Chapter One: The True Secret to Transformation CHAPTER ONE The True Secret to Transformation Two large coffees, skim milk, three Splendas, two dollars--it was the same every day. The guy behind the street cart outside my downtown New York City office knew my order without having to ask. This was 2003. I had just turned twenty-one years old and was freshly out of college. In those days, I lived off this coffee concoction loaded with artificial sweetener, caffeine, and the hope it would somehow make my day go by faster. As I sipped the coffee on a bench steps away from the subway entrance, the Financial District in downtown Manhattan in the month of September felt like a movie set to me: the smell of roasted nuts mixed with the taxi exhaust, people in suits no matter how sweltering the outside air, and the feeling that things were always beginning. I should have felt like I had the whole world in front of me, but instead I was lost. Graduating summa cum laude and Phi Beta Kappa from an Ivy League university with a degree in international relations meant that I was really, really good at school--and not good at much else. I had learned to use my intellect as armor, always having the right answer, always making the right choice, justifying the wrong choices as right ones, and living perpetually in my head. Armed with this "I must have all the answers" outlook, I subsisted on a rinse-and-repeat combination of caffeine, red wine, and calorie restriction (in the body-dysmorphic way, not the biohacker way) that cycled me through days in the office and nights out partying. I was very far away from becoming the doctor, mom, and CEO I am today--in fact, I could never have imagined this kind of future then. My first job out of college was as a paralegal in New York, where I prosecuted securities fraud for the US Attorney's Office. The job was a gift, and not just because it was a relatively distinguished opportunity for a recent college grad and came with the highest security clearance I will certainly ever have in my lifetime. It was a gift, because in a mere six months it showed me exactly what I didn't want to do with the rest of my life. While someone very smart should absolutely prosecute securities fraud on behalf of all Americans, I remember telling my best friend over drinks one night that I didn't think it should be me. The "this is not working" feeling I had about my career was compounded by my romantic relationship at the time. I had been with the same boyfriend for almost three years, but we'd long cruised past the territory of "healthy relationship" into what I would describe as a wildly immature, dysfunctional, and competitive relationship. I regularly spent lunch breaks outside the office, tracing the paths of City Hall Park, sipping my fake-sugar-sweet street-cart coffee while crying and arguing with him on the phone. In my early twenties, I survived on coffee, green apples from the farmers' market outside my apartment building, protein bars, and grilled chicken from the sandwich counter at my local bodega--no exaggeration. I unknowingly subscribed to the cult of orthorexia before the obsession with "healthy" eating became a thing. At the time, I had no pretenses around being "healthy." Instead, I just thought healthy equaled skinny. To accomplish that end, I also ran on the treadmill at the YMCA three to four times a week, Z100 blasting in my headphones as I thought about which flavor of Tasti D-Lite I would reward myself with after my run. Being "healthy" to me simply meant fitting into a size Small while simultaneously subsisting on sugar in alcohol, protein bars, and fake sweeteners. I was doing well at work, and despite my crazy gone-on-too-long relationship with my boyfriend, I had a great social life, lots of friends, and endless evening plans. The lack of sleep, perma-hangover, daily brain fog, and mood swings didn't seem to me to be an issue. It's what we all did. The only problem was that I didn't feel good. I was anxious, stressed, and lost, and without realizing it, I started to try to find a way out--of everything. On some visceral level I knew that I wasn't on the right path--I certainly wasn't on the path to become who I am today. But I had absolutely no idea where that path was or how to find it. Like a mouse in a maze, I started walking, a lot. Initially, it was just around the neighborhood where I worked. My paralegal duties most days were manageable, so unless one of the cases I was responsible for was at trial, I had extra time on my hands, and walking took the place of sitting at my desk reading the New York Times online for the fifth time. A few months into my wanderings, I happened upon a flyer pasted to a streetlight on Warren Street. It was for $5 classes at a yoga studio in a fourth-floor walk-up above one of those jam-packed ground-floor shops in New York City that has a little of everything--staplers, screwdrivers, Halloween costumes. The neighborhood was slowly coming back to life after 9/11, and my first three classes were going to be only $15. This was attractive because I was broke (my government paralegal salary barely paid the rent), and I signed up because I needed something to do when I didn't feel like window shopping or crying on the phone. I knew nothing about yoga--the practice was hardly standard curriculum for college students in those days, and my upbringing in Baltimore had emphasized team sports like soccer and lacrosse instead. I was skeptical of yoga at first. The studio was only one