Episode 110 | Dec 20, 2024

Embracing Good Stress for Better Health, With Dr. Sharon Bergquist

What if stress could actually make you healthier? This week on Health Coach Talk, Dr. Sandi welcomes lifestyle medicine expert Dr. Sharon Bergquist to explore the transformative power of “good stress” and its role in building resilience. Their conversation explores lifestyle medicine’s expanding role in addressing chronic disease and offers practical strategies for health coaches to help clients integrate these principles into daily life.

“Taking on these good stressors really is an antidote to chronic stress… at the end of the day, stress is a part of our everyday lives. And once we recognize that, we shift our focus to building resilience. And that’s what good stress does.”

Dr. Sharon Bergquist

Dr. Bergquist’s passion for lifestyle medicine grew from her experience in traditional healthcare, where she saw patients meeting treatment goals but still struggling with their health. Determined to address the root causes of chronic disease, she launched the Healthy Kitchen program at Emory, a hands-on initiative blending evidence-based practices in nutrition, exercise, sleep, and stress management. With a focus on behavior change and community-building, Dr. Bergquist’s work highlights how experiential learning and health coaching can support sustainable wellness. Her research demonstrated significant improvements in participants’ diet quality, exercise habits, and mindful eating—results that have power to positively impact families and communities.

In this episode, Dr. Sandi and Dr. Bergquist unpack the science behind “good stress” and how it differs from the chronic stress we all know too well. They discuss the importance of deliberately embracing challenges, such as cold plunges or resistance training, to activate the body’s repair mechanisms and build resilience. Dr. Bergquist also reveals how mindset and recovery are critical in transforming stress from a harmful force to a health-enhancing one. Together, they outline how lifestyle medicine, good stress, and health coaching can shift the focus of healthcare from reactive to preventive, improving lives on multiple levels.

Health coaches will find inspiration in the actionable insights Dr. Bergquist shares, especially around leveraging community and behavior change strategies. Her Healthy Kitchen program demonstrates the value of combining clinical knowledge with the art of coaching to facilitate real, lasting transformation. Coaches can take these principles into their work, helping clients address chronic stress, adopt healthier habits, and build resilience for a more vibrant life.

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Dr. Sandi: It’s my pleasure to introduce to you Dr. Sharon Bergquist. Sharon, we met at an event just because I happened to sit down next to you at lunch, and we soon discovered that we had a lot in common. So, I’m thrilled to bring you on to introduce you to our audience.

Sharon: I was thrilled as well, very fortuitous that we sat next to each other, and I’m very excited about our conversation.

Dr. Sandi: Well, we share many common interests, particularly in lifestyle medicine, as well as stress. That was a field that I had focused on way back in the ’70s. I think I still have my old notes of workshops that I was giving on at that time. We called it stress management. But let’s begin with lifestyle medicine. There may be some confusion. If somebody were to ask, “What is lifestyle medicine? How would you describe it?”

Sharon: Yeah, lifestyle medicine is really a very rapidly growing subspecialty within medicine. Like it sounds, it’s the application of lifestyle but in a very evidence-based way, things such as our nutrition, our exercise habits, stress management, which we all get back to, sleep, recovery. These daily habits, our behaviors, and how they impact our health is really the crux of lifestyle medicine. And we know that 80% of disease is preventable. So, lifestyle medicine is really at the foundation of how we should reform our healthcare system towards prevention because it holds the power to prevent, treat, and even reverse a lot of the chronic diseases that are epidemic.

Dr. Sandi: Oh, absolutely. I could not agree more, which is why we’re training health coaches to guide people in these areas of lifestyle medicine to make these changes, which are often very difficult to initiate and even more difficult to sustain. They tend to fall off the wagon. And it’s pretty hard.

But if somebody were to make these changes in lifestyle, do you see it really making an impact on chronic disease? And I know you are interested in the research behind this. And you did your own research, which I would love to get into. So, can you describe your work at Emory and how this research project and your work with… I love the healthy kitchen that has been established. I’d love for you to describe that.

