00:03
Welcome, hi, I'm Mikki and this is Mikkipedia, where I sit down and chat to doctors, professors, athletes, practitioners and experts in their fields related to health, nutrition, fitness and wellbeing and I'm delighted that you're here.

00:30
Hey everyone, it's Mikki here, you're listening to Mikkipedia and this week on the podcast I have the pleasure of talking to Professor Peter Stirling about the allostatic stress load and its impact on health. The term aliostasis has been coined to clarify ambiguities associated with the word stress and it refers to the adaptive processes that maintain homeostasis.

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through the production of mediators such as adrenaline, cortisol and other chemical messengers. And I don't doubt that you listening into this today are well familiar with those stress hormones and the potential impact on health. And Dr. or Professor Sterling, who is the author of What is Health?

01:27
as a different way of looking at stress in our response to stress. Now we have such a great conversation because Professor Stirling has such an interesting background with his focus on neuroanatomy, physiology, psychology and human behaviour slash social issues and we discuss some of his very early background as his parents were somewhat of activists.

01:54
and how this then led to the career path that Peter took, which was quite unusual at the time. We also discuss how his informal anthropological research taught him about the stress response and the pillars of health that he then went on to write about. And it's interesting to think that once upon a time we didn't think about stress the way that we do now. And Professor Stirling was really sort of at the helm of our

02:23
I suppose our understanding of stress and how it has changed over time. So, Professor Peter Stirling, he's a professor of neuroscience, got his degrees in biology at Cornwall University in 1961, and in medicine at New York University School of Medicine 1962, and then finally his neuroscience degree or PhD at Western Reserve University in 1966. And

02:50
His broad goal with his research has been to learn how the brain is designed, so the functional architecture of it. And he's done a range of different both clinical or laboratory studies and then also looking at social behavior as well. So his theoretical interests extended to basic issues of physiological regulation and behavior leading to the concept of aliostasis.

03:20
in between a lifestyle block in Panama and also Pennsylvania. And I've got in our show notes a link to his book What is Health and also to Google Scholar and a list of his publications, some of which have been cited several thousand times. So he really is a thought leader in this area. So just a reminder before we crack on into the podcast.

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The best way to support this podcast is to hit the subscribe button on your favourite podcast listening platform. That increases the visibility of the podcast out there and amongst the literally thousands of other podcasts so more people get the opportunity to learn from guests that I have on the show. And if you felt like leaving a 5 star review on Apple podcasts, that would be alright with me. Alright team please enjoy this conversation that I have with Professor Peter Stirling.

04:23
Peter, thank you so much for taking the time your afternoon to speak to me about your work in this field. Super fascinating, listening to your talk on aliostasis, probably haven't said that properly actually, health, but also how you arrived at the place that you got to with regards to your career and your personal experience. Can we begin a little bit with your background so the listener gets an idea of that? Sure.

04:53
So how did I get into this? Well, I grew up in a suburb just north of New York City. I was born in 1940. So as I'm speaking to you, I was 83 yesterday. Happy birthday for yesterday. Yes, exactly. Thank you. So I grew up in, it was country then, it was the woods and fields and so on. And my mother was interested in nature and encouraged me to be that way.

05:22
And she wrote, she wrote, both my parents were writers and she wrote books about nature. And both of my parents were members of the US Communist Party, actually, between about 1935 and 1955, when it didn't make sense anymore. And so they, they were dedicated to working against racism in the US. There was

05:50
massive racial segregation, there was lynching and so on. And so I bought into that passion as well. So from when I went to college, I studied zoology, biology very intensely, and I organized various activities against racism.

06:18
Was that unusual, Peter, at the time? Or I guess you would surround yourself with people who are like-minded, I imagine. Well, yeah, there were a few others. So we were called, the term here developed later, a red diaper baby, the children of American communists. And so, yes, we were a very small minority. But we...

06:47
we were trying to educate and recruit companions in this. So I submitted my first scientific report to my advisor at Cornell University. And then I drove with some older graduate students down to Mississippi to join the Freedom Rides. And the Freedom Rides, even U.S. younger people don't recall, this is 1961.

07:16
was an effort to bring particularly students from all over the country, black and white together to converge on Jackson, Mississippi by buses or trains to integrate the lunch, integrate the eating facilities and the restrooms and so on, and to force the Kennedy administration. This was John F. Kennedy was president, his brother Robert Kennedy was attorney general,

07:46
signing off saying there will be no more segregation and interstate travel. How big was that rally, Peter? So that's a good question. So I looked this up a few years ago. Across the summer, we arrived in May, it started in May, people arrived all during the summer, and by November,

08:13
the Kennedys actually signed the thing and interstate travel was desegregated. The number of people involved was only 400 riders. 400. It was 1% of all the students that could have gone. It was a very small number. And many of them were actually red diaper babies. Not all by any means, but certainly the white ones from the North, many were.

