Dr. Michael Hosking: Mental Health – The Real Reason Exercise Can Help

August 13, 2019 | Episode #15

Millions of Americans struggle with mental health issues—some situational, some chemical. Unfortunately, there are no conclusive medical tests to diagnose certain conditions, nor are there universal “prescriptions” for lifestyle and/or pharmaceutical remedies to treat them. However, one oft-cited source of relief is exercise. In this episode, Dr. Michael Hosking, biologist and founder of Revocycle Mind and Body Cycling, walks us through the science of exercise using the lens of his own struggles with mental health.

“I decided that I would start a fitness company … that gives people an opportunity to exercise for mental health reasons rather than just to lose weight or create a certain type of body.”

Announcer: The true WELLth Podcast is made possible by Brighton Jones. Brighton Jones is the financial wellbeing firm that helps you align your wealth, your passions and your purpose. Learn more about how you can live a richer life at brightonjones.com.

Michael Hosking: Yeah, I used to go through literature trying to find descriptions of depression by writers or artists or poets. And for all of them, it’s a very difficult thing to describe. Here’s how I used to describe it to my family because they wondered, why can’t you just get out of this? What’s wrong? Can’t you just get up out of bed and can’t you go do this? Just go do this. You’ll be happy if you do that.

Michael Hosking: And I would describe to them this dread and almost a paralyzing sense of fear and layered on top of that complete helplessness and hopelessness. And then take all of that and pair it with sheer exhaustion, and then you’ll capture a little bit of what it might feel like.

Manisha Thakor: Welcome to the true WELLth Podcast where we strive to help you better align the way you spend your money and your time with what matters most to you in life. Our goal with each season is to bring you a smorgasbord of insights from experts in the four core areas of wellbeing: Financial, social, emotional, and physical. Why? So you can put into action any ideas that you feel will enhance your overall wellbeing.

Manisha Thakor: Regular listeners of true WELLth know we kick off each episode with a short audio snippet that tends to err on the side of being uplifting, funny, and relatable. But just as smorgasbords can contain foods you’d rather stay away from or don’t even recognize, so too in life are there issues we steer clear of.

Manisha Thakor: Today’s episode is about exactly one of those, mental illness. Visualize for a second, running into your neighbor at a local coffee shop and being surprised to see them on crutches. What do you do? Most likely you ask, “What happened?” And how you can help. Now think about encountering a friend or a coworker who is struggling with mental health.

Manisha Thakor: In fact, the odds are high that you already have done so this month. That’s because globally one in three people deal with some type of mental health issue, so let’s just say the unspoken out loud, mental illness is hard to talk about. There remain such stigma around the subject likely neither you nor that friend or coworker wanted to talk about it and it’s awfully hard to be supportive or get support if you can’t speak honestly about what’s going on.

Manisha Thakor: Our guest today is Dr. Michael Hosking, an accomplished scientist who can speak with both great detail and crisp clarity about this topic. He shares with us the depth of his personal struggles, and how he used his passion for biology and love of bicycles to let the sunshine in.

Michael Hosking: I don’t know, 10 years ago or so, maybe a little less, I experienced just a massive, massive bout of depression. And I was the national director of curriculum for an online high school company and I just absolutely had to quit that job because I just really could not handle the work anymore.

Michael Hosking: And I quit the job, went home and spent the next two years trying to get better. And that involved going to a psychiatrist once a week and getting prescribed every known antidepressant available on the market, getting prescribed every known anti-anxiety drug on the market. And then on top of that your atypical antipsychotic drugs which are used as adjutants to antidepressants that aren’t working.

Manisha Thakor: One of the hardest things about mental illness is that there is no blood test to diagnose it. Additionally, mental disorders exist along a spectrum. While a fractured femur is a fractured femur, one person’s experience with say depression, anxiety, bipolar or schizophrenia is unique as they occur in different point on the spectrum for every person.

Manisha Thakor: And once it’s clear there is an issue, there are no one-size-fits-all doses or types of medicines that will work for everyone. As if that isn’t enough, the mix of remedies which can range from hardcore atypical antipsychotics to more common antidepressants and anti-anxiety medicine to holistic remedies may work for a time and then for no reason at all, just stop.

