Dr. Sarah Stombaugh:
Before we get into the episode, I am thrilled to announce we are launching an online course, The GLP Guide. The GLP guide is a must have resource for patients who have been prescribed any of the GLP medications such as Wegovy, Ozempic, semaglutide, Zepbound, Mounjaro, tirzepatide, Saxenda, liraglutide. There are a lot of them and this course is available for anyone to purchase. We often hear from people who haven’t been given much information about their GLP medications. No one has told them how to handle side effects, what nutrition recommendations they should follow, or what to expect in the longterm. And it can be really intimidating and simply frustrating to feel like you’re alone in your weight loss journey. With the GLP guide, you’ll get access to all of the answers to the most common questions for patients using GLP medications, not sure how to use your pen, struggling with nausea, wondering how to travel with your medications. We’ve got you covered for only $97 for one year access. This is an opportunity you do not want to miss. The course is launching on October 1st. For more information and to sign up, please visit www.sarahstombaughmd.com/glp. You don’t have to be on this journey alone. We are here to guide you. And now for today’s episode.

This is Dr. Sarah Stombaugh, and you are listening to the Conquer Your Weight Podcast.

Announcer:
Welcome to the Conquer Your Weight Podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here’s your host, obesity medicine physician and life coach, Dr. Sarah Stombaugh.

Dr. Sarah Stombaugh:
Hello everyone and welcome to this week’s episode of the Conquer Your Weight podcast. I’m really excited today to bring you a guest, Dr. Rashmi Schramm. We are going to be having the most wonderful conversation about the nervous system, the safety of it, the regulation, and the role that this plays certainly in our health and in our weight journey. I was so excited when Dr. Rashmi and I were talking about this together. Rashmi and I have been friends for a while now and learning from her in her experience and having someone to talk about this topic with my guests or with my podcast listeners, I am so, so excited about. Rashmi is a family medicine physician by training. She is also a coach, a host of retreats, does meditation teaching. And thank you, Rashmi, for being here today. We are going to have so much fun talking about this topic.

Dr. Rashmi Schramm:
Thank you so much, dear Dr. Sarah, for having me. It is such an honor to be here.

Dr. Sarah Stombaugh:
Wonderful. Well, I’m excited. Tell me a little bit about your background because, of course, you’re a family medicine physician. You have had a lot of evolution, I’ll say, in your practice. How did you come to be where you’re at and what you’re doing right now?

