Sofa King Happy in COVID-19 Quarantine.

This is a relatively tough time for Americans, but it’s tough times that reveal our true character. We all have a role to play in fighting this virus. For many it means staying home and avoiding other humans. While social distancing helps us collectively, it can be hard on us individually. Our mental health can erode. Depression, anxiety, and paranoia can set in. We can start believing that there is a global conspiracy led by Bill Gates to hurt the economy and cover up the murder of Carol Baskin’s husband. There can be a silver lining, if we do the right things. We can stay healthy, avoid depression, and we may even learn a few things about ourselves in the process.

Below are the top 10 things you can do for your mental, physical, and emotional health in a home isolation situation.

Author’s disclaimer: To be clear, I am taking this pandemic extremely seriously, both professionally as a physician and personally as a parent and son. That being said, there are jokes in this article. Humor is not a reflection on the seriousness of this pandemic but rather as a ploy to get you to keep reading.

10. Get Sun. Because many of us are not supposed to go anywhere, we stay inside. That’s a mistake and leading us to increased levels of depression and pastiness. Most of us have an area to get sun while maintaining our social distancing like a balcony, patio, backyard, roof, window, or mega-yacht. Use this space. Vitamin D from sunlight is crucial for our mood, mental health, and immune system. Lab rats show narcotic-like withdrawal symptoms when sunlight is removed from their habitat. Humans tend to get sad and tired. When I’m getting sun, I try to take off as many layers as I can without getting additional legal charges from my uptight neighbors. Also, morning sun is best for setting our circadian rhythm, exercise, and mindfulness while afternoon sun is best for drinking a lot of wine.

9. Set goals. When I set goals like “Become fluent in Ancient Greek,” “Write the great American Novel,” or stop saying “that’s what she said”, I’m bound to fail. Instead I set the bar low, like learning a card trick, practice mindfulness for 20 minutes, or baking. These goals help to keep us busy, which also helps loneliness, boredom, and the temptation to shop online or spend the whole day treating your body like an amusement park. You know what I mean.

More importantly, these goals will keep our minds’ sharp. The concept of brain plasticity is a two way street. Brain damaged individuals can experience improved function over time by connecting neurons, but this concept can work in reverse. Sharp people can become dull and connections can disappear because of brain plasticity. Six weeks of nothing but the Kardashians and Pornhub can turn a once brilliant mind into a functional idiot.

Once you have your goal, make a specific plan to accomplish it. Ex: I will practice mindfulness for 20 minutes immediately after I brush my teeth or I will practice chainsaw juggling after my 3rd whiskey of the morning. A goal without a specific plan to accomplish it, is just a daydream. I read that on a poster somewhere once. When we fail to plan, we plan to fail, also from a poster. Hang in there, it’s almost Friday. Poster.1_MLOrsakNk3Kv3KRytrb_2A

8. Sweat. Exercise has found to be as effective as 20mg of Prozac for treatment of depression, and the side effects are way better. I know we can’t go to the gym. Despite this, I’ve been getting great workouts using the “100 pushups” app ,, and Here’s an article on how to get started working out from home: 36,000 Seconds. An Exercise Call to Action by Dr Jason Valadao.

7. Snack. I don’t normally snack because it is terrible for maintaining a healthy weight. That being said, when I’m home like this, I can’t help myself. So this makes our snack choices super important. I’ve been stocking up on pickles, veggies, hummus, nuts, full fat Greek yogurt, nut butters, frozen berries, and popcorn. What do all these things have in common? They’re not processed foods and they won’t lead to crazy amounts of weight gain. Also, their fiber will feed our gut microbiome which promotes better emotional well being and also better poops. To achieve smarter snacking, the key is better decisions at the supermarket because now more than ever, if it’s in the house, we will eat it. Willpower is a finite resource, we shouldn’t use it up by having temptations like potato chips, Cheetos, and Ben and Jerry around the house. Ben and Jerry are a couple of very fit firefighters who live down the street from me…actually they can stay.

6. Prioritize Sleep. I’m working hard on this, here’s what I’m doing. A psychiatrist friend pointed out that with every single mental illness in the DSM 5 (official book of psychiatric diagnoses), we see a sleep disruption. I’m not saying that every psychiatric problem is caused by poor sleep, but sleep is an issue with all. Sometimes it’s a chicken and egg problem. Sometimes it’s a vicious circle, but if we don’t get adequate sleep, our mental health can not improve.

With our mandate to stay home, it’s tempting to stay up to 3AM playing Animal Crossing. Besides eroding our mental health, this can weaken our immune system, and cause weight gain. Sleeping in a little is fine, but we should get to bed at the same time every night. I aim for 9–10PM. Despite being #6 on the list, this is the most important thing.

5. Relax. Give yourself permission to take a sensual bubble bath for one. Enjoy some wine, your favorite music, or a cup of tea. If you watch TV, do this intentionally as well. Make a list of quality movies you’ve never seen, and start watching. Also, avoid excessive amounts of news, reality TV, and anything on the Bravo network as this can lead to depression and loss of IQ points. IMDB’s Top 250 movies and top 150 comedies is a good place to start, but is also a bit ridiculous. How can the top comedy of all time be a silent film and not Spaceballs? Also, if you haven’t seen Game of Thrones, you should. Also, HBO is free right meow.

4. Create. Making a vegetable lasagna or a batch of pecan sandies for a neighbor can brighten their day and yours. Just leave the gifts on their porch or something. Exploring your creative side by writing poetry, painting, or even making a new recipe can be very satisfying. I have been drawing charcoal sketches of my dreams and giving them to my friends. The sketches come in three genres: erotic, horrific nightmares, and both.