Manisha Thakor: Let’s not stop there. Some mental health issues are situational, some are chemical and some are a combination. My point, this is a very muddy area indeed. If there’s any doubt, consider what Michael has to say about pharmaceutical ads addressing these conditions.

Michael Hosking: Next time you see an advertisement for an antidepressant on television or in a magazine, I want you to look at the very, very bottom in the small print and you will see they say, “We do not know how blank drug works. It is thought to work by,” and then they lay out a hypothesized mechanism, which is to say that no one really understands why the antidepressants work for the 30% to 40% of the people that they do work for.

Michael Hosking: I was taking quite the cocktail of drugs trying to address this depression and in the midst of all of this, I also spent a month at a psychiatric institution in Arizona. With all the drugs and with the time at Sierra Tucson in Arizona, nothing was working for me. I was still very seriously depressed with a high level of PTSD and anxiety, and my psychiatrist was just absolutely baffled. And she said to me and I’ll never forget that day, “I have never seen anything like this, Michael. I don’t know what to do. I think I’ll have to put you on lithium.”

Manisha Thakor: Lithium, just the word sounds scary and with good reason. Lithium toxicity can occur if you take even a slightly higher amount than your recommended dose. And even though doctors still don’t know exactly how the drug works on the body, they are often forced to prescribe it as a last ditch effort to keep someone from doing permanent harm to themselves.

Michael Hosking: I remember those words so well thinking, “Oh, my.” Now lithium is not a death sentence or anything like that, but it’s a bit of a last resort given our modern pharmaceuticals. And I remember thinking, “Oh, my goodness, has it really come to this?” And I went home thinking, “What can I do? What did I use to like to do? What made me happy previously before these two years of me laying in bed?”

Michael Hosking: I thought of listening to music. I thought of playing my guitar and I thought of riding my bike, none of which I had done in two plus years. And I thought maybe I’ll try and ride my bike. And as you probably have seen in people in your life, Manisha, when you’re really seriously depressed, the idea of actually going out for a bike ride can be just overwhelming.

Michael Hosking: And so I decided I’d make little steps and just kind of piece together over the course of a week everything I needed to do to get out on my bike. The first day I found my cycling socks, and I put them next to my bed and went to sleep. And the next day I found my cycling shorts, put them with the socks, then went to sleep.

Michael Hosking: And so over the course of a week, I got everything together and I was like, “Well, the next step here is for me to get on the thing. So I got dressed and went for a two-mile ride out and two miles back, four miles total, which is nothing in the world of cycling. That is not even a warm up. But for me, that was everything because I remember feeling some kind of happiness, some kind of relief of the stress that had engulfed me for years and a little bit of a light at the end of the tunnel.

Michael Hosking: I thought, “Well, this is worth trying again.” So I did. Next day, same thing. Again, I felt that feeling and I started to put together day after day of riding, and I went into my psychiatrist the next week and told her that I was feeling better and I’m going to keep this up. And so, over the course of a month, I started to feel a whole lot better, went to my psychiatrist and said that I don’t think I’m taking these medicines anymore. I’m going to trust in this.

Michael Hosking: I did. I quit taking the medicines. I kept my riding. And in my mind that was the start of everything for me because I then started to dive into the research to try to understand as a scientist, as a biologist, what in the world is going on here. And that led me to all kinds of new research on how exercise can change the brain.

Manisha Thakor: Michael, I feel like I can hear my parents saying to me when I was a kid, “Manisha, get outside and get some exercise. It will be good for you.” There’s often deep wisdom in these kinds of age-old colloquial sayings. What did you find out about the relationship between exercise and brain chemistry?

Michael Hosking: Yeah. And that’s what I was trying to dig in and find out. I learned so much, Manisha, that I just had never learned in my undergraduate or graduate training in biology. And in fact, much of this science was so new that it was not even covered in textbooks. And we’re talking 2010 or so.

Michael Hosking: There’s a couple of mechanisms at work here. One is the stress response and the stress response is this HPA axis thing in the human body, the hypothalamus, the pituitary gland, and the adrenal gland. And those three structures are what produce the stress response in the human body. And the stress response is a good thing. It’s useful in certain instances, but when it’s on all the time, it just wreaks havoc on your body and on your brain. And so one of the first things I learned is that aerobic exercise tamps down that stress response, it literally shuts it down.

