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Indoor Epidemic with Dr. John La Puma · To Your Good Health

0:00
David Friedman, BS: Hello, this is Dr.
0:00
David Friedman, host of To You at Health Radio.
0:03
When was the last time you were outside?
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Not walking to your car, not glancing at your phone on the porch.
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I mean really outside.
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Sun on your face, eyes looking at something far away from the screen.
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If you're drawing a blank, you're not alone.
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The average American spends 93% of their life indoors, surrounded
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by artificial light, recycled air, pixels and notifications.
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And then we wonder why we can't sleep, can't focus, and need three
0:30
cups of coffee just to feel human.
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Most of us blame stress, aging, and of course being burned out.
0:36
But according to our next guest, the real culprit is something far more fixable,
0:41
and the prescription might surprise you.
0:44
Doesn't cost a dime, doesn't require a gym membership, and takes less
0:48
than the time it takes scrolling through your morning news feed.
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Joining me is Dr.
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John Lipuma, author of Indoor Epidemic, and he's here to make the
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case that your body wasn't built for the life you're living, and the fix
1:01
is literally right outside your door.
1:05
Stay tuned.
1:05
This episode starts now.
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Our next guest is a board-certified internist, professionally trained
1:22
chef, and regenerative organic farmer.
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A frequent keynote speaker, he has presented at TEDMED, TEDx, and at
1:30
major medical institutes nationwide.
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He served as clinical associate professor of medicine at the University
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of Chicago and teaches the first CME course in Nature as Medicine at the
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David Geffen School of Medicine at UCLA.
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He's hosted 120 episodes of Health Corner on Lifetime television, and his work
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has been featured in The New York Times, Wall Street Journal, USA Today, NPR,
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PBS, Today, and Good Morning America.
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What a mouthful.
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He's been everywhere.
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Now he's here.
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We're lucky to have him.
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His new book is called Indoor Epidemic.
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Welcome to the show, two-time New York Times bestselling author, Dr.
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John Lipuma
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John La Puma, MD: David, how wonderful to be with you.
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I'm so excited to speak with you today.
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Thanks so much for having me
2:15
David Friedman, BS: Yeah, it's such a unique topic, as
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I shared before we started.
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It's one that medical doctors rarely focus on.
2:20
First, what motivated you to write Indoor Epidemic?
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John La Puma, MD: I myself have been, as you see, very much in the public
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eye and have needed a kind of break.
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And so I thought I would buy an abandoned nursery because I
2:34
thought it was sort of static and it could continue to do my work.
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But it turned out it was fascinating and drew me in in ways that I
2:42
didn't expect, and I became kind of rejuvenated about what there was to do.
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A lot of my own sleep problems and burnout problems and other maladies went
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away, and I was fascinated about why.
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So I had to dig into the science and find and read 2,000 studies to
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create this new book, Indoor Epidemic.
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what this book is really about is that we've, as you've just said,
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removed inputs that our brain and bodies require for optimal function.
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And what I like about your work, especially your Germs Are Your
3:15
Friend, terrific podcast, everybody go listen to that if you haven't,
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is that, you know, you challenge assumptions people have about their
3:23
health, and that's really what this…
3:25
what we're trying to do here.
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We're trying to say, "Look, we're the first indoor species in human history.
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We've moved 93% of our life inside."
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It became normal to have a screen-centered life after COVID, but it's not normal.
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Your body actually reads that as captivity, and it answers
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with bad sleep and brain fog and weight gain and inflammation
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David Friedman, BS: Yeah, I know you open the book with that bold claim.
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You say, "We are the first indoor species in human history."
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What do you mean by that, and why is that such a concern?
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John La Puma, MD: Well, we evolved over two hundred thousand years
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primarily outside, and especially with COVID, it's become normal
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to have a screen-centered life.
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It's a problem for two main reasons.
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The first is that indoors has a lot of microinflammatory excitations to
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the body, not just molds and mites and dust, but VOCs, organic compounds,
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sprays that we kind of take for granted, we're often sealed inside.
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That's a kind of box for us, and that's not how we evolved.
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the other half of it is that being inside so much deprives us of the
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circadian rhythm biology that our bodies actually need to function.
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They're required biological inputs.
