Victoria Maizes: Hi Andy. Andrew Weil: Hi Victoria. Victoria Maizes: I am really looking forward to speaking today with Dr. Lise Alschuler, who is our Fellowship Associate Director, and she's also a leading expert on dietary supplements and natural the products. Andrew Weil: And we're going to talk about adaptogens. Victoria Maizes: Yeah, it's something that. I think few people know about and is actually an incredibly useful tool for enhancing health and resiliency. Andrew Weil: Cool. Well, let's get to it. Victoria Maizes: Dr. Lise Alschuler, is a naturopathic doctor with board certification in naturopathic oncology. She's on our Center faculty as the Associate Director of the Fellowship in Integrative Medicine, and as a professor of clinical medicine at the University of Arizona, she is co-author of Definitive Guide to Cancer now in its third edition and Definitive Guide to Thriving After Cancer Lise has won many awards, including the 2014 American association of Naturopathic Physicians, Physicians of the Year. Welcome Lise. Lise Alschuler: Thank you. Pleasure to be here. Victoria Maizes: So I was excited to hear a little bit about your philosophy about adaptogens, which is the subject of our conversation today. And, you say that adaptogens work gently, but persistently they increase resilience, stamina, energy, mental and emotional wellbeing, and immunity and nothing else can do what adaptogens do. They are truly special contributors to our health and wellness. Pretty amazing. I think we have to start by asking you to define what are adaptogens and have people heard of them. Do they know of them? Lise Alschuler: Well, you know, they've been around for a long time. The term adaptogen was coined by some researchers in Siberia. And, this was back in there early 1900’s, and it was really around this idea of how do we keep our workers healthier and more productive? Is there some kind of plant medicine that could enable that productivity and that basically birthed a lot of research into plant medicines. And there was a group of plants discovered, which, later became known as adaptogens. And some of these are native to that area of the world. There are things like Siberian ginseng, for example sometimes referred to as the mother of all adaptogens, because it really was the first one that was studied in depth and led us to this whole category. So these are unique plants, but they're not new. They're unique because they have this ability to support people's health. No matter where we are on that continuum of health. So they have kind of a balancing effect or they bring people back to what we sometimes refer to as homeostasis or a sense of balance dynamic balance, which is very unusual. Very unlike say, we're tired and we drink a cup of coffee that acts more stimulant. So it moves us in a very specific direction. Whereas adaptions don't necessarily do that and we'll kind of get into the mechanisms, I'm sure, but, um, they are unique. There are no minerals that do this, and no medications that do this. There are no vitamins that do this. There are no minerals that do this. There are no other supplements that do it a day after day. Andrew Weil: Lise I have to make a comment here. We can't say that adaptogens are plants because a big category of them is mushrooms and mushrooms are not plants. And the Chinese did not have the term adaptogen. They suddenly had the idea and their category of superior medicines, which included ginseng and a lot of mushrooms, uh, were considered to be superior because they worked generally on the body to increase resistance to stress. I think it was the same idea, but mushrooms are some of the most prominent ones there. So I would say natural products. Lise Alschuler: Yeah it's true. You know, mushrooms are this weird hybrid sort of animal, like plant like. Andrew Weil: Yeah separate kingdom, right. Lise Alschuler: And you're right separate kingdom. You know, cordyceps mushroom is one of my very favorite adaptogens, so absolutely, good correction. Victoria Maizes: And I wonder if there's is anything in conventional medicine that you could consider an adaptogen over the years? I've heard people say, maybe we should think of aspirin as an adaptogens and because of its wide-reaching effect, but I don't think it has that homeostatic effect, which Andrew Weil: One of the main characteristics of adaptogens is nontoxic and longterm use. And you can't say that about aspirin. And I think in general, any of the medications you come up with in Western medicine, the toxicity problem is rules them out. Victoria Maizes: So this is one of the really wonderful parts of integrative medicine, from my perspective that it adds elements that just don't exist in conventional medicine. As you both pointed out certain plants and mushrooms have this potential. You pointed out in your philosophy that these are good for stress, but it turns out adaptogens can also make us more resistant to infection. And Andy, I'm