room, and you changed behind a curtain. The windows had been retrofitted with stained glass. Was this a church? The people in class, mostly women, were older than me for the most part and appeared to be very fit, but not in the skinny Splenda-wine-and-coffee way. They actually looked strong. I wasn't sure that I was supposed to be there, because it felt like they all knew one another. But I had nothing better to do. Yoga was immediately different from running on the treadmill at the Y. My breathing slowed. My focus stayed in the room. I discovered that holding still was more difficult than moving quickly. After the thoughts stopped racing through my head, I became acutely aware of my body in space for the first time. My sweat felt like it was coming from a deeper place than just below the surface of my skin. It wasn't just energizing--it was also frustrating. I realized that I had no core strength whatsoever. I learned that while I was great at moving forward through time and space, I was terrible at balancing in the here and now, as I fell over simply trying to stand on one foot for several seconds. The "Om"-ing was weird and awkward, and the corpse pose, which meant lying around on the ground doing nothing, felt like a waste of time for a workout class. I had no idea what the Sanskrit words meant, just that I felt a little too woo-woo for even being in a room where they were said out loud. After my first class, I threw my drenched clothes in a bag. It wasn't hot yoga; the class had just been that hard. As I walked back down the four flights of stairs, I noticed a strange feeling. First, my legs were shaking like I'd just run ten miles. Second, I was calm, possibly for the first time ever. My head wasn't spinning through that cycle of external blame and internal shame that I'd been stuck in for years--the same one I had used to rationalize my reality. Instead, I felt suddenly in the present, without worrying about what was going to happen next or reexamining everything that had already happened in the hopes of reaching a different outcome. That feeling of constant tension, like my body was attached to a live wire, was gone. I felt free. While I didn't appreciate it at the time, I had just used my body to change my mind--I had used my physiology to overhaul my psychology. This wasn't just a quick fix, feel-good moment: This was the beginning of a transformation of my baseline emotional state leveraged by a shift in my physical state. This metamorphosis of your emotional and mental health triggered by a change in your physical health is what I call a State Change . A State Change is when you establish a new normal, or a new set point for how you feel on a daily basis. At baseline, you feel happier, have an easier time discovering what you want, are able to tap into your passions, feel more confident in your decisions, and are able to unlock a new level of consciousness that you may have never realized even existed. State Changes don't happen after one yoga class. But for me, one yoga class was the unexpected first step toward rethinking my daily behaviors, or core actions, as I call them throughout this book: the things we do every day with or to our bodies that can have a huge impact on our physical and mental health. After my first yoga class, I found myself going back for a second and a third. After ten classes or so--and a similar experience following each one--I became fascinated by the connection between my mind and my body. I hadn't ever known I could feel so clear, present, calm, and connected. The feeling lasted far beyond the hour-long class, influencing the way I saw my life and myself. Yoga was still weird to me, and I routinely made fun of it to my friends, but I found myself going back again and again, searching for that feeling and the consequential confidence that seemed to magically result. My first State Change led to a major shift that ultimately changed my life. This started, though, with a physical, mental, and emotional wake-up call. Suddenly, I realized just how many of my waking hours were spent in a continual state of distraction and anxiety, as I began to discover through yoga more clarity, energized calm, and mindfulness. Eventually, a calmer, more energized state wasn't just my in-class mode but my new baseline--how I felt on a consistent, regular basis. Unlike other types of exercise where I felt exhausted afterward or like I was literally and figuratively stuck on a treadmill, yoga showed me how to slow down, enjoy the moment, and feel more comfortable in my skin. The practice helped me see that my body wasn't the enemy--something I had to beat into shape or force to tone up or whittle down--but a beautiful vehicle for movement. I started to focus on feeling strong rather than making sure I worked out for a certain amount of time, lifted X pounds of weights, or burned Y number of calories. But it wasn't just about yoga--or even exercise in general. After my first State Change, I began to examine other core actions--the foods I regularly ate, how I slept, how and how much I stared at screens--and ways I might be able to shift these core actions, like I had done with exercise, to achieve a State Change on another level. In particular, I started paying attention to how certain foods made me feel, as I realized many of the things I consumed on a regular basis left me feeling wired, tired, or bloated. Similar to exercise, I began to see that I had been using food for the wrong reasons--to be skinny, for example, not