Latest / The Sober Creative Podcast / Episode 072 - The Wrong Question About Drinking With Dr. Lucy McBride

Transcript

Episode 072 - The Wrong Question About Drinking With Dr. Lucy McBride · The Sober Creative Podcast

• 0:00
  SPEAKER_01: Welcome everyone to The Sober Creative Podcast.
• 0:03
  SPEAKER_01: Every guest has done some version of the same hard thing.
• 0:06
  SPEAKER_01: They got honest about what alcohol was costing them.
• 0:09
  SPEAKER_01: Some quit, some cut back, some don't use a word for it at all.
• 0:13
  SPEAKER_01: What they share is that they're creating from a space that's actually theirs.
• 0:17
  SPEAKER_01: I'm your host, Josh Woll, and I'm excited to bring you today's guest.
• 0:20
  SPEAKER_01: Dr. Lucy McBride is a primary care physician in Washington,
• 0:24
  SPEAKER_01: D.C., where she's been seeing patients for 25 years.
• 0:28
  SPEAKER_01: She studied at Princeton,
• 0:29
  SPEAKER_01: earned her medical degree at Harvard Medical School,
• 0:32
  SPEAKER_01: got a master's in pharmacology from Cambridge,
• 0:35
  SPEAKER_01: and trained in internal medicine at Johns Hopkins.
• 0:39
  SPEAKER_01: She founded her own practice, Acrolemic Bride Group.
• 0:42
  SPEAKER_01: On a belief, she comes back too often.
• 0:45
  SPEAKER_01: The most important things about your health rarely show up on a lap report.
• 0:50
  SPEAKER_01: She learned that as a patient first.
• 0:52
  SPEAKER_01: In her 20s,
• 0:53
  SPEAKER_01: she was seriously ill,
• 0:55
  SPEAKER_01: And spent a long stretch going from specialist to specialist,
• 0:59
  SPEAKER_01: tested for everything from giardia to a brain tumor.
• 1:04
  SPEAKER_01: She knows what it's like when a system treats the symptoms and missing the person.
• 1:10
  SPEAKER_01: Today, Lucy writes,
• 1:11
  SPEAKER_01: Are You Okay?,
• 1:12
  SPEAKER_01: a weekly newsletter with more than 43,000 subscribers and hosts the Beyond
• 1:17
  SPEAKER_01: the Prescription podcast.
• 1:19
  SPEAKER_01: Her writing has appeared in the Atlantic and the Washington Post.
• 1:23
  SPEAKER_01: Her new book,
• 1:23
  SPEAKER_01: Beyond the Prescription,
• 1:25
  SPEAKER_01: A Doctor's Guide to Taking Charge of Your Health,
• 1:29
  SPEAKER_01: came out in August from Simon & Schuster and became a USA Today bestseller.
• 1:34
  SPEAKER_01: On alcohol, Lucy doesn't deal in absolutes.
• 1:37
  SPEAKER_01: She cares about a patient's relationship with drinking as much as the amount.
• 1:41
  SPEAKER_01: And she makes the case that drinking doesn't have to reach the level of addiction
• 1:44
  SPEAKER_01: to change your sleep, your mood, and your blood work.
• 1:48
  SPEAKER_01: She's tested this on herself.
• 1:50
  SPEAKER_01: After a month without alcohol,
• 1:51
  SPEAKER_01: she found that whining down at night took real effort,
• 1:55
  SPEAKER_01: so she went back to journaling.
• 1:57
  SPEAKER_01: In her words, I sat with discomfort instead of numbing it.
• 2:01
  SPEAKER_01: Lucy is married to her college sweetheart and has three grown children.
• 2:05
  SPEAKER_01: Please welcome Dr. Lucy McFry.
• 2:08
  SPEAKER_00: What a lovely introduction, Josh.
• 2:10
  SPEAKER_00: I am so happy to be here.
• 2:12
  SPEAKER_00: Thanks for having me.
• 2:13
  SPEAKER_00: And just listening to your voice is so soothing and calming.
• 2:16
  SPEAKER_00: That's what I should do to wind down the other day.
• 2:18
  SPEAKER_00: Listen to Josh Woll talk.
• 2:21
  SPEAKER_01: I did have recorded some guided meditations.
• 2:24
  SPEAKER_00: I would.
• 2:25
  SPEAKER_00: I would.
• 2:26
  SPEAKER_00: I'm quite serious.
• 2:26
  SPEAKER_00: Yeah.
• 2:28
  SPEAKER_01: Yeah.
• 2:29
  SPEAKER_01: How are you doing?
• 2:30
  SPEAKER_01: How was the day?
• 2:32
  SPEAKER_00: I'm doing great.
• 2:35
  SPEAKER_00: As you said in the intro, I published this book, my very first book, in 2012.
• 2:41
  SPEAKER_00: In August with Simon & Schuster.
• 2:45
  SPEAKER_00: And I'm finally, it has been amazing.
• 2:48
  SPEAKER_00: It's done better than I ever expected.
• 2:50
  SPEAKER_00: The goal of the book for me,
• 2:52
  SPEAKER_00: Josh, was not to be Mrs. Popular, although I love getting media attention.
• 2:56
  SPEAKER_00: It's really to help the average person out there who is feeling let down by
• 3:00
  SPEAKER_00: the medical system and who is lured by the wellness industry but doesn't know how
• 3:05
  SPEAKER_00: to make sense of all the information coming at them.
• 3:08
  SPEAKER_00: It's really an ode to the person out there who's Trying to figure out how
• 3:12
  SPEAKER_00: to make sense of information in their own bodies and doesn't know who to trust.
• 3:17
  SPEAKER_00: It's not a do as I say book.
• 3:19
  SPEAKER_00: It's a here's how to think about your health book in a nuanced way.
• 3:22
  SPEAKER_00: And naturally,
• 3:23
  SPEAKER_00: one of the topics that comes up all the time in my office with patients,
• 3:27
  SPEAKER_00: and I talk about a lot in the book, is the relationship with alcohol.
• 3:32
  SPEAKER_00: But to answer your question,
• 3:33
  SPEAKER_00: I'm doing great because finally,
• 3:35
  SPEAKER_00: the book,
• 3:36
  SPEAKER_00: the surge, the tornado around the publication is like a little bit winding down.
• 3:41
  SPEAKER_00: And I'm feeling like,
• 3:42
  SPEAKER_00: you know,
• 3:42
  SPEAKER_00: when you feel in your body like a sense of like peace and calm instead
• 3:46
  SPEAKER_00: of being like just vigilant, vigilant, vigilant.
• 3:48
  SPEAKER_00: I'm like sleeping well.
• 3:50
  SPEAKER_00: I'm like going back to my yoga.
• 3:52
  SPEAKER_00: Like I feel so much better.
• 3:54
  SPEAKER_00: It was a lot of fun.
• 3:55
  SPEAKER_00: I don't regret the hype and the blur of the whole thing,
• 3:58
  SPEAKER_00: but it's really nice to be a little bit calmer and present.
• 4:01
  SPEAKER_01: Yeah.
• 4:02
  SPEAKER_01: Well, it's well-deserved.
• 4:04
  SPEAKER_01: It's a really good book and I can't wait to talk about it more.
• 4:07
  SPEAKER_01: Yeah.
• 4:09
  SPEAKER_01: Well, so, and we'll jump into that soon.
• 4:12
  SPEAKER_01: So I guess, like,
• 4:14
  SPEAKER_01: before we get into all the details with alcohol,
• 4:17
  SPEAKER_01: if you want to let me know, like, what's your relationship been like over the years?