3. Make a schedule. I plan the next day while winding down for bed. Having a loose plan keeps me from looking at memes on Instagram through 2nd breakfast and into happy hour. My day plan* has a couple “core” items that will help me move forward in life, a few “FTA (feed the animals)” activities that keep me from getting evicted or fired, and some “Sharpen the Saw” items to keep me from wearing down. I keep the list small and work until it’s done, but when it’s done, I cease being productive. Here’s a copy of today’s plan. untitled

2. Cook. Some of us are gonna be great cooks after this. Some of us will be full blown alcoholics. Some of us may be both. COVID-19 isn’t a pass to start immediately binging on processed food (see #7). The only time we should eat processed foods is in a survival situation.

So for now, we should cook real food and save the Twinkies, Hot Pockets, and Slim Jims for when shit really hits the fan. Also, “Cooking” doesn’t mean you have to make a six course meal for you and your cat. Making soup or even perfecting your morning coffee ritual counts too. Here’s mine.

1. Connect. Check-in with people who may be struggling. Email your best friend. Call your mom. Host a virtual happy hour. DM your supervisor’s daughter. You’ll be glad you did, probably.

What not to do. Normally, I am a big fan of extended fasting, but for most of us, this is the wrong time. We are already deprived of some things, let’s not make things harder on ourselves with extra pressure. I am continuing some light intermittent fasting, which is essentially breakfast skipping, but I still find this to be quite easy, even in relative isolation.

While it might be tempting to start a major DIY home improvement project, these can end with trips to the ER, so it’s best to defer such activities. Also, don’t change your medications until you can chat with your doctor. Basically, pretend like hospitals are a breeding ground for a highly communicable disease that poses a threat to you and your family, because that is pretty much the case.

As a side note, lack of time is the number one reason people give for not exercising, meditating, reading, sleeping enough, corresponding, and cooking. Just saying.

Finally, the book Solve For Happy has been the impetus for an incredible positive change in my overall mood and happiness. I can’t recommend it highly enough, especially now. Since I’ve read it, I’ve noticed that my shower crying has decreased in both total time and intensity.

In conclusion, we shouldn’t feel pressure to use this time to start a side business, lose 50 pounds, or prepare for a triathlon, but if we set some small intentions for our time in isolation, when we emerge from lockdown, we can be a healthier and happier version of ourselves with positive habits, new skills, and based on our recent purchasing patterns, super clean buttholes.

If we don’t take care ourselves, we can expect to return from isolation with a beer belly, soul crushing depression, pre-diabetes, scurvy, and an internet porn addiction. The choice is yours. Choose wisely.

*My day plan is taken from a combination of The 7 Habits of Highly Effective People and the motivational speaker Brian Ward.

Doctor’s Secret Immune Boosting Tips. COVID-19 Edition.

With COVID-19 fear gripping our society, I felt compelled to share ways to strengthen our immune systems. To be clear, these tips are not a substitute for home-isolation, social-distancing, hand-washing, and other recommended measures. We should all do those things too.  With COVID-19, over 80% of people seem to have mild flu-like symptoms, not requiring medical care, but a small percentage of people need to be hospitalized and some will become critically ill.  Who gets really sick and who doesn’t, has a lot to do with our immune system, which is influenced by age, other medical problems, genetics, but also factors we control.

Author’s disclaimer: I am taking this pandemic extremely seriously, as a physician and personally as a parent and son. That being said, there are jokes in this post. Humor is not a reflection on the seriousness of this pandemic but rather as a ploy to get you to keep reading.

Backstory: I spend most of my time in hospitals, taking care of patients, many with contagious diseases. It’s a regular occurrence for people to cough, sneeze, bleed, vomit, and poop on me, and not just while I’m in line at Walmart, but at work too. Also, I have two small children at home, who attend elementary schools, which have rates of communicable disease higher than Charlie Sheen’s poolhouse.  Despite this, using the advice below, I literally never get sick. Your results may vary.

First disclaimer, I am fully vaccinated and I wash my hands a lot, but I am by no means a germophobe.

Second disclaimer, I wasn’t blessed with an iron clad immune system. As an adolescent, I had pneumonia twice and as a child, suffered from frequent ear infections. In college, I got…Nevermind, it’s not important. The point is, my baseline immune system is average at best.


Why are they shaking hands? C’mon!

Immune system overview and COVID-19:Besides physical barriers like skin and nose hairs, we have two parts to our immune system.  The innate immune system and the adaptive immune system.  The innate system is always working against all potential threats, like an electrified fence.  The adaptive immune system works more like a sleeping security guard.  It only activates when it identifies a new threat or recognizes a past threat.  When activated, the adaptive immune system makes antibodies to help identify and attack invaders.  With COVID-19, those with weakened innate immune systems (electrified fence) tend to do poorly, while those with less strong adaptive immune systems (security guards) do fine.  Transplant patients are an example of the latter whereas the elderly are an example of the former.immune

Children have strong innate immune systems, but not fully developed adaptive immune systems, which may be why we see less severe illness in them.

Sometimes, we can sort out the right way to do something, by finding the wrong way and doing the opposite, like George Costanza. Two groups of people who suffer from terrible immune systems, are poorly controlled diabetics and meth users. Why is this the case? High blood sugar lowers our innate immune defenses. One study showed for five hours following a high sugar/carb meal, non-diabetics had their immune response reduced by 90%. Diabetics get extra immunizations because their immune system is weakened and their high blood sugar is a breeding ground for infection.  Bacteria grow fastest in the lab on agar, which is a sugary gelatin, but not as delicious as it sounds.

