An Expert Warns: Too Much Time Indoors May Be Raising Your Risk of Heart Attack & Stroke — Here’s How to Overcome Our Indoor Epidemic with Dr. John La Puma

John, a pleasure to have you here. And a pleasure to meet you. And you too. We have lots in common. We have lots in common, and my audience cares so much about this topic. But interestingly enough, if you go to the average person on the street, and you say, hey, are we increasingly spending more time indoors? Most people would say, yeah, I think so. I think generally we're spending more time indoors. But the thing that most people have no idea about, even I polled a few friends in anticipation of this interview. Friends that think that they're very healthy. And I said, did you know we're spending 93% of our time indoors as human beings? And not only that, it's taking an incredible toll on our physical and mental health. Let's start off. What's the cost of this 93% of our time that we're spending indoors? Isolation, immune deficiency, insomnia, intensive fatigue, cognitive deficits, myopia, increased sedentaryness, obesity. It's just kind of the list goes on. And it's actually, I think, a root cause of a lot of those chronic diseases that we simply have not been able to identify. And there really hasn't been a prescription until now. That's a pretty bold statement coming from a physician. Do you think that a lot of your colleagues in this space, we're here recording in Santa Monica, you did your residency at UCLA, if we went to them, your peers that went to medical school with you and said, hey, is a root cause of a lot of the chronic diseases that we're seeing out there, things that are exploding amongst people, especially in the last few decades, is a root cause of that, the amount of crazy amount of time that we spend indoors. What would they say? Well, I mean, it's at least a co-factor for each of those conditions. And I think that they would say, show me the data. Okay, where's the data? And I would say, I read 2,200 studies in the peer-reviewed literature to put this together, studies that referenced everything from light and air to gardens and forests to try to put together a thesis for why it is we've seen so much chronic disease accelerate and what the indoor environment is doing to us. So this isn't just me saying this. I'm reflecting what the research shows and I'm formulating it in a new way because I think it needs a name. We haven't really had a name for this. And since COVID, it's become normal to have a screen-centered life, but it really isn't normal. We evolved over 200,000 years outside and we're kind of living in a 50-year built environment and we're the first generation, I think, to move indoors and stay there. And that's impacting our biology in the kind of serious medical ways I think that the literature supports. What's new about this is not just the formulation that there is an indoor epidemic and that it hurts us and that inside isn't nearly as safe as we've been led to believe, but that there is a fix and that the fix is actually much simpler and much more accessible and less expensive than a lot of traditional solutions to these medical problems, which certainly have their place. I prescribe pharmaceuticals, I prescribe devices, I prescribe operative procedures, I send people to surgeons. I'm saying that outdoor prescription, outdoor prescriptions in general and my outdoor RX, which I point to and describe in indoor epidemic, are easy, that there are protocols, that anyone can implement them and that they're easier to do than you think. Going back to your colleagues, you said that they would say, show me the data. Sure. And often in medicine, if you study the history of medicine, the data, sometimes that's clinical experience, sometimes that's controlled studies, case studies, other things. The data is often there, but it takes somebody to come in and connect the dots because if you weren't taught about it, you may not know about it. Exactly right. Just like I got two hours of nutrition in cooking school, I got about two hours of nutrition in medical school. Now, nutrition is going to be taught more broadly. We taught the first culinary medicine course in the country. Michael Royzen and I founded the Cleveland Clinic Wellness Institute and now culinary medicine is taught in 80% of schools. I think that this is starting in the same way that we have a chance to introduce the kind of research that's needed. And I think many clinicians rely on peer review trials. It's not enough just to have experience of another doctor, not enough to have case reports, not enough to have them as anecdotal evidence, not enough to have your own observations in practice. We want to take those observations and then put them in research protocols and test them. What I'm saying is that much of that data actually already exists and it's coming online very fast. Since I've reviewed the literature, there are literally 700 more articles than when I reviewed them for this even last year. And that's because there's intense interest in this space, in the space that suggests that light can be a nutrient, that air can be a nutrient, that you can change your biology with specific intentional exposure to blue and green spaces. Yet, you need to be really specific about what the science is. You need to be specific about natural killer cells activity going up 56% with a two-hour forest exposure. You need to be specific about blue-like suppressing melatonin at night by 21% when you have that exposure within 60 minutes, some people think within 90 minutes, of sleep. And then that effect lasting an hour and a half of suppression, not being able to get to sleep. You need to be specific about gardening and long-term gardeners having 37% less dementia than non-gardeners and the act of gardening itself lowering hemoglobin A1c by 0.5%. The same as initial dosimette foreman. You need to be specific about circadian biology works, how the mitochondrial system works, how the glomphatic system works, how the gut brain access works. And when you do that, when you put these four things together, you have a protocol that begins to make sense to science-oriented clinicians. Green exercise, I mean, I could talk for hours about this, but green exercise is essential for what I know you're especially interested in mitochondrial action and flexibility. And movement improves mitochondrial action when movement is outside and mitochondrial biogenesis. These are cellular mechanisms that result in clinical effects. And that's what people care about. What do I do? Yeah, you're talking about what people care about and to really bring home this idea of the indoor epidemic. There's this idea that you share in the book pretty early on. And it's this idea that what if the reason you're tired, anxious and not sleeping well, isn't your diet, although diet's important, it isn't your supplement or it isn't your routine necessarily, but the fact that you're spending 93% of your life indoors. Do people actually know when you talk to individuals or patients or former patients, do they actually know that, hey, the reason that I feel like crap or have that afternoon slump especially might be because I'm spending way too much time indoors? Is that connection being made? I think it's going to be made. I think people like you are helping to make it, frankly. And I think one way to understand that is this concept of digital obesity that I introduce. That's not my original term, but it's a term that I found in the literature that describes what happens when people are in front of screens too long. Because when we're inside, we're not often in front of a screen. Whether that's your phone and when your phone's in your hand, your brain thinks it's time to work. Whether that's at night or in recreation or on the beach or walking down the street, some people walk that, or at a car. Too much sugar burns out your metabolism, too many pixels burn out your brain. Susan Magnuson at Johns Hopkins, who a neuroscientist there said just yesterday that we used to have cognitive attention of up to 90 minutes and now it's only 20 minutes. So when you're bagging out at the end of a 60-minute meeting at work, it's not because you're lazy, you have a character flaw, or because you just can't pay attention because you're distracted by something else. It's because your brain is overloaded and you need to restore your attention, which you can do. One of the things I describe in the book is a way to do that. You look at the horizon, I think everybody should look at the horizon. If you can't see the horizon, you look as far away through a window as fine as you can. Rooftop, the sky, one minute an hour. It's really all it takes to reset your attention, which has been too focused on a screen, on sometimes something this far away, sometimes 18 to 24 inches away. Distance vision allows your brain to reset. It's a safety signal. It allows you to engage the relaxing signals in your brain to then go back and refocus. It's super important because what you're talking about here is that the idea of the book is that we're spending 93% of our time indoors, and we'll do a breakdown of where that time is. Of course, it's the home, but it's other things too, but the silver lining is that we don't have to all move to a lifestyle where we're spending all of our time outside. We need to take that 7% of the time that we are spending outdoors and tweak it so that we get the maximum value of the healing power of the environment, nature, that's around us. Is that correct? Exactly. What we're spending outdoors now is incidental time. Give an example of that. What's the incidental time that people are finding in that 7% percent? The incidental time is like you go outside to pick up the door dash. You walk down the street to a coffee shop. You go from your car to the office. You go from a parking lot to another parking lot. You have time that is not intentionally deployed in a blue or green space to change your biology, and that's what the prescription is. Our 93% is 86% in buildings and 7% in vehicles. The buildings can be office, it can be home, it can be restaurants, it can be businesses. The 6% in vehicles can be depending on where you live. I was in Manhattan last week, a subway, a car, a bus, a train. When you're in those indoor environments, you don't get any biologic signal. You could be really virtually anywhere and not receive any of the light cues you need, any of the air cues you need, any of the visual cues you need, even any of the aroma cues you need. That's what's special about the 7% that's incidental, that you're going to repurpose as intentional time. By the way, the minimum effective dose is only 17 minutes a day. It's not