Dr. Rashmi Schramm:
Yeah, absolutely. So I was actually born in India. I’m an immigrant. I’m a first-gen immigrant. I lived there until I was 12 with a very large extended family. Part of that included a lot of spirituality and connection to meditation, yoga, Ayurveda, that sort of thing. My grandmother was sort of the OG feminist, if you will. She was teaching me things that only boys were supposed to know and things like that as I was growing up. And so I had this very close-knit, deep connection to herbal things and just being within ourselves and those kinds of practices that aren’t necessarily the normative ones here in the West. And we immigrated, I immigrated with my parents and my brother when I was in sixth grade into a very small coal mining town in the Appalachian Mountains in Virginia. And that necessitated, that kind of assimilation necessitated that I abandon all of those previously understood sort of practices and things like that and continued on. I went to college. I was a closet meditator, I say, when I was in college. I was going to meditation sort of programs, but not really talking about it because I had decided I wanted to go to medical school. And it It just didn’t feel safe at that point. It just didn’t feel like it was a welcome space. That was just my understanding. Who knows what the reality was. And then medical school was at the University of Virginia, where you are, which was so fun. And I met my husband. We moved to Florida for residency. And then we started practicing, had kids. And you know all the things, right? Like when there are two parents that are working a lot, and then the kids are little, there can just be just an onslaught of stress. And I started to realize that I really, really did not understand how to manage my own stress, how to deal with my own stress, how to deal with my own anxiety, which really peaked as soon as my first one was born and probably didn’t really go anywhere until I really started to look into, okay, this cannot be the way that I live my life. How else can I live my life? And so about 15, 16 years ago, I started to, just for my own healing, started to get really curious about a deep dive into meditation. And back then, there was no social media. And so I actually joined a meditation teacher program in California, which is a little bit of a ways from Florida to California. But it really had a big resonation with me in that the parts that resonated for me was that it was science forward, but also deeply sort of studied into spirituality and transcendence and things like that. And so it was like melding the things that I really felt in my own being. And that was so many years ago. And I had no intention back then of teaching meditation per se. But it turns out to graduate from that, you really do have to teach. And so I was teaching at my local Y. I was teaching just at lunch, just at my office. And people were having wild results. And it became like the kind of gateway drug, if you will. Then I got trained in Ayurveda. And then I got trained in all these other things. And all along the way, I was finding that my own health was getting better. Because what led me to joining that wasn’t just that I was anxious, because that wasn’t enough, right? It wasn’t just that my emotional health was I really had to get physically sick for me to give myself permission to go and look for something else. And so I was having all of your classic sort of symptoms. I was having chronic daily migraines and I had tried all the drugs out there. I was having lots of GI issues. I was having kidney stones in my early 30s. I mean, these are all things that I have now tied back to ways in which I probably didn’t need to drink four Diet Cokes a day. I probably didn’t need to not sleep. I probably didn’t need to have three drinks every weekend. There were all of these different ways in which I was trying to cope with what I didn’t really know how to cope with any other way that started to get so much better when I went back into a meditative practice that was consistent for me. And so this long story to say that it began to evolve into a bit of a niche practice for me for many, many years. And so I was at a very large, high volume family medicine clinic for many, many years. And all the way up until about 2017, 2018, we had the capacity to practice the art of medicine, which is completely lost now in those big systems. And so I was able to say, this isn’t number of patients I’ll see, this is how long I’m going to spend with them. And I was really practicing integrative medicine, or what’s now known as integrative medicine. I was integrating all of those things in for many, many years. And then when metrics took over, when the squeeze came, it became really apparent for me that this is not the place that I can be fully expressed. And so I left. And I’ve, you know, since then, I’ve really started to focus on my coaching practice, which is just the most beautiful thing. And it’s sort of the flowing of that is in-person retreats. I have group programs. I have this conglomeration of how I feel so aligned with how I serve. And it sometimes just feels like a dream when I’m moving through my day. And so I just am eternally grateful for the long circuitous route that’s gotten me here. And I feel like I’m just getting started.

Dr. Sarah Stombaugh:
That’s amazing. I love your journey. Somehow we have never addressed the role of stress. Now, it’s interesting because we talk about it a lot in my medical practice. We do a lot in sort of situational stress, the how to react, work through different situations. But I think there is this more pervasive when we think about our nervous system. And you’re kind of alluding to this even in your own health journey of that just really dysregulation, beating really quick. We’re in this society where things are just moving so quickly all the time all around us. And it’s like we’re constantly just being inundated with stuff. And what we know is that that can play major roles in our health and then also in our weight. And so I’d love to hear a little bit for my listeners, tell me nervous system regulation. When you say that, what does that mean? And then how does that end up impacting our health and then our weight as well?

Dr. Rashmi Schramm:
What a great question. And yes, the sort of groundwork for that that you just laid is that if somebody’s listening, they are more than likely experiencing chronic daily stress and way more stress than what is helpful for us. Because there’s eustress, which is we got to have a little bit of stress in order to function. And the vast majority of humans now just have way more stress than they’re really able to or capable of processing at any one given moment, just like you alluded to unless we are very conscious of it and being proactive with it, which is really where this idea of nervous system regulation comes from. So this really, as a broad sort of way of thinking about it, is directly from Dr. Stephen Porges’ polyvagal theory, which was not present when I graduated from medical school, and I haven’t really even come across it in any of my CME programs just yet. But it does have a ton of science behind it, and it sort of makes sense intuitively when I start talking about it. And so nervous system safety is really this idea that our autonomic nervous system is constantly, constantly, every second of the day, really purveying our environment and the people that we’re with and the beings that we’re with. Is this person safe? Is this situation safe? Or is it unsafe? And now this is a perception, right? It isn’t the actual reality. And so we’re really looking for this nervous system is pre-programmed from the past and is looking at is there mental and emotional safety here? And is there somebody that I can co-regulate with? And so from that standpoint, we can look at, let’s say, on a daily basis, the vast majority of folks, right? When we’re rushing from one thing to the other, to the other, to the other, which is very usual, then we can stay in that sympathetic state. overdrive, right? So we think of the parasympathetic and the sympathetic, but polyvagal theory takes it even a little bit further than that. It talks about when we are in that sympathetic overdrive, right? Our heart rate is up, our breath is short and shallow, and cortisol is high, adrenaline is high, all of those things. And we know evolutionarily that we actually need that in order to run from predators, for example. If we’re about to be in a very on high alert. So it isn’t like we don’t want to demonize it. But what’s happening is on a day to day basis, the vast majority of us are living significant amounts of time in that sympathetic overdrive. And what that will do is it’s very metabolically costly for the body. And so at some point, automatically, it will move into what’s known as dorsal vagal, where you look calm on the outside, but you’re really disconnected and you’re numb. It’s a numbing kind of place, right? And so when we are in dorsal disconnect… We actually look fine, but we’re just not even there. And so the idea of nervous system regulation is can we recognize when we’re in these other two states and can we see about bringing ourselves back into what’s known as ventral vagal, which is where we are truly connected and we have the capacity for creativity. We have the capacity to communicate clearly, all of those things. And so the way that I think about nervous system regulation isn’t that we always have to be in ventral vagal. It’s impossible and it’s not It’s not a great goal. It’s that, can we have enough awareness that am I in overdrive? Am I totally disconnected? And do I want to move into ventral vagal? Because the truth is sometimes it’s unsafe to be in ventral vagal, right? Like if you’re an ER doc, it’s not hugely helpful to always be in ventral vagal. We don’t have the emotional capacity to be in ventral vagal all the time. So this idea of nervous system regulation is that we’re constantly seeing cycling through these three states of being and when we become really aware of them we can have certain tools and certain practices that when we are ready to come into ventral vagal to feel that calm from the inside out not the outside in then we have these certain tools and these practices to bring us into ventral vagal.