to feel more vibrant, alive, calm, and comfortable in my digestion. As I experimented with what I ate, I began to understand there were lots of ways to have a State Change. I didn't have to start or stick with exercise--I could use any core action to achieve a new baseline. These core actions, or what I did daily with my body, weren't just a "lifestyle," which had always seemed like a wishy-washy concept, but doorways I could open to feel better, healthier, and happier. My State Changes weren't just physical, mental, and emotional. After I discovered a new baseline with yoga, I found myself reevaluating what I wanted to do with the rest of my life (surprise, federal prosecution was not my future), not from a place of fear but rather from a place of tapping into the things I now cared about. The first was a new interest in health. So in the summer of 2004, I quit my paralegal job and started working in the psychiatric research unit at NYU's School of Medicine. I also stopped running like my life (and my weight) depended on it. I broke up with the boyfriend--eventually. And over the next year, I slowly cut out all the calorie-counting and fake sugars and began to eat real meals. Amazingly, I was shocked to find I still fit into my jeans. Actually, they fit even better, as I discovered I was far less fixated on the number inside the waistband. I also discovered that I liked working in psychiatric research at the Manhattan Veterans Administration hospital. I liked administering EKGs and drawing blood. I liked interviewing patients. I liked learning about brain scans. It was work with a purpose that felt helpful, not punitive. I liked my colleagues, too. I didn't have time to wander or be lonely, although I did work it out with my boss to come in early--7 a.m. most days--so that I could leave by 4 p.m. to make it to 4:15 p.m. yoga in FiDi. One day, as I was getting coffee at a bodega on Twenty-Third Street during my walk from the 6 train to work, I found myself in line behind a middle-aged woman ordering a large coffee with skim milk and two Splendas. "I don't mean to pry," I told her, "but that stuff will kill you." She looked at me evenly for a beat. I thought she was going to tell me to mind my own business. But before I could mumble "Sorry," she turned back to the counter and said, "Never mind about the Splenda." She then looked at me, smiled, and said, "Bless you." This is when I began to turn the intellectualism I had once used as a shield into a key, plying it to get into medical school at Columbia. I worked hard to earn my medical degree and finish my residency before deciding I could do better than just medicate and operate: I wanted to help people get truly better. I wanted to find and treat the root causes of physical pain and emotional distress. I wanted to help patients discover how wonderful life could be--and feel--when they no longer had to rely on caffeine, alcohol, sugar, and/or addictive drugs. Most of all, I wanted to help them experience their own physical-emotional transformations that I knew would change their lives like my own transformation had already changed mine. It would be years before I knew enough about medicine to actually help people make these changes through testing, medications, and science, but my "why" was set, and I was on my path. Now it's your turn. I believe that a more impassioned, empowered, energetic, and healthier life is possible, no matter who you are or what you're dealing with. You can have a State Change. And it all starts with one thing: your body. The Big Problem with the Health Issues We All Have F41.9. R53.83. They may look like model numbers for the next Android phone, but there's nothing cutting-edge about them. They're medical classification codes--F41.9 for an anxiety diagnosis, R53.83 for general fatigue. I know them like my own phone number because they're the two most common diagnosis codes used at my medical clinic, despite the fact that most patients come see me for physical problems like migraine headaches, gastrointestinal conditions, arthritis, and hormone imbalances. I don't hand out these codes like candy because I like to play part-time shrink. Quite the opposite: I care about how my patients feel, both physically and emotionally. I also screen for anxiety, depression, sleep disorders, and general fatigue as part of our general intake process. That's not standard practice at most primary care offices, but Parsley Health, which is the medical clinic I started in 2016 that now sees tens of thousands of patients across the country, is not a standard practice. At Parsley, we want to know as much about your mood, ability to focus, and whether you can find joy, as we do about your blood pressure and bowel movements. If your doctor isn't also asking you these types of questions, I can't say I'm surprised--but you may want to find a new doctor. Some patients want to know why I'm so interested in their mental and emotional health. I tell them that if you're anxious, depressed, not sleeping well, or tired all the time, getting rid of that stomach problem you came in for is going to be much more difficult, if not impossible. More important, there's a good chance that your stomach problem--whether it's from an ulcer because you're not dealing with your stress, or an imbalance in gut bacteria because you're eating too much sugar--is what's causing you to feel anxious, depressed, restless, or tired all the time in the first place. F41.9 and R53.84 aren't the only diagnoses that are