08:43
Did this mean that you were part of the rally for that amount of time? I continued. I went from shortly after that to graduate school in neuroscience in Cleveland, Ohio. I did the same thing. I worked in a laboratory and I often would slip away from my microscope. I was a neuroanatomist.

09:09
and be involved in canvassing in Black neighborhoods as a member of the Congress on Racial Equality Corps, it was called. Yeah. Wow. And so Peter, when did you sort of get an interest in the brain and wanting to study more about what was going on there? I think when I was a student at Cornell, my junior year, I took a course in neuroanatomy and with a very inspiring man.

09:40
Yeah, I sort of committed myself, my interest to the brain. And so that's what I did in graduate school. And after graduate school in Cleveland, we moved in 1966 to Harvard Medical School to study with a pair of neuroscientists named David Hubel and Torsten Wiesel. And I was their first postdoc, one of their two first postdocs.

10:10
15 years later, they got the Nobel Prize. So it was a very exciting period in their lab. Yeah, what would end, what did they get the Nobel Prize for? So this is a period where people were just beginning to investigate the activity of neurons in the cerebral cortex by poking tiny, tiny microelectrodes into the...

10:38
brain recording the impulses of a single neuron. If you listen to it on an audio amplifier and you shined a light across, moved it across the screen, you'd hear, bop, bop, bop, bop, bop, bop, bop, like that. And if you moved it back, maybe nothing. Bop, bop, bop, nothing. And so those were cells that were clearly computing the direction of motion. And there were many, many such studies.

11:07
pioneered in these studies, and they also study the anatomical architecture underlying this stuff. My partner and I chose a different part of the brain. They didn't encourage us to mess up their studies in the cortex, so we chose to study a part of the midbrain called the superior colliculus with the same approach.

11:34
And I did that for about five years or something before I changed what I was doing. Yeah. And so with that in mind, what did you move to? I found my way. What I found was that I was like them. I was interested in the functional, what I call functional architecture, how the connections, neural connections

12:02
give rise to these very complicated responses. And in the superior colliculus, we found that there was an input from the retina and an input from the visual cortex that interacted somehow to produce this miracle. And I wanted to study the synaptic connections. The synapse is a tiny structure about a micron across. And I wanted to see those retinal and cortical synapses contacting the

12:30
neurons in the superior colliculus. And to do that, I had to learn electron microscopy. So that was a new field then, and it was certainly new for me. So I spent a year after their lab, an anatomy lab at Harvard, to learn the techniques of electron microscopy. And then when I took a job at the University of Pennsylvania in 1969, and I stayed there

12:59
2009, 40 years, I used both techniques. I continued to study physiology and the structure of retinal circuits. I moved from the cortex and the superior colliculus to study the retina. The retina is in the back of the eye, but it's really a part of the brain that has grown out into the eye to process signals.

13:29
structure to study by electron microscopy because it's the cerebral cortex is a millimeter and a half thick and the retina is a tenth of that. And so you have a better chance of actually following the connections in the retina. And that's still, we know an awful lot now about the retina and the cortex is still a challenge. You know, there are new techniques, but it's still a challenge.

13:57
big challenge. So that's what I did, focused for many years in the science part on the retina, but then I also moved along in my social, my interest in social aspects of health. Yeah. And then Peter, how did the two sort of integrate? Right. So when I was in Cleveland, canvassing door to door, I was studying

14:25
the cortical projections to the spinal cord and brainstem. And when I went out into the community and knocked on doors, they were in the black community, many people came to the door sort of limping or their face sagging and the speech was slurred. And back in the lab, I learned that this was because they had had a stroke. And I learned that stroke was caused by hypertension.

14:53
And I'd never seen this in the white communities where I grew up, or in the white community at Harvard. But I did remember that this ghetto in Central in the 60s, which was black, had been a Jewish ghetto two generations before where my grandfather was also segregated and forced into a Jewish house painter's union. He was an immigrant. He immigrated in 1907.

15:24
And he also had had hypertension and an early stroke. And so I began to think that maybe hypertension was related to social tension. And so arriving at Penn, I began to investigate that, not in the street, but in the library. Yeah, okay. And at that time, Peter, were you in a position in your career where you were responsive

15:53
you had autonomy in what you could do or did you have to sort of convince people around you that this was something to be investigated? The the the US Academy at that time good universities if you were appointed assistant professor You were expected to get a grant to do research and publish it and the rest was sort of up to you nobody was paying attention really and so Except occasionally when

16:22
my activities would come to the attention of my chair and I'd be called in and said, yeah, what the hell are you doing? You know, getting arrested, you mean? Yeah, or making a statement to the student newspaper or something like that. And so, so he said, look, if you're going to do something that's going to be in the newspaper, tell me first. Yeah. So about six months later, I

16:51
I noticed that the neurosurgeon at the University of Pennsylvania were doing frontal lobotomies. And this was in 1972 or something like that, long after everybody had understood that this was a disastrous thing to do. And I was asked to testify as an assistant professor on behalf of a guy who'd been damaged by a lobotomy.