Sharon: Yes, Sandi, when I started in healthcare, we really didn’t put a lot of emphasis on lifestyle. I was trained in the late 1990s. I’ve been in healthcare now for over 25 years post-residency. And so much of the focus of how we’ve been taught has been on how to appropriately treat disease or use guidelines to diagnose disease early. But similar in my career, it occurred to me that my patients were getting sicker despite hitting all of these metrics of what is optimal blood sugar control, what is optimal blood pressure, because we weren’t treating the foundation of disease.

And that led me down a path towards doing both the research as well as figuring out ways to introduce in the clinical space how we can hit these foundational aspects of our health. So, one of the things that I created, along with a very large group of people that were experts in respective fields, is a Healthy Kitchen program, which we created as a clinical trial. And what we did is we used a teaching kitchen model. So, we thought everybody comes together around food, and it became the perfect learning lab for teaching a lot of behavioral and life skills.

So, we went to experts in our academic organization that had expertise in nutrition, and exercise, and yoga, and sleep, and ethnobotany, stress management, and gardening. And because we have such a large academic medical center, we were able to bring together people, really break down some of the silos that exist as people work in different schools within the institution.

And we created a curriculum. Part of the curriculum was didactic, just what is the science behind how these behaviors affect health. But being clinical, like you just said, behavior change is hard. And a big part of our program was to make these implementations experiential, so not just to tell people what to eat but how to prepare meals using the ingredients we were advocating for. Not just to tell people they should exercise but how do you do it.

So, we combined the didactic with the experiential in the setting of a group. And that community that we created really was the secret sauce to having people make the behavior changes. We did this as a clinical trial, looking at different behavioral health outcomes, looking both at the short-term like a three-month change as well as yearlong to see if people could sustain.

And you hit the nail on the head talking about the importance of health coaches because we use coaches to facilitate some of the sessions, as well as throughout the year, to help people who wanted a health coach to really reinforce the behaviors that they were learning. I’m happy to talk about the outcomes because it really speaks to the value of adding lifestyle as a component of clinical care and retain mainstream traditional healthcare.

Dr. Sandi: I would love to hear more about the outcomes. I think that this is such wonderful research. I don’t know why it’s not front-page news as we’re talking about the crisis and escalating incidence of chronic disease, as well as soaring healthcare costs that accompany rise in chronic conditions. This needs to be everywhere. We need to be shouting it from the rooftops.

Sharon: Thank you, Sandi. I share that passion. And I think just as you said, there’s so much focus on bending the cost curve, that we’re doing it by restricting care by requiring prior authorizations and screenings. But if we focus on the foundational aspects of care, we would be reducing the cost and bending the cost curve by making people healthier. And that’s really, I think, where we need to shift the emphasis of health care.

When we look at lifestyle medicine and programs like this, as well as providers who do this type of work helping people change their behaviors, it not only makes patients healthier, but it improves the quality of life of the physicians as well. It’s so gratifying, and it reduces burnout. It also helps with healthcare equity, planetary health. It’s really a win-win across the board for everybody involved.

With regards to our clinical program, I think some of the most biggest lessons, I should say, that we learned is a lot of behavior change programs, especially worksite wellness programs, and look at the ROI, or the return on investment, on outcomes such as body mass index, kind of weight loss, etc. But our goal was to look at behavior change, right, because we were not interested in creating a weight loss program. That wasn’t our primary goal. We wanted people to change their behavior, which we knew reduced the risk of disease, improved their quality of life, and their perception of their own health, which has tremendous value in how they carry about their day, their mindset, their mental health. And so many of these programs get reduced to weight loss and BMI.

We did measure biometrics that we felt that what was getting left out of the equation was looking at outcomes such as people’s dietary habits, their micronutrient intake, were they eating mindfully, were they exercising. What we did is we measured these behavioral outcomes through various surveys that are validated in the medical literature.

What we found by implementing our teaching kitchen-based program is that people had a statistically significant improvement in their dietary quality. We used questionnaires, such as Starting the Conversation. We saw statistically significant improvements in mindful eating, which I don’t think we talk about enough. We saw trends in improvement in people’s confidence towards preparing meals on their own from scratch. The art of home cooking, I think, is becoming a lost art as more than 50% of meals are now eaten out of the home or from prepared food. And we saw statistically significant increases in exercise, both aerobic as well as strength resistance and yoga.

