303: REVIVE: Supporting Physician Well-Being With Lifestyle Medicine | Dr. Robyn Tiger & Dr. Melissa Sundermann

00:00:00 Maya: This is a Healthy Lifestyle Solutions podcast, and I'm your host, Maya Acosta. If you're willing to go with me, together, we can discover how simple lifestyle choices can help improve our quality of life. Let's get started. 

00:00:15 Maya: All right, welcome back to another episode, my friends. So this is a special episode dedicated to physicians. So if you're struggling to balance your professional responsibilities with your personal wellbeing, or you're feeling burned out and need support, this episode is gonna be for you. Join us as we sit down with Dr. Robyn Tiger and Dr. Melissa Sundermann, two board certified lifestyle medicine physicians who have created a unique and supportive program, specifically designed for physicians that will discuss their personal experiences with burnout and how they overcame it, as well as share valuable insights into the pillars of lifestyle medicine and how to prioritize your own health and wellbeing. So don't miss out on this. You're gonna learn the first step towards reviving your own wellbeing. As always, the full bio and the links for each of my guests can be found on the website, healthylifestylesolutions.org. Welcome, doctors.

00:01:14 Guest: Thank you. 

00:01:15 Guest:Thank you. Thank you so much for hosting us today, Maya.

00:01:17 Guest: So excited to be here, Maya. Thank you.

00:01:21 Maya: Yes. You know, as I was preparing for this conversation, I decided to kind of look up what physician burnout looks like. And Dr. Tiger has been on the show before, and this is what she has dedicated her life towards, is supporting her colleagues. I was reading that in a recent study associated with physician burnout, that more than half of physicians in the United States experienced symptoms of burnout, including emotional exhaustion, and everything from reduced sense of personal accomplishments to just feeling like anxiety and stress and all of  that. So I was wondering if we could start with that first, let's talk about physician burnout. 

00:02:04 Robyn: Yeah. Well, you know, Maya, we thought that statistic was staggering when we first heard it several years ago. And that is actually the statistic that we knew pre pandemic that one in two physicians or half of physicians were burned out. And what we've learned since the pandemic came upon us is that that number has gone up significantly. So some studies report as high as four out of five, so going from one out of two to four out of five. So for example, if we have 1 million physicians in the country, that's 800,000 doctors that are experiencing this. So there's some a tremendous increase in burnout just in the past few years.

00:02:54 Maya: That's incredible to hear.

00:02:56 Melissa: Yeah. Oh, I was just gonna say, sorry, Maya, to interrupt. I was just gonna piggyback on Robyn and I am still in clinical medicine, and I recently did a pivot. And after 24 years of being in conventional medicine as a primary care physician, I've transitioned out and just doing lifestyle medicine. And really that shift of the pandemic as an internist and having experience as a hospital, as I was redeployed to the frontline for 12 months. And then I came back to my office and there just really was this shift in so many ways, so many ways of, obviously, was very stressful. Everyday, I would go to the hospital and be dealing with covid face-to-face and risks to myself, risk of bringing it home to my family, my parents and things like that. But also there was a shift of coming back to the office and everything about the pandemic, not everything, but a lot of it became very polarized. It became very political.

00:03:54 Melissa: And suddenly, you know, patients that really trusted me all these years were now questioning, you know, why do I need to be vaccinated? I read a… you know, I saw YouTube, I watched an influencer, and really, you don't know what you're talking about and, you  know, this is how you should treat it. And so really, it just did not settle well, right? And, you know, I think that has contributed when with Dr. Tiger was talking about the difference pre pandemic and post is that I felt this internally, but I also was experiencing this externally from the patients that I was caring so much to take care of. So I think that has probably contributed as well.

00:04:37 Maya: Yes. Thank you for sharing that. And as a matter of fact, I was wondering if Dr. Tiger could kind of share the story briefly about your own experience with burnout, since we are addressing that, and how that led you to then create and really you found it, the stress-free MD to support your colleagues.

00:04:58 Robyn: Yeah, so probably, maybe about 15 years or so at this point ago, I was on the outside looking like I had the perfect life. Amazing husband, two beautiful young children. I was working as a physician. We had the beautiful home and everything looked perfect, but it wasn't for me because on the outside, things were very different than what was going on on the inside for me. And I started to develop several symptoms that seemed very disconnected. It started initially with migraine headaches, with this intractable vomiting, was really debilitating. Actually, had to stop packing and delay our Disney trip. I was very sick several times, not being able to be present at certain family events and even had trouble, uncertainties getting to work from that. I developed vertigo and tinnitus. For those of you who are not in medicine, vertigo is that sensation of the room spinning and tinnitus is the ringing in your ears.

00:06:13 Robyn: I developed really bad pain in my body that I felt like I couldn't even move like the tin man. It got so bad that my head and my chest moved as a unit. I couldn't actually turn my head. I was that tight and that stiff. My gums were just bleeding spontaneously for no known reason. I was experiencing lots of reflux. That heartburn, that burning chest pain. I couldn't sleep. I was exhausted. I was very reactive saying things that I wish I could take back, doing things I wish I could take back. And I had this very scary symptom that came on, which are called intermittent paresthesias, which means I had numbness and tingling in my hands, my feet, and the left side of my back. And these things happened at really scary times, particularly, the paresthesias where I would actually be driving in my car and lose sensation of the steering wheel. Or I would be cutting up vegetables for a salad and lose sensation of the knife in my hand. Or I'd be doing a breast biopsy, for example, and I would lose sensation of the biopsy gun in my hand. I'd be right there at the lesion and my tech would say, hey, Dr. Tiger, you're right there. Like, kind of, what are you doing? And I would just say, oh, yeah, I'm just checking to make sure I'm exactly where I wanna be. But the truth was, I couldn't actually feel the gun in my hand. 