17:21
So I agreed to do it. And so I dutifully went to tell my chair that I was about to testify against another member of the medical school. And I let the dean of the medical school know as well. And so he was grateful for the heads up, what we call a heads up notification. And throughout my career, I did speak out.

17:47
I once spoke out all the way in the 90s against a racist lecture I was attending in my class, my course. And I stood up in the back of the room and stopped the lecturer from continuing this sort of racist baiting. And it got everybody freaked out. The black students walked out. And I wasn't fired from my job.

18:17
the teaching faculty and my chair decided that maybe they better let me not teach in that course anymore, even though I had invented it and so on. Oh, this is sort of interesting. Well, it's a lot interesting. Was the lecturer themselves cognizant of the fact that they were racist or was this just completely ignorant? Like, I'm just interested. Yes, it was completely ignorant.

18:44
He was making jokes. He was a neuro radiologist and he was making jokes about the images that he was studying. This was in the early days of CAT scans and so when you could really see the brain well, he said, this is a brain of a prostitute who was pushed down the stairs, possibly by one of her customers. And the students are laughing. These are first year students, 160 students. So I stood up in the back and I said, you know, you just can't.

19:13
can't talk. I said, what was most outrageous, I said, are you better than a prostitute? Is anybody in this audience think they're better than a prostitute? And it happened to be Good Friday. And so I said, you know, it's Good Friday. Who washed Christ's feet? A prostitute. And the guy went nuts, really. He couldn't stop. So I created a certain kind of chaos.

19:42
But I have no regrets about it. So I was asked the next Monday by my chair, who was a neurologist and a neuroscientist, he said, well, why didn't you just talk to him quietly? Doctors say this in the operating room all the time. And my answer was that they might say that in front of five students who are watching, but this was 170 first-year students. And this was a teaching moment, and either I was gonna call them out or I wasn't. And I didn't care explaining to him.

20:13
I don't know what he believes to this day, but I saw what was going on, and I called it at the time. So it was a very difficult time because I received from friends and other faculty members in other departments support, but I received not a word of encouragement or support from any of my faculty members in my department. To this day, I have never heard that.

20:42
And so it was quite painful to me, but I feel like it was the right thing to have done. However, I was not asked back to teach in the course. Wow, what a shame. Peter, so from there then, because that's such a, like, I can imagine the distress that that would have caused at the time for you. And of course, so much of your research is in stress.

21:10
you know, that sort of connection between the brain and our health. And so can we sort of like maybe move that conversation to that part of your sort of research? And of course, you were talking about social injustice, hypertension, the link between then went to the library. Did you find anything at the time, actually? Yeah, that yeah, that's it. That's a great question. That's getting back on the on the track. In that period, early at my time at Penn, I met.

21:38
a man named Joseph Eyre who was studying what causes hypertension, what causes early death by society, what are the contributions of social stress and inequality to death of various sorts. And I began listening to him. He was four years younger, very, very brilliant man. And

22:03
he began saying stuff I hadn't heard. And so I would go to the library and say, is this right? Everything... He said, for example, that the people who live hunting and gathering for life don't work as hard. They have plenty of time for play and social interaction. And they don't have high blood pressure. And their blood pressure doesn't rise with age. We're taught

22:32
you have a blood pressure here, but it just goes up and up and up and that's natural, but it isn't true. And so I began to pursue that and then I began to pursue, well, how does the brain, if the brain is registering social stress and inequality, how does it communicate that to the biological mechanisms that cause a rise in pressure, a chronic rise in pressure?

23:01
And I found, going to the library, a couple of just stunning discoveries. One is that it was an electron micrograph of a very high resolution picture of a neural synapse on a neuroendocrine cell in the kidney. And those cells were already known, their hormone was already known to raise blood pressure and also to raise the...

23:31
appetite for salt. Yes. I also found pictures of nerve cells, nerve endings covering all the blood vessels in the body. Every arterial vessel is bound in a mesh of nerve fibers. And I found that essentially all the other endocrine glands and cells in the body have nerve fibers on them.

24:00
an immense grip on these regulatory mechanisms and on every cell in the body. So that was a very, as a scientist, a really exciting thing to understand. And the other thing I saw at that point, which is a very vivid memory, is I found a recording, a 24-hour recording.

24:30
of a man who had a catheter stuck into his artery in his arm. And it showed the diastolic and the systolic pressures going up and down across 24 hours. And it was completely clear that there is no such thing as you don't have a blood pressure. You have an average blood pressure, but that's because it goes way, way, way up for a moment and then way, way down and so on.

24:59
And it responds, you could see this was correlated with various events in the course of this guy's day. And you could see that every mental event was raising his pressure before he needed to do something. And this was very counter to the standard idea of physiological regulation in biology.

