Health Archives | The Art of Manliness

The SEEDS Framework for Boosting Testosterone Naturally

Brett & Kate McKay — Mon, 30 Mar 2026 15:27:30 +0000

I’ve been writing about testosterone on this site for over a decade because testosterone is an important part of a man’s overall health and wellness. It helps with strength and muscle mass, strengthens your bones, improves your sexual health, and boosts your mood.

You’ll find a lot of information out there on the interwebs about how to increase your testosterone naturally. Cold showers, taking testosterone-boosting supplements, and even exposing your balls to red light.

But after talking to experts on the podcast about testosterone and reading a ton of research on the topic, the conclusion I’ve come to is this: hormone health comes down to consistently doing the boring stuff.

Several years ago, I spoke with fitness coach Vic Verdier on the podcast about how men can combat the fall-off in vitality that can come with aging, including the natural decline in testosterone. His answer was taking care of the fundamentals.

Vic uses an acronym he calls SEEDS to capture the basics of what you need to do to keep your T-levels healthy. It stands for Sleep, Exercise, Environment, Diet, and Stress.

Let’s talk about each of the testosterone-improving components of the SEEDS framework:

Sleep

A large portion of daily testosterone production happens during sleep. So if your sleep consistently sucks, your testosterone drops. When researchers at the University of Chicago restricted young men to five hours of sleep a night for one week, their testosterone levels fell 10-15%. Aim for 6.5 to 9 hours a night.

If you’re looking for ways you can improve your sleep, check out these AoM articles and podcast episodes:

Exercise

Exercise helps to boost testosterone by increasing muscle mass and decreasing body fat. Carrying around too much body fat isn’t good for T because body fat converts testosterone into estrogen; the less fat we store, the more T we have.

Two forms of exercise are particularly helpful for increasing testosterone. The first is lifting heavy weights with compound lifts that target large muscle groups, such as the squat, deadlift, and shoulder press, and taking adequate rest between sets. The second is HIIT or “High Intensity Interval Training,” which calls for short, intense bursts of effort, followed by periods of less-intense recovery.

But beyond regimented exercise, Vic recommends just staying active throughout the day. Your body wasn’t designed to do 45 minutes of structured exercise while being parked in a chair for the other 15 waking hours. Walk. Do yard work. Play catch with your kids. All those little “movement snacks” can keep your body running like a finely tuned machine, including the parts that manage hormones.

Environment

Vic’s specific point here is about sunshine and vitamin D, which is closely linked to testosterone production. If you’re spending most of your waking hours under fluorescent lights and only seeing the sun through your windshield on the commute, you’re probably falling short. So get outside more. Eat lunch in the sun. Take your phone calls on a walk. If you live somewhere that gets dark for months during the winter, use some tactics to get more sun during this cold and dreary season. It may be worth supplementing with vitamin D3. But actual sunlight on your skin is the goal.

Besides helping with vitamin D production, getting outside can also help manage stress, which, as we’ll see in a second, is another important factor in hormone health.

Another factor to think about when it comes to your environment and healthy testosterone levels is to make sure you’re not bathing in T-killing chemicals. Pesticides and industrial chemicals can dampen testosterone (and can cause cancer), so definitely limit your exposure to that stuff. Wash produce thoroughly, eat/drink from glass or stainless steel containers when possible, and limit use of products with heavy chemical fragrances or pesticides around the home.

You also want to reduce your exposure to xenoestrogens that are found in a lot of consumer products. Xenoestrogen is a chemical that imitates estrogen in the human body. When men are exposed to too much of this estrogen-imitating chemical, T levels can drop. The problem is xenoestrogen is freaking everywhere — plastics, shampoos, gasoline, cows, toothpaste. You name it, and there’s a good chance there’s xenoestrogen in it. I wouldn’t spend too much mental bandwidth trying to buy products that are completely xenoestrogen-free. Just don’t microwave your food in plastic containers and don’t lick your CVS receipts, and you’ll probably be fine.

Diet

You don’t need to do any special T-boosting diets like eating Ron Swanson amounts of eggs or consuming three Brazil nuts before you go to bed because the selenium will boost testosterone production while you sleep.

Just eat a balanced and varied diet. Get enough protein. Get enough carbs to fuel workouts. Get a moderate amount of fat for hormone health. Research suggests that about 20% to 40% of your calories should come from fat for healthy testosterone levels. Eat plenty of fruits and vegetables to get the micronutrients your body needs for hormones. If your diet is solid, you’ll probably have no reason to supplement.

Diet can also help with fat loss, which will help reduce estrogen and increase T. For help with nutrition, check out these articles and podcast episodes:

Stress

Cortisol and testosterone compete for resources in your body. When cortisol is jacked up all the time from work, doomscrolling, or a schedule crammed too full, testosterone suffers. I think managing stress is particularly important for guys in their 30s, 40s, and 50s who are running hard and wondering why they feel depleted. Vic’s prescription is to build a life with some margin. Give yourself some time to chill the heck out. Take up a hobby. Become a cinephile. Download the Headspace app and meditate if you have to. Getting better sleep will also help with stress, so make that a priority.

None of these are exotic interventions for boosting T-levels. They don’t require a lot of time or money or exposing your balls to red light. Do them consistently, and your hormone health should be fine.

But…

If you’re doing all of this consistently and you still have symptoms of low T (low energy, brain fog, declining strength, low libido, low motivation), get your levels checked and talk to a doctor about whether testosterone replacement therapy makes sense. But make it the last option, not the first. Get the basics right and your body will usually handle the rest.

More testosterone-related AoM podcast episodes:

For more tips on maintaining your edge as you age, listen to our whole podcast with Vic Verdier:

This article was originally published on The Art of Manliness.

Podcast #1,109: The Hidden Power of Heat — How a Good Sweat Heals Your Body and Mind

Brett & Kate McKay — Tue, 17 Mar 2026 14:29:01 +0000

Cold exposure has gotten a lot of attention the past few years, with people dunking themselves in ice baths for the sake of their health and well-being. But, good news here, exposing yourself to heat by sitting in the sauna or even a hot tub, might actually be even better for you, not to mention more pleasant.

In his new book, Hotwired: How the Hidden Power of Heat Makes Us Stronger, Bill Gifford unpacks the dichotomy of heat: how it can be both a danger and a healer. In the first part of our conversation, we dive into that former side, discussing what happens when your core temperature gets too high, why some people handle the stress of hot temperatures better than others, and how heat tolerance can actually be trained. We then talk about the advantages of heat exposure over cold exposure, and the benefits of heat for both body and mind, including how it can boost athletic performance and heart health, and may even be an effective treatment for depression. We also talk about how to get the most out of your sauna sessions and how Bill and I like to sauna.

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This article was originally published on The Art of Manliness.

6 Lifesaving Skills Every Man Should Know

Brett & Kate McKay — Sun, 15 Mar 2026 14:14:54 +0000

Life-threatening health emergencies can happen at any moment. While you should always call 911 and summon professional medical attention for a victim, oftentimes time is of the essence, and paramedics are minutes (or much longer) away. If the person is going to live, they can’t wait for a medic to get to them. They need help now.

That’s where you — a family member, friend, or random bystander-on-the-scene — come in. If someone close to you was stricken with a life-threatening emergency, would you be prepared to be the first first responder?

I talked to ICU nurse (and Strenuous Life member) Jared Shears about the basic lifesaving skills every man should know. While all of these can be performed by laypeople, Jared highly recommends taking an in-person first aid course so you can actually do some hands-on practice. Check with your local Red Cross for times and locations for these classes.

How to Perform CPR

If someone is unresponsive, doesn’t have a pulse, and isn’t breathing, they’ve likely gone into cardiac arrest. To prolong their life until an AED (see below) or advanced medical care is available, you’ll need to perform hands-only CPR (the American Heart Association recommends that untrained bystanders who see someone collapse do only the chest compression part of CPR, sans the mouth-to-mouth part).

In our in-depth article on how to recognize and treat a heart attack, paramedic Charles Patterson strongly recommends that everyone take in-person CPR training:

Having hands-on training to help you understand the mechanics of CPR and feeling the appropriate rate and depth of compressions is extremely beneficial and cannot be matched by simply watching a video or reading instructions online. Being able to go through the steps of CPR on a dummy will help you build confidence and remain calm in the event of an emergency.

How to Use an AED

In a cardiac arrest emergency, hands-only CPR is performed to prolong life until a shock from an AED is given or an EMT arrives. As soon as an AED is available, use it.

AED stands for Automated External Defibrillator, and it gives the heart a shock to get it going again.

AEDs are located in most public places like stores, offices, and gyms. While most AEDs provide automated voice instructions when you turn them on, as with CPR, Charles recommends getting in-person training from the Red Cross or the American Heart Association so you can go through the steps manually and know what it feels like to use this device.

How to Perform the Heimlich Maneuver

Choking is the fourth leading cause of death by unintentional injury. Thankfully, with a bit of know-how, choking deaths can be prevented. Enter the Heimlich maneuver.

Before you perform the Heimlich maneuver, the Red Cross recommends first leaning the person over your arm (put one of your arms under one of theirs and across their chest) and giving them five hard blows on the back with your other arm. Often the item becomes dislodged with just these back slaps. But if that doesn’t work, then initiate the abdominal thrusts dictated by the Heimlich maneuver.

Be sure to go through our in-depth guide on how to perform the Heimlich maneuver in different circumstances, including on pregnant women, obese people, babies, and even dogs.

How to Use a Tourniquet

A tourniquet is used to stop severe bleeding and prevent deaths caused by severe blood loss. For many decades, the tourniquet was seen as a measure of last resort because it was believed that completely stopping the blood flow to a limb would result in tissue or nerve damage. But studies out of the wars in Iraq and Afghanistan proved that the application of a tourniquet could save lives while having an extremely minimal chance of leading to nerve damage or limb amputation. As a result, many civilian EMTs and doctors recommend that tourniquets be applied more routinely in severe blood loss situations to prevent deaths. But it’s essential that you know how to use one properly.

For an in-depth guide on how to use a tourniquet, check out our article written by Iraq war veteran and Army medic Bruce A. West.

How to Save Someone From Drowning

The first step to saving someone from drowning is recognizing what drowning actually looks like. The signs can be much less dramatic and obvious than you think.

After you’ve established that a person is drowning, your initial response shouldn’t be to jump in the water and try to bring them ashore yourself. A person who’s drowning can be panicked, and clutch, kick, and grab at you as you try to rescue them, dragging you both underwater. So rather than jumping in yourself, extend a rope, oar, or stick to the victim from the shore or from a boat. If the victim is too far away for this course of action, and you can’t use a boat to get closer, then get in the water yourself, grab the drowning person from behind, and physically tow them to safety.

How to Treat Major Burns

While minor burns can be treated and managed at home, third-degree burns will require professional medical attention. However, the immediate care a burn victim receives before getting to the hospital can go a long way in mitigating the extent of the damage and reducing the chance of the burns being fatal.

Burn care varies according to the kind of burn it is (thermal, chemical, electrical, etc.), and, despite on-the-scene intervention being so crucial, most people are unaware of what it involves. Jared directed my attention to this comprehensive and detailed guide on how to treat severe burns while you await the arrival of paramedics. Print it off and study it.

For help in remembering things like how to save a drowning person, how to recognize that someone is having a heart attack (or stroke), along with other lifesaving information, check out these nine mnemonics that are easy and essential to commit to memory.

With our archives 4,000 articles deep, we’ve decided to republish a classic piece each Sunday to help our newer readers discover some of the best, evergreen gems from the past. This article was originally published in March 2021.

This article was originally published on The Art of Manliness.

How to Sauna: All the FAQs

Brett & Kate McKay — Sun, 15 Feb 2026 17:08:53 +0000

Saunas are awesome, and we’ve previously covered the many mental and physical benefits of spending time in one.

If you’ve been thinking about getting more restorative, satisfying heat exposure in your life, today we cover all the questions you may have about making sauna-ing a regular ritual.

How to Choose a Sauna

Should I go Finnish or infrared?

Saunas fall into two types: Finnish or infrared. They both make you hot and sweaty, but do so in different ways.

Finnish saunas. This is a traditional sauna. A Finnish sauna uses a heater (wood-burning or electric) to heat the air in a wood-paneled room or barrel. The air temperature in traditional Finnish saunas ranges from 160 to 220 degrees Fahrenheit, with a typical temp of 190-200. The superheated air is what heats your body through the process of conduction.

Most of the studies that have been done on the benefits of saunas were done using Finnish saunas.

Infrared saunas. Instead of heating up the air in the room to heat up your body, infrared saunas use near and far thermal radiation waves to heat your body directly. Sort of like getting cooked in a microwave. That might sound questionable, but the waves are safe and won’t give you cancer or turn you into a mutant. Because infrared saunas can heat your body directly, they don’t have to get the room as hot as a Finnish sauna to get you all hot and sweaty. Infrared saunas don’t feel as hot as Finnish saunas, but you still get similar benefits.

The type of sauna you go with is a matter of personal preference and budget. Infrared saunas are more inexpensive, and require less energy and a smaller footprint (people put them in bedrooms/garages/basements) than Finnish saunas. If you also don’t like the feeling of super-hot air that you experience in a Finnish sauna, then infrared may be the right choice for you.

If you’ve got the room and budget, and want the traditional sauna experience, then I would recommend the Finnish style as the way to go. I don’t think the benefits of sauna sessions come completely from the heat alone; it’s not like popping a supplement. Rather, I’d venture to say that its healthifying effect derives from an amalgamation of the heat itself, and the ritual of it. There’s something about the feel and smell of the wood, being able to throw water on the rocks to create a cloud of steam, and the hot, hot air. Feels good, man.

The other nice thing about Finnish saunas is they can be pretty large, and you can put them outside. My sauna from Almost Heaven can comfortably sit six grown men and resides in the backyard; it’s nice having a “third space” apart from the house, getting some fresh air as you walk to and from it, and being able to see a little nature outside its glass door.

Where can I find/buy a sauna?

Saunas are available at gyms, health clubs, and tanning salons.

If you’re interested in buying your own, you can get saunas direct from sauna manufacturers as well as on Amazon and even from Costco.

If you’re looking for a reasonably-priced Finnish sauna, check out Almost Heaven. As just mentioned, that’s where I got mine. Make sure to check their site regularly; they often have sales.

How to Sauna

Precautions With Sauna

Before we get into the nitty gritty of sauna-ing, it’s worth emphasizing that the heat of a sauna acts as a physiological stressor, and you should take precautions before using one if you:

Have heart issues. As mentioned in our previous article, sauna sessions give your cardiovascular system a workout. If you have heart issues, talk to your doctor before using a sauna.

Take prescription medications. Certain medications don’t mix well with heat exposure. If you’re taking any prescription medications, talk to your doctor before using a sauna.

Have certain skin conditions. Sauna-ing can be good for skin, as it increases blood flow and circulation, bringing more nutrients to the skin. But it can be bad for skin if you have certain conditions.

The hot air in a sauna can exacerbate skin problems like eczema and rosacea. For eczema sufferers, adding steam can mitigate that, and some claim that using an infrared sauna can actually help the condition.

While you might have heard that sauna-ing is good for acne, because it opens up your pores, the heat, steam, and resulting sweat can actually inflame those pores, and exacerbate breakouts, especially if you have a type of acne which involves inflammation, like cystic acne. If you’re prone to acne and still want to sauna, be sure to wash your face soon afterwards to cleanse it of residue.

Are concerned about your fertility. As explained in our article about male fertility, the reason why testicles reside outside the body is to keep them cool. Sperm counts decrease as the temperature increases. Sitting in a sauna warms up your testicles, resulting in decreased sperm counts and motility.

These effects aren’t permanent and are quickly reversible. You just have to stop using a sauna for a while.

If you’re trying for kiddos, consider foregoing the sauna. Try a cold shower instead.

How hot should a sauna be?

Researchers haven’t determined a precise temperature and time for optimizing the benefits of sauna sessions, but you generally want them to be pretty hot and of a moderate length (more on that below).

Studies that have been done on the health-promoting effects of sauna sessions have often set the temperature for participants around 180-200 degrees Fahrenheit. My usual go-to sauna temperature is 210.

If I plan on having a long bull session with my dudes, I’ll start off with the temperature at 130 degrees Fahrenheit. It’s more like a sweat lodge experience than a sauna. Low and slow. When the night is done, we finish with 10-15 minutes with the sauna at 210 degrees.

For infrared saunas, shoot for the air to get heated to between 175 and 195 degrees.

How long should a sauna session last?

20-30 minutes is the traditional sauna length for Finnish saunas, and most of the studies cited in our previous article had participants sit in the sauna for at least 20 minutes.

But the length of your session will really depend on the temperature you set: if it’s high, a shorter, 15-20 minute session will do the trick; if the temp is low, you can go much longer. On my sauna nights with friends, we’ve slowly, yet comfortably, cooked in the sauna at 130 degrees for 90 minutes.

If you’re using an infrared sauna in that 175 to 195 degree range, 20 minutes is all you need to get hot and sweaty.

You can divide up sauna sessions with cooling breaks. When my pool is open during spring, summer, and early fall, I intersperse my sauna sessions with jumps into the water. During the winter, I just step outside the sauna and walk around in the cold for a few minutes before getting back in.

With the duration of your sessions, the bottom line is really to just listen to your body: first you’ll feel warm, and then hot, and then hot and kind of uncomfortable (but in a satisfying way) . . . and then eventually you move beyond just kind of uncomfortable to feeling like, “Okay, this is too much, I’m done.” That’s the time to either take a break, cooling off before getting another dose of heat, or to just call it a session. Listen to your body!

How frequently should I sauna?

You could sauna every day if you wanted.

But keep in mind that, again, sauna-ing is a stressor on your body. There’s a balance you have to walk with it. At the right dose, sauna sessions can help you recover from life and workouts. Too much though, and they can actually increase your fatigue. You can get the benefits of sauna-ing with just two 20-minute sessions a week. Experiment to see what works for you, and again, listen to your body; once you tune in, you can actually feel your body kind of “craving” a sauna session, or conversely, saying, “Now’s not the right time.”

When should I sauna?

You can sauna whenever you want, but if you have a fitness program you’re following, you’ll want to avoid doing the sauna right before a workout. Not to beat a dead horse here, but remember, heat is a stressor. Stressing your body with heat before you stress your body with exercise is a recipe for poor performance. If you exercise regularly, try to do your sauna sessions on your rest/recovery days or right after your workout.

What should I do in a sauna?

I’ve seen people bring their phone into the sauna to listen to music or a podcast, but the heat isn’t good for your phone, and sauna sessions are an optimal time to disconnect from your tech and from all the annoying distractions of your life. Let the sauna be your sanctum sanctorum.

You might think about bringing a paperback into the sauna with you, but your focus/higher level thinking skills will diminish as your body heats up and your heart rate rises. Plus, your hands are going to get way too sweaty for holding a book.

You can do light stretches and bodyweight exercises if space allows. Your muscles will feel nice and limber and supple. Keep in mind though that your body is already being taxed by the heat, so any kind of movement will require much more exertion than usual; take it easy and listen to your body.

In general, I recommend simply doing in the sauna what traditional sauna-ers have long done: nothing. Just sit there. Or lie down if you have the room (you’ll find it’s hotter when you sit up though, as hot air rises). Let your mind go. Do some reflecting while your thinking is still sharp; meditate when your mind starts going blank. Just be.

What are some rules of sauna etiquette I should be aware of?

We have a whole article on this topic!

What should I do after I sauna?

During your sauna session, you’ll lose a lot of water through your sweat — up to four cups during a twenty-minute session! Be sure to rehydrate with plenty of water afterward. Supplement with electrolytes as needed.

You’ll be incredibly sweaty afterwards, so you’ll likely want to shower; a cold one will feel great (and be far more tolerable than usual)!

Be sure to listen to our podcast with Bill Gifford all about the hidden power of heat:

This article was originally published on The Art of Manliness.

How to Get Enough Sunlight in the Winter

Brett & Kate McKay — Thu, 08 Jan 2026 16:57:31 +0000

There’s something about sunlight that really recharges you. If you don’t get enough of it, you feel very much like a potted plant that’s been kept too far from a window — you start to feel as though you’re physically and mentally drooping and wilting.