• 4:23
  SPEAKER_00: So my relationship with it is that I come—so my dad had an alcohol problem
• 4:29
  SPEAKER_00: when I was growing up
• 4:32
  SPEAKER_00: that was— He was the person who was highly functional
• 4:37
  SPEAKER_00: and would go to work, but had a real problem.
• 4:40
  SPEAKER_00: And it caused a lot of strain on my parents' marriage.
• 4:45
  SPEAKER_00: He finally quit.
• 4:46
  SPEAKER_00: And now he's been sober.
• 4:48
  SPEAKER_00: My dad's been sober since he was 50 and he's in his mid-80s.
• 4:52
  SPEAKER_00: And he's an inspiration and amazing.
• 4:55
  SPEAKER_00: And my husband has also struggled with his relationship with alcohol.
• 5:01
  SPEAKER_00: They say that you marry your father.
• 5:02
  SPEAKER_00: And I don't know if that's true,
• 5:03
  SPEAKER_00: but in many ways,
• 5:05
  SPEAKER_00: My husband's like my dad in like the best possible ways,
• 5:08
  SPEAKER_00: but certainly in that one way.
• 5:09
  SPEAKER_00: So it's been a very,
• 5:10
  SPEAKER_00: and then my brother who died from mental illness two years ago also struggled
• 5:15
  SPEAKER_00: with alcohol at various times in his life.
• 5:17
  SPEAKER_00: So I've been very familiar with the fact
• 5:22
  SPEAKER_00: that people have very different relationships with alcohol.
• 5:24
  SPEAKER_00: Myself, like I am someone who,
• 5:29
  SPEAKER_00: I think I'm like a lot of people who I don't,
• 5:34
  SPEAKER_00: I don't technically drink that much by like a doctor standard,
• 5:40
  SPEAKER_00: you know, when doctors ask you like, how much do you drink a week?
• 5:42
  SPEAKER_00: But I am very aware of the gravitational pull of alcohol
• 5:50
  SPEAKER_00: when you're feeling exhausted or stressed or anxious.
• 5:56
  SPEAKER_00: It's ability to help you numb out uncomfortable feelings and numb out from like a hard day.
• 6:02
  SPEAKER_00: I'm very, very aware of that and very aware of how that can become a slippery slope.
• 6:09
  SPEAKER_00: I'm fortunate,
• 6:10
  SPEAKER_00: I would say,
• 6:10
  SPEAKER_00: that I haven't really struggled,
• 6:13
  SPEAKER_00: but I don't count that as a moral win or something that is like I'm there for...
• 6:19
  SPEAKER_00: It's not because I have better willpower than the next person.
• 6:21
  SPEAKER_00: It's just I haven't had that terrible struggle that a lot of people did,
• 6:26
  SPEAKER_00: that my dad did, that my brother did, and my husband did.
• 6:32
  SPEAKER_00: But I'm very aware of the ease with which it can become a coping mechanism
• 6:39
  SPEAKER_00: and not just a pleasure and how blurry that line is.
• 6:43
  SPEAKER_00: And when I quit drinking for...
• 6:46
  SPEAKER_00: I've stopped drinking many,
• 6:47
  SPEAKER_00: many times in my life for the purpose of sleeping better,
• 6:52
  SPEAKER_00: getting more clear mentally, to be more fit and healthy in general.
• 6:57
  SPEAKER_00: And I quickly become aware of how...
• 7:02
  SPEAKER_00: Insidious it is and how it sort of the tentacles of alcohol,
• 7:05
  SPEAKER_00: like, like, like grab you in all different ways.
• 7:09
  SPEAKER_00: And like your digestion is worse and your thinking is less clear and you're
• 7:13
  SPEAKER_00: a little snappier with,
• 7:15
  SPEAKER_00: you know,
• 7:15
  SPEAKER_00: someone at work or it's just the effects,
• 7:19
  SPEAKER_00: even if you're not someone who is quote unquote addicted or dependent, um,
• 7:26
  SPEAKER_00: The myriad effects of alcohol on behaviors,
• 7:31
  SPEAKER_00: feelings, thoughts, relationships never ceases to amaze me.
• 7:36
  SPEAKER_00: And so my relationship with alcohol has been like a lot of people's.
• 7:39
  SPEAKER_00: It's complicated.
• 7:40
  SPEAKER_00: It's like a love-hate.
• 7:41
  SPEAKER_00: And I think I bring that awareness to my conversations with patients because...
• 7:48
  SPEAKER_00: As you said in the intro, I'm not an absolutist.
• 7:51
  SPEAKER_00: I have patients for whom one drink a week is one too many and would send them into
• 7:56
  SPEAKER_00: a terrible, terrible place of addiction.
• 7:59
  SPEAKER_00: I also have patients who don't think they have a problem at all
• 8:04
  SPEAKER_00: and drink quantity-wise a lot more than is ideal,
• 8:08
  SPEAKER_00: and they do have a problem with it.
• 8:11
  SPEAKER_00: And then I have patients who are in the middle.
• 8:13
  SPEAKER_00: Who are like social drinkers, you know, what's the big deal?
• 8:16
  SPEAKER_00: It's legal, it's socially acceptable.
• 8:17
  SPEAKER_00: Why are you even asking that question, Dr. McBride?
• 8:19
  SPEAKER_00: Like, you know, do you think I'm,
• 8:21
  SPEAKER_00: you know, are you judging me?
• 8:24
  SPEAKER_00: And it's so fascinating,
• 8:25
  SPEAKER_00: the ease with which we judge ourselves and then we're quick to defend ourselves
• 8:29
  SPEAKER_00: when we don't think we have a problem and someone may be peering into the recesses
• 8:33
  SPEAKER_00: of your brain.
• 8:34
  SPEAKER_00: So what I do with my patients is start with,
• 8:39
  SPEAKER_00: you know, the fact that I'm not, there's no judgment here.
• 8:40
  SPEAKER_00: There's no moral prize for being sober.
• 8:43
  SPEAKER_00: I'm hugely impressed with people who commit to sobriety.
• 8:46
  SPEAKER_00: I'm just saying it's not a moral prize.
• 8:48
  SPEAKER_00: And there's so I think that the key for anyone who's thinking
• 8:52
  SPEAKER_00: about their alcohol use,
• 8:54
  SPEAKER_00: as I know everybody here on this call knows,
• 8:56
  SPEAKER_00: is radical self-awareness of what it does for you and what it doesn't for you.
• 9:01
  SPEAKER_00: And just starting there is a good spot.
• 9:04
  SPEAKER_01: Yeah, I mean, it's like that word awareness is just so big, you know, and it's I think.
• 9:13
  SPEAKER_01: For the longest time, I didn't have awareness that I had a problem.
• 9:18
  SPEAKER_01: I was probably like your dad where I felt like I was functional.
• 9:22
  SPEAKER_01: I could have eight or nine and then the next day could just crush it with work or whatever.
• 9:30
  SPEAKER_01: Maybe not crush it, but yeah, still.
• 9:32
  SPEAKER_01: I didn't ever think I had a problem.
• 9:35
  SPEAKER_01: I think the knowledge and awareness that you get and Gosh, I mean,
• 9:41
  SPEAKER_01: you said it so well and how the tentacles and how it affects so many areas
• 9:47
  SPEAKER_01: of our life and feelings and emotions and all that.
• 9:52
  SPEAKER_01: And that's what I love about your approach is,
• 9:55
  SPEAKER_01: you know,
• 9:56
  SPEAKER_01: it's going a bit deeper than the surface level of like, well, how many do you have?
• 10:01
  SPEAKER_01: You know, it is way more complicated.
• 10:05
  SPEAKER_01: It's way deeper.
• 10:05
  SPEAKER_01: Yeah.