the whole 7 to 12 hours that you might be spending incidentally outside. It's only 17 minutes a day. In fact, the clinical benefits top off at five hours a week, which is about 42 minutes a day. I spend more than that. I know you do as well. We're talking about most people who spend 93% of their time indoors. Even here in Southern California, where we're both privileged to live, it's like an hour a day that people spend outdoors maximum. It's not intentional. It's not in a blue or green space. I talked to somebody on another podcast who phoned in from Chicago, who hadn't left his apartment in 36 hours. He was feeling really anxious and a little bit pissed off that he was getting emails that he had to respond to. He's digitally burned out. And just burned out overall. This actually is a great reset for anyone who's feeling burnt out. The first thing to do is to help him teach him the dive reflex so that he could bypass his cortex and not freak out at the email he's getting. That gets pissed off at the person who was sending the email because it wasn't an angry email or anything. It was just doing work. But his brain was so overloaded that he couldn't handle it. So splashing cold water in his face for 15 seconds triggers his trigeminal nerve, the fifth cranial nerve that innervates your face, bypasses the brain and helps you just force quit your stress response. I like that. That's a great tip. You mentioned something a little bit earlier, and this is about taking the things that we do normally, but what happens when they become much more intentional, which sometimes maybe means it could be a little bit extra time for that thing. Like you're talking about DoorDash, for example. People go out in the morning, maybe they're ordering something from DoorDash. People literally get coffee DoorDash to them. That's always funny to me. A through line inside of the book and a starting place of one of the ways that you can start to radically reset your internal environment with the outdoor environment is light. So let's give that example of DoorDash. Somebody's getting DoorDash in the morning, they're getting breakfast, they might just pop out really quickly, grab it and then dash right back inside, you know, to consume it. How could they use some of the teachings of light and the power of light to help regulate our health, our mood, how we feel? How could they use that, especially in the morning, to be a little bit more intentional? Something I don't hear people talk enough about when it comes to digestion is enzymes. These are the workhorses of digestion. They're what actually breaks down your food into nutrients your body can use. The catch is that enzyme production naturally declines with age. And when that happens, even healthy meals can leave you feeling a little bloated, a little heavy or a little sluggish, not because the food is quote unquote bad, but because your body may not be able to break it down efficiently. That's one of the reasons I'm a huge fan of digestive enzymes support. 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Clean protein, radical transparency, that's puree. So I like to think about this as light first coffee second. But an easy intervention is to take that Dordache breakfast and have it outside and have it outside without sunglasses and have it outside enjoying it preferably off your device. Because as I said, when your phone's in your hand, your brain thinks it's time to work. And what we want is to let the light hit the back of our retinas, which it will no matter where you are. Don't look at the sun, see please. Look at the sky. Look at the different colors of green. Look at the wind. Look at your sandwich if you like. Look at anything outside because the rays of the light will find the back of your retina, which sends a signal to the back of your brain, the suprachiasmatic nucleus, which is your master clock, which regulates your circadian rhythm, as you know. And the circadian rhythm sets the time in all of your organs. So what light does when you get it in the morning, light first, coffee second, having breakfast outside 10 minutes, I think is a minimum 15 if you can swing it. More is probably better, but we're going from no light to 10 minutes. That's a big deal. So what that does is you know is all kinds of good things. It gives your cortisol in the morning a big 50 to 100% response. So you feel awake from the inside instead of just giving you a boost this way. They're complimentary actually. You get a boost from your cortisol. So it's your brain's awake alert signal. You only get that with morning light. And it also helps to set melatonin for 14 to 16 hours later so that your brain releases the melatonin and you can go to sleep easily. And you can get deep sleep. And deep sleep is, as you know, the phase of deep of sleep, a slow wave sleep in which a lot of good things happen. You build bone. It's the only time that you reform bone, especially important for women who are worried about osteoporosis. You repair muscle that you might have injured during the day, maybe during a workout, maybe in another way. It's a great place to repair muscle. You consolidate memory. And maybe most important for us, the glymphatic system kicks in. And as you know, the glymphatic system, which was identified in 2013, and Nobel was awarded for it in 2017, is the system in the brain which takes out the toxins that have accumulated in the brain, including beta amyloid and tau proteins, which are in the brain normally, but are part of waste products and flushes them out. If they don't get flushed out, they stay there. And during in Alzheimer's disease, especially, they accumulate. And although there's not a causal relationship known, it is known that we don't want them to accumulate. So light in the morning does all these good things. Cortisol boost, melatonin released, bone building, muscle repair, glymphatic system, deep sleep. From the outside, it could look like, great, those are all things that we would want for everybody. And then just to build on a little bit further, taking some studies that you talked about. Like if anybody knows anybody in their family, friends, other stuff who has anything from the blues, right? We all get the blues at some point in time, or actually dealing with depressive symptoms. Interesting. Some data that you have in your book, morning light exposure can reduce depression symptoms by 50%. That's crazy. Yeah, light as an antidepressant is powerful. And I would say, often complementary to prescription medication. One of the magic things about this, and I probably use that term a little loosely, but it does seem like everything that I've been able to identify about light, about distance, about air, all of these things work together. And there's seven steps in the book to do this, amplify everything else good that you're doing for your health. You don't have to stop taking medication or be medication averse. These are things that are going to supercharge everything else in your life that you're doing. I believe so. And that's been my experience. And that's what the literature says. And it's kind of unbelievable to me that we haven't really been able to focus on this until now. It's also understandable. There's a lot else going on. But I find though that the results of these kinds of steps, particularly light as we've been talking about seems to change sleep patterns within several days for some people, up to a week. But within a few days, people feel they're all of a sudden getting more sleep than they have. They all of a sudden can go to sleep more easily. These two ideas, morning light as we've talked about, and avoiding blue light at night within 60 minutes of night, improve sleep problems more than almost anything else I've seen in 30 years of practice. And there are other things that interfere with sleep. Don't get me wrong. Sleeping with a pet often not helpful. The wrong partner often not helpful. Bright light at night or loud noises or hot temperatures not helpful. Alcohol not helpful for sleep. But these two things, morning light and avoiding screens and bright blue light within 60 minutes of bed line and getting purposeful amber light, which we haven't talked about, to cool the brain and to allow you to relax and maybe having a ritual, as many people do, before bed that's more analog than digital, improve sleep patterns almost more than anything else I've seen. In the book, you talk about how so many people think that even if they have really great lighting in their home, super bright lighting, they have no idea how not bright that lighting is from a luxe capacity. That's, you know, we're in a bright studio. I have a luxe meter on my phone. I actually haven't ever measured it. But I'm guessing even with, you know, four, five, six lights inside of here, we're barely going to probably get to like 100, 200 luxe. Yeah. Right. And in my home, it might be three, might be three, but it's 25 to 50 times brighter outside, no matter where you are. And on a cloudy day, it's still 10 to 15 times brighter than anything indoors. A bright department store, a bright grocery store is a bright grocery store is maybe, maybe a thousand luxe, probably not. Outdoors, it's almost never less than 5000 luxe. And it's usually 10, 15, 20, 25. On a super bright day outside, it's 100,000 luxe. And that kind of light stimulus to your brain continuously throughout the day is important because it keeps you alert, which you don't get from the inside of a conference room. And you also don't get through a window because the window blocks the wavelengths of light that your brain needs to be alert. So that's why it's important to go outside. You don't have to, as we're lucky in California, go outside and stay on the lawn. If you have a doorway, if you have a threshold, if you have an open window, that's enough. If it's cold outside or super hot outside, I'm not talking about doing crazy things. I mean, don't stand in the doorway if it's 20 below zero and you're not bundled up and it's not something you welcome or like. Or if it's 110 degrees, don't do that. It's harmful. When it's not that and you can get morning light, you need to. It's a powerful health intervention that we've just, it's so accessible to us and so easy to teach and so easy to see results from everyone should do it. And as you say, it supercharges everything else that you're doing well and doing good for your health. In this bold quote, you know, everybody cares about longevity in this day and age and we all have, you know, we're looking for that magic supplement, cream, whatever anti-aging that's there. But you have this bold quote from the book about the indoor epidemic and the havoc that it's wreaking on our