25:29
called homeostasis. And that is the idea is that if you have some pressure or a level of a metabolite or something, it's supposed to be within these temperature, within these narrow limits. And if it departs from the limit above or below, some feedback mechanism in the body will detect this and correct it automatically. Okay, so that's homeostasis. And that not only was taught back then, it's still taught.

25:59
That's what I learned. Yeah. Yes, that's right. And I checked back to you Penn's curriculum a couple of years ago when I was writing my book and it's still taught. Yeah. Now is that incorrect overall though, that concept of homeostasis, or is there room for more than one sort of theory, depending on what system we're sort of talking about? Yeah.

26:28
That's a very good question. So one of the things, I will answer it, but let me give you the other alternative, which is that with all of these connections to the body and all these cells and all these peripheral things is that the brain actually thinks ahead, predicts what's gonna happen, and then it adjusts everything to be ready for it.

26:54
Okay. And this is called predictive regulation. And it's sort of what Toyota has that slogan for the assembly line, just enough, just in time. You don't want a huge excess capacity, it takes space, it takes storage. You don't want to go short because then bad things happen. So it's better to predict and match than to wait for an error and correct. It's much, much more efficient. And...

27:23
And so that is sort of what I...an alternative view of the body. In the beginning, I thought homeostasis is completely wrong. And so I named this term homeostasis is for stability through constancy, allostasis, no E, not Elio, allostasis, is stability by variation, by flexible variation.

27:53
I gradually realized that if you were going to say, well, what is health? It's not having all these parameters in a little narrow range. It's flexible variation to optimize whatever is your metabolism and so on for whatever is going on. With regards, like that concept intuitively makes sense for, as I understand, health in terms of our ability to be resilient under times of stress.

28:23
you're talking about, although what I will say is with that predictive regulation, I immediately think of AI, like how well the brain can predict what happens next reminds me of AI and what we're seeing with regards to prediction. But it's, you know, that's a bit of a tangent to be honest. AI is too far from me now, right? No, I get it. But what about the resiliency idea, Peter? Is that what you're saying? Okay. So the current use of resiliency is, you know,

28:52
Basically, life is tough, we're in trouble, and so we have to respond with resilience, which is to struggle against adversity. And I don't disagree with that, but the problem is that the body, so allostasis is about moving things up and down. So that when you've spent some of the body's resources...

29:20
then there's a time to replenish them. And there is a medial level, medium level, where we were, our genetics and our inheritance sets these things. So for example, human blood pressure across the globe in all conditions, it's about a hundred and it's maybe 110 or something over 80, but basically,

29:49
it's meant to be under normal, peaceful, reasonable circumstances, about 100. And if you go into today's hunter-gatherer societies in Africa and Asia, in South America, Central America, I have spent...I got interested in this, and so I went and spent some time in these societies. Their pressures are not only low...

30:17
but they're flat with age. They do not rise with age. In the US, our blood pressures start to rise at age six or seven when children enter school. They leave the family and it starts by graduation at 18, 25% of them pressures are in the hypertensive range. And I actually think that if I'm not mistaken that our

30:44
our concept of normal with regards to blood pressure, like a lot of the markers or blood biomarkers have sort of shifted up as the population health has sort of declined. So instead of being like, yeah, so many people are, you know, have high blood pressure or, I don't know, the markers or whatever, they've sort of moved that population norm. So more people are normal, but not necessarily healthy. To some extent, but...

31:12
I wanted to get back to the resilience thing, but I'll answer this question first. For blood pressure, medicine worldwide acknowledges that pressures above about 120 are hypertensive. And if you move, they formally define it as 140 for pharmacological treatment. But it's very clear. It's been clear for 50 years.

31:42
the more damage is done by various mechanisms such as enhancing atherosclerosis, causing strokes, a number of different things. And it's bad for the brain, it's bad for the kidney, and so on. So there's no question that blood pressure for health long term should be low. And so, but the standard approach to this in the 50 years that I've been involved, I

32:11
is to treat it with drugs. And so the first, you have a hypertension patient, and you give the person a diuretic, and that causes them to spill more salty water basically into the urine. It acts on the kidney. And so that reduces the plasma volume. Blood pressure comes down. The brain thinks...

32:38
Oh, you know, we need to be, you know, moving, you know, we're under stress. And if that pressure is coming down for that reason, I will raise it by increasing the heart rate and the force of contraction. So you get shots of adrenaline that do that. And so you give another drug called a beta blocker. It blocks the synapses from responding to...

33:07
the norepinephrine. And the result is, yes, the heart rate comes down, blood pressure comes down, and performance comes down. So I walk with many of my male friends at 80 are taking this drug for one reason or another. And if we come to a slight rise on our walk, they have to stop. The next thing is, okay, you've blocked the kidney, you've blocked the heart.