• 10:06
  SPEAKER_00: Yeah, and I think the unfortunate,
• 10:09
  SPEAKER_00: arguably the most unfortunate problem with our medical system is that our system,
• 10:15
  SPEAKER_00: the insurance system, pays for transactions, not conversations with doctors.
• 10:20
  SPEAKER_00: So when your doctor only has 15 minutes and is likely to interrupt you
• 10:24
  SPEAKER_00: in 11 seconds, that's what the data show.
• 10:27
  SPEAKER_00: By the way, through no fault of the doctors, it's just how the system is geared, right?
• 10:31
  SPEAKER_00: It's actually not geared for a conversation.
• 10:32
  SPEAKER_00: It's geared for it.
• 10:33
  SPEAKER_00: A prescription, a procedure, a transaction, a sort of a quick checklist.
• 10:38
  SPEAKER_00: So when it comes to something like alcohol,
• 10:40
  SPEAKER_00: that's this very important substance in people's lives that can play a big role
• 10:49
  SPEAKER_00: in their health.
• 10:51
  SPEAKER_00: It's really unfortunate that sometimes the only question you may get asked
• 10:54
  SPEAKER_00: at your annual checkup is like, how much do you drink?
• 10:57
  SPEAKER_00: And that just doesn't begin to scratch the surface of Of what
• 11:00
  SPEAKER_00: the actual meaning there is, right?
• 11:02
  SPEAKER_00: Because there's the quantity of alcohol.
• 11:05
  SPEAKER_00: And I think we can all agree that like there are certain quantities
• 11:07
  SPEAKER_00: that are probably not okay, no matter what your relationship with alcohol is.
• 11:12
  SPEAKER_00: But that depends on the person.
• 11:15
  SPEAKER_00: And then there's the relationship with alcohol, which is really much more interesting, right?
• 11:19
  SPEAKER_00: Because even if you drink, say, five times a week and it's social and it's paired with food and
• 11:28
  SPEAKER_00: If you're using alcohol,
• 11:29
  SPEAKER_00: I argue,
• 11:30
  SPEAKER_00: if you're using alcohol to sort of medicate uncomfortable feelings as a coping tool
• 11:40
  SPEAKER_00: that you're relying on,
• 11:42
  SPEAKER_00: and if it's interfering with any health issue,
• 11:44
  SPEAKER_00: whether it's your blood pressure,
• 11:45
  SPEAKER_00: your sleep,
• 11:46
  SPEAKER_00: or your sleep apnea,
• 11:48
  SPEAKER_00: and if it's interfering with your relationships or your development of other kind
• 11:51
  SPEAKER_00: of Healthier coping skills, then those five drinks are arguably a problem.
• 11:56
  SPEAKER_00: Not that you are a problem, you are a failure.
• 11:59
  SPEAKER_00: It is worth discussing.
• 12:00
  SPEAKER_01: And
• 12:03
  SPEAKER_00: by the way,
• 12:03
  SPEAKER_00: the discussion in my mind from a doctor's standpoint shouldn't be quit drinking,
• 12:08
  SPEAKER_00: it's bad for you, don't you know better?
• 12:10
  SPEAKER_01: That
• 12:11
  SPEAKER_00: doesn't usually land well.
• 12:13
  SPEAKER_00: That's why people don't report alcohol use to their doctors because they expect
• 12:16
  SPEAKER_00: that kind of shame and blame and absolutism.
• 12:20
  SPEAKER_00: The better...
• 12:21
  SPEAKER_00: Conversation is the conversation that's not being had in doctor's office,
• 12:24
  SPEAKER_00: which is like, hey, it's a question.
• 12:28
  SPEAKER_00: Like, is it possible?
• 12:29
  SPEAKER_00: I just said this to a patient last week.
• 12:31
  SPEAKER_00: Is it possible that the alcohol you're consuming is contributing to your,
• 12:36
  SPEAKER_00: you know, blank, blank, blank, GI distress, migraine headaches, sleeplessness?
• 12:41
  SPEAKER_00: If you pose it as a question, because it may not be, but that requires time.
• 12:47
  SPEAKER_00: And that's the last thing doctors have.
• 12:49
  SPEAKER_00: Therefore, The conversation about alcohol becomes reduced to a set of questions about quantity.
• 12:56
  SPEAKER_01: Are there things that you can see in a chart where you can tell a person
• 13:05
  SPEAKER_01: that you know that they have a problem?
• 13:08
  SPEAKER_00: I mean, you don't always know, but there are certain indices.
• 13:12
  SPEAKER_00: I mean,
• 13:12
  SPEAKER_00: I kind of pride myself on my patients being honest with me because I try to provide
• 13:17
  SPEAKER_00: a nonjudgmental kind of safe space, if you will.
• 13:20
  SPEAKER_00: But sure, people underestimate their alcohol use, even if they're trying to be honest.
• 13:25
  SPEAKER_00: And then sometimes people just blatantly lie to me, and that's fine.
• 13:27
  SPEAKER_00: I mean, I have three young adult kids,
• 13:29
  SPEAKER_00: so I've become accustomed to not having the full truth all the time.
• 13:33
  SPEAKER_00: But elevated MCV is a—so the MCV is the red blood cell size.
• 13:39
  SPEAKER_00: It's a marker of the chubbiness of your average red blood cell in your body.
• 13:43
  SPEAKER_00: And if it's elevated, that's commonly from alcohol.
• 13:47
  SPEAKER_00: Interestingly,
• 13:47
  SPEAKER_00: the liver function tests,
• 13:49
  SPEAKER_00: the AST and ALT, can be completely normal on someone who's a heavy drinker.
• 13:56
  SPEAKER_00: So the liver tests don't always mean there isn't liver toxicity from alcohol,
• 14:02
  SPEAKER_00: but certainly if you have high liver tests in a certain pattern,
• 14:05
  SPEAKER_00: higher AST and ALT that suggests alcohol use.
• 14:10
  SPEAKER_00: So...
• 14:12
  SPEAKER_00: But as you know, the effects of alcohol can be profound without even showing up in blood work.
• 14:23
  SPEAKER_00: So my job as a physician isn't just to look at people's lab work and say,
• 14:27
  SPEAKER_00: okay, labs are normal, therefore you're healthy.
• 14:32
  SPEAKER_00: You can be completely normal in lab work and have a relationship with alcohol
• 14:36
  SPEAKER_00: that is problematic, wobbly, causing harm.
• 14:42
  SPEAKER_00: And it never shows up in lab work.
• 14:43
  SPEAKER_00: Another reason why it's so sad that doctors don't have time
• 14:48
  SPEAKER_00: to have these conversations with patients.
• 14:51
  SPEAKER_00: I mean, the effect of alcohol on a societal level is so profound.
• 14:59
  SPEAKER_00: And it's fascinating how we consider other things, you know, we consider some things...
• 15:06
  SPEAKER_00: Dangerous that are so much less dangerous than alcohol.
• 15:08
  SPEAKER_00: Do you know what I mean?
• 15:09
  SPEAKER_00: Like take hormone replacement therapy.
• 15:11
  SPEAKER_00: People are,
• 15:12
  SPEAKER_00: you know,
• 15:12
  SPEAKER_00: there's still a lot of doctors even and patients,
• 15:14
  SPEAKER_00: of course, who are like afraid of hormone replacement therapy.
• 15:16
  SPEAKER_00: But if you look at the risk for breast cancer,
• 15:18
  SPEAKER_00: alcohol poses a far greater risk for breast cancer
• 15:21
  SPEAKER_00: than hormone replacement therapy does or ever did.
• 15:24
  SPEAKER_00: You know, it's just a question of how you conceptualize risk.
• 15:26
  SPEAKER_00: Just because something's legal and socially acceptable doesn't mean it's good for you.
