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Better Mental Health Starts with These 6 Lifestyle Pillars with Casie Mair-Miley · NHA Today Podcast

• Stephan Esser MD: Hello and welcome to another NHH Day podcast. I'm your host, Dr. Stefan Esser. And today I'm joined by Casey Mare Miley, who is a board certified psychiatric mental health nurse practitioner and diplomat of the American College of Lifestyle Medicine. Casey, welcome to the podcast. Casie Mair-Miley: Thank you so much. I'm so honored to be here amongst all my plant-based heroes. Stephan Esser MD: Love it. Well, on the podcast we talk a lot about physical health, but really not enough about mental health. And so I'm super excited to have you on. So that today we're gonna dig into the mind-body connection with you. And I really hope that our listeners walk away more in tune with and more empowered, right? To kind of tackle the mental health side of their health journey. So, you know, let's jump right in. Have you always been interested in the mind-body connection, or has that been more of a recent passion? Casie Mair-Miley: Well, I think that my current understanding of the mind-body connection probably started back in the late 1900s when I was a shiny new nurse and I was taking my first job at a elementary school and we had a brand new school, beautiful campus. Everybody was very excited to open this brand new school in the neighborhood. And the kids showed up. My first little patient was a kindergartner. He walks in, he's got a tummy ache. It's like, my tummy hurts and I'm leaning in to give him, you know, my my comfort and and doing a little assessment and he vomits all over me. Stephan Esser MD: my gosh. Casie Mair-Miley: So I realized, okay, lesson number one, first thing if they say they have a tummy, grab the trash can, right? Stephan Esser MD: Ha ha ha ha. Casie Mair-Miley: So I must have grabbed the trash can thirty more times that day by the end of the day. It was nerves, right? Stephan Esser MD: my goodness. Casie Mair-Miley: Everybody was just so nerved up. And that was a you know a a real testament to the power of the mind-body connection. And that has really colored the way I have viewed health in the last 30 years of my practice. Stephan Esser MD: Wow. How interesting. Yeah. I mean, to think of all those little ones being separated for the first time from their families, right? Coming in and the fear and the anxiety. And so many of us feel that, right? So interesting. So so you had a different lens almost after that kind of thinking about people. And they're Casie Mair-Miley: Absolutely. Stephan Esser MD: wow. Give me a give me another example. Any other examples that you can think of off the top of your head of kind of that as you experienced during your practice years? Casie Mair-Miley: Well, you know, certainly everywhere everywhere and every job I've had, I've seen consistently that the you can't separate the mind and the body, that every ailment has some piece of the other side of the story tied into it. And I think, you know, it's it's in Western medicine we do a disservice to our patients when we try to compartmentalize them into body parts instead of treating them holistically, right? whether it's psychiatry or the physical health, however we're looking it you just can't separate And so I I've I've always tried to counsel my patients that way and they kinda look at me cross eyed like what this is nonsense. But I think we're seeing more and more as the science progresses at at how true this really is. Stephan Esser MD: Yeah, that interconnectedness. You know, I I had a chance to peruse your resume, which was quite impressive. And, you know, kind of noted that you've worked in a lot of different settings, right? I mean, schools, businesses, addiction clinics, even, right? And kind of as you worked in all those different venues, have there been any sort of threads of interconnection that you've seen in each of those different areas? you know, as far as kind of the mental health aspect and mental health, you know, kind of how it comes all the way across. Cause to even now. To your passion for lifestyle medicine. Casie Mair-Miley: Right. you know, I I I I think again it it's it's in all my roles I've seen that mind body connection. I've seen that the way we live our life informs how happy and healthy we are. that it you know w and and it's it's tough when you're getting into a rut to get out of that rut. but but until we do, until we make those changes those health changes, our mental health isn't gonna improve and vice versa. Right. Stephan Esser MD: Yeah. Now, do you have any personal experience in your own family or anything of any, you