Michael Hosking: And so it reduces the stress hormones ultimately in your body. That then gives you a sense of being able to take a deep breath and a little bit of relief in and of itself. It’s also known that high levels of stress are associated with depression. I mean, depression can be described as a high level of stress for some people, so there’s that mechanism of reducing the stress response in the body.

Michael Hosking: There’s a second mechanism that I found even more fascinating and that is the neurogenesis in the hippocampus of the brain. And that is this understanding that vertebrates like us humans can actually grow brand new neurons in the hippocampus of the brain is a real revolution in our understanding of the vertebrate brain and the human brain. When I was in my PhD program at Indiana University, if I had said out loud to anybody in the department that humans or vertebrates can grow brand new neurons in the brain, they would have escorted me to the door and said, “Thank you very much. We don’t need your presence here anymore.”

Michael Hosking: It was just understood that vertebrates and humans can’t grow new neurons in the brain. All you can do is have kind of this growth spurt in adolescence as children. And then from there on out, all you can do is kind of enhance synapses or degrade synapses or degrade the whole sections of the brain with traumatic injury or chronic drug use or alcoholism or things like that, or just the brain diseases that arise with age.

Michael Hosking: But the idea that you could grow brand new neurons was just out of bounds. You could not do it. And yet in the late 1990s and into middle 2000s, scientists started seeing evidence that in fact there is neuro growth in the brain, or neurogenesis as we say, and that in fact it is happening in the hippocampus of the brain. And the hippocampus and amygdala, these little structures deep in the brain are the center of depression.

Michael Hosking: And then scientists, once they started discovering that new neurons can be growing in the hippocampus of the brain wanted to figure out a way to enhance that process so they could study the cellular mechanisms at work. And they discovered that if you take a bunch of rats and make them run a lot on a treadmill, that enhances the neurogenesis in the brain.

Michael Hosking: Scientists interested in this phenomenon just started running rats and then they’d look at their brains and they’d see massive growth of new neurons in the hippocampus of the brain. So aerobic exercise was associated with neurogenesis in the hippocampus through this understanding that it’s just a great way to get the cells grow so you can study them.

Michael Hosking: The two mechanisms, Manisha, that I think are most interesting are the aerobic exercise reducing that HPA axis, the hypothalamus-pituitary-adrenal gland axis, which is the source of the stress response in the body. Aerobic exercise can reduce stress and it can boost neurogenesis in the hippocampus. And that neurogenesis in the hippocampus is associated with reduction of depression of depressive symptoms.

Manisha Thakor: When you talk about aerobic exercise, you’re talking cardio, right? And so is that why we get the “runner’s high”?

Michael Hosking: Yeah, absolutely, Manisha. For decades now, people have talked about the release of endorphins and when you exercise and how that make you feel good. And there’s some interesting work around that in the last few years. Endorphin, for those that don’t know, is a shorthand for endogenous morphine and it’s just been shortened to endorphin. Endogenous, meaning created within the body.

Michael Hosking: Endogenous morphine or endorphin is released under high stress aerobic kind of activity situations. And those endorphins are just like exogenous morphine, they’re painkillers. And in an evolutionary sense, it makes all the sense in the world that if you’re running for your life and let’s say get a small fracture in the bone of your foot, it would probably be a good idea to dull that pain until you can get to a place where you’re safe and keep running.

Michael Hosking: And so people think that these endorphins, these endogenous morphines, the system evolved to dull pain under very stressful situations and then you get into a safe place. And then the pain manifests itself again because again, pain is also evolutionarily adapted. It tells you you’re injured. And we’ve probably all had that experience where we were doing something really intense. And then later when we finish and we rest, we realize we might have hurt ourselves and something’s really painful but we didn’t notice it in the moment.

Michael Hosking: These endorphins are associated with pain relief. And over the last few years, it’s been determined that it’s not likely that those molecules are causing the kind of high that we think we get from exercise because they’re pretty large molecules and they’re not likely to pass the blood-brain barrier. And so they’re probably not doing a whole lot of work within the brain because they’re just too large to pass through the blood-brain barrier. But there’s still work being done on that.