bodies. I'll read it out here and say, every hour you spend sealed inside is an hour your body quietly and prematurely ages. Yes. I love that you think that this is bold. I think it's so just like evidence based. It's not bold to me because I know all about this, but I think if you go to a lot of people and you say that, hey, all this time you're spending indoors is supercharging your aging. We're all going to be aging, but this is an accelerated aging that's happening. It is. It actually literally phrase your telomeres. So there are two things that are important about this. One is that even passive exposure to green spaces and by green, of course, I mean anything with trees or shrubbery or dense greenery improves telomere length by two and a half years. That's not an interventional trial. That's an observational one, an epidemiologic one, actually, where they compared people who were close to green spaces versus people who were very far away from green spaces and close means within 500 meters and found that they're and measured and showed their telomeres that compared telomeres for both, that the telomeres of people who were age matched and otherwise matched were less degraded than those further away. So passive, what's been shown about longevity and telomeres and green space is that passive works. What's been shown about the biology is that active works, the kind of engagement that I describe in the book, gardening and forest bathing and looking at the stars and the sea, that kind of acting engagement has other types of physical action that impacts longevity. Exercise, as you know, is particularly moderately vigorous exercise that Eric Topol describes in SuperAgers and that has been described in the literature elsewhere, improves telomere integrity up to nine years. What I describe as indoor aging is in part because of the cognitive tax. When we're indoors for long periods of time in sealed modern buildings, CO2 develops and builds up. There are a number of companies that now are forward thinking of CO2 meters to gauge that. We have one here right in the office. There you go. You could often improve the IQ room just by opening a window. That's because outdoor air is actually cleaner than indoor air. It doesn't have that buildup. It doesn't have the off-gassing toxins. It doesn't have the VOCs that build up, the forever chemicals and so on. That's a whole related discussion. But being inside deprives you of the biologic inputs that your brain needs to improve your health and to reduce risk for cardiovascular disease. And inside, especially about cardiovascular disease, makes you older by in part increasing your risk for cardiovascular disease in part because 40% of us go to sleep with a lamp or a TV on. And when that happens and we get that bright light, the blue light we've been talking about between 12.30 in the morning and 6 in the morning, our risk for a heart attack goes up almost 50%. Our risk for stroke goes up almost 30%. A-fib and heart failure similarly. And this is not subtle. This is 111,000 people published in JAMA over 34 years, last year in 2025, showing that night light is actually as big a cardiovascular risk factor as smoking or sedentaryness and loneliness is three quarters of a pack of cigarettes a day. This is a serious problem that we've underestimated, I think. I mean, that's really the key is that the data is all out there. But because we've underestimated it, it's so easy to overlook these simple solutions because a lot of people think and they scratch their head and say, well, if it was that bad, there'd be a national campaign about it. Right? But then they forget that, you know, if you look at the history of here in America, we knew smoking was bad for a long time. We did. And it really took a while before all the things came around till the recommendation said, hey, smoking causes cancer. And we need to actively discourage people from smoking. And you're sort of arguing in that same way. We're in that space right now. It's just that some people know it and a lot of people don't. Well, it's what you also causes heart disease and respiratory problems and secondhand smoke and allergic reactions. There are national campaigns, but there are national campaigns in other countries. Singapore is way ahead of us on this. Singapore is a national campaign to have parents take out their kids two hours a day for free play without their devices to reduce the real epidemic of myopia. 90% of Singaporean children, that's ongoing in Asia. And myopia, which is nearsightedness, is not such a bad thing. You wear glasses or you get eye drops, but about 5% of myopia is high myopia. And by the age of 40, about 5% of people with myopia experience significant eye damage, corneal damage, retinal damage, and in some sphere cases, blindness. And we don't need to risk that for something with as simple a solution as this has. And myopia is a real thing. It's actually 40% in California where we are. Because we are so dependent on near devices, and it's called near work, then our eye actually, our eye is actually physically elongate. It changes the shape of your eye to do as much near work as we're doing. And the fact that you could forestall that by getting distance vision, by getting free play, by going outside and having activity. I mean, actually your eyes need distance, like your lungs need air. And that's what those kids are getting when they're playing outside. It's what adults should be getting when we're playing outside. I gave a talk in New York last week, and there was an initiative with the soccer team, and I talked to the women afterwards about it. And she said, I'm so glad you gave a shout out to sports because I did. A lot of people think that play is just for children. And I thought, wow, how did that happen? That I mean, my peers play sports every day. You can't give that up just because you're not a kid anymore. And athletics and sports are incredibly important. And guess what? Most of them are outside. Most people don't appreciate that outside is social. I have a whole book and chapter in the book about social connection, as you know, and why that's important for longevity and for reduction in chronic disease. Nature is social. It's not just the Pacific Ocean, not just the Rocky Mountains, not just some faraway place. It's the park down the street. It's the window sill garden you might have is the houseplant on your table. It's the wind that blows it blows the curtains. It's maybe even the lettuce in your salad and where that came from and who grew it, maybe you or maybe somebody who you know, you know, nature is very close. And we are, of course, are part of nature. And we need to use our time in nature intentionally in a blue or green space. Has a health intervention that we can deploy because it's just available to us. Let's talk a little bit about origin story, because I feel like when people understand how these ideas all came together for a guest, it starts to help them understand the why behind the drive, like why you have so much commitment, besides the obvious that you're a doctor and you've sworn an oath to make sure you look after people, you know, and this is just another extension of a practice that's there by teaching people that, you know, things that they can do. But give us some of the first early things as part of your story where you noticed that this absence of blue and green space was taking a major toll on society. Most people think about hormones in terms of things like puberty, fertility or menopause, but your hormones actually control far more than that. Your endocrine system helps regulate metabolism, sleep, stress, response, appetite, mood, and energy. 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But let's keep it real. Sometimes you don't just want plain water. And a lot of times you don't need a soda or something else out there that's not going to be that great for you. That's why I've started keeping elements sparkling right next to me when I record or work in the afternoon. It's this crisp, lightly salted sparkling drink that actually supports hydration instead of just tasting refreshing. Because a lot of times that midday fatigue or brain fog isn't about needing caffeine. It's about electrolytes. Element gives you key minerals your body meets, sodium, potassium and magnesium without sugar, artificial sweeteners or junk. The new sparkling slim cans have been a great addition during my recording sessions or long workout blocks. I'll usually grab a can of orange salt, pineapple salt or cherry salt. And I've been using Element for years now. So is my family, by the way. So it's nice to have that same electrolyte formula in a cold sparkling format. They've been a huge hit in my household. And right now, Element is offering my community a free sample pack of their electrolytes with any purchase. Just go to drink element.com slash true. That's drink. D R I N K element L M N T.com slash D H R U. Drew, that's me. If you're searching for something sweet, something fun, something crisp midday, make it something that actually supports your body. Check out Element sparkling at drink element.com slash Drew. Well, in my own story, as you know, I have a small organic farm in Santa Barbara. And when I bought it about 15 years ago, it was an abandoned nursery. And it is basically a sand dune with nursery structures. And it was static. So I thought I could leave it alone. I mean, it was all sand and a few trees. And so I bet went about doing my life and had seeing patients and I had a TV show at the time on Lifetime. And I had a new book. And I went to New York to be on a TV show. And this is about a year after I owned the farm and is starting to learn about it. And instead of booking five or seven other events while I was in New York for this one TV show, which was 3000 miles away and a lot of money to go back and forth, I just like I was back home as fast as I could. I didn't I didn't spend more time booking events. I just came back home because I wanted to see what had happened with the trees I planted. And I thought, that's weird. Why am I doing this? I mean, it's so counter productive for my career. What am I doing? And and I just didn't understand it. And I had people over to the farm in that first year and they kept going, this is so beautiful. And I'm thinking, no, it's empty. Why is it beautiful? People felt better right away. You could see it on their faces. And those two things, anybody who came over felt immediately better and asked me, you know, if they could stay longer. And my own return to the farm away from this high profile opportunity, and many other opportunities that were available to me, made me want to know why this worked. That's