• 15:32
  SPEAKER_01: Yeah, and I mean,
• 15:33
  SPEAKER_01: it's like cigarettes have come quite a ways with having a big,
• 15:37
  SPEAKER_01: bold, this kills you, you know, label on it.
• 15:41
  SPEAKER_01: I don't foresee that happening with alcohol anytime soon.
• 15:46
  SPEAKER_00: No, I mean,
• 15:47
  SPEAKER_00: look at the pandemic,
• 15:47
  SPEAKER_00: the pandemic, you know, we closed schools and bars are still open, right?
• 15:52
  SPEAKER_00: And look, I'm not a prohibitionist.
• 15:54
  SPEAKER_00: I don't,
• 15:54
  SPEAKER_00: you know,
• 15:55
  SPEAKER_00: I think that like marijuana should be legal and I'm not advocating for prohibition.
• 16:01
  SPEAKER_00: I'm just saying that Especially in this day and age,
• 16:05
  SPEAKER_00: people want to make informed decisions about their health.
• 16:08
  SPEAKER_00: And I think it's really important to recognize that just because something is legal
• 16:12
  SPEAKER_00: and socially acceptable, like alcohol, doesn't mean it's safe for you.
• 16:18
  SPEAKER_00: And the safety can be on your behavioral health,
• 16:22
  SPEAKER_00: your mental health, your physical health, or your entirety of your health.
• 16:26
  SPEAKER_00: And I think having curiosity about how alcohol is affecting you
• 16:32
  SPEAKER_00: on those different levels is really the first step towards understanding
• 16:37
  SPEAKER_00: where you are.
• 16:38
  SPEAKER_01: Just becoming the CEO.
• 16:40
  SPEAKER_00: That's right.
• 16:41
  SPEAKER_00: That's right.
• 16:42
  SPEAKER_00: That's right.
• 16:44
  SPEAKER_01: So I'm curious, how would you define addiction?
• 16:47
  SPEAKER_01: Oh,
• 16:49
  SPEAKER_00: well, that's an interesting, that's such a great question.
• 16:52
  SPEAKER_00: Yeah.
• 16:54
  SPEAKER_00: So addiction is different than dependence, right?
• 16:58
  SPEAKER_00: Addiction is where there is
• 17:04
  SPEAKER_00: relationship with a substance or
• 17:07
  SPEAKER_00: a behavior like alcohol or
• 17:15
  SPEAKER_00: pornography or recreational drugs or shopping,
• 17:19
  SPEAKER_00: like some behavior or substance.
• 17:22
  SPEAKER_00: But there's a relationship that is It's detrimental to your mental,
• 17:27
  SPEAKER_00: physical, and spiritual health.
• 17:29
  SPEAKER_00: And it's causing problems in your life.
• 17:33
  SPEAKER_00: And I think, if I'm not mistaken, I probably should look up the definition of addiction.
• 17:38
  SPEAKER_00: I think it also needs to imply,
• 17:42
  SPEAKER_00: if you're going by the books,
• 17:43
  SPEAKER_00: it needs to imply that you're like,
• 17:47
  SPEAKER_00: that people are commenting on it or saying something to you and you're ignoring it,
• 17:51
  SPEAKER_00: that you're not taking help, that you're in denial about it.
• 17:54
  SPEAKER_00: But I guess the reason why I don't know the definition
• 17:58
  SPEAKER_00: because I think it's all one big continuum.
• 18:01
  SPEAKER_00: And I think the language around it matters, of course.
• 18:08
  SPEAKER_00: But so does what's happening in this person's life.
• 18:10
  SPEAKER_00: So does that make sense?
• 18:15
  SPEAKER_00: Like addiction can have many, many different faces and many different forms.
• 18:24
  SPEAKER_00: But like to distinguish addiction from dependence is dependence is like you need it
• 18:30
  SPEAKER_00: to function.
• 18:32
  SPEAKER_01: Yeah, which it's like when you say it's there's like multi levels of it.
• 18:39
  SPEAKER_01: You know, it's not could be genetic based.
• 18:42
  SPEAKER_01: Maybe not.
• 18:44
  SPEAKER_01: In regards to.
• 18:45
  SPEAKER_00: Yeah.
• 18:46
  SPEAKER_01: Yeah.
• 18:48
  SPEAKER_00: I mean, I think of so if you want to break it down, I think addiction has like sort of
• 18:54
  SPEAKER_00: I like to think about disease in the biopsychosocial model.
• 18:59
  SPEAKER_00: So addiction,
• 19:01
  SPEAKER_00: like many diseases,
• 19:02
  SPEAKER_00: whether it's diabetes or heart disease,
• 19:06
  SPEAKER_00: there are biological roots, there's psychological roots, and there's social roots.
• 19:10
  SPEAKER_00: And I think the degree to which biology,
• 19:13
  SPEAKER_00: psychology,
• 19:14
  SPEAKER_00: and your life, social life, undergird your addiction depends on the person.
• 19:22
  SPEAKER_01: Mm-hmm.
• 19:23
  SPEAKER_00: So some people have an addiction to alcohol through a genetic predisposition.
• 19:30
  SPEAKER_00: Some people have an addiction to alcohol because of a depression and an urge
• 19:36
  SPEAKER_00: to medicate dysthymia or dysphoria, like low moods.
• 19:41
  SPEAKER_00: Some people have an addiction because they were born into a family with addiction
• 19:46
  SPEAKER_00: and that's all they knew.
• 19:47
  SPEAKER_00: And some people have the biological, psychological, social roots all together.
• 19:52
  SPEAKER_00: So I think The reason that matters is because I think it's important to understand
• 19:56
  SPEAKER_00: in each individual what the roots are because understanding what the roots are can
• 20:00
  SPEAKER_00: then help you target the right intervention.
• 20:05
  SPEAKER_00: You and I were talking before we got on the call here that I was talking
• 20:10
  SPEAKER_00: about how Ozempic and Zetbound,
• 20:12
  SPEAKER_00: the GLP-1 medicines that are used widespread for weight loss and Type 2 diabetes are
• 20:19
  SPEAKER_00: so interesting to me.
• 20:20
  SPEAKER_00: They're very sophisticated medications.
• 20:23
  SPEAKER_00: They're extraordinarily effective at helping patients with type 2 diabetes
• 20:27
  SPEAKER_00: and obesity lose weight and unlock that metabolic insufficiency that has driven
• 20:32
  SPEAKER_00: a lot of shame and disease.
• 20:36
  SPEAKER_00: What's fascinating is those medicines also help people crave alcohol less.
• 20:42
  SPEAKER_01: Okay.
• 20:42
  SPEAKER_00: And I'm using them off-label.
• 20:44
  SPEAKER_01: Yeah.
• 20:45
  SPEAKER_00: For maybe five or six patients I have,
• 20:47
  SPEAKER_00: patients who don't need to lose weight,
• 20:48
  SPEAKER_00: patients who don't have diabetes,
• 20:50
  SPEAKER_00: for the GLP-1's ability to help them not crave alcohol.
• 20:57
  SPEAKER_00: And what's really cool about that is that A, it works, not universally.
• 21:02
  SPEAKER_00: It's not like a vaccine.
• 21:05
  SPEAKER_00: It doesn't inoculate you against alcohol cravings.
• 21:09
  SPEAKER_00: But B, that when it does work,
• 21:12
  SPEAKER_00: What it does is,
• 21:13
  SPEAKER_00: and if people don't,
• 21:14
  SPEAKER_00: they're not interested in alcohol,
• 21:16
  SPEAKER_00: or they're drinking less,
• 21:17
  SPEAKER_00: like they're able to execute on their intention with alcohol.