populating our patient records like suggested passwords, either--there are also the codes for brain fog, burnout, depression, attention deficit hyperactivity disorder, and insomnia. And this isn't just happening at Parsley Health--it's a phenomenon that's happening everywhere. Feeling like general crap is so pervasive, in fact, that in 2018, the World Health Organization added "burnout" as a diagnosable medical condition (Z73.0 for the code-curious). Today, more than 90 percent of US workers say they feel burned out, as if they can't wake up and don't have the will or a way to try. The stats on other aspects of our mental and emotional health are similarly staggering. For example, one in five Americans has clinical anxiety. One in twelve has major depression. Ten percent of all kids are diagnosed with ADHD, a condition that doesn't magically disappear on someone's eighteenth birthday. These numbers reflect only those who seek help and get a clinical diagnosis as a result. In reality, the prevalence of these mental health issues is much higher, because most people don't raise their hand and ask for help from anyone, let alone a doctor--and if they do, too often no one is there to help them, given the shortage in mental health services. Outside of clinical diagnoses, one in every three Americans doesn't get enough sleep, which may be why three-quarters of us say we feel tired all the time at work. In 2018, 13 percent of the country also reported feeling unhappy--a more than 50 percent uptick since 1990. Unfortunately, the coronavirus pandemic hasn't done anything to help our national emotional health emergency. Instead, the outbreak has practically put anxiety, depression, and stress into the public water supply. In spring 2020, some experts estimated that the crisis had produced depressive symptoms in at least half of all Americans. Pandemic or not, there are more Americans suffering from at least one emotional issue than there are people in this country with almost any other medical condition. And the problem is, no one is calling out our anxiety and feelings of being burned out or bummed out as a public health crisis. On the contrary, we've normalized these conditions simply as consequences of modern American life. They're part of our collective low baseline. For proof, look inside the goldfish bowl of pop culture. Which celebrity, CEO, or similarly high-profile person isn't anxious, depressed, or teetering on the edge of total burnout? Everyone from entertainers like Oprah Winfrey and Robin Williams to business tycoons like Sir Richard Branson and Charles Schwab to world leaders and members of the British royal family has admitted to suffering from various mental health problems, including depression, anxiety, and burnout. While it's amazing these issues aren't actually stigmatized for celebrities in mainstream media, what's not so great is that we've come to accept these conditions as hallmarks of what happens when you try too hard to get everything you want in life. Imagine if a friend told you that she never once felt stressed, tired, burned out, sad, anxious, or unfocused. You would probably either accuse her of lying or wonder how she managed to quit her job, move to Bali, and forgo all her other responsibilities. Not only is this perspective deeply troubling, it's also total BS: Feeling anxious, tired, burned out, sad, and unable to focus should not be the new normal--and it's certainly not what you need to sustain if you want to be a functioning member of the twenty-first century and balance your career, family, and personal life all at once. Flipping the Script on the Mind-Body Connection So, why are we all so anxious, tired, burned out, and depressed? And what can we do about it? From my experience as a physician, the answer to the first question, paradoxically, isn't in our heads. The reason so many of us suffer from emotional health issues, whether we've been diagnosed or not, isn't because life is inherently more stressful today or because our jobs are that much more difficult. Quite the opposite: Technology and other modern-day advancements have in some ways made life easier now than ever before. What has changed, however, is not what's happening around us but what's happening inside us. Compared to several decades ago, we now consume more sugar (an average of sixty pounds per year), are far less active (sitting up to ten hours per day, with only 23 percent of us getting enough exercise for general health), stare at screens for twelve hours, take an average of four prescription drugs, and are exposed to hundreds of toxic chemicals in our diet and environment every day. None of these factors existed to this degree even thirty years ago, and these fundamental changes are the real reason so many of us feel sad, sick, and tired, despite our best efforts not to be sad, sick, and tired. In other words, the root of our emotional health issues is our physical health--or lack thereof. I see this every day in my patients. High-sugar diets are the norm for most, even though subsisting off sugar, whether directly in sweets and soda or indirectly in refined carbs, creates blood-sugar imbalances and brain inflammation that can lead to anxiety and depression. Exercise may fight bad mood as effectively as antidepressants, but most of us aren't doing anything active, as we sit and look at screens all day. Our smartphones are also problematic because they're addictive, activating the same brain receptors as cocaine to create daily highs and