just wondering if you want to speak about COVID-19 we're recording this during the pandemic. Are there any adaptogens that you see as potentially useful during this pandemic? Andrew Weil: Well, Lise has written an article on this subject. I think the ones that I would be most interested in astragalus and probably also a number of the mushrooms that, uh, you know, we can talk about that at that seemed to enhance certain aspects of immunity. Victoria Maizes: So let's talk about astragalus, cause that's really an old one, as you were talking about, these are not new medicines, right? Lise Alschuler So astragalus comes to us in the Western world from traditional Chinese medicine and, uh, we use the astragalus bark. So in traditional Chinese medicine, it's typically made into soups and, uh, consumed as a beverage. And that's very true for a lot of adaptogenic plants. If you look at their history of use, people consume these as part of their diet on a regular basis. And nowadays we tend to extract the plants or the mushrooms and use them as supplements, which also works. But in the case of astragalus… astragalus is interesting in a couple of ways. Number one is that it is thought to tone of defensive key in, and I'm not a Chinese medicine practitioner. So forgive me for those of you who are listening, who are, but it basically allows our system, our lungs, especially to be more resilient against infection. And we now know from further studies in Western medicine, that there are very specific effects of astragalus extract on the immune system. And it does two things which are uniquely important. As for example, with, with the COVID-19 pandemic in that the astragalus enhances our initial immune defenses against infection. So it kind of upregulates are the immune cells, uh, attack invading microorganisms. And at the same time it has some anti-inflammatory properties. So it helps to control an immune response that would otherwise go on unregulated, which is where some of the complications from the SARS Covid 2 virus comes into play. So it really is sort of perfectly suited if you will COVID-19. And again, because of that, that specificity in the lungs, it's really good. Especially for people who have a weakness or maybe history of asthma or COPD or something like that. Victoria Maizes: I imagine in your work as a naturopathic oncologists, you are using it as well in patients with cancer. Lise Alschuler: Yes, there's a good body of data looking at astragalus list in cancer, again, you know, not so much to cure cancer, but really to support the immune system either during cancer treatment or as part of the recovery from cancer treatment, maybe has some cancer, preventative properties. Again, I think that that's probably some of the wisdom behind the traditional use of eating it on a regular basis. And Victoria Maizes: Andy, you have been making a recommendation to people with cancer to use astragalus for many, many years. What, what have you seen? Andrew Weil: Well, you know, this is a part of a something called Fuji Ang therapy in Chinese medicine, which is a cancer supportive therapy designed, especially to protect the bone marrow from damaging effects of radiation therapy and chemotherapy. So mostly, I've seen very good results in, in marrow recovery, uh, people that have suppressed white cell production as a result of radiation or chemotherapy to the astragalus it seems to counteract that, um, unfortunately I have to tell many cancer patients better not mention this to your oncologist because. Most conventional oncologists simply say, don't use any supplements or any herbs they haven't learned about astragalus and they think they might interfere. But the fact is, you know, most of the mushrooms that are used astragalus I think are quite safe and they don't interfere with conventional therapy. Victoria Maizes: And truthfully, this is one of the, uh, dietary supplements that has been studied. There is actually good trial evidence especially I think in lung cancer for using astragalus. Lise Alschuler:] Yes. And again, I, I would echo what Dr. Weil's saying in that, you know, this is, I would say almost always true, which is that the therapies that we have from the natural Materia Medica are very useful as complementary therapies to conventional treatment. You know, the good news is that in my experience, more and more oncologists are open to the idea, especially if you can present them with the research or, you know, a patient, you can ask your, your natural or integrative provider to present some of the research to the all just so the oncologist is mainly concerned that whatever you're adding into your treatment plan is not going to interfere with what they're recommending or in any other way harm you. So if you can make that case, then there's more openness now than there was 20, 30 years ago, for sure. Andrew Weil: Through the traditional use of strike lists in China is to ward off colds and flus and there is