• 21:21
  SPEAKER_00: What it shows people is that their alcohol overuse,
• 21:25
  SPEAKER_00: dependence,
• 21:26
  SPEAKER_00: tolerance, addiction, before the GLP one, wasn't a willpower problem to begin with.
• 21:31
  SPEAKER_00: It was biology, right?
• 21:33
  SPEAKER_00: Because they aren't a different person.
• 21:34
  SPEAKER_00: They aren't a stronger, more, you know, person the next day.
• 21:39
  SPEAKER_00: And maybe they have shamed themselves for not being strong or willpowered enough to cut back.
• 21:46
  SPEAKER_00: But instead,
• 21:46
  SPEAKER_00: they're taking a medication that occupies the dopamine receptor in the brain
• 21:50
  SPEAKER_00: that helps them crave less the thing they're compelled
• 21:53
  SPEAKER_00: to use despite their knowledge or desire not to.
• 21:57
  SPEAKER_00: So that's what's really interesting.
• 21:58
  SPEAKER_00: That speaks to the biology of addiction right there.
• 22:00
  SPEAKER_01: Yeah.
• 22:02
  SPEAKER_01: Do you feel like the GLP-1 is too soon to tell, like,
• 22:05
  SPEAKER_01: does a person have to stay on this drug for the rest of their life in order to,
• 22:10
  SPEAKER_01: like,
• 22:11
  SPEAKER_01: control their relationship with it if they didn't want to drink or if they came off
• 22:16
  SPEAKER_01: when they go back?
• 22:18
  SPEAKER_00: So I think that we don't know.
• 22:22
  SPEAKER_00: But if you apply the lessons we've learned today,
• 22:27
  SPEAKER_00: On the GLP-1s with regard to obesity and compulsive eating or overeating
• 22:31
  SPEAKER_00: or emotional eating or eating beyond hunger,
• 22:35
  SPEAKER_00: which is the mechanism by which a large share of my patients
• 22:40
  SPEAKER_00: with obesity have struggled with.
• 22:43
  SPEAKER_00: And you see how well patients on GLP-1s are able
• 22:48
  SPEAKER_00: to finally regulate their relationship with food.
• 22:52
  SPEAKER_00: And they feel like for the first time in their life,
• 22:54
  SPEAKER_00: they're not walking around like with a tiger on a leash.
• 22:57
  SPEAKER_00: Like my patients who have struggled with obesity are not people who are like lazy
• 23:01
  SPEAKER_00: or unaware of the harms of excess weight or they aren't people
• 23:06
  SPEAKER_00: who are not exercising.
• 23:07
  SPEAKER_00: They're smart, motivated, educated, right?
• 23:09
  SPEAKER_00: Like they want to lose the 50 pounds or the 100 pounds.
• 23:13
  SPEAKER_00: And then when they get on a Zempick,
• 23:14
  SPEAKER_00: they see with their eyes wide open that their relationship with food is one that is
• 23:22
  SPEAKER_00: That is calibrated to hunger and satiety instead of some urge that was
• 23:25
  SPEAKER_00: beyond their control.
• 23:27
  SPEAKER_00: So there are people who will need to be on GLP-1s for that relationship
• 23:33
  SPEAKER_00: with food issue, probably in perpetuity.
• 23:36
  SPEAKER_00: And there are people who have used the learnings,
• 23:40
  SPEAKER_00: the insight, the self-awareness, the power of the medicine to then taper off of it.
• 23:44
  SPEAKER_00: It's the same thing with alcohol.
• 23:45
  SPEAKER_00: So I don't know how the data will play out.
• 23:48
  SPEAKER_00: We don't actually have It's not FDA approved right now for alcohol use disorder.
• 23:53
  SPEAKER_00: So I don't,
• 23:54
  SPEAKER_00: not a lot of people are prescribing it as far as I know for this reason,
• 23:58
  SPEAKER_00: but it's hard not to use it when it's so effective in the right person.
• 24:03
  SPEAKER_01: Yeah, true.
• 24:04
  SPEAKER_01: Absolutely.
• 24:04
  SPEAKER_01: Yeah.
• 24:08
  SPEAKER_01: So when, you know, you're working with your patients, you know, how...
• 24:16
  SPEAKER_01: How do you go a bit deeper in regards to seeing what they need in regards to
• 24:21
  SPEAKER_01: that relationship they have with it?
• 24:25
  SPEAKER_00: So it goes back to that biopsychosocial question.
• 24:32
  SPEAKER_00: I think I've found in 25 years of caring for patients that people
• 24:38
  SPEAKER_00: who are drinking more than they'd like or more than they, quote,
• 24:42
  SPEAKER_00: should often haven't Thought deeply about the psychological underpinnings
• 24:51
  SPEAKER_00: of their alcohol use.
• 24:59
  SPEAKER_00: You know,
• 25:00
  SPEAKER_00: sometimes because the alcohol was not allowing them to access those feelings
• 25:04
  SPEAKER_00: or thoughts that were uncomfortable.
• 25:07
  SPEAKER_00: And because it provided a handy place to kind of park those feelings, right?
• 25:11
  SPEAKER_00: Right.
• 25:12
  SPEAKER_00: So I think what is interesting is asking people a question like to kind
• 25:19
  SPEAKER_00: of like slow down the impulse between feeling like you need a drink and
• 25:25
  SPEAKER_00: then grabbing for it and trying to identify like what is happening in your body
• 25:30
  SPEAKER_00: and what is happening in your mind.
• 25:33
  SPEAKER_00: And for a lot of people, that sounds like a really weird question.
• 25:36
  SPEAKER_00: And they're like, what are you talking about?
• 25:38
  SPEAKER_00: Like, I just like wine.
• 25:41
  SPEAKER_00: And some people are like, that's a really interesting question.
• 25:45
  SPEAKER_00: I've never thought about that.
• 25:48
  SPEAKER_00: But even planting the seed for patients who are very literal,
• 25:50
  SPEAKER_00: like, oh, I just drink wine because it's legal and it's like after work.
• 25:53
  SPEAKER_00: And what do you mean it's a problem?
• 25:56
  SPEAKER_00: Well, maybe it's not, but let's figure out what are we treating?
• 25:58
  SPEAKER_00: What are we addressing?
• 25:59
  SPEAKER_00: Maybe you're not treating anything.
• 26:00
  SPEAKER_00: Maybe you're just like it with your steak.
• 26:04
  SPEAKER_00: But I think when you can ask people to slow it down and try
• 26:06
  SPEAKER_00: to identify what it's doing for them and maybe against them,
• 26:11
  SPEAKER_00: That's where the insight is born, right?
• 26:13
  SPEAKER_00: That's where the insight is born about what's actually going on beneath the surface, right?
• 26:17
  SPEAKER_00: I mean, to the extent that to me, health is about...
• 26:22
  SPEAKER_00: If I were to find health to you, Josh, to me, it's...
• 26:26
  SPEAKER_00: And for me personally,
• 26:26
  SPEAKER_00: but also what I try to think of for my patients is like the integration
• 26:31
  SPEAKER_00: of our conscious mind and our unconscious mind, right?
• 26:35
  SPEAKER_00: Like we live on the surface of consciousness.
• 26:37
  SPEAKER_00: Like we react to thoughts and feelings every day.
• 26:39
  SPEAKER_00: We're like...
• 26:40
  SPEAKER_00: You know,
• 26:40
  SPEAKER_00: rowing on a boat on the top of the ocean surface,
• 26:43
  SPEAKER_00: reacting to the waves and kind of like, you know, going about our day.
• 26:48
  SPEAKER_00: But below the surface of the ocean is a whole world and universe of thoughts
• 26:54
  SPEAKER_00: and feelings that are untapped, that are unexamined, that are unexplored.
