly does create a different type of regulation for you. I think that is an important one. And then this thing that you mentioned, forced bathing prescription, you mentioned inhaling immunity. How does this impact our nervous system and perform as immune medicine?

38:26Forest bathing was described in 1982 in Tokyo by Dr. King Lee, who's an immunologist. And he identified a number of Japanese executives actually who needed some, who had hypertension and were stressed out and took them into the forest for three days and gave a two-hour session on each day, I believe, to try to recenter them. And he measured not just their blood pressures and stress levels, but also chemicals in the forest that were, he thought, immunologically active. And he was right. He took them to Japanese cypress forests because that's the forests that were nearby. But this actually works in many different types of tree gatherings.

39:19It doesn't have to be a Japanese cypress forest or anywhere else that's classically described. These chemicals have been identified in cypress. They're alpha-pinene and beta-pinene. In citrus, they're D-limonene, also present in lots of citrons, the predecessor of citrus, like Buddha's hands. And the way it works is that these aromatic chemicals, they're phytoncides, chemicals that trees make to communicate and to ward off predators that will eat their leaves or damage them, have this immunologic activity in people so much that your natural killer cell count, which is the kind of navy seals of your white blood cells that go out and zap cells that are affected by tumors, are affected by viruses and kill them before they can do harm to you, goes up 56%, both in count and in activity.

40:23And that effect lasts for a month. One two-hour session did this. It's been documented for even less. So forest bathing, which really should be called something like parasympathetic activation or green environmental hormonal reset or given some other real scientific name instead of a woo-woo name just for those of us who are scientifically oriented and analytically oriented and want to know exactly how it's affecting our immunological chemistry. Forest bathing is offered from everywhere from the Harvard Arboretum to the Santa Barbara Botanic Garden to hospital systems and many progressive businesses.

41:08And there are guides for forest bathing who can help you and take you through the steps. I hired a forest therapist to teach the UCLA physicians forest bathing and the how-to at our used to a CME course last year for clinicians. And it was very instructive. People loved it because not only did they get 30 days of immune benefit, I assume, but also because you learn again to use your senses. And as you're a nature fan, that's how you understand nature. We don't understand it through cognitive work like we do notifications and texts and projects and AI. We understand it through touch, listen, see, smell, taste.

42:04We use our senses. And sensory deprivation is, I think, not only at the core of burnout, but also and light deficiency, but that sensory deprivation is what we're often missing when we're overwhelmed by pixels, when we're saturated by pixels, when we forget that there's a touching feeling world out there. It actually makes performance better to reset. I was going to tell you that I gave a talk at Edelman PR in New York City last month and at the their town meeting for all the Edelman PR agencies in New York and they announced right after the talk that because of the book Indoor Epidemic they had were going to have a walking Wednesday they were going to have go to pocket parks and other parts in the inside of Manhattan, downtown Manhattan, where there are corridors, so that everyone got outside during the workday.

43:15And is that beneficial if you're not seeing as many trees as a forest? Yes, it is. It's still beneficial because you're still getting better air than you are inside. You're still not looking at a screen, you're getting your brain to rest. You're not eating lunch at your desk. You might be eating lunch outside on this walking Wednesday. You're still having the social interaction with your peers, which is actually a good thing and makes you feel less lonely when instead of just looking at a screen or at your projects. You're still getting the benefit of looking at distance. Remember, horizon or distance is one of the inputs that we're missing.

43:56And that can be solved even in Manhattan. Now, what if you wake up in Manhattan and you have a doorman, you're on the 20th floor, how am I supposed to get outside? You can still look outside for the furthest point you can see, even if you're on the first floor, the furthest point you can see. And you don't need a forest for forest bathing. You just need a sky view to relax your eyes. You don't need a retreat is fun to go on, is immersive, is cool. But if you're working every day, you need a doorway, you need a fire escape, you need a threshold, you need something so that your eyes get distance.

44:38And you feel less alone and like the world isn't just your computer screen. I love that. One of the jobs I had was at this company called Catalina Marketing. And it's down here in the Tampa Bay area. And it happened to be adjacent to a little pond, bigger than a little pond. It was probably a half a mile walk around it. And I had a direct report who asked me if we could start doing our one-on-ones and do a walk. And it had so many benefits that I started to do it with all my direct reports because I found, one, it got you outside. to even when you're in the office and you're having a discussion, there's so many things that can distract you.

