Mental Health As Longevity Pillar

SPEAKER_00 0:06

Welcome back to Healthy Mind, Healthy Life. I am Nazizh, and tonight's conversation goes somewhere we don't talk about enough on the shows about longevity. My guest today is Dr. Eric Sakarega, a concierge physician and longevity medicine specialist practicing in Portola Valley, California, at the heart of Silicon Valley. He has over two decades of experience caring for someone of the most informed and high-functioning patient in the world. He's trained at NMOR, the University of Washington and UCLA, has served in senior leadership roles at Major Bay Area Medical Centers, founded B Mobile Care, and serves as chief editor of the procedures sections at the Metscape and WebMD. He writes at the longevity lens on drshaqarga.com where he engages people at their level with evidence-based honest medicine. So tonight we are not talking about supplements or biohacks. We are talking about the most underappreciated pillar of real longevity, mental health, and why anxiety is even in the most optimized lives, is quietly through the roof. So I welcome you to the show, Dr. Eric.

SPEAKER_01 1:30

Thank you so much for having me. It's really a pleasure to get this opportunity to talk to you.

SPEAKER_00 1:35

Wonderful. So before we go ahead, listeners, some statements reflect personal beliefs and experiences and are presented as individual views, not medical advices. So listeners should consult qualified professionals for medical conditions. So, Dr. Eric, before we start with this conversation, like I know that you have spent your days with patients who have access to the best of everything. And they have read the research, they they know the science and they have tried the intervention. So when did you first realize that for all the optimization happening around you,

Why High Achievers Feel More Anxious

SPEAKER_00 2:15

the deeper issue, the anxiety and the underneath the data wasn't getting addressed?

SPEAKER_01 2:22

Well, that's a great question. And I think that it has been a matter of a creep, um, meaning that over time it has gotten worse. It wasn't that just one thing happened that caused a huge shift, but rather modern, really just modern society has increased anxiety that there are more demands, whether it's financial uh or uh social media. You could go on and on about what it is about our modern society that is increasing anxiety. And interestingly, we do so much in-depth evaluation of our patients, looking at what their risks are and what they could do to optimize that an interesting thing is happening where I've found that people now, to some degree, by being aware, have also increased their anxiety. We have so many more ways of monitoring metrics and monitoring our health. And in doing so, that has made people hyper alert and just added one more aspect to be worried about and to have anxiety. Um, so with all of this going on, uh it's it it's easy to ignore the anxiety, but often not until a point that it reaches a breaking point.

SPEAKER_00 3:48

That is something. I mean, that that though these things really tell us about how we are not addressing the issues that are required to be addressed in ourselves.

SPEAKER_01 4:01

Yeah, you're absolutely right. And I I find that when it comes to medicine in general and even more so in mental health, that people don't always want to put the work in to get better. They want a quick fix or an easy answer. When it comes to sleep, and so often sleep is related to the anxiety and worries that people have. It's so much easier for someone to take a pill than it is to do the work of cognitive therapies that are more beneficial, or to say I'm putting away my computer and I'm not going to have alcohol. Um, people would rather just take a pill and have have that part be better, but you're not addressing the underlying problem and you're probably making things worse.

SPEAKER_00 4:56

Yeah, that is that is so true. So, you know, everyone is measuring something, like they're testing something, supplementing something. I'm curious, from your vantage point as a physician inside the most informed patient population in the world, what is the biggest misconception that people carry about what real longevity actually requires?

SPEAKER_01 5:18

Oh, that's such a good question. And when it comes to testing, I think people believe that testing really gives a really good view of what's happening in the body and that these results will give us answers. And that's often not the case, that we can do many, many, many tests and really still not get a perfect picture of what's going on with somebody. And more testing doesn't always mean better testing, that testing tends to be the most useful when we are looking to confirm something we already believe to be the case or

Testing Limits And Stress Signals

SPEAKER_01 5:55

rule out something. There are instances in which screening is important. Um, but I don't think that uh with all of this testing that we are really getting the full picture, and it's certainly not getting the picture of stress and anxiety, mental health just through labs. Um, that being said, we there are certain ways of monitoring people now that will give them clues that they are, there is too much anxiety, um, even though certain lab values like your cortisol are not great at giving the full picture. You can look at certain metrics like the heart rate variability that tells us, hey, in times of stress, is the sympathetic nervous system that fight or flight overriding the parasympathetic of response of calm? And so there are actually ways of monitoring that people aren't recognizing. They're just looking at their step counts or they're looking at uh their sleep numbers, but there are certain metrics there that that have value. Um and uh gives some people actual data for those that are data driven, something to show them look, your your heart rate variability has been miserable and it's been getting worse, and you're not sleeping as well. This is not something that is that is a minor issue. This is your body is responding to this and not in a good way.