lows, reinforce feelings of inadequacy, and even atrophy the brain's gray matter. Our air, water, food, and personal-care products are filled with pollutants, hormone disruptors, and heavy metals, all of which erode cognitive function. And sleep--forget about sleep. Between caffeine, alcohol, stimulants, screens, and light and noise pollution in our bedrooms, almost none of us sleep long enough or well enough, which leads to more brain fog, sugar addiction, anxiety, and depression even in those who are otherwise healthy. These are the current core actions that are causing many people's baseline, or set point, for how we feel on an everyday basis, to be so dismally low. All this means that we are a set up for sickness, physically. All you need to do is take one look at the US's skyrocketing rates of chronic illness like diabetes and arthritis, which now collectively account for 90 percent of our annual $3.5 trillion healthcare costs. But no one is paying attention to how our physical state is changing our mental and emotional health. This includes no one in modern medicine, in my experience. You would think that, given all the advancements in healthcare these days, doctors should be able to treat whatever physical issues we have if those issues are, in fact, causing us to feel burned out, bummed out, and anxious at an alarming rate. But in reality, conventional healthcare is the reason so few of us are able to sustainably remedy our emotional problems. I'm not saying your doctor is causing your depression, fatigue, burnout, ADHD, or anxiety. But all too often, he or she isn't helping you solve the root of the problem, either. Here's why. In conventional medicine, mental health and physical health are siloed into two separate buckets. If you have a mental or emotional problem, you see a psychiatrist or a psychologist; if there's something wrong with you physically, you see a primary care doctor or a specialist. While I was doing my medical training at Columbia University and Mount Sinai Hospital in New York City, for example, if someone came into our primary care clinic and was identified as having a mental or emotional health issue, we referred them out to the psych clinic, which usually involved a month or longer wait. If a patient was hospitalized for a heart attack but also had anxiety, we'd call a psych consult to make a recommendation--and if we determined that severe anxiety had precipitated the heart attack, this patient was moved to the psych floor and no longer considered our problem. From the very first days of my medical training, I was taught that emotional and behavioral issues were not my department. Literally: not my department. It works the other way, too. Psychiatrists are trained medical doctors, with the capability to order medical tests, do physical exams, and treat the body as much as they do the mind. But very few, if any, do these things. Instead, they typically say "not my territory" and refer patients with physical problems to primary care doctors. We get these kinds of referrals all the time at Parsley, where we'll diagnose a thyroid imbalance as the true cause of a patient's depression, caffeine or alcohol abuse as the real cause of another's insomnia or chronic migraines, or sleep deprivation as the ultimate reason for someone's anxiety. Of course, psychological trauma and genetics can each be big factors in mental health issues, too, and not all such issues can be solved at the physical level. But what never ceases to amaze me is that the psych community ignores the physical as being either a possible cause of the problem or, at minimum, a helpful part of the solution. Because, again, it's not their department. In reality, there's no magic concrete wall separating our minds from our bodies. And in medicine, if we're not looking at the full picture, we aren't playing with a full deck of cards. Our mind, cognitive function, and emotional state are all part of a complex physical ecosystem that functions and thrives as one: body and brain, mind and emotions, thoughts and actions. None can be neatly siloed or separated out. Aha, the mind-body connection! you think. But this book isn't about that. The mind-body connection, which states that our mind influences our body, is 100 percent valid, but it's also 100 percent unidirectional. What we need to do is flip the script. This book is about how mental and emotional health is rooted in physical health--a truth that's been ignored by both conventional medicine and the psych community. It's about the fact that as much as the mind informs the body, the body also informs the mind. In other words, our physiology determines our psychology. And if we truly want to get to the bottom of why so many of us feel tired, anxious, burned out, and bummed out, we need to step back and take a comprehensive, holistic look at what's really going on inside our bodies. I take this comprehensive, holistic look with each and every one of my patients. Because of this approach, I'm able to help them resolve or improve long-standing mental or emotional health issues, often without medication. In fact, data from Parsley shows that we reduce patient reliance on psychiatric drugs by 47 percent. This isn't to say that these medications--the Zolofts, Prozacs, Xanaxes, and Ambiens of the medical world--aren't powerful tools that have an important place in our practice. They do, and we prescribe them; they can be lifesaving. But let's be honest: No one is lying awake at night because they're suffering