actually why I wrote this, because I then had to read all about this, figure out why I was so drawn to be in a space that, yes, it was wide open, but didn't have a lot of greenery, wasn't to my eye beautiful. Everybody kept saying it was a diamond in the rough. And all I could see was it was a sand dune. And with my training as a chef, and the work that I've done as a chef, and the long 30 years of practice I've had, I knew that I could grow things, but I didn't know enough about how I could make them nutritious, because I didn't yet understand how to feed the soil. And that's what being regenerative and what organic has taught me. And actually, just not that, but the hundreds of people who have come over to help me make sense of this and to work with me on it. So I've used the farm as a kind of laboratory for the book to try out different things that might be helpful, not just on me, but on the people who visited. And as I told you earlier, when we were talking, I put together the first skills-based elective in nature as medicine for physicians with UCLA and Elizabeth Coe, Heads Integrative Medicine there. And we taught that last year at my farm in 2025. And so we taught people how to forest bathe, not people, but other clinicians who needed to tell their patients about it. How to forest bathe, how to garden, how to exercise outside, what activity was most meaningful, why nature was social, and really as much as we could about gardening and how to grow things. And when clinicians get this, how easy it is, how easily transferable it is, you know, my origin story just goes away. It's just lucky that I got trained as a doctor, trained as a chef, and now trained as a farmer, and understand much about how those things integrate. So I could put together this idea that it isn't just food and it isn't just pharmaceuticals, and it's not just the outdoors. It's how they work together. But if you don't have one of those legs on the stool, you can't sit and you certainly can't stand. So what this makes sense to me about at its core is that you have more control than you think. You know, 80% of heart disease is preventable, 50% of depression and anxiety are preventable, 40% of all cancers are environmental and preventable. And I think with this intervention of outdoor RX and using the hundreds of ideas I have in indoor epidemic to take advantage of the outdoors, to use it as a medical tool, the protocols that are available, we can begin to reverse some of the disintegration we've seen of our fabric and the acceleration of chronic disease. I want to pull on one of those threads. You mentioned heart disease. I'll just use it as an example. The number one killer of men and women, a lot of people forget that, you know, breast cancer gets a lot of attention. Other things, other diseases get a lot of attention as they deserve. But heart disease, still the number one killer of people that are out there. You've already mentioned one thing related to heart disease. Bright night, light night. And how that can accelerate all sorts of very challenging things and tax our heart health, our endothelial system, right, increase our chances for AFib, etc. What are some of the RX protocols that are in the book, for example, there's a ton of them for a lot of different things. But for heart disease, what are a few of the RXs if a patient came to you and said, hey, doc, I have a family history of heart disease that's there. You know, I think about some of my own friends who lost their father early. And, you know, I really want to be proactive. I try to watch what I eat. I, you know, I'm not obese, but sure, I might have a couple of pounds extra. And, you know, I'm trying to keep an eye on my LDL or now everybody's aware of APOB. But how can these blue, green spaces, environment RX, nature RX, how could I use that to accelerate? We've already talked about avoiding blue light at night and making sure that the lights are dim, potentially using amber lights, blue light blockers, whatever's needed to support that. What are the things would you suggest to them? There's a lot in that question. First, I want to say that the laboratory data are really important. I'm not, I'm not at all dissing the importance of LDL or blood pressure or smoking or lifestyle habits or your community or your, your partner, your alcohol intake, all of that stuff adds up to potential risk for heart disease and it all needs to be addressed. Now, adding outdoor exposure to that to supercharge what you're doing well already can actually interact with many of those things. So simply having a meal outside instead of at your desk, if it's you're eating something that's good for your heart, have it outside, have lunch outside. This also gets you away from the office where your adrenergic system is going, your cognitive system is working over time and outdoors, you engage your senses more. So that's automatically more relaxing for your heart. It's automatically reducing the adrenergic hormones that are, are charging through your system much throughout the work day. And that's actually how we experience nature. We experience nature with our senses and our senses are touch, listen, sight, smell, taste, all in your face. And I do that because it's important to remember what they are. Many people are not in touch with it, what their senses are, but that's how you experience nature. And that's a way to help you in lunch. Appreciate the flavor of your sandwich, appreciate the aroma of the flowers that might be by, appreciate the wind that's blowing on your face. So that's one thing. Another is outdoor exercise. Exercise outdoors is actually 20% less perceived exertion for the same exercise indoors, which means that you're doing as much as you're doing indoors, but it feels 20% less. And you may even be doing in some studies 28% more work in that same time, even though it feels like less. So exercise outdoors exposes you to a lot of things that are good for your heart and your immunity. It improves your, you're getting microbially rich air, you're getting air that's filled with fightin sides if you're near a blue or green space. And a fightin side, P-H-Y-T-O-N side is an aromatic chemical that a tree releases to communicate with other trees and to fight off predators and bugs, but it has an immune effect for people that improves natural killer cell account, killing tumor cells and virus infected cells in your system. And the cardiovascular system and the immune system work together. When you're outside and you're doing exercise, you increase mitochondrial biogenesis. You increase metabolic flexibility so that you can tap both fat and carbohydrate as energy sources. So building mitochondria is a really good thing because you're burning more fuel and you're making your metabolism more efficient. Being outdoors is important for your cardiovascular health also because you're getting better air outside than you're getting inside as we spoke about. And that's important for your respiratory system. You know, I'm not talking obviously about days where the particulate matter 2.5 rating is very high. If there's extreme pollution, if you live next to a smokestack, if you have like we've had out here, severe fires, that's a very different circumstance. Unfortunately, it's time limited for most of us. So then of course, you want to be mindful. You want to inside run HEPA filters and live in a well building if you can. So those are some of the ways that being outdoors interacts with the cardiovascular system. I do think this nightlight idea is super important and under appreciated and something people can do right away because so many of us go to sleep with a light on and because that light is blue. You mentioned blue blockers and amber light. You know, blue blockers work if they're blocking enough. Many people use them as cosmetics or kind of as a cool look and that's okay. But if you want them to do work, they really have to block the blue light. And on your device, on your laptop or on my phone, you should run and I bet you do already f.lux to change the spectrum of your the light that comes from your laptop or your computer. That's in addition to night shift on an iPhone or I'm sure it's on pixels and other devices as well because it doesn't actually block all of those wavelengths, just some. And you want to have as much amber light in the evening as you can to get your brain ready for sleep, which is like the most important thing that you can do to restore your brain. I love it. You know, this really brings back one of the big ideas in the book is that these small doses, these small little things that we do consistently, right? That's one of the key themes consistently. Yeah, yeah. They add up to major changes. Right. So if you're financially minded, it's compounding, you know, it's like compounded interest, small, consistent, every day, not big. I call them microdases because they're really small. 17 minutes a day, everybody has in fact, you're already spending seven to 12 hours outside. 17 minutes a day, minimum effective dose, all you got to do is reorient some of that instant time, tweak it as you say, so that it's intentional time. And we can add that up right now. We can get 10 minutes of morning light. Okay, you don't do it every day. Let's say you only do it five days a week, but that's amazing. And it helps you even that five days a week, even once a week to start. You know, I'm a clinician. I'm used to having people make small changes that make a big difference. And starting with a small change is much bigger than saying, oh, you're a carnivore. I want you to go vegan. That like never works. It worked for Dean Ornish for a number of people who were facing very serious heart disease and needed to have an operation or not in the early 1980s and into the 1980s and more props to him. He's amazing. It doesn't work for most people to go from carnivore to vegan. It's not going to work for most people to go from totally inside 24 hours a day, which some people are to, to as much time as I spend outside, which is probably five hours a day. And, and so what do you do? You do the minimum effective dose. How much is that? It's 17 minutes a day. What do you do during that time? You get 10 minutes of morning light. You have your lunch outside or you have a walking meeting outside or you have a phone call outside. Does it happen not to be a blue or green space? Okay. Do you get full microbial and green benefits? You don't. Do you get some? You do. You should take it outside. And then in the night, in the evening, after dinner, it'd be great to get a 20 minute walk. Everybody would that be optimal. But if you get outside five minutes and you walk, you know what? Your blood sugar starts to drop. After 20 minutes, your blood sugar is 30 milligrams per deciliter lower and you don't even need an insulin for it. It just gets vacuumed up. Morning light. Anytime during the day, a phone call, a walking meeting, lunch, because that bright light tells you you're still alert, tells your brain to wake up. If you have your arms and legs exposed or even just your arms, you're making vitamin D during midday, which you don't do in the morning and you don't do in the evening. And during most of the country, you don't do it from November till April because the angle of the sun isn't proper for that activation of vitamin D in your skin. It's not truly making it. It's activating it in your skin. And in the evening, a little walk after dinner. You know, the tradition in Italy and in other parts of the world is a passagiate, which is a stroll after dinner. And we used to think, oh, that's just social. It's just fun. It's just show off your partner. It's to say hello to people on the street. It's more than just social. It's actually biologic. It's information for your body. It's time to cool down. That it's time to experience life with your senses. It's time to engage your parasympathetic system instead of your sympathetic nervous system and the rest and digest system, as you know, rather than the fight and flight system, which you've been keyed up for most of the day. It's time to get away from that digital obesity where your brain feels too burned out by so many pixels. It's time to power down. And even five minutes makes a difference. 