And I think this speaks to how such a program can make a difference. Our results showed a change at the three-month mark as well as sustained behavior change at the one-year mark. And I can’t say enough about how our participants raved about the program, how much they felt it made a difference in their lives. And even though the participants were employees at our academic health institution, they brought it home to their family, and we could see the ripple effect on their spouse or significant other and their children. And this, to me, is how we really reach that tipping point where we change the culture towards prevention.

And so we were very excited to create this program. We did a year-long program that was on-site, hands-on, in-person. We did cost analysis, and I can give you numbers around a year-long program like this. For us, the delivery per participant was $755 with a marginal amount of $141 per participant. But for our population, which was employees at our institution, that exceeded their ability to pay.

So, we created a hybrid program that is part virtual, with the components that were experiential being delivered as a shared visit, which is covered by insurance. And we found that hybrid model, with some components being delivered virtual, had nearly the same outcomes but a tremendous cost savings. And it gave us the ability to scale the program to reach a broader population without the limitation.

We’ve now even created it into a course that people can take. So, we really want to make this very accessible. I’ve spent a good part of my career very committed to not only encouraging lifestyle medicine and understanding the science behind it but to making it mainstream in traditional care, because I feel like, at the end, that is what ultimately needs to happen for our country to make people healthier.

Dr. Sandi: So beautifully said. And this study was so comprehensive. You really touched all the key elements of lifestyle, because it’s not just… And I’ve seen this where people will misinterpret, “Well, just have people eat better or just get everybody to decrease their sedentary behavior.” But it’s not just one element. It has to be all of those modifiable lifestyle factors. You need to address stress, which we’ll get to in the conversation. You need to look at relationships, and what better way to do that than get people together in a community? Because we’re so lonely, we’re so isolated, and they get together in these groups. That is really where the magic happens, as well as they’re getting more sleep. That’s another component as well, or better sleep, I should say. So, you’re touching all of those areas.

And I could really assist for workforce wellness because a company could initiate this type of program. But also, as you mentioned, in medical offices, because we have insurance now that can reimburse for a group medical visit. It’s done even online. You can have a demo of cooking. You can have the health coach as your facilitator, educator. And then the provider is taking people out into breakout rooms for their evaluation and management, basically their normal doctor’s visit. But that 10, 15 minutes is within the group where they are getting all the value that you have just outlined. And I would say that if we were to analyze what’s most valuable, it would be that group process. And so I would love your thoughts on that. How can we expand this?

Sharon: Yeah, I think there are several components to expansion. Currently, the reimbursement models for this type of program are very limited. We can do shared medical appointments, as you just described, but there are some limitations around that for different groups and the logistics around that.

I think one of the biggest factors that will help move the needle really comes down to what insurance companies are willing to reimburse so it doesn’t put the burden of a cost on the patient. We spend so much money on health innovation that’s at the margins, and we are really just skipping over the foundations of health. And we put so much into technology for innovation, again around tertiary care, the subspecialty innovation.

But if we apply that technology and how we can help people with some of the fundamentals, how we use AI going into the future and different ways to assist along with the human touch, as you said, through health coaching, I think it really comes down to what our insurance model values and how contracts are negotiated. Do we move towards value-based care where these outcomes are ultimately what are financially looked upon as the most important measures?

So, we’ve got work to do, but I’m very optimistic in our goals to help provide the data that help support this type of program so that it goes from the theoretical to the quantitative, so people can have these measured results, and we hope that’s a step forward.

Dr. Sandi: Yes. Well, this study that you did really brings me back to a time when I was working as a psychologist. And I had an oncology group that referred a lot of patients to me. And I decided that I would go in one day. I said, “I’m going to start a group in your practice.” And I took over their lunchroom, where the staff had lunch, and we cleared it out that time, the pizza boxes left over from the drug reps bringing in lunch.