• 26:57
  SPEAKER_00: So to the extent that alcohol is a very handy way to like push down
• 27:03
  SPEAKER_00: the unconscious thoughts and feelings that bubble up and cause turbulence...
• 27:07
  SPEAKER_00: Sometimes people don't have to explore what's under them, what's under the hood.
• 27:11
  SPEAKER_00: I'm mangling and mixing so many metaphors right here.
• 27:14
  SPEAKER_00: Bear with me.
• 27:15
  SPEAKER_01: No, it's good.
• 27:16
  SPEAKER_00: But what I'm saying is that what's so interesting to me
• 27:20
  SPEAKER_00: about human beings is their ability or difficulty with which they are able
• 27:28
  SPEAKER_00: to access their unconscious mind.
• 27:32
  SPEAKER_00: Because accessing your unconscious mind,
• 27:34
  SPEAKER_00: if you're willing to be curious about yourself,
• 27:37
  SPEAKER_00: you're willing to be honest and you're willing to think beyond just
• 27:42
  SPEAKER_00: the surface layer of your thoughts is really where agency comes from.
• 27:47
  SPEAKER_00: I mean, our thoughts and our feelings drive our behaviors.
• 27:52
  SPEAKER_00: Our behaviors drive our health.
• 27:54
  SPEAKER_00: So if you aren't thinking about how you think and feel and how you think and feel
• 27:58
  SPEAKER_00: and then how you behave,
• 28:01
  SPEAKER_00: I think you're really missing an opportunity to be an agent of change
• 28:04
  SPEAKER_00: in your own life.
• 28:05
  SPEAKER_00: And so to the extent alcohol is a common sort of blocker of agency for people,
• 28:13
  SPEAKER_00: I think the interesting question is what's going on under the surface
• 28:19
  SPEAKER_00: in your unconscious mind that's driving the habit.
• 28:23
  SPEAKER_00: But, you know,
• 28:24
  SPEAKER_00: as you know,
• 28:24
  SPEAKER_00: for a lot of people,
• 28:24
  SPEAKER_00: that's not something they want to do or it also can be very uncomfortable.
• 28:31
  SPEAKER_00: It can be very painful, right?
• 28:33
  SPEAKER_00: I mean, not everybody wants to be,
• 28:35
  SPEAKER_00: even if they're curious, they don't want to know what's under there.
• 28:38
  SPEAKER_01: It's like the ignorance is bliss, like in Matrix, he's eating a steak, you know?
• 28:44
  SPEAKER_00: Yeah.
• 28:44
  SPEAKER_01: It's just like, I don't want to sit with these uncomfortable feelings.
• 28:49
  SPEAKER_01: So like, but if,
• 28:51
  SPEAKER_01: you know,
• 28:52
  SPEAKER_01: being that you practice this, like, what would you suggest are ways that people...
• 28:59
  SPEAKER_01: Could use to cope and help with their health outside of alcohol.
• 29:05
  SPEAKER_00: So if you're asking me, like,
• 29:07
  SPEAKER_00: what are some healthy coping tools that can allow you
• 29:12
  SPEAKER_00: to process whatever's underneath the surface subconsciously and as opposed
• 29:18
  SPEAKER_00: to alcohol?
• 29:20
  SPEAKER_00: I mean, I think it depends on the person,
• 29:21
  SPEAKER_00: but I think self-compassion is a great thing to practice.
• 29:25
  SPEAKER_00: Yeah.
• 29:27
  SPEAKER_00: I wrote on a prescription pad for a patient a couple of weeks ago, self-compassion.
• 29:31
  SPEAKER_00: She came in, she's caregiving for an elderly mother.
• 29:34
  SPEAKER_00: She's got a very busy job.
• 29:36
  SPEAKER_00: She started drinking more alcohol to kind of numb out from a busy day and the stress
• 29:40
  SPEAKER_00: of all the responsibilities she has.
• 29:43
  SPEAKER_00: And she was shaming and blaming herself for drinking more alcohol.
• 29:46
  SPEAKER_00: She knew exactly what she was doing,
• 29:48
  SPEAKER_00: drinking more coffee,
• 29:49
  SPEAKER_00: you know, feeling wired and tired and miserable and her labs were abnormal.
• 29:54
  SPEAKER_00: And she's like, you know, thought I was going to be mad at her.
• 29:56
  SPEAKER_00: And I'm like, oh my gosh, I'm not mad at you.
• 29:58
  SPEAKER_00: I said, what you need first and foremost is self-compassion.
• 30:02
  SPEAKER_00: Like, give yourself a break, my friend.
• 30:05
  SPEAKER_00: You're holding so much responsibility.
• 30:08
  SPEAKER_00: You're doing what a lot of people do, which is like grab a drink to take a load off.
• 30:13
  SPEAKER_00: Like, stop it with the shaming.
• 30:15
  SPEAKER_00: Self-compassion first.
• 30:17
  SPEAKER_00: So, you know, practicing self-compassion is a good thing to do.
• 30:23
  SPEAKER_00: Other ways to manage stress and that are healthy coping strategies.
• 30:27
  SPEAKER_00: I mean, exercise.
• 30:29
  SPEAKER_00: I don't need to tell anybody here that exercise is good for you, but exercise is good for you.
• 30:35
  SPEAKER_00: It's good for mind, body, spirit.
• 30:38
  SPEAKER_00: And as I say to my patients,
• 30:39
  SPEAKER_00: it doesn't have to be fancy or formal or, you know, inexpensive gym clothes.
• 30:44
  SPEAKER_00: It just has to be movement.
• 30:45
  SPEAKER_00: So find something you like to do.
• 30:47
  SPEAKER_00: Find something that, you know, you're inclined.
• 30:50
  SPEAKER_00: The best exercise program for you is the one that you will actually do.
• 30:55
  SPEAKER_00: I mean, community.
• 30:55
  SPEAKER_00: I think we have an epidemic of loneliness.
• 30:59
  SPEAKER_00: I think loneliness drives alcohol overuse.
• 31:01
  SPEAKER_00: Alcohol use drives loneliness.
• 31:04
  SPEAKER_00: I think alcohol is not the only reason why there's a loneliness epidemic.
• 31:07
  SPEAKER_00: I think we live in a lonely time where people are more connected by social media,
• 31:13
  SPEAKER_00: but then less connected because of the way the world is going.
• 31:16
  SPEAKER_00: And so I think being in community is huge and an important investment in your health.
• 31:23
  SPEAKER_00: Even if you're an introvert,
• 31:25
  SPEAKER_00: I think finding your people and making routines around social activities is huge.
• 31:34
  SPEAKER_00: I think finding things that bring you joy and contentedness and peace,
• 31:40
  SPEAKER_00: whether that's doing the crossword puzzle or reading a book or having hobbies.
• 31:46
  SPEAKER_00: So...
• 31:50
  SPEAKER_00: And those are just a few things.
• 31:51
  SPEAKER_00: I mean, also a huge believer in therapy.
• 31:53
  SPEAKER_00: I'm a huge believer in AA and Aladon and,
• 31:58
  SPEAKER_00: you know,
• 31:58
  SPEAKER_00: whatever you need to make sense of what you're dealing with,
• 32:03
  SPEAKER_00: to have community and support and then people to ask for help.
• 32:10
  SPEAKER_00: Because I think it's a lot to do life alone.
• 32:13
  SPEAKER_00: I think it's a lot to manage, you know, behavioral change alone.
• 32:19
  SPEAKER_00: I think that's why AA has been so successful.