Dr. Sarah Stombaugh:
Okay, amazing. I love, I’m like taking notes over here. And so it’s so fun to think about this because it’s even beyond really my own understanding to think about this polyvagal principle. So I appreciate you sharing that. Tell me, you mentioned the metabolic consequences of some of these different states. Tell me when we’re in that sympathetic overdrive or if we’re in the dorsal vagal, or even maybe for the good in that ventral vagal place, what does that do in terms of our metabolic health?

Dr. Rashmi Schramm:
Right. That’s a great question because the mind and body are always functioning together, right? And I mentioned ventral vagal, dorsal vagal. So it’s worth mentioning the vagal nerve, which is the single most important healing nerve in the body. It’s the 10th cranial nerve. And you remember dissecting it in medical school. I remember because this thing is giant. It goes everywhere. I totally remember. The whole body. The whole body. And what’s really interesting is this vagal nerve, 85 to 90% of the fibers are afferent, meaning that the body is actually speaking to the mind.

Dr. Sarah Stombaugh:
Right.

Dr. Rashmi Schramm:
And so the brain itself is actually gathering data through the vagal nerve. And so a lot of the healing work that we do comes from the bottom up, if you will, the bottom up approach, because we can manipulate the body a lot faster than we can the mind. And so let’s talk about the metabolic consequences and let’s talk about the other way as well. So some of the metabolic consequences, which makes sense if we’re in fight or flight, which again, we don’t want to demonize because for short periods of time, it’s really helpful. Like for example, this morning I was on a walk and I happened to live by the woods. It was pretty early. It was sunrise. All of a sudden, next to the woods, there was this really crazy loud noise. Out came these two wild turkeys just fighting each other. It was nothing to do with me, but it was so loud. Wouldn’t you know that my heart rate was up? My breath got short and shallow. I ran for a little bit. That’s me in regulation. That’s actually what needed to happen. If there was a wild boar or something like that, it would have been helpful for me to be mobilized at that standpoint. But what would have happened in that period of time for me, for example, is that my cortisol level would be high. It needed to be high because I needed a lot of sugar at that point, right? The adrenaline needed to be high because I really needed to run for a long period of time, which I did from these sweet wild turkeys that were minding their own business, having their own fight. But if I did, then I had the capacity to do so. Now, over a long period of time, So in about five minutes, my heart rate, all that stuff came back down and I had a good little chuckle about it. But let’s say we’re at work and we just don’t have the capacity to come back into a more calm state, then what will happen is that cortisol level continues to be high, which means the glucose level continues to be high. And we know for sure that when that’s the case, that the body wants to store fat because it doesn’t know when it’s going to get the next meal, right? So that visceral fat can start to accumulate amongst others things. It can have so many other metabolic consequences. Long periods of time, we get high blood pressure. We have certainly obesity. We just talked about that. And as far as immune function, cortisol will also decrease immune function because this is no time to worry about that. This is no time to worry about reproduction. This is just survival. And so when the body is in just that kind of survival mode, it can have really dire consequences, which I think I was having way back when I when I was describing to you that I just couldn’t find any amount of connection to my own self or my own piece. I think I was just in that overdrive. And guess what, it’s actually easy for me to go back in there when the circumstances are just right. And so it’s so much of this is just awareness. And so that’s generally as a kind of a very simplistic way. That’s generally what happens in an overdrive dorsal vagal really, at that point, it’s much more emotional and mental types of things that can start to happen, right? When we’re disconnected from ourselves, it’s really difficult for us to connect with other humans. And we as human beings, we’re a tribe species. And so we can really start to have consequences of loneliness and isolation, and that can turn us into all kinds of spirals. And so we really want to know if our home is in dorsal vagal, if you will. Now, let’s take the opposite, which is ventral vagal. And the That is the rest and digest. This is where the cortisol levels are lower. This is where adrenaline is lower. This is where over time, certainly with mindfulness practices, like when I work with my groups or when I want, we can start to see increases in neurotransmitters like dopamine, serotonin, GABA, all of those things that are very, very restorative to our mind-body health. And this is where glucose metabolism can be a little bit better. We have awareness of cravings, for example. We have awareness of our certain patterns of thought, things like that. And so there’s a real mind-body consequence to nervous system regulation.