data to support that. And I often recommend that to people at the start of winter cold and flu season, or to people who said that you get everything going around, it can be taken longterm. And I think it decreases risk of viral infection. Lise Alschuler: Yeah. And I think the prevention piece is really key. There's, there's a little axiom that I learned from my TCM colleagues that it's really good to prevent just as you said, but if you have an acute infection, you should stop taking it. The idea is that it sort of hardwires that infection in and it makes it more difficult for the body to remove the infection. So I think that's generally a good. Rule of thumb. Victoria Maizes: So astragalus good for prevention. Also good in recovery, but during the acute infectious process, better not to take it. Another thing that, um, we're really wrestling with, um, at this moment in time are the mental health effects of this pandemic. Um, a lot of people are experiencing anxiety and depression. Is there an adaptogen or more than one adaptogen, a favorite that you would have to help people who are struggling? One of the other anxiety or depression. Lise Alschuler: There's there are many, so let's look at anxiety first. I think, first of all, I have to say that when an herbalist uses an adaptogen, they often will combine an herb that's primarily an adaptogen with another herb or supplement that has what we call nerving properties. So in the case of anxiety would be unusual to treat that with just one herb, but that being said, you know, for the purposes of discussion, there are certainly some that come to mind. So for anxiety, one of the favorites is something called ashwagandha. Now this comes to us from a different tradition of medicine, the Ayurvedic tradition of healing. This is also known as Withania somnifera is the botanical name in that second Latin name is the same word that gives us some sleep. So it kind of gives you a hint that it has some sedative, like properties. It's not a sedative like we would think of. If you were to take a sleep medication for example, but it does take the edge off and kind of alleviate anxiety. So it's very good for anxiety at the same time um, ashwagandha is especially indicated for people who are very debilitated. So either debilitated by their anxiety or they're just debilitated from illness. And they have anxiety as an element of that because it helps to restore and rebuild stamina at a very deep level. It encourages or it improves people's ability to utilize iron. And so it's good for anemia. It also improves white blood cell count. It has some very gentle thyroid supportive actions. So it, and that can contribute to fatigue and interestingly anxiety as well. It helps people get a good night's rest. Most adaptogens are typically recommended in the morning that people take them in the morning when their energy should be highest because most adaptogens improve stamina and energy and wellbeing and not like coffee, but give you kind of a stronger sense of energy for the day can be a little stimulating. Victoria Maizes: Some of them can be quiet stimulating. Lise Alschuler: Some of them can, yes. But ashwagandha is the opposite of that. It has this. So it's unique in the world of adaptogens. It has this kind of sedative quality. So it's best taken either in the afternoon or in the evening, actually. But so that's kind of one of my top ones for anxiety. Andrew Weil: If I could give out two for possible uses in mental health. Uh, one is Rhodiola and the other is Tulsi. Lise Alschuler: Yeah. So you and I are on the same wavelength today. So my next favorite I was going to say is Tulsi or Holy basil. Mostly cause I like to say, “Holy basil!” , but Holy basil is just an amazing, I find it to be an amazing adaptogen. It's it has antiviral properties just in context of our earlier conversation, but it, I would use more, so it actually relieves anxiety, but it also relieves depression. So it has this, you know, ability to kind of address people with a mixed presentation of being somewhat depressed, but also having an overlying anxiety. Tulsi is very, very good at that. And combined well actually with ashwagandha and my experience. And if you look, there's a lot of Ayurvedic formulas that contain those two herbs, I think for that reason. Victoria Maizes: Can you take the evening still because it's got the ashwagandha or would you not be, not be as important to dose it in the evening? Lise Alschuler: Yeah. If I was using those together, I have a little more my dosing. I would probably dose it in the afternoon. If I was using them together, I forgot Andy. What was the other one? You mentioned Rhodiola. Right? So Rhodiola is a good example of what Victoria said earlier where some adaptogens can be stimulating. Rhodiola is, is very energy producing. Current research suggests that it probably actually works on what are called the mitochondria a little energy store houses in our cell and our