SPEAKER_00 7:31

Yeah. I believe we we try to avoid it. Like it sounds like data alone cannot always capture the full human experience.

SPEAKER_01 7:42

Absolutely not. Um, the way you state that full human experience, I really like because that human experience is so much about what medicine is about. We are not machines, and yeah, I don't know, maybe it's because we're here in the Silicon Valley to think that with more data that you can engineer the body, but you you can't engineer the body. And um whether it be doing tests, looking at your at your biological age, um doing tests to look at your what your longevity is, um, it's it's not as easy as that. And uh as I said, it does take work, especially when it comes to these components of medicine that are not as data-driven, like mental health.

SPEAKER_00 8:32

Yes, yeah, that is that is so true. And you know, especially when it comes to things like stress and anxiety that don't always show up neatly on a test.

SPEAKER_01 8:44

Yeah, and often they don't, but they're unmistakable when you get to the heart of what is uh of symptoms. People generally don't come in and talk to me, and when I say it sounds like this is largely anxiety-driven, they don't sound shocked. People know when anxiety is a problem. So it's less about diagnosing it than it is about addressing it. And that addressing it part is what is is a challenge. Um, people don't want to give up their lifestyle, people don't want to give up the hours they're putting in and uh the complexity of their lives, people don't want to walk away from that. And so I, as I often say to people, stress is normal, stress is is expected. And I'm not asking you to stop doing things that are stressful. It's about how are you managing it? How are you managing the stress in a way that is healthy? Are you managing it in a way that is actually making things worse, whether it be that you are just simply distracting yourself, are you drinking alcohol um or using sedatives versus are you meditating? Are you are you getting out and getting exercise? And then another part of that is just your social interactions. Such a big piece of of mental health is um is about those social interactions and meaningful social interactions that I'm afraid that again in modern society we're not as dependent on um and need to remain at the core of our of our lives.

SPEAKER_00 10:24

This reframe is really important more than people realize, like because we have been sold longevity as a stack, a list of optimization series of metrics to manage. But what you are saying is something so much deeper than that, that you can have a safe, you can have a perfect A, P, O, B and still live in a body that feels unsafe inside its own.

SPEAKER_01 10:52

Yeah, exactly. And and look, I'm I

Managing Stress Without Quitting Life

SPEAKER_01 10:55

um I certainly don't mean to suggest that there isn't value in what we're doing in longevity, um, because in the longevity space, we're recognizing that a lot of these tests that we do are very valid and are very helpful, and people aren't getting them done. Um, it's less about them not being as important than it is to say that they are only part of the picture, and that you do need to look at the whole picture, otherwise, everything else won't matter.

SPEAKER_00 11:29

Yes, yes, that is so true. So, you know, I think longevity longevity has become a movement. Like everyone is measuring something and all these things are happening, but anxiety is also there, like anxiety as as a record level, even among the people with extraordinary resources and knowledge and access to care. So, what do you see like after two decades of clinical practice as an actual root pattern driving this rise?

SPEAKER_01 12:02

You know, I hate to say it, but in some ways the longevity movement has increased anxiety for the reasons I said, which is that because you can track, the more that you track, the more you pay attention to. And I've had times where I've looked down and realized I had an aura ring and a whoop and uh on at the same time, along with my Apple Watch, and I'm getting alerts, I'm checking to sleep, see where my sleep score is. And that's a complete misuse of these gadgets. And why do I use all this? Well, for me, it's a learning experience, and I love being a part of my own experiment because I can give feedback to others. Uh in fact, I was saying this before it became very widely known that people are actually having more anxiety

Wearables That Inform Not Control

SPEAKER_01 12:50

because they're checking their sleep score when they wake up. And it rarely ever, if ever, gives them anything beneficial. Because if they wake up and get a poor sleep score, they may actually say, Oh, I'm not supposed to feel good. That I my my aura ring told me that I didn't sleep well and that I'm not supposed to be active today. When really what matters is, well, how do you feel when you wake up? And so looking at these over the big picture, I like people ignoring it. Wear it, and then after a week we'll review. Or if you're gonna take an actionable step to see whether or not there was uh a change that was positive, that's when I find it useful. So if you said, okay, I'm gonna start getting better sleep, I'm gonna stop drinking. And for two weeks, I'm gonna not drink. And then at the end of that two weeks, let's see how your sleep score changed, that's a good use of it. Um as opposed to uh it telling you how you should feel.