45:24And I learned that it kind of gave you alone time where you could be completely present with the other person. And I found it improved your health too, because you're moving. So to me, it was something simple that we don't even think about that really anyone can do. and what your work proves is it has multifaceted benefits that you don't even realize are happening and something that is really enjoyable. It really is. You can't bottle a sunrise, right? You can't out-supplement an indoor life. You've got to get outdoors and engage. And when you are outdoors, as you've just pointed out, and this can be incorporated in a workday, not only do you focus more on the problem rather than on the individual, which is a real benefit of walking side by side.

46:15And walking meetings are part of what Edelman does now, and even in Manhattan. But you can also just have your lunch outside. It changes your dynamic instead of sitting in front of your desk and thinking you're going to squeeze in two more things before the next meeting. A lot of people feel like, well, I already get vitamin D. Why do I need to be outside? And that's not at all the point of the book, but it is a really important point to make because we do need vitamin D, but it only covers one aspect of light as a bioactive source. Because you need infrared light for your mitochondria. You need blue light for your morning waking response.

47:01You need UV light for nitric oxide release in your skin, which actually lowers your blood pressure. and you need full spectrum light. And that's what you were talking about during your walking meeting for your mood to improve mood. This is powerful, even on cloudy days, even on cloudy days in the morning, you get enough bright blue light to reset your circadian rhythm. If you spend just 10 minutes, even better 15, but just 10 minutes within that first hour. And then you can get the rest of your 17-minute minimum effective dose throughout the day. If you're an optimizer, and many of our listeners are, and we are as well, you want to get at least 43 minutes a day because the data top out at 300 minutes a week of intentional time near green or blue spaces used for prevention and sometimes treatment, but certainly prevention of chronic disease.

48:05And I believe treatment of problems like burnout, sleep disorders, mood disorders, memory problems, insulin resistance, and immune problems. John, another thing I wanted to hit on was, and I'll use it myself as an example. Prior to getting into this routine that I've gotten into doing this walk, I used to love to do an early morning spin class. But the problem with the spin class was I'd missed that circ circadian moment. So I'd supplement it by going outside for eight to 10 minutes without sunglasses on and just trying to let myself get the morning ambient light. But what I found was that when I did the spin class and on the mornings when I skipped the spin class and take a bike ride and experience the sunrise, it's like my whole outlook on the day felt completely different.

49:02And I know for a lot of people, the natural inclination is we go to the gym instead of exercising outside. What's the difference? And what was I experiencing? Because there's certainly a difference in how I felt between that spin class and riding outside. These kinds of exercise are complimentary. You actually need both for maximum, all-cause mortality benefit. So a study done at Harvard that was published just in the last few months that identified in their nurses' health study and physician health study of now 34 years, which activities reduced mortality the most. Number one was walking, the vast majority of which is done outside.

49:49the gym or strength training was like fifth after tennis after soccer I've forgotten the other two but when you combined walking with one of the other activities people who did both outdoor exercise and indoor exercise the all-cause mortality benefit rose to 19 from 17 from walking outside alone. I think there are many reasons for this mortality benefit, including the cycling outside. Microbially rich air, bright light for all the reasons I just mentioned, the full spectrum for mood and blue light to reinforce your cortisol to tell you're awake, your infrared light for your mitochondria. Yeah, I think activity outside feels is easier than in activity inside.

50:46It's been shown that it experienced if you do the same cycling or running inside versus outside, it feels like 20 % less perceived exertion outdoors. And that might be because the brain finds the forms of outside, the fractal patterns of leaves, the way that the wind moves trees, what's around you. And I'm talking about exercising in a nature environment, not in an urban, dense urban environment. Riding down the street in New York City or Chicago or LA is not at all the same as riding on a trail. So that less perceived exertion is because of the green environment and its many benefits. Or blue environment.