00:07:45 Robyn: And so I had all of these physical symptoms going on, which were terrifying. And I was seeing lots of doctors for them. Gastroenterologist, periodontist, neurologist. Of course, I started with my internist and I was taking lots of pills. They weren't helping, a pill for an ill. Symptom pill, symptom pill. Everybody saw me as an isolated symptom. And I was having every imaging study imaginable because as a radiologist, I had everything you could have to see the inside of my body. And everything was negative. And I had every lab test that physicians could possibly think to order, and they were all negative. And I started to have terrible thoughts, right? So I described lots of body-based symptoms, but my mind started doing lots of things, you know, really questioning my ability as a physician and my ability as a parent, as a wife, as a human. I was even questioning if I wanted to be here anymore. So I had some pretty dark thoughts showing up. And so I sought mental healthcare professional advice and support. And even through that, I wasn't getting better. 

00:08:53 Robyn: And so I had all of this going on at once. Very disconnected, it seemed. Lots of pills, not working. Mental healthcare professional onboard, not helping. And I had lost three  physician friends to suicide. And I was really terrified that I was heading on that path. And I looked at my children. I looked at my husband. I looked at everything. And I said, I have to figure this out because I am heading on their path. And I didn't want that. And western medicine is amazing, but it wasn't helping me in what I needed at that point. I was already eating a very healthy diet, predominantly plant-based. I was exercising a lot. It wasn't enough. And so that is when I started to dip my big toe and start looking outside traditional western medicine to see what else is there, what can I do to help myself? And that's when things changed.

00:09:52 Maya: I know that when you shared your story, what really helped you is discovering lifestyle medicine. And so I'm very excited to have this conversation. I recently interviewed another physician who's also a hospitalist, and he talked about the depression and the anxiety that he was going through. And I said, are you familiar with Dr. Robyn Tiger, the StressFreeMD? This is what she dedicates her life to, in terms of supporting her colleagues. And he was intrigued. But, you know, what really stood out was, so you were going through all these physical and then psychological experiences that were taking you to a dark place. This physician who I interviewed said that when he would come home, his wife actually one day said to him, how is it that the patients get the best of you? And when you come home, we see the worst of you.

00:10:47 Maya: In other words, he was bringing home all that anxiety and frustration and depression home. And so having these conversations has really, like awakening me as a patient, as a layperson to really pay attention to my health providers and seeing, you know, checking in also and asking how they are doing. So I appreciate that you're having these conversations with us. Dr. Sundermann, you also talked about having been a hospitalist and how, you know, this becoming polarized during the pandemic kind of aggravated or added it to your own frustration. How did you find your way towards partnering with Dr. Tiger?

00:11:29 Melissa: Well, the universe did that, Maya. Yeah. So, you know, I wanted to, what resonated with me is what you were just saying with this physician you had interviewed and his wife's comment. And that just, it really hits hard home. About a year ago, I was back in the office and I would like to go for a walk during the day. And that's like Dr. Tiger was saying, I felt like I was doing everything correct. And so I would invite my husband to join me. And he was great. He would always join me. I would talk. And it wasn't until recently he shared with me. He said, I   showed up every day that you invited me to walk with you, Melissa. But most of the time it was really difficult to be around you.

00:12:20 Melissa: You were agitated, you were upset, you were negative. In fact, you were actually kind of like, crass talking about, I mean, not specific patients, but just, it wasn't who you were. Like, I know you and why you went into medicine is to help people, to develop relationships with them as a primary care physician. And I was seeing that fade away from you. And he said, but I knew I needed to be there for you. And I knew I just needed to listen and not say anything. But now I see this difference in you and you've come back to yourself and why you truly went into medicine and why you wanna help people. So I didn't realize it at the time, you know, and like Dr. Tiger was saying, symptoms that I was having, and they weren't maybe the same as Dr. Tiger.

00:13:10 Melissa: But I have what I now call my stress ankle. And I had this, my right ankle that was swollen. I would limp. And I'm a runner. I like to run. That's part of my mental health, physical and mental health. So I just kept brushing it off, that, I overdid it running. I just overdid it running. You know, I'm getting older. My joints can't handle this. And it wasn't until putting the pieces of puzzle together and I wasn't sleeping well. I'd always wake up at two or three in the morning, and that's never a good time to wake up in the morning, right? Or never thinking about double rainbows or anything like that. We're spiraling. And now that I can look back and my ankle is not swollen, I am not limping and I'm sleeping throughout the night. You know, I was like, oh my gosh. I was really unhappy and really stressed. 

00:14:02 Melissa: And there's times that, you know, when we go to medical school, Dr. Tiger and I were talking about this last night. You know, this journey starts out when we're very young for a lot of us. It started off for me when I was eight years old and wanted to go into medicine. I didn't have any doctors or even nurses in my family, but I just had this interest, this curiosity and this calling. So from eight years old, I wanted to be a doctor. In fact, I would practice writing my name, Dr. Melissa, right? And so then, you know, in high school, I wanted to do well so that I could get into a good university. And then in the university, I wanted to do all the right things to be able to apply to medical school.

00:14:40 Melissa: I actually didn't get in the first time I applied. So I even worked harder. And I did research for two years at the University of Michigan. And then I got in. And then during  medical school, we're working really hard to get into an internship and then an internship into a residency. And then during residency, you climb up through the ranks, right? As a junior resident, a senior resident. And always, you know, on this pathway of just focusing on the next thing and not really knowing how to take care of ourselves because it was always just, be  robotic, conform, you know, achieve. And so I think that as we go through life and so many of our colleagues, we haven't learned really how to take care of ourself. We know how to, you know, diagnose and take care of patients. And lifestyle medicine has made that even better for us because now we really know how to take care of patients. But we didn't learn how to take care of ourselves. 