from an Ambien deficiency. By looking deeper and putting nutrition, sleep, movement, toxin exposure, and technology onto the prescription pad alongside meds, we've helped thousands of people improve--and even cure--their mental health issues. Most of medicine doesn't take the comprehensive, holistic view we do at Parsley, though. Despite the fact that food and lifestyle are responsible for 90 percent of all medical outcomes, both are treated as immaterial by our medical system--or at least as someone else's department. When was the last time you picked up a prescription for more green vegetables and eight hours of sleep, taken daily for at least three months? Never. This is one reason so many of us lack clarity, focus, energy, and optimism, not to mention why 60 percent of us suffer from at least one chronic illness, like cancer (50 percent of which is preventable, according to the National Cancer Institute), diabetes, rheumatoid arthritis, or heart disease. Rather than treating our daily core actions like what we eat, how we move, and how much we stare at screens, conventional medicine pulls the same two arrows from its favorite combined quiver: prescription drugs and invasive procedures. While drugs and procedures are absolutely necessary at times, when either is prescribed without investigating the root cause of a medical problem--mental, emotional, or physical--it's like slapping a Band-Aid on a bleeding wound without addressing what triggered the hemorrhage in the first place. That's not an especially effective strategy. Today, the prescription drug industry is a $600 billion annual money grab. Approximately two-thirds of all Americans take at least one prescription drug, while more than half of the US population over age sixty-five takes at least four prescription medications. While this is great news for Big Pharma, it's terrible news for the rest of us, because these drugs aren't solving our problems in many instances but are just leaving us overmedicated and undertreated. In other words, the healthier we try to be, the sicker we get. Unfortunately, this is how American healthcare works. I want to show you how to overcome conventional healthcare's limitations in order to transform your mental and emotional health without waiting for the system to catch up. I'll give you an example. I had a patient at Parsley who was in her forties, living in New York City, and working a typical desk-jockey job. Nothing was particularly unusual about her life, but at the same time, everything was wrong with it. She came to see me because her doctor had prescribed her statins, blood thinners, and Zoloft to treat her high cholesterol, high blood pressure, and depression, respectively. But despite swallowing this fistful of pills every day for years, she wasn't getting any better. She was also overweight and couldn't seem to lose fat no matter what she did. When I saw her at Parsley, I didn't just run some basic blood work or try to find another prescription drug that might work better. Instead, I took a holistic view and looked at everything from her emotional health to her nutritional habits and other daily core actions to assess whether she might have a nutritional deficiency or underlying medical condition. What I found was that she was subsisting on a high-sugar diet (common), had a thyroid problem no one had tested for (common), and was sitting all day in front of a screen without any daily movement, let alone dedicated exercise (common). I suggested she make a few simple changes to her nutrition and started treating her thyroid issue, and our health coach taught her how to move more throughout the day while cutting back on her screen time, all without asking her to quit her job or become a full-time gym rat. Several months later, not only was she clinically healthier, she also felt better. Her cholesterol and blood pressure had normalized, and her depression had improved. She had also dropped twelve pounds without even one day of the diet-and-deprive mentality she had for years associated with weight loss. This story shows us that if you want to end anxiety, fatigue, and burnout and finally feel really good--not just okay or able to get through the day or surviving but actually energized, optimistic, and focused--you have to understand that your body is a fundamental driver of your emotional health. Once you wake up to this fact, something truly powerful happens: You unlock a huge potential to change how you feel, right here and now, regardless of whether you have a doctor willing or even able to help you. It doesn't matter if you have a clinical diagnosis for depression, burnout, ADHD, insomnia, or anxiety--most of us aren't formally diagnosed, but many of us still suffer from these conditions to some degree; they're part of being human. What matters is that you're willing to make small, simple changes to help yourself. So many people have fallen into the chasm of feeling crappy, emotionally and physically, and conventional medicine isn't going to pull them out. You might have to climb out on your own. And I'm going to help you. Starting with Your Story It was our first appointment together, and Alyssa, thirty-four, was sitting on my exam table, sobbing. I could see why. She had been dealing with severe bloating, gas, headaches, and brain fog for years. The migraine medication another doctor had prescribed for her headaches was making her dizzy, and the ADHD drug Adderall, which she took for brain fog, had only made her digestive issues