basically an improves their ability to make ATP or the currency of energy. Um, so it can be very energizing, which is fantastic for people who are feeling low energy or have a more lethargic type of depression. But for some people with an anxiety to begin with, if they take Rhodiola can actually experience a slight worsening of their anxiety. Cause it's a little bit too much too early, so that when I'm a little bit more, um, cautious about in certain people, but for people who don't have that anxiety and who are just tired and kind of worn out. It's an amazing plant. Victoria Maizes: I have to admit that I have used a variety of adaptogens for my own health and wellbeing over the years and wrote all and made me feel wired. I, I didn't like it very much. I really like schizandra, which you haven't mentioned yet. And I think one of the reasons I like it is that, uh, least when you teach about it, you say it turns a worrier into a warrior. Lise Alschuler: I love schizandra. I'm so glad that you love it too. Yeah, schizandra is, um, that's the way I think of it. It really takes this kind of fretting type of anxiety and helps people regain a sense of, uh, control or what I call agency in their life so that they have a little bit more grounded-ness to move forward and kind of meet their anxiety head-on or utilize that the energy of anxiety in a productive way. Um, Shas Andrew is also unique in that there are lignans in the plant, which are very, uh, hepatic protective. So they actually are very good for supporting the liver in the context of environmental toxicity or, uh, if somebody is consuming high amounts of alcohol or anything that could be otherwise inflammatory to the liver, schizandra very good at helping to support the liver. So that's just a nice kind of secondary benefit to schizandra. Victoria Maizes: Andy, I want to pull in a little bit on your expertise as an ethnobotanist a least mentioned to us a little bit about the discovery of these plants in Siberia, but what else do we know about the use of these plants from a ethno-botanical perspective? Andrew Weil: Well, first of all, the reason that people look for things in Siberia was that there was, uh, the, there was incentive of Soviet scientists to find substitutes for ginseng because, uh, then as long in history, the worldwide demand for ginseng has greatly exceeded the supply. And it's one of the most expensive herbs out there. So there was a, a project that tried to discover alternatives sources that closer to home and explore, found this plant that looked like ginseng growing in Siberia. That's a ginseng relative. I think China is the most interesting place to look because this, uh, you know, you've heard me say this, the Chinese medical philosophy, uh, divides drugs into inferior, middle, and superior categories on the inferior category of drugs that have specific actions for specific ailments. And that's in Western medicine, that's our highest ideal of a drug, something that has a specific action and the superior category those that work generally good for everything and we don't take interest in them, uh, in the Western world, because we think if something works for everything. It can't work by specific biochemical mechanism. So that really, I think it limited our search for these nontoxic substances that, you know, bolster health and improve homeostasis. Um, and, and it's remarkable the history of ginseng it's just fascinating how long it was completely yours in the Western world. And we let our own native form ginseng American ginseng be harvested, almost extinction, to be exported to China and nobody bothered to study it, to see what properties it had. Victoria Maizes: It is fascinating how still so many people don't know what you're talking about. When you say something is an adaptogen, it's not really in our lexicon. So Lise, tell us how these work. What's the mechanism? What is it doing to our physiology that has this wonderful normalizing function? Lise Alschuler: So we are still learning about this from what we know so far years that adaptogens have many different mechanisms of action, which is one of the reasons why they have their fingers in so many different biochemical places. One thing that we've long known about adaptogens is that they help to normalize our stress response, which sometimes practitioners refer to as the hypothalamic pituitary adrenal axis. So this is a neuro-endocrine response system that we, we are hard wired to react, to perceived stress in a way that allows us the capacity to move away from that stress. So if we see a tiger in the grass, our HPA or hypothalamic pituitary adrenal axis fires off, and we get more blood flowing into our muscles. We shut down our digestive system and we're ready to run from the tiger, you know, in the modern world, we don't see tigers in the grass. Instead, we have people cutting us off in traffic. We run out of half and half for a coffee. We have all these other little mild