33:37
blood pressure goes up. Well, that's because the blood vessels are constricting. So you can block that with another bunch of drugs and you can block salt intake. What you end up with is basically a sick person who's being treated by polypharmacy. And it's a very precarious thing because, for example, the beta blocker improves the blood pressure, but it makes the diabetes glucose worse.

34:06
And so those interact. So it's the homeostatic understanding where the brain doesn't really matter. It really generates polypharmacy drug after drug after drug. And each problem is called a disease to be fixed by some of these drugs. And of course, one of the problems is it's really being driven.

34:34
a great deal by the manufacturer, the drug companies. And it's very disheartening to watch our health being totally in the hands of these companies. Now, back to resilience. Resilience is part of the response to a challenge. If allostasis

35:03
sort of peaceful on vacation, it pulls things down here to a normal level. It allows us to regenerate. But if the next day is driving it up and keeping it up high day after day after day, the, the, the, the system, uh, adapts to that. And it does come to expect this new level and it's very dangerous. So resilience, um, that is what resilience is really is. It's, it's.

35:31
teaching you how to stay up there like that, as though there was no cost to it. It's very costly, both emotionally and physically. Yeah, okay, interesting. Yeah, because I was thinking about it from an almost an adaptive response, in that you rise to the challenge, then things settle and calm down, but that's not how you see it. It's okay if it happens once in a while. Yeah, sure, you need it. It's part of the dynamic range, it's expected to go up there.

36:01
But if you make it stay there as a way of life, it's damaging. And that is what you would have been seeing both sort of personally in your sort of experience with different communities and people, but also in the literature as well. With the social injustice. I missed that. With the social injustice. So as you're sort of understanding more, you're like, well, the...

36:29
problem with the stroke with the people that I'm seeing is that level of stress that their lives have sort of related and cause that. Yes, exactly. So I wrote a paper with Joseph Ayer on this in 1977 and then on the distribution of stress-related mortality. It's called Social Organization and Stress-related Mortality. And then that led me to the question of what are these?

36:59
local biological mechanisms through which these behavioral things are expressed. And so I published that with Joe in 1981, Biological Basis of Stress-related Mortality. And so many of these ideas are documented in great detail in that paper. And then it took me a while to come to this, to call it, name it allostasis. And I did that because I wanted something to stand up to homeostasis.

37:29
There's another point I have come to understand more clearly, and I published this in a new last paper review in 2019, that there is a role for homeostasis, and specifically because many, many features of our body, many conditions are really not predictable that well. And so you're bound to have errors.

37:56
If errors are unavoidable because of the things are intrinsically unpredictable, you need negative feedback to correct them. And so there are various examples of where the two interact in a positive way, but you just can't get a theory of our human species based on simply on negative feedback. No, for sure. And Peter, when you...

38:24
published this paper, how well was it received? Was it well received and accepted or has it been a constant battle? I'm sure it hasn't been a constant battle. We know so much more now these days about stress and the impact on health, but at the time, it sounds to me like these were very new ideas. They were adding to the pile of evidence in a very small part of the field where nobody was really interested. So I published, Joe and I published a paper.

38:53
our first paper in a journal called Journal, I Think of Radical Political Economics. It's a very small, you know, thing. But, you know, it's still cited, actually. And the next paper on biological basis was in a journal called Social Science and Medicine. It's a very respectable journal. It still exists, but it's not...

39:19
cited every day in nature. I mean, it was a fairly obscure paper, but over the years, so I've put all of my writings on this topic on a website called a research gate. And anybody can dial into my thing and they can get in any of the papers that are on there. There's a whole list of papers in my other podcasts and recent writings on this. So it's available.

39:49
Back then, and it's also, you know, I go on Twitter to try to publicize this stuff. Back then, no, you'd publish this thing and you'd wait for the splash, but it would be a decade. Yeah, yeah, yeah, no, absolutely. Piri, your, like, so did your anthropological sort of interest, because obviously you studied zoology and biology at university, so you, and of course the brain.

40:17
but then you went on to spend time with traditional hunter-gatherer populations. Did that enhance your interest in... I'm thinking about evolutionary biology there. Was that what you were thinking about as well? That's a very good question. I was reading all this stuff about blood pressure and society. There was a very good group at Harvard.

40:44
headed by Irvin DeVore and Richard Lee. They were studying the so-called Kung Bushmen in Botswana in the desert, Kalahari Desert. And I read all those studies, and they were just fascinating and they supported the idea of low blood pressure, very highly social, very unstressed people. And so a whole field of...

41:08
evolutionary anthropology grew up around studying these sort of peoples, and they wrote books, and I read every one of them. I mean, I was just fascinated. At the time I was married, I had two young kids, and so I couldn't exactly, you know, change fields and sort of knew. And I mean, but I was really... So what I was then began looking for is what are the connections between the biology I know and the way human beings live?

41:37
you know, and lives... The interest of these people who now still live this way is that that is the way we live for 200,000 years since our species emerged until very, very recently. So most of our evolutionary history and the population, the crossing of the Pacific to Australia, to the New World, all of these things were done as people were hunter-gatherers.