Michael Hosking: The other chemical that seems to be creating this kind of relaxed, peaceful, almost high feeling from aerobic exercise are what are called endocannabinoids. And you might be familiar with that root term cannabinoid, which comes from cannabis.

Michael Hosking: And so it seems like the most recent research is showing that in fact there are also endocannabinoids released in high-intensity aerobic exercise. And it’s likely those that are causing that kind of high, peaceful feeling associated, that that feeling we’ve called the runners high for so long.

Manisha Thakor: So quite literally it’s a high.

Michael Hosking: That’s the newest thinking and it’s probably the endocannabinoids acting in your brain. And as some of us here in Oregon and other states increasingly may realize that certain cannabinoids have a real calming effect and some can produce a euphoric effect. And so people who study aerobic exercise in the brain tend to believe that it’s endocannabinoids creating that kind of euphoric, calm, peaceful feeling.

Manisha Thakor: Michael, so how much should we exercise?

Michael Hosking: This is an active area of research. And to go more broadly and repackage your question a little bit, is there a dose that is appropriate. People are studying this, trying to determine what’s the appropriate dose of aerobic exercise in order to treat major depressive disorder or anxiety disorder. And the short answer is no one really knows for sure right now but that 20 to 30 minutes of moderate to intense exercise is enough to get to the point where you’re actively reducing that stress response axis and actively producing enough of these growth factors that trigger neurogenesis in the hippocampus to have an effect.

Manisha Thakor: One of the things I find so fascinating about your story, Michael, is that you didn’t just stop at the research. You kept going. Tell us about what happened next.

Michael Hosking: Once I had started to study the science of aerobic exercise in the brain and learned about those mechanisms that can treat depression through aerobic exercise, I ended up going to Esalen in California, which is this wonderful place in Big Sur on the coast. It’s been there since early 1960s. And I spent a week studying with John Ratey, a professor of psychiatry at Harvard Medical School. And John has written a book called Spark: The Revolutionary New Science of Exercise and the Brain.

Michael Hosking: In that book, he summarizes a lot of the research we’ve talked about today and I was just so excited about everything I’d learned about aerobic exercise and the brain and the stress response in the hippocampus and depression that I spent a week with him studying all of this. After a week down there, I decided that I would start a fitness company whose focus was exercise for physical and mental health, and there would be a mechanism by which we could communicate these new findings around exercise in the brain to people and it gives people an opportunity to exercise for mental health reasons rather than just to lose weight or create a certain type of body.

Manisha Thakor: I want to pause here to emphasize something Michael said because it’s really, really powerful. Michael said he decided to start a fitness company whose focus was on physical and mental health as a mechanism by which to communicate and turn these scientific insights into tangible practice that everyday people can benefit from. Or said slightly differently, he created an exercise studio focused not on helping members to get fit, although that absolutely happens, but on exercise as a benefit for your mental health.

Manisha Thakor: Michael, the company you founded is called Revocycle and your living laboratory is an active cycling studio in Portland, Oregon. Walk us through the experience of a new student coming through your doors.

Michael Hosking: Well, it’s interesting. Typically, we’ll give new people a little introduction to what we’re about because we’re so unusual in the fitness world, and so unusual specifically in the spinning world. And I will often tell people, “Look, we’re a different kind of place here. We’re never going to talk about bodies, so we’re not going to talk about weight loss or calories burned in class, so you don’t have to worry about that.” And I have had young women stop, look at me, and start to cry when I say those words.

Michael Hosking: I found it profoundly moving the first couple of times that happened. But of course, if you think about it, the fitness world, the magazines in the grocery store, the websites all tell women that they need to change their bodies and that once they do that, they’ll be happy.

Michael Hosking: Embedded in that message is that you’re not good enough right now. You aren’t good enough but if you come and do our workout, you will be. And then once you’re good enough, you’ll be happy. I find that a sad message to communicate to women. When I tell them we’re not going to be talking about that or communicating that message, just a sense of relief comes over them. That’s where those tears come from.

Michael Hosking: And so that, that is just an amazing feeling. It’s liberating to people to know that they won’t be told they need to change their body. It’s liberating to them to know that they won’t be singled out or that they won’t be reduced to what their body looks like. So there’s that level.