stressors, but it triggers the same stress reaction. And over time. This stress reaction gets stuck in the on position basically, and it doesn't turn off. So we don't kind of reestablish our homeostasis, our baseline function. And when that happens, we develop high levels of one of the stress hormones called cortisol. And with that ourselves throughout our body become resistant to that cortisol. So instead of the normal physiology taking place, we get this kind of reverse response. And under this constant barrage of cortisol, we start to experience more inflammation. We start to over decades, actually degrade the quality of our tissues. We can develop digestive issues, joint disorders. Even cognitive issues, mood disorders. So there's lots of ways in which chronic stress has a very clear physiology, and that's a very shortened version of complex concepts. But to wrap that up the adaptogens, one of the things that they do is that they reset the, the hypothalamus and the pituitary to the turnoff signal of cortisol. So it helps our body to turn that system off. Andrew Weil: The standard research model for determining whether a natural product has stress, protective properties or a drug is the rat swimming test. You drop a rat into a column of water and you see how long it swims until it gives up. And hopefully you pull it out then I don't know whether they do that and then you'd give it something ashwagndha, ginseng, a steroid and you see prolongs the time that the rat can swim until it gets yeah. Exhausted. And if it prolongs the time, it is considered to have a stress protective effect. Probably by working on that hypothalamic pituitary area, that's the way we assess these things. Victoria Maizes: I believe there's now some human trials as well. So what do we do to assess in humans, Lise? Lise Alschuler: Well, you know, and I just want to mention one of the thing, which is that in addition to that, we also now know that the adaptogens improve on an within ourselves improve the ability of ourselves to make ATP and to protect itself against various stressors like oxidative stress. So that's important because that allows, that also explains why those rats could swim longer. Could because they have more endurance, more physical endurance all the way down to a cellular level. Andrew Weil: Mushrooms are, may work by different mechanisms. I mean, these, uh, some of them have, uh, polysaccharides versus polysaccharides, which we don't think of as being pharmacologically active compounds. Uh, but they're similar to cell wall components of bacteria. And one thought is that they stimulate the immune system and the way that a foreign bacterium would. Lise Alschuler: Right. Victoria Maizes: Andy, since we're on the topic of mushrooms, maybe just name a few of your favorites, adaptogenic mushrooms. Andrew Weil: Well, one of the most famous is reishi. This is the hard lacquered looking fungus that's been much esteemed in Chinese medicine for extending longevity. It has significant anti-inflammatory properties. It has immune modulating properties. Non-toxic, the anti-inflammatory properties are very significant. Um, and I use them in patients with inflammatory disorders. Lion's mane mushroom is one that has particular effects on nerve function and cognition. Now being intensively studied. There's so many of these as Lise mentioned earlier, a lot of these things cross the line between medications and foods, uh, and in Eastern medicine, particularly, there is not much of a distinction between. Drugs and foods that many ingredients in Chinese cuisine or Japanese cuisine are there as much for their perceived medicinal properties as for textures or flavors. So shitake mushrooms, which are common and people know them very well. Uh, also have, uh, antiviral properties it's like cancer, protective properties, cholesterol, lowering properties. You know, there's so many of these and there's a lot of good resources now on, on medicinal mushrooms. Victoria Maizes: Andy, would you recommend that if we could, we include these in our diet as opposed to taking them as the supplements? Andrew Weil: Definitely. And it's gotten easier to get a lot of these mushrooms, you know, until relatively recently, there was only one species of mushroom that we in North America could get the common button mushroom. Agaricus brunescent as in its various forms, but now in many locations you can find shitake maitake, enoki mushrooms, oyster mushrooms, lion's mane. These are being connected, they did more and more. A lot of them are very delicious. So if you can. Include them in the diet. That's great. You can also buy a dried mushrooms and reconstitute them and make tea out of them. And for many people the, that liquid or, or solid extracts, maybe easier ways to take them. But yes, if you can eat mushrooms, I think they're good additions to diet also, by the way, they're full of prebiotic substances that probably foster a healthy gut microbiome. Victoria Maizes: So since these have this wonderful normalizing properties, since they reset the hypothalamic pituitary adrenal access should we be taking them indefinitely or should we start and stop? How safe are they? How long can you take them? Lise Alschuler: You know, this depends on who you ask, but since you're asking us, I will say that I think most of us would be benefit from having an adaptogen or adaptogens in our daily life. Um, and that's primarily because the, the degree and nature of stress that we each now experience in this world is pretty unheard of, and it's, it's really a daily assault to our neuroendocrine system. So I think adaptogens are generally beneficial. That being said, you know, your adaptogen is not necessarily going to be my adaptogens. So I think that there is a room for seeking some integrative practitioner advice to really find an adaption that would be best suited and even that may change over time, depending on your circumstances. But. I myself have been taking one or more adaptogens for 30 plus years. And again, I would feel a little bit naked without it. You know, I think just given the environmental toxicity, the microbial assault, the day to day stress, the, you know, kind of weird lighting that we have in our world now, the lack of time in nature, all these things really make it hard for us to maintain our homeostasis. So my belief is yes. Most people, if not everyone would benefit from an adaptogen. Andrew Weil: And I think these can be used safely, very long-term. There's no evidence of toxicity or loss of effect. In my own life I eat, uh, I take, uh, extracts of a number of Asian mushrooms. I also eat garlic almost every day and I would consider garlic and adapted. It has a wide range of, of properties that I think improve health generally and increase resistance to infection. So, you know, that's, that's part of my routine and I take astragalus I say periodically if you know, during flu season or if I'm traveling or exposed, if I can remember what it's like to travel or, you know, if I'm exposed in areas where respiratory infection might be likely. Victoria Maizes: So we have a really relevant question from Carol. She asks something that we get asked all the time about how you find a high-quality products. Listener Message: Hi this is Carol and I was just wondering if there is a brand of vitamin or mineral supplements that is recommended by it from a health food center or if the brands that claim they are pretty natural that you get at your grocery store pharmacy are good enough I’ve been trying to do as much research on this as I can and I’ve kind of hit a brick wall. Thank you Lise Alschuler: You know, it's such an important question. And unfortunately, my answer is not entirely straightforward, but I'll make it as straightforward as possible. So first of all, I just want to say that many people are under the misconception that dietary supplements are unregulated and that's not true. They are regulated. They have their own very unique set of regulations because they're not exactly pharmaceuticals and they're not food. So they have a hybrid set of recommendations. And although not universally true, most dietary supplements are on a scale of safety, much safer than say a drug. So the regulations are based on the presumption of safety and the regulations are oriented to identify problematic supplements and remove them from the marketplace, as opposed to say drugs, which are presumed unsafe until proven otherwise so they have a lot of pre market rigor, they have to undergo before they're able to be sold. So that's, that creates some challenges because if I were to walk into a store to seek a certain, let's say, adaptogen or whatever. I wouldn't necessarily know which abides by the regulations in which she doesn't. So some ways that we can kind of determine that are some clues that are helpful. Number one is it's very important to always buy supplements from the manufacturer itself. So not use third party sellers, so that you can cause on every dietary supplement brand, there's a phone number and you can call that company. You can ask them about their quality practices. And I encourage people to do just once call the brand and say, do you have a quality manufacturing unit? You know, how do you test for your product quality? And just the openness to their answers will be a big clue. So that's a five-minute investment of time, but it's worth it I think so buying from the brand itself, number two is look for. What are called third party verifications. So there are certain companies which will go in and make sure that the company is following the regulations for manufacturing systems. Look for our USP, as well as something called NSF. Those are both organizations that certify the quality of the manufacturing and you can see those seals on the products. So that's other thing the third recommendation I would have is to find an integrative practitioner who's trained in the use of