It’s not just in your head. Sunlight packs a potent cocktail of health benefits: it lowers blood pressure, fights inflammation, supports optimal testosterone levels, improves insulin sensitivity, strengthens immunity, and improves mood and sleep. These benefits don’t just come courtesy of the vitamin D production that sunlight triggers; some of them occur independently of it and are the products of sunlight itself.

Unfortunately, it’s hard to get adequate sunlight during the winter months. The sun’s angle in the sky is lower, days are shorter and grayer, and UVB rays — the ones your skin needs to make vitamin D — often don’t penetrate the atmosphere enough for meaningful production in many northern latitudes.

Despite these challenges, winter doesn’t have to cut you off from the sun’s benefits entirely. By using the strategies below, you can still get meaningful exposure — even during the year’s darkest months.

Maximize the Moments of Sun You Do Get

Even if sometimes pale, winter does offer moments of sunlight. The trick is to capture these moments and maximize them.

Time it right. Aim for outdoor exposure around midday (roughly 10 a.m.–2 p.m.). That’s when the sun is highest and its light is most intense, giving you the biggest punch of bright light you’ll get all day.

Get 15–30 minutes when you can. In summer, you can often meet your sunlight needs with 15 minutes of exposure several times a week. In winter, because sunlight is weaker, you’ll want at least that much, and ideally even more, every day. If you can, head up to higher altitudes for a more potent dose.

Get active outside. Choose activities that get you outside — everything from walking the dog to shoveling snow counts — and try to deliberately engage in outdoor recreation like going snowshoeing on the weekend. Staying active outside will keep you warm as you soak in the rays, and movement has its own benefits for vitamin D metabolism, energy levels, and mood — so you’re getting triple value out of each minute of outdoor activity.

Sunbathers on a cold day at Coney Island

Expose as much skin as you can. What’s tough about getting sunlight in the winter is that not only are the rays weaker, but you’ve probably covered up your whole body to keep out the cold.

If the only skin you can expose is your face and hands, you can still get some exposure that way — even lying in a warm mummy sleeping bag with just your face exposed works. But bare more if it’s bearable. Consider wearing a very warm vest (keeping your core warm has a disproportionate effect on keeping the rest of your body warm) while wearing a short-sleeve shirt to expose your forearms. Especially consider doing your workout outside; it’s much easier to shed skin-covering layers once your body is warmed up from physical exertion.

Skip the sunscreen. Unless you’re going to be outside for a long time, will be up at higher altitudes, and/or are very concerned about sun-related aging, you can skip the sunscreen during the winter to allow more rays to penetrate your skin.

Go outside, even on cloudy days. Clouds may block some rays, but daylight is still far brighter than indoor lighting — meaning you’re doing your circadian clock and mood a favor just by stepping outside.

That’s something to keep in mind with wintertime sunlight exposure in general: even if it’s lower in intensity compared to summer and you’re not absorbing enough to trigger vitamin D production and other health benefits, daily access to bright light still helps maintain your body’s rhythms and mood regulation systems.

Supplement as Needed

In many regions, especially north of about 37° latitude (much of the continental United States and most of Europe), the sun, from about October through March, simply isn’t strong enough to offer all its potential health benefits. So you may need to employ some sunlight supplementation strategies.

Use light therapy. SAD (Seasonal Affective Disorder) lamps and bright light devices mimic intense daylight and can help with mood, circadian entrainment, and overall energy. Sit in front of a 10,000‑lux lamp for 15–30 minutes each morning to help offset the lack of natural light. These lamps don’t produce vitamin D directly, but they’re helpful for your brain’s light-sensing pathways.

Go tanning. Some people swear by the power of tanning beds to curb the winter blues. But to get their full benefit, you’ve got to choose the bed you use carefully.

Many modern commercial tanning beds, especially those marketed for “bronzing,” emphasize UVA rays, which penetrate deeper into the skin and will mimic some of the benefits of natural sunlight, but don’t produce vitamin D, which requires UVB radiation (specifically in the 290–315 nm range).

So look for a tanning bed that emits a mix of UVB and UVA, or is labeled as a low-pressure tanning bed (these tend to have higher UVB ratios). Ask the salon specifically: “What is the UVB percentage of your bulbs?” Ideally, you want at least 2–5% UVB.

Yes, tanning beds do carry a skin cancer risk, but occasional, limited use — 5–10 minutes, 1–2x per week — is generally enough for light to moderate skin types to boost vitamin D without overdoing exposure.

Even though I’ve already got brown skin, I’ve done a little tanning in the winter and have found that the warmth and light boost my mood.

Take a vitamin D3 supplement. Even though some of the benefits of sunlight are independent of its vitamin D-producing properties, adequate vitamin D levels are still important for health.

While you can get vitamin D from foods like fatty fish and egg yolks, many people won’t get enough from their diet alone and should consider taking a vitamin D3 supplement (the form closest to what your body makes from sunlight). Most adults looking to maintain or improve levels during winter should take about 2,000 IU per day, but the exact dosage you need can vary by age, skin tone, body composition, and existing vitamin D status.

If you supplement with D3, look for one that includes vitamin K2. D3 helps you absorb calcium, and K2 ensures that calcium is deposited in your bones and teeth — not in places you don’t want it, like arteries and joints.

Fill Your Sunlight Camel’s Hump With a Low-Latitude Vacation

People who live in cold, dark, snowy locales often take a trip to warm, sunny, low-latitude locales in the middle of the winter, and it’s wise to do so.

A week of regular sun exposure (30–60 minutes/day with skin exposed) can generate tens of thousands of IU of vitamin D. Since vitamin D is fat-soluble, it’s stored in body fat and released gradually over time. One week of tropical sun can significantly elevate your circulating vitamin D levels, with effects lasting 4–8 weeks.

Multiple days of steady sun exposure will also help reset your circadian rhythms, improve sleep, and give mood-enhancing neurotransmitters like serotonin and dopamine a big boost.

It will also help you chill out: sunlight, particularly its UVA rays, triggers the release of nitric oxide from the skin, which relaxes blood vessels, lowers blood pressure, and contributes to the calm, mellow — sometimes downright euphoric — feeling we associate with being out in the sun. There’s a reason you feel less tense when you’re on a beach vacation.

The circadian/mood/blood pressure effects of a week of sun exposure don’t last as long as the vitamin D benefits — just a week or two after you come home from vacation — but they all add up to a nice reprieve from the tightly-wound and more downcast state you can find yourself in during the winter.

Seek the Winter Sun

Winter makes accessing sunlight more challenging, but the season doesn’t have to deprive us of its light-giving rays entirely. By being intentional about getting outside, using supplements when needed, and maybe even taking a tropical getaway, you can get the physical and mental benefits of sunlight all through the darkest months. Keep actively seeking the sun through winter’s gray days until its rays return in full force come spring.

This article was originally published on The Art of Manliness.

Podcast #1,096: Why You Don’t Follow Through on Your Health Goals — and How to Fix It

Brett & Kate McKay — Tue, 09 Dec 2025 14:33:02 +0000

Most of us know what we should do to be healthier: eat better, move more, sleep well. The real challenge? Actually following through.

On today’s show, I talk to behavioral psychologist Amantha Imber, author of The Health Habit, who argues that the missing piece in most health advice isn’t more information — it’s learning how to bridge the gap between knowing what to do and actually doing it.

Amantha first outlines four “habit hijackers” that sabotage your best-laid plans and shares practical, research-backed tactics to overcome each one. We then dive into some specific health habits that will give you a lot of transformative bang for your buck. We discuss how restricting your sleep can help you sleep better, the truth about the popular 10,000 steps a day recommendation, the underrated power of an after-dinner walk, and more.

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Transcript

Brett McKay:

Brett McKay here and welcome to another edition of the Art of Manliness podcast. Most of us know what we should do to be healthier, eat better, move more, sleep. Well, the real challenge is actually following through. On today’s show, I talk to behavioral psychologist Amantha Ember, author of The Health Habit, who argues that the missing piece in most health advice isn’t more information. It’s learning how to bridge the gap between knowing what to do and actually doing it. Amantha first outlines four habit hijackers that sabotage your best laid plans and shares practical research-backed tactics to overcome each one. We then dive into some specific health habits that will give you a lot of transformative bang for your buck. We discuss how restricting your sleep can help you sleep better. The truth about the popular 10,000 steps a day recommendation, the underrated power of an after dinner walk and more. After the show is over, check out our show notes at aom.is/healthhabit. All right, Amantha Ember, welcome to the show.

Amantha Ember:

Thanks for having me Brett.

Brett McKay:

So you wrote a book called The Health Habit. You are a behavioral psychologist. I’m curious, how did you think about using your behavior psychology to help people establish and maintain healthy habits? Because there’s a lot of books out there about eating right, exercising. What did you think you bring to the table as a behavioral psychologist as to the discussion about health?

Amantha Ember:

Well, it was actually a bit of an aha moment. I was in my local bookshop. I was under a little bit of pressure from my publisher at Penguin to put in a proposal for my next book, and I’m a huge consumer of health and wellbeing kind of books, and I’m a massive experimenter on myself. And it just kind of occurred to me as I was browsing through the many titles that exist in any bookshop around how to improve your health, that if any of them actually worked in the sense that you read the techniques and you changed your behavior and suddenly you were healthier and those new habits stuck for life, then there would be no market for health books. And I thought the missing thing from all these health books is actually the psychology around how do you make all this great health advice stick? And so the idea for the health habit was taking a lot of science backed evidence backed strategies for how can we improve our sleep and nutrition, the way that we move or exercise, but actually give people the psychological tricks to make those great habits stick for good.

Brett McKay:

Yeah, I’m sure if there are any doctors listening who are family practitioners, they’ve probably seen this. They can tell their patients, well, you need to quit smoking, you need to start eating right, you need to start exercising. And then the patient doesn’t do it. Information is not enough. You have to be sort of a psychologist to help your patients implement these things you’re telling them that they know they need to do.

Amantha Ember:

That’s exactly right. I mean, I don’t think there’s too many people listening that would be thinking, oh, is exercise really good for me? Of course exercise is good for us. We all know that. Yet gym memberships go completely unused every month because there’s a real gap between knowing something and actually doing the thing.

Brett McKay:

What keeps people from following through on their health goals? They say, I’m going to start running, I’m going to start weight training, I’m going to start eating right, but then they don’t do it. What are the big obstacles there? I mean, is it just misguided ideas about habits or behavior change? What do you think is going on?

Amantha Ember:

Well, when I was researching for the health habit, I identified that there were four main barriers that get in the way for a lot of people. I call them hijackers. And very briefly, there are four of them. The first one is motivational. So where you kind of feel like you have to do the thing but you don’t really want to do the thing. So there’s a motivational barrier at play. The second are relational barriers where perhaps the social norms in your life are making it harder for you to do the thing that you want to do. Let’s say you’re trying to eat more healthy, but you live in a household where everyone loves junk food. There’s going to be a relational barrier at play. The third are environmental hijackers. This is where the physical or digital environment that you are living and working within is just not setting you up for success. And the fourth one are cognitive hijackers where you’re just feeling really stressed or exhausted or overwhelmed. And when we feel that way mentally, it’s really hard to change our behavior.

Brett McKay:

Do different people get hung up on the different hijackers?

Amantha Ember:

Well, often at different times in our life and for different habits that we’re trying to change, there might be a different hijacker in the way. So for example, let’s take the idea of someone wanting to quit sugar and a really common barrier there. Environmental barriers where if you’re like a lot of people, you’ve probably got sugary snacks in your pantry, perhaps at eye level, perhaps in a transparent container. And if that’s your home environment, there’s a massive environmental hijacker at play if the sugary treats or snacks within plain sight whenever you walk into your pantry. So that’s one example. Another example around say motivational hijackers is that most people know they have to exercise or should exercise, but they don’t really love it. And so there’s often for people, a big motivational barrier at play there.

Brett McKay:

Whenever someone’s looking at, okay, what’s preventing me from doing the thing I want to do? Whether it’s eating right or exercising or getting better sleep, is there a way to figure out which hijacker is the obstacle?

Amantha Ember:

There is! I designed a really simple survey. It’s in the Health Habit book, but I’ll also give you a link that you can pop in the show notes for anyone to just for free, just assess what is the biggest hijacker getting in the way of you successfully making a change to your behavior right now.

Brett McKay:

Okay, well we’ll link to that and that’ll be a great thing that our listeners can do. So you have these different hijackers, but you provide ways to overcome these habit hijackers. Let’s talk about motivational hijackers. What are some tactics that people can use to overcome motivational hijackers? So let’s say there’s this thing they want to do, they just don’t feel motivated to do it. What are some research backed tips that they can start implementing to maybe boost their motivation a little bit?

Amantha Ember:

Okay, so my favorite one, and this is the one that I personally use most often is temptation bundling. So this is how it works, and an example of the science that it comes from. So there was one particular study, and there’s been many studies done on temptation bundling that looked at how could we get people to exercise more often. So they recruited a couple of hundred people at a university campus and they looked at their exercise behavior. So specifically how often did they visit the gym on campus for 10 weeks? And people were split into three different groups. So there was one group that was given an iPod, which I know really dates this study. It was done over 10 years ago, and they were given an iPod and it was preloaded with top ranking audio books. And these participants were told, use this iPod, but only when you are at the gym, only use it when you’re exercising and enjoy these brilliant audio books.

The second group were given the same iPods, same audio books, and they were told, look, listen to it when you exercise, but also just enjoy it for the next 10 weeks whenever you want to listen to an audio book. And then the third group were given $25 and that was it, which is actually quite a lot of money for these university studies, but no iPod. What the researchers found is that the people that were in group one, the people that were given the iPod and said only to these audio books when you’re doing exercise, went to the gym over 50% more often than the cash group, which was the control group, the second group that had the iPod but listened to it whenever they wanted. They also went to the gym more often. It was about 25, 30% more often, but not as frequently as the group that only listened to the iPod when they were exercising.

So this is an example of temptation bundling where you are pairing the undesirable activity of exercising with something that is inherently pleasurable in this case, some great audio books. And so for example, how I use this technique in my life is I actually love weight training. I have no motivational issues there, but I do have a motivational problem when it comes to cardio exercise. So I own a very expensive exercise bike and I actually hate using it. And so a few years ago I created a rule for myself where one of my guilty pleasures is watching the Bachelor, which I think, I dunno, I feel like it’s in, it’s like 200 season now or something, but I am a sucker for bitchiness on TV and I feel quite guilty just sitting on the couch and watching The Bachelor. So what I did is I created a rule for myself and I said, I’m only allowed to watch The Bachelor when I’m on the exercise bike. And it completely changed my relationship with riding on the exercise bike. It also meant that I get through seasons pretty slowly and I read all the spoilers, but that’s okay. I still love the show. Temptation bundling, highly recommend it. If there’s a motivational barrier at play,

Brett McKay:

I’m the same as you. I have no problem. I love weightlifting. It’s my passion. I’ve done it for years. Cardio is just a chore.

And so for me, what I’ve done with the temptation bundling is I watch movies while I’m doing the treadmill. I’m just walking at an incline on the treadmill and it’s been awesome because I’ve had this goal for a long time, become a cinephile. I want to watch the Criterion Collection like Seven Samurai and Casablanca, but just didn’t have time for it. So I thought, oh, I can do that while I’m doing cardio. And so yeah, I just queue up a movie and I’m on the treadmill for an hour and I’ve gotten through a lot of the Criterion Collection just by doing some temptation bundling.

Amantha Ember:

I love that. Great example.

Brett McKay:

One tactic that you highlight on how to overcome motivational hijackers is, and I’ve never heard of this one, it’s question powered self-talk. What is that?

Amantha Ember:

Yes. So often when we are trying to do the thing, let’s just stay on the exercise example, I need to exercise today. It’s not particularly motivating when we tell ourselves, okay, I need to exercise today. What psychologists have found is if we can actually change that into a question, we’re much more likely to do things. So instead of going, I need to exercise today, saying to yourself or asking yourself, “Will I exercise today?” makes us significantly more likely to do exercise. So what our brain is doing when we’re asking ourselves a question as opposed to giving it a statement is we’re tricking ourselves into feeling like we have choice, we have autonomy over the decision. And when we feel like we’ve got choice, we’re far more motivated to do the thing. So when we ask ourselves, well, “Will I exercise today?” We think, oh, will I? I’ve got a choice in the matter. And then because we’re trying to be good and trying to do the thing, we will be much more likely to go, yes, I will exercise today.

Brett McKay:

That’s really interesting. I like that. And I’ve seen that in my own life. There’s been times where I’ve used digital nudges to get me to do certain things, get up to walk with your Apple watch, you can set it if you’ve been sedentary for a certain amount of time, it’ll say time to get up for a walk. And I’m like, eh, you’re annoying. Get out of here. But I imagine if it just said, Hey, would you like to get up? I’d be like, oh, you know what? Do I want to get up? Yeah, maybe I do want to get up. It would give you that sense of autonomy.

Amantha Ember:

Yes.

Brett McKay:

So I really like that idea of turning your self-talk into a question. Any other things that you can do to overcome motivational hijackers?

Amantha Ember:

Yeah, I mean, look, there’s quite a few in the book. One that I have found to be very effective is fining yourself. And what I mean by that is, and look, I’ll give an example actually from someone on my team at work who used this. So this particular teammate, she is a crazy mad fan of Leeds. So she follows the football in the UK and she’d set herself the goal of, she wanted to read one nonfiction book for six months every week, a new one every week, which is a pretty impressive goal. And she declared to the team that if she did not hit this goal, she was going to donate I think $100 or something to Manchester United, i.e. the enemy. And this kept her motivated. I think she also had said she was going to post a picture of herself on social media wearing a Manchester jersey, which of course is just a disgusting thing to do if you happen to go for Leeds. So finding yourself and giving that money to somewhere that you absolutely hate can be very, very motivating to stick to a behavior.

Brett McKay:

Let’s talk about relational hijackers. What are some tactics that are research backed that can help us overcome those relational hijackers? So that’s basically our social environment is getting in the way of us accomplishing or fulfilling our health habit goals.

Amantha Ember:

That’s right. I would say if you’re listening to this and you feel like you’re someone that’s maybe a bit of a people pleaser, there’s a good chance that there might be a relational hijacker at play. And so we can actually use those people pleasing tendencies to our advantage. And one of the most effective things that we can do is to make a public pledge. So this might be on a group WhatsApp group to say, I am going to, I don’t know, eliminate all unhealthy snacks from my diet for the next four weeks, or I am going to do the couch to 5K program for the next eight weeks. And if you announce your goal publicly, so it could just be to friends and family, it could be on social media, just somewhere public, you are much more likely to actually stick to that goal because you don’t want to let other people down and you don’t want to look like an idiot. So it’s really utilizing that tendency that you feel quite accountable to the people around you.

Brett McKay:

Yeah, I think it’s also useful too, that public declaration saying, Hey look, I have this goal. I want to eat better or I want to exercise. And you tell this to your family and you can say, I want you to hold me accountable if you see me going for a fourth serving of mashed potatoes, like, hey, can you give me the nudge? Like, Hey dad, do you really don’t tell ’em dad, don’t eat the mashed potatoes like, dad, do you really want to eat those mashed potatoes? Cause you want to do the self-talk, give ’em some autonomy.

Amantha Ember:

Yeah, exactly.

Brett McKay:

What about environmental hijackers? What are some tactics to overcome those?

Amantha Ember:

So I would say if you dunno where to start, or if you’re thinking, oh, these all sound like barriers, environmental hijackers and overcoming, those tend to be some of the most powerful strategies. So one of the biggest things that you can do is have a think about the behavior that you’re trying to change and think about what in your environment, what is your environment setting you up to be the default choice? So let me give you an example. A lot of people have the goal to improve their sleep. They want to stop scrolling on their phone before bed, very common behavior goal. And if your phone charger is on your bedside table, I can tell you right now that your environment is setting you up to fail. It is very hard to simply just rely on willpower to say to yourself, okay, even though my phone is within arms reach before I go to bed, I’m just not going to scroll on it.

I’m going to do something else. Or maybe I’ll just go straight to sleep really, really hard. So what you want to do in that situation is you want to disrupt the default choice because the default choice in that environment is to pick up your phone and scroll before bed. So to disrupt that default, you might want to, for example, take your phone charger and put it in a completely different room, put it in the corridor, put it in the kitchen, and instead charge your phone there because it is no longer the default option to go, oh, I’m going to scroll on my phone before I go to bed because your phone is not near your bed.