00:15:35 Melissa: And so coming back to your question, how did Dr. Tiger and myself, how did we meet? Well, we met on LinkedIn. That was a very good dating site for us. The marriage has worked out great thus far. So we had connected on LinkedIn and I think we both were thinking, wow, this person's really cool. And it's like we've already known each other. And then a mutual, for me, a colleague and she was at a conference where Dr. Tiger was presenting and doing some experiential workshops with the attendees. This woman said, oh my gosh, you need to meet Melissa Sundermann. And Dr. Tiger said, wait a minute, we have already connected. So then we were able to meet in person and from that first date, right, we knew that we were a match to be. And what we like to call ourselves is, we are the unicorns of medicine that finally found each other. Because I think for both of us, going throughout our careers in medicine, I felt oftentimes like an outlier because I knew that wellness was more than pills and procedures. 

00:16:43 Melissa: And again, western medicine does remarkable things, right? As a primary care physician and being a hospitalist, I have relied on medications and procedures to keep my patients alive. However, there are the pillars of lifestyle medicine, which are far more important and start way more weight downstream than early detection, right? True, prevention is the pillars of lifestyle medicine. So I think we both always had this feeling. And then when we met and we discovered that we both were board certified in lifestyle medicine, we just said, wow, this is a special kindred spirit relationship.

00:17:23 Maya: That sounds so exciting that you've come together. I know, Dr. Sundermann,  that one of the things that you're passionate about is using nature as medicine. And you talked about just taking walks with your husband. So I can't wait to dive into what the program REVIVE looks like. So where do we wanna start with the pillars of lifestyle medicine?

00:17:45 Melissa: Dr. Tiger, do you wanna start with that? 

00:17:47 Robyn: Sure. Well, Maya, you know, as you mentioned, I created StressFreeMD and I started with myself in the lab, right? I always think of myself as a lab rat. And so anything that works for me, I like to share with others. And so I started diving into stress related programming and techniques to relieve my own stress. And all the symptoms that I described earlier, all in a way. So that's when I realized, just like Dr. Sundermann has a swollen ankle, for me, it's like just outside my lower left sacroiliac joint. I know that my stress lives there after chiropractor and physical therapy and occupational therapy and, you know, massage and you name it. It's actually when I relieve my stress, certain things go away. And so everything went away, including those paresthesias, including the numbness in my hands and feet, including the dark thoughts and so on.

00:18:49 Robyn: I started there and as I got more and more into recognizing what was going on with me, I wanted to learn more. Well, sleep, while that's so important, how can I sleep better? And while I'm already eating what I thought was pretty good, pretty well, right? But actually I'm not eating well enough and well, what does good exercise really mean? Like, am I doing the right thing or not? How come when I'm on the spin bike for 45 minutes, I feel great, but when I walk up the hill with my dog, I'm out of breath. Maybe I'm not really doing exactly what I need to do. And so all of these pieces of wellbeing were things that I was diving more into and studying. And then I found out that there was an organization, the American College of Lifestyle Medicine, which had all of this and more within it. And so that's when my hunger got even stronger and I dove in deeper and studied more deeply all of the things that I knew was helping me so that I could help others. 

00:19:45 Robyn: And so the reason that this program came together as this unicorn, Dr. Sundermann and I came together is that we're both so passionate about, well, if we don't know these things and we're board certified physicians, then other physicians don't know these things either. And we don't wanna be selfish and just hold it all to ourselves because that's not helping anybody. And I've known over the last decade that my own clients that started out initially just wanting help with their stress were like, well, how can I sleep better? And well, how can I eat better? Or how can I lose that weight that's not coming off? And what does good exercise mean? And I really don't wanna be around other people. Can you help me with that? And I'm drinking too much at night, and so on and so on.

00:20:28 Robyn: And so it just came into this, well, can we create this whole package and hand it to our colleagues instead of going to this place? Oh, let me help you with your sleep and to this one, let me help you with your fitness and over here with your stress and over here with everything else in nutrition and so on. Well, can we just package it and say, here, like, we've got you. You know, we wanna teach you everything that we've learned, the medical literature shows that's gonna help you become the healthiest, happiest version of you and to live your life to the fullest. And so that's how this program came to be, is that we started talking about this, and then one day, Dr. Sundermann was on a run and she texts me. She's like, revive. What do you think about that? And I said, I love it because that's what we wanna do. We wanna teach our physician colleagues had a revive. And so that is how this program started and that's how it came to be. 

00:21:31 Maya: That's beautiful. And it's exactly what I hear often from physicians who are trained in lifestyle medicine, my husband and then myself too. I'm interested in these topics, so I research them as well. And it seems like the more we learn, the more we apply these things to our lives. So we understand that, you know, we need to get adequate sleep, we need to be exercising. And it seems Dr. Tiger, that it's in our minds, on our minds all the time. If we're achieving our goals of lifestyle medicine, are we really living those pillars that we talk about? And it's become very important for my overall health as well to focus on this, stress management. It's important. So I know that I need to do yoga and meditate in order to just be a little bit more relaxed and calm because I have, you know, a lot on my plate like many people do. So Dr. Sundermann, please tell us more as well.

00:22:27 Melissa: Sure. So I'd like to think about the pillars of lifestyle medicine as spokes on a wheel. And I think probably all of us have ridden a bike at some point in our lifetime. And I don't know if you've ever broken a spoke on your wheel. I have. It is not a good thing. The wheel does not revolve properly and you're at risk of falling. Okay. It's dangerous, it's dangerous to break a spoke. So if you picture the pillars of lifestyle medicine, which I'm just gonna go through, maybe some of your listeners aren't as familiar. So the six official pillars of lifestyle medicine, our food is medicine. And we do advocate, in the American College of Lifestyle Medicine, a plant predominant dietary pattern. So a dietary pattern rich in fruits and vegetables and whole grains, beans, nuts and seeds, lots of fiber, lots of antioxidants, lots of phytonutrients.