know, rocky roads or experiences you've had along the way? Casie Mair-Miley: Yeah. My baby girl. My baby girl. I had a stunning daughter and she's always been beautiful. She was that child that people would stop you in the street to tell you how beautiful she is. To which I would reply, and try to balance, she's also very kind. And she also d turned out to be very, very gifted. She was given an IQ test in school and She was off the charts, exceptionally gifted. And all of that comes at a high cost. And so by the time she was eight, we started seeing a lot of emotional distress in her. And it started building and getting worse. And I got her into therapy and she, you know, kind of kind of responded, didn't mind it, but it got worse. She started self-arming, started cutting. She so more therapy, right? Eventually I got her in to see a psychiatrist who put her on medication. That didn't seem to help. Then the suicide attempts started and they got more and more serious. And as they got more serious, I got more serious about, you know, interventions. And let's get her, you know, some, you know, deeper therapies and more aggressive therapies and more aggressive medication and measure for measure. The more interventions we had. even at the best facilities. I mean w I was driving her hours out to the to the highest rated pediatric psychiatric facilities in the state and and nothing seemed to be helping. And she just by the time she was fourteen she had had two serious hospitalizations in the intensive care unit. from suicide attempts where the doctors didn't couldn't tell me if she was gonna survive or not. And Stephan Esser MD: Well Casie Mair-Miley: she spent the better part of two years in and out of psychiatric hospitals, one spent nearly two years at the most prestigious children's psychiatric facility. And it no matter what we tried, nothing seemed to be helping. And and finally it was during COVID and I couldn't see her in person. It was could only talk to her on the phone. And She was begging me to get her out of there, begging me to get her off these meds. She couldn't first of all, on her tiny little 100-pound frame, she'd gained 40 pounds in a matter of months, side effects of the medication. She couldn't read, write, sing, just write songs. She couldn't do any of the things that she was passionate about. Her fire was totally extinguished. And the doctors explained to me, yeah, we have to put her in this chemical strait jacket, they called it. Because this only way to keep her from killing herself. And I said, No, no, I don't accept this. This is she's not she's no longer alive. She's a walking zombie. This is she's miserable. She couldn't even sit down. She couldn't sit in her own skin. This these are all side effects of these meds. Stephan Esser MD: I Casie Mair-Miley: And and that doctor, and I'll never forget his words, he said, if you get take her off these medicines, you will be killing her. And now it's just like there's gotta be a better way. So right about that time, a friend introduced me to Ocean Robins Food Revolution Summit, and I hung on every word of every one of those doctors and presenters. It was gold to me because I they weren't really talking about psychiatry or mental health at all, but what they were saying and what I knew about the mind-body connection, I knew that those things what turned what I came to understand as the six pillars of lifestyle medicine could save my daughter. And and so I dove into the the literature. I dove into learning everything I could. and that's about six years ago. Eventually got her home, schools opened backed up and I said, Look, let's try this. And we did. We implemented those six pillars. We slowly weaned her off medicine. We I I I bargained with her. She didn't really She'd been she had gone from refusing to go to school, refusing to do homework, she was failing everything. and I made I I made her a promise to join the track team, to socialize, to go to bed at a reasonable time. We did meditation every day. And we whole food plant-based, of course, that's to me almost the easiest thing, because this is just straightforward. This is what we're eating. That we Stephan Esser MD: Right. Casie Mair-Miley: did the kale smoothies every morning, we had packed her a nice balanced whole food plant based lunch, came home to a nice healthy dinner and salad every day. And of course she quickly lost the weight, but more importantly, sh her her mind settled. She Stephan Esser MD: Yeah. Casie Mair-Miley: stabilized. She never had another instance of self-harm, never had another suicide attempt. She has been med-free ever since. She's twenty years old now. She's in her third year