Brett McKay:

I love that. I think you can do that with nutrition if you’re trying to eat better. Don’t buy junk food, don’t keep it in the house and instead buy lots of healthy options and make sure it’s visible

Amantha Ember:

A hundred percent. And look, if you say have kids that demand the sugary treats or whatever, or maybe you’ve got a spouse that is refusing to give up sugar, for example, what you can do to disrupt the default is instead of say having those treats at eye level in the fridge or in the pantry and in transparent containers, you can put them in opaque containers, you can put them out of arms reach. So maybe you have to get a stepladder to reach those snacks or maybe just put them right at the bottom of your pantry or fridge where you’re just not going to see them every time you are in those locations.

Brett McKay:

A big thing that I’ve done to overcome environmental hijackers for exercising, that’s paid off big time for me just having a home gym. It just makes it so easy. I just walk down to my garage and I can exercise. And you don’t even have to have a whole home gym. It could be you got a kettlebell or you have some sort of pull bar and it’s just there in your house and you remove all that friction from exercises. You don’t have to, okay, I got to get in the car, drive to the gym workout, drive back, you can just do it.

Amantha Ember:

Yes. And friction is really important because when you’re trying to do more of a behavior, if you can reduce the friction that is involved in doing that good behavior rather than having to drive to a gym, it’s right in your home. And I did the very same thing and have had a home gym set up, oh gosh, since 2020. And it’s easy. You can also, when you’re trying to not do a behavior or try to eliminate a behavior is you can put friction in the way. But I do love the idea of removing friction. Something that I have heard a lot of people do successfully that are trying to do more exercise is to sleep in their gym clothes. Because when you wake up, there is no excuse not to exercise because you are literally dressed for the gym. I also applied this strategy to parenting many years ago when my daughter was in the earlier years of primary school. And for those that have young kids, you’ll know that sometimes getting them dressed into their school uniform takes a lot of time and is a massive battle that most of us don’t have the patience for in the morning. So I started dressing my daughter to go to bed in her school uniform. So she would wake up and she would be dressed and ready to go, and yes, it would have some creases, but hey, who cares?

Brett McKay:

Alright, so environmental it sounds like, look for friction points and see if you can reduce them. That’ll go a long way. Or if you don’t want to do something, increase the friction. Let’s talk about cognitive hijackers. What are some research backed tactics to overcome those?

Amantha Ember:

Well, probably my favorite one here is the power of a particular word. And that word is “don’t.” So this comes from some research that was led by Professor Vanessa Patrick and what she did, she got a group of people into the lab under the guise of she was just there to teach them some strategies to make healthier choices with their eating. And she divided people into two groups. One group were taught to say, when presented with an unhealthy temptation like chocolate, they were taught to say, I don’t eat chocolate. And a second group were taught to say I can’t eat chocolate. So very similar strategies, literally just changing two letters versus don’t. Then everyone left the lab. But the crux of the experiment actually happened when people were leaving the lab and they were presented with an option of two different snacks. So one option was a chocolate bar, the second option was a healthy granola bar or muesli bar.

And what the research has found is that those that were taught to say, I don’t eat chocolate, were 50% more likely to take the healthy granola bar instead of the chocolate bar all through just changing one little word in their self-talk. So why that works so well is when we say I can’t do something, which is pretty reflective of a lot of people’s self-talk like, oh, I can’t do this, I can’t do that. Oh, I can’t really eat dessert because I’m on a diet, is we just feel a bit restricted and a bit crappy about ourselves. But when we say I don’t do the thing, I don’t eat chocolate, I don’t eat dessert, I don’t have sugar as examples, we actually feel like that is part of myself identity. And as humans, we want to act in a way that is consistent with how we see ourselves. So for me, I used to be a massive sugar addict and this strategy had the biggest impact on me quitting sugar, and it’s been over a decade now since I quit sugar as a daily habit.

Brett McKay:

One tactic you recommend for overcoming cognitive hijackers is using the power of a fresh start to boost your health habit goals. And I think this could be useful coming up on a new year. What is the fresh start tactic?

Amantha Ember:

Yeah, so the fresh start effect is a really handy one, and it suggests that when you pick a date that is the start of a new thing. So it might be the start of a year, January one, it might be the start of a new season, like the start of spring or fall, or it might be even just the start of a week like Monday. We are significantly more likely to stick to the habit that we want to do because it literally feels like a fresh start. It’s like a new chapter in our book. We don’t need to worry or think about all the times that we’ve failed in the past because it’s a fresh start today. So when researchers have looked at people that have tried to kickstart a new habit on say a Monday compared to a Thursday or in the middle of a month versus the first of a month, those that start at the start, if you like, of that month or that week or that season, are far more likely to be able to stick to that new behavior.

Brett McKay:

Another tactic you highlight to overcome cognitive hijackers, I’ve used this with my own health habits, is giving yourself a hall pass to bend the rules. Tell us about that.

Amantha Ember:

I love this strategy and I use it for myself across several different realms of my life. So we’ve probably heard of the term hall pass when it comes to say marriages and having a hall pass if this particular celebrity ever wanted to spend a night with me. But hall passes are really great when it comes to changing our behavior. So there was one particular study that looked at people who were trying to do more steps, do more walking in a day, and all the participants in this study were given the goal of doing 20% more steps than their current month’s average. So it was a bit of a stretch target. So one group were basically told to walk every day for 30 days and try to hit their goal 20% more steps every single day. The second group were given two hall passes every week for the four weeks of the study.

So the researcher said, look, hit your goal every day, but we’re going to give you two hall passes so you can pick two days whenever you want them to be per week, where you don’t need to worry about hitting your steps target. And what the researchers found is that those given the whole path strategy were actually more likely to hit their daily steps target. And when they had a day where they failed, they were much more able to bounce back so they were more resilient. So if there’s a daily habit that you are trying to create, and I think this is particularly good for people trying to turn over a new leaf with their eating or dieting or something like that, what typically happens is we’re like, okay, I am starting a diet on Monday and then by Thursday we’ve, I don’t know, binged on a bunch of things that we’re trying to avoid. We have this thing that psychologists call the what the hell effect? And it’s like, ah, what the hell? I’ve broken the diet, I may as well just go back to my normal eating. But hall passes overcome that because we can simply just say, well, Thursday I decided to take a hall pass and I’m going to get back on the good behavior regime on Friday.

Brett McKay:

Yeah, it gets rid of that all or nothing thinking

Amantha Ember:

Yes.

Brett McKay:

Yeah, I’ve used that with my own health habits with eating and exercise. Some days I’ll have days where I need to train and I’m just not feeling it because I’m tired, I’m stressed out and I say, okay, I’m not going to do my usual, my program session, I’m just going for a walk. And it’s not exactly what I wanted to do, but I at least moved my body intentionally. Or when it comes to nutrition, I track my macros, so I try to hit certain protein and carbohydrate and fat targets. But sometimes you’re at a party and there’s like pie or cake and you don’t want to be the guy’s like, I’m not eating that and just I want to enjoy food’s, a way to socialize. So I’m like, okay, I’ll have some cake. It doesn’t exactly fit my macros. I don’t need to have three slices, but I can have a small slice, that’s fine, and I’m okay with that. I don’t beat myself up because I just had a piece of cake.

Amantha Ember:

I think that’s so great. It’s also why cheat days are actually really effective according to science.

Brett McKay:

So let’s talk about some specific health habits. So we established this framework of how you can use behavioral psychology to overcome habit hijackers. You then have a section in the book where you talk about specific health habits that you picked out that you thought based on research would provide the most bang for your buck. So let’s see how we can apply this framework to help stick to these different health habits. The first health habits you focus on relate to sleep. You’ve struggled with insomnia, but now you’re a great sleeper. What are some of the health habits that you implemented in your own life to make sleep better for you?

Amantha Ember:

Yeah, okay. Lemme talk about the one that has had by far the biggest impact. So I am someone that has struggled with insomnia during my twenties, during my thirties, and then in my forties where I am now, it’s pretty much gone. So what happened in my twenties is I was living in Sydney at the time and every morning I would drive across the Sydney Harbor Bridge to get to work and it would be early in the morning and I would always be tired. And one morning it was about eight o’clock in the morning, I thought to myself, I wonder if there are people that don’t actually feel constantly exhausted like I do. And I thought, well, what a stupid thought. Of course there are people that feel that way. And then I thought, huh, I wonder if I’ve got a problem because I’m always tired.

And so I got to the office that morning and I Googled sleep, doctor Sydney and I booked myself in to see a sleep doctor. And what sleep doctors typically recommend is to go into their rooms or a hospital and do an overnight sleep test where you are hooked up to about 30 or 40 different electrodes and it’s very uncomfortable. And then the doctor says, okay, now sleep. So it’s not a fun night, but at least it’s a night where you can get some data on what is going on. So I did that. I felt like I had a terrible night’s sleep, but hey, nothing new because most nights were terrible night’s sleep. And I went back to see the sleep doctor a couple of weeks later with the results and he said, look, the good news is that there’s nothing physiologically wrong. You don’t have a sleep disorder, you don’t have sleep apnea, but I guess the bad news is that it means that it’s psychological and there is no magic pill to fix that.

And so what he prescribed, so to speak, was sleep restriction. So he asked me, how many hours do you reckon you’re spending in bed right now? And I told him that at the time I was getting into bed at about 9:00 PM and I was getting out of bed at about 7:00 AM and so that’s 10 hours in bed, which might seem like a lot of time. But in my sleep deprived brain, I thought, well, the longer I’m in bed, the better the chance I’ve got of catching some sleep, which I think is how a lot of insomniacs think. It kind of feels rational, but it’s actually not. So the sleep doctor then asked me, how many of those 10 hours do you think that you are actually spending sleep? And I thought about it and I said, I reckon maybe six hours. And so he said, okay, what you’re going to do now is you are going to limit the time that you are in bed to just six hours per night.

And so he said, keep your wake time the same. So keep getting up at 7:00 AM because one of the other habits I talk about in the book is having a consistent rise time or consistent wait time. But he said, you are only now allowed to spend six hours per night in bed, which means you’re going to go to bed at 1:00 AM. And I was in shock because going to bed at 9:00 PM versus 1:00 AM, that’s a very big change. And I thought, how am I going to stay up so late? But he said, this is really important because we need to retrain your brain to associate bed with sleep as opposed to bed with catastrophizing and ruminating and worrying that you’re not getting enough sleep. So for the first few nights I managed to stay up until 1:00 AM and by the time my head hit the pillow I was out and I was managing after a few nights to have a really solid six hours of sleep.

And then once I was managing to do that for a few nights, the sleep doctor then said, you can extend your window by half an hour. So I was allowed to go to bed at 1230 instead of one in the morning. I did that for a few nights until I was sleeping pretty consistently for six and a half hours and gradually brought back that go to bedtime until I was in bed for about eight hours, which is what I’d estimated at the time was how much sleep I needed. So sleep restriction therapy is generally with most sleep doctors when there’s a psychological issue, generally the first point of call is what I found and it is so effective.

Brett McKay:

So with sleep restriction, you’re only going to be in bed for the amount of time you are actually asleep each night and you’re doing that so that you only associate your bed with sleep. So to start out, you’re going to count back the hours you do sleep at night from your wake time, and that’s going to be your new bedtime and that’s going to be much later than you’re typically going to bed to start. I did something recently, it wasn’t exactly sleep restriction, but I was trying to retrain my sleep schedule and it involved staying up till midnight every night and it was pretty daunting or demoralizing to make yourself stay up late when you don’t want to and you’re not used to it because I love going to bed early. So knowing that it’s hard to do, what can we do? What sort of tactics that we talked about earlier, can we use to stick to sleep restriction so that you can get the benefit of it?

Amantha Ember:

And look, sleep restriction is a good one to think about temptation bundling because you are going to be dreading those hours that you are forcing yourself to stay awake. So try to make those hours fun. Don’t do something stimulating because that is not going to be helpful in terms of sleep, but you might say save up episodes of your favorite podcast to listen to in those hours where you’re trying to stay awake. Or you might save up episodes of your favorite TV show because TV watching is a pretty passive activity. So I would recommend that people think about what is something that they can really look forward to make staying awake those extra few hours more doable and maybe even a bit more enjoyable.

Brett McKay:

Yeah, that’s why I did, I started playing video games. I’m not a big video gamer, but I started playing this video game again that I’ve already played two or three times. It’s called Red Dead Redemption. You’re basically a cowboy in the American West and it can be stimulating because you’re a bad guy and you’re shooting other bad guys. But I would just go on there to ride my horse in this fictional American west and go hunting for bears and it was actually really relaxing. And so you mentioned some other things you can do for your sleep, wake up at the same time. That’s a big one. And then also I think the stuff that people already know, establish a good going to bed routine, practice, good sleep hygiene, set a time where you’re, okay, I’m going to get off my smartphone, get off Twitter or X Instagram and I’ll do something a little bit more relaxing.

Amantha Ember:

Yes, those are all really important. And then when we wake up in the morning, one of the most important things to do is to get exposure to daylight, to sunlight. So doing that just resets our circadian rhythms. It resets essentially our body clock and it makes it easier to fall asleep at night. Research shows that even just getting out for five to 10 minutes into natural light and daylight in the first hour or two after waking can be incredibly effective at resetting our body clock.

Brett McKay:

So let’s talk about habits we can implement to improve or increase the amount of we move during the day. You highlight a lot of research about what not only just exercise, but just general movement can do for our health. One health habit you recommend is vipa. This is an acronym, so V-I-L-P-A. What is VILPA?

Amantha Ember:

So VILPA stands for vigorous intermittent lifestyle physical activity. It is a mouthful, but it is incredibly effective, particularly for those that hate exercise or say, I don’t have time for exercise. So what VILPA is, and remember, it’s lifestyle, physical activity. These are just moments that might be a one or two minute moment in your day where you are somehow incorporating quite vigorous physical activity into your day. So an example might be if you say catch the bus or the train or subway to work and you’re running late and you sprint the final four or 500 meters, that is an example of VILPA. It’s not exercise like you didn’t map out a minute in your day to do this exercise. It was simply just part of your lifestyle for that particular day. Another example is where maybe it’s after school after work and you are out in the backyard and you’re playing chay with your kids and you’re doing some intermittent bursts of running around.

Again, it’s not exercise that you planned, but it’s just happens to be in your lifestyle where you’re doing a one or two minute burst of pretty vigorous physical activity. So what a huge research study found into VILPA, and this is looking at people who had three to four bouts, if you like, of VILPA. So those one to two minute intense physical activity moments in their day were 40% less likely to die early. So when we look at all cause mortality, they basically had dramatically reduced the chances of dying prematurely from diseases that were largely preventable if we can be healthier with our habits. So it’s a really great thing to actually deliberately incorporate into your day. Maybe instead of just randomly running late to catch transport to your workday, you can just challenge yourself every morning, I’m just going to sprint that final 500 meters to the bus stop, for example. Or every afternoon I’m actually going to plan a game with chase with the kids, or when I take the dog for a walk, I’m just going to sprint those last few blocks with the dog to get some VILPA into my day.

Brett McKay:

One thing that we do in our family is we have this rule, I guess this would be an implementation intention. I think you talk about this in the book, but it’s our rule to get some VILPA is if there are stairs, we take the stairs. We got this from Michael Easter. He’s an author who writes about health and fitness and he has this statistic, I don’t know if it’s true, but it’s basically 2% of the population take the stairs if there are stairs.

So we tell our kids and ourselves, all right, McKays are two percenters. If there are stairs, we’re taking the stairs. And you see this a lot at the airport especially because you’ve got your big giant suitcase, and it’s so tempting to be like, all right, we’re taking the escalator. Can you just stand there with your, it’s like, Nope, we got to get your suitcase, hold it, and you got to go up the stairs. And it’s a short little workout. I mean, it is vigorous.

Amantha Ember:

Oh yeah, it is. It is. Yeah. I love that being the 2% club

Brett McKay:

Another habit you recommend for getting some more movement is to get at least 7,500 steps in a day. Why just 7,500? Typically the number you hear thrown out there is 10,000 steps.

Amantha Ember:

Absolutely. Most people, if they’ve got a walking goal or a steps goal, it’s 10,000 steps a day. And there is absolutely no science behind that number. Where it actually came from is that a company in Japan found that the Japanese symbol for walking looks like the number 10,000, or rather the symbol for 10,000 looks like a man walking. So they thought, oh, okay, let’s create this. I think it was a pedometer that suggests that you should do 10,000 steps a day, and that is how the myth was created. But when there have been meta-analyses conducted around how many steps per day actually reduces the chance of dying early from things like heart disease, what they found is that typically it’s about seven and a half to 8,000 steps a day. That is the magic number. So I would love it, listeners, just adjust their daily steps goal, make it a little bit lower, seven and a half thousand steps because there’s actually science behind that as opposed to 10,000 steps, which was purely a marketing gimmick.

Brett McKay:

So any tactics that we’ve talked about earlier and how you can implement this happen and stick to it.

Amantha Ember:

Yeah, look, I personally love the whole past strategy for this, and I think one of the interesting things about the whole pass strategy, as I described, there was a study that actually looked at people who had a steps goal and the impact of incorporating hall passes. So it might not be possible every day to do seven and a half thousand steps. So just give yourself two hall passes a week and say to yourself, this is my daily steps goal, but there’s going to be two days every week where I give myself permission to not meet my steps target for whatever reason. Maybe you found yourself in back-to-back meetings and you just had no chance to get out for a walk, for example. So use the whole past strategy to make yourself more likely to get that daily steps count.

Brett McKay:

Another health habit related movement that you talk about is taking a walk after a meal. Why that habit?

Amantha Ember:

Okay. So I think that most people know that when it comes to blood glucose or blood sugar levels, which is what happens in your body when you eat something or do certain things, particularly if you have a big sugary high carb snack, you’re going to cause your blood glucose levels to spike and then crash. And you will have experienced this crash if you’ve ever felt really tired or brain foggy or even hungry just after you’ve had a meal, typically about 30 minutes after you’ve had that kind of a meal. And there’s not many nutrition experts that would disagree that we need to try to keep our blood glucose levels as stable as possible. So any strategy that we can use that’s going to help stabilize our blood glucose levels, particularly after we eat, is really, really good for managing our health and managing our energy.

And so what researchers have looked at is what is the impact of after we have a meal, and let’s just say that it is a meal that would normally spike our blood glucose levels, like a really big bowl of pasta is something that will typically spike most people’s blood glucose levels is what if we actually move after that meal? And they’ve looked at all sorts of movement patterns like moving straight after the meal, moving for one minute versus 10 minutes versus an hour. And what they found is that on average, the best thing we can do after we’ve eaten is about half an hour or so after we’ve eaten, just have some gentle movement incorporated into your day for about 10 minutes. So if you aim after, say your lunch or your dinner about half an hour afterwards just to go for a 10 minute leisurely walk around the block, you will significantly increase the chance of your blood glucose level of staying pretty stable and you’ll significantly decrease any spike that was going to happen.

Brett McKay:

I’ve actually experimented with this and it’s true. So there was a period a couple of years ago where I was using a continuous glucose monitor, and I heard about this research about taking a walk after you eat can help reduce blood glucose spikes, particularly if you eat a high carb meal. And it’s true, if I didn’t take the walk and I ate a carby sugary meal, my blood sugar would go up to 140, 150, but then if I waited 30 minutes, it was interesting, I had to wait 30. If I did it right after I ate, if I did the walk, what would happen? The spike would just be delayed. I think what happens is your body, it takes about half an hour, 45 minutes for your body to start breaking down the carbs into glucose. So if you do it too early, all it’s going to do is just going to delay that glucose spikes. But if you time it so that you do the movement right when your glucose is spiking, your body’s digested and sending the glucose to the different parts of your body. You move your muscles and your muscles are just basically vacuums for glucose. Your muscles run on glucose, and so you get those vacuums going by moving your body. It just sucks up that glucose. And if I took a walk 30 to 45 minutes after I ate, the glucose monitor would just be up to one 20, it wouldn’t be as high. So it does work. It is really powerful.