worse. Pulling at a tear-and-snot-soaked tissue in her hand, Alyssa said she was worried these drugs would interfere with her ability to have a baby and that she didn't feel old enough to be struggling with such persistent health problems. As she talked through her tears, I knew what was wrong with Alyssa before I even examined her. As part of Parsley's intake process, all new patients like Alyssa complete an online health biography before they show up for their first visit. Our health biography isn't like any other doctor's form you've ever filled out. I essentially want all my new patients to tell me their entire life story. Because your entire life story is also the story of your health. As part of your health biography, I want to know every influential event that's happened to you physically, medically, and emotionally since the day you were born. I want to know whether you were born vaginally or by C-section, the foods you ate growing up, the illnesses you had at ages five, fifteen, thirty-five, fifty-five--whenever--the medications you've taken from the time you were an infant until today, and even how willing you are to make changes to your personal life. In other words, I want the entire story of you, because that story is what created the person who walks into my doctor's office with troubling symptoms and/or general malaise. Back to Alyssa: After reviewing her health biography, I knew she had taken antibiotics for sinus infections for most of her twenties. Her diet was also mostly made up of sugar and low-quality carbs, even though she assumed she was eating "healthy" because she was consuming things like low-calorie yogurt and gluten-free bread--the mid-2010s version of protein bars, aka high-sugar convenience foods green-washed as "healthy." She didn't connect her digestive issues to her headaches or brain fog, and no one had ever tied what was going on in her body and mind today with what had happened in her body and mind in the past. But Alyssa's symptoms didn't just fall out of the sky and suddenly hit her over the head last week. While the antibiotics she had taken throughout her twenties might have killed off the bad bacteria causing her sinus infections, I knew they had also devastated her body's population of good microbes that she needed for healthy digestion. A long-standing microbiome imbalance was why she felt bloated and gassy today and was also contributing to her constant headaches and brain fog. I could have doubled her dose of Adderall and migraine medication, but I knew it wouldn't stop her symptoms because it wouldn't address the root cause of her problems: her gut. At the end of our appointment, I sent Alyssa to get a specialized breath test to see what was going on inside her GI tract. Even though it was early in our process, I didn't necessarily need to see the test results to know what was going on. I knew that Alyssa likely had small intestine bacterial overgrowth (SIBO), caused by years of antibiotic overuse, and that she was addicted to sugar--a dietary drug she used to try to relieve her headaches and brain fog, but which had only perpetuated her microbiome imbalance. Alyssa's health issues weren't the bad-luck hand she believed her body had dealt her at age thirty: They were the result of her life story, and conditions that had been written into her body years ago. By telling me her story, Alyssa was able to get off the medications, clean up her diet, restore her gut health, and finally end her indigestion, brain fog, and headaches. Today, she's focused, clear-headed, and symptom-free--and the mother of a healthy baby boy. Alyssa's story illustrates what I tell all my patients: No matter what happened in the past, how long you've been sick, or how sick you are, ownership of your health starts now. Now could be when you're eighteen years old or when you're sixty years old. You may have grown up in a food desert, without access to healthcare, or with a genetic predisposition to heart disease. You could have a diagnosis of cancer or Lyme disease, have been in a car accident that required surgery, or have a history of psychological trauma leading to depression. None of these conditions or diagnoses are your fault or could have been prevented, and there's no shame or blame in them. But while they may not have been under your control and there's nothing you could have done to prevent them at the time, there's almost always something you can do differently now to change the trajectory of your future. Taking ownership of unfortunate things without feeling shame is missing in our culture--which, to me, is the biggest shame. Taking responsibility of your health right now--good or bad--and acknowledging what you know about the state of your body and mind are empowering actions. As far as I'm concerned, you can leave shame at the door, as it's not a helpful sidekick for this journey. Once you know what you need to do to improve your health, you know. And from there, you have the opportunity every day to rewrite the story of your physical, mental, and emotional health with the foods you eat, the medicines you take, the exercise you do (or don't do), the kind of sleep you get, the way you deal with stress, and the other core actions and behaviors you incorporate into your being through your time and your dollars. No matter what you've done with your life up until this moment, the core actions and behaviors you choose from this day forward can reshape your future narrative, influencing your physical, mental, and emotional