The latest research, learnings, and insight on mental health.
by Dr. Hillary Lin
When I was in medical residency, I was the perfect example of everything you shouldn’t do to live a happy, healthy life.
A lot of it was out of my control, at least if I wanted to continue being a doctor. My work schedule demanded frequent 12-14 hour shifts and occasional 24 (really up to 28) hour ones. I had zero emotional bandwidth to do more than shower to decompress each day, and “golden weekends” (when you get two whole days off in a row) were so rare that I’d use them to take whirlwind weekend trips which exhausted me even more. I missed out on what most 20-something-year-olds get to do - date, go out, make new friends, move cities, change jobs, and much more. And the physician culture promoted this - everyone in medicine is a martyr, and the “winners” are those who suffer the most.
Some of it was in my control, but I had no willpower left to address even these things. I wanted to sleep enough, start meditating, eat right, get exercise, and read to learn. I wanted so much to experience “real life” and meet a diverse group of friends outside my workplace. I wanted deeply to become a citizen of the world, rather than a dreamer and tourist at best. I instead found myself settling into easy routines, an easy relationship, and manageable goals because I had no emotional energy for anything else.
The best thing I ever did was to completely turn my life upside down. I finally realized, when I had a moment to breathe after residency, that I needed to spend serious time getting to know myself and the world I lived in. Living vicariously through my patients was not enough (although it was, and still continues to be, an important way I learn about diverse people and cultures).
So in a span of two years, I moved across the country, left traditional clinical medicine, got divorced, and started Curio. Plus the COVID pandemic started somewhere in the middle, which actually made it easier for me (it turns out that quitting your job and going through a divorce is not as huge a deal when the whole world is imploding around you anyways).
During that time, I got closer to my inner focus and passion. I had always desired to understand what drives human behavior at a deep level. I learned quickly, through experience, how to start a fast-growing health company focused on this very topic. Personally, I have met the most curious and wonderful group of friends in my beloved NYC - one of whom is my partner with whom I share a life of joyful and intellectual pursuits.
I would never have been able to do any of the above without saying goodbye to my prior life and suppressing all whispers of regret, FOMO, anxiety, and grief. The beginning of a new age in my life started with a massive shakeup.
So why am I writing about all of this at the beginning of a new year? Because my 2023 resolutions - all 14 of them - are based on foundational life practices I cemented into my day-to-day during my massive shakeup.
During this transition, I had many sleepless nights and tearful days. I lost friends and familiar routines, and had to make a completely new way of life in the midst of a worldwide pandemic.
The way I got through it all wasn’t terribly fancy. I stuck to the scientifically-backed basics of health and happiness, as laid out in my method called SPEED.
Sleep was utterly miserable for all of us in the deep pandemic. I saw in my patients the same insomnia I personally experienced. The days were long and nights even longer. But I knew from published research and my long medical education that it was imperative to tackle sleep first, no matter how elusive it felt.
One of my favorite classes in undergrad at Stanford was “Sleep and Dreams” with Dr. Dement. This “father of sleep medicine” incidentally passed away around the time of my reinvention, but his legacy has kept on giving. The “Sleep and Dreams” class taught us treasures like how you can never make up lost hours of sleep (without taking the time to sleep), and that catching up on sleep on weekends often made things worse than if you maintained a regular sleep schedule every day.
I once spent an entire golf cart ride with Dr. Dement (he used to drive students selected via lottery to class) telling him over and over again how much his sleep research and teachings changed my life (this was a very repetitive conversation because I lived a very long way from the center of campus).
Boiled down to the basics, here is how to optimize sleep.
I start with this rule, because it triggers everything else. You may feel utterly miserable the first few days, but eventually you will get tired enough that you fall asleep earlier. Add a bit of sunshine to help yourself wake up - from an outdoor walk, opening the window blinds, or using a light therapy lamp can help.
In addition to rule #1, this is related to developing a strong Circadian rhythm (inner biological clock) which governs everything from your wake cycle to your mood. Note: you should plan enough time to get ready for bed and fall asleep while keeping in mind your wake time. Most people need 7-9 hours of sleep, but the real test is whether you wake feeling rested, even sharp, without the aid of stimulants like caffeine. I used to conduct sleep research with Siberian hamsters in Dr. Craig Heller’s lab. Some hamsters had interrupted sleep and some who had regular sleep schedules. The interrupted sleep hamsters slept significantly more in terms of time (they napped a lot), but were drowsy and terrible at mazes and other tasks compared to the efficient, regular sleepers.