Amantha Ember:

It totally does. I love that you’ve mentioned continuous glucose monitors, which for those who haven’t heard of CGMs, if you imagine something that’s about the size of a ping pong ball flattened and stuck to your tricep with a little needle that pierces your skin, it’s basically a way of getting a continuous read on what your blood glucose levels are doing. They typically last for a couple of weeks and they sync with an app on your phone. And I’ve experimented with them at different times over the last few years, and I find that it is such a great tool for actually changing your behavior because you’ve got the data right there in front of you. There’s no, oh, well Samantha said this or research said this, but is it going to work for me? You can see the data and when you can actually see how the inside of your body is responding to different tactics or experiments that you’re trying, you’re much more likely to keep going with those experiments when you can see, oh, they’re actually working for me.

Brett McKay:

What about just making a regular workout part of your routine? Any advice there?

Amantha Ember:

Oh look, definitely a regular workout is a great thing, and what we overestimate is how long we have to spend working out. So there’s been some great research into not just HIT training, which I think we all know is high intensity interval training, but what is called re-hit training, which is basically boiled down to shorter and less frequent bursts of all out intensive exercise. So what some research from McMasters University found is that the smallest, if you like, minimum viable dose of exercise that we can do to get massive benefits for our cardiovascular health is just a 40-second microworkout where you do a little warmup, get your body warm for two or three minutes, then do an all out 40-second sprint. It might be sprinting around the block for 40 seconds or doing a sprint on an exercise bike and then doing a cool down. And you can get the same kind of gains from a micro workout or reheat workout as you can from going for a 40 minute, 45 minute jog. It’s absolutely amazing. And for anyone that is saying, I don’t have time to exercise, well, all you need is 40 seconds and you will get some amazing benefits from that.

Brett McKay:

Let’s talk about nutrition habits. What hijackers frequently get in the way of sticking to nutrition habits?

Amantha Ember:

I would say that environmental hijackers are the biggest ones here. If you think about what is in your fridge and what is in your pantry and how much of that is the food that you want to be consuming more of versus food that you think that you should be consuming less of quite often. There’s a lot of food that we do want to be consuming less of that are at eye level in plain view whenever we go to make a food decision. So I would say environmental hijackers, if we can change the physical environment that we’re living in and working in to make it really easy and just natural to select the thing that we want to be eating more of that will go a huge way to having healthier habits when it comes to nutrition.

Brett McKay:

Yeah. So you have specific habits in this environmental framework that you talk about that people can use to reduce the temptation to sabotage your diet. So the big one is to reduce the amount of hyper palatable foods, so the really tasty Oreos, Doritos, and then the ultra processed foods, which are typically hyper palatable as well.

Amantha Ember:

Yes.

Brett McKay:

And just keep those out of the kitchen as much as you can.

Amantha Ember:

Definitely.

Brett McKay:

We’ve had a guest on the podcast talk about the microbiome, the gut microbiome and how it affects everything about health, from your weight to mood, to sleep, and to support your gut microbiome. You recommend that instead of taking a probiotic, people eat their probiotics. So how can they do that and make it a habit?

Amantha Ember:

So eating probiotics, so this is all about eating fermented food. Things like kefi, things like sauerkraut, kimchi, and yogurt is probably the most easily accessible palatable probiotic that you can eat. And so certainly what Tim Spector, professor Tim Spector from the UK recommends is ideally having some fermented food, eating your probiotics just in small amounts four or five times a day. So you might have a couple of tablespoons of yogurt with your breakfast, for example. Maybe a little bit of kimchi or sauerkraut just as a little side. Again, a couple of tablespoons is all you need with your dinner. So just having small doses throughout the day is one of the best ways to improve gut health.

Brett McKay:

Yeah, what I do, I started doing a while back ago, is I have some kimchi with my eggs at breakfast and it’s not very much. I get there’s a little bag and I just scoop out like a serving of it, not even a serving, just like a spoonful of it, and I got to eat that. And the other one is I eat yogurt. I eat Greek yogurt for a snack and probably get all the probiotics I need. Just making those really small changes.

Amantha Ember:

And it’s far cheaper than getting expensive probiotics from the chemist.

Brett McKay:

Correct. This is true. So if someone is listening to this episode and they’re feeling overwhelmed by the health habits they want to implement, what do you think is the smallest habit you’d have them start with tomorrow to build some momentum?

Amantha Ember:

I would come back to environmental hijackers. I would think about what is the behavior that you’re trying to change and think about your environment, your physical environment at home and work, and any other places where you spend a lot of time and think about what is one change you can make to your environment to make it easier to do the thing that you’re trying to do more of, or to make it harder to do the thing that you’re trying to do less of.

Brett McKay:

I love it. Well, this has been a great conversation. Where can people go to learn more about your work?

Amantha Ember:

Well, they can go to amantha.com or they can check out the Health Habit book to learn more about this. And I host a podcast called How I Work, where I talk about different rituals and strategies that some of the world’s most successful people use to get more out of their day.

Brett McKay:

Well, fantastic Amantha Ember, thanks for your time. It’s been a pleasure.

Amantha Ember:

Thank you so much, Brett.

Brett McKay:

My guest was Amantha Ember, she’s the author of the book, the Health Habit. It’s available on amazon.com. You can find more information about her work at her website, amantha.com. Also, check out our show notes at aom.is/healthhabit where you’ll find links to resources where you can delve deeper into this topic.

Well, that wraps up another edition of the AoM podcast. Make sure to check out our website at artofmanliness.com where you’ll find our podcast archives. And while you’re there, sign up for our newsletter. You’ve got a daily option and a weekly option. They’re both free. It’s the best way to stay on top of what’s going on at AoM. As always, thank you for the continued support. Until next time, this is Brett McKay reminding you to not only listen to the podcast but put what you’ve heard into action.

This article was originally published on The Art of Manliness.

Podcast #1,092: Hercules at the Crossroads — Choosing the Hard Path That Leads to a Good Life

Brett & Kate McKay — Tue, 04 Nov 2025 14:30:54 +0000

In a story from ancient Greek philosophy, Hercules faces a choice between two paths: one promising pleasure and ease; the other, hardship and struggle — but also growth and greatness. According to today’s guest, this ancient parable is more relevant than ever.

Dr. Paul Taylor, a psychophysiologist and the author of the new book The Hardiness Effect, returns to the show to argue that comfort has become our default mode — and it’s making us mentally and physically sick. To reclaim health and meaning, we must actively choose the path of arete — a life of effort, engagement, and challenge.

Paul first outlines the four traits that define a psychologically hardy person and how we grow by embracing and even relishing discomfort. We then dive into the physiological side of hardiness. We discuss how intentionally seeking stressors can strengthen both body and mind and some of the practices and protocols that lead to optimal health. We end our conversation with what tackling heroic, Herculean labors looks like today.

Resources Related to the Podcast

Connect With Paul Taylor

Paul’s website

Listen to the Podcast! (And don’t forget to leave us a review!)

Listen to the episode on a separate page.

Download this episode.

Subscribe to the podcast in the media player of your choice.

Transcript

Brett McKay:

Brett McKay here and welcome to another edition of the Art of Manliness podcast. In a story from ancient Greek philosophy, Hercules faces a choice between two paths, one, promising pleasure and ease, the other hardship and struggle, but also growth and greatness. According to today’s guest, this ancient parable is more relevant than ever. Dr. Paul Taylor, a psychophysiologist and author of the new book, The Hardiness Effect, returns to the show to argue that comfort has become our default mode. It’s making us mentally and physically sick. To reclaim health and meaning, we must actively choose the path of arete a life of effort, engagement, and challenge.

Paul first outlines the four traits that define a psychologically hearty person and how we grow by embracing and even relishing discomfort. We then dive into the physiological side of hardiness. We discuss how intentionally seeking stressors can strengthen both body and mind and some of the practices and protocols that lead to optimal health. We enter conversation with what tackling heroic Herculean Labors looks like today. After the show is over, check out our show notes at aom.is/hardiness. All right, Paul Taylor, welcome back to the show.

Paul Taylor:

Thanks for having me, Brett. It’s such an honor to be a returning guest on your bloody awesome show.

Brett McKay:

Well, we had you on a few years ago to talk about your book, Death by Comfort. You got a new book out called The Hardiness Effect, and I love that word, hardiness hardy. People need to use that more. And we’re going to talk about what that is exactly. But I want to talk about how you opened up this book and how it frames what you talk about in the book. You start off The Hardiness Effect with one of my favorite myths from antiquity. It’s the choice of Hercules. For those who aren’t familiar with that myth, can you walk us through it and then explain why did you use this myth as the framework for your book?

Paul Taylor:

Yeah, look, it’s one of my favorite stories as well, Brett, and the myth goes back to Socrates who told the story of a young Hercules and in the Greek version he’s Heracles, but we’ll just go with Hercules. So he was the son of the God, Zeus, and he found himself standing at a literal and a moral crossroads, and two goddesses appeared in front of him. One was Kakia who said her name was happiness, but it was actually vice and the other was Arete, which means virtue. Now, Kakia was beautiful and seductive, and she promised Hercules an easy life, one of luxury, one of comfort and pleasure. Without effort, everything he could possibly want would be handed to him. And then on the other hand, on the other road was Arete. She was pretty plain in appearance, but she had a bit of a natural beauty.

And she told him the truth that her path would be hard. It would demand discipline, courage, and effort, but it was the only one that led to true fulfillment. So Hercules, as we probably know, he chose the Arete path and that choice actually defined him. It leads to the famous 12 labors of Hercules. These were impossible challenges that he had to undertake, that forged his character and ultimately led to Zeus deifying and making him a God because he was impressed with this character. Now, this story, it’s not just mythological, it’s also psychological as well. And it actually inspired Zeno who I know you know Brett was the founder of Stoicism. And today, this represents the choice that we all have between a life of comfort and a life of challenge. And I used it to frame the hardiness effect because I believe that we’re living through our own version of that myth right now, only Kakia has had a makeover. She no longer tempts us with this debauchery, but seduces us with a life of comfort and convenience, the life of, we think about it’s climate controlled homes, processed foods that are engineered to hijack our dopamine systems. We have endless digital entertainment that gives us an illusion of connection, but ultimately delivers loneliness. And this modern life of ease, I think leads to a life of disease. Now it’s really comfort creep on a civilization scale. We’ve now medicalized normal emotional experiences. We’ve created effort for ease and created a society with a default discomfort. And the outcome really is fragility. It’s physical, it’s mental, it’s emotional fragility. And we see that in rates of obesity, chronic disease and mental illness reflecting it. So really the story of Hercules at the crossroads became my metaphor for modern human condition. And every day we choose, do we walk Kakia’s path of ease and decay or Arete’s path of discipline, growth and meaning. And really the hardiness effect is an instructional manual for choosing arete. In the modern world, it’s about building the psychological and physiological capacity to take the hard path because that is the one that leads to the good life.

Brett McKay:

At the beginning of the book, you talk about the consequences of our modern day Kakia path that a lot of westerners are living. And you get into the statistics, obesity, diabetes, mental illness has just been creeping up for the past several decades. And you argue that it’s because just our way of life where we can be sedentary and be isolated and not do hard things is what’s contributing to that?

Paul Taylor:

Absolutely, a hundred percent. If you take an animal out of its natural environment, that animal does not do well. And this is what’s happened to us is that we have slowly over time moved into an environment that is not natural for us. We are not meant to be creatures of comfort. It is actually through challenge, physical and mental challenge that we actually become really human. And when we don’t have those challenges, we actually decay. The body just reacts to the environment.

Brett McKay:

Yeah, I mean, we had Herman Posner on the podcast. He studies metabolism.

Paul Taylor:

Yes.

Brett McKay:

Yeah. One of the big takeaways I got from him is that the human body has to move. You have to move for overall health, and if you don’t, you just get fat. What’s interesting, other primates like gorillas and chimpanzees, they can sit around and eat leaves all day and they don’t get fat because they don’t have to move. But for some reason, humans, you have to move in order to stay metabolically healthy. And our environment, our lives no longer compel us to do that anymore.

Paul Taylor:

That’s right. And actually when you look, our biology is so wired from movement. Hernan is absolutely correct. And what we know is that when we don’t move, not only does it affect us physically, but it also affects us mentally and psychologically. Every time you exercise, I like to tell people there is a neuro symphony going on in your brain. There is this orchestra of neurotransmitters. Everybody knows about endorphins, but when you exercise, we also release dopamine. We release serotonin, release noradrenaline, release endocannabinoids, and cafallons in our brain. And these are all positive neurotransmitters that not only help your brain to function well, but are really important for good mental health. And so I always say to people, if you have a life where you’re not moving very much, and especially if you combine that with eating a crappy diet and not sleeping very well, good luck with your mental health because you are swimming upstream massively. We’re just starving our body of what it actually needs to perform normally, nevermind optimally.

Brett McKay:

So we all face this choice to choose Kakia, but the problem we have today is that it’s not so much a choice. Like Kakia is almost like the default and you have to kind of fight against it. And you have to choose arete intentionally. I mean, maybe you can argue 200 years ago you were kind of forced to choose arete because you had to farm and you had to work hard just to live your life. And kakia was sort of like a luxury. Today it’s the opposite. And you have to intentionally choose arete, and you propose that hardiness is the way to choose the path of arete. And what’s interesting, hardiness, it’s a fun word I think of the hardy boys, kind of these vital young men, you’re full of vigor, but there’s actually a psychological concept. How do researchers define hardiness?

Paul Taylor:

Yeah, look, it’s a bit of a close cousin to resilience and often they’re used interchangeably in the research, but they’re actually not the same. Resilience is more of an outcome. It’s about bouncing back, but it doesn’t tell you how to get there, hardiness actually does. So it was first identified by Dr. Suzanne Kobasa and Dr. Salvato Maddi in the 1970s and really explains why some people thrive under stress while other people crumble. So they did this landmark 12 year study at Illinois Bell and Telephone company, and they were going through a corporate crisis. And they found that over these 12 years, about two thirds of the employees fell apart under pressure, but a third of them didn’t just cope, they actually grew stronger. And they found that these group, they shared three core attitudes, a challenge orientation, a control orientation, and a commitment orientation. So let’s look at each one of those.

Challenge orientation and hardiness is about seeing both change and adversity as opportunities for growth rather than threats. Control is the belief that you control or heavily influence your environment or your destiny. And in psychology we call that an internal locus of control, and it’s also about focusing your energy on what you can control or influence rather than feeling like a victim. And then the last is commitment. This is about being fully engaged in life and living with purpose instead of withdrawing or wandering aimlessly. Now these guys started the research, but other researchers like Paul Bartone, he’s a US Army psychologist and he’s great and he’s a bit of a mentor of mine in this area. He really expanded the research and he found that hardiness actually predicted who passed and who feels basic military training, and then found that hardiness predicted who passed special forces selection course.

And it’s then it’s been shown that hardiness predicts career longevity and high pressure careers such as the military, police and first responders. And so if resilience is about bouncing back, hardiness is about bouncing forward. It’s the process that creates resilience. And the benefits are huge as well as predicting success in high pressure environments, high hardiness scores predict better cardiovascular health, stronger immune systems, lower rates of anxiety and depression. And even kids who are higher in hardiness are much more likely to go to university independent of their socioeconomic status, which is pretty critical. And then in my own PhD research, we ran a six week hardiness intervention and we saw measurable improvements, statistically significant in mental wellbeing, in stress tolerance and hardiness as well as measures of cognitive performance. So we showed that you can learn it, it’s not just a trait you were born with, it’s a set of learnable skills. And I’ve added a fourth C that of connection, which I’m sure we’ll unpack a little bit. But really for me, choosing hardiness, like you said, is today’s version of choosing the path of rite. It’s committing to growth through discomfort both psychological and physiological. And the payoff is a life that’s not just longer but also fuller and more engaged and more meaningful.

Brett McKay:

So what you’ve done in the book, you’ve broken down hardiness to two parts. There’s psychological and physiological hardiness, and it seems like those three C’s you laid out the challenge control commitment. And then the fourth one that you’ve added connection. We’ll talk about that here. That makes up psychological hardiness. Correct?

Paul Taylor:

Correct. That’s right, yes.

Brett McKay:

Well, let’s dig deeper into these different components, these four C’s of psychological hardiness you mentioned. The first one is challenge. This is about seeing adversity as a challenge instead of a stressor. How can seeing stress and adversity in your life as a challenge as opposed to something just to upset you, how does that change your psychology and even your physiology?

Paul Taylor:

Yeah, look, it has a massive effect. It changes how we think, how we act, and even how ourselves behave. So at its core challenge orientation, this is about how we appraise stress. It’s the view we take of it. So when something tough happens, whether it’s you’re in a big project given an argument or some sort of a setback, your brain decides almost instantly is this a threat or is this a challenge? And that split second perception actually dictates both your psychological leaning and your physiological response. So if you view it as a threat, you go into avoidance mode. So you’re motivated to leave, to procrastinate, to run away. It’s the flight part of fight or flight. Whereas if you see as a challenge, it’s what we call approach orientation. In psychology, you actually lean in and then physiologically it’s very, very different. When you see as a threat, your body constricts your blood vessels, cortisol rises, your cognitive flexibility drops, and the chemicals that the major stress hormone is cortisol, and I’ll come back to that in a second.

But when you see something as a challenge, your cardiovascular system actually responds like it does during exercise, your blood flows freely, oxygen delivery improves performance and cognition actually rise. And this is the fight part of the fight or flight. Now, the chemicals involved in your body with a challenge orientation, it is about the hormones, adrenaline and no noradrenaline, which in your side of the ditch, they call it epinephrine and norepinephrine. Now the half-life of those chemicals is about a minute, and that means with about four half-lifes, that chemical’s out of your body. So within five minutes, your body is back to homeostasis. So same me and you both have the same situation. You view it as a challenge, your body is back to homeostasis within five minutes. With me, because I’ve released cortisol, the half-life of cortisol is well over an R. So that means that ours later, even when that challenge or threat is gone, my body is still in a stress field. I still have cortisol going through my bloodstream, attacking my organs and my brain. Now this isn’t just theory. There’s research by numerous psychologists that show that our mindset towards stress literally changes our biology. And people with a challenge orientation, they recover faster from stress, they got lower inflammatory markers and they performed better under pressure. And I recently interviewed professor Jeremy Jameson. He ran a series of experiments with college students before an exam, I think, do you call it the GRE Brett?

Brett McKay:

Yeah. To get into grad school.

Paul Taylor:

Yeah, that’s it. The one to get into grad school. And he told half of them that anxiety was a normal thing and it actually prepared their body to action and could translate into better performance. And the other half the control group, he told no such thing. And then they all did a mock exam. And the people who he primed that anxiety, this challenge orientation, they did better in the mock exam, but they also then did better in the real thing as well. So your perception influences your performance as well. And the stoics understood this. 2000 years ago, Seneca said “A gem cannot be polished without friction, nor a man perfected without trials.” And the idea is that the friction is the forge. Hardiness is about leaning into that friction deliberately. That’s the key thing.

Brett McKay:

Yeah, I think that’s a powerful concept to understand if you see your stress in your life, not as a threat, but as a challenge, there’s so many benefits to that. Any tips that you found? Research backed tips on how you can strengthen your challenge muscle? I mean, I think one you talked about is this idea of acceptance and reprisal.

Paul Taylor:

Yeah, yeah, yeah. So this is really key. It goes back to even the historics who talked about life being hard, the Buddha, the first noble truth of Buddhism is life is suffering. Well, the word is actually dca, which means hard to do. So it’s first of all accepting that life is going to be hard. And then it’s about accepting that you are going to come through challenges in your life. And I tell this to my kids, I say to my kids, life is amazing, but it is also going to be hard at times. And it’s about how you react to that. So first of all, it’s just accepting that life is going to be hard, that occasionally you will get shit sandwiches from the universe and that acceptance puts you into a state where you can then reappraise. This. Reappraisal is training your brain to interpret stress as fuel rather than poison.

I call it stress alchemy. When you feel that surge, the heart rate rising, your tension, instead of saying to yourself, I’m anxious, say I’m energized. That’s the key thing. And this is the psychological framing, and it’s basically the Stoics talked about life being a contest. So it’s about getting yourself up for the contest of life and seeing these things as challenges to actually test and develop you. So that’s really key. And that reappraisal of viewing stuff as a challenge rather than a threat. You can do it not just in the moment when you’re dealing with stress, but also you can look back on it and actually taking time for your listeners to think of times in your life that were really hard or stressful. And then looking back now, how did that benefit you? What was the silver lining that came? So you can do this arete appraisal two ways. One is viewing things as challenges, but then secondly, looking back on the hard stuff and going, Hey, what did I learn from that? How did I actually grow from that? And that’s really key.