00:23:19 Melissa: The second pillar is exercise. I tend to use the term movement. I find that to be more inclusive. Some people, when I'm counseling them about exercise, they think they have to go to the, what that looks like is going to a gym or lifting heavy weights. And that's great if you enjoy doing that. But for some of my patients, it's like, well, I really love bird watching. And I said, that's movement when you're looking around for birds, or I really love working at my garden and weeding and mulching, or I'm really enjoying pickleball right now. So movement is very inclusive. The third pillar is sleep. And I think as physicians, Dr. Tiger and I trained in the 90s, and this is before the reform rules came about, about shifts, right? So we would work 36 hour shifts, not just once a month, not just once a week, a couple times a week. 

00:24:08 Melissa: And so I think I was trained with the false assumption that I didn't need sleep because look at this, I just worked 36 hours straight. I went home and took a cat nap and I'm back at work the next day. So for many years I thought, you know, the quote, “I'll sleep when I'm dead.” Life is too short. There's not time for sleep and how wrong I was, right? Healing, so much important healing happens when we sleep, our brain is, we're getting rid of toxins that built up. I give a talk here. I work at Canyon Ranch and I do a talk on brain health. And sleep is really… Lack of sleep can be a risk factor for Alzheimer's dementia. So sleep is an utmost importance. The fourth is gonna be avoidance of risky substances, such as tobacco, excessive alcohol and drug use. I think that physicians, along with the rest of the population, we can self-medicate and that can be very unhealthy, right? 

00:25:11 Melissa: The fifth official pillar is stress management. And we have StressFreeMD here and that we all experience stress in our life. But it's what we do and how we manage our stress and the tools that we can help manage that, whether it's mindfulness or meditation or yoga, deep breathing, so many useful tools to help manage that. And the sixth official pillar is connection. And I think we're finding more and more evidence to support loneliness and connection is actually a health risk factor and can lead to chronic disease. But in my brain health, just by being lonely as we age, there's actually brain matter changes. The gray matter is different, looks different in a lonely, isolated individual rather than someone who is still connecting with friends and family or engaging. So social connection is very important. I think we all felt that. I say we had the biggest social psychology experiment with connection during the lockdown when we were told to stay home, don't see your family, don't see your friends, my gosh, don't even think about hugging them or kissing them, right? 

00:26:21 Maya: Right. 

00:26:21 Melissa: And after a year and a half or two years, we all felt like something's wrong. Something, I'm missing something. It was that, it was connection, it was oxytocin. You know, when we hug people, we hug our pets, we hug our kids, we hug our family, we hug our friends. Oxytocin, that hormone, is released. So those are the six official pillars. Now, Dr. Sundermann, and I happen to be a DO. There are MDs and DOs. I'm a doctor of osteopathy. And it's taken me 25 years of clinical practice to realize that the DO, not only stands for doctor of osteopathy, but it stands for doctor outdoors. So, I am a doctor outdoors. It's a very big proponent of the power of nature. And I'm working very hard to have this known as a seventh unofficial, maybe someday of an official pillar. 

00:27:15 Melissa: In fact, I just launched the Nature’s Medicine Committee for the American College of Lifestyle Medicine. Dr. Tiger is involved in that. It's very exciting. We know that spending time outdoors at least 20 minutes per day can lower our cortisol level, our stress hormone. Can lower our heart rate, our blood pressure. It actually improves our immunity just by going outdoors. Increases our natural killer cell activity and natural killer cell activity are involved in yes, immunity of preventing us from getting sick, but also natural killer cell activity. The higher the natural killer cell, the lower the risk of cancers. So all of these benefits by just going outdoors. And when we go outdoors, we are present, right? We are aware of our outdoors, we can cultivate curiosity and awe and wonder. So those are the seven pillars that we're gonna talk about. 

00:28:09 Melissa: And I think that, like Dr. Tiger was saying, we go through all of this training, and it wasn't until I studied for my lifestyle medicine boards that I really learned about these pillars. I thought I knew about nutrition, I thought I ate healthy. That wasn't the case. The average medical school and residency in this country receives about 17 hours of nutrition education. And quite frankly, when I think back that nutrition training was biochemistry. It was memorizing a Krebs cycle, or it was maybe learning how to do tube feeding in the hospital. It wasn't every day practical healthful nutrition. I didn't know about sleep. I didn't know exactly what healthy exercise looked like. We didn't talk about stress management. That wasn't an option. You show up to work, you code patients, you do the procedures, you do your notes, you know, and God forbid, you ever call in sick, right? So we just feel like there's so many of our colleagues that as a profession that we love and care for so deeply by sharing what we have learned, what is working for us, what wasn't taught in medical school or throughout our careers or training will just, you know, enrich everyone's life.

00:29:35 Maya: Absolutely. I love the idea that you're going to talk to us about how you support physicians in doing this, in taking care of themselves since they were not encouraged, since you were not encouraged during medical school. It's almost like you're expected to be super people, superheroes that are resilient and nothing affects you. Nothing phases you, but at the same time, you're exposed to a lot of illness. And I've always wondered if energetically you pick up on  that. You know, you absorb some of that, the sick care that you're managing in some ways. Dr. Tiger, so in the plant-based world, when we help educate people about how to just get started on a plant forward diet, we talk about, you know, how to do groceries, what to have in your pantry, in your refrigerator, simple meal prep ideas to, you know, help people kind of become more comfortable in the kitchen.

00:30:34 Maya: We find that many people lack those skills and it's a large population of people that never learned how to eat. I mean, it's just part of our society. Everyone eats out. So if that in some ways can be a little bit challenging because people have to really plan out their days and their weeks to eat healthy, how challenging is it to then go to physicians and say, by the way, are you familiar with these pillars and these are the ways to get started? Can it feel overwhelming to try to meet all those goals?