What about meth users? They go many days without sleeping. This wrecks their immune system and they are prone to all sorts of infections, and not just the sexually transmitted ones.  Studies show that rats who aren’t allowed to sleep, die of infection after only 7 days, because their innate immune systems shut down entirely.  Human studies show that four nights of poor sleep weakens elements of our innate immune system by over 50%.  Here’s my article discussing the importance of sleep.

So don’t blow your COVID-19 stimulus check on sweet tea, Monster Energy Drinks, and crystal meth? I know that’s not breaking news, but getting the proper amount of restorative sleep is clinically proven to be crucial.  Furthermore, since restricting carbs, especially carbs in the form of sugar, wheat, and processed food, my immune system has become strong to quite strong. I have seen similar results in my patients as well.  Here are some other things that may help…

Having normal levels of vitamin D helps our immune system, but it must be the D we get from sunlight and diet.  If you are found to be low and then take supplements, there’s probably no benefit.  So get outside and eat a diet rich in vitamin D.  Side note, I’ve never seen a super sick person with a great tan, so there must be something to this sunlight thing. vitamind

Manage chronic stress.  When doctors want to turn off someone’s immune system, we give them cortisol (corticosteroids), our stress hormone. This is helpful if they have an over active immune condition that is hurting their body but it’s bad for fighting viruses, especially COVID-19, except in certain ICU circumstances.  Keeping our cortisol levels low is super important for healthy immune function.  Here’s how to fight chronic stress. 

Exercise, but skip the ultramarathon. Reasonable amounts of exercise are immune enhancing but if you find that you’re regularly crapping yourself during training or if your nipples are currently bleeding, that’s not good.  Studies show that prolonged, extreme, intense, endurance workouts can temporarily weaken our immune systems.

Our bodies can only operate in one mode at a time. We can’t run from a tiger and maintain an erection or train for an ironman triathlon and fight off a virus.  Alternatively, yoga, weight lifting, Tabata (brief high intensity interval training), light jogging, and brisk walks are great for both physical, mental, and immune health.


Take vitamin C but stop drinking OJ and other things that are high in sugar.  Orange juice (even fresh squeezed with no sugar added) is loaded in sugar. Whole oranges are healthful, but when we juice them (and other fruits) we take out the fiber and are left with a sugar (fructose) bomb.  2000mg of vitamin C per day has been shown to help our bodies recover from illness, but even this is controversial.* Higher levels can cause diarrhea and haven’t been shown to be helpful.  Also, I recommend taking 40mg of oral zinc daily.

What about other anti-oxidants? Don’t they help our immune system? Yes and no. Imagine a virus as an axe-murderer in your home. Your immune system is you with a machine gun, but you are a terrible shot. So in the process of defending yourself, you shoot up your house and hopefully kill the axe-murderer. The machine gun represents our white blood cells and the bullets are “reactive oxidative species (ROS)” or “free radicals” which are deadly to intruders but also cause a lot of damage to our home (AKA our body).  In fact, these bullets keep bouncing off of our walls until neutralized by anti-oxidants.  Every bounce could be a hit to your DNA, leading to damage, aging, or even cancer.freeradicals

Without anti-oxidants, our immune system would do a lot more damage to our body every time it’s activated. Anti-oxidants also protect our cells against free radicals from UV rays, pollution, cigarette smoke, and chemical pesticides. The point is that anti-oxidants are great, but technically they don’t actually fight infections.  They limit collateral damage.

Tumeric is a tasty spice that has a little evidence that it helps inflammation and immune function. I like it in food, but also coffee and tea. If you are on blood thinners, you need to ask your doctor before starting supplementation. This also applies to garlic, except I don’t put it in my coffee and tea, and you don’t have to ask your doctor.

Chicken soup. This is not just something your grandmother says. Real scientific studies have shown its immune boosting properties. I like mine hot and spicy because it helps to drain and open my sinuses.  Vegetable soup would probably work too.

Hot and Cold. Sauna has shown incredible benefits for immune function, but since the COVID-19 shutdown, my sauna has been closed. I’m experimenting with hot baths but I don’t get the same euphoria, maybe it’s the lack of hot sweaty dudes. Periodic cold exposure, contrary to popular belief, can also boost immune function. I hate cold showers, so I’m regularly jumping in a cold pool which is also great for getting deep sleep.  Here’s a protocol to check out. 

ACV with Honey. Apple cider vinegar lowers blood sugar and has anti-oxidant properties and honey is great for sore throats and cough.  I combine them with hot water and add fresh ginger, turmeric, and garlic at the first sign of a throat tickle or sniffle.

Fun Fact: When drug companies were testing kid’s cough syrup, honey served as the “control” drug and honey outperformed any cough medicine big pharma could safely offer kids. Don’t give honey to children under one or anyone with a severe honey allergy. Incidentally, I get a rash from honey when it’s applied at high temperatures to my feet and ankles.

Today, more than ever, we must keep our body’s immune defense strong and ready for a fight.  Vince Lomabardi said, “The best defense is a good offense”, but with COVID-19, I say that an even better defense is just staying the f**k home.  Please consider these immune system tips long after our COVID-19 crisis is over.  Thanks for reading, please stay safe, and God Bless.

*Vitamin A and E, also help immune function but both are fat soluble and the body can recycle these vitamins, so supplementation of A and E is generally not needed.  Vitamin C can only be used once and is water soluble, so it’s tough to overdose and our supply needs to be replenished daily in the form of a healthy diet and/or supplements.