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And that sounds simple, bright light and fresh air and movement outside
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and distance, but they turn out to be pharmaceutical-grade interventions
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if you know how to deploy them and you know how to time them.
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That's the real key.
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Timing these interventions, not just how many minutes, but timing them is the core
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David Friedman, BS: Yeah, I know a jaw-dropping statistic from your
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book was you said sitting 10 hours a day can make you biologically eight
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years older than your actual age.
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Can you share why and what it means for the average desk
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worker that's saying, "What?
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What did he just say?"
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John La Puma, MD: Yeah, that's, not a metaphor.
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It's actually your DNA measured.
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You know, 30 minutes of daily movement though outside erases that
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gap, erases that biological aging.
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And when we sit for that long, we're not just, sedentary so our muscles
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don't move, but we deprive ourselves of our senses and of distance.
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You know, most people don't look more than 20 feet in front of them
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at, at any given time, never mind looking at the horizon or the sunset.
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that sounds kind of woo, but it's not, because your eyes need distance
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like your lungs need oxygen.
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You need to relax the ciliary muscles that make your eyes scrunch, the
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temporal muscles around either side of your forehead that can give you a
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headache, because we're often in our current lives digitally saturated,
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especially sitting that much.
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And digital saturation leads to digital obesity where you are-- like too
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much sugar burns out your metabolism, too many pixels burn out your brain.
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So sitting that long makes you older.
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It makes your real age older, it makes your, biologic age of
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your body as you're choosing to lead your life older in your DNA.
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But that's a fixable problem, as we'll get to
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David Friedman, BS: Yeah.
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you mentioned the, eyes I read something that you mentioned the
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projected, need for glasses by 2050 will be half of the planet.
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you're saying it's not the screens, it's the rooms.
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Give us an insight on this, pun intended there, insight
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John La Puma, MD: Very nice.
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so myopia is nearsightedness, it's driven by sustained close focus dim indoor light.
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This is reasonably new findings even published this year in
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February in Cell Reports.
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What happens is that by doing so much what's called near work, where we look
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at an iPhone or we look at a computer screen in very short distances in dim
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indoor light, most people don't know that indoor light is only 100 to 300 lux, and
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outdoor light is anywhere from five to twenty-five to even fifty thousand lux.
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Outdoor light is twenty-five to fifty times brighter than indoor light.
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By being in dim indoor light in close focus, the retina doesn't
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get the kind of light input it needs and physically elongates.
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This is now ninety percent of Singapore, forty percent of California is myopic.
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We're going to see, almost five billion people myopic by twenty fifty.
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And that doesn't sound so bad.
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You get glasses or eye drops, and you're done.
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But actually, A, it physically elongates the eye.
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It actually distorts your anatomy to have this much near work.
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And secondly, about twenty percent of myopia turns into high myopia,
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which is either cataract damage or retinal damage or changes in vision
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by the time you're thirty-five.
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And that's a serious problem and, and no reason to, risk it.
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because what you actually need for this, and what public health
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campaigns in Singapore are about, are two hours a day reduces risk
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for myopia by forty-five percent.
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Those public health campaigns tell parents to take their children outside and play
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without their devices two hours a day.
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But that's not the minimum effective dose for moving your own biology.
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The minimum effective dose that's daily is just seventeen minutes.
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To reduce risk for myopia, you need to get up from your desk, you need
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to go to a window, a window is fine.
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You need to look at the furthest point you can see.
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If you can see the horizon, great.
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If you can't, look at the sky.
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If you can't see the sky 'cause you're in inner city, look at a rooftop,
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look at the building that's furthest from you, and watch for five minutes.
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You'll notice things you haven't seen before, the shape of a cloud, the
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way that leaves move, you'll hear the sound of a bird that you might not have
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heard, and it will relax your vision.
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You're giving your biology the kind of distance it needs to do optimal work.
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This is actually neuro-optimization
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David Friedman, BS: And you know, that makes such sense 'cause the average person
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s- I mean, probably more than average, probably 95% go outside and they're
9:57
looking at their tablets or phones.
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They don't look outside at the trees and the birds and, the surroundings.
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So I think that you're like, "Well, I'm looking at nature on my phone."
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Not same thing, right?
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John La Puma, MD: Not the same thing because your brain is
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using that cortical input.
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What you want to do is give your brain some relaxation.