of college. Before that, let's just I wanna brag that she graduated as in the top ten of her graduating class. She was Stephan Esser MD: Wow. Casie Mair-Miley: the star. she played Belle in Beauty and the Beast in in the in her senior year. And you know she just she was just thriving. Now she's in her third year of college. She's studying psychology and she wants to be a therapist to help other people who were suffering the way she was to get through their harvest times. So I couldn't be prouder of my baby. And she of course Stephan Esser MD: Wow. What a what a Casie Mair-Miley: is What what brought me here? Stephan Esser MD: I was going to say, what a powerful story. What a powerful story of transformation and you know, kind of going through such a deep low to such a high level of success. You know, it's so you you talked a little bit about kind of those different, you know, experiences that you went through. And I'm sorry you went through that. I'm sorry your daughter went through that. There's such such trials, but but but certainly it sounds like you you brought out of that a lot of value. You know, as you think back about what you went through, how did that experience influence? Kind of how you practice now. Casie Mair-Miley: Yeah, well it it's it it definitely brought me where I am now. Like I couldn't I couldn't ignore how powerful this is. And it it's just not really a charted course. There if you look for lifestyle psychiatry, there's very, very, very few resources. Stephan Esser MD: Right. Right. Casie Mair-Miley: So I'm I as like I my baby's life was saved because of this. Our lives were turned around because of this. you know Course, not to mention all the physical improvements I had experienced myself. You know, my arthritis went away. I I was always a runner, but I I was no more injuries, no, you know, quick recovery time, like I was feeling like I was in my twenties and in my fifties. So it was wonderful, remarkable difference. And and knowing that, it's like how can you not like want to spread that? You know, especially as a nurse, as somebody, you know, my my purpose is to take care of others and What a you know powerful testament and knowing the power of lifestyle medicine in psychiatry, I I felt like compelled I had to do something. So then I went back to school, I got board certified as a lifestyle practitioner through the ACLM, and I got board certified as a psychiatric nurse practitioner. It took me a while, so I'm just now kind of launching this this second career, I guess. but yeah. I'm I'm super, super Stephan Esser MD: Mm. Casie Mair-Miley: excited about the power there. Stephan Esser MD: Yeah, and as I hear you talking, right, I'm always thinking in my brain, kind of, okay, well, what were the scientific parameters? Well, how did that work? What changed in the body? And, you know, makes me think back to what I read recently, right? Talking about how like 50% of our feel-good hormone dopamine is produced in the gut. Right. And so, you know, you think about that interconnectedness there, you know, as as as you hear that data and, you know, what do you think happened in her gut to kind of help kind of with the all the positive results she had? Casie Mair-Miley: Right. Well, you know, and a lot of this is new stuff that's coming out. It's it's one thing like science is not static, right? We science is the study of something. And so we're constantly studying and learning more and and unlearning things we thought we knew and we thought all the serotonin was in the brain. Guess what? Ninety five percent of that stuff comes from our gut, right? Fifty percent of dopamine. And what's interesting, the dopamine comes from bacteria. Not our own cells, whereas the serotonin is it's our the lining of our of our intestines that will produce the serotonin. And those those sources of dopamine and serotonin, serotonin being the happiness chemical, right? they don't actually cross the blood-brain barrier. But from what we understand is that they travel and communicate through the vagus nerve. So anything that that That you can do, and this is not the understanding that I had at the time that I made these changes for my daughter, but these are these are more recent understandings as the science has been progressing. That anything that you can do to support the gut, gut health, the microbiome, all those the good bugs, you're you're helping your brain via the vagus nerve. Also, let's you can help help the vagus nerve as well. So there's a few things I can point to like Like eating the rainbow, right? Getting your polyphenols, getting your berries and your your cocoa beans. I eat I nibble on raw cocoa beans every day