Leading medical journal published 10K words on intermittent fasting (IF). Here’s my 3 minute summary.

Within minutes of this paper’s release, my buddy, (and blog contributor) Dr. Jason Valadao texted me the link.  I later replied with a thumbs up, two big hearts, gold trophy, and five eggplants emojis.  This article is a big deal because The New England Journal of Medicine (NEJM) is the most highly respected medical publication in the world, just narrowly beating out JAMA, The Lancet, and  The NEJM’s recent extensive article on the many benefits of intermittent fasting (IF) marks a turning point in the study of health.  It firmly puts tired statements like, “eat 6 small meals per day,” and “breakfast is the most important meal of the day,” in the same category as those old timey scientific proclamations, “smoking helps us breathe better,” “masturbation will make you go blind,” and “redheads don’t have souls.”  This post is a very brief summary of the NEJM article, but not a how-to guide of IF.  Here’s a link to the full NEJM article and here’s a link to my short guide to easy intermittent fasting.


Defining IF.  The NEJM defines IF as, eating in a 6-8 hour window each day, with 16-18 hours of fasting (18:6 vs 16:8) or eating normally for five days per week and only eating one moderate sized meal per day on the other two non-consecutive days (5:2).

Daily Caloric Restriction (CR).  Animal studies have repeatedly shown that calorie restriction extends the lifespan of animals, ranging from yeasts and worms to dogs, rats, and monkeys.  The life extension can be dramatic, up to 80% in some cases and the restriction does not have to be lifelong.  Even starting CR in older animals shows a huge life extending benefit.


This is the face of daily caloric restriction.

The problem is that daily CR can be miserable.  These animals may live longer but they often seem to be praying for death, and there are side effects like brain shrinkage (seen in monkeys), depression, cold intolerance, decreased energy, and slow metabolism.  Humans subjected to daily CR also start resembling Woody Allen, an unpleasant side effect indeed.

It seems that the benefits of CR may be a result of the restricted feeding time window and not the CR.  In more recent experiments, animals were not calorie restricted, but their feeding was time restricted (IF) which showed the same life-extending benefits of CR, but is much easier for humans to follow and doesn’t have the unwanted side effects.

What Happens when we intermittently fast?  IF obviously helps us lose weight, but so does Jenny Craig. So what’s the big deal? I’ll tell you.  When we fast, our bodies switch fuels, from glucose to fats (in the form of ketones).  This switching to ketones acts as a signal to the body to activate a host of anti-aging processes.  IF allows for old, useless cells to be killed (autophagy), which doesn’t occur when we stay in a “fed” state, here’s a link to my article about it.  Even better, after the old cells die, new young cells take their place.  Studies show that the benefits of IF are independent of the healthy effects of weight loss and therefore IF is a good idea whether we are overweight or normal weight.  Here are some more benefits of IF discussed in the NEJM article:

Weight Loss:  This seems obvious, but the type of weight we lose is also super important.  Studies show that IF causes greater loss of body fat, specifically abdominal fat, resulting in a smaller waist circumference, as compared with caloric restriction.

Maintenance of muscle mass.  Keeping your muscle mass when you’re losing weight is important for metabolism, insulin sensitivity, and increasing your odds of waking up with attractive strangers.  Studies show that IF is great for this as well.

Heart Health.  Decreased inflammation, blood pressure, and LDL (bad) cholesterol are all helpful for keeping your ticker healthy, and are coincidentally all documented benefits of IF.  The subtle theme of this post is that IF is good for you.

Brain Health.  IF research has shown improvements in cognition, balance, coordination, and active memory, both in young people and in older folks with dementia.  IF has shown promise (in animal models) to reduce the risk of stroke, Alzheimer’s, Parkinson’s, and other neurodegenerative diseases.

Type II Diabetes.  IF cures type II diabetes.  That’s all I have to say about that.

Cancer.  As we age our risk of cancer increases exponentially.  IF is shown to prevent cancer through many different mechanisms, but IF also shows promise in improving the survival of those with active cancer, and reducing the side effects of chemotherapy.   Despite this new research, patients with cancer are often told to try to gain weight, and thus are discouraged from fasting, but I expect this will change soon.

Other.  IF has shown early evidence of benefit in rheumatoid arthritis, multiple sclerosis, asthma, traumatic brain injury, spinal cord injury, other inflammatory or autoimmune conditions, and the gum disease gingivitis.  That last one may be bullshit.

Healthchecklist (1)

Bear Avoidance is the most important

Dr. Jimmy’s Editorial Conclusion:  So, why does IF help all these very different health issues?  Here’s my take.  Our single greatest risk factor for all of these diseases is age and IF fights the aging process.  Our bodies don’t have a clock that keeps track of time in hours, days, and hockey seasons.  Instead, our bodies age by detecting things like inflammation, nutrient consumption, cell divisions, and damage to our DNA.

IF reduces our body’s inflammation, strengthens our DNA, lowers insulin, and keeps things tight both at the cellular level and with regards to our midsections.  Many people say that they don’t want to live to be 95 or 100.  What if you feel amazing at 94, with a sharp mind, supple body, an active sex life (gross), and you just inked a sweet deal with a member of the Nigerian Royal family who needs five hundred dollars in order to access his family’s vast fortune which he will share with you?  Cha-ching!  Would you still want to check out at 95?  I didn’t think so.

IF has shown that it can fix what ails us today and delay what is coming down the road tomorrow.  Also IF is pretty easy, as well as being free.  So instead of making the same doomed and clichéd New Year’s resolution to lose 30 pounds by joining a gym, counting calories, or cutting off a limb, start IF to lose the 30 pounds and in the process you may gain 30 years.  Thank you for coming to my Ted Talk.