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when your phone is your hand, your brain thinks that you are still working, whether
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you're outside on the beach or you're on a park bench, it doesn't matter.
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Your brain thinks you're still working and you're not able to reset.
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being inside this much has given us brain fog and weight gain
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and inflammation and bad sleep.
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we can fix that.
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my book is about how to do that
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David Friedman, BS: Yeah, definitely.
10:38
You know, I thought about something recently.
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When I was growing up, the worst punishment my parents could give
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me was being sent to my room.
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That was punishment.
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Today, parents are threatening to send the kids outside.
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Somehow the bedroom went from being a punishment to a preferred destination
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'cause that's where the gadgets are.
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And it's sad how fresh air and sunshine now feels like a punishment.
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John La Puma, MD: Yes.
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And so how crazy that is, A, and B, teens up to like 60% of teens
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have a device in their room.
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And if you watch bright light before you go to sleep on a tablet, on a TV, on a
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monitor, on a phone, you have about an 80% reduction in release of melatonin,
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and that lasts for an hour and a half.
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So your quality of sleep is going to drop significantly if you watch
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TV And about 40% of Americans go to sleep with a lamp or a TV on.
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If you wake up between 12:30 in the morning and 6:00 in the morning and
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watch that bright light, what you get is an increase in risk for heart attack by
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50% and increased risk of stroke by 30%.
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This is 90,000 people in the UK Biobank study published in 2025.
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And that's dramatic.
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light, the wrong kind of light, the wrong kind of artificial light
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stimulated at the wrong time is actually a serious cardio risk factor
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just as much as smoking or obesity
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David Friedman, BS: Yeah.
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So try-- I remember years ago, Toyota ran a commercial where a teenage girl signs
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her parents up for Facebook 'cause she felt sorry for them because they only
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had a dozen friends compared to her 950.
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And the twist, while she's alone staring at this screen laughing at her
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parents, her parents are out biking outdoors having fun with real friends.
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And my question to you is, how did we allow a tech company to redefine the
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definition of, quote, "being social?"
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John La Puma, MD: most people don't understand that
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nature, in fact, is social.
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the digital screens have their place inside because they are good
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for us for doing cognitive work.
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You and I probably prepared for our interview using one.
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That's just fine.
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The problem is doom scrolling.
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The problem is thinking that the world on your phone, on your tablet, on
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your computer is all that there is.
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And it's so easy to do.
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It-- They've made it so seductive.
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But because you eventually become saturated with those pixels.
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But what happens when you use your minimum effective dose of seventeen
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minutes a day in a specific targeted way, es-especially near green or a blue
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space, near greenery or near water, what happens is that your brain changes.
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Your brain and immune system depend on regular exposure to soil microbes,
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plant compounds, outdoor air, natural light, and movement outside.
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So this neuroimmune regulation is something that is enhanced
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when you meet somebody.
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if you wanna do just one thing, you should get ten minutes of morning light before,
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in the first sixty minutes of waking.
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what does that mean?
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It means you go outside, open window.
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if you're inside with a screen, better outside, but if you can't go
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outside for some reason, you can open a window and look through a screen.
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The window otherwise blocks the wavelengths that you need,
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as do sunglasses, by the way.
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And you want to go outside, and if you meet someone when you're
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outside, it drops your blood pressure, first of all, usually.
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usually a stranger is a someone that is makes your journey feel more personal
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and larger than you by yourself.
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And it enhances your oxytocin level.
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That's also true when you walk with someone.
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enhances your oxytocin level, and your blood pressure drops slightly,
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even better than walking alone.
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all this magic kind of science happens when we're, with other
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people or meet other people outside.
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That's why there's a whole chapter in the book about social connection and
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how important it is for us to be with another person or with a companion animal.
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There's another section in the book about companion animals and the benefits
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that they bring to us, as well as the joy that we get to share with them of
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unconditional love, and they with us
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David Friedman, BS: Yeah.
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I love your prescription.
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It's, 17 minutes, not an hour of hiking, not a weekend retreat, 17 minutes.
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And people don't realize if you watch an hour show, there's
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17 minutes of commercials.
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So just that, that alone.
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how did you arrive at that specific number?
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is that enough to create that, mood, blood sugar, blood pressure, improve sleep?