because that's my like my little guilty pleasure without the sugar. But your yeah, whatever whatever polyphenol sources, your favorite green tea, and getting 30 plants or more a day. All that supports your your gut health and though and those dopamine and serotonin precursors. As well, you can just eat tryptophan and tyrosine. You can get that through pumpkin seeds and bananas, let's see avocados, almonds, tofu, all that. The those are the precursors to dopamine and serotonin. So you can just eat some of those and kind of short shortcut there. and of course, prebiotics, anything that feeding your gut health. So I put a little bit of Druseler to choke in my smoothie, powdered form. course, to make it a little easier, but you can garlic, onion, oats, those are other sources Probiotics, you know, they're kind of it used to be the big bum ra but now I I do make a water keeper. I I brew a water kefir and I put that in my smoothie for a little bit of probiotic boost. sometimes I eat some vegan kimchi but I guess there's some studies that are coming out that maybe it's a little controversial, you know, to be pushing the the fermented foods. I don't know. So I don't want to recommend something that might end up being harmful. but then vagus nerve stimulation itself, whether it's a lot of people do cold therapy. I personally don't like being cold, so I I stick with the diaphragmatic breathing, you know, deep breathing, exhaling longer than you inhale, hold. and and so forth until you're kind of calming everything down and that keeps your vagus nerve toned and so you have a smoother communication between the dopamine and the serotonin in your gut and your brain. And then I guess the final thing to say is to limit those disruptors, right? So sleep deprivation is a disruptor to gut health. Stephan Esser MD: Right. Casie Mair-Miley: Right? So again you're tying in all these pillars they really are interconnected. So yeah, and ultra processed foods, emulsifiers, anything like that, that they really damage your gut, as does alcohol. So those are all just Stephan Esser MD: Right. Casie Mair-Miley: avoiding those things, keeping your gut as healthy as possible, to give them all those advantages, helping all those feel-good hormones or neurotransmitters flourish. And I think, yeah, I think that's exactly what was going on with my daughter, and why why those changes were able to help her Stephan Esser MD: Beautiful. Casie Mair-Miley: so profoundly. Stephan Esser MD: Beautiful. You know, and it just as you're talking, it makes me think about, you know, people who make healthy behavior, you know, healthy choices, let's say, with their behaviors, end up harvesting the benefits of those healthy choices, which in turn just seems like it feeds itself, like it's this feedback loop, right? In a similar Casie Mair-Miley: Yeah. Stephan Esser MD: way to like you were saying, right? The person who stays up till three AM watching Netflix and then has to self-medicate with sugar and whatever to kind of get the day started. And then that's just this vicious cycle, right? Of now their dopamine depleted because their body's not producing as well because the sleep deprivation. And then they it's just right in that cycle versus the opposite happens that you know you're making the healthy choice to go to bed at a reasonable hour, wake up, rested, renewed. Now you're more capable of making clearer choices and healthier choices to choose that healthy option with the food and with the exercise, et cetera, which then gets your gut healthy and feeds the bay brain. And it's just it's beautiful. You know. When Casie Mair-Miley: Absolutely. Absolutely. Stephan Esser MD: when it's all working together. You know, you mentioned the American College of Lifestyle Medicine and one of their parameters that they often talk about are those six pillars of health. I want you to introduce our viewers to what those six pillars are, if you would. Just kind of Casie Mair-Miley: Sure. Stephan Esser MD: walk us through each one because it's so nice to have guideposts in our life. And I think these are great reminders of of things that we can do. So please. Casie Mair-Miley: Yeah, sure. I'm sure it's this not new news to to any of the listeners, but I'm happy to go through them again. so easiest one I think that most people focus on and probably the most important is the whole food plant based nutrition, right? And that also along with that s low salt oil and sugar. So we call that SOS. So I I try to be SOS free, absolutely you know, starting with whole foods and and minimally processing them as much as possible. So that is pretty profound. You're eating plants and and everything we need