How Stress Makes us Fat. The Cure Involves Wine and Getting Plenty of D.

If you are having difficulty seeing the results from a new diet, take this five question quiz.

1. Do you avoid processed foods? Here’s why you should.

2. Have you stopped eating fast carbs (sugar, wheat, and fruit juice etc.)? Here’s why that’s important.

3. Are you physically active? If, not read Dr. Jason Valadao’s tips for geting started.

4. Do you engage in some form of time restricted eating, intermittent fasting, or longer fasting? This is why we all probably should.

5. Have you signed up for email alerts for

If you answered “no” to any of the above questions, then that may be the issue, but if you answered “yes” to all and are still having trouble achieving your ideal weight, then it’s possible that chronic stress is holding you back. While this occurs in men, I see this much more commonly in my female patient population for reasons I do not fully understand.

Chronic stress activates our “fight or flight mode”, but for most of us, it never gets turned off. This is bad. Cortisol is our body’s chemical response to stress. Cortisol raises our blood sugar levels, and causes a host of other problems (see diagram below). Cortisol also causes us to hold onto our body fat when dieting or fasting, and our body’s only recourse is to slow our metabolism (fatigue) and burn protein (muscle) as fuel, both of which are bad. Chronic stress often leads to poor sleep, which leads to even higher levels of cortisol. I wrote about this here. To make matters worse, stress and lack of sleep both encourage stress eating. This makes stress a triple or even quadruple whammy (I lost track of whammies) in regards to our weight.

So why do we have chronic stress?

Our stress response evolved to help us survive when we were running from sabretooth tigers. We don’t have many sabretooth tiger encounters today, so why are we so stressed? My theory is that during ancient times the tiger encounters served to calibrate people’s internal stress meter. Stress levels were high when tigers were near, and stress levels were much lower when they weren’t. Also, before lightbulbs, we had not choice but to relax, socialize, and rest when it got dark outside. Today many of us have a 24-7 bombardment of stressors from our jobs, our kids, cable news networks, and baseless criminal investigations. None of our stressors today are as dangerous as sabretooth tigers, but today’s stressors are more constant, more numerous, and therefore overwhelming. This is the problem. Our stress response is locked in the “On” position. Add on the facts that most of us aren’t getting enough sleep, and we have access to an unlimited supply of processed foods, and it’s not surprising that America is over-stressed and overweight.

So how do we reduce chronic stress?
As tempting as it sounds to quit our jobs, enroll our kids in boarding school, and move to a naked hot yoga commune, in a non-extradition country, we really just need to adjust our response to stress. A Man’s Search For Meaning, by Victor Frankl proposes that we choose our responses to stressors, but most of us react instinctively, effectively giving up the power to choose. He discovered this truth while being a prisoner at Auschwitz. While his guards had the power to hurt him, only he had the ultimate power to choose his own response to their actions. This is literally the most empowering concept I’ve learned in 25 years of self-improvement reading. That’s a little deep for this space, and I promise a meme or penis joke is forthcoming, but first here is a model of his theory I made, no big deal.

That space between stimulus and response is our opportunity to choose to not stress and to let it go, like Elsa from Frozen. Just fucking let it go. The choice is ours. I just want us to realize that it is a choice. When I hear someone say, “He made me so mad…” I want to say is, “Karen, what really happened was he did something, and you chose to get mad, and then you asked to speak to the manager.” We all choose. If Victor Frankl can choose not to hate his guards, then I can choose not to get mad at the guy who cuts me off in traffic, and therefore I choose not to stress in the first place. Also, we need to de-stress. Here’s a few things I recommend.