00:30:26 Robyn: Yeah, so we set up the program through the doctor brain because Dr. Sundermann and I understand how doctors think they're super busy, they need everything evidence-based, and it has to be really organized and quick, right? And so we are teaching what I like to call the what, why, and how of all of these concepts. So we are told what, what is, you need to eat better. You need to sleep more, you need to exercise, you need to decrease your stress, you need to hang out with people, you need to stop drinking, you need to lose weight, blah, blah, blah. Right? That's the, what. The why is two-part. The why is well, why do I need to do those things? Because the doctor's left brain needs to know the why. Don't just tell me to do something, but well why? What does the medical literature say about those things?

00:32:04 Robyn: As Dr. Sundermann was describing, I never knew these amazing things happen when you sleep. I thought sleep was a luxury. You do that on the weekends if you can or on vacation, you're two weeks a year that you would get, right? So why are these things important? And the second part of the why is well, why do the things work that we're gonna tell you? Like, well, why does it work when I ask you to do this, that other thing? So the physiology and the anatomy behind the things that we're sharing. And then there's the how. And that's the thing that is missing the most in physician education is, well, how do I do that? Well, how do I sleep better? What exactly do I need to do? How do I decrease my stress? What exactly do I need to do? How do I eat better? What exactly do I need to do and exercise and so on. 

00:32:52 Robyn: And so we've broken up the program into 10 weeks and each week, we meet twice. The first part of the meeting is on a Monday, and we will meet to give more of the didactic, more of the what and why. And then on Wednesday, we show you the how. We are gonna be, live in our kitchens with you cooking. We are going to be giving you recipes that are simple and easy to make, and we are gonna make them with you and we are gonna eat them together. And you're gonna see how delicious they are and how easy it is to make these things. You know, we are gonna talk to you about stress management and I'm gonna teach you in, very short amount of time, how you can feel better in less than a minute, right? We're gonna talk to you about the things that help with your sleep, and then we're gonna show you how to do those things in experiential way and so on. 

00:33:45 Robyn: So we've divided into the what, why, and how of each of these pillars and more. And we'll teach you how to make goals that you can actually achieve. You know, most of the time, even at New Year's time, the literature shows us that over 80% of New Year's resolutions never come into fruition because we actually don't have an organized way to create a goal and to succeed at it. So we are gonna help you make those goals each week and implement them, so you can be successful in improving your wellbeing. And what I like to think about is just being 1% better each day, right? As doctors, we think we have to do all the things right away now. We gotta get them all done and everything's gotta be perfect. 

00:34:29 Robyn: And so what I recommend, and I actually learned this in working with first responders, SWAT teams, firefighters, police officers, as an expert in this area for them, which was a program called O2X, created by Navy SEALs, is 1% better every day. And we just make that our goal. And that's, everything is off the shoulders, right? It's just so much lighter. Well, how can I just be this much better tomorrow? And then how can I be just this much better the next day? And by creating it in a group setting, we've built in the social connection. So we've got that support from us and that support from everyone else there. That's like, yeah, I've got you. We've all got each other and we're going through this together and it's gonna be amazing. 

00:35:18 Maya: Coming together and doing it as a team, having that support is so encouraging. And you know, the Lifestyle Medicine conference just took place this past fall in Orlando and [Riz] headed over to the fitness center and he said, it's packed. It's always packed during the lifestyle medicine conference. You have all these healthcare or practitioners out there taking care of their health. And there was the Walk With A Doc. There was some representation from them, and then there was the 5K that was happening. And it's so encouraging when you see these physicians. And I see physicians, but we're talking about all people in lifestyle medicine that are really applying what they're teaching, either patients or their clients. Let's talk a little bit more about what I call for is bathing Dr. Sundermann because I know you've talked about nature as medicine. And when I heard about that MIG coming up, I said, oh my God, I wanna join it.

00:36:15 Maya: It's one of my favorite topics. I'm very much about nature for my mental health,  for my physical health, or my overall well being nature. It contributes too much to my wellness. I had the first experience of forest bathing in Oahu. I wanna say it was 2019 with a trained guide in forest bathing. It was about a four hour event. And we finished off with a tea ceremony. And I know that these things don't have to happen for four hours, but it was an amazing experience for me. And after that, I took that and said, well, how can I do this on my own as I'm spending time in nature? So tell us a little bit more about what nature as medicine looks like.

00:37:01 Melissa: Absolutely. And thank you for wanting to join our committee, Nature's Medicine. We will welcome you with open arms. So I wanna start off with a statistic. So the EPA did a study of Americans about time spent indoors versus outdoors. Typical Americans, not the three of us, 87% of time spent in buildings, our houses, our workplaces, our schools, grocery stores, other shops. About 7%, or I'm sorry. And then, the other time is spent in automobiles, leaving 7% of the day, is spent outdoors. So typical Americans only spend 7% of their day outdoors. The other time is spent in buildings or in automobiles. That's not very much time. So shinrin-yoku, forest bathing, actually started in the 80s in Japan. And the original thought behind it was that Japan was looking at ways to reduce stress in its workforce. So now we're all about workplace wellness, right?

00:38:14 Melissa: This was back in the 80s before this became mainstream. So they're very forward thinking in that we need to reduce stress in our workers. And so there was a researcher, Dr. Kinley, and he came up and posed this question. He thought, well, we know that being outdoors can reduce stress. So perhaps, let's dig into this and this could actually help our workforce. So they invested like $1.5 million. It was about 1982 and he conducted the first forest bathing study. So that first study was pretty small, but he took subjects from their home environments and he took them into forests for two days. He was looking at natural killer cell activity. And remember I spoke about how that's involved with our immunity, not only preventing illness and inflammation, but also potential decreasing the risk of cancers. So he would test natural killer cell activity at baseline and then day one and then at day two.

00:39:14 Melissa: And what he found was that on day one, the natural killer cell activity went up and it went up even further on day two. So they said, well, maybe it's just ‘cause they're away from their home, right? And they're just happier just being away from home. It feels like it's a vacation. So they take that same group of participants and brought them to an urban environment. So urban city, big buildings and concrete, not really any green space, loud noises. And did the same thing, measured natural killer cell activity at baseline day one and day two. And there was not a change, it was level. So they thought there's something to do with being out in nature. So they decided to, let's take this further. And so then they expanded and they took subjects across 24 forest environments, and each group had 12 participants.