we can get right from plants. And the next thing is physical activity, and that kind of means different things to different people, and and I will tell you that the the ACLM And and not just the ACLM, actually many of the organizations that are medical organizations, they all have come to a consensus that the recommendations for adults is 300 minutes a week of physical activity, moderate activity or 150 minutes of vigorous activity each week. and that's defined by you could use your heart rate, but you could also just use your your breathing. Like how hard are you breathing? So if you're just strolling along and you're going taking the dog for a walk, that's better than sitting on your butt at the desk or or at the TV. But you're if you're not getting breathless, if you're if you're able to sing a song, you're not at the moderate level. So you want to be able to move your body in whatever activity it is to the point that you're you're have you're a little bit winded. And then if it's vigorous, you're not having a conversation at all. Right. You're you're so that's a little measure that that you can use to know if you're really getting your physical activity. And and you can do that in big chunks or small chunks. And I also don't want to turn anybody off because it's it's not about perfection, right? It's just about getting started. So 10 minutes Stephan Esser MD: Right. Yeah. Casie Mair-Miley: is better than zero minutes, and that's a great start. Stephan Esser MD: Huh. Casie Mair-Miley: And like you said, with that loop, once the more you do it, the more you're gonna want to do it, the better you're gonna feel. Stephan Esser MD: Right. Casie Mair-Miley: Right. And it's just it so just get started. That's all you gotta do. Just a few minutes. And then don't let that three hundred minutes or a hundred and fifty minutes stop you because you don't need to do all of it every the first week. Just start small and get there. and then strength training twice a week. That's absolutely important at all ages. so that's that was pillar number two. Pillar number three will be restorative sleep. And that is seven to nine hours. Many people think they can get by with less than seven hours and they think they're functioning just fine, but test after test has proven that there is nobody that can function well with less than seven hours. More Stephan Esser MD: Right. Casie Mair-Miley: than nine hours is too much. So you either now you're getting into kind of a depressive, like I don't want to get out of bed, and you're not that so that's that's not healthy either. So between seven and nine hours, everybody has their sweet spot. And trying to do the Consistent bedtime and consistent wake time, even on the weekends, it's hard for us to do the way our culture is. But the the closer you can get to being consistent, the better. And then let's see what else. Stress management would be number four. So some of us are better at that than others. but you know, that would include your your mindfulness, your breathing exercises, yoga, anything that can help you. Handle stress and keep on top of it. Stress is not a bad thing, but too much of it being in a chronic state of stress is a bad thing. So Stephan Esser MD: Right. Casie Mair-Miley: and then number five, positive social connection. And so I like that they added the positive because you know, not every family is filled with positive social connection. so it's important to find your support person or your community and being involved in a community where you are uplifted and and you do feel that positive connection where where you you can turn to when when you're feeling stressed and you have that kind of feeling of safety and it really does a tremendous amount for your well being and your longevity. All the ACLM principles are based on on research, right? Solid research. And then finally that last one is avoidance of risky substances. which you know that could be alcohol, tobacco, marijuana, any Stephan Esser MD: Yeah. Casie Mair-Miley: kind of recreational drug use, even whatever it is that could be harmful to your body, to just to avoid that and and of course for so many reasons. But that would be the six pillars. Stephan Esser MD: Yeah. Love it. You know, you I had a question for you. I know you worked in addiction medicine for a period of time. and obviously most of us when we think about addiction, we think about risky substances, we think about alcohol, you know, illegal drugs, things of that nature. but the reality is, right, these ultra-processed foods that have, you know, kind of found this bliss point are extremely risky substances for people. And so Casie Mair-Miley: Yes. Stephan Esser MD: when you think about, you know, kind of Having worked now in both areas, right? You know, lifestyle medicine and addiction medicine, quote unquote. what are the commonalities you've seen there for people? Casie Mair-Miley: Well, you know, food addiction I think is huge and we aren't really identifying that so much. I think i in our circle, in the whole food plant based world, we we do see it because we know, hey, this is the ideal what we should be eating. Not everybody understands what we should be doing. But those of us that do understand what we should be doing and still struggle to do the right thing, we that's food addiction, right? Stephan Esser MD: Yeah. Casie Mair-Miley: And sugar i mean they they've got studies that show how incredibly powerfully addictive that sugar is right and even even cheese casomorphine in cheese more Stephan Esser MD: Right, right. Casie Mair-Miley: morphine relative right this these they there's receptors in our brains for these things and so yeah once you're hooked into that like but what but on the other side of that once you're able to get off and once you you're you're done with sugar And you go without sugar for long enough, you don't miss it, you don't crave it, and it's offensive when you get I I remember I'd gone you know did the plant-based thing, and my favorites were Reese's pieces. They used to be. And then I was like, all right, I'm gonna treat myself with this little Halloween pack of Reese's pieces. And I had one and I was like, what did they do to this? This tastes like waxy crap. It was awful. I couldn't believe it, it was ruined. but but how how wonderful, right? So I think you know, I guess getting back to what you're saying is the food addiction is is every bit as real as any other of these chemical addictions and maybe a little more challenging because while you don't have to smoke, you do have to eat. So and And on top of that, maybe smoking isn't quite as socially accepted as it used to be. But eating, I mean, it is very, very hard to go out to eat or to socialize. Here we we want you to be, you know, socially active, but a lot of that is based around eating. And so here we are trying to eat and not be difficult by having our special diet and you know Stephan Esser MD: Right. Casie Mair-Miley: but it so it that's tough one. It's a super, super tough one. To overcome when you're struggling with trying to be like eliminating the sugar. I feel personally, I feel for mental health the sugar is the most offensive of like the salt, salt oil sugar, or the case, all those things that want to be optimal health, but the sugar I think causes just so much inflammation that it it really becomes problematic with mental health. Stephan Esser MD: Yeah. I mean, I think there's so many people who, you know, w especially when it comes to kids, will say, why are you taking away their fun? What's the big deal? Right. But Casie Mair-Miley: Yeah. Yeah. Stephan Esser MD: I I find it so fascinating because you say that when they're a kid, but then as soon as that young lady becomes, let's say, a twenty four year old and she's strong with obesity, Casie Mair-Miley: Mm-hmm. Stephan Esser MD: what do you do? You suddenly turn it on her as though it's her fault. Casie Mair-Miley: Shame. Yeah. Stephan Esser MD: right. It was shame and blame. Instead of being like, Well, wait a second, we were celebrating every birthday party with fill in the blank, right? And so you were Casie Mair-Miley: Yes. Stephan Esser MD: make creating that addiction. and that dependence. And now you're saying she's the one with the problem when it's really we've created we've acculturated or you know, her two those food like substances abuse. So interesting. Casie Mair-Miley: Yeah. And and and and relating sugar with reward. I mean it's Stephan Esser MD: Right. Casie Mair-Miley: already a pleasure center, hitting our pleasure center, but but saying like, good job, you got us straight A's, let's go celebrate with some ice cream or you know, whatever in s in school, anywhere you go. This is w Stephan Esser MD: Right, right. Casie Mair-Miley: how we celebrate with unhealthy food. That's it's such a shame. Stephan Esser MD: Right. So what's the answer? What's the answer? Casie Mair-Miley: Well, I'm just conscious conscious behavior. Right? We I I don't Stephan Esser MD: What what do what do you say to the parents? What what should the parents do? Yeah. Let's start there. Casie Mair-Miley: right. The pay well the parents just yeah. The parent like please realize what you're what you're giving your children, just like our th the meats are carcinogens, right? We're not don't give your child a hot dog. You wouldn't give your child