20 minutes optimal. Can you watch the sunset? Can you get those red and amber waves? You can. And what does that do for you? That's the only light that doesn't suppress melatonin. That only light that you can look at and just plain enjoy and not worry about not getting to sleep that night. Growing up, my grandparents, my family's ancestry is Indian. Growing up, my grandparents would spend time. My dad has seven brothers and sisters total. And so the grandparents would go to different, you know, and spend time and get a chance to be with the different grandkids. And when they would come with us, I love my grandparents. I'm so close to them. But I always felt a little bit embarrassed in the evening because we would always go as a big posse, a big group. We'd have dinner and my grandfather, and actually it was usually my grandmother would say, okay, it's time to go walk. And we'd walk in our street, you know, and even back then it was kind of, it was different. You know, my 80s baby, it was different to see like a whole family walking in like a suburban neighborhood altogether. And on top of that, my grandmother was wearing like traditional Indian garb, like a sorry. And you know, people were like, hey, what is this family up to? Yeah, right. And looking back, I have so much appreciation for those times and also the fact that so many cultures from around the world, this was inherently how they lived. They didn't have the science to back it up. Yeah, right. That this evening walk after a meal, that was just one example of something my grandparents did was so powerful family connection. Yeah, we tell stories. That's cool. Sometimes my grandmother would sing a little bit. Nice. And it was just a really beautiful opportunity. And it was like a ritual. And I loved it, even though I was secretly embarrassed of like, oh, which friends are going to see me. You don't really understand. Yeah, when you're a kid, you don't get it. Yeah. But then you learn that and you you miss that when you get older. And now obviously everybody lives in different houses and other stuff. We're still close as a family. My grandparents are no longer here. But you're like, man, that what a beautiful tradition to bring in, not to mention all the health benefits that come along with that. Yeah. Here's another one of those. There's I don't think I actually cover this in the book. There's a the tradition of a digested beef where in many parts of the world, particularly in Europe, Southern Europe, actually all over Europe, you used to sometimes you have something bitter before a meal. Cinar or a morrow has a little alcohol in it and a little sugar, but mostly it tastes bitter. That's actually triggering your GLP one. And if you don't want to do the booze, and you know, arugula has the same effect, a cruciferous vegetable also bitter. Gentian is like the most bitter substance possible. That bitterness tells the GLP one that you should prepare to get full, because we cuts your appetite a little bit. And that's the science behind that long tradition. They knew it worked, but the science nobody knew. So I mean, this is really tries to be a scientific roadmap through the hundreds of different kinds of things that you can do outside to turn those incidental minutes into medicine. You were talking about the seven pillars in the beginning, right? And we covered a couple. Is there one right now at the stage of the conversation that you want to dive into a little bit more as an example of some of the incredible content that's inside the book? I'd like to talk about gardening because I please love gardening. And I made this coaster, which I give away a tox. And here we go. That's upside down. So I'm not selling these, by the way. But I do get them at tox. And the reason I made this coaster, which has embedded inside basil, parsley, and chive seeds is that many people are like a quarter of people are afraid of spiders. That's one of the reasons we do it outside. And gardening, even though 70 million of us are gardeners, is still a leap for a lot of people because we're afraid we're going to kill plants. I did the study of burnout in a corporation in Santa Barbara, and I gave people an office plant, had them go outside for five minutes, and then also send them funny texts, 12 texts over four weeks. And it was a controlled trial. So you got each of these. And the people who went outside had the most benefit, reversed burnout, actually, and the symptoms of presenteeism increased, and the symptoms of absintheism dropped. It was pretty significant. And the people who got the house plant did the worst because they worried about the plant and they over watered it. House plants need six ice cubes every two weeks, by the way. So same for office plants. But gardening, if you've never gardened, this is kind of a gateway, because all you got to do, and there's a QR code to plan on it, and you can get it if you come to my own talks, it's also on the website, is put it in organic potting soil. And organic potting soil is important because it has the right kinds of microbial richness in it, including my mycobacteria vaxii, which is a mycobacteria that triggers serotonin producing neurons in your brain and in your gut. And as you know, you make serotonin in both your brain and your gut. So gardening is actually a kind of serotonin intervention, as well as something that gives you, in this case, basil and chives and parsley. So I think you should have your hands in the soil once a week. And that's to improve your microbiome. It's to not just on your skin, but also in your lungs and in your GI tract, and to help you produce serotonin to feel better. And that's kind of a weird thing. Like why should you have your hands in soil? But when you begin to understand the physiology of it and the medicine of it, it becomes something that is an evidence basis for something you might enjoy doing anyway. And putting this in organic potting soil, so you know what you're getting so that the mycobacteria in the potting soil, not just mycobacteria vaxii, but the fungi and bacteria that transmit minerals between roots and the soil are able to be active and go into the plant that you're about to eat eventually, either the leaves of or the fruit of, is a way that you get more nutrition. So organic potting soil, press this down, add half an inch of potting soil on top of it and water it. This is something you can't overwater actually until it comes up and then water it like every other day or every third day. And it's magic because growing things connects you with the nature experience. You're part of nurturing something. That's not a lot of experience that we get now except for nurturing a person or an animal, which is also a section about the book, Importance of Companion Animals. Gardening, I think, is and gardeners are way ahead, but if you do this especially organically without synthetic artificial chemical pesticides, herbicides, and fungicides, you are not just getting a plant that's grown up on growth hormone on junk food in a way. You're getting a plant that's extracting minerals from the soil and that makes your food richer, higher in nutrient content. And we've seen this in the studies of regenerative farms. We've seen higher mineral content, potassium content, organic content, other nutrient content in the studies of regenerative farms producing vegetables primarily. I'm not aware yet of one that produces fruit, but I haven't looked at this literature in six or eight months. And that's one reason to grow your own or to go to farmers markets and buy from someone who grows because then you can have a relationship or to go to a market that sells things that are locally grown in organic soil or grown organically. I don't think it has to be certified organic even though my farm is certified organic because that structure is sometimes cost prohibitive for farmers and it's not a half a percent that they can afford to pay plus all the record keeping which is quite burdensome. So gardening is an intervention that pays you not just in tomatoes and in herbs but in serotonin production in having your hands in the soil and improving your microbiome with that biodiversity of organisms and people with more diversity in their microbiomes have more metabolic flexibility and less GI disease. It's actually increasingly important not just in the amount of fiber that you get but in the way that you make hormones because as you know that's what the internal microbiome does, makes protein in hormones and it's about the same size as your brain, about three pounds. For a lot of people who were listening who were like oh I don't have like a backyard or a condo, can they start with you know house plans? Yes, this is designed to fit in a four inch kitchen that's gardening in my view. As long as you're touching soil you have a four inch pot. I prefer a six inch pot for this because you're going to need it but if you only have a four inch pot fine get a little bag of organic potting soil. This is a beginning gardening as long as there's getting enough light even in a window, a bay window, a window that gets even six hours of light is enough for this and you don't