51:30We both live near water. The blue environment actually changes your brain waves from agitated beta to alpha and theta waves, so you're more relaxed. One of the reasons that having a fountain nearby, and this happens even in the shower, and there's a great Stanford study to document this, that having running water is a powerful tool for creativity and actually save money over time. A Cornell study document, it was a hundred thousand dollars over a hundred workers to have with improved creativity with better outdoor engagement and window views of both greenery and blue. So there's extraordinary data for both these things.

52:20After we get off this call, I'm going to the gym. Strength training is a powerful longevity tool, and we all should be doing it at our ages, especially. But it doesn't replace outdoor exercise. It complements it. It improves our mitochondrial count. It makes us feel good and confident we should do it. Cycling outside, you should do. Cycling indoors, okay. strength training endures definitely, but the combination of the two is what actually reduces mortality, improves longevity, and there is fantastic, very good data to show that even living near green spaces within 500 meters of greenery improves longevity, stabilizes telomeres.

53:13telomeres, by the way, are the protective end caps on chromosomes that fray as we age, but can be stabilized for a two and a half year benefit from the literature that I reviewed to when you actually live near a green space. John, the last thing I wanted to cover with you is one of the big wake up things for me in the book was that most people spend nearly 12 hours a week already in fragments and right that's like walking to a car walking from the car to your office dog walks lunch breaks errands we do so how do we convert all these things these scattered minutes into medicine how can the normal listener do this very good so that's an incidental time that we're spending outside and repurposing this time is the secret to giving your minimum 17 minutes effective dose a day.

54:09You don't need to add time because you've already spent it outdoors, as you said. So what does that mean effectively? It means that when you're walking, you're not scrolling. You're not on your device. This sounds dumb, but I have a friend who broke his leg going up a stairway looking at his device at the beach. And he's in great shape. He recovered in four months, but he's almost my age and he, like, why four months in the chaos? I don't get it. So when you're outside, get off your device is the first way. That alone frees up the time. Second, in the morning when you have coffee, light first coffee second or light coffee and dog all at the same time what does this mean almost everybody drinks something in the morning go outside and drink your coffee don't scroll when you're outside remember the first rule just drink the coffee and either if you want plan your day or just notice what's in the environment take your dog with you let him or poop if that's what's on the day what's first in the morning and already you're gaining benefits of the morning light that i've discussed in the evening when you're outdoors if you're coming home from work or coming home from school what you want to do is not just get off the subway or get of the car and get inside and do whatever you're going to do, flip on the TV or whatever.

55:51You want to flip a switch and take the time that you would get from in your home to, rather your vehicle to home commute, and look at the sky deliberately for two minutes. Because that time, which is an extra two minutes on your commute from your home, from your vehicle to your home, resets your brain knowing that you're going somewhere different and out of a work mode and out of things to do. Again, what you're not doing is looking at your device. When you are outdoors with a dog or me, know that nature is social. Engage that time when you're outdoors, if you happen to be with a dog or if you happen to be in a garden, a community garden or a park, use that time if you happen to be there to say hello to someone else.

56:51This sounds weird, I know, but it reduces isolation. It improves oxytocin release. When you walk, because everyone does, try to walk with someone else, whether it's at work or at home. Sometimes you feel like taking a walk by yourself. Okay, great. But if you have the opportunity to walk with someone else in the walking meeting that you did, the walking meetings now are corporate policy at Edelman, in part because of my book, Indoor Epidemic, then you not only improve oxytocin release, but you improve creativity, you improve idea generation, and that should translate to better performance and better productivity.

57:36There are probably studies for it. I haven't identified them because I'm in this role instead, but know that even the extra effort of morning sunlight, of getting out in that morning, as I've described, reduces depressive symptoms by 50%. An hour of sunlight during the day reduces depressive symptoms by 50%, which is the same result in a randomized control trial against an SRI, Prozac. So walking outside even can lower blood pressure, almost like an initial dose of beta-pocker. The data are seven millimeters systolic and four millimeters diastolic, if you do it deliberately in a green or blue space for enough time.

58:23So we can repurpose the minutes that we have in the morning, at lunchtime, or during the day and in the evening to turn those minutes into medicine by being intentional, by being near a green and blue space, and know that the prescription is a window, a walk, a screen, not necessarily more another wellness app, not more corporate wellness spending. It's a window, a walk, and a screen curfew. That's what we want. And that screen curfew, by the way, ought to be at least an hour, preferably three hours, but at least an hour before bedtime because bright blue light at night suppresses your melatonin release by 80%.