In addition to a regular schedule, there are a few core principles to proper routines for best sleep. Having a relaxing wind-down period 30 minutes prior to your goal sleep time away from blue light (electronic screens) is a core component. Some people, like myself, are also sensitive sleepers and should also optimize a sleeping environment free from disruptive lights and sounds. I even utilize a split bed setup to deter my extremely sleep active bed partner from invading my sleeping space.
Other principles are covered in the rest of SPEED or are more advanced, so I’ll leave them for more in-depth posts later. But truly, you can do so much by simply respecting your body’s needs for adequate, regular, quality sleep.
This may seem like a catch-all, but what I’m referring to specifically is caring for your physical health by minimizing illness. This means if you have a cold or flu, taking it seriously. I’m one of the worst at this (see section above on how doctors are the worst patients). This past season I pushed through shingles, pyelonephritis, and some non-COVID respiratory virus while traveling to conferences and hosting my team in NYC without taking much more than a half day’s break. It was not great (I thought I was dying), which is why I’m diligently sticking to my resolutions for 2023.
When you are sick, everything else goes out the window. It’s hard to eat or sleep well, and exercise is far less effective. Your brain feels fried (I am well-acquainted with long-COVID brain or inflamed sick brain now) and your work declines. Adequate rest and recovery is needed to tackle any serious effort. Contrary to popular belief, this doesn’t mean taking more drugs (see below section on Drugs), but rather means following some basic rules:
Take time off work, sleep more, and hold off doing heavy workouts or exposing yourself to extreme elements.
Take in water and electrolytes to keep up your energy. It is easy to become dehydrated when sick because you feel too ill to drink or eat much. When you get sick enough, your body will even require more help from water and electrolytes to keep up your blood pressure.
It’s tempting to eat unhealthy comfort foods, but it’s important to stick to healthy nutrition when you’re sick. Junk foods stress and inflame the body further, which makes you feel worse when you’re already ill. Chicken soup really is good for you, by the way.
Spoiler alert for the last section of SPEED. I personally hate how pharmacies make available ridiculous numbers of over-the-counter drugs without adequate direction. Most people don’t know which ingredients are actually even helpful for their symptoms, and can take too much of certain ingredients which may be harmful. Sometimes I feel like half my job as a doctor is to tell people to stop taking certain over-the-counter medications.
Oh, and stop taking antibiotics for viral illness! It leads to resistance not only for you, but for everyone else. Plus, it doesn’t do anything to fix the problem. Sometimes, it can even lead to fungal infections and dangerous outcomes like ruptured tendons or C. difficile (a terrible, life-threatening, watery diarrheal disease).
Finally, your mental health evaporates when you are physically unwell. Some people are extremely strong practitioners of emotional resilience and can feel perfectly sublime through illness, but most mere mortals need to take one thing at a time. If you have a chronic illness, like diabetes or cancer, healing and treatment is harder and requires longer focus. But it is still well worth your time to focus on that healing so you can get to feeling better and happier.
Eating lean and clean and nutritionally is the key to health. But how is the question. This is a complex topic because nutrition research is notoriously difficult to conduct. But in general, Western diets are too full of high tech foods (processed foods) which deliver calories and not much else. We each also have nuanced needs and variable education around food. Those of us who grew up in the days of the food pyramid need to unlearn the flawed idea that we need massive amounts of carbs for a balanced diet, for example. Thankfully, the CDC these days offers a much more science-based set of diet recommendations.
Every person has somewhat different needs, but you can follow these basic rules if you are otherwise healthy:
Clean foods are those which are minimally processed and contain plentiful nutrients. These are foods that are as close to their natural state as possible. Organic foods are somewhat controversial, given we can’t be sure what the labeling means (due to limited regulatory oversight, etc.), but leaning toward foods without harmful pesticides or added hormones or antibiotics is healthier for humans.
Note that not all “chemicals” are bad. There was a social media trend where people were refusing products and foods with ingredients they couldn’t pronounce, but I (sorta) joke that’s a problem with literacy rather than with any chemical. Some funny-sounding ingredients are perfectly fine; for example, erythritol is pretty hard to pronounce but is actually a healthy, natural sugar substitute with less than a tenth the amount of calories of table sugar.
Eat enough calories, but not too much. Most people have never carefully tracked their calories and underestimate their calorie intake by up to 50%! For those people looking to lose weight, the most straightforward way is to get better at tracking calories. A good calorie calculator can tell you how much to aim for depending on your goals. Note that not everyone is trying to lose weight, but it’s such a common new year’s goal that I thought it’d be a good note to add here.