Brett McKay:

Alright, let’s talk about that second C, which is control. It’s about having an internal locus of control. What can the stoics and Admiral James Stockdale teach about developing an internal locus of control?

Paul Taylor:

I love that. So I have a copy of Epictetus’s Enchiridion, which roughly translates as a manual for life. And the very first line of this is of things, some are up to us and others are not. This is really about the stoic dichotomy of control and it’s one of the most powerful psychological tools ever developed. Marcus Aurelius, he put it beautifully, you have power over your mind, not outside events. Realize this and you will find strength. And this is really what’s at the heart of the control component. When you’re in control orientation, you don’t waste mental energy on things you can’t change, whether it’s the weather, other people’s opinions, the economy or those sorts of things. You focus on what you can do and what you can influence. And that actually reduces our stress. It takes us out of victim mode and gives us some agency, right?

So the stoic said that we must focus on that which we can control and refuse to invest our energy in that which we can’t control. And a lot of people get into trouble psychologically when they’re investing their energy in stuff they can’t control. They’re in their own heads wishing their past to be different, wishing other people to be different, wishing the universe to orientate around them. These are all things that we can’t control. Now, Stockdale, I love that you mentioned Stockdale. He’s a bit of a personal hero of mine and he is a modern day stoic and he really embodies this control orientation. Now Stockdale, he was shot down over North Vietnam and he spent seven and a half years in the infamous Hanoi Hilton prison camp. And four of those years he was in solitary confinement. He was tortured on 15 separate occasions. But what kept him going was stoicism is specifically Epictetus’s Enchiridion that he had brought that to war with him when he got shot down.

He talks about this in a number of his books as he ejected out of his aircraft and he was coming down to land, he could see the Vietcong coming in to capture him. And he said to himself, I’m now leaving my world, the world of technology and I’m entering into the world of Epictetus. And he knew that he couldn’t control his captors or his circumstances or the torture, but he could control how he responded to it. So Stockdale famously, he took control of his mind. He maintained leadership over the other prisoners because he was the senior officer in there and created meaning within chaos. And it was that focusing on what he can control that was really central to his success in there and him helping his other fellow prisoners to get through. Now, studies in both military and organizational settings show that people who have a strong internal locus of control, they experience less anxiety, they perform better under pressure and they recover faster from trauma. And so it’s proactive rather than reactive. And you can actually train yourself into this way as well. You can develop your control muscle if you like.

Brett McKay:

Yeah. How do you do that?

Paul Taylor:

Well, it’s basically changing your narrative. So say you got pissed off about something, a lot of people will go, they made me angry or this ruined my day, or I had no choice in this. All of those things are handing away control. It’s actually about self-awareness is really the first thing. And reframing that in your head from they made me angry too. I chose to feel angry. I decided to let that affect me. Now that can be a bit uncomfortable at first and a bit awkward, but it really is incredibly I empowering because what you’re actually training yourself to do is to realize that you have a choice about how you react to things. That’s really key. And I think that another second practice is the stoic idea of visualizing your day. Now this might seem a bit pessimistic, but it’s actually really helpful. It’s basically the stoic excuse to Marcus really famously would do this.

He would think about all the things that could possibly go wrong, the bad people he would meet and what he would actually do for that. So it’s about mental rehearsal so that when the bad stuff happens, you’re actually ready to do that. And then it’s about doing little small daily acts is about making your bed properly, finishing your workout even when you don’t want to. Choosing the healthy thing rather than the unhealthy thing and then reflecting on it and going, Hey, I made a conscious choice. There are around control. Every little action just builds that muscle bit by bit.

Brett McKay:

Alright, so the third C is commitment. What is it about commitment that makes us more hearty?

Paul Taylor:

Yeah, so it’s interesting, there’s a number of different elements to commitment, but they all interact with each other. So it’s really about being fully engaged in life. And I am increasingly concerned about modern society, and I know you are Brett as well. I listened to your podcast that there’s an increasing amount of people who are spending an increasing amount of their spare time within the confines of four walls with their heads buried in a bloody screen, either scrolling on social media or watching crappy tv. These people are what I call passive consumers of life. And it’s the polar opposite to high hardiness commitment, high hardy, committed people are fully engaged in life, whether it’s their work, their relationships, their health or their learning. They’re people. You know these people because they’re curious, they bring positive energy, they derive their meaning from participation, not from results.

And I really think that this commitment, it’s a bit of an antidote to apathy. So in our culture it’s really easy to live that passive life of scrolling, multitasking, of numbing yourself with drugs and alcohol. But when you’re committed, you’re really present. And the stoics really talked about this as well, and Seneca said, it’s not that we have a short time to live, but that we waste a lot of it. And this is about whether or not you are fully engaged. Now, linked to that in commitment to orientation is a sense of meaning and purpose. And in Viktor Frankl’s book, Man’s Search for Meaning, which I read as a 17-year-old that had a pretty profound effect on my life. And he showed that those who survived the concentration camps, they weren’t the strongest or the smartest, but they were the people who were committed to a purpose that was bigger than themselves. And the hardiness research actually echoes that. Salvador Maddie found that people who were high in commitment, they kept deeply engaged in their work and their relationships under stress. They handle stress far better than people with low commitment and they actually experience a lot less burnout.

Brett McKay:

So what are some things we can do to develop our commitment muscle?

Paul Taylor:

So one is about really clarifying your values. And I think part of the problem in modern society is the decline of religion. Now, I’m not religious at all, I’m more of a spiritual person, but I think what religion does was it gave people a sense of shared values and meaning. And when that’s missing, if you don’t deliberately find it, people can end up in an existential vacuum. So it’s really about getting clear on your values, the stuff that is meaningful to you, and then it’s about creating systems around because motivation that will get you started. So this gets into another part of commitment to orientation, which is about being committed to your health. It’s not just about having goals, but it’s about having processes that will actually help you to get to the person that you want to be and ideally linking them to your values.

And then I like to get people to do what I call a tombstone statement, which is what would you like to be written on your tombstone that would sum up your contribution to society or your little corner of the universe? It’s kind of a morbid thing, thinking of how would I be thought of when I’m dead? But that is the thing that uncovers that deeper sense of meaning and purpose. So getting clear on your values and on your purpose in life and then trying to live intentionally using those values as a compass. These are the things that really help to drive that commitment orientation.

Brett McKay:

Alright, so you added a fourth C to these three Cs of psychological hardiness. That’s connection. What is it about connecting with others that makes us more psychologically hearty?

Paul Taylor:

Well, look, Brett, the human brain is essentially a social organ. And we need that social connection. We know that when somebody is lonely, it is as bad for their health as smoking 20 cigarettes a day. It takes 10 to 12 years off your life and it’s hugely, hugely important. We talked about Stockdale in the Hanoi Hilton. The thing that got these guys through when they were put in solitary confinement was they created this thing called the tap code where they could tap out the letters of the alphabet on the walls and the pipes and they created all this shorthand and the tap code was the glue that held these guys together. When you connect with somebody else, you release oxytocin and vasopressin in your brains. Now they’re the hormones of love, trust, and social bonding, but they are also the most potent anti-stress chemicals that human beings produce.

And decades of research on military veterans as well as people who’ve been through trauma shows that those who are socially connected, who have people that they can lean into, they suffer much less PTSD and suicide than people who don’t have those social connections. And it’s because we are evolved to survive and thrive in tribes. And social support is one of the most powerful buffers against stress that we have. I mean Paul Barone showed this on PTSD and also there’s a researcher, she showed the people with strong social relationships, they’ve got a 50% lower risk of premature death than people who don’t have those relationships. So connection for me is hugely, hugely important. And that’s part of today’s massive problem of Kaia is that we are massively digitally connected, more connected than we’ve ever been, but we are really disconnected when it comes from to face to face perspective.

Brett McKay:

Yeah, we had Derek Thompson on the podcast a while back ago. He wrote an article for The Atlantic about how it’s basically there’s no loneliness epidemic because people aren’t really feeling lonely because we have all of this technology that can basically, we don’t feel like we’re lonely and so we don’t feel like we have the need to reach out to people, but we’re still seeing the ill effects of not actually connecting with other people.

Paul Taylor:

When you do face to face interactions, it is very, very different to online interactions. And he makes a good point that we don’t actually notice it because we still think that we are connected. But there is nothing that replaces that face-to-face interaction. And other research has shown that it is about catching up with people in person. It’s about having good friends that you will see at least once a month. That is one of the real key things here.

Brett McKay:

So it takes intention. You have to be intentional about this because everyone’s schedule’s crazy. You’re not just going to run into your friends like maybe you would’ve done a century ago. You have to plan for it, you have to choose it.

Paul Taylor:

You absolutely do. You’re a hundred percent right Brett. And it’s not about waiting for other people to organize something, it’s about being the connector in your little corner of the universe. Taking that on board I think is really key.

Brett McKay:

Alright, so that’s psychological hardiness. So there’s the four Cs challenge orientation, have an internal locus of control commitments to being engaged, have a higher purpose that you’re going for and then connecting with others that can give you psychological hardiness. Let’s talk about physiological hardiness. And we had you on last time talking about your book Death by Comfort. And one of the things we talked about in that podcast was how hormesis can be the antidote to the damage that all this comfort is causing to us physiologically. For those who aren’t familiar with hormesis, what is it?

Paul Taylor:

So hormesis is basically it’s summed up by the words of Frederick Nietzsche, that which does not kill us, and I’m sure all your listeners can finish the sentence makes us stronger. And this goes back, it actually goes back to biology like core biology. Edward Calabresi first noticed in his PhD research he was giving pesticides to plants to try to kill him and seeing what was the smallest dose that would actually kill them. And he found that at small doses, the plants actually flourished when they were given small doses of poison. And that led him to a whole heap of research and other researchers that they enjoined in. That shows that when we are exposed to small intermittent doses of stress, we actually get stronger, more robust at a cellular level. So when your body is presented with stressors, something called the cell danger response kicks off.

And that is the cells actually responding to stress by upregulating protective pathways. I describe them in the book, there’s things like NRF two and HIF one, but these drive our antioxidant defenses, they make our mitochondria stronger and they drive cellular cleanup processes like autophagy. And it’s basically your sales saying, Hey, we’re under a bit of pressure here. We need to get fitter, we need to train for this eventuality. And so for me, physiological hardiness and psychological hardiness or physiological hormesis and psychological hardiness, they’re like two sides to the same coin. The hardy mind reframes stress as a challenge and the body uses stress as medicine. So we actually, because of exposure to small amounts of stressors, and think of the obvious ones like exercise, cold exposure, heat exposure, all three of these activate these stress response pathways and not just in humans, in fruit flies, in worms, in cats, in dogs, in rodents, all primates all respond to those stressors and fasting as well with an upregulation of these stress response genes that in humans switch on at least 300 protective mechanisms.

So the goal here is not to avoid stress, but it’s to dose it deliberately. So there’s a hermetic curve. If you don’t do anything, it’s bad for you. You start to do some of these stressors, it’s good for you, a bit more is better, but there is an optimal point where it starts to become too much after that. And so this is about dosing it deliberately and intermittently. And the ancient stoics, they did it with cold baths and fasting, and this is about stress inoculation, it’s about nature’s physiological hardiness because of exposure to stress and appropriate recovery. That’s the key thing. And it actually keeps us biologically young and adaptable.

Brett McKay:

So in the book, in the section about physiological hardiness, physiological robustness, you provide different forms of hormetic stress, stress that can be medicine for individuals. One of the most potent ones is exercise. And in that section you recommend that people focus on two markers of fitness, VO2 max and strength. Why those two?

Paul Taylor:

Yeah, look, they are really critical. Just before I dive into that, two legendary exercise physiologists released a paper, I think it was 2013, exercise prevents and or treats 26 common chronic diseases. That is just crazy. You imagine if the pharmaceutical industry produced a pill that would simultaneously reduce your risk of 26 chronic chronic diseases and that the reason is that it releases all of these mykines, which are signaling molecules. But to answer your question now, so your VO2 max, that’s your maximum oxygen uptake, how much oxygen you can take in and use, and it’s the gold standard measure of cardio respiratory fitness. And lots of your listeners will have heard of it. And if they have an apple watcher or Garmin or whoop band or an oil ring, it’ll actually estimate their VO2 max and then you can look up tables online to see where you are.

What we now know is that your VO2 max is the single biggest predictor of how long you’re going to live way above everything else. So there was a massive 2018 study I talk about in my book from the Cleveland Clinic that followed over 120,000 people who’d all done stress testing on their heart and had their VO2 max measured and they followed these guys, they were in their fifties or their sixties at the start and they followed them for 15 years and a bunch died and a bunch obviously didn’t. And then they went back and looked at the data 15 years ago around their VO2 max and they found that VO2 max was associated with dramatically lower all cause mortality and there was no upper limit that meant that the fitter people got the longer they actually lived. And it was way more predictive of future death and having heart disease or diabetes or high blood pressure, any of those things.

So it is about training for your VO2 max. So how do you do it? Well, first of all is a bit of a base of zone two training, and your listeners may have heard of this. It’s 60 to 70% of your max heart rate. Basically you can talk but you can’t sing. Now that’s a base, but you can’t just do zone two and hope to improve your VO2 max. That will really help your mitochondria. The best way to build your VO2 max is the Norwegian four by four protocol. So this is basically you do four minutes of all art exercise, you can pick any piece of equipment, a rower, a step or a treadmill, whatever, or you can just be out running and you go as hard as you can for four minutes to the point that at the end of those four minutes, your heart rate should be 95% of your maximum. That is like I’m almost dying. And then you recover for three minutes. You just sort of turn your legs over for three minutes and you do that four times. That’s the four by four protocol. That is the single best way to re your VO2 max. And you only need to do that once a month. That’s key. And then I think, did you ask about the second one, which was about strength

Brett McKay:

Training? Yeah, strength, yeah, strength training.

Paul Taylor:

Yeah. Look, I know you’re a big fan of strength training and the second biggest predictive of how long you’re going to live is your muscle strength. And it appears in the research to be muscle strength, not your muscle mass. Stronger people live longer and they stay independent for longer. And it’s because our muscles aren’t just for movement. I mentioned it earlier, they are endocrine organs. Your muscle is an endocrine organ that secretes these molecules called myokines that reduce our inflammation, improve our brain health, and improve the health of all of our different organs. So really it is about using that muscle. And we know that becoming stronger is protective against sarcopenia. That’s that loss of muscle and bone as you age. And that if you become sarcopenic in old age, it actually dramatically increases your risk of pretty much every chronic disease. So I’m a big fan that everybody who’s listening to this podcast should be lifting heavy.

I don’t care what sex they are, what age they are. In fact, the older they are, the more important it is to lift heavy. And a good program if people don’t do it would be just full body strength training sessions. Ideally three of those a week focusing on compound movements, the big lifts that use multi joints, things like squats, deadlifts, presses, pull-ups. Plus also I think it’s really important to add in single leg work like Bulgarian split squats or lunges because that stability is really, really important, especially as we age and especially if you get over 50 as well as single leg work, do some balanced stuff as well because what we now know is if you’re in your sixties and you fall over and break a hip or a pelvis, you got a 50% chance of being dead within the next five years. So the takeaway here is simple. You need to train your body to be hard to kill. Cardio makes you harder to kill from the inside out and strength makes you harder to kill from the outside in and together is this physical foundation of hardiness. I think we need to do both.

Brett McKay:

Awesome. So yeah, strength train three times a week and then get in some zone two cardio and then a HIIT workout.

Paul Taylor:

Get comfortable with being uncomfortable with the Norwegian four by four and you can just look it up. It’s not pleasant, but it’s useful.

Brett McKay:

I do it once a week. Yeah. So another hormetic stress you talk about is light. How is light a stressor?

Paul Taylor:

So light is both, as I said, it’s a hermetic stressor so you don’t get any of it and it’s really bad for you. You get some, it’s good, you get more, it’s better. But there is an optimal point and everybody knows with sunlight that you could get too much sun and that can cause skin cancer. But what most people don’t realize is that if you have low vitamin D or even suboptimal vitamin D, which according to different agencies, between 70 and 80% of us globally have suboptimal vitamin D, if you have suboptimal vitamin D, it increases your risk of pretty much every cancer other than skin cancer. Now, if I take a step back and talk about light in general, we now know that light is a signal to our body and it triggers adaptation. So morning sunlight sets your shahinian rhythm, it boosts your serotonin, it anchors your sleep wake cycle and without it your hormones drift, your sleep quality tanks and even your metabolism suffers.

So as I said, low vitamin D levels, they’re not just linked to increased risk of cancer, there is a significant increased risk of cardiovascular disease, a massive increased risk of depression. And actually they’re finding increasing vitamin D acts like an antidepressant. People with low vitamin D have immune dysfunction as well. So I’m all about outcomes. So it’s about getting your blood tested and you want your level to be, if you’re in the states, 40 to 60 nanograms per deciliter, that’s what you use. Over here we use nanomoles per liter. So it’s between a hundred and 150 MLEs per liter, or if you live in the states, 40 to 60 nanograms per deciliter. Now the other thing is you’ve got to look at your skin tone. If your skin is darker or you live further from the equator, you’re going to need to get more sun exposure than people with light skin or who live closer to the equator.

And then when we get to red and near infrared light, that’s when things get really spooky. I mean, Einstein talked about quantum physics as spooky action at a distance and we now know that light has quantum effects on our cells. It’s just ridiculous. But rather than do a deep dive into that, I want to talk about how we use this therapeutically. So red light and near infrared, their wavelengths are between 620 and about 1,050 or more. So red light, which is that sort of 620 to 700 ish, that has a massive effect on your skin. It’s great for healing, it’s great for inflammation, it’s great for eczema and even childhood acne and even in adults, it has really good effects on our skin. It’s good for wound healing, it’s good for burns. They now treating burns victims with red lights straight away and then near infrared lights, which has a slightly longer wave of length, kind of 820 to 1,015 nanometers that actually penetrates through your skin and actually interacts with your mitochondria and triggers the activation of an enzyme called cytochrome sea oxidase.

That’s really important for the electron transport chain, and I don’t want to get too geeky in the physiology, but basically near infrared light stimulates your mitochondria to produce more a TP, the cellular energy, and that’s the fuel for everything in your body. And we know that having good efficient mitochondria protects you against a whole he of physical diseases. So really this is about driving this cellular agents of energy, your mitochondria through that near infrared light. And then as I said, the red light’s good for your skin, but also sunlight is also therapy as well. And then the darkness is really, really important as well for those circadian rhythms. When you change your sleep wake cycle, basically you mess with your circadian rhythms and you mess with your biology. Most people don’t realize, Brett, that your hormones run off circadian rhythms and lots of your cells do too. So when you mess with your sleep cycles, you’re actually messing with your biology.

Brett McKay:

How do you get red light near infrared light?

Paul Taylor:

Yeah, so you can get panels and masks and things like that. So they’re all available commercially and there’s a range of expense based on the size of them and the par and all of that sort of stuff. I get mine direct from China from a factor, it’s called red L led and it’s a lot cheaper and they will make a lot of the ones that American brands put their brand on and doubled the price from it. But I have a red and near infrared light panel and I used it. I had open heart surgery at the start of this year. I found I was born with a dodgy aortic valve and I think that red light and near infrared massively helped my recovery.

Brett McKay:

So another stressor you recommend is nature. Typically we think of nature’s, oh, it’s relaxing to be out in nature. How is nature a stressor?

Paul Taylor:

Well, it’s this balance of stress and recovery that’s really key and nature definitely falls up more on the recovery side. Now there are obviously there’s a bunch of challenges out in nature, temperature, variation, terrain, microbes, all of these things that can stimulate adaptation and they strengthen our immune and our nervous system. So we actually know that when you spend time in nature, if you go walk through the forest, you actually pick up some of the microbiome from the forest, even walking beside the sea. You’ll pick up some of the microbiome in the sea and it actually is good for us. There’s stimulation of it, but then spending time in nature can be hugely relaxing as well and can give us profound recovery. The Japanese, they call it shin Yoku or forest bathing as some people may have found. And when I was researching the book, I couldn’t believe how many research studies, there were studies around forest bathing and study after studies showing that spanning even 20 minutes in nature, lowers your cortisol, lowers your blood pressure, lowers your heart rate, and actually improves immune cell activity.