  1. Get a lot of D. The catch is that the D has to be natural D, the kind of vitamin D you get from sunlight and a healthy diet and not from a pill. People with naturally normal vitamin D levels are less stressed and maintain better body weight, but studies show that this does not apply to people who are taking oral D supplements. Lab mice when deprived of sunlight will get elevated cortisol levels, and even show drug addiction withdrawal symptoms, which all stems from a lack of sufficient D.
  2. Sauna. Not everyone enjoys 20 minutes in the sauna as much as I do. Perhaps the sweating, extreme heat, spicy odors, and naked men aren’t your thing. Try it anyway. If you do an honest self-assessment 30 minutes after, you will feel more relaxed, less stressed, and signifiantly happier. The body releases natural endorphins during and after a sauna, similar to exercise and sex. Also, don’t exercise or have sex in a sauna. I will write an article about sauna soon, but it’s my go-to stress reliever that just happens to make us live longer too. I distract myself during my sauna with crossword puzzles to get through the whole session. I bring water with electrolytes and a towel to cover my private areas, and you should too, especially if you go to my gym. Please and thank you.
  3. Exercise. You already know this. I won’t go into details, but exercise helps stress. Thanks, Captain Obvious.
  4. Mindfulness AKA meditation. This really works but unfortunately, it often takes 2 or 3 consecutive days to feel the results, but the results are ridiculously good. I feel so good after a few days that I often forget to do it and then rebound. I (and probably you) just need to make it a regular daily habit like flossing, manscaping, or messing with your spouse’s toothbrush. Initially, I recommend committing to two weeks of a daily practice. If you don’t feel 50% better at the end then maybe it’s not for you, but trust me, it’s for you. I’ve used and enjoy the Calm, Headspace, and Brain FM apps for my guided mindfulness. My favorite is the Calm 10 minute loving kindness practice.
  5. Bath with Epsom’s Salts or transdermal magnesium. Baths can relax us but adding Epsom’s salt is a whole different level of relaxing. Why? The salts contain magnesium. Magnesium is a natural relaxant and is best absorbed through the skin. This allows it to go straight to our nervous system and skips some of the GI side effects. This is also great for sleep. If you don’t want to bathe, just apply transdermal magnesium in the evening.
  6. Sleep. This is huge. Check out my article if you haven’t already.
  7. Yoga. If mindfulness and exercise had a child, it would be called “Yoga.” And if sauna, exercise, and mindfulness had a threesome their baby would be “hot yoga.” PS I don’t do yoga in front of people. I do room temperature yoga, at home, at least once per week to prevent back pain and improve my core strength, but also as a substitute for mindfulness. Despite not being flexible at all and having very poor balance, I’m super good at yoga, because yoga isn’t a competition. It’s like soccer for six year olds, if you just get out there and try, you get orange slices and a trophy. In yoga, we’re all winners. I’m going to buy a yoga trophy for myself and display it proudly on my mantle. I use the app for my yoga, but there are a lot of good apps and YouTube channels out there for home yoga. Message me with your favorite, and I’ll update this post.
  8. Lavender or Sage oil. I add lavender or sage oil (depending on my mood) to activities #2,4,5,6,7, and 10 as a way to bombard my senses with anti-stress messages and to disengage from the flight or fight mode.
  9. Wine*. I’m not suggesting getting drunk in order to de-stress and forget about our problems. For legal reasons, I ask that you re-read the previous sentence. Often when we are dieting, we stop our evening glass or two of wine because it’s an extra 80 calories per glass. If that’s your way of unwinding after a long day, then I think you should keep doing it*, especially if stress is an issue for you. Also, red wine has a lot of benefits, and a glass can overall help your metabolism.
  10. The 5 Minute Journal.** I do this every day and it has significantly decreased the amount of time I spend crying in the shower. It’s amazing. I previously used the hard copy version but have switched to the app because I was misplacing the book, and the app allows me to upload pictures. Here’s a screenshot from one day’s entry. There’s also a great daily quote and a part where you recap what could have been better.
I was parked when I took this picture.

The journal is also great to do with your kids as well. The process teaches gratitude and helps ground us and reminds us that we aren’t being chased by tigers and also sets intentions for the day. The recap at night helps me relax before bed. The app is only 5 bucks. Get one for yourself and someone you care about. You’ll be glad you did.

This was supposed to be a short article, but I ramble. If you are on the path to wellness and feel that you are stalling out, consider addressing chronic stress. We don’t need to run from our stressors but instead learn to address how we respond to them and use positive tools to let go of stress once it has affected us. Also, we need lots of D. I know this is a little touchy feely, but stress is a serious medical problem that doesn’t just cause weight issues, but also cancer, chronic inflammation, depression, anxiety, and Netflix bingewatching. If you aren’t affected, you know someone who is. Forward this article to them and encourage them to sign up for my email alerts.

*Don’t start drinking if you are a non-drinker, as this is a slippery slope, moderation can be difficult, and excess alcohol is bad. This should be self-explanatory.
**This was a Tim Ferris recommendation.

Tips to Dominate in the Bedroom. Plus Coffee, Tequila, and Shark facts.

Maybe this title was misleading. To be clear, this is your one stop guide for getting great sleep. If you came to this article looking for something else, I apologize, for nothing. Fixing broken sleep has been transformative, in terms of my health but also my mood, attitude, and overall life satisfaction. I didn’t even know my sleep was that bad, until I fixed it, and I’m pissed I didn’t fix it sooner. To put things in perspective, here are the top three things I have done to improve my health in the past ten years.

3 Minimized/eliminated processed foods, sugar, and wheat. Here’s why.

2 Engaged in regular time restricted eating and periodic longer fasts. Here’s the article.

1 Prioritized getting 8 hours of quality sleep. Here’s why.

That’s right, sleep is numero uno. If you take my advice, it can be life changing for you as well. Here are some unbelievable sleep facts followed by my best recommendations for getting great sleep.

Amazing fact #1. Did you know that when we set our clocks forward in the spring and collectively lose an hour of sleep for daylight savings time, the rates of car crashes doubles? You did? Damn. But did you know that the rates of heart attacks, suicides, strokes, hospital admissions, coffee consumption, and people being late to work all skyrocket on that day as well. All this, from just one hour of collective sleep loss. What’s even crazier is that when we turn the clocks back and get an extra hour of sleep, the heart attacks, strokes, suicides, crashes, and work tardiness collectively hit all-time lows. This daylight savings example shows the far-reaching and devastating effects of just one hour of sleep loss.

Amazing fact #2. All animals sleep, even sharks. As a kid, I loved shark week on the Discovery Channel. I was told that sharks don’t sleep because they’ll die if they stop swimming. False. In actuality, they sleep and swim at the same time. #sharkfacts.

Getting this tattoo is on my to-do-list.

Amazing fact #3. When scientists completely deprive rats of sleep, they die, after only 7 or 8 days. What’s most interesting is how they die. I would have guessed car crashes or drug overdose, but in actuality these rats suffer a breakdown of their immune system and get terrible intestinal infections leading to septic shock and eventually death. Our immune systems fail when we don’t get enough quality sleep as well. One study showed that cancer fighting cells (NKC’s) decreased by 70% after patients were limited to just four hours of sleep. Another study gave rats tumors and then cut their sleep by half. The sleep starved rats’ tumors grew 2-3 times faster than rested rats, and experienced metastasis (spreading to other parts of the body) whereas the normal sleeping rats had small tumors that didn’t spread. These studies show how poor sleep lowers our immune defenses, and not just for colds and flu, but also for cancer.