SPEAKER_00 13:57

Yeah. Um, you know, when you actually start seeing those changes in you, even though they are little, big, or small, but those but as simple as improving your sleep quality, as simple as feeling happy through the day or getting and you know, just going through the day, it really matters. It really makes you feel so much better about yourself.

SPEAKER_01 14:20

Absolutely. And look, this is the reason that we're having this conversation is because this does matter and because it does pay off. Um, it just takes work to to get there. And if it wasn't going to make your life better, we wouldn't stress it so much, would we? It's absolutely hearing that there's a better life on the other side. And so uh it is so important that we continue to to push this and recognize how vital it is for our patients.

SPEAKER_00 14:56

I completely agree. And you know, that is something sobering in what you said, like, you know, we have treated anxiety like a system to manage when it is often keeping body, when it is often the body keeping scores on life that hasn't slowed down in yours.

SPEAKER_01 15:14

Yeah, exactly. And I I read an art, a very interesting article from one of my colleagues recently about uh about this and about the idea of of running hot, the the idea that we by doing more and being driven, um, that that contributes so much to burnout. And uh the comparison that my colleague made was that race cars, they burn out, they need to be fixed all the time, but the Toyota Camry lasts forever, and that perhaps running, we need to focus more on running cool than we do need to focus on being the best, being the fastest, um, being more driven. And that also goes for health, that we need to be cognizant of what matters, but we should not be hyper alert to every little signal that is likely well is unlikely to be of true significance.

SPEAKER_00 16:15

Yeah, that is that is so true. And you know, uh, you know, picture to a person like Lisp, any person who anybody who might be listening right now, like maybe there's a professional, there's a founder or a parent, someone who's trying to keep up, like they're trying to they're trying, they're they're sleeping with a ring on their finger, they're tracking the stress on their word, just like you said. So, how does this kind of chronic optimized anxiety actually show up in someone's daily life?

SPEAKER_01 16:46

Well, it often doesn't show up until they slow down, you know. When you're you're going full speed, you feed off of that adrenaline,

Burnout And Hidden Anxiety Symptoms

SPEAKER_01 16:55

you feed off of that sympathetic nervous system being driven. And it's when you try to slow down that you realize you can't, and that's where it's a problem. And like what I said with sleep, well, that's a perfect time where you're supposed to be letting your mind cool off, and instead you're still going, going, going. And so that's when you are most likely to feel it, but it doesn't mean that there are other times during the day where that sympathetic drive, that high cortisol levels aren't having effects on you, and you may not be feeling those effects. You're not feeling the effects of the high cortisol. It may be manifesting in ways that are detrimental but are not directly obvious. For example, eating, your cortisol levels are high, you're more likely to be stress-eating. Um, your ability to just cool down and enjoy yourself taking a walk is not there because you can't calm your mind. And um, and so these are in so many ways, you don't see the what is lingering underneath that needs to be fixed. And um so when we do have those obvious signs like sleep or something more severe like a panic attack, I I think it's important to recognize that it is now you're I don't want to say too far gone, but you're you're there's simply manifestations of what has been going on for quite some time.

SPEAKER_00 18:42

Yeah, that is so true. There has been manifestations and we do see little things, but you know, just like always we see it, we just let it go. Yeah, but but I I believe everybody who has come to this point in this podcast will actually be thinking about those things because I am yeah, so yeah, it it it does land with a lot of our listeners today.

SPEAKER_01 19:10

Well, and look, I I I I think that uh it's it's easy to recognize these because look, I've lived that life. I was an ER doctor for much of my career, and um I was driven by that. I was driven by the go go go. And it was when I shifted gears in my life that that go go go never ended. And so when I preach what people should be doing, recognize that hey, it's a challenge for me too. And um, and so I know how difficult it can be. And um and yet I could also say that there is uh, as I said before, a better life uh on the other side.