• 32:20
  SPEAKER_00: I don't know what your thoughts are on AA, Josh,
• 32:23
  SPEAKER_00: but it's not for everybody,
• 32:25
  SPEAKER_00: but for so many of my patients and certainly for members of my own family,
• 32:29
  SPEAKER_00: it's been extraordinarily helpful as a place.
• 32:33
  SPEAKER_00: Yeah.
• 32:35
  SPEAKER_01: Yeah, I didn't have much involvement with AA, but I definitely support it.
• 32:41
  SPEAKER_01: I think what you're leaning towards is there's so many tools out there
• 32:45
  SPEAKER_01: that it's just being curious and trying and seeing what works for you.
• 32:51
  SPEAKER_01: I think it's really interesting that you point out it's like we're in a world
• 32:57
  SPEAKER_01: where we're way more connected, but we feel way more isolated and lonely.
• 33:05
  SPEAKER_01: Given we're on these devices and such, and that could be another form of addiction.
• 33:11
  SPEAKER_01: It can be.
• 33:13
  SPEAKER_01: I'm so curious.
• 33:16
  SPEAKER_01: I don't know.
• 33:19
  SPEAKER_01: I see these things, and it's like we are connected, but at the same time, it's like we're not.
• 33:27
  SPEAKER_01: Do you see that more in your patients over the years and health overall?
• 33:35
  SPEAKER_00: I do.
• 33:35
  SPEAKER_00: I mean, my older patients I worry about with loneliness and isolation.
• 33:40
  SPEAKER_00: You know, back in the old days, we lived multi-generational families in the same home, right?
• 33:47
  SPEAKER_00: And people are so spread out.
• 33:50
  SPEAKER_00: Devices can give you this false sense of connection when they actually can be kind of isolating.
• 33:54
  SPEAKER_00: So I do, like,
• 33:58
  SPEAKER_00: one of the things I commonly recommend to patients who are widowed or
• 34:03
  SPEAKER_00: who are Older is to make sure that they are connecting with other people.
• 34:09
  SPEAKER_00: And it's not just older patients.
• 34:10
  SPEAKER_00: I mean, just in general, I think social connection is a hugely important part of being healthy.
• 34:19
  SPEAKER_00: So, yeah, that is...
• 34:20
  SPEAKER_00: I don't know if you follow Dr.
• 34:22
  SPEAKER_00: Murthy, Vivek Murthy, who is the Surgeon General under Obama and then under Biden.
• 34:29
  SPEAKER_00: And his whole...
• 34:30
  SPEAKER_00: He's on Substack, too.
• 34:31
  SPEAKER_00: His whole...
• 34:34
  SPEAKER_00: His whole jam is about the loneliness epidemic and fighting it with more connection,
• 34:40
  SPEAKER_00: more human-to-human connection.
• 34:43
  SPEAKER_00: So I think because it's part of health.
• 34:46
  SPEAKER_01: Yeah.
• 34:47
  SPEAKER_01: So it's so key.
• 34:48
  SPEAKER_01: I mean, it's like we're meant to be connected, you know, like a pack and such.
• 34:53
  SPEAKER_01: And so, yeah, it's just finding your people.
• 34:57
  SPEAKER_01: What about creativity?
• 34:59
  SPEAKER_01: What do you do for that?
• 35:01
  SPEAKER_00: Oh, my gosh.
• 35:01
  SPEAKER_00: So creativity...
• 35:04
  SPEAKER_00: So I write, as you know.
• 35:06
  SPEAKER_00: Writing is my way of taking the noise in my brain and all the subconscious noise
• 35:15
  SPEAKER_00: that bubbles up and processing it and thinking it through.
• 35:22
  SPEAKER_00: So I've always been a journaler.
• 35:23
  SPEAKER_00: I don't know, when I was a little kid, I was just drawn to writing things down.
• 35:30
  SPEAKER_00: For me, journaling when I was a kid was a way of making thoughts less Overwhelming
• 35:35
  SPEAKER_00: or less scary.
• 35:36
  SPEAKER_00: It's like externalizing things and putting them on a piece of paper.
• 35:39
  SPEAKER_00: It helped me make sense of thoughts instead of them like sitting around,
• 35:42
  SPEAKER_00: pinging around like a ping pong wall.
• 35:44
  SPEAKER_00: So writing is my form of creativity.
• 35:47
  SPEAKER_00: My main form.
• 35:48
  SPEAKER_00: Also like clothing.
• 35:50
  SPEAKER_00: Like this sounds maybe weird, but like I am such a clothes, like fashion person.
• 35:57
  SPEAKER_00: Like you wouldn't necessarily know that.
• 36:01
  SPEAKER_00: But like,
• 36:03
  SPEAKER_00: And it doesn't sound like necessarily fancy, but I love clothes as a form of self-expression.
• 36:10
  SPEAKER_00: Like my mom had a clothing business when we were growing up.
• 36:13
  SPEAKER_00: She made all of our clothes.
• 36:15
  SPEAKER_00: And then she had a business, like a cottage industry.
• 36:17
  SPEAKER_00: And like, I just find it so fun.
• 36:19
  SPEAKER_00: It's like an art form.
• 36:21
  SPEAKER_00: And so that's my,
• 36:22
  SPEAKER_00: that's like my,
• 36:23
  SPEAKER_00: that's my,
• 36:24
  SPEAKER_00: I'd say it's my guilty pleasure,
• 36:25
  SPEAKER_00: but I'm not that, I don't feel that guilty about it.
• 36:27
  SPEAKER_00: Like, that's just, that's just what I, like, I love clothes.
• 36:31
  SPEAKER_00: And I think it was a creative outlet.
• 36:34
  SPEAKER_00: Getting dressed every morning,
• 36:35
  SPEAKER_00: maybe not every morning is fun, but it's a way of respecting myself.
• 36:42
  SPEAKER_00: It's a way of creativity.
• 36:43
  SPEAKER_00: It's self-expression.
• 36:44
  SPEAKER_00: And so that to me is really fun.
• 36:46
  SPEAKER_00: There's a consignment store near my neighborhood, and I am known there.
• 36:52
  SPEAKER_00: You know that show Cheers?
• 36:55
  SPEAKER_01: Yeah.
• 36:56
  SPEAKER_01: I know your name.
• 36:58
  SPEAKER_00: No, Norm.
• 36:59
  SPEAKER_00: You know, Norm would walk into Cheers and everyone would go, Norm.
• 37:02
  SPEAKER_00: I go into this consignment and everyone's like, Lissy.
• 37:04
  SPEAKER_00: Because I go there and I send my friends there.
• 37:07
  SPEAKER_00: And it's just this like, it's community.
• 37:09
  SPEAKER_00: It's community and it's fashion and it's creative and it's fun.
• 37:12
  SPEAKER_00: And then I have, my brother is a professional musician.
• 37:16
  SPEAKER_00: My son is a musician.
• 37:17
  SPEAKER_00: Like I grew up with a lot of creatives in my family.
• 37:20
  SPEAKER_00: And I've always seen, and I was an art history major in college.
• 37:23
  SPEAKER_00: I've always seen creativity And beauty and art and music as,
• 37:29
  SPEAKER_00: you know, wonderful escapes and also wonderful ways to be in the present moment.
• 37:36
  SPEAKER_01: Yeah.
• 37:36
  SPEAKER_01: And just talk about the unconscious connection,
• 37:39
  SPEAKER_01: you know,
• 37:40
  SPEAKER_01: is through that,
• 37:41
  SPEAKER_01: through that part form that you are connecting deeper with yourself.
• 37:47
  SPEAKER_00: That's right.
• 37:48
  SPEAKER_01: Yeah.
• 37:49
  SPEAKER_01: Yeah.
• 37:49
  SPEAKER_01: I mean, like when you go in the consignment store, do you have an idea in your head already or?