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Is it 17
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is the magic number
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John La Puma, MD: Yeah, that's where the biology begins to bend, begin to bend.
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It's 200 minutes a week, which is averages to 17 minutes a day.
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So, it actually tops out at 42 minutes a day for the biological benefits.
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But again, this is very purposeful movement where what you're doing
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is, there's simple interventions.
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For example, have a walking meeting outside.
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Most of our meetings are in conference rooms, and when you
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seal up that conference room, the carbon dioxide level goes up.
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Some progressive companies now have CO2 meters in their room because
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that CO2 above 1,000 parts per million reduces cognitive function
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by about 15%, and actually impairs decision-making by executives.
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so much so that you can often improve the IQ of a room by opening a window.
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Nevertheless, what we want to do is be able to use this time deliberately.
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So have a walking meeting, preferably with someone, and now you're actually,
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you're getting not just the microbial benefits of the air, many important
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phytoncides, which are plant chemicals that trees make to protect themselves
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and communicate with other trees, benefit our own immune system.
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The data about forest bathing is just remarkable in terms of its ability to
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lower blood pressure and improve immunity.
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The natural killer cell count that each of us has, which are kind of the
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Navy SEALs of white blood cells, where they kill tumor cells and virus cells
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in your body, actually goes up by 56%, and that activity increase lasts
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for a month just by having the right timing and duration of forest bathing
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or being in the companies of trees.
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And you get some of that microbial benefit no matter where you are outside.
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David Friedman, BS: one thing you mentioned pretty profound, you've shared
16:57
research showing weak social ties cut survival odds in half, and it's the
17:01
equivalent of smoking 15 cigarettes a day.
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So people might hear beginning, "Oh, so my glasses, I'll have problem
17:07
with, with seeing, I'll just get g-" No, this is like death, correct?
17:11
It's going outside can fix this.
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John La Puma, MD: Loneliness kills like fifteen cigarettes a day.
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I mean, it's kind of the new three-quarters of a pack.
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Outdoor time, I think, David, is the most underused social prescription in
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medicine, and that's because physicians and clinicians of all kinds have
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not been trained in how to use it.
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It's also rather hard to commercialize.
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It's not a prescribable pharmaceutical.
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but it does have pharmaceutical-like effects.
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for example, I mean, we both, I, I think, love gardening, and that's kind of a
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high density delivery system for these types of signals, microbial exposure,
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outdoor light, specific high quality air, green, movement all at once.
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that gardening actually functions, there's a whole chapter about it, as you
17:56
mentioned, I do organic farming in Santa Barbara, as a neurochemical regulator.
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That is a serotonin booster because there's a bacterium in the soil called
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mycobacterium vaccae that helps your neurons in your brain and your gut
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generate serotonin as you garden.
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and it's a epidemiologic finding, but gardeners seem to have,
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long-term gardeners have thirty percent, thirty-seven percent
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less dementia than non-gardeners.
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So why is this?
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We don't quite know if it's because it's social, because of the serotonin boost,
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because gardeners eat more vegetables than non-gardeners and fruits as well.
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But we do know that this is a terrific season for gardening,
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that house, plants are actually a, threshold for outdoor gardening.
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And, there's a section in the book on houseplants as well, and their
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powerful effects on our own, sense of mortality as well as our care of others.
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We've done studies of houseplants actually for offices, as part of burnout prevention
18:59
David Friedman, BS: Yeah.
18:59
I just read an article on plants and how science shows they actually have feelings
19:03
and think and they know when you're there.
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It was like, wow, this stuff is not hokey pokey.
19:07
This is legit.
19:08
These plants really benefit us, and they're like part of our livelihood.
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One thing that I like you have a GLP-1 angle in your book that's fascinating.
19:16
You're saying that nature works through the same metabolic
19:19
pathways as drugs like Ozempic.
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What does that mean in practical terms?
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John La Puma, MD: In practical terms, it means it works upstream of most GLP-1s.
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So it hits some of the same levers that GLP-1s hit.
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It allows better insulin regulation, because in movement, you're not only
19:40
increasing blood sugar uptake by insulin, but you're also, leveraging
19:45
mitochondrial activation when you are, in light and bright light outside.
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you are using, your microbiome you're have your hands in healthy
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soil or when you're touching trees or other plant forms.