And then we have the microbiome connection that I talked about. So when you or your kids, they play in the dirt or the garden or you walk barefoot, you’re actually exposed to the microbes in the soil and they interact with the microbes in your skin and even in your gut. And that helps us to regulate inflammation and immune function. So we know that kids who live on farms, adults who live on farms have got much more diverse microbiomes than people who live in cities. This is linked to something called the hygiene hypothesis, that basically our obsession with cleaning and disinfecting everything has actually weakened our immune systems and increased rates of autoimmune disorders and allergies. And an interesting little tidbit for your listeners, Brett, I live in Melbourne in Australia that has the highest rate of allergies anywhere in the world. And you know what they’ve linked it to.

Melbourne also has the highest rate of cesarean section birth anywhere in the world. And what we now know is that being born cesarean section completely changes the immune system, mostly through the gut microbiome. Having a natural birth actually triggers the activation of the immune system. So that time in nature is hugely important. And then there’s this whole idea of grounding or earthing, which I used to think was woo woo. But again, looking into the research, there’s actually a lot of physics behind it that basically when your feet or your body is in contact with the earth’s surfaces, the electrons on the earth, they have biological effects. Now the research is pretty early, but it’s very, very interesting. And there is evidence increasing, evidence of improved sleep, reduced inflammation from grounding our earthing and probably it’s due to changes in our autonomic nervous system and stress as well. So just getting out, spending some time walking, getting your feet, your bare feet on the surfaces of the earth, grass, sand, rock, whatever, actually reconnects us to the world and resets our electric charge. It’s pretty bonkers, but it is real.

Brett McKay:

And one prescription you give people to get more time outdoors is following the nature pyramid. We’ve written about this on the website, it’s really cool. So it’s the 20-5-3 rule. So you want to get 20 minutes in green space three times a week, five hours in a semi wild environment once a month and then three days completely off grid annually. So that’s like a camp out or something. And that’ll give you enough nature that you need for overall health and wellbeing.

Paul Taylor:

Yeah, I love that. I love the stuff that’s just simple that people can go, yeah, you know what, I can do that. And I tell you what, if you do that 20-5-3 prescription, you will notice a significant effect.

Brett McKay:

Going back to that balance between stress and recovery, you talk in the book about nutrition and you focus on a few things that are essential for health and strength. You talk about avoiding ultra processed foods, which is something we discussed the last time you’re on the show. You talk about protein, how essential protein is people should aim to get at least 0.7 grams per pound of body weight. It’s often better to get more, get a gram per pound of body weight. And then you talk about the importance of omega fatty acids. What are omega threes and why are they so important for hearty health?

Paul Taylor:

They’re essential and they are structural fats for your brain and they’re also very potent anti-inflammatories for your body. And I really encourage people to get their omega index tested. You can do this at omega quant QAN t.com. I’ve got no association with these guys whatsoever. They just do brilliant testing. So they’ll give you an omega index or an omega score. It’s the amount of omega threes and percentage of those fats in your rare blood cells. And what we now know is that if people with a score of 8%, they live about five years longer than those who score around 5%. Like you show me some one thing in nutrition that can extend lifespan by five years. I don’t think there’s anything other than omega fatty acids. And what we now know is that the Japanese, on average, their omega index is about 8%, Americans is about 5%, and the Japanese live five years longer than the Americans.

So we really need to increase our omega index and we can get there if you eat lots of fish. That’s why the Japanese have it, particularly fatty fish, salmon, sardines, anchovies. But a lot of people will have to be supplemented. If you’re not eating fish three or four times a week or more, you really got to supplement and about two grams of high quality fish oil or if you’re plant-based algal oil, the stuff algae, the stuff that the fish feed on, that is actually a really good way to reach your omega fatty acids as well. And I think as well as minimizing ultra processed foods, they are the two most powerful nutritional interventions you can do.

Brett McKay:

Yeah, something I’ve been doing lately for the past couple months is I’ve started eating anchovies and sardines. As a kid I was like, that’s gross. That’s what grandpas eat. But then Michael Easter, he had an article on a substack about you need to eat more small fish. I was like, okay. So I went to Whole Foods and bought some cans of sardines and anchovies and they’re not bad. They taste like tuna fish, anchovies a little salty, but I try to get two to three of those a week and it’s easy and it’s cheap. It’s not that expensive.

Paul Taylor:

Yeah, that’s right. And I’m a fan of eating anchovies, and I think it’s useful to explain to people why small fish, small fish don’t live as long the big fish, particularly big fish like tuna, you’ll find that they tend to have more heavy metals in them, more mercury, because they eat lots of small fish. So having the small fish like sardines and anchovies is a really good way to do it.

Brett McKay:

So you wrap up the book by revisiting the Myth of Hercules, and you frame your recommendations using Hercules’ mythical 12 labors, and they’re kind of a summary of the principles we discussed. So let’s end there. What are the Herculean labors a modern person should undertake to live a life of arete?

Paul Taylor:

Yeah, look, the first one I think is overarching and it’s actually forging the hardiness mindset. This is that actually choosing to see change and adversity as opportunity for growth just as Hercules did then it’s embrace life’s challenges. And I love this idea that stoics talked about life as a contest. The Olympic games are upon us, and I think we need to view life as a contest and actually get into the contest with passion and view all of these challenges as little tests of your character and wake up every day and go, you know what? I’m ready for the contest. I think that’s really key. Then it’s focus on the stuff that you can control. Don’t invest your energy in the stuff. You can’t get committed to life. Be fully engaged in life. I get people to look at their screen time and if you are spending three Rs or four hours of your life on screens extrapolated over your lifetime, that’s like 10 to 15 years of your life with your head buried in a screen.

So it’s, for me, it’s about choosing to engage fully in life. And then the other say about connection, having meaningful face-to-face interactions with friends. And then the rest of it is really about that physiological hardiness is actually engaging in these deliberate stressors of exercise, of heat, of cold exposure, of nourishing your body when you’re eating, of exposing yourself to beneficial light and then making sure that you recover. But the key for me, Brett, I think the last thing that I’d like to impart to your listeners is that recently scientists have roughly estimated our chances of ever having being born, and they reckon it’s about one in 400 trillion. And if you think about it, all of your ancestors way back to your homo Habilis, homoerectus ancestors, they all had to survive in order for you to be alive. Somebody probably survived the plague in England, one of your ancestors, somebody probably survived just World War I or World War II. But this is the thing is waking up every day and going, I have won the greatest lottery ever. I’ve had a one in 400 trillion chance of being alive. Let’s not waste it and let’s embrace the contest. I think that’s the key thing.

Brett McKay:

Well, Paul this has been a great conversation. Where can people go to learn more about the book and your work?

Paul Taylor:

So the best place to go would be my website, which is paultaylor.biz. You can get the book there. You can also get the book on Amazon and also my podcast, which is the Hardiness podcast. I think if you’re interested in this, there’s going to be a big deep dive on hardiness in that podcast.

Brett McKay:

Fantastic. Well, Paul Taylor, thanks for your time. It’s been a pleasure.

Paul Taylor:

Thank you for having me on again, Brett, and love your work. Absolutely love it.

Brett McKay:

Thank you so much. My guest was Dr. Paul Taylor. He’s the author of the book, The Hardiness Effect. It’s available on amazon.com and bookstores everywhere. You can find more information about his work at his website, paultaylor.biz. Also, check out our show notes at aom.is/hardiness where you’ll find links and resources to delve deeper into this topic.

Well, that wraps up another edition of the AoM podcast. Make sure check out our website at artofmanliness.com. Find our podcast archives and check out our new newsletter. It’s called Dying Breed. You sign up at dyingbreed.net. It’s a great way to support the show directly. As always, thank you for the continued support. Until next time, it is Brett McKay reminding you to not only listen to the podcast, but to put what you’ve heard into action.

This article was originally published on The Art of Manliness.

Skill of the Week: Stop a Nosebleed

Brett & Kate McKay — Sun, 05 Oct 2025 15:25:52 +0000

An important part of manhood has always been about having the competence to be effective in the world — having the breadth of skills, the savoir-faire, to handle any situation you find yourself in. With that in mind, each Sunday we’ll be republishing one of the illustrated guides from our archives, so you can hone your manly know-how week by week.

Your snoz is full of blood vessels, and nosebleeds happen when they incur some kind of damage. That damage can come from vigorous nose picking or blowing, outright injury (as in taking a punch to the face), or, very frequently, from exposure to dry air (whether via the outdoor climate or indoor heating). Nosebleeds are particularly common in children ages 2-10, but can occur at any age.

We don’t often see our blood outside of our bodies, so that when a nosebleed occurs, it can feel a little alarming. But unless nosebleeds are extraordinarily heavy, accompanied by other symptoms like high blood pressure and trouble breathing, last longer than a half hour, and/or happen more than twice a week, they’re almost certainly harmless. They’re just messy and annoying, so that you want to stop your own, or your kid’s, as soon as possible, by following the instructions above.

To prevent future nosebleeds, it helps to keep the nasal membranes moist by putting a humidifier in your home/office, using a saline spray 2X a day, and/or applying Vaseline inside the nostrils. More frequently occurring nosebleeds may need to be addressed through cauterization.

Illustration by Ted Slampyak

This article was originally published on The Art of Manliness.

Skill of the Week: Tape a Sprained Ankle

Brett & Kate McKay — Sun, 14 Sep 2025 12:45:55 +0000

If you’re physically active, you’ve likely rolled an ankle now and again. Ankle sprains come in two types: an eversion, in which the ankle rolls outwards, and an inversion (by far the most common type), where your ankle rolls inwards. Either kind of sprain results in the painful stretching or tearing of ligaments. When you sprain an ankle, you should immediately ice it, compress it, and elevate it to reduce swelling and inflammation.

But when can you start walking or even running again after you’ve sprained an ankle? The answer varies depending on who you ask. Many physical therapists and sports doctors recommend that you don’t resume physical activity until your ankle no longer hurts when you take a step. Depending on the severity of the sprain, that could take weeks.

Other physical therapists and sports doctors suggest that movement may in fact speed the healing process, and that walking and even running can resume less than 24 hours after a sprain so long as the ankle is given support through proper taping. Taping limits the range of motion of your ankle, which reduces the chances of it spraining again, which allows you to continue to engage in physical activity while it heals. Taping also compresses the injured area, which helps reduce swelling and inflammation.

Sprains are rated as mild, moderate, or severe. With a mild sprain, the ligament has just been stretched. Your ankle feels stable when you put weight on it and just feels a little sore and stiff. With a moderate sprain, the ligament has torn a bit. Your ankle doesn’t feel entirely stable when you put weight on it, you can’t move it very much, and it’s swollen. With a severe sprain, the ligament has been completely torn. You can’t put any weight on it, can’t move it, and it hurts a ton. Taping an ankle to resume physical activity immediately after a sprain should only be reserved for mild to moderate sprains. For severe sprains, you need to stay off your ankle for a few weeks so that the torn ligament can heal.

While you can buy an ankle brace, using medical tape is the better option for folks engaging in physical activity. The biggest benefit tape provides is that it isn’t as bulky as an ankle brace which makes getting your shoes on a whole lot easier. When done correctly — as demonstrated above — tape can provide the same amount of support as a brace.

Illustrated by Ted Slampyak

This article was originally published on The Art of Manliness.

Podcast #1,084: Overdiagnosed — How Our Obsession with Medical Testing and Labels Is Making Us Sicker

Brett & Kate McKay — Tue, 09 Sep 2025 15:06:19 +0000

Modern medicine has given us incredible tools to peer inside the body and spot disease earlier than ever before. But with that power comes a problem: the more we look, the more we find — and not everything we find needs fixing.

My guest today, neurologist Dr. Suzanne O’Sullivan, argues that our culture of over-diagnosis is leaving many people more anxious, more medicalized, and sometimes less healthy. In her book The Age of Diagnosis: How Our Obsession with Medical Labels Is Making Us Sicker, she explains how screening tests, shifting definitions of “normal,” and the rise of mental health labels can turn ordinary struggles or idiosyncrasies into problems in need of treatment. We dig into everything from cancer and diabetes to Lyme disease and ADHD and discuss how diagnosis really works, why screening can sometimes harm as much as it helps, and how to know when a label is and isn’t useful.

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Brett McKay: Brett McKay here and welcome to another edition of The Art of Manliness podcast. Modern medicine has given us incredible tools to appear inside the body and spot disease earlier than ever before. But with that power comes a problem. The more we look, the more we find. And not everything we find needs fixing.

My guest today, neurologist, Dr. Suzanne O’Sullivan, argues that her culture of overdiagnosis is leaving many people more anxious, more medicalized, and sometimes less healthy. In her book, The Age of Diagnosis, How Obsession With Medical Labels is Making Us Sicker, she explains how screening tests are shifting definitions of normal and the rise of mental health labels can turn ordinary struggles and idiosyncrasies into problems in need of treatment.

We dig into everything from cancer and diabetes to Lyme disease and discuss how diagnosis really works, why screening can sometimes harm as much as it helps, and how to know when a label is and isn’t useful after the show’s over. Check out our show notes at AoM.is/diagnosis.

All right, Suzanne O’Sullivan, welcome to the show.

Suzanne O’Sullivan: Thanks for having me.

Brett McKay: So you are a neurologist and you’ve got a book out called The Age of Diagnosis, how Our obsession with medical labels is making us sicker and you’re making the case that in the past few decades we’ve developed this culture in the West where you have patients who are actively seeking.

Medical diagnoses for things they might not have thought about addressing a few decades ago. And this might actually be doing us more harm than good. And so in your book, you talk about over-diagnosis. What do you mean by over-diagnosis and why is it a problem?

Suzanne O’Sullivan: Yeah, so I think the definition of over-diagnosis is crucial here because I think a lot of people, if they hear over-diagnosis, their mind immediately goes to this idea that, oh, there’s nothing wrong with that person.

They’ve been diagnosed and, and they’re complaining about nothing. But that’s really not what over-diagnosis is. Over-diagnosis could mean that someone is really suffering and they definitely have a problem. But that medicalizing, that problem is doing more harm than good. So if I give you a couple of examples, it can happen in different ways.

So one way that over diagnosis occurs is over detection. So now we’ve got all these amazing tests we can do. We have MRI scans, we have blood tests that weren’t available decades ago. The consequence of those tests is that we can pick up diseases and abnormalities at earlier and earlier stages. And when we do that, we usually treat everything that we find, but not everything that we find was inevitably going to cause a medical problem in the long run.

So not everything we find actually needs to be treated. So that’s kind of over-diagnosis by over detection, treating things that are there but did not necessarily need to be treated and wouldn’t have caused health problems if left alone. And the second way that we get over diagnosis is through over medicalization.

So that’s where you begin applying medical labels to things that may really just be ordinary types of suffering. So that may be giving mental health labels, for example. To people who are genuinely suffering. But it may be that that suffering is better addressed through examinations of life, such as, you know, changing your work circumstances or changing your relationship rather than referring to that suffering by a medical label.

So it’s really sort of, overdiagnosis doesn’t mean that a person doesn’t have a problem, but it’s asking the question whether referring to that problem as medical, is that really the right thing to do? And I also want to, I, my. Terrible talker, and you may often need to interrupt me, but at the, at the outset you said that we are seeking this out.

I have to say that that’s not my perception. I think it’s a kind of a collusion between scientists and doctors and the public. We’ve got tests and we want to do them, and we want to find diseases at earlier, earlier stages. We are calling people forward to be medicalized, but people are equally coming forward quite willingly and allowing that to happen to them.

Brett McKay: Yeah that was one of the big takeaways that I got from your book was that one of the reasons why this overdiagnosis is happening is that we just have these tests that are available to us that weren’t available decades ago. And I think what it’s done, and you talk about this in the book. Is that it’s really maybe distorted the lay person’s idea of how a diagnosis is supposed to work.

Because I think now with these tests, we think, well, you just take a test. You do the MRI, you do the blood test, maybe answer a few diagnostic questions, and then the doctor gives you this definitive diagnosis. But you argue with any medical diagnosis, there’s. An interpretive element to it. It’s not just this objective test.

Can you explain what people misunderstand about how diagnoses are actually made?

Suzanne O’Sullivan: Yeah, so I mean, a diagnosis is much more of of a clinical process, so that means that you have a complaint, it’s a pain, or it’s a lump, or something along those lines. And through the doctor listening to the story of what happened to you and examining you, they form a theory about what the diagnosis might be and then the test.

And I think people often think the test is then done to make the diagnosis, but really the test is done in order to help with. The clinical diagnosis a doctor has already made. Now, the important distinction here is that tests are meaningless without that first part of the stage. And I think MRI scans are a great example of this.

So I have to always remind people that MRI scans only came into regular clinical use in the 1990s. So. We’ve really only been using them in clinics for actually a relatively short amount of time, and the early MRI scanners weren’t very strong. So the new scanners have only been around for 10 or 20 years.

Before we had an MRI scan, it wasn’t possible to look. Inside a healthy person safely. We didn’t know what the inside of a healthy body looked like. ’cause you wouldn’t do a CT scan, a CAT scan, which is the predecessor really well still in use. But you wouldn’t do a CAT scan on a healthy person because it comes with a big dose of radiation.

So you only did CAT scans if you really needed to. The consequence of that is we didn’t really know what the inside of the healthy body looked like until we began doing regular MRI scans, and we’d never seen the inside of the healthy body in high definition until we got the MRI scan. Another thing I remind people then is look at how different we are on the outside.

Most of us have two eyes, two ears. You know, we, we are basically the same, and yet we are completely different on the outside. We are also different on the inside. So we suddenly have this technology that allows us look at the inside of the healthy body as we never could before, and we’re suddenly finding all these differences that we quite frankly just didn’t realize were there because we’d never looked at the inside of a healthy body before.

So in the same way that some of us have big noses and some of us have small noses and some of us have birthmarks and you know, other kind of outward differences. We also have inner differences that really don’t matter in any way to our health. The minute you do a test, be it an MRI scan or a blood test or, or almost any test, you begin finding all these irregularities by the time you get into your fifties.

About 50% of people have an abnormality on their MRI scan. So what I’m trying to point out is that these tests will pick up loads of little things that doctors call incidental omas. So just incidental findings that don’t matter to a person’s health. So the thing you find on the scan is not making a diagnosis, it is being taken in the context of the story you told your doctor and what your doctor found when examining you.

And then the doctor dismisses or places emphasis on what they found in the test based on that story, the test. Produce red herrings all the time, and this is the case for almost every type of test. So doctors are constantly filtering through those red herrings based on the quality of the story that they got from you.

So it’s not really a case of that you go to your doctor and they ultimately do the test to make the diagnosis. They’ll make the diagnosis clinically, and then they’ll use the test to help them. So it’s a real art, but the story is still really central to diagnosis.

Brett McKay: Have you noticed that younger doctors who have gone to medical school where these tests existed, they rely more on the tests than maybe an older doctor who didn’t have these tests when they were coming of age?

Suzanne O’Sullivan: Yeah, I absolutely have noticed that actually, and it is a concern. You know, I’m sort of, unfortunately, I hate to have to admit to it. I’m getting into the older doctor territory now. You know, I’m in my fifties and I qualified as a doctor in 1991, so I qualified just before we had a real kind of technological explosion.

And I think doctors of my era understand the clinical art and its importance a little bit more. Not in all younger doctors, but recently qualified doctors have all these incredibly high tech tests at their fingertips, and I’m not sure that they’ve learned the art of using them as well as they could always.

Of course, there’s many. Excellent doctors, but also there are doctors dependent on technology when I think really technology is a kind of an aid rather than something you should be dependent on.

Brett McKay: Yeah, I noticed this. So I had a general practitioner for a long time. He was an older guy in his sixties, and at the physical we do blood work, the typical thing.

And sometimes he’d say, well, here’s this thing. It’s a little. Out of the normal range, but uh, it’s not a big deal. And he’d ask a few questions, are you experiencing any of the issues? I’d say no. And he’d say, okay, we’ll just keep an eye on it, but you’re fine. Well, he retired and then I got this new general practitioner when she was younger.

She was younger than I was. That’s a weird moment whenever your doctor’s younger than you. And I went in to meet her and she’s like, well, while you’re here, let’s just do some blood work. And I’m like, okay, whatever. Sure. And we did it, and there was some stuff that came back abnormal, not super out of the range.