59:12So repurpose that time indoors by giving yourself an hour wind down. I described this in the book about half a dozen different ways to do this, but one of the easy ones that actually engages your brain in a new way is by writing in a journal. Handwriting takes a lot more of a neurological symphony than tapping on a screen. Tapping on a screen is just tapping or clicking, but handwriting is a neurological workout. You've got to coordinate all kinds of things, and plus you get to document what it is that went well during the day, maybe a gratitude journal, maybe chamomile tea, maybe a hot shower, a warm shower actually improves sleep because your body temperature drops right afterwards.

59:59So there are hundreds more of these ideas in the book, Indoor Epidemic, for how to make your incidental time intentional and to escape this indoor epidemic because you're not burned out, you're indoors too much. John, I came away from reading the book feeling that it's really not a book necessarily about going outside. It's a book about recovering the biological and essential rhythms modern life has pulled away from us. And I think that's what I hope the listener will take away from today's discussion. And some of the things we didn't even get to explore that are bonuses in this comprehensive book are companion animal connection, birding, house plants, immersion, nature art, et cetera.

1:00:53So John, thank you so much for coming on today. If a listener wants to learn more about you and your work, where's the best place for them to go? It's our website, IndoorEpidemic.com, or my personal website, which is DrJohnLapuma.com. There's actually a free seven day outdoor RX reset that listeners can get. And just go to IndoorEpidemic.com to get it and we'll send it to you free. It's a good start. And from there, there are a lot more resources that we're happy to provide. And when I give talks about this, I usually give away a coaster. I don't know if I have one here. This is fun. It's a seed coaster.

1:01:34And inside are paisal, parsley, and chive seeds. It has my face on it. You can plant me. And there's a QR code like how to plant it in case it's not easy. But I gave everybody at Edelman these as well. And all you have to do is get good organic potting soil, plant it, put another half inch of good organic potting soil, and this you can't overwater. So you just need a pot to fit it. And in about three weeks, you'll get sprouts. It's a way to connect with easy things to grow. They're high antioxidant, high anti-inflammatory herbs, as all herbs are, and they're flavorful. You can add them to salads and frittatas and lots of foods.

1:02:18And it really connects you, especially if the weather isn't good. So try it and see. John, such an honor having you today. Thank you so much for joining us on PassionStruck. My pleasure, John. That brings us to the end of today's conversation. One of the ideas stayed with me is how often we try to solve biological challenges with cognitive solutions. When we're tired, we search for better productivity systems. When we're stressed, we look for new coping strategies. When our focus declines, we search for another app, another tool, or another technique. Those approaches can certainly help. But today's conversation reminds us that human beings are not separate from their environments.

1:03:00Our bodies respond to light, movement, fresh air, temperature, nature, and rhythms that have shaped human life for thousands of years. When those connections weaken, our health often suffers in ways that are easy to overlook because the changes happen gradually. Earlier this week, Eric Ries helped us understand what happens when institutions become disconnected from the people they were built to serve. Today, John LaPuma challenged us to reconsider what happens when people become disconnected from the environments they were designed to thrive within. Next week, we'll continue our exploration of the connection crisis with bestselling author Greg McCohen.

1:03:34In a conversation that surprised me in all the best ways, Greg and I explore what may be one of the deepest forms of disconnection in modern life, the growing gap between being surrounded by communication and actually feeling understood. If this week's episodes focused on reconnecting with the environments that support human flourishing, next week's conversations explore reconnecting with the people around us and perhaps with ourselves. For 10 years, I have been asking the question, what is the primary bottleneck to living out essentialism or effortless ideas in practice in the world of relationships, teams, organizations?

1:04:10What's the primary bottleneck? And the answer to my surprise is that it isn't talent. It's not strategy. It's not execution. The primary bottleneck is like confident misunderstanding. We are wrong. We think we're right. And we act upon that. And that's it. That's it. Until next time, remember that flourishing is rarely found by adding more to our lives. Often it begins by reconnecting with what has been there all along. I'm John Miles, and you've been PassionStruck.

1:04:57Thank you.