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that microbiome activity also translates to improved immunity
20:06
in your metabolic system.
20:09
it acts as an upstream lever.
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I think GLP-1s are very good drugs that, many people are benefiting by
20:17
and have excellent types of safety profiles as well, although there are
20:23
certainly adverse effects for most people.
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But this is an amplification.
20:29
The kinds of prescriptions that I offer in the book, the two hundred and fifty ways
20:33
to go outside deliberately to enhance your own biology and health actually amplifies
20:40
almost everything else that you're doing right, including taking the right
20:44
medication like GLP-1s for many people
20:47
David Friedman, BS: one thing we briefly mentioned was, air pollution.
20:50
You know, most people assume this is an outdoor problem, something
20:52
we escape when we close the front door, and now we're safe inside.
20:56
But research shows the air inside our homes is significantly
20:59
more polluted than outside air.
21:01
What's causing this, and why aren't more people talking about it?
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John La Puma, MD: I think more people aren't talking about it because it's
21:05
kind of invisible, and the people who are susceptible to indoor air problems
21:11
often have kinds of canary in the coal mine profiles, where they of a sudden
21:17
get sick, and no one else is, and no one understands why, but everyone else
21:21
is healthy in the same environment.
21:23
I think that it's one of the principal problems here are, as
21:27
I've mentioned, molds and dusts and mites that, accumulate, many of the
21:33
artificial chemicals that we kind of take for granted, fire retardants,
21:37
VOCs, or volatile organic compounds from paints and from, furniture.
21:43
You know, that off-gassing smell that goes away in a few days or a few weeks,
21:48
actually is still residual in many, implements and, objects in the home.
21:54
there are many possible ways of trying to clean this, that includes everything
21:59
from, the right filters for heat and air to the right filters for, water,
22:05
and open windows when you can, because that gets you better quality air.
22:10
But I think we have a lot of work to do on reducing the inflammatory
22:14
components of the indoor environment.
22:16
and that can be as easy as opening a window because as you mentioned,
22:21
it's outdoor air is almost always two to five times more clean than
22:26
indoor air, much different than what we've been led to believe.
22:29
David Friedman, BS: Yeah.
22:30
What about, since we're talking about indoor, EMFs, those electromagnetic
22:33
frequencies, the Wi-Fi, the tablets, the smart TVs, the appliances.
22:37
We fill their homes and offices with all these devices inside.
22:41
Where does the real science land on these, and should we be
22:43
concerned, or is this just something that's, you know, conspiracy?
22:45
John La Puma, MD: I have not been able to review that science in detail.
22:49
I did look at it briefly for the book as I did grounding,
22:52
which I think is fascinating.
22:54
it just didn't rise to the level of, "Gee, I need to write a chapter about this."
22:58
but I think it's very interesting what EMF and, other forces act as.
23:04
As you know, David, almost everything, actually literally everything
23:08
in life is a form of energy.
23:12
And we're quite interested in where that energy is from.
23:16
the recent discovery meant of an interstitial circulatory system, may begin
23:22
to explain why acupuncture is effective for some people because the acupressure
23:28
points seem to hit exactly where some interstitial flow now has been tracked.
23:34
So I don't rule it out that, EMF is a thing.
23:38
but I'd love to see much more serious research that requires often,
23:44
great deal of resources to be able to, to isolate it as a variable
23:49
David Friedman, BS: Yeah.
23:49
I know you offer a seven-day outdoor reset.
23:51
Can you briefly tell us about that and how the listeners can get that?
23:55
John La Puma, MD: Yes, it's free.
23:56
Come to our website, which is indoorepidemic.com.
23:58
It's a, simple one day at a time, just do this one thing to get people started.
24:04
As you know, when we're starting from 93% of us being inside, small
24:10
changes make a big difference.
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And, many people are not really burned out, they're just indoors too much.
24:16
The simple thing of using daytime before screen time and enjoying
24:21
the light first and coffee second, all are part of the free seven-day
24:26
outdoor reset at indoorepidemic.com.
24:29
it just takes you through one step at a time.
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And if you like it, there's a book.
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There's a-- We're doing a new course next month.
24:35
there are a lot of ways to try to enjoy this and help yourself
24:39
David Friedman, BS: Yeah.
24:40
Also, I know you coined the term digital obesity.