00:40:05 Melissa: And this time they were looking at cortisol level, heart rate and blood pressure. And it was actually a crossover. So the participants, six of them, would go to a forest environment, they would sit for 15 minutes and then they would walk for 15 minutes. Because a lot of times when people think about forest bathing or Shinrin Yoku, they think, oh my gosh, I have to go climb a mountain. That's how I get it. And so this was really looking at just being in nature or going for a gentle walk. And so six would go to the forest on the first day and six would go to the urban environments. And then on the second day of crossover, and they looked at comparisons of cortisol, blood pressure and heart rate. And what they found was just being in the forest and moving your body in the forest, all of those markers were improved, meaning decreased just by being in the outdoors.

00:40:55 Melissa: And so, and, and Dr. Kingley, he's done some pretty cool experiments. In fact, he did one, which would never pass IRB standards these days. But he took 12 subjects and locked them up in a hotel room for three days. They couldn't leave the hotel room. And in half of the subject's rooms, he was emitting cypress oils from the Japanese trees. And then half of them he was not. And what he found was the rooms or the participant, the subjects who were exposed to those oils, which are actually fighting sides, these trees emit these, these organic volatile compounds who were inhaling these, these fight insides from the trees. They actually had a 20% increase in their natural killer access cell activity. Whereas the participants inside this room that was emitting 0 to nothing, had no change in their natural killer cell activity.

00:41:47 Melissa: So these benefits that we’re finding. And so more and more research is being done. Now for me, I've always had this connection with nature. I don't know exactly when it developed. I don't remember when I didn't have this connection and periods of my life that have been really, really stressful. Really tough situations to go through every day. I knew I needed to get outdoors and be grounded. You know, that was my medicine. And when I talk about nature, I'm an internal medicine doctor and a lifestyle medicine doctor. I said, my nature pill is my favorite pill to prescribe. And I'll tell you three big reasons for that. One, it is cost effective. We talk about drug prices nowadays, right? There's all these injectable medications that are thousands of dollars a month. Co-payments can add up to hundreds of dollars a month.

00:42:43 Melissa: I say a lot of times my medication is free. You could walk out your door, you know, and sometimes people are like, well, I don't really, I live in a big apartment building. I have to go to a park. Well, maybe you have to pay an entrance fee or a yearly fee. But the cost is really affordable for most. Secondly, side effects. Now I think we've all heard pharmaceutical commercials and at the end of the commercial they'll do that side effect ranging from rash to like death, right? And about 30, you know, different side effects, possible side effects in between. And I say my side effects about 99% of the time are gonna be positive side effects. Occasionally you might get stung by a bee, occasionally maybe you know, have poison IV out here in the east coast, we have to be worried for ticks, but really they're just gonna be positive side effects.

00:43:35 Melissa: And third, my pill is long acting. A lot of medications my patients have to take every day, twice a day, three times a day. Very few me medications are long acting. There's some drugs for osteoporosis that's maybe once a week or once a month, but majority are once a day or several times a day. Dr. Kingley took his studies further to look at that elevation of natural killer cell activity. And he saw that from being out in nature. He saw a bump on day one, day two, he took it further and they measured natural killer cell activity at day seven. And then at day 30, and even at day 30, there was still an elevation of baseline of natural killer cell activity. So my nature pill is long acting. And recent studies that have been done really are all pretty much agree that 20 minutes per day or 120 minutes per week is an optimal dose.

00:44:32 Melissa: So again, I'm not asking people or recommending people quit your job because you need to be in nature eight hours a day, no, 20 minutes a day. And in fact, just before this podcast, I had a break in between my morning patients and I'm getting ready for this podcast and I said, I've got 20 minutes, I'm just gonna go outside. And it was wonderful. You know, I just was in the present moment. We had a big snowstorm the other day, but today it's sunny. And so just noticing all the snow in the trees and I could smell the evergreens and hear the birds chirping. And I came back feeling really alive, really grounded, really present. So trying to just educate about that. And what I find in our physician colleagues and my patients is that they don't really know that, right? They really don't know the medicinal benefits of being outdoors.

00:45:21 Melissa: And the thing I like about nature too is I think as kids, we're innately curious, right? We like to build forts and we like to discover things and  we wanna learn. And then as we get older, a lot of us, we get programmed, right? This is how my day is structured and you know, and I've got responsibilities. And so that curiosity is kind of thwarted. Nature is an area that we can be curious. It's always changing. I go for a run before work most mornings, and I get to see the sunrise. And there is never a duplicate sunrise. The clouds are always different. The colors are always different. In fact, five minutes between five minutes, my sky is different. So it really inspires us to of, I get a feeling of gratitude. I'm curious. I have a sense of wonder and awe. And I think that's a wonderful area where, you know, nature,  can bring that alive in all of us.

00:46:27 Maya: Yes, I love that. And you know, as you're talking about that, I'm reminded of, for example, even camping. When people go out for a couple of days to camp and hike in a certain location for us, we learned it's only an hour and a half away. . Since we have really understood the benefits of lifestyle medicine, we are now making an effort to do that. And it's not always available to us. But even if you're glamping, you still get the benefits, right? Dr. Sunderman.

00:46:56 Melissa: Absolutely. So any, any kind of fresh air and we, we talk about green spaces in Shinrin Yoku, but we don't wanna forget about blue spaces as well, right? Blue spaces and oceans and rivers and waterfalls and ponds and lakes and streams are all equally important for wellbeing. Um, and so, and even when I have people who live in big cities,  I have patients that live in New York City or Boston, I remind them that there are parks, Central Park or the Boston Garden. But even just on your balcony, if you surround that in plants or in your home office, have plants because anything that's green is gonna emit fighting sides. And those are, when we inhale them, those are gonna help with our natural killer of cell activity, help with just sedation and or just make us feel more fresh, reduce our stress.