SPEAKER_00 19:59

Absolutely, you know, that is so true. And I think there aren't the like, you know, the shallow bread, the disrupted sleep, and the chest that never quite unwinds, and the inability this is the with to be in a quiet room without reaching for the phone. I mean, these aren't the quirks of modern life, they're actually the signals uh from the system that has been carrying

Starfish Breathing And Teaching Calm

SPEAKER_00 20:25

too much for far too long.

SPEAKER_01 20:29

Exactly. And a funny story along those lines, and saying before about having to check myself, I found that I was I was trying to get my five-year-old daughter to bed and that she was a little bit amped up, and I just wanted her to get to sleep so I can go back to getting my work done. And she started teaching me a breathing exercise, my five-year-old, who something essentially like box breathing, but she called it starfish breathing, where she would trace her finger up her thumb on inhale and down her thumb on exhale and up her index finger. It was basically box breathing. And I'm thinking to myself, wow, my five-year-old is teaching me something and not teaching me something that is just something bizarre she learned on TV. I mean, she likely learned it in class, but what a valuable thing to be doing for children in these times like this where you think, boy, are are we what is it that we're teaching our children? Are we teaching our children about how to be on our cell phones all the time and how to not be present? And we can learn so much from children who don't have that anxiety, and we need to make sure that we don't pass that on to the next generation. So um it's uh it's a learned behavior, and it's learned because of our societal pressures and and how we feel like we need to keep pushing and driving, um, but we still need to live our lives in a in a way that is fulfilling.

SPEAKER_00 22:01

That is so true. And you know, Dr. Eric, this has been such a wonderful conversation with you. So before we close, I just want to ask you something that on behalf of everybody listening tonight who has built an impressive life on the outside and who is doing all the right things on the paper. I hope, but who so quietly wonders? Why do they still feel so anxious underneath all of it? What would you want them to hear tonight?

The 10 Year Plan Plus Reset

SPEAKER_01 22:30

I would want them to take a step back and take some time out of your schedule to really reflect on what it is that you want out of life and that what is the 10-year plan for you? Not what is it that you need to get done today, but what do you want to be able to, where do you want to be in 10 years? And what you're doing over the next several days is going to be a reflection of that. And if you're unhappy because of how much anxiety and stress you have, don't plan on it just getting better. There's no such thing that you will do something when life calms down. You have to make it calm down and you have to come up with a plan of how it will calm down. Otherwise, it never will. It'll only get worse or continue. And you owe that to yourself. Um, you deserve to be happy, you deserve to be well. Um, but it may take some reframing of what's important to you.

SPEAKER_00 23:29

Absolutely. That is very true. Thank you so much for sharing that with us. And you know, I believe longevity is not the absence of disease, it is the presence of a life worth living.

SPEAKER_01 23:41

Wow, and I like that.

SPEAKER_00 23:43

Yeah, and the most important pillar of a long, healthy years is one that we have set spent the least time honoring. That is our mental health.

SPEAKER_01 23:56

Absolutely. Well, I really appreciate you bringing this to light and talking about this uh uh with me and on other podcasts. I think what you all are doing is wonderful and you have such a great message. So uh keep up the great work.

SPEAKER_00 24:11

We will, but I believe there will be listeners who want to follow your work because it is absolutely wonderful and the longevity lens and learn more about how you practice and everything. So, what is what is the best place for them to find you?

SPEAKER_01 24:27

Yeah, so the best place I do have a substack, which is the longevity lens. Um, you could also see most of my posts on on my website at www.drschraga.com. And um uh those are the main platforms I'm using, and you're welcome to reach out to me through either of those platforms.

SPEAKER_00 24:52

All right. Thank you so much, Dr. Eric, for this wonderful episode. I will make sure to include these details into the show notes so that a lot of people can reach out to you and learn from you. Thank you so much for being here with us.

SPEAKER_01 25:04

And thank you so much.

SPEAKER_00 25:05

Yeah. And dear listeners, that was our episode of Healthy Mind, Healthy Life. If something in this conversation made you pause, made you wonder if the anxiety you have been carrying is asking for something more than another supplement or another tracker. Take that as a sign. So tonight, before you reach out for your phone, before you check, one more metric, do one quiet thing. Sit for 60 seconds, no screen, no input. Just you and the breath that has been keeping you alive. The most underappreciated pillar of your longevity is the one you can build right here. So until we meet here again, take care of that body that's been carrying you, and take care of that mind that's been carrying it. So we will see you soon.