• 37:55
  SPEAKER_01: Do you, does it pop when you get in there?
• 37:57
  SPEAKER_01: Yeah.
• 37:58
  SPEAKER_00: No, it just like, that's, what's fun about it is it's like, it's like the spirit moves you.
• 38:01
  SPEAKER_00: Do you know what I mean?
• 38:02
  SPEAKER_00: Like I never,
• 38:03
  SPEAKER_00: ever shop Josh with like something,
• 38:05
  SPEAKER_00: like I'm not the person who's like, I need a white t-shirt.
• 38:07
  SPEAKER_00: I'm going to go find a white t-shirt.
• 38:09
  SPEAKER_00: I'm just like, I'm like a canvas that I'm always like painting on.
• 38:12
  SPEAKER_00: Do you know?
• 38:14
  SPEAKER_00: I mean, my husband is definitely like, don't you have like seven pairs of like black shoes?
• 38:20
  SPEAKER_01: I'm like, oh, but that is, that is
• 38:22
  SPEAKER_00: not the point at all.
• 38:23
  SPEAKER_00: Like, just, just step aside.
• 38:24
  SPEAKER_00: Like, That is the wrong question.
• 38:29
  SPEAKER_00: Yeah.
• 38:30
  SPEAKER_00: No, it's not the point.
• 38:31
  SPEAKER_00: It's about how you feel.
• 38:32
  SPEAKER_00: It's about the silhouette.
• 38:34
  SPEAKER_00: It's about the emotional valence of what this piece of art looks like on your foot.
• 38:41
  SPEAKER_00: You know what I mean?
• 38:43
  SPEAKER_01: Yeah.
• 38:44
  SPEAKER_01: Yeah.
• 38:45
  SPEAKER_01: That's so good.
• 38:46
  SPEAKER_01: So good.
• 38:46
  SPEAKER_01: Thank you, Lucy.
• 38:48
  SPEAKER_01: Yeah, I think we'll get close to wrapping up.
• 38:53
  SPEAKER_01: I just want to take a moment for everybody that's here.
• 38:55
  SPEAKER_01: This is Lucy's book that she just came out with.
• 39:01
  SPEAKER_01: And I'm going to say I think it's like a Bible of health.
• 39:07
  SPEAKER_01: I think it's really strong.
• 39:09
  SPEAKER_01: It's really, really good, Lucy.
• 39:11
  SPEAKER_01: So I haven't been able to fully finish it yet, but the way that she's...
• 39:17
  SPEAKER_01: The way that you've structured it and everything is just so easy to read and there's
• 39:25
  SPEAKER_01: so much value in it.
• 39:27
  SPEAKER_01: So thank you.
• 39:28
  SPEAKER_00: I appreciate that.
• 39:29
  SPEAKER_00: It's really meant to be, like I said in the beginning, it's not a do as I say book.
• 39:32
  SPEAKER_00: It's not a here's how to live forever in five steps.
• 39:39
  SPEAKER_00: It's really a here's how to think about your health.
• 39:41
  SPEAKER_00: Here's how to take stock of your interiority, your biography.
• 39:47
  SPEAKER_00: The things you're embarrassed to say out loud,
• 39:50
  SPEAKER_00: all the parts of your health that you don't have time to talk to your doctor about.
• 39:52
  SPEAKER_00: And here's how to map out your health so that you have a more sort of authentic
• 39:58
  SPEAKER_00: and deeper rendering of your health to then show up at your doctor's office
• 40:04
  SPEAKER_00: with sort of yourself as like with a more honest rendering of yourself at
• 40:09
  SPEAKER_00: the doctor's office.
• 40:10
  SPEAKER_00: And here's how to talk to yourself.
• 40:12
  SPEAKER_00: Here are the questions you want to ask yourself.
• 40:15
  SPEAKER_00: So my argument really is that health isn't about having all the answers.
• 40:20
  SPEAKER_00: Having answers and solutions are nice.
• 40:23
  SPEAKER_00: But it starts with asking yourself the right questions and asking
• 40:27
  SPEAKER_00: the right questions to the people responsible for your care.
• 40:31
  SPEAKER_00: And so it's basically a library of questions to ask yourself and your doctor
• 40:34
  SPEAKER_00: to squeeze the juice out of that 15-minute transactional appointment
• 40:37
  SPEAKER_00: where they ask you, how many drinks do you have a week?
• 40:39
  SPEAKER_00: And you're like, ugh.
• 40:42
  SPEAKER_01: It does go by quick.
• 40:44
  SPEAKER_01: You can kind of sit there like, oh, did that just happen?
• 40:47
  SPEAKER_01: Yeah.
• 40:49
  SPEAKER_01: I waited two hours for this?
• 40:51
  SPEAKER_00: Yeah, and it's like a box checking exercise.
• 40:54
  SPEAKER_00: And that's the way medicine is.
• 40:58
  SPEAKER_00: And doctors are not happy about it.
• 41:00
  SPEAKER_00: Patients are not happy about it.
• 41:02
  SPEAKER_00: So my greatest hope is that we reinvent the healthcare system.
• 41:04
  SPEAKER_00: I'd love to be part of that conversation.
• 41:06
  SPEAKER_00: Yeah.
• 41:08
  SPEAKER_00: So that everybody has access to a primary care doctor or provider
• 41:13
  SPEAKER_00: who knows their name, not just their diagnosis codes.
• 41:16
  SPEAKER_00: I mean, that should be a right, not a privilege, right?
• 41:19
  SPEAKER_01: Yes.
• 41:20
  SPEAKER_01: We could go on and on about that.
• 41:23
  SPEAKER_01: So, well, thank you for your time and all this wisdom.
• 41:28
  SPEAKER_01: And yeah,
• 41:29
  SPEAKER_01: if you want to let everybody know where they can find your book
• 41:32
  SPEAKER_01: and what you're working on.
• 41:33
  SPEAKER_00: Sure.
• 41:34
  SPEAKER_01: Yeah.
• 41:35
  SPEAKER_00: So my book you can find on Amazon or anywhere you buy books.
• 41:40
  SPEAKER_00: You can go to my website, lucymcbride.com.
• 41:44
  SPEAKER_00: And you can also sign up for my Substack.
• 41:45
  SPEAKER_00: It's free.
• 41:46
  SPEAKER_00: And each week I write about a different topic.
• 41:48
  SPEAKER_00: Like this week I wrote about, is your aura ring wearing you?
• 41:52
  SPEAKER_00: Or I write about GLP-1s or I write about heart health.
• 41:55
  SPEAKER_00: It's free information for anyone who's looking for help making sense
• 42:02
  SPEAKER_00: of this crazy life we all live.
• 42:06
  SPEAKER_01: One day at a time.
• 42:07
  SPEAKER_00: One day at a time.
• 42:08
  SPEAKER_00: Amen.
• 42:11
  SPEAKER_01: Oh, man.
• 42:12
  SPEAKER_01: Well, thank you again, Dr. Lucy.
• 42:15
  SPEAKER_01: I appreciate it.
• 42:15
  SPEAKER_01: Thank you.
• 42:16
  SPEAKER_01: Everybody that's been here and spent time with us.
• 42:18
  SPEAKER_01: Thank you so, so much.
• 42:20
  SPEAKER_00: Thank you for joining us.
• 42:21
  SPEAKER_00: All right, Josh, I'll see you around the hood.
• 42:24
  SPEAKER_01: Sounds good.
• 42:25
  SPEAKER_01: Have a good weekend.
• 42:25
  SPEAKER_00: Okay, bye, Josh.
• 42:26
  SPEAKER_01: Goodbye, everybody.
• 42:27
  SPEAKER_01: Bye.