Dr. Sarah Stombaugh:
Okay, wonderful. I love, you know, as we think about that, and it makes sense when we find ourselves in a situation that we’re just constantly go, go, go, go, go, a lot of people are feeling that and feeling that mental, but it has all of these physical consequences as well. And certainly in the metabolic, as you were talking about chronic migraines and, you know, chronic pain syndromes, lots of other things are correlated with this as well. Now, certainly the practice of re-regulating that and re-establishing that regulation, the ability to observe and see and that awareness, it’s a practice. And so I think this is where it’s very often jumped into like, oh, we should… meditate or you know you should have these solutions for bringing yourself down for someone who is just starting out and they’re like in the state of like go go go they’re feeling overwhelmed what are some of the strategies that they could use to help re-establish that connection to help re-establish that safety to help re-regulate their bodies.

Dr. Rashmi Schramm:
Yeah for sure so Meditation has certain connotations that I want to just kind of break right off the bat. Meditation is just a formal way of practicing mindfulness. Let me define mindfulness, which is just the awareness that arises when we are paying attention to this present moment without judgment and with awareness. And so meditation is just a formal practice of that. And there are lots of different kinds of meditations. And every ancient wisdom tradition and every part of the world until very recently had already incorporated meditation and don’t have to have a fancy cushion. They don’t have to have any kind of fancy equipment. So having said that, there are other practices that I work with. So let’s say, so meditation is generally what people will come to work with me for, but occasionally there will be so much trauma that is still present within the mind-body system or grief, for example. It’s just not safe. It’s just not safe for them to sit and be with themselves, at least not yet. And so some of the fastest, easiest ways to come into regulation or anything with nature. So going out for a 15 minute walk in nature without headphones, without any electronics, and just noticing what sounds we’re hearing, just looking at the sky or the trees or the cars, whatever it is, just noticing, just bringing ourselves into this present moment without necessarily having a huge agenda around it can actually bring us into ventral vagal. There are things that we probably already do that we don’t recognize as breath work, but a sigh, a loud sigh actually activates the ventral vagal network. And so humming will also activate the vagal nerve. And so these are ways in which if you think about it, kids are already doing it. They’re already doing it.

Dr. Rashmi Schramm:
No one taught them how to do it. And so my invitation is that mindfulness is already our innate state of being because my guess is, and Sarah, you’ve got little kids, so they’re already always mindful and you didn’t have to teach them how to be curious and you didn’t have to teach them not to judge. You didn’t have to teach them to just be present. Like they just are. And so over time, as the stressors accumulate and the layers of stress accumulate, we just tend to lose that part of ourselves. So a lot of these practices that we’re talking about, including nervous system regulation, is already always within us. It’s just a matter of letting go of what’s not us so that we come into the center being of what we are.