Michael Hosking: But then once people start to regularly practice cycling with us and start to really internalize our message that we come here to feel good. At the end of class, I want you to notice how good you feel right now. One of the things I often say at the end of the classes I teach is these next 15 seconds as we sit here and really tune in and notice how we feel are the most important 15 seconds of your workout because this is when you notice the stress reduction. This is when you notice that little burst of joy or sense of accomplishment.

Michael Hosking: If you can really tune into that, that’s what gets you out of bed on those rainy mornings when you’re not feeling great. That’s what gets you in when you’re tired at the end of the workday. Once you start to build up that over time, you start to seek out exercise because you know deep, deep within that it makes you feel good and you want to do it in order to feel good. It has nothing to do with the body, you just end up in shape. That’s that, that kind of shifting of emphasis and understanding of what fitness is for that we see all the time.

Manisha Thakor: This was a very moving episode for me to work on, for I first met Michael four years ago when I myself was struggling quite literally to get out of bed and fortuitously stumbled upon his Revocycling Mind and Body studio in Portland’s Pearl District, and it changed my life. For more on my experience, check out the show notes for this episode where in my attempt to support the movement de-stigmatizing mental health, I share quite openly and deeply.

Manisha Thakor: If you’re ever in Portland, Oregon, I can’t recommend strongly enough taking a cycling class at Michael’s innovative studio. Having seen the benefits myself firsthand, I’m hoping one day Revocycle will be franchised so it can be available in gyms and studios across the country.

Manisha Thakor: Now, if there’s one overarching macro insight that I hope every listener walks away from this episode with, it is this. It is time to normalize discussions around mental health. As for specific takeaways on the relationship between brain body chemistry and exercise, I had three.

Manisha Thakor: Take away number one, our HPA axis, which stands for hypothalamic-pituitary-adrenal gland axis which is the source of the stress response in the body. Like most people, I’ve heard that 20 to 30 minutes of moderate to vigorous aerobic exercise is good for you. But what I learned from Dr. Hosking was why – that this amount of exercise has been shown to tamp down the HPA axis’s stress response, i.e. that’s why stress reduces exercise.

Manisha Thakor: Takeaway number two, exercise can boost neurogenesis in the hippocampus of the brain, which is associated with the reduction of depressive symptoms. In plain English, this means we are growing brand new neurons when we exercise and the hippocampus along with the amygdala are in many ways the centers of depression in the brain, i.e. aerobic exercise boosts growth of new neurons in the brain which is associated with the reduction of symptoms of depression.

Manisha Thakor: Takeaway number three, endorphins are not exactly what we thought. Many of us talk about the exercise high we get after a high-intensity aerobic workout, saying things like our endorphins are making us feel great. But ironically, those molecules are pretty big and potentially are not making it through the blood-brain barrier and causing the effect we think they are.

Manisha Thakor: Currently, research is being done about whether or not this delightful runner’s high is actually being more influenced by endocannabinoids being released in our brain. You might notice that the word sounds a lot like cannabis. And, yeah, that may be what is causing this euphoria or in other cases calming effect.

Manisha Thakor: Mental illness affects far too many people we love and care about. It’s time to pull this issue out of the closet, talk about it and support people who struggle with it. In the show notes, I’ve included links to resources Michael referenced as well as to several national organizations such as the Brain & Behaviour Research Institute, which supports mental health research by non-corporate sources such as academics, i.e. not mega pharmaceutical companies, and NAMI, the National Alliance on Mental Illness. You’ll also find an excellent article from The Scientific American Mind about the effect of exercise on mild to moderate depression.

Manisha Thakor: As always, you can find our show notes at truewellthpodcast.com, and that’s WELLth, W-E-L-L-T-H. We normally end each episode by saying, “Should you know of someone who can benefit from this information, please share with them a link to this episode.” If ever there was a topic that could benefit from a wide sharing, it would be this one. For even something as simple as a conversation or a podcast can pay off in spades in terms of helping improve someone’s quality of life. Another way to get the conversation going is to visit makeitok.org, a nonprofit with a mission of eliminating the stigma around mental illness.

Manisha Thakor: I’m Manisha Thakor, and that’s it for this episode of true WELLth.

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