00:47:42 Melissa: So there's ways to go about doing that. Um, and so it doesn't have to look perfect. What Dr. Tiger was saying is that 1% is better progress, not perfection. And I think some, sometimes physicians, we are trained that we want to know everything and it makes us uncomfortable  when we have uncertainty. So it's, it's a shift to say this doesn't have to be, you know, all or nothing. This is just baby steps. And what you find with habit change is when you break it up into baby steps, it's doable and it's sustainable. And as lifestyle medicine physicians, that is our goal. Our sustainable healthful behaviors. We're not talking about crash diets, we're not talking about P90 X for 30 days. We're talking about healthful, sustainable lifestyle behaviors that once you implement these behaviors into your life, you don't wanna go back. You don't even know how to go back because it's just ingrained in you and it's not as hard sometimes,  when you just look at it. It's just taking one step at a time.

00:48:11 Maya: Yes. And so, Dr. Tiger, you, you mentioned that this is a 10 week program. When have you started your first 10 weeks? When does it start?

00:48:20 Robyn: Yeah, we’re starting it this spring in April. So we are super excited about it and as we started to put it out there, we were getting lots of questions. So Maya, we decided to have a masterclass to really go over the concepts and to answer any questions that people have. So we are actually going live. We're gonna have two master classes. The first will be Wednesday, March 29th at 7:00 PM Eastern Standard Time, and the second is Saturday, April 1st at 11:00 AM Eastern Standard Time to give ample opportunity depending on your schedules to attend. And we are really excited to just show up and answer questions and share in preparation for REVIVE and having all these physicians revive. And as one of my physician clients email me the other day saying, and coming home to themselves, she emailed me and said, “thank you so much for teaching me how to come home to myself”.

00:49:25 Robyn: And of course, I'm getting teary thinking about it again because it's just so, it's so amazing that, you know, one of my other physician clients said, “medicine trains us away from ourselves”. And then this client physician's client said, “I'm now home. You brought me home to myself. You taught me how to come home to myself”. And so that's reviving right there. And so we're very, very excited about it. So the program will start in April, but we are having two master classes, live where we'll be kind showing up and answering questions and sharing a little bit more about what we'll be doing then. Also want to say that it includes CME. So, we believe that physicians should be getting credit and for learning how to take care of themselves. So both the masterclass as well as the program itself includes CME.

00:50:18 Maya: That's wonderful. This is so encouraging. Is there a fee for the 10 week course?

00:50:24: Robyn: Yes.

00:50:24: Maya: And is this only for physicians or,  is it open to other practitioners?

00:50:29 Robyn: So this cohort is just for physicians,  because we wanna create a safe space. I've been in this space of wellness for over 10 years now, and I found that physicians are more open to learning and open to sharing,  when they're with their own PAs, or more open to learning and sharing when they're with their own medical students are… and so on. So I try and keep groups of people that understand each other together. So this first cohort is just for physicians, although we have been getting requests. 

00:50:59 Robyn: Dr. Sunderman just got one yesterday from nurse practitioners and some other types of individuals as well as non-healthcare professionals have been reaching out interested. So we will be creating cohorts for those who are interested, depending on, you know, what comes up. But this first one is for our colleagues, and there is gonna be a fee. It depends also if you come to the masterclass, we have a surprise for those of you who show up in terms of what that fee will be, and a gift will be giving you towards that. And there will be also a payment plan. So stay tuned to learn more about that.

00:51:32 Maya: Oh, I'm so excited about this. I often think about how with my husband, I try to, you know, support him as well in these modalities in terms of making sure that we practice yoga together. Because my schedule is different than his obviously, but I make sure that he tries to get at least yoga, one yoga a day per week. And I noticed a tremendous improvement in how he feels. And I often feel that we need to work a little bit harder to support our physicians, whether there are physicians or our spouses or our family members to really be there to support our physicians. So yes, I love this. 

00:52:13 Maya: Is there anything else that you'd like to share that we didn't cover? And also, what is the best way for my listeners to learn about this program? To share with their physicians if they're interested, and also just,  how they can follow each of you?

00:52:27 Robyn: Yeah. Well I wanted to share one recent statistic that's really, very concerning. Medscape just came out with their 2023 report and they report that only 40% of physicians are taking care of their own health and wellness almost, or most of the time, right? That's 40% are taking care of themselves most of the time. And I'm not even sure exactly what that taking care of themselves and their own health and wellness is, but whatever it is, it's really low. 

00:53:03 Robyn:We are the gatekeepers of health. People look to us as representing what health and wellness should be. And so if we're only caring for ourselves 40% of the time, then we have work to do. And I believe that most of that is because we're not taught how, we're just not taught how, and we're not taught how to do it in a very simple, effective, easy way.

00:53:27 Robyn: And so I think it's really important for physicians out there to understand that if they feel this way, they're not alone. It's not your fault. You just weren't taught. So let us, let us share with you what we've learned,  in terms of the masterclass. You can go to www.stressfreemd.net/masterclass and choose the day and time that work best for you. To reach out to me to ask me any questions. Um, you can reach out to me through my website at stress-free md.net or on social media. I'm on LinkedIn, Facebook, Instagram,  Twitter. I'm not on TikTok yet. And I'll let Dr. Sunderman share how she can be reached as well.

00:54:13 Melisa: Right. So same. We're having fun with social media right now posting. And so I am known as Motivator Melissa on Instagram and also the Doctor Outdoors on Instagram and also on Facebook, and also on LinkedIn. So if you follow us, we'll be doing some fun content,  letting people know about REVIVE! and we'd love for you to learn more. And we're really excited for this.

00:54:37 Maya: Yes, absolutely. And I was gonna say also, I'm wondering, do we tag physicians that we know about,  you know, like on social media to tell them about REVIVE and see if they're interested? What's the best way that we as lay people, like patients can support our physicians this way?