42:07
and with a very primitive technology. And so I think it's of interest, there's a very good group sponsored by the US Nationalists of Health study, for example, long-term studies of a group in the Bolivian lowlands of the Amazon named the Chimani. And they've been studying these people for 20 years. And the further they get out in the Chimani territory,

42:35
the lower the blood pressure is, the lesser and the greater the cardiovascular fitness. And these people are very healthy. And they live quite a long time and they have careers. The career starts at 20 when you go off into the forest to learn how to hunt. And this student, a young hunter at 20, just starting, his productivity increases over the next 30, 40 years.

43:03
And so, sorry, probably 25 to 30 years. And so what that indicates is that hunting and gathering is really a career. And it's not something now we have people stamping a passport or scanning a barcode. That is not a career. And it doesn't do justice to this tremendous brains that we have. It's just a very unhealthy way to live. And so.

43:32
sorry to get back to the question, how did I get into the anthropology? By the late 70s, I'd read all these things. I just, I was dying to see a person, people, community that was closer to that. And so I took off a month. My career was roughly under control by then in science. And I took off a month and went to Panama.

44:01
because I had been told that it's a small place and you can get lost into the pretty deep, jungly places pretty quick. It doesn't take a month. You can do it in a day. You can walk a day's hike and you're in Indian territory, what was called. So I did that and I hiked across the mountains from the Pacific to the Atlantic Caribbean side and back.

44:30
I traveled to the Darien Gap, which is now being publicized because it's a source of migrants coming up from Colombia. But then it was quite wild, quite very indigenous groups, in particular the Embara, who were living basically very, very simply.

45:00
with cooperative work and very small families, communities. And so I got to live with them for a couple of days and I worked with them and I was fed by them. I tasted that their food also was salty, but their blood pressure is not high. And so basically for the next several decades, every chance I could get to sort of go to some other little

45:30
group and see what it was like. I did. My wife came to enjoy this. We went off to Costa Rica and Honduras and Panama. Yeah. As I understand it, do you still have a house somewhere and you sort of divide your time? Is that still the case? Yes. Right now, I'm living in Amherst, Massachusetts. It's a very...

45:58
It's a university town and an agricultural town. Very pleasant in the summer and beautiful in the fall. But about almost 20 years ago, we were on a spring break in Panama, in the mountains, the Western mountains, and we were shown a farm that was for sale. It was of naval oranges and we bought it. We didn't do any research or anything like that. You know, it was something.

46:28
we could afford and we bought it. So now we live there, we built a small house and the farm is sort of worked and managed by an indigenous family. So we go there from November through May. Oh, that sounds nice. And I imagine that the weather is a whole lot better than it is in Massachusetts. Yeah.

46:54
I mean, it's sometimes windy, sometimes rainy, but it's milder. Yeah. Yeah. Yeah. Yeah. Oh, nice. So your understanding of health, then, Peter, you mentioned four pillars in a presentation that I saw you give. Could we go over them briefly? Like if it's not salt and it's not, not that it's not salt, but you know what I mean. Like it's you know, what is it about society that could sort of enhance health under these four pillars?

47:23
To be honest, I don't remember these four pillars, but I can make it up as I go along. Social inclusion. Well, even before that, I would like to say that our physiological regulation, our behavioral interactions, and our social level of interactions, it's very important that they generate on a daily basis.

47:52
small little pulses of the chemical everybody knows as dopamine. Because dopamine acts on the brain and to some people describe it as pleasure, but it's really it's a relief. Your part of your brain is driving you. Get out there, find work, find this, do that, find a mate, do this.

48:21
brain circuits in various degrees. And when you get a little pulse of dopamine, you stop. And so, and so it's the satisfaction of the unexpectedly positive thing. A hunter gatherer is working around all day, and he shoots a rabbit. Oh my god, we got dinner. Yeah, his wife finds a route, you know, okay, we got a soup, you know. So, you know, just to

48:51
make it short. But so we need these sources of dopamine and we get them from social interactions. We get them from empathic behaviors, altruistic behaviors. When you do that, the person getting it gets the dopamine, but the giver gets possibly more, you know? And so there's a whole level of these interactions which require a slower pace.

49:21
and more empathic cooperative behavior. And that's how we evolved, okay? And as many things drive us away from that today, but that's where we have to get back. And that could allow health, okay? Just interact in any interaction that is counter to, that we were also, these behaviors I'm talking about were done also on the basis of equality.

49:50
families in a community that was moving and migrating and hunting and gathering, they required each other's cooperation because one day I might not get a rabbit, but you got a pig, you know? And so there was very rigorous sharing to iron out the fluctuation, the economic fluctuations and so on. So now we just go to the supermarket and we don't need each other in that way. We don't interact in that way. And

50:19
And so we need to find ways to get back to more equal, to more.