24:42
I love that.
24:43
And it's like, wow, no one considers that.
24:46
briefly tell us, you know, where you came up with that and what's
24:49
exactly getting overloaded?
24:50
How does someone know they have it?
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John La Puma, MD: I can't quite claim to have invented it.
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I'm perhaps popularizing it, but it existed in the scientific literature in
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a more obscure place several years ago.
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I found it and thought that it worked in this context.
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Digital obesity is simply the idea that your brain is overloaded on pixels, that
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our attention span, because of our modern environment, has declined significantly.
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There's a neuroscientist at Johns Hopkins who's said that this is
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now only twenty-two minutes in a conference when just a decade
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ago it was up to over sixty.
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And because we have so many digital inputs coming past us, it's very easy
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just to be overwhelmed by them, but not consciously overwhelmed, instead
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subconsciously overwhelmed, so that we glitch from one thing to another.
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We feel wired but tired.
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We are, not able to focus fully on any one thing.
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If that's happening to you, the fix is, there dozens of them in the book, but a
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simple fix is, to get up from your desk or wherever it is that you're looking at
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for-- at your device, and go to a window and look out for a minute, an hour.
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Don't…
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Leave your device behind and just look out a minute look at the sky.
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You need a sky view, not a forest.
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Just look at the sky and watch the clouds change.
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Look at the different types of colors.
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if you have soil, or an outdoor place available to you, that's even better.
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Go outside and, arrange rocks on the soil or Look at the different
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colors of grass or listen to the way that the birds are changing.
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It completely takes you out of your burnout phase, your overwhelm, and
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allows you instead your brain to reset so that you can go back inside and
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focus on the work that you need to do because you are engaging your senses.
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we experience nature by using our senses, which are touch,
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listen, see, smell, taste.
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And we don't do that in cognitive work.
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But it is actually not just a balance for our co-cortical cog-cognitive
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work, but it's also a way to allow our brain to escape this digital obesity
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or this digital saturation and go back to a more potential for focus.
27:23
David Friedman, BS: Fantastic.
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We got a minute left.
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Is there anything we didn't cover today that you'd like
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to share with the listeners?
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What can they walk away with?
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John La Puma, MD: I'd like to say that what you can do is turn some
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of the time you're already spending outside incidentally into medicine.
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So this is called Minutes into Medicine.
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Many of us are in a parking lot and walk for two minutes and
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try to park as close as we can.
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Park a little further away and notice something in the sky, something in a
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tree, something in nature as you walk.
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when you're, outside for any reason, try to give yourself an excuse to park.
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If you're picking up your kid from school, park three blocks away and try
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to walk to noticing something green.
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purposely go to a, a body of water that might be near your house, even a pool or
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a fountain, because running water at a fountain speed can change the brainwaves
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that are from an agitated beta space to a more relaxed theta space as you go.
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That's one of the reasons that works for sleep.
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so many easy fixes.
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you just daily, seventeen minutes a day moves sleep, mood, focus, blood
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pressure, blood sugar, metabolism.
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It's really worth a try
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David Friedman, BS: Fantastic.
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You know, on this show I usually thank my guests for sharing insights,
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but you're the first guest I can thank for sharing outsights.
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Yeah.
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Thanks, thanks so much.
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I enjoyed this.
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everybody get a copy of this book.
28:54
It's called Indoor Epidemic: 93% Inside Steals Sleep, Focus, and Years.
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The 7% Outdoor Prescription Restores Them.
29:04
You can get your copy at indorepidemic.com,
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and while there be sure and sign up for a free seven-day outdoor
29:12
reset that we discussed, and helpful other resources available like
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videos, articles, and recipes.
29:17
You can follow him on Instagram and TikTok @DrJohnLiPuma.
29:22
On Facebook, he's at Dr.
29:24
John LiPuma.
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So TikTok, John LiPuma, and then add doctor in front of that on Facebook.
29:29
You can follow me on Facebook at Dr.
29:31
David Friedman.
29:32
On Instagram, I'm at Dr.
29:34
D Friedman.
29:34
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29:37
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29:39
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29:41
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29:48
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29:49
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29:50
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29:52
You can also subscribe to our podcast on Apple, Spotify, and iHeartRadio.
29:57
More to come.
29:57
Stay tuned and stay well.