And this group went on for three years and people looked forward to coming. They were people who were mostly seniors and had multiple diagnosis of chronic conditions, but we were doing just what you’re describing. I had someone who was a co-facilitator with me. We brought in our blender, showed them how to do smoothies. They would walk together after the meeting, but the primary factor was the community. And this was an open-ended group, so people would come and go. And when new members came in, the old-timers, they loved to be of service. And they would tell people how they were making changes and how difficult it was at first, “Oh, you’ll get there. We’re going to support you.” So, that community is so critical.

Sharon: I couldn’t agree more. People need to be in an environment where they’re with peers, where people going through the same problems, encountering the same obstacles are helping them problem-solve. And making that facilitated through healthcare is also a challenge. I think there’s obviously a revolution of that occurring online, and I think healthcare can be a part of that as well.

Dr. Sandi: So, what needs to be a part of it is handling stress. You have a book that will be coming out, but you have switched in your… Like, on your Instagram, good stress. So, we tend to think of stress as bad. Stress is bad, and we need to de-stress. But can you talk about this concept of good stress? What constitutes good stress? How can we get more of it in our lives?

Sharon: Yeah. So, the stress that’s in our lives is primarily chronic stress. That’s really our framework of what stress is like. It’s toxic, it’s debilitating, and it harms our health. And that’s because that’s the predominant type of stress in our life, but what we really don’t see is that there are different types of stress, and good stress has really the opposite effect.

Good stress, by definition, is really intermittent stress followed by recovery. And certain types of good stress activate cellular responses. So, they tell our cells that there’s stress. Our cells switch to a stress-resistant mode. And in that hunkering down when they switch from growing and proliferating to being in stress-resistant mode, they really carry out these vital functions. They do house-cleaning functions where they recycle damaged parts. They help repair DNA. They repair proteins. These are vital components to making our cells healthier.

When the stress is passed, so during the recovery after the stress, we make healthier cells. We renew our body. We create connections between our cells that make us more resilient so the next time we handle similar stress, we are better able to handle that stress. So, it’s really important. The reason I feel so passionate about this is when the message that we get is that chronic stress is harmful, the natural instinct is to reduce stress from our lives. And when we are facing chronic stress that has so much value and it’s so important, but when we do so indiscriminately, we’er also eliminating these good stressors that make us more resilient. So, it’s really paradoxical and somewhat counterintuitive that we can become more resilient through stress. But we need these good stressors to help us handle the inevitable stressors that we can’t control in our lives.

Dr. Sandi: That’s beautifully said. And really, the importance of that good stress builds resilience, it’s like that old saying, “What doesn’t kill you makes you stronger.” And so you’re giving the body that challenge, and then they’ll come back stronger the next time. I wonder, because when I initiate something that some people would describe as stressful, let’s say I don’t do the cold plunges. I’ve tried it, but I haven’t invested in a cold plunge yet, but I do take cold showers, and people say, “Oh, that’s awful. Like, how could you do that? I couldn’t stand that.” And as I am taking that cold shower, I just, “This is exhilarating. This feels so great,” for example, or doing something like high-intensity interval training and telling myself, “I feel so good,” or, “This feels so good afterwards.” And so bringing in that mindset, generating thoughts and images that we’d say are positive, does that have a role in this good stress? Whereas if someone thinks, “I can’t stand this. This is awful, and I’m in pain when I’m doing this,” that would counteract the effect of the good stress. I’ve often wondered about that.

Sharon: Yeah, Sandi, I think mindset about stress is really a big component of how our bodies respond to stress. So, if we take the example of a cold plunge, if a person gets into a cold environment, obviously it’s incredibly uncomfortable. And if all a person thinks about is, “I must get out, and this is terrible,” it doesn’t have the same benefit if a person just takes deep breaths in that setting.

And by doing so, you’re building your ability to work through stress. You’re using a physical stressor, in this case, thermal stress. And if you can learn to take deep breaths and work through cold exposure in a calm manner, it prepares you for when you’re facing psychological stressors or emotional stressors. So, there’s this cross-adaptation.