a cigarette. Understand that that that twinkie is basically the same thing. Right? We've got to be really careful about you know what we're we're growing our children with. And setting them up for success in in another it's already such a a a challenging world to grow up in. We want to give them the absolute best chance that they can have. Don't feel guilty about withholding treats. Don't don't feel guilty about sending your your kid to school with a whole food plant-based meal in a little k kit. Right. Stephan Esser MD: Right, right. In their bento box. So when you think about these pillars of lifestyle medicine that you t you just shared with us, which one do you feel like is the hardest for you? Casie Mair-Miley: You know, I think the hardest one had been the cheese. I gotta say. That the quesomorphines really were had me hooked. And if I was gonna cheat, that would be my my big cheat. and then eventually I started hearing, think of it as cowpus. And that did it for me. And it's been a Stephan Esser MD: So the way the magic Casie Mair-Miley: Turned me off so bad. I I and I don't miss it now. Now you can be eating a cheese pizza in front of me and I'm like, okay, you eat that cheese house. You're I'm good. I don't the my Stephan Esser MD: Right, right. Casie Mair-Miley: my little neurotransmitters or receptors, I mean, for the the quesos, queso Stephan Esser MD: Kids of morphine, yeah. Casie Mair-Miley: morphins, they're done. They they don't need it anymore. So I'm over that. yeah, and now you know I've recently You're you're making me tell on myself here. But I recently moved to Northern California in the wine country and you know I've I've got a bad case of Stephan Esser MD: Right. Casie Mair-Miley: FOMO and so you know we're we're bringing all our out of town guests to Napa and all these these wine countries and so I've been a little bit hypocritical with the tasting of the wine but I think that I th there are so many non alcoholic options out there. I just gotta find a winery that has them. So Stephan Esser MD: Nice. Casie Mair-Miley: All right, you wanna Stephan Esser MD: That's right. Casie Mair-Miley: go to winery? Fine, we'll go to a winery and I'll have my NA over here. Stephan Esser MD: Well your options, that's right. Some nice grape juice. So yeah, I mean that's the reality, isn't Casie Mair-Miley: Right. Stephan Esser MD: it? It's it's kind of creating an environment that helps support you, right? I mean, it's like if you go to a Casie Mair-Miley: huh. Stephan Esser MD: bar every night, you're probably gonna drink at some point. You know what I mean? It's kinda like Casie Mair-Miley: Right. Right. Stephan Esser MD: that's we all we all can get into trouble putting ourselves into places you know, that can compromise us a little bit. and then what's the easiest one for you as far as those six pillars, which has been the easiest? Casie Mair-Miley: Well it's you know, it I I think well gosh once things become routine, it's all pretty easy, right? I think the thing I enjoy the most is the exercise. you know, I I love I love running and I love I got you know, now I'm into strength training now that I'm of that age that they're really pounding it down your throat like you gotta strength train. Stephan Esser MD: Right. Casie Mair-Miley: So I'm doing it. and it feels great. Yeah, it's it's well I'm on the up cycle, right? It's so The more I Stephan Esser MD: Nice. Casie Mair-Miley: now I've got hills to run and mountains to climb and I'm just I'm just loving it. So yeah. Stephan Esser MD: Awesome. Awesome. You know, I I always want to leave our viewers as we're getting close to our end time here. I want to leave our viewers always with some tangible tips, some things that they can apply. You know, we've talked about kind of mental health, the interconnection between our nutrition and exercise, things like that, some very powerful personal stories. Thank you for sharing with us. you know, and and my thought is maybe you can leave us all with some tangible tips that people can say, okay, that's something that I can apply starting today. So what you got for us? Casie Mair-Miley: Alright, let's see. just start moving, right? I you know, it it it kind of this is all depends how useful it is based on where you are. But just generally speaking, move every day. If you got ten minutes, whatever, you don't need an hour, just just move for ten minutes. Just just get started. Yeah, but so that'd be number one tangible. Number two, tangible, let's get the phones out of the bedrooms. Sleep is so important, and the phone, while you know, a lot of people use it for an alarm clock or they charge it by their bedside, or you know, just