have to use my coaster buy seeds that are organic that you could just sprinkle on top and press in. That pressure actually tells the seed to begin to reach out to the soil around it. I know that sounds a little woo but it actually does. It triggers a little sensors on the outside of the seed to know that it's not in a packet anymore, that it's in a growth medium. That growth medium again is important for getting not just extracting minerals but other types of nutrition so that when you eat that plant you get the nutrition that the plant has and you know exactly where it's from. You have the experience of not just nurturing it but being in touch with something that's natural powerful because you are nurturing it and because you've had a lot of experience outside when there you've gotten light if you're outside and you're potting your seeds. You've gotten microbially rich air so you're benefiting from the fighting sites that are improving your natural killer cells. You're getting distance because you're able to look outside. I have some people put a post-it on their fridge that says look up today because you can't look up. You are seeing a ceiling here. Look up today goes outside and look up. It's just a little prompt to a nudge and that's all this is. A nudge to do the right thing. That GOP one thing I said also a nudge because that's what people need to know. Hey this is kind of fun and the joy is actually the best nutrient. The joy is the way that people continue to do this. It's why they continue to do it because it's fun and actually they not just feel better but they are measurably better. You know I love the videos or clips or even a couple times I went to Japan or I was in Sicily once and you see older people who are gardening and a really beautiful site is like they're squatting. They're squatting down. Not everybody gardens that way especially here in America but like in a lot of these other countries. This is still like a city environment. It's not like some like crazy rural area or it's a little bit more urban and to see them squatting down and you look at I'm like man I have probably you know a quarter of my friends that are my age that couldn't even squat down and regularly get up and get down like they're doing and you know the gardening and then anybody who's seeing like the Blue Zone documentaries and the Okinawans and other stuff and how much they gardening is a part of their life. It's a very inspirational idea and they don't do it because it's good for their health. They do it because they enjoy it and for many of them they're also doing it because they are getting food that way as well too. Steamer here. Give me the dirt. Work is stressful. My life is a disaster. Help me. The first is mental clutter. The second is physical clutter. One requires meditating. The other requires Stanley Steamer. Start with what you can control. Then go outside. Absolutely. Dan Beetner has done a brilliant job of not just naming the Blue Zones with his colleague but also popularizing them and popularizing the habits from them. As you know he has nine principles he's extracted that he's applying here in America and gardening together is what many of those people in the Blue Zones do. It's not a solitary activity as much as it is a social activity and that's important not just because nature is social as I point out here but also because you get to share. Almost always when you garden you produce too much of one thing so it's got to go somewhere and if they're tomatoes you can put them up or almost anything else you can put them up and can them or freeze them or dehydrate them. We do all those things but for many people it's also trading. Now for squatting you need those hip flexors. You need those hip extensors and it is actually learned as an adult to squat if you've not been doing it all your life. But that kind of mobility and flexibility lead me to the green exercise part of this book which is that for my age group especially flexibility, gait and balance and strength are so much more important than aerobic. Aerobics is great when you're young but you actually don't need it as you age as much as you need these other things and you need flexibility which you do when you squat. You need balance which you do when you squat and you need strength particularly core strength when you do when you squat because it prevents you from falling and falls cause injuries in older people and if you can prevent yourself from falling you are going to be able to powerfully age and reduce your health span which is what this is all about. Health span as you know is the time that you're alive that you're healthy and longevity or lifespan is how long you live and in America we have about a 10-year gap so if the average age of death in America is about 79 now that means that around 69 things start breaking down and you are not spending those last 10 years playing pickleball rolling around the floor with your grandchildren and you know going to see the sights in Japan, Sicily and wherever you're kind of recovering from your last hospitalization from your last operation from the polypharmacy you might have to take and so on and we want to avoid that. We want to live as healthfully as we can for as long as we can and when we die we want to die only because we've been sick for a really short time. We want to use all of the life that we have. We want to be able to enjoy it for as long as we have and doing flexibility, gait, balance, strength exercises ought to be part of everybody's routine and green exercise allows you to do those things and experience the benefit of the outdoors as you do them. The light benefit, the microbial benefit, the distance benefit, all of the things come if you do your squats outside. When you look around today one of the things that every family seems to be navigating and a lot of people just think it's just normal because it is kind of normalized these days. Everybody is just busy all the time and it seems that this busyness is one of the things, this bubble of busyness. You know you ask people even at the grocery store, how are you, you check in with a colleague, you'll say, how are you? Oh, busy, busy. It's kind of like a very standardized response that's there and that busyness seems to be crowding out a lot of room mentally that we can do some of the things that we know. Many people are listening today. They know a lot of these things are good for us. They may not know the science and they're excited to have you and check out your book and hopefully buy it. We have the link in the show notes. Please pick up a copy and they'll often say, I just feel the sense of we're so busy all the time. I know. I used to say that all the time too. Yeah. What do you think is going on there and for the person that's feeling that, what would you want to talk about with them? Doesn't matter where you live. Live in an inner city. You live in the country. It takes 17 minutes a day and you're already spending seven to 12 hours outside in a week. So this is time that you're just repurposing and you have a scientific roadmap to do it and you're turning these incidental minutes into medicine. So you're already spending the time outside. This just means doing something different that you're in a time you're already spending. It doesn't take extra time. Even if you maxed out at 42 minutes a day, it still doesn't take extra time for most people because most of us are spending at least an hour a day outside even though it's incidental. And most importantly, changes your biology in a way that makes you feel better. And not only do you feel better, you actually are measurably better. That outdoor cardiovascular benefit you asked me about before, that also lowers your blood pressure. And blood pressure is not something you can feel unless it's 210 over 140. And then it feels awful. And you really, some people can feel low blood pressure, but generally it's got to be a big drop right away to feel it. So cardiovascular benefits to being outside lower blood pressure, lower cortisol level, lower stress level, more enjoyment, less stress. So yes, everybody's busy. This is incidental time, incidental minutes, you're turning into medicine. Everybody's busy, but busy is often a perceived sense of busy, which when people really do an audit within themselves, it's a sense of I'm not doing enough. I don't feel grounded. I feel a ton of vision from this digital obesity that we're all walking around with all day. And you are in this constant state of being reactive. And the beautiful thing about these green and blue spaces and everything you talk about in your book is that when you take a step away from reactivity, even if there's a lot going on, you actually just don't feel as busy. You don't feel as reactive because you're taking a moment for yourself. Yes, that's very much. And that's why so many people feel when they go on that walk, you have study inside of the book about 90 minute nature walk reduces activity in the brain regions tied to rumination and depression. Yeah, definitely. How many people are overthinkers? I know, even though my natural state, I think a lot of people on the same boat, my natural state is not stuck in rumination all day. But when I'm so tunnel vision on the screen, I notice that my brain is constantly in these loops when I'm always reacting to that email. Or as you mentioned, just having your phone in your hand, your brain thinking it's time to work. I will get stuck in overthinking and then I'll go for a walk. And sometimes it's like that thing where you're like pulling off the band and you're like, I just need to go for a walk for a second. You're like, why the hell did I not do this sooner? Everybody has that feeling because you feel so good. And you're no longer reacting to the media of the world reacting to the social media of the world, reacting to all the priorities of everybody else. And you can actually say, hey, what do I need to do for myself, for my family right now to actually feel good and to thrive? And sometimes that's doing less. And doing something that I think seems less, but might be helping yourself in a new way. I think in my 30 years of practice, the most overlooked healthcare datum is where people spend their time. And if we're only spending our time inside, we're missing 99.9% of the world. It might seem like we have it because it's all on our phone. I read recently that traffic accidents are increased not because people are just looking at their phone, but because they're looking at video on their phone, YouTube and others. But that actually outside is even more active than this thing you're addicted to, this thing that children are addicted to. Antidepressant prescriptions