On a side note, I have noticed in my weight-loss patients that many feel emotionally better as well. This is documented in scientific research, although we are still beginners at understanding why. Harvard psychiatrist and scientist Chris Palmer, MD has conducted a wealth of research and clinical practice on how ketogenic and low carb diets can treat mental health conditions from depression to even schizophrenia. The theory is there are complex immunoendocrine and psychosocial mechanisms at play. Translation - your mind is deeply influenced by inflammation such as that caused by high sugar diets. Also, losing weight and getting fit makes us feel more attractive and improves confidence, which is correlated with better mental health.
Whole foods have the best nutrition. This means veggies, some fruits, and lean meats and other healthy sources of protein. I don’t care how many ads and gurus claim their vitamins are magical, I don’t buy it from a medical or scientific standpoint. Studies upon studies have shown that supplements do not prevent cancer or other major illnesses. Supplements are also not well absorbed by the body compared to whole foods (our ancestors evolved to eat food, not pills). The exception here is for those who have serious medical conditions like cancer or past surgeries which affect their digestion enough to require additional supplements.
And before one more person asks me about vitamin D supplementation, no the evidence is simply not there for the vast majority of people. That means, most people will not benefit from taking vitamin D supplements. Even people with fairly low levels of vitamin D have not benefited by taking supplements. The research is extremely mixed due to the variable effects of taking the extra pills (we see some benefit and some disadvantages in clinical trials). That being said, if you are deficient and your doctor recommends it, it may be ok to try vitamin D supplements if you otherwise have little way to consume it in your food or get enough through sunlight. (Also, I get that vitamin gummies taste delicious and are a sneaky way we slip sweet snacks into our lives while saying to ourselves, “It’s healthy!”)
Before I was 30 years old, I never had a gym membership. I was convinced that I could stave off death and aging by simply eating less and metabolizing less (this rate of living theory has been debunked in recent decades). In my defense, I had an early life exposure to caloric restriction science when I worked on a high school research project in a yeast lab (lesson no. 2 in this paragraph - do not directly apply your experience with microscopic organisms to practical living as a macroscopic human).
Now that I am medically educated (and have finally escaped the rigors of medical training), I know and do better. There are both immediate and long-term benefits of physical activity, including the following:
Ok I’m just kidding about the last one, but exercise really does seem magical.
The problem is, most of us live fairly sedentary lives. Also, like food, every person can handle or could benefit from different levels of physical activity. Assuming good health and no special considerations (pregnancy, illness, injury, and so on), the Apple Watch’s default settings are pretty on-par.
Fast walk, jog, run, cycle, or swim at least 2 days a week and for at least 75 minutes a week. I do this by running 15 minutes a day, 5 days a week. My co-founders at Curio do this by biking 45-100 miles a week which I won’t say is obscene, but maybe some people would say so.
Work out your muscles at least twice a week, and don’t forget any muscle groups! Before last year, I would never pick up a dumbbell heavier than 10 lbs. Now I can do (somewhat) more than that, and I can do pushups. I’m not going to say exactly how many in public, but let’s just say it is infinitely more than I could do not long ago.
The CDC has a pretty good set of recommendations for different populations you can follow here.
Also, find a workout buddy! You might be like me, where it feels like everyone around you is way fitter (I live in a neighborhood nicknamed “Fitiron”). Or, you may be surrounded by equally or more unmotivated couch potatoes. But find a role model or an actual partner to inspire and motivate you, and you may inspire someone else in turn.
I once had a patient in the cardiac ICU who ended up there because she took too many vitamin D and calcium supplements. She literally caused a life-threatening cardiac arrhythmia (heart block) by taking vitamins. I also had another patient who ended up in the ER because she took too many anti-histamines (in all fairness, she didn’t realize they were all the same drug class because over-the-counter drugs don’t warn you about details like that). Finally, I have had countless patients on SSRIs and other drugs who relied on them far longer than recommended (SSRIs were never intended for years-long daily use) and ended up obese and with blunted libidos.
All that is to say, we need to take fewer drugs. It is a systemic issue where we expect solutions in pill form and longer-term solutions are difficult. But it is an important one which is incredibly overlooked because the capitalist incentives drive health systems and companies to push for more drug use, not less.
As a physician, I often counsel patients to consider their illness and whether they really want to start a daily medication. Lifestyle change is incredibly hard, but often can solve chronic issues like depression and diabetes. When medications are necessary, I urge my patients to use them for a short period, such as 1-3 months. At each visit, I ask if this might be the day they decide to tackle the problem with behavior change instead.