00:54:56 Melissa: Yeah, if you can tag, that's amazing. And if you can share, you know, I've actually gotten physician clients from their patients. I've actually taught classes to individuals on the cancer journey who say to their doctors, go their doctors and say, you know what? You need to meet Dr. Tiger. So I've had patients actually refer their doctors to me. And so, yes, you know, if you know physicians in your life, whether you are a physician or a healthcare professional or not, who could benefit from this education, please, please share it with them.

00:55:30 Robyn: ‘Cause we're all in this together. And you know, we have heard some other staggering statistics that 47% of healthcare professionals will be leaving by 2025. You know, Forbes put that out recently and some of those numbers are going up. And so we're talking about half of the healthcare professional workforce gone in less than two years. So Dr. Sunderman and I want to keep people in medicine. We wanna let doctors be the healthiest, happiest versions of themselves. So if you know any physician in your life that you care about, please send them our way. We wanna help.

00:56:05 Maya: Yes. And you know, Dr. Tiger, we started this conversation really addressing burnout and, you know, the side effects of all of that, that the physicians are experiencing. And we know that once they dive into this world of lifestyle medicine, they feel revived. You know, just like the name of your program. They come to life and they start to see, especially if they have the opportunity to really work closely with patients in, you know, applying the pillars of Lysol medicine, that the way that they view their practice, the way they view the approach towards helping their patients, really revives them.

00:56:43 Maya: Changes their perspective in terms of medicine when they're able to partner in some way with their patients in working together to help the patient take control of their health. In other words, rather than just prescribing medication or doing diagnosis, both have this understanding that the pillars can play a significant role in improving one's health. And, you know, physicians that are trained in this field do apply these skills. And so it just changes the whole dynamic between the doctor and the patients. Not true.

00:57:13 Robyn: So true.

00:57:14 Melissa: Absolutely. Maya, I'm still in clinical practice and I will tell you what, there is nothing more gratifying or fulfilling when I have a patient who ends up coming to me because they're struggling with a chronic disease, maybe several chronic diseases. They don't feel well. They're taking so many medications, they're having side effects from the medications. And as a lifestyle medicine physician, I believe that it's possible to change. 

00:57:41: Melissa: I have other colleagues who are not in lifestyle medicine who said to me early on, “why do you spend your time doing that? They don't wanna change. Patients don't wanna change, they just wanna take their pills”. And I said, I really don't believe that. I really believe that everyone wants the opportunity to have a life full of vitality, to have dreams and aspirations and have the health to pursue that. And so what it takes though is not only believing in my patients, but also like Dr. Tiger said the how, the why, you know, and in giving them tools.

00:58:14 Melissa: Okay. And so when I see empowerment in my patients and they come back and guess what I say, they're like, “thank you so much Dr. Sunderman, thank you for helping me get better”. And I said, “you did this yourself. I maybe gave you some tools, but you did this yourself”. And that's a lot more gratifying for myself and my patient than saying, well, I gave you a pill and you took it. Right? Those are, and a lot of times we know that pills are band-aids and,  really getting to the underlying root cause of chronic disease is so important. 

00:58:45 Melissa: So it has completely switched how I feel in that I'm seeing patients get their life back, you know? And playing with grandkids and being able to take that bucket list trip that they wanted to do, you know,  walk their granddaughter or daughter down the aisle. Things that are just the “why” in their life, and having them be able to achieve that. Why? 

00:59:13 Robyn: Yeah. 

00:58:15 Melissa: It's really amazing.

00:58:16 Robyn: You know, Maya, the ripple effect, Dr. Sunderman is just describing, you know, I've had physicians come to me saying, “I wanna work with you so I can help my patients”. Well, of course they're also getting benefits as well. But the stories that I've heard over this last decade of the improvements that patients have had because their physicians have educated themselves that much more, it's just so rewarding and you know, I think it's my amenities that says the greatest form of giving is teaching another person how to help themself. Teaching another person how to help themself. And that is that just makes my heart sing. 

01:00:01 Maya: Yeah. 

01:00:02 Robyn: We don't want people to be attached to us forever. We want them to have the tools to go on and live with their lives and walk their granddaughter, you know, at down the aisle and to chase their grandchildren around and to take that bucket list item and go and run with it. And, and to just be right. And we know that longevity is increased. You actually gain years of your life by following these, these steps, these tolls, these pillars. You live longer. It's amazing.

01:00:30 Maya: Well, I wanna thank both of you for being here today and,  really sharing this important information for our listeners to understand how we can support our physicians and also for the physicians who might be also tuning in. We really thank you both for being here today.

01:00:46 Robyn: Thank you so much for having us, Maya, and for all that you do.

01:00:50 Melissa: Thank you so much, Maya. It's been our pleasure. 

01:00:53 Robyn: Yes.

01:00:54 Maya: Well, my friends, that is it for today's episode. Thank you so much, Dr. Tiger and Dr. Sundermann for joining us today and sharing your expertise on the importance of physician self-care and lifestyle medicine. Your insights on stress management, nutrition, physical activity and social connection are invaluable, not only for physicians, but for anyone looking to improve their overall health and wellbeing. 

01:01:19 Maya: We hope our listeners found this discussion as informative, inspiring, as we did myself. And remember, taking care of yourself is not selfish. It's necessary for us to be able to take care of others. And I also wanna encourage you, my listener, the next time you see your physician, just take a few minutes to look into their eyes and ask them, how are you doing today? Okay, my friends, I hope you enjoy this episode. And as always, thank you for listening. 

01:01:49 VO: You've been listening to the Healthy Lifestyle Solutions podcast with your host, Maya Acosta. If you've enjoyed this podcast, do us a favor and share with one friend who can benefit from this episode. Feel free to leave an honest review as well@ratethispodcast.com slash hs. This helps us to spread our message, and as always, thank you for being a listener.