in children or in teenagers are up 69% over the last six years. And a lot of that is late at the feet of social media. And especially addictive social media, particularly video. So it's not that it's bad necessarily, it's just that it's overwhelming. And it's too much. It's more than our brains can handle. You're describing burnout, which so many workers feel exhausted, unable to cope. And the thing is that it's a biologic response. That's a biologic response. It's not a, as I said, not a character flaw. It's not their fault. It's because your brain can only handle so much before it needs a break. And we've forgotten that. But distance can restore it, outdoor time that restored the study that you cited of 90 minutes outdoors in a meadow versus on urban street that was done in Palo Alto, Stanford. It's beautiful. I mean, Palo Alto is a nice town, nice street trees too. But they had people walk down the street and walk in a meadow. And the prefrontal cortex where rumination starts and continues was so much calmer. And people would walk without the distractions of cars, of lights, of the potential for the device, of stuff to do, of lists in their head, of direct messages, of text notifications, of all the things that your brain is tuned to when you're inside. And when you're outside, you're using your senses, your parasympathetic nervous system shifts. You are restoring your brain content. It's actually an intervention. Kids who look outside the window, look out their window at school, they're not, they shouldn't be punished. You know, you mentioned school. And it feels like there could be an opportunity here in the States to make some changes that allow some of these habits to be baked into how kids learn from a young age. I remember reading a story. I think it was, I forgot the author's name, it was Jonathan Hyde. He wrote the book on GLPs and when they first kind of came out and his experience on them and food noise. And in his book, he was talking about this story about Japan's history with obesity. And Japan always had a pretty low obesity rate. I think it was like in the 3% tile, 3%. And then there was one period of a year that their obesity rate went up by like something very small, like half a percent or 0.3% or something. And there was like a national freak out. And they were like, we need to get to the root of this, what's going on? You know, obviously, people know the stats compared to like America, where the obesity rates are like 40 plus percentage. And some of the things that they did are some of them are very controversial, you know, some of the bigger companies, they really encourage bigger companies, public companies there to actually help employees with their weight and mandatory sort of check-ins with, you know, nutritionists and weigh-ins that would be there so that if your weight started creeping up beyond your sort of own personal mean or average that was there, they would really say, hey, what do we need to do to help you sort of reduce the weight? But some of the really interesting things that they did with kids are number one, there was mandates that every school had to have a nutritionist that was assigned to the school that was there. And another rule that came out of it was every school daily had to have food made from scratch that was given to the kids. And another one, this was not something that was implemented in every single school, but that schools were highly encouraged to get kids involved at a young age with some version of, you know, interacting with foods and more time with foods like hands-on, like cutting foods, spending time outside, they have a big cleanup culture over there, kids regularly participating in cleanup. I always thought that was really interesting, you know, in America here, we pride ourselves on freedoms, don't tell me what to do, you know, don't be in any state, etc. But could you see, you know, taking this idea of the indoor epidemic and how bad it's gotten here? Could you see certain things working on a state level, on a national level when it comes to children and installing some of these habits to the degree that they just feel like this is not, this is a normal way? And I think more schools need gardens and need people to work in them, particularly kids. It's been obvious for, I mean, all the time that I spent with Chef MD and in culinary medicine, it was clear even 15 years ago that kids who participate in growing food were much more likely to eat it. In fact, even kids who pick a bell pepper from the store because they chose it are more likely to eat it. And anything you can do to get kids to participate is going to be powerful medicine. Probably the most important factor in getting kids to participate in outdoors and off their devices is their parents. And it's tough to get parents off their devices to do this with kids. But when they begin to learn the science, they've learned how myopia elongates the eye, how it's essential for children to get not just the microbial benefit but the social benefit, then it becomes easier to go to the park and fly a kite or throw a Frisbee or use the time down the street. In schools themselves, and Alice Waters pioneered this in the Bay Area, gardening can be used as a curriculum for everything from math to English to history to social science. And actually she did that in some Bay Area elementary schools to change the curriculum so that it was focused around gardening as a stimulus for those areas. I would say that schools themselves and teachers can use this information in new ways in understanding children who are looking out the window as children who are resetting their brain in teaching some of the powerful connection that people have with nature to children have with nature as a way of experiencing life. The senses are emphasized in school and they're not really emphasized in later education except in culinary school where we got a lot of it and as we should have and chefs really appreciate this. Anyone who cooks actually I think appreciates the importance of the senses. What we haven't appreciated is that we can use our senses outside as well. So I think schools are fertile ground for curricular changes and curricular modifications but even afterschool programs that celebrate the idea of outdoor play and the importance of outdoor play continuing in life as a life habit. When I went to medical school a long time ago I was drilled into us from the very beginning that what we were learning in medical school would likely change and half of it would be wrong. And that's turned out I haven't kept track precisely but I feel that to be true. And the fact that we've needed to learn more things new things about how that work caught in medical school but are now being taught because of peer reviewed science and people who can put it together in new ways needing to keep up with lifelong learning is just like having a lifelong nature practice or a lifelong play practice. These are powerful medical tools as well. Gardening as I said is a serotonin intervention. Morning you know we have a glimphatic system, a mitochondrial system, a gut brain access. All those systems work together putting them together in ways that make it easy for people to do small things micro doses that make a big difference gets us on the track to say hey this is fun. It's changing my biology too but it's fun. That's all I want. You know as we're winding down the day it feels like and you've written about this a bunch inside of the book it feels like for a lot of people you start to understand that this indoor epidemic is a problem. Now you have some stats to back it up you know that 93% of our time is in indoor and then the next extension of that is that as you've been spending more time indoor we've also become more isolated as a group of people. It's most extreme in sort of older men right at least from what I've seen inside of the data but it's now impacting a lot of young people as well too. Kids are not playing in the same way that they used to and when you look at a lot of these prescriptions these protocols that you talk about and the idea that we want to match it up with consistency over time the super charging aspect to that is that it's a lot easier to be consistent when we're doing these things with other people. Give us an idea from your own personal life some of the things we've talked about maybe some things we haven't you mentioned pickleball what are the ways that you have regularly used your social community to not only stick to these habits but to actually make them so much more enjoyable to the degree to the degree that you look forward to doing these things. Oh actually pickleball is a pretty good example because I've never really thought of myself candy laughs at me but I've never thought of myself as an athlete I didn't play competitive sports when I was growing up I was on any teams I was in the library a lot you know this is my eighth book and so write a book you have to keep your butt in the chair and write and just over the last 10 years I would say that changed and it changed because I found that I liked exercising with other people and I didn't know that about myself and pickleball is a lot the you know fastest growing sport in America and and it's not just because older people can do it it's actually the fastest growing sector is 25 to 39 but it's also because you can have fun within 20 minutes of learning it and and also it forces you to do a lot of to get out of your house for one if it breaks that isolation that Dr. Mercy talked about of being the equivalent of three quarters of a pack of cigarettes loneliness is and it makes you be polite when you're playing pickleball you have to introduce yourself you have to not hit it at the other person's head and if you do hit it at the other person's head either in Kensley or otherwise you have to go apologize if you don't apologize you're like what who's he and at the end of the game if you've competed hard and you know we believe in competition you're you click paddles you say thank you and you sit together for a moment before going on to the next match and those skills those basic social skills are missing for a lot of people they don't quite know how to do that until they re-engage them and when they re-engage them not just that does their oxytocin level go up just like when you take a walk with someone your oxytocin level goes up it's easier more fun less stressful when you when you walk with someone then you walk alone and you feel better you're happier but you feel like your own problems may not be as big as they are you're part of something larger than yourself you're becoming more of who you are instead of less of who you are or just who you are