There are some exceptions of course, like broken bones, cancer, or autoimmune disease. Sometimes a person’s body is far too damaged to fix with behavior along (i.e. after a stroke has already occurred). Medications and sometimes procedures like surgeries are necessary in such cases. But for the vast majority of people’s illness, we can manage with other methods.
This rule applies to recreational drug use as well. By that, I primarily mean alcohol. We have been conditioned to believe alcohol is okay to consume as long as it’s after 5 PM somewhere, but the truth is it is one of the most harmful substances still legal and prevalent. For example, alcohol is the second most significant carcinogen (after tobacco) whose exposure is entirely within our control. It can also damaging to nearly every organ in the body, most notably the heart, liver, and pancreas. Finally, it is a direct neurotoxin. We know it’s bad to drink while pregnant because our babies turn out less smart, but when we drink alcohol ourselves it is directly killing neurons and leading to poor mood, thinking, and memory. A University of Pennsylvania study on over 36,000 adults showed that even a few drinks a week leads to brain shrinkage and rapid aging.
Other recreational drugs come with their own set of issues, particular opioids (we’re still in a deadly epidemic). This is a long topic which I will likely write about in the future, but needless to say it is important to consider what drugs do to use before we consume them.
Also, quit smoking if you smoke. I think there’s been enough said about this that I won’t harp on this much, but it is the number one most significant detriment to one’s health within one’s capacity to control.
Some people may ask, why are you starting a psychedelic health care company if you recommend minimizing drugs? It is because I want to get people off daily drugs that I started Curio. With intermittent, interventional usage of psychedelics like ketamine, a patient can heal their depression or other mental health condition much more quickly and with far fewer, transient side effects. But even among our members, I greatly recommend the extra-pharmaceutical (non-drug) methods which we teach in our coaching and education over more frequent or higher doses. The psychedelic intervention is the jump start, not the whole solution.
To sum up D for minimize Drugs…
Look at every herb or drug you ingest via prescription, supplement, or recreation. Talk to your doctor or a pharmacist about what these ingredients have been proven to do, both good and bad.
Get rid of as many drugs from your life as possible. Like I mentioned above, some will be necessary (I use daily anti-histamine eyedrops for an autoimmune condition called atopic keratoconjunctivitis, for example). However, many are likely unnecessary. For some drugs, like alcohol or SSRIs, your body may have developed a physical dependence and you need to discuss weaning down slowly with your doctor. Do not try this on your own.
Evolve your lifestyle for minimal drug exposure. For me, I have had to consciously cut down on my alcohol use over the years. I’m finally at a point where I can happily do “Dry January” without (too much) a second thought. Despite my sleep struggles, I fight insomnia largely without supplements like melatonin these days. I work on my attention difficulties not with stimulants, but with meditation, good sleep, and strong planning and boundaries.
This is a tough one for many, which is why it’s the last in SPEED. But it is just as important as every other item in this foundational framework for improving your overall health and happiness.
A final note here about the importance of support. I did not get to where I am alone. Nobody who is happy or healthy does. In my worst times, I relied upon the support of professionals as well as my closest friends (whom I trusted to see me as a blubbering puddle of sad mess). I could not see from one day to another during these times, much less push myself to think of a single new year’s resolution. There are many people, perhaps you yourself, who are in a that state of despair even now.
The key thing is to find someone reliable and trustworthy to help you as you work through frameworks and programs like SPEED. Our philosophy at Curio is that a comprehensive approach, more than any one factor like a medication, psychedelic, coach, or therapist alone, is the real way toward happiness and health. We all come with our set of traumas, negative thought patterns, dysfunctional relationships, and flawed self-images. It is a forever life journey to parse out and tackle each of these very human experiences. You don't need to do it alone.
Time and again, I try to think of a better set of foundational practices, and keep falling back to the basics outlined in SPEED. They work well for me, my patients, my colleagues, and more. Yes, there are higher level skills and topics which are also important (mindfulness, reflection, communication, connection, relationships, and so on). But they all fall apart if you ignore the SPEED basics.
I have no fewer than 14 SMART goals for 2023. Almost every single one is related to a SPEED topic (I’ll reveal the others in a future post!). My challenge for you, dear reader, is to tackle just one. If you manage to sleep well this year, for example, I have no doubt that one win will pay countless dividends toward your success in life and happiness.
The latest research, learnings, and insight on mental health, curated by Dr. Hillary Lin.
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