Amazing Fact#4. Sleeping pills can kill you. Taking sleeping pills is shown (in 24 different large studies) to greatly increase our risk of all cause mortality AKA death, which should be put on the label, but isn’t. Here are the studies, and here’s another one. Death is one of the worst side effects I can think of, right up there with hair loss, anal leakage, and the gum disease gingivitis. Exactly zero studies show any measurable health benefits from taking these meds. Even the best sleep medications don’t provide quality sleep and only beat placebo (sugar pill) by a few minutes in terms of how fast they get you to sleep, and that is using big pharma’s own data, which is likely bullshit.

So what are sleeping pills good for? Making big pharma rich. Ambien made 4 billion dollars in profits in just two years. There are 61 countries in the world who’s entire gross domestic product is less than Ambien, and that’s just one of many lucrative drugs. Here are some other big pharma stats that are ridiculous. In conclusion, sleep meds are dangerous, habit-forming, incredibly profitable, and they don’t work. Here are some things that do work and don’t require a prescription from someone like me.

  1. Get more light in the day and more dark at night. Our bodies are continually looking for cues about whether it’s night or day, in order to set our internal clock and control the release of melatonin, our natural sleep hormone. Before Edison’s lightbulb, our bodies knew what time it was.  Now, not so much.  Daylight has 50 times more lux (unit of light) than even our most brightly lit cubicles, offices, and Walmart Superstores. So even in a well lit room, our bodies are very confused.   At night, the blue light from our smartphones and computers tricks our brain into thinking it’s daytime, because the blue light they emit suppresses our sleep hormone melatonin.  I encourage my patients to get morning sun (without sunglasses) to help establish our circadian rhythm and to get outside periodically throughout the day. In the evening, I keep my rooms dimly lit, wear blue light blocking glasses (it’s a thing), and have night shade mode on the screens of my electronic devices, to increase my natural melatonin release.  Also, I use an app call F.lux that will block blue light from my computer screen.  
  2. Get Cold. Our core body temp must drop a couple degrees in order for us to go from light to deep sleep, and going to bed a little cold can also help us get to sleep faster. I use a dip in a cold pool or a cool shower to help achieve this. One study showed cooling down patients with terrible insomnia (using cooling headcaps) got them to sleep faster than people without insomnia, and no drugs were required.  I also keep my AC on high most of the year in my bedroom to help me get to sleep and stay asleep. I aim for mid 60’s in my room.
  3. Don’t sleep completely naked. This really only applies to people who spend the night on my couch. I’m looking at you Handsome Eric. So feel free to sleep in the buck at your own house, however soft gloves and socks encourages blood flow to extremities and can help lower your temp, which is a good thing.  
  4. Use your bedroom for sleeping and sex. Don’t use your bedroom for arguing, watching TV, studying, social media trolling, or blog writing. Sex can help us relax and also make us quite sleepy, even if you’re alone. If your sexual activities involve torture devices, cattle prods, or more than three people, then consider taking it to a basement, windowless van, or your local LaQuinta Inn and Suites and be sure to have a “safe word”.  No judging.  Did you know that “LaQuinta” literally translates to “next to Denny’s”?
  5. No clock-watching. Take the clock faces out of your bedroom, as this can lead to increased angst regarding sleep and set your phone to “Do not disturb”, unless you get a lot of late night “you up?” texts.
  6. Listen to an “Adult Sleep Story”. This is not porn. I hate that the porn industry has stolen the word “adult”. Not all adults are into porn, and frankly that implication is disgusting. Statistically there are literally hundreds of men in the U.S. who don’t regularly look at porn. I use the “Calm” app (not porn) for these adult sleep stories and for my mindfulness practice, which is also good for sleep. This app has hundreds of stories that are just stimulating enough to hold your attention but soothing enough to put your sweet ass to sleep. They even have celeb guest readers like Matthew McConaughey, Bob Ross, and Sam Smith. My favorite stories are “Blue Gold”, “A Magical Winter’s Night”, or anything involving trains. Once again, this isn’t  porn. The app is free, but has a premium membership as well.  Also, there are sleep stories for kids on the app that are good as well. Here’s the link.
  7. Magnesium + Apple cider vinegar + Honey + Melatonin (5mg). This elixir is the go-to of Tim Ferris. I pretty much try whatever he suggests and this stuff really works. Magnesium is a natural relaxant and something your body needs anyway.  Sometimes magnesium can cause you to poop too much, if this is an issue, try the more bioavailable topical magnesium, and you will be spared this side effect.  I added the melatonin to this combination.  It really will help, but most people are taking it incorrectly. The key is the timing.  A lot of patients have told me it doesn’t work for them, but when I get them to take it earlier (like 2-4 hours before bedtime) then it works. The rest of us only need to take it 30 minutes to an hour before bed.  
  8. Sleep Mask + Ear plugs + Lavender oil.  I have turned my bed area into a sleep sanctuary.  It’s important to get your room quiet and dark for sleep. My room is pretty dark, but sometimes road noise, cat fights, or my oldest child’s night screaming can disrupt my slumber. I use “Mack” ear plugs and a sleep mask with adjustable eye cups (GoZheek brand) as double protection against sleep disruptions. Lavender oil helps relax me.  It’s been used for thousands of years for sleep and has some data behind it*.  My brain has permanently linked the scent of lavender with sleep, not unlike how Guy Fieri associates the smell of bacon with intense sexual arousal.  