in case somebody needs whatever their excuses, what it serves is first of all, it's that blue light exposure that we all know is is not great for our circadian rhythms. and and even if you're using your blue light glasses. It's still a source that scrolling and and that that's their hits of dopamine, which are activating, disruptive to sleep. And they're also a source of stress and anxiety. You know, whether it's you know you're looking at your funny reels or or you're reading your stressful emails, none of it is good or productive for sleep. So just get the phone out of the bedroom. Plus if it rings or alerts you, whatever it's breaking your REM cycle, it none of it's good. It doesn't need to be there. Get a cheap alarm clock. So that'd be my my second tangible. And I think my Stephan Esser MD: Good one. Casie Mair-Miley: my last tangible, I'd say for anybody who's still drinking alcohol, switch to NA if you need if you feel like your your social circle or your social demands kind of make it awkward to not drink at all. There are so many non-alcoholic options out there. Just get, you know, order a you know a slotter with lime or get a non-alcoholic corona. There's almost all the beers now come with a non-alcoholic version. So it's really easy to do. And if I might just explain a little bit about why that is so important. It has besides the disruption that it's doing to our dopamine and serotonin in our guts and it's killing our bacteria and it's and it's causing cancer and it's doing all these things. I want to talk about the GABA and the and the glutamate. And Because so many of us come home from work and like, my god, that was a stressful day. I'm gonna get a glass of wine. It's gonna help me relax. And and it does momentarily, maybe the first time you have that first glass of wine. But what it it does is it changes. So GABA is the neurotransmitter that calms us, right? It helps you sleep, it reduces your cortisol, it reduces your stress. Glutamate is your excitatory neurotransmitter. And it gets you it helps you with your memory, it helps you with learning, and it gets you anxious and and and panicky feeling. It gets you that that stress and it makes you snap quick. so so we really need to balance those things. So what the alcohol will originally do is kind of d decrease the glutamate, increase your your GABA, so you're feeling calm and relaxed. But then what happens is the brain is like, We gotta increase our glutamate neuroreceptors because otherwise we're gonna fall asleep when we're not supposed to be asleep, and and it so it kind of boosts the excitement up. And so then when that alcohol wears off, you're all agitated. And you some people are more in tune to this than others, but i so you'll wake up in the middle of the night. If you go to bed, if you have a drink before bed, that's why I've heard a lot of people say, if you're gonna drink, make sure it's in the afternoon and in and earlier in the day, because if you drink in the evening. You're gonna screw up your sleep, you're gonna be wide awake in the middle of the night because your glutamates are like, Phew, we're here, we're ready, let's go. And then over time, you're in a chronic state of increased glutamate and decreased GABA. So you're no longer able to self-regulate, you're no longer able to calm yourself down without that alcohol. So you have you very quickly create this cycle of dependence on the alcohol to be relaxed. So It's just not worth it. You know, whatever whatever Stephan Esser MD: Right. Casie Mair-Miley: it's doing for you, you're you're really just postponing that anxiety, you're postponing that stress, and you're gonna increase it. So that's my last tangible. Switch to NA if you if you're still drinking. Stephan Esser MD: Love it. So three very tangible things for us all to do and start now. You know, it's a pleasure to have you on the podcast today. And, you know, if people want to connect with you further, learn a little bit more about what you're doing, where should they go? What can they do? Casie Mair-Miley: Well, I'm I have a LinkedIn profile. You could find me there, contact me there. And I'm just setting up a website called lifestylepsychnp.com. So you should be able to find me there too. All right, great. Stephan Esser MD: All right. We'll we'll look for it when it's up flourishing. So thank you so much for joining me today. I really appreciate it and enjoyed learning with and from you. And thank you for sharing so much of your passion with our viewers. Casie Mair-Miley: Thanks for having me. Stephan Esser MD: All right, everybody, thanks for joining today. And look forward to having you again soon on another NHA Today podcast.