50:27
to rely, to processes that where humans rely on each other in a cooperative way, more than we are doing. Yeah. And so I would, yeah. Yeah. It's interesting you mentioned dopamine, Peter, because of course, it's a bit of a buzzword actually right now, or it feels like it with Huberman podcast and every other, I know, and all the rest of it. And actually just the, that we can get dopamine, that dopamine hit from so many different

50:57
places that do not require social interaction or the tenets of health, which you sort of underpin your, how you talk about it. Well, let me address that. I think it's a very important

51:19
incorrect way of thinking about it that these people said, oh, yeah, we're always searching for these great jolts of dopamine, yeah, yeah, yeah, well, but they don't ask why. And I want to tell you why that is. It's because in a community where daily life involves multiple hits across the days of dopamine from social interactions for finding food that you can't go to a supermarket, it's unpredictable, and you find it.

51:49
and from sharing and all these different things, those people are not searching for giant hits of dopamine. Those people now are raising coca leaf. They've used the coca leaf for thousands of years, but they are not cocaine addicts, and they raise poppies, but they're not heroin addicts. So people who live in a way where they give each other small hits of dopamine.

52:18
are accustomed to these, it's like blood pressure. If it's around 100 average, that's good. So if the dopamine is going up and down, that's what you need, but that's enough. Once you lose, once you go from a life where you get to go out every day and try to find your dinner, to scanning a barcode, you've lost it.

52:48
So the social isolation now is really driving and the preoccupation with these. So you do get a hit from a tweet or a retweet or something or else, but that is supporting the social isolation that we've gotten to, which is really a source of rising in the US, rising...

53:16
suicide, rising drug, alcoholism, all of these things are not because looking for these little hits, they're desensitized. They wouldn't even notice a little hit because they're up at this level of banging their brains with these drugs that do raise dopamine. Yeah, yeah, yeah. No, that makes perfect sense. It's that instead of little pulses, we're getting these massive hits. That's right. And we're not. We search them out. We search them out.

53:45
because we're not getting the little hits, because we've wiped them from our society. I mean, I'm gonna give you an example, if we have a moment. I just came back from Denmark, where I was giving some lectures, and I came back with a serious urological issue. And in Denmark, I was treated in a hospital, like in five minutes.

54:15
for nothing. When I got back here, I told my, in fact, before from Denmark, I emailed my Harvard medical school run, huge practice that covers all of, from Boston out here to Arizona out here. And I could not get anybody to talk to me for a week. And you go in and you leave these messages and nobody answers. Sometimes they do, sometimes they don't. They answer too late.

54:45
And the anxiety I've spent two weeks just because you get says, well, call here. So you call and you get it onto a call center and then you get there. You're on that for an hour and a half. And so after seeing I was in Helsinki, Finland, and in Aras, Denmark, and after seeing how that does not happen there by a large.

55:13
I mean, I didn't see that much, but I was treated extremely well, very promptly, and by people without having to go through a phone tree. So this is really, I feel, the last two weeks of dealing with the impossibility of social interaction is built in, you cannot have one. I think it's been terrible, you know. And

55:40
sure it's cost me a month of my life. It's just really bad. And so this is now, this is my personal experience of this destruction of social interactions. Yeah. Yeah. No, I appreciate. And that is obviously a massive deal to you, a small example of what people are experiencing every single day. Yeah. Yeah. Exactly. Yeah. Yeah.

56:10
So if you're looking like, if I'm thinking about that, you're 83 and you've got this body of work behind you that supports your premise of health. And then do you sort of feel a little bit of despair at the idea, like, I just can't see how we'd get back to a lifestyle that would allow for health in the way that you think about it. I don't know, what do you think?

56:35
We're not going back to be hunter-gatherers. No, certainly not. But the idea of, yeah, can we exist in this environment the way that would be optimally healthy, I suppose, is... Absolutely. OK. Absolutely. We need more equality, less inequality. Well, I saw it in Finland and Sweden, I mean, in Denmark. I mean, it's not that there are no differences between people and ability or things.

57:04
But you just feel that the city is organized for people to encourage healthy things and to be supportive. People are paid salaries. And so that's a simple matter of taxing people who have a gazillion dollars and redistributing in some reasonable way as they do in Europe. They're much closer to having

57:34
reasonable life. And so, and their death rates, their death rates are falling, the US death rate is actually rising, you know, and from suicide and alcoholism and so on, it's rising at a site. Yeah. And for the very young people. Yeah. Yeah. Yeah, very good point. But we can do it. It's just a matter of people deciding. To do it.