dietary supplements and is familiar with various brands and ask for their recommendations to direct so that they can direct you to the most appropriate brands. And then the final, uh, piece of advice I would have is that there is a website called consumerlabs.com and they independently test various products off the shelf for identity and for the presence of heavy metals as a marker of quality. It's not the only way that we determine quality. It's just an indicator of quality and they'll publish all the companies and the products that have passed their test. So that's another thing that you can check is to just go to their website and see if the product you're looking for or has met their, their, uh, their specifications. Andrew Weil: And I would add that with regard to herbs and mushrooms, I would recommend that people avoid products coming from China. Theres a high likelihood of contamination with heavy metals and other toxins. Victoria Maizes: Now wasn’t that issue seen with Ayurvedic products. So another thing we often see when we're trying to buy a product is the claim natural does natural mean something on a dietary supplement product. Lise Alschuler: It's not well defined in the regulations. So I would say it's a very good marketing term, but not a very good educational term. Lise Alschuler: So I would say no. Short answer no. Victoria Maizes: As a part of our listeners, a lot of health professionals, and there was a question from a health professional who said I would love, help and advice seeing patients on dosing of supplements. I have great difficulty making the time to find, read and digest really great papers would really appreciate some curation. And I want to say, this is one of the things we do in our training programs. So we would invite health professionals to consider either our fellowship or one of our other training programs. But in addition, there's a really wonderful resource called Natural Medicine Comprehensive. Database, uh, at least can you tell people how to find that and what they might, why they might find that useful? Lise Alschuler: Yeah. So Natural Medicine Comprehensive Database is available by. A subscription online. And it is, it's really a tremendous database that has been put together by pharmacists and they essentially organized things in what's called a monograph format. So for any particular dietary supplement ingredient or herbal product, or, you know, whatever the case might be, they will describe in a very succinct, easily readable way current research, current usage, uh, potential interaction issues with drugs side effects that have been reported in clinical trials. And they will give you dosages that have been studied in clinical trials. So it is a good way to kind of get at a kind of a glance in depth information. Victoria Maizes: I like to ask all of our guests, since we're been talking about health and best practices whether there's some vice that they have. So Lise what’s one vice? Lise Alschuler: Well at least you're limiting me to one. That's good. No, this is not a confessional, so I'll limit it to one. Well, um, I guess I would say a couple of things come to mind, but I think maybe the vice that comes to mind, that might be worth discussion is that I have a tendency to be a bit of a workaholic, so that in turn makes me more sedentary and I've done a lot of things to try to mitigate that. I have this little bike that I sit at and pedal at my desk and I try to take breaks, but I can be a little bit more sedentary because of that. And also then shorten my time to do things, which I believe are really important to my health. Namely spending time in nature, relaxing, doing those kinds of things. So, that's something that, you know, is a work in progress. I don't know what to tell you about that I'm aware of it. Awareness is the first step. I'm trying to do some things to mitigate that. But yeah that’s a vice. Victoria Maizes: Thank you, I think that's probably a common bias. And so we probably should, let you get off of the podcast so that you can go off and be in nature. Lise Alschuler: Yeah. Yeah. I think there's the, I was reading a book recently called the Finnish way because part of my heritage is Swedish Finn is sort of part of my ethnicity and in Finland, they have this concept called sisu, which is really about this resilience that comes from a sense of determination and self-reliance, but there are very many components that build people sisu, and one of them is spending time in nature. Nature is a very important part of day to day life in Scandinavia. And just reading that book reminded me of, you know, the importance of that. Just simple living, good, just simple quality food and balance, balance in all things. Victoria Maizes: Thank you Lise much for being on our show. It's been wonderful to have you as a guest, and it's wonderful to have you as a faculty member at the Andrew Weil Center for Integrative Medicine. Lise Alschuler: Thank you so much.