  9. Alcohol. Alcohol is used by many of us to get to sleep, but drunk sleep isn’t restorative for a number of reasons.  Just because we lose consciousness, doesn’t mean we are getting real sleep. A 2×4 applied with enough force to the side of our heads will induce sleep, but that isn’t quality sleep either. When I told my mother about alcohol’s negative effects on our sleep, the anger, desperation, and fear in her eyes told me that quitting Nana-juice was going to be a multi-step process, probably 12 or so. So instead of recommending abstinence to you and The Betty Ford Center to my Mom, I came up with some mitigation strategies. Here is Dr. Jimmy’s 5 point plan for boozing and still getting good sleep.
    1. Start early. Happy hour drinks are much less likely to mess with your sleep as compared with a night cap. So start your drinking earlier and stop well before bed with a goal of being soberish, by night-night time.
    2. Avoid beer, especially close to bedtime. Beer is mostly water and it irritates our bladder and that makes us pee a lot. Getting up to go pee in the middle of the night isn’t great for your sleep.
    3. Get colder than cold. Alcohol raises our core body temp a bit because its a vasodilator. As I mentioned, lower body temp is needed for deep sleep. To fight the warming effects of alcohol, keep your room extra cold and consider a cold shower or bath immediately before bed.
    4. Afrin + Nasal “Breathe Right” Strips + CPAP. Alcohol can induce snoring and worsen sleep apnea. If you have sleep apnea, be sure to wear your CPAP mask, especially when you’ve been drinking. For the rest of us, Afrin (OTC nasal spray) and the Breathe Right nasal strips can help keep our airway open and increase the oxygen to our brain. Don’t use Afrin too frequently, it can be habit forming, once a week is fine though.
    5. Don’t over do it. Too much alcohol stops us from getting into REM (dream) sleep which over time, leads to early dementia, and a host of mental health problems.  Also, you know how upset your mom gets when you get puke on your Yoda pajamas.
  10. Make a Caffeine Adjustment. I love coffee. I wrote about why it’s good for us (here is the link) but if abused, it can screw up our sleep. I used to drink an espresso after dinner and be asleep in an hour, but I’ve stopped drinking caffeine past noon. Let me tell you why. Caffeine has a half-life of 6 hours and a quarter life of 12 hours. So if you have a Starbucks grande drip coffee (350mg) at 2PM, it’s like having a regular coffee at 8PM (175mg) or a shot of espresso at 2AM (87mg). Anyone with even a hint of insomnia really needs to consider these facts and stop the afternoon caffeine.  But Dr. Jimmy you just said that you can fall asleep after an espresso, so what’s the big deal? I’ll tell you. Even if we can fall asleep with caffeine, the sleep we get is seriously degraded. That espresso ages me by 20 years, in terms of my sleep. This poor sleep makes us tired the following day, which encourages us to drink more coffee later in the day, which makes our sleep worse, and now we are in a vicious caffeine cycle.
  11. Workout in the AM. Even just five minutes can help set your body clock. I admittedly hate morning workouts, but I begrudgingly acknowledge that this helps. Also, avoid workouts within 4 hours of bedtime. 
  12. Track your sleep. There are lots of sleep trackers out there (Fitbit, Apple Watch, Oura Ring). I suggest using one to monitor what helps your sleep and what doesn’t. I try to be in bed 8.5 hours prior to my wake up time. I don’t sweat it if I’m not asleep the whole time. I think this takes some of the pressure off, which helps me relax.  My in-bed mantra is to relax and let go.  When we try too hard to fall asleep, there’s increased stress and pressure which can make sleep elusive.
  13. Have a regular bedtime and wake time. This is impossible for many of us due to our work schedules. When I get very little sleep because of a night shift in the emergency department, I try to give myself at least one 90 minute nap in the daytime. 90 minutes is the length of one sleep cycle. While this situation isn’t optimal, it helps me to be more functional in the day while still being sleepy enough to not have insomnia at night.  One of the downsides is that a 90 minute nap can cause something called sleep inertia where you feel groggy for a period of time, but once that is over, you will be better off, because 90 minutes allows your body to get into both REM and deep sleep.  The shorter 20-30 minute “power nap” can be refreshing, spare you any sleep inertia, and can help you function later into the evening but it’s not a replacement for your night time sleep, the way a longer 90 minute nap can be.  Also, if you have trouble falling asleep at night, try not to nap in the daytime.  

Thanks for checking this out. Let me know what you think or if you have any questions. Also, sign up for my email list on the right side of the screen. It will alert you when a new article, video, or recipe is posted. I’m also going to start giving away free stuff to my email subscribers. I won’t share your email address with anyone and I won’t try to sell you anything or ask for any personal information.

*Author’s rant: Many studies involving natural products are not taken seriously by the scientific community and I think that’s a mistake. They’re generally disregarded because the studies are small and often underfunded. They’re underfunded because the stuff they are testing aren’t billion dollar prescription medications or procedures. I am in favor of evidenced based medicine, however the bar for evidence should be raised and lowered based on the risk of the product being tested. If a study shows that carrots are helpful for weight loss but the study was only involving a few hundred people and only lasted a few years, this doesn’t mean we shouldn’t recommend eating carrots for weight loss because there’s not enough high quality data. We can say that there is some evidence for carrots We know carrots are good for us and the risk of the intervention (carrots) is low, so go ahead and give it a try. Instead, we disregard these small studies of benign interventions but freely prescribe sleep medications that have a high risk associated with them (and an FDA label) when in reality they need more high quality evidence showing benefit to be safely recommended.