health for years to come. I've always been clear about the fact that the story of your health is the story of your life. Ninety-nine percent of our health happens to us outside a doctor's office, while we're eating, sleeping, moving, going to work, interacting with other people, swallowing prescription drugs or supplements, and getting exposed to toxins in our air, water, food supply, and general environment. If you're my patient and I'm going to understand your health, I need to know what is happening and has happened to you outside my exam room--today and every day since you were young. In functional medicine, a paradigm that informs the way I practice, doctors use an acronym called ATMs (antecedents, triggers, and mediators) to help determine the root cause of a patient's symptoms. I like ATMs because it's another way of getting people to think about their life story. Here's how it works: Antecedents are the conditions that predate your symptoms. Sometimes they can be genetic, but many times they are core actions, like what you eat, your exercise habits, technology consumption, and prescription-drug use. They might also include a specific event that laid the groundwork for you to start feeling unwell--for example, if you made a hectic move to a big city in your twenties or had a major surgery in your thirties, either incident could have driven up your stress levels and driven down your sleep. Triggers are what provoke symptoms. They include things like illnesses and infections, a bacterial imbalance, a major life event, or, as in Alyssa's case, a bout of prescription medications. Mediators are the daily core actions that sustain your symptoms, making it impossible for you to get rid of them. For example, if you're continuing to eat the same foods that helped derail your intestinal health years ago or are staring at screens for ten hours a day and wondering why you might still have headaches, these are the mediators that are likely keeping the lid locked on your ability to overcome your issues. I want you to start thinking about your own life story right now using the health biography below as a starting place. This is the way that you can begin to understand the story behind why you might feel the way you do now--mentally, emotionally, and physically. Telling your story, whether you share the information with a doctor or not, can help you uncover what may be wrong not only with your health but also in your life, and empower you to make the small but powerful changes that can finally help you feel focused, clearheaded, and happy. In the following exercise, use your own words to answer the questions as honestly and thoroughly as you can. The story of you is not short, so take your time and think about each answer carefully for as long as you need to. If something pops into your head, even if it seems trivial, write it down: Everything can be important, even those details you might assume are not. Your health biography can be only for you if you choose so; the goal is simply to get your story out of your head and your heart and into a place where you can look at it, objectively and analytically, for clues that can ultimately help you understand where your health came from, where it is today, and how you can turn it into a new story tomorrow. 1. How do you feel now? Be as specific as possible, including any mental or emotional issues you may have, like brain fog, fatigue, anxiety, or general sadness. 2. When did you last feel well? Not just okay--I mean consistently great. 3. How long have you had the symptoms you feel today? Has it been weeks, months, or years? Can you pinpoint the time when your symptoms started? Have you had these issues your whole life? If not, when did they start? 4. What was happening in your life when you first began to feel unwell? For example, did you start a new job or begin traveling more frequently? Did you get sick, have surgery, or end up in the hospital? Did someone close to you enter or leave your life? Did you change your diet, exercise, or sleep for any reason? 5. What symptoms did you have when you first began to feel unwell? Be as specific as possible, including any ailments like digestive issues, headaches, body pain, anxiety, and insomnia. Among these symptoms, can you identify which manifested first, second, and so on? Awesome. Now keep your answers someplace safe, because I'll be talking about your health biography throughout this book. Remember, it's an important story--perhaps the most important story that you can and will ever tell for your overall longevity and joy. Before you tuck your answers away somewhere safe, take a good look at what you wrote and see if you can connect the dots, like you started to feel X symptom after you switched jobs or Y symptom shortly after starting a new medication. You may be able to identify patterns--like that your digestive problems correspond with low emotional periods in your life--but if you can't, that's okay. By the end of this book, you'll get there. The goal right now is to simply have your story down on paper. Because if you don't know what's happened in your life and with your health, no doctor or other medical professional will be able to know. Now that we've looked at your past, it's time to take you inside the present and get to the bottom of how you really feel, right now. Excerpted from State Change: End Anxiety, Beat Burnout, and Ignite a New Baseline of Energy and Flow by Robin Berzin All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.