And she said, okay, we gotta do more tests. I’m worried about this. And I’m like, wait a minute, I don’t. I don’t think there’s a problem. I’m not experiencing any things. She’s like, no, we have to do it. And for a while there I was kind of spooked. I thought, oh my gosh, maybe something’s really wrong with me. I don’t know.

But it was interesting. I saw that difference between a younger doctor. And the older doctor, maybe that’s just a situation where as she gets more experience, she won’t be so test happy.

Suzanne O’Sullivan: Yeah, I think that probably is the case. You know, I think medicine is still really one of those careers where maturity makes a really big difference to how you practice.

You learn from, you know, what you see regularly and you will become a little bit less trigger happy with tests. But your story really, it illustrates the exact problem is if you do enough tests, you’ll find irregularities, especially as we get older. If I do blood tests in people in their sixties, I’ll rarely find that I get a hundred percent normal tests back.

There’ll be lots of little irregularities and that can really send a person down a rabbit hole, you know, ’cause you have a test to check the test and then that test shows something. And I’ve seen quite a lot of people going down that sort of medical rabbit hole that led nowhere. And a lot of us would shrug it off.

You know, most of us would just say, Hey, you know, it’s, you know, you’re a little bit worried, but it’s probably nothing. But it can take over some people’s lives. It can be very anxiety provoking. It can also have a lot of practical impacts on people in terms of insurance and things like that. So we, we do need to be, I think sometimes people don’t know what a good doctor looks like.

And I would say to people that good doctor isn’t the doctor who, when you go to them every time you tell them you have a pain or an ache somewhere, they do a test. That to me, isn’t the good doctor. The good doctor is the one who listens to you and understands when to do tests and when not to do tests.

If they do tests every time, then that’s a situation that concerns me.

Brett McKay: One of the arguments you make in the book is that doctors should only give a diagnosis whenever it would be useful. What makes a diagnosis useful or not.

Suzanne O’Sullivan: So again, you know, we’re doing all these tests and we’re constantly turning up irregularities, and it’s really part of the clinical acumen of a doctor to know how to communicate.

That to their patient and, and, um, what a patient can understand. So I, I think I use the example in the book. We can do a lot of genetic tests now and people with children who have learning problems can have quite extensive genetic tests done that sometimes show up. These things that we call variants of uncertain significance.

So again, we’re, we’re talking about a test here that’s only been around for 20 years and is turning up results that we don’t understand. And in the world of genetics, if you get a result you don’t understand, you call it a variant of uncertain significance. Now imagine you had a a two year-old child who’s struggling a little bit.

You get genetic tests and you’re hoping, those genetic tests will either tell you, you know, this is the problem, or there is no problem, and instead you get that middling answer, oh, your child has a variant of uncertain significance. Now nobody knows what that means. Could be absolutely nothing, could be something.

The question that I’m really asking is if that test result. Tells you nothing. Is it information that I need to pass on to you? I don’t think there’s a right answer to this question, by the way, because I think it depends on the doctor and the patient and their interaction. But if it’s possible that this test result that I got back that I don’t understand at all, and that might be meaningless and that I can’t really explain to you because it’s clinical significance is unknown.

If I pass that on to you and you spend the next 20 years. Terrified for your child’s health. Have I really done you a favor? Or if I withhold that information, am I being paternalistic and withholding information? You might want to know. So I think there’s a real delicate balance in medicine about what information you share and what you don’t share.

Because our job is not to find lots of irregularities that we don’t understand and then scare the living daylights out of our patients, which is becoming increasingly easy with all the tests we have available to us.

Brett McKay: So in the book you talk about different areas where we’re seeing over-diagnosis happen.

Let’s talk about over-diagnosis in cancer. So I think all of us have probably seen reports that cancer rates are increasing, particularly among young people. Do we know if cancer rates are actually increasing or is that we’re just catching more cancer because we’re doing more screening?

Suzanne O’Sullivan: Yeah, I think there’s pretty good evidence that cancer rates are increasing.

So if I make the distinction between symptomatic cancer, so symptomatic cancer is something you found a lump where there’s blood or there’s pain, you know, so you have a symptom that draws your attention to the cancer. And then the second type of cancer I’m gonna talk about is cancer found on screening.

And that’s where you are 100% healthy. You’ve been called forward for screening, and someone has. Found something that you didn’t know was there. So the first kind of cancer, symptomatic cancer that is increasing, you know, there is evidence that people under the age of 50, younger people than ever before are getting cancer.

So I do think there’s a real increase in cancer rates. Maybe it’s related to lifestyle, diet, obesity, et cetera. But we also have a problem of. Overdiagnosis in this group of screened cancer. So this is where people are being called forward and having mammography or blood tests to try and detect cancer that they haven’t detected because they’re perfectly well.

This type of cancer is subject to huge overdiagnosis, which I think it might be a little confusing to people, but we’re back into that sort of territory of. The inside of the healthy body is riddled with little irregularities. And until we got the technology to find them, we didn’t know that people lived out their lives with these super early looking cancer cells that never grow and never cause health problems.

So if you do autopsies and lots of people who died for other reasons, you find little. Abnormal cells that would be technically considered to be cancerous, but they never grew enough to cause health problems. The problem is when you do screening, you find these irregularities. They were always there. They were there in previous generations.

We didn’t know they were there in previous generations because we never looked at at them. We started screening and say the 1970s. Pre 1970s, we didn’t know that people lived out their lives with little abnormal cells that never go into anything dangerous. Post screening. We’re now finding these things, but we cannot tell the difference between an abnormal cell that will become malignant, life-threatening cancer, and an abnormal cell.

The won’t become malignant life-threatening cancer. And the consequence of that is we kind of have a tendency to treat all of them as equal when they’re not really equal. So a lot of people who are treated for cancer and screening probably would’ve been perfectly fine if we never treated them. I hasten to say, I don’t want to put people off from screening with this conversation.

You know, if they’re screening programs, it’s reasonable for people to present themselves for that, for that, but they need to know. About the uncertainties of the results so they can have a good conversation with their doctor about what they do if they got a positive result. So for example, if I have breast cancer screening and I was found to have an abnormal cell, I wouldn’t necessarily automatically say, well, I want, you know, all bells and whistles, cancers.

Tests and treatment, I might say, well, if it’s a very small localized abnormal cell and I know about these things, perhaps can we just do another scan in two months time and another scan two months time after that and see if it’s growing. So there are different ways of addressing these abnormalities when they’re found, and that’s what I want people to take away from this.

Brett McKay: Yeah. So a watch and wait.

Suzanne O’Sullivan: Exactly. A watchful waiting.

Brett McKay: What’s interesting though, with all this, and this is kind of counterintuitive ’cause I, I had a hard time wrapping my head around this, is that overall mortality rates for cancer are down. And so people would think, well that’s because, you know, we’re just catching this stuff earlier.

So the early screenings work, but that’s not entirely what’s going on. So what is going on?

Suzanne O’Sullivan: Well, it’s a little bit a mixture of things and it is kind of a hard thing to wrap your head around. Certainly people are surviving from, say, symptomatic cancer, so cancers that unequivocally need to be treated.

People are surviving better because cancer treatments are better. You know, there used to be no treatment for melanoma. Now there is a treatment, so, you know, treatments for cancer are getting better. However, we also have these sort of really, um, kind of difficult to interpret cancer survival statistics from people who are getting.

Diagnosed with cancer from screening. So just imagine that you screen a thousand people for, for cancer, and let’s say a hundred of those were destined to get symptomatic cancer at some point in their lives, but you over diagnose 300 people and you treat all of those 300 people for cancer. Well, 200 of of those 300 were never going to get symptomatic cancer in the first place.

But if you now look at how successfully you treated those people, the results will look really optimistic. They were never gonna get cancer, therefore they didn’t get cancer and therefore they didn’t die of cancer, but they were never going to. Anyway, my hope I’m making sense here because it’s, yeah. It’s, you know, if you over-diagnose people with cancer and you treat too many people for cancer, you will make cancer survival statistics look a lot better than they actually are.

And that’s why a more useful way sometimes at looking at how successfully we’re treating cancers that are found on screening is to look at what we call all, all cause mortality. So you can look at one of two things. Did they die of cancer? One would hope if you’re overdiagnosed in cancer, that the answer to that question would be no.

So let’s look instead at this thing called all cause mortality. So deaths for any reason. And there was a really sobering study published, I think it was in the Journal of the American Medical Association in 2023 in which they looked at all cause mortality. People who’d been diagnosed with cancer and screening for a whole bunch of cancers like colon, prostate, breast, and they found that they had not prolonged any lives in most of the groups through cancer screening and the colon cancer group.

They had prolonged life by three months, but in the other groups like prostate and breast, people did not live any longer courtesy of their screening and cancer diagnosis. And the reason for that is if you’re over diagnosing, so you screen people. You save somebody’s life for sure. So you found somebody who had cancer that was gonna grow.

You found it, you treated it, you saved that life. But probably there are 10 or 20 other people who you treated who never needed to be treated, and now you have negatively impacted the health of those 20 people. So you’ve saved one person’s life, but you have. Affected the health negatively of 20 or 30 other people who might die of complications of treatment, for example.

So you’re saving some lives, but you are having a very negative impact on others. So it’s a kind of zero sum game, you know? Yes, some people are safe, but other people are given unnecessary treatment that is dangerous to them.

Brett McKay: Yeah, cancer treatment is rough.

Suzanne O’Sullivan: Yeah. You know, people always relate very strongly to the life that was saved in these questions because we all know people with cancer and we know people who’ve died of cancer, and it’s a very frightening thing.

I don’t think we think long or hard enough about the people who got the unnecessary treatment because. Radiotherapy, chemotherapy operations. These are really enormous things physically, but also the psychological impact of being told you have cancer is absolutely enormous. And then we’ve got the kind of financial impact in terms of insurance or jobs or applying for mortgages going forward.

So there’s, we’ve got a very kind of strong focus on saving that one life. And I think we have an unnecessarily kind of blase attitude to that overdiagnosed group.

Brett McKay: One area in cancer where you see a lot of over-diagnosis due to screening. There’s a lot of debate around it. Is prostate cancer, why is prostate cancer so prone to over-diagnosis?

Suzanne O’Sullivan: Yeah. I mean, you know, so. Prostate cancer. It’s because the type of screening they do for prostate cancer at the moment. Now this will change and people are working on improving this, but at the moment the most common type of screening is just to measure a blood test for prostatic specific antigen. So this is sort of a, a blood test that if it is elevated, it doesn’t mean you definitely have prostate cancer, but it means that you could potentially have prostate cancer.

The problem with that test is it’s just completely unreliable. You know, I draw people’s attention to the fact that there is no national screening program for prostate cancer in the US or in the uk or in most countries in the world. And that’s because this particular test has such a reputation for over-diagnosis.

You know, studies are really different on these statistics. To give people a rough idea. If you screen a thousand men for prostate cancer using PSA, you will likely save one life, but you will probably find an elevated prostate in about 240 or 250 people. That’s a lot of men who are now kind of gonna go on a diag.

They won’t all be diagnosed with prostate cancer, but they will all be started on a kind of diagnostic odyssey of do they don’t? They have prostate cancer and tests and screening. A small number of them will have biopsies and. Small number of them will be told that they do have prostate cancer. But most of those never needed to know that because as men get older, a huge number of them develop cancerous cells in the prostate that never progress.

So there was an interesting study done in Detroit where the autopsies were done on people who had died in accidents and things unrelated in any way to the prostate. And they found that 45% of men in their fifties have abnormal cells in the prostate and 60% of men in in their. Might have that. Statistics might be slightly low actually, of men in their sixties have abnormal cells in the prostate.

So as men get older, they all get abnormal or a large number, get abnormal cells in the prostate. Once you start screening for that, using prostate specific antigen, you’ll over diagnose lots and lots of men. So the unreliability of the test is the reason we don’t do this now. I think the solution to this.

Is to screen the right people. So there are men who are at higher risk of prostate cancer than other people. People with family history of prostate cancer, for example. Um, black men are more likely to have prostate cancer, so you can still do screening. But screening is more meaningful if it’s done in people who are at high risk.

Whereas if it’s done in people with low risk, it can produce very unpredictable results. And also, if a person is really concerned about their health, they may still wish to discuss getting a PSA test with their doctor, but it’s important they know before they have that test done. How. Uncertain. The interpretation of the results will be know yourself in a sense.

You know, are you the kind of person who if they get that abnormal result back, will struggle to live with that knowledge? Or are you the sort of person who can enter a watchful waiting program and not worry too much? So it’s all about knowledge, so you know what to ask, and knowing whether you can handle the information that you get back.

Brett McKay: Yeah, I got an example of someone who had a deleterious outcome because of a PSA test. So he is in his fifties. Got the PSA, it was elevated and the doctor’s like, I’d like to do a biopsy. And for those who don’t know biopsies, they basically stick a needle through your rectum to your prostate and then extract some tissue.

And he’s like, I don’t want to, no, I don’t. I don’t think so. I don’t think I have prostate. I’m healthy. I don’t have a history of it. And the I said, no, you need to do it. And so he, he did it and he ended up getting sepsis from the biopsy. And he was in the hospital for a few weeks and he didn’t end up having prostate cancer.

There was nothing there.

Suzanne O’Sullivan: Well that’s, that’s it. Precisely. I mean, you know, you will save the occasional life through this type of screening, but you will send a lot of people on this very, very unpleasant road of tests. So they’re working obviously very hard on, on proving this screening. And in the future I hope that things will be better, but at the moment, there is no national screening program for a reason, and that’s worth thinking about.

Brett McKay: We’re gonna take a quick break for your word from our sponsors and now back to the show. You mentioned colon cancer and there’s been more of a push in the past decade or so to get a colonoscopy, but I think the recommendation for the age to get your first one has been lowered. It used to be 50, now it’s 45, at least here in America.

Suzanne O’Sullivan: Yeah. We don’t have colonoscopy as a standard screening tool in most countries. It’s usually testing for blood in your feces, and if there’s blood there, then that potentially is symptomatic cancer, but it could also be hemorrhoids. So that’s the usual type of screening that it wouldn’t be to go straight to colonoscopy because colonoscopies, you know that that’s an unpleasant test that comes with risks of things like perforation.

You don’t want to. Leap into that unless you have a family history. Again, we’re we’re, we’re always back to this sort of, these things need to be made. These decisions need to be made in the context of risk. It’s like, what’s your clinical story? What’s your story? What’s your background? If you’ve got a family history of colon cancer, then you’re in a high risk group, and then certainly colonoscopy is something you’d wanna consider.

But if you’re someone who’s very healthy with a very healthy diet, who is asymptomatic. Then that may be not something you want to consider.

Brett McKay: Yeah, that’s something I’ve interesting. I’ve noticed America tends to be screening happy, like we love our tests and not so much in Europe.

Suzanne O’Sullivan: Yeah. Well, do you know what we do fair bit of screening as well, but I, I think you’re, you’re right, we’re not quite as, I think it’s how to, a certain degree is how our health services differ.

You know, we, in the National Health Service in a way. I, I consider myself to be protected by the NHS from Overdiagnosis because, you know, there’s no, you can’t have a test on demand. We’re much less likely to have whole body MRI scans or to have MRI scans if you have no, or minimal symptoms and a. I’m quite happy with that term of events because the more tests you have, the more likely you are to find these incidental things.

And I think that once really sobering, um, study was in the New England Journal, I’ve forgotten the date of it now, but a very, very recent in the twenties roughly. And they looked at cancer diagnosis in high income countries like the US for example. Versus low income countries. And what they found was that, yeah, people live longer in high income countries.

Well that’s not surprising. You know, you, you don’t only have better healthcare, you also have better lifestyles, et cetera. But they found something else that is worrying. They found that much more people were being diagnosed with cancer in the high income countries than in the low income countries. But the cancer survival rates for those cancers were actually quite similar.

So. It seemed like a lot of people in high income countries, by virtue of having more tests and more high quality tests are being diagnosed with cancer potentially unnecessarily. No extra lives were saved by all the extra cancers being diagnosed. The paper estimated that, you know, for every cancer diagnosis, through all of this availability of technology, 10 probably weren’t necessary.

So, you know, I know that the NHS has a great deal of problems. It is. Needs to be a a lot better funded than it is, but there is something to be said for the lack of financial dealings between patient and doctor. You know, a patient comes to see me. The diagnosis is dependent on nothing but the story that they tell me.

I have no, they’re not my customer. I don’t need them to come back to me to be paid and so forth. And there’s something in this kind of financial transaction between patient and doctor that is, is potentially harmful. And I don’t think people always realize that.

Brett McKay: Another area you talked about where there could be.

Overdiagnosis going on is diabetes. I mean that’s because the diagnostic boundaries have shifted in the past, I think, decade. What was that change and how has that led to overdiagnosis?

Suzanne O’Sullivan: Yeah, so this is a trend in medicine in multiple different areas of medicine. So, you know, there’s lots of medical problems, which the diagnosis isn’t based on there being an abnormality.

It’s. Based on drawing a line between normal and abnormal, like what level of blood sugar are we willing to accept as normal? What level of blood pressure are we willing to accept as normal? And we’ve had this assumption in medicine that if we kind of keep moving, that if we can detect more and more people with borderline diabetes or borderline hypertension.

Or borderline obesity, borderline mental health problems, that we will help more people and therefore we keep adjusting the line between normal and abnormal to diagnose more and more people. So I think it was in about 2003, we had created this condition called pre-diabetes. So this isn’t diabetes. This is a kind of borderline state between being perfectly healthy and potentially going on to develop diabetes.

In 2003, they made this slight adjustment. To the measure that would allow a diagnosis of pre-diabetes and then a fasting blood glucose. You fast, you have your blood sugar taken. And on one day in 2003, if you had a measure of 6.1 millimoles per liter of fasting blood glucose, you were healthy. But then they adjusted that and said, no, 5.6 will be the new cutoff.

So it’s just a small change, you know, one day. 6.1 is normal. The next day, 5.6 is normal, but the result of that is that if the changes in the way that pre-diabetes was diagnosed was applied to everybody in the world, this small adjustment along with some other changes in how the diagnosis made would mean that half of Chinese adults would be pre-diabetic and a third of us adults would be pre-diabetic.

So. You are sitting at home minding your own business essentially, and you feel you’re perfectly healthy. And meanwhile, somewhere in the background, a committee is convening and deciding, you know what, what counts as normal glucose? And on a Monday they change it and suddenly you are. No longer healthy.

Now you are a patient, and this is done with very good intention. It’s because, well now we’ve recognized loads of more people with pre-diabetes, we can stop people getting diabetes. The problem is that it’s not working. The rates of diabetes are rising all the time. Even though for 20 years we’ve had escalating diagnoses of pre-diabetes, and this is really the absolute definition of overdiagnosis, is you identify more and more and more patients.

But you’re not actually making people healthier. And it may be that they’re not following the advice that they were given, for example, but what is clear is that this kind of growing, um, group of people with pre-diabetes is, is not benefiting them to know that.

Brett McKay: Yeah. And it’s essentially about pre-diabetes.

It’s in this weird gray area ’cause it’s not officially a diagnosis, but then people treat it like a diagnosis. They think of themselves as a patient. Well, I have pre-diabetes and I have to do certain things to make sure I don’t get full-blown diabetes.

Suzanne O’Sullivan: Yeah, that’s it. It’s not actually a disease, pre-diabetes.

It’s like a pre disease state, but it sounds very much like a diagnosis and in one sense it could be a great thing. So it depends really on your mindset and your lifestyle and how you respond to news. You know, if I was told that I had pre-diabetes, then perhaps I would respond by improving my diet and exercising a bit more and trying to lose some weight.

And, you know, it could have a really positive impact on me. It could be a really good. Thing for my long-term health, but somebody else might respond differently to that. If you take a healthy person and tell them, you know, now because of this blood test, I consider you a patient. That can have a very negative impact on other people.

It can affect, if you turn a person into a patient, they can start behaving like a patient. They begin noticing things about their body. You know, being told that you’re unhealthy turns your attention inwards to your body. And then you start noticing little things and worrying about symptoms you didn’t worry about before.

You know, in a sense, the creation of pre-diabetes, we created it to protect people’s long-term health, but we’ve underestimated the impact of the news that you have pre-diabetes on a person, how that might affect their kind of self-concept and how it might affect how they feel about their body and so forth.