58:03
to do it and how, I mean, yeah, just to change economic policies, change your social policies, nothing, you know, nobody has to die. It's just, you know, they have to decide what they want. Yeah, yeah. Yeah. And then therefore, I guess, if we reached a place where most countries had a similar social structure and policy structure, then do we do then is it in your opinion that other things which we focus on like

58:32
diet and exercise become not less important, but they're not as influential on health, if we consider the sort of overarching... Well, I think diet, I mean, I think the problems of lack of exercise, lack of physical activity,

59:02
are most prevalent among the parts of our society who have the least education, the least opportunity, the worst jobs in every way. And that's where the bad stuff is. When I go to a university where most of the people and research jobs are teaching, they're full of energy, they're not obese and they're not unhealthy.

59:28
And their eating is naturally, you know, something halfway reasonable, you know? Yeah. They're not just doing takeout, they cook their dinners, you know? So I've seen this over and over and over again in institutions where people are engaged, they have work they like, they're interested, and they ride their bikes. I mean, and they're all fit, you know?

59:58
the mass, people know those people, you know, take out and take all these drugs and they're really, you know, in trouble. Yeah, no, that makes perfect sense. Makes perfect sense. So Peter, do you think that, I mean, if it's, I guess this is my end, don't worry, I know that we have to, we're up on time. But do you think you'll see it in your lifetime?

01:00:27
of policy that will allow these changes? No, I don't. I actually think that we're facing a period of tremendous chaos. I think there's going to be issues of population decline, greater immigration, the climate. I think now we're entering a very dangerous period.

01:00:57
part of getting older and realizing I've been pushing at this needle all my life and I can't move it. Yeah. Yeah, yeah. So I don't think it's true. I mean, I think I have introduced a new idea, some thinking, but it's not enough to... Yeah. Well, Tina, I've really appreciated your work and I've read a few of your articles. And of course, you've got your book, What is Health?

01:01:26
that's very readily available. And as you, yes, that is it. Yeah, yeah, yeah. And easy to read as well. So, oh, thank you. So I would just add that we just last week did an audio version that we're putting together. And so, yeah, so that will be available, I hope not too long.

01:01:54
And MIT just signed a contract with a Chinese publisher to bring it out in Chinese. And last year it came out, I published it in Spanish as well, KS La Salud. So yeah, I'm still plugging. Yeah, yeah, yeah, that's awesome. And Peter, this is the final question. What do you do day to day to look after your health? Because

01:02:21
I have to say, and maybe it's just a reflection of my age as well, is that when I speak to people who are older than I am, you certainly don't seem like you're 83. It is phenomenal, actually. So, Harvey, is it genetics or what do you do day to day? Well, everything is some genetics, but the fact is that my wife and I pay quite a bit of attention to getting exercise.

01:02:47
Sally goes out for a walk every day, big long walks. I don't quite keep up with her, but I make sure to get out and we get our steps. We're competitive about our steps. 14,000 steps on Sunday. Wow. That's amazing. I'm also quite competitive about steps, to be honest. If Sally needs the car and I have an appointment in town.

01:03:15
How am I gonna get back to my house? It's four miles. I walk. Yeah, yeah, yeah, yeah, yeah. You know, unheard of. Yeah, yeah, probably. And then I'd say at night, I start getting ready for bed. I now have really to take care of what teeth I have left. I mean, they're all in my jaw, but they're falling apart. And so I wash them and I floss them and I do this and I do that and I rinse them. And I also, I live.

01:03:44
I do some exercises with weights, small five pound weights for maybe 15 minutes or so. And then I garden off. I have a nice vegetable garden. And that can be good exercise. And we do the same thing in Panama. So no, I think it takes staying healthy. And I drink, actually. I mean, I drink alcohol. But I've discovered actually that the less I drink, the better I function.

01:04:14
Yeah. The better I sleep and the better I dream. And so I make an effort to keep, to have a glass of wine at dinner and not really more. So I'm not telling anybody what to do, but that's what I think we found. Yeah. Peter, I could talk to you for hours. And it was funny when I sent you through my notes and you were like, there was no way we're going to get through this in an hour. Am I?

01:04:43
And you were so right. But I've really, really enjoyed getting to speak to you and about your work and your life. And I will put a link in the show notes to your research gate and to the Amazon link to your book as well. And we can look in future for the audible version to come out, which is great. Yes, great. Well, I've enjoyed this very much. And I think it worked out. Yeah. So I'll send you the link.

01:05:12
That sounds lovely. Thank you so much, Peter. Thanks a lot. Yeah. Take care now.

01:05:28
Alright guys, hopefully you enjoyed that and hat tip to my co-host Bevan McKinnon on Fitter Radio for alerting me to Professor Sterling and his availability for a podcast. He was very open to that and I was just so thankful.

01:05:43
Next week on the podcast we speak to another professor David Dunstan all about sedentary behaviour and its links with health which you know I'm hugely passionate about this sort of the area of movement and just being active in everyday life so we talk a lot about that. Until then though you can catch me over on Instagram threads and Twitter @mikkiwilliden, Facebook @MikkiWillidenNutrition, head to my website mikkiwilliden.com

01:06:13
Book a call with me. Why not? Let's get your nutrition sorted. Alright team, you have a great week.