So, how you approach and encounter doing hard things carries over to other aspects of your health because it does build resilience. So, you’re absolutely right. It’s welcoming a little bit of healthy discomfort in your life, welcoming doing hard things, and realizing that with growth comes freedom, and that this is the gateway to transforming your body.

Dr. Sandi: Yes. And I see that applying to resistance training as well. So, I was in the gym, and I have a trainer that I use because I need a spot. And I’m in those areas of the gym that were always very intimidating to me. So, we were doing bench presses, and these were where you’re lying on a bench and you have this heavy barbell and he kept putting on more weight. And I reached a point where it was really heavy. And the difference between fear of that stressor, so fear like, “It’s going to crush my chest, and I’m not going to be able to get it back up.” But what he described was, “I’ve got you. I’m spotting. I’m not going to let this crush your chest. You can do this. You’re strong. And just feel that.” And then, whoa, I was able to do it. So, the impact of… So, would you say that’s a good stress in terms of the resistance training, that I challenged my body to push way harder on a heavier weight than I would have been perhaps comfortable doing?

Sharon: Absolutely. So, good stress can come down to the kind of stress, and certainly exercise with intensity is a good stress. There’s a Goldilocks amount where we paradoxically benefit, and it sounds like you hit that Goldilocks amount where you were left, after the stress, doing the hard thing of lifting the weight, in an exhilarated way, and that’s how you know that you were in that Goldilocks range.

And the critical part is strategic recovery after the stress. So, after the weight resistance, giving your body the chance to repair to heal after the microdamage that happens during strength resistance. And it’s in that recovery that our muscles grow. They hypertrophy, they remodel. And that happens in every part of our body, from our cells to our organ systems. And really that’s how stress makes us healthier. So, absolutely.

Dr. Sandi: What about mental or emotional stress? So, after you’ve been through a period that we might say is stressful, and now we have that recovery or we should have that…it would be important to have that recovery. Does that apply as well?

Sharon: Absolutely. And to me, this is such a critical part about understanding good stress. So, chronic stress, again, that is our current framework. It is inherently unpredictable, and it’s uncontrollable.

And what differentiates good stress is by its very nature, it’s deliberate, it’s a choice. So, it’s controllable, but it aligns with your purpose, meaning for you. It is usually very pro-social, improving the lives of other people. And the biochemistry of our stress response, when it is a good stress, is very different than the biology of our stress response that we know, which is the fight-or-flight response.

So, when we are taking on a good stress that has meaning for us, we’re also releasing dopamine, not just epinephrine and noradrenaline and cortisol, which everyone knows are the stress hormones, we are doing something that’s generative, that’s benefiting others. We’re also releasing oxytocin, that cuddle hormone. And it’s bringing together a different biochemistry that ultimately helps us emerge from the stressor in a more resilient state because it’s these other hormones that help us become more resilient. They help us support our parasympathetic state.

So, yes, taking on these good stressors really is an antidote to chronic stress. We put so much energy into trying to draw boundaries around stress, which is important. But at the end of the day, stress is a part of our everyday lives. And once we recognize that, we shift our focus to building resilience. And that’s what good stress does.

Dr. Sandi: That’s the key, building resilience in so many ways across the board, talking about mental, emotional, social resilience, physical resilience. Well, Sharon, this has been such a fascinating talk. I would love to continue the conversation, follow your research, your new book, which will be coming out, which we will make sure to let our community know about. But for now, how can people find you?

Sharon: So, I’m on all the social media channels. You can find me, for example, on Instagram, @thegoodstressdoctor, also on X as TheGoodStressDr. My website, drsharonbergquist.com. I will have updates about the book on how to use good stress and how to really reset our resilience at a higher set point so we’re less vulnerable to both mental and physical illness.

Dr. Sandi: That is such a good goal. We need to all be generating more good stress in our lives and letting go what’s no longer serving us. So, this has been a wonderful conversation, and I would love to continue it and have you back.

Sharon: Oh, thank you so much. I thoroughly enjoy talking to you and really respect and appreciate all the work that you do.

Dr. Sandi: Thank you.