Brett McKay: Yeah, it threw me for a loop for a while, so I remember I had some blood work done. My fasting glucose was high. It was like 102, and I was like, oh my gosh. I got pre-diabetes and I even went out and I bought a glucose monitor, started measuring my glucose every day, and I’m like, I don’t know what I’m supposed to do.

’cause I exercise, I eat right, I don’t drink. I’m doing everything. I’m not overweight. And I remember I finally talked to a doctor, I was like, what do I do? I have pre-diabetes. And they’re like, well, let’s check your insulin, your fasting insulin looks good. So you don’t look like you’re on the road to diabetes.

Maybe your glucose just runs a little high. In the morning and that’s your normal.

Suzanne O’Sullivan: Yeah. Well that’s it. You know, again, I kind of remind people of how different we are on the outside and you know, these sort of differences exist on the inside too, and it doesn’t have to be an abnormality. And in a sense you made the important point there, which is you are otherwise a very healthy person.

You know, these things have to be taken in context. If I was told I had pre-diabetes and I was also a smoker. You know, my father had heart disease and my mother had a stroke and I’ve also got borderline high blood pressure. Well then these are issues that need to be addressed. But if you’re otherwise a very healthy person with a borderline blood test abnormality, then you don’t necessarily have to be so worried about it.

So we need to take these things in context and, and not be terrified of every abnormal result.

Brett McKay: You mentioned high blood pressure, uh, has undergone. Uh, a change similar to diabetes and how we define it?

Suzanne O’Sullivan: Yeah, I mean, you know, uh, so there’s this thing sort of borderline hypertension, which I guess is the same as pre-diabetes.

You know, you, your blood pressure’s kind of in that border area. You’re not really hypertensive, but you could spill over into that region. The level of blood pressure required to have borderline hypertension just keeps shifting and. In the US Now, borderline hypertension is a measure of 130 over 80. Now, when I was in medical school in the 1980s, 130 over 80, you’d be delighted with that blood pressure.

That’s perfectly normal blood pressure. Whereas now if if it’s a little bit higher than that, you potentially. Could be offered. Well, you’ll definitely be offered lifestyle changes, but you could also be offered drug treatment for that, something which would’ve been considered completely normal two or three decades ago.

In Europe, we use a slightly more generous cutoff, more around 140 over 80, or 140 over 90, because these are arbitrary cutoffs. No one knows where normal blood pressure begins and ends. So committees of experts get together and make arbitrary cutoffs. And when they do that, when the change was made to decide that blood pressure should now be normal, up to 130 over 80 and abnormal above that, that immediately made a third of American adults a borderline hypertensive, which is just astonishing statistics.

Can it really be true that a third of adults in the US are borderline hypertensive? The purpose is good. The purpose is prevent heart disease, prevent strokes. But how many people with borderline hypertension do you have to treat to prevent a stroke? Well, that could be, if I treat every single person I meet with borderline hypertension, I might prevent.

You know, one stroke per per a thousand people, but I might treat 150 people who never needed to be treated. So you always, with these adjustments, you’re always saving somebody, but you are equally, you can be guaranteed. You’re overtreating a great deal. Many people. More people. So you’re probably, you know, per life save you’re probably overtreating a hundred and 150 people.

But that’s, you know, that’s okay if it’s just a little kind of reminder to be healthy. You know, if you are the person who goes to your doctor and they say you’ve got borderline hypertension, and then you go home and your lifestyle is suddenly transformed by the news, well then that’s been great for you.

And I don’t object to that. But you could be the person whose life is taken over by concern about your blood pressure or who goes on tablets and gets side effects that makes you sick when you weren’t sick before, or whose health insurance goes so high that you can no longer afford it. So we have to think both sides of it.

Brett McKay: Another area you talk about where there’s a lot of over-diagnosis is Lyme disease. Why is Lyme disease so hard to diagnose and why is it vulnerable to over-diagnosis?

Suzanne O’Sullivan: You know what, uh, the first thing I’d say is I don’t think Lyme disease is hard to diagnose. Lyme disease is very well defined clinical criteria and you know, no test is a hundred percent reliable, of course, but pretty reliable.

Two stage blood testing, there’s two stages of blood testing you have to make the diagnosis. So actually, I’d say diagnosing Lyme disease. Is relatively straightforward. The reason it’s so overdiagnosed is twofold. One, because Lyme disease causes a huge array of symptoms, many of which are symptoms that any one of us could, you know, have probably experienced at some point in our lives, like fatigue, joint aches, and pains.

Just these kind of non-specific symptoms that are part of loads and loads of different medical problems, including psychiatric problems, but also physical problems and also aging. So these are super common symptoms, so that makes Lyme disease very available to overdiagnosis. If you go to your doctor tired and they can’t think of any other explanation.

Well, Lyme disease is one that can be provided if you are desperate for an explanation. That’s one reason I think it’s overdiagnosed. It’s in a world where people are suffering and want answers, it’s an answer. The other reason it’s overdiagnosed is because the tests are misused. Really. You know, as I’ve said before, tests need to be taken in a context.

The tests for Lyme disease have lots of reasons. You can have a positive test but not have Lyme disease. So if you spent your whole life, you grew up. Living beside a forest in Connecticut where there’s loads of Lyme disease, chances are that in childhood you’re exposed to Lyme disease and developed immunity.

And later in life, if you have a blood test, you can test positive for Lyme but not have Lyme disease. Or maybe if you’re sick in some other way, you’ll get a false positive on the test. So the tests are easily misinterpreted and you’ve got a disease that has symptoms that overlap with so many other things.

And you’ve got a society that needs explanations when they’re not feeling well, and if explanations aren’t readily available, then Lyme disease. Will account for quite a wide range of symptoms. Then you also have an element of corruption added in here. You know, if you have a diagnosis that is available to give to people who are desperate for an explanation and you work in as a private doctor in, in this area, then over diagnosing is very, very simple because of the uncertainties in the blood tests.

Brett McKay: Yeah, I thought it was interesting you talk about, there’s a surprisingly large number of people who have been diagnosed with Lyme disease in Australia, but Lyme disease, the bacteria that causes Lyme disease doesn’t exist in Australia.

Suzanne O’Sullivan: Yeah, I mean, this really speaks to the problem, so, you know, e exactly that.

I mean the, the type of the climate in Australia, the type of ticks that carry the bacteria that cause Lyme disease, they can’t survive in Australia because of the climate, and therefore nobody has ever found the bacteria in any ticks that. In Australia, and yet there’s something like a half a million people in Australia who believe they contracted Lyme disease in Australia, which is fundamentally impossible.

And yet people are getting these diagnosis. But you know, there’s similar. Very high misdiagnosis rates in the us. So a specialist Lyme disease clinic reviewed the diagnosis of a, a large thousands, I think it was 5,000 people who had a diagnosis of Lyme disease. Went to this specialist Lyme Disease Clinic, and they determined that 85% of the people who thought they had Lyme disease did not have Lyme disease.

So this is a diagnosis that is overused at an enormous rate. It’s estimated that about 60,000 people test positive in a, in a proper lab that is making the diagnosis correctly in the US 60,000 people per year. And yet something in the region of half a million people are being treated for Lyme disease.

So the number of people being overdiagnosis is very high. And I think that’s because it’s an available explanation for symptoms that people struggle to explain. And I think it’s also because there is a problem with people. Essentially giving out slightly over exuberant diagnosis for monetary reasons.

Brett McKay: What do you think is going on with these people who, you know, they get the diagnosis of Lyme disease, but maybe they don’t have it? Like they do the test and they don’t, there’s like, okay, you don’t, there’s no way you could have Lyme disease, but they’re obviously suffering. You know, they’ve got the fatigue, the joint pain, brain fog.

Similar thing happened with people after COVID and they’re like, I got, you know, this whole idea of long COVID, they’re obviously suffering. So what do you think’s going on?

Suzanne O’Sullivan: Yeah, I think, I mean, that’s a super important point to emphasize, which you just did, which is to say that someone has been misdiagnosed doesn’t mean they’re not suffering.

But yes, so there’s, at any one point in time, there’s a lot of people who are suffering with non-specific symptoms like headaches, difficulty sleeping, joint pains, tiredness, and those people will be given a diagnosis that sort of makes sense at a. Particular point in time, and as you said, during a COVID pandemic, if you have that collection of symptoms, you’ll be, could be told you have COVID or long COVID.

You know, if you live beside a forest filled with Lyme disease or in a period when Lyme disease is common, you be given Lyme diseases that diagnose for the exact same symptoms. What is going on with these people? Well, there’s a variety. People are probably just hard to diagnose. They have something that we have not yet fully understood, like an autoimmune condition that we don’t yet fully understand.

But I would suspect that the largest proportion of these people probably have what I would refer to as psychosomatic symptoms. So I’m a neurologist. This would be something I would see very often. So a lot of people in response to stresses or anxiety or difficult lives or unhealthy lives, develop non-specific symptoms.

So we’ve all had this experience. You know, if you’re stressed, you get a headache, or if you are. Just very tired or not looking after yourself, you’re more likely to pick up colds and flus, or you get aches and pains. So our bodies are very vulnerable to developing physical symptoms in response to psychological stressors, and very common symptoms in that context are things like tiredness and aches and pains.

I actually see people with much more extreme versions of this with seizures, paralysis, blindness, and so forth. I think a great, many of these people have psychosomatic symptoms, but we live in a society that. Looks down on psychosomatic symptoms. So you know, if somebody is very sick, if they’re bed bound because they feel so bad, they literally can’t get outta bed.

And you learn that the problem has a more of a psychological cause than a physical cause that’s looked down on, you know, we don’t have a lot of respect for that. And that pushes people into the need to find an explanation that society is more understanding of. And usually that’s a physical disease. So I think there’s a lot of people who have an array of physical symptoms that probably arise out of psychological distress, but which are diagnosed as a disease because that’s the culture we live in.

You know, psychological suffering is not respected to the same degree as physical disease.

Brett McKay: And you talk about once someone gets a di, like a medical, a biological. Diagnosis for what could be psychosomatic. It causes the nocebo effect where you start paying more attention to your body and thinking, oh, this is actually, this shows that I have this thing.

And it just sort of creates this vicious cycle downwards.

Suzanne O’Sullivan: Yeah, I mean, this is the problem with all the medical labels we’ve been talking about. This is the problem for the people with hypertension, the people with pre-diabetes, the people with cancer, et cetera, is that once you’re given a medical diagnosis, it, it can have, you know, it’s, everyone’s familiar with the placebo effect, which is if you given a tablet and you believe it will work, it can alleviate your symptoms.

The exact same happens in the opposite direction, referred to as the no sibu effect. So this is where you know, if you believe something will make you sick, it can make you sick. I always say to people, listen, there is examples of this in everyday life everywhere. You know, if you were about to sit down to your dinner in a restaurant and you turned around and you saw the chef.

Coughing into the food, which immediately changes your experience of your body following what you’ve just eaten. You know, um, if you eat something and then you suspect it was unhygienic after the fact, you can start feeling sick. This is the most normal thing in the world. So imagine now that somebody has told you that you have a disease and that it causes, you know, X number of symptoms.

You immediately kind of look at your body and beginning examining yourself for those symptoms. And I guarantee you, especially as you get older, your body is awash with things to be found. If you pay enough attention, you know that aching knee that you know, it only lasted a day. Normally you’d dismiss it, but you’ve just been told you have Lyme disease, so now you.

Place a lot of emphasis on that aching knee, whereas you might not have worried about it yesterday or you know, some little mole on your skin suddenly gets heightened in your perspective through anxious tension. This is the problem with medical labeling, is it reinforces not in everyone, but in a percentage of people, it can reinforce symptoms.

By turning anxious attention to your body and really worrying less about your health is sometimes the answer.

Brett McKay: There’s been an increase in mental health diagnoses in the past few decades. Are there actually rising rates of mental health issues or are we diagnosing people that maybe don’t need a diagnosis?

Suzanne O’Sullivan: Yeah, so it’s such a super hard question answer in the sense that it’s so hard to untangle. In in one sense, there does seem to be evidence that suggests that particularly in the group of adolescents to young adults, say age 16 to 24, there does appear to be more mental health issues in this group, for example, more than any other, and that means they’re more likely to go to the doctor with symptoms and also that they have more mental health symptoms.

But does that mean that there is more mental health illness in this group because that can be explained in so many ways. It could be that we’ve got all these awareness campaigns going now, often targeted at young people and awareness campaigns in schools that bring people’s attention to mental health problems.

So are they going to their doctor because they’ve been. Given express instruction to examine themselves for problems, and they’re finding things we wouldn’t have found before because we didn’t think that way. Are they more symptomatic because of the anxious attention that they’re paying to their moods, or are they genuinely more symptomatic?

So I think it’s really hard to untangle. To what degree is the fact that young people have more mental health problems there because we have created that through awareness campaigns, through telling people to worry about small changes in mood, or is it a real increase in mental health problems. But I think whatever.

Conclusion you come to on that you have to say that there is an over-diagnosis of conditions like ADHD, and autism. Now, again, I emphasize that when I talk about over-diagnosis, I’m not saying this person isn’t suffering and you should ignore them and tell them to snap out of it. That’s not my attitude.

I’m saying that. Adolescents sometimes have struggles, and by over-diagnosis, I mean medicalizing those struggles by referring to them through labels of ADHD and autism might be harmful to them. The reason I say there’s over-diagnosis is very hard to spot over-diagnose an individual. So let’s say you’ve got a 16-year-old and they’ve been told they have a DHD, and they’re validated by the diagnosis and they feel better.

Is that over-diagnosis or isn’t it? You can’t really tell. You can tell by looking at the population. So we’ve been making mental health diagnosis at escalating rates since the 1990s. We’ve been telling young people they have ADHD and autism at escalating rates since the 1990s. Now, the purpose of seeking out those young people and giving them those labels is that the problem should be recognized.

They should get support, and then they should be happier, healthier. Better adjusted adults, but what do we see downstream? We’ve got way more teenagers getting diagnosis of ADHD and autism, but we also have way more young adults who now have mental health problems like depression and anxiety, and that’s the very definition of over-diagnosis.

It’s not to say that original group who were told they had autism and ADHD didn’t have a problem at all. But it seems to me that framing the problem through these lenses of autism and ADHD has not resulted in healthier and happier adults, and we really need to rethink what we’re doing. You know, my real fear is that you take an adolescent and you tell them that their communication problems are.

Abnormal and due to a brain chemistry abnormality or that their sort of attentional difficulties are not because they’re a teenager and teenagers have attentional difficulties, but because they have a dopamine and abnormality in their brain, then you potentially make that problem so concrete that a child can’t overcome it.

Adolescence is a time of change. You should have the opportunity to mature out of your difficulties or to work on things, and I’m afraid that because we tend to make a diagnosis and then accommodate them, we’re not giving children the chance to make the changes that we all made.

Brett McKay: People get really touchy about this, particularly around ADHD and autism.

Uh, I know it can get very heated, the debates about it. Why do you think that is?

Suzanne O’Sullivan: Yeah, I think it’s mostly because people kind of understand this conversation to mean that. Their difficulties are being dismissed as irrelevant or they don’t have struggles, and that’s certainly not how I feel about it. I think that adolescents in particular is a real time of difficulty, but also people who are getting diagnosis in older age, I believe the difficulties are real.

But I don’t think medicalizing the difficulties with these labels is the right thing to do. So I wouldn’t wish in any way for anyone to feel that. I’m saying we should go back to the old days where everyone was told to snap out of it or you know, I was in school in the eighties, you know, nobody in my class of 120 was recognized as having a special learning need.

There must have been someone, you know, so we had an underdiagnosis problem. I’m not suggesting we should go back there, but I’m suggesting that we should think about how we are helping struggling people and ask if it’s the right kind of help, you know, is it really optimal? I still think we should. If someone has a problem, then they need to be able to voice it and then their problem needs to be acknowledged, but is then attaching a medical label, the right way to go about things.

And I know that it can make people feel validated and I don’t want to take that away from people. But I think that a diagnosis needs to come with something more than validation. It needs really to lead to something more positive. Unfortunately, when you’re validated by a diagnosis, it can just make the symptoms worse because in order to.

Remain validated and remain part of this new tribe that you belong to. Courtesy of your diagnosis, you have to continue to not be well. Getting well means you lose your tribe and you potentially lose your diagnosis. So how do you get well in those circumstances, I think we’re better to frame our difficulties in terms of, you know, what in my life can be changed to make me feel better.

Rather than framing them through internal chemistry.

Brett McKay: And in the case of ADHD, I mean, one of the things you do to treat it is, you know, prescribe Ritalin or Adderall, which, I mean, those are schedule one substances, like those can be highly addictive substances. And it’s like, well maybe you don’t need to get on that if you don’t need it.

Suzanne O’Sullivan: You know, it’s interesting how, how badly we learned from the past. You know, we had a whole benzodiazepine crisis in the eighties. You know, it seemed to be a drug that did amazing things for people, but then people got highly addicted to it. And then we had an opioid crisis, you know, for a while everyone thought opioids were the best thing ever, you know?

And look, look where that led us. We are not very good at learning from the difficulties of the past. You know, I’d be very loath to take a medication that is fundamentally a stimulant, which isn’t amphetamine-like drug unless I knew I had to take it. Now, that’s not to say that I don’t think there’s a role for medication.

There will always be people who have extreme disability. There always are hyperactive children who are so hyperactive. They really cannot. Engage in education and they may need something to help them through a difficult period. So I’m not a kind of, never say never, but this wide prescribing of stimulant drug seems really ill-advised to me.

Brett McKay: So what do you think the right balance is between diagnosing too much and not diagnosing enough? Like what do you want readers to take away from your book the next time they’re dealing with a health concern?

Suzanne O’Sullivan: Yeah, so I think what’s really important is first of all, you know that you have choices very often, and I think that’s something people don’t really realize.

Uh, most medical. Situations are not urgent. So we have occasional emergencies, but most things you go to your doctor with, you can get a test result and you can think about it. So I think that we should be creating a system of more slow medicine where you get test results back and then you consider all the variables.

Are you a high risk? Person, what else in your life might put you at risk of this particular disease so that you can decide whether you need to react urgently or whether you may be someone who doesn’t have to worry and can go down a more watchful waiting pathway? I think it’s very useful for people to understand the uncertainties in test results ’cause it, it might feel like the best thing in a certain circumstance to have that blood test or to have the scan. You know, a lot of neurologists wouldn’t have a brain scan as it happens, and I think it’s useful for people to know that, that sometimes the scan that you have to relieve your anxiety can actually cause more anxiety.

I really want people to just do a balancing exercise when it comes to diagnosis. Ask themselves before they get that. Mental health diagnosis or ADHD or autism diagnosis. If I get this diagnosis, what will I get? What will it bring me that is positive? And if I get this diagnosis, what are the potential negative impacts of that diagnosis?

And you really need to be sure that what you get is substantially greater than what you lose through a diagnosis.

Brett McKay: Well, Suzanne O’Sullivan, this has been a great conversation. Where can people go to learn more about the book and your work?

Suzanne O’Sullivan: Well, I hope everybody will buy the book, which is called The Age of Diagnosis, How Our Obsession With Medicine is Making Us Sicker.

You know, I feel like sometimes when I talk about this subject, people might think I’m an outlier doctor that you know, who is this doctor coming along and saying all of these kind of slightly scary things. But actually everything I’m talking about is widely discussed within medicine. We’re just not having a good enough public conversation yet.

Brett McKay: Well, Suzanne O’Sullivan, thanks. Your time has been a pleasure.

Suzanne O’Sullivan: Thank you for having me.

Brett McKay: My guest there is Dr. Suzanne O’Sullivan. She’s the author of the book, the Age of Diagnosis. It’s available on amazon.com at bookstores everywhere. Check out our show notes at AoM.is/diagnosis where you can find links to resources and we delve deeper into this topic.

Well that wraps up another edition of the AoM podcast. Make sure to check out our website at artofmanliness.com to find the podcast archives. And while you’re there, sign up for a newsletter. We have a daily and weekly option. They’re both free. It’s the best way to stay on top of what’s going on at AoM. And if you haven’t done so, I’d appreciate it if you take one minute to review the show on your podcast app or Spotify, it helps out a lot. And if you’ve done that already, thank you. Please consider sharing the show with a friend or family member if you think you’ve gotten something out of it. As always, thanks for the continuous support. Until next time this is Brett McKay. Put what you’ve heard into action.

This article was originally published on The Art of Manliness.