and that's a great feeling it's a great feeling to know that you're part of something bigger and so my example of pickleball is just me I mean but my patience example of of joining a newcomers group if you're a newcomer in town we have a newcomers group in Santa Barbara all of a sudden you have like 800 people who've moved to town in the last two years who you can be friends with joining and this is also true for me I have never been part of groups and and just in the last few years I decided I would try it more because I knew it was better for me you know not everything that you want to do at first is fun or that's good for you not everything that is good for you you want to do but when you try it you find some benefit and then actually there turns out to be more benefit in it so you keep doing it these things in the book that I'm suggesting morning light and gardening and forest bathing which I haven't talked a lot about and looking at the sky and the sea and the stars and the social connection in nature and and evening light these things are pretty easy they're really pretty easy and it's a minimal commitment 17 minutes a day when you try them you might be surprised that they snowball so that you might want to spend more than 17 minutes a day and that's success that's actually pretty cool because you've discovered something about yourself that not only is improving your health directly measurably but also makes you feel better and that might be the reason you continue to do it and that's great that's enough for me when we do things with other people even if it's a little bit challenging not everybody is an extrovert or wants to be around a group of people but we were designed as a species and you don't need a hundred friends no yeah a couple people that you're close to Dan beaters points out that moai are like four people five people the the groups that okinawan women and men have since they were young since they were four or five those are four or five people but they always have your back yeah and because we move a lot and because people move a lot and people vacation in different areas we do have to actively go out of our way to cultivate that because the inertia of life is so much so that it'll just bring you in and have you be isolated before you even know it there's some people who just don't want to socialize that are just happy by themselves and just leave me alone and i get that i'm actually more introverted than i am extroverted i can be extroverted you know i'm here and i've had a tv show and i like being on stage that's fun for me but then i need to recuperate i need to restore my energy being with people opens up an avenue to of yourself that you might not have been aware of that you might really like if you're primarily an introvert or if you like just being by yourself and the data showed that actually you get happier when you walk with someone as i've just suggested even when you garden with someone in you and you when you trade vegetables or trade fruit when you donate people who give to other organizations spend their time with others actually get more out of it than the recipients in psychological benefits they feel like they're part of something bigger it helps us to give to other people and to other organizations which we believe in that's actually a medical benefit not just a personal one or a psychological one so we nature is social and we can and should enjoy that aspect of it just like we can and enjoy we can enjoy watching the sunset by ourselves though every time i go to watch the sunset at the beach near where i live there are dozens of people lined up watching the sunset too because it draws us and that's the cool thing about nature it draws our attention it's less imposing on our brain the patterns of fractals that are apparent in nature in leaves and in plants are more relaxing for our brain than the pixels that we bombard them with nature draws your attention pixels demand it what are you doing today what are you doing it what are we going to get done how fast are we getting done who is waiting nature oh i noticed that burn oh there are two shades of green oh the wind is moving the leaves that's a different part of your brain and is restorative to the cognitive part of your brain it's so easy it there's hundreds of ways to do this it's an important reminder in a world that is driving us away from nature and yet it's so crucial it's how our genetics evolved on this earth nature was here yeah before we were here yeah and because we've gotten so far away from it it's scary the price that we're paying in our body and our mental health the price that our kids are paying as well you see this whole nostalgia amongst young people yearning for a pass you know there were i have i have a nephew and niece that are just just gotten to high school and they love watching saved by the bell and they're like man that seems like the golden age you know like midnight in paris like oh my gosh like that was the best times to be alive because you weren't on your phone and you have all these distractions and you know this analog movement that people are doing absolutely yeah i have 30 analog devices in the book i think people should use an alarm clock i think they should write in a journal i think that and it's been shown that that kind of repetitive motion of writing in a journal lowers your cortisol level too this is actually being implemented as an intervention in john hopkins studies in neuroscience analog tasks even physical handwriting as i've just pointed out but game playing board games are use different parts of your brain than watching the same game or playing the same game on your device they are good for motor coordination they're good for visual coordination they're good for engagement with others they analog devices are complimentary to what we are doing now and some cases should replace them i have an alarm clock by my bed in addition to my fitbit and and i use both and it's easy enough to use analog devices to engage i was on i don't remember on a beach somewhere else and these 25 year olds were taking pictures of each other with a polaroid camera and and it was perfectly normal like why was i taking pictures with my iphone and i admired it and i think there is a yearning for this connection and what people i think are unaware of is it actually measurably improves their biology to do to use analog devices some analog devices anyway and it's not one or the other um you can an interesting place is wearables you know that modulate your sleep or improve your sleep that there's some good evidence for at least a couple of them and their terrific devices they work pretty well but they're they're treating the symptoms of deprivation and what i'm interested in is stopping the deprivation john the book is out there it's available people can pre-order it pick up a copy this is an important topic and it's one of those epidemics that everybody when they hear it they know it's there they just needed somebody to connect the dots and you've done that today for our audience in this interview so i super appreciate it indoor epidemic 93 percent inside steel sleep focus years the seven percent where we can make these little tweaks small micro doses that you've talked about you bet or the outdoor rx restores them so that's super appreciate you um if people want to know more about you the farm yeah all the great things you're up to indoor epidemic dot com is the book website the farm website is lapuma farms dot com but we have a free cheat sheet we have a free outdoor rx that you can download we feature resources that and organizations that are doing this for underprivileged people and people without optimal access visit it check it out it's got everything you need can i get one of these coasters too yeah i brought them for you are you kidding amazing i mean separate from me can the audience buy these or request them or they have to come in person to the farm they can if they come in person to the farm they get one okay yeah okay and wherever i speak i give them away not yet in the business of selling them i'm not sure that i i want to it's more of a it's more of like a token for a talk or a little souvenir it is but it's really excited or it's a serotonin intervention hey running a farm is hard enough business you don't need to uh have uh uh you know pride cost uh you know to mail these out is is operation itself so it's well just on the farm i i'm happy to give them to people i interact with yeah because it really is magic to be able to grow something and it's a serotonin intervention and it's really fun to eat what you grow and this is such a simple way to do it and i just i love giving them to people and they have a qr code on them so you don't remember how to plant them you can just scan and i tell you yeah well i love it i'm going to plant one of these oh goop yeah and my in my kitchen condo here in los angeles great so many pictures yes absolutely john thanks so much for making it down here that's i'm excited to look forward one day to visiting the farm up there and thank you for the years of work that you've been doing in this space thank you to make healthier living just baked into our normal lives to the degree that i always tell people like you focus on your health for a little bit of time so that it's baked into your life so that you can give love and attention to everything else that matters yeah you can do this along the way you you don't have to retire and do it you can do it every day no matter how old you are that's the message thank you thank you hi everyone drew here two quick things number one thank you so much for listening to this podcast if you haven't already subscribed just hit the subscribe button on your favorite podcast app and by the way if you love this episode it would mean the world to me and it's the number one thing that you can do to support this podcast is share with a friend share with a friend who would benefit from listening number two before i go i just had to tell you about something that i've been working on that i'm super excited about it's my weekly newsletter and it's called try this every friday yes every friday 52 weeks a year i send out an easy to digest protocol of simple steps that you or anyone you love can follow to optimize your own health we cover everything from nutrition to mindset to metabolic health sleep community longevity and so much more if you want to get on this email list which is by the way free and get my weekly step-by-step protocols for whole body health and optimization click the link in the show notes that's called try this or just go to drew paroet.com that's dhru purohit.com and click on the tab that says try this