Dr. Sarah Stombaugh:
I love that. And I love thinking about, as a mother of young children, it is so beautiful to see playing out so many pieces of regulation of appetite, for example, or satiety, regulation of when they’re feeling tired. And I will watch my children disengage from an activity and go sit quietly on the couch for a moment. And these things that we as adults have been taught by society, by our families to override and disengage from what’s going on, but you’re right, those sighs or even I was thinking and talking with one of my patients earlier today about dispelling when we’re having that really high energy negative emotion and how screaming or stomping our feet or punching and dispelling that energy is so powerful. And I can watch my five-year-old or even my seven-year-old still behave that way. And as an adult… you know, this idea that that type of thing would be wrong. And so the recognizing when we’re in certain states and then what, you know, what is the response that would be most loving, most nourishing, most in alignment with what my body actually needs right now. That’s, that’s really neat. So this, and I love what you talk about too, the mindfulness and meditation, what that means. It’s so fascinating, something that’s been around for literally thousands of years, that this idea that it is new age is really actually quite you know, contrary. Like it doesn’t quite make sense that that would be the case. But recognizing how do I take that moment, take that breath, recognize, oof, like I’m unnecessarily… Because we all find ourselves in that state. How can you not in 2025 where, oh my gosh, I’m having… this reaction to something I’ve just heard a friend say or on the news or in some other environment. I just find myself like, why this traffic is not going to kill me. Why am I reacting as if this is the end of the world? And so that observation is so powerful. And then you get to make the choice of how do I help myself out of this.

Dr. Rashmi Schramm:
Yeah. And in so many ways, a mindfulness practice is truly a way back into self-compassion, into self-trust, into this way of, again, remembering who we are. So it really requires us to be very soft with ourselves, especially when we find certain patterns. Otherwise, we’re actually just kicking ourselves right back into a sympathetic overdrive for beating ourselves up. And so some of this is really just a practice of self-compassion.

Dr. Sarah Stombaugh:
I love that. And there’s so many parallels too in weight in that when we look at the food choices that we make, for example, or any decisions that we’ve made, it’s so easy to find ourselves in a place where we beat ourselves up and, oh my gosh, I can’t believe I ate that thing. It’s not in line with my goals to eat food that way or to eat that quantity of food. And we find ourselves back in the state where like, is it going to kill you to have overeaten chocolate? No, it’s not. And what’s ironic is that spending more time in that negative state creates you know, just propagates that even further rather than like, oh, isn’t it interesting that I found myself eating chocolate in that way, for example, and what led me to do that? Was I hungry? Was I dealing with an emotional response, for example? So I love this curiosity about it rather than the judgment. Especially with things like response to stress, like response to emotions, there’s so much where oftentimes we’re making food choices or other choices in our life responding to a stress or responding to an emotional trigger in our life. How can understanding this regulation of the nervous system help to address some of those emotional eating patterns, for example?

Dr. Rashmi Schramm:
Yeah, for sure. So there is a little bit of a difference between reactivity, which is part of a pattern versus a response. And so a lot of times, we are actually reacting to a trigger or some kind of stimulus. And that is our pattern when we catch ourselves. So a common pattern, like for me, might be if I go out to eat, I’m gonna want some chocolate afterwards, for example, that’s just going to be a reaction. Or if I feel stressed out, I want a glass of wine, for example, those are all kind of common reactivities, right? And so When we notice that we are in a pattern like that, and it isn’t something that is aligned with where we are going or who we say we are, then we may then choose to step out of it as soon as we are aware of it. And so some of the tools that we might use really are just movement. Sometimes when we’re feeling stuck in a particular craving, for example, if we’re feeling stuck in some kind of loop and some kind of thought loop, and sometimes we just want to break it. And so a quick way to break it is to binge eat on something. Like these are all parts of the human experience So first of all, there’s no shame and there’s no blame. And so like making sure that we dissipate any shame or blame first and foremost. And then at the next sort of point is just getting curious, like you said, right? Like getting really curious as to, huh, isn’t that interesting? Every time this happens, I want to go have a glass of wine. Isn’t it interesting? Every time that happens, I really just want to eat this amount of fast food or whatever, whatever it is that you start to notice. And at the same time, you can start to make a little bit, you know, and I’m sure you teach your patients and your clients so many of these different techniques, but it’s really the radical act of sort of noticing the pattern as it’s happening. And sometimes we just have to keep noticing over and over and over again with a lot of softness until we’re just sick and tired of it. And that’s okay. Until we’re just like, I am sick and tired of watching myself do this. And I no longer want to do that, right? Like there are, you know, I’ve worked with so many patients who just like yeah I kind of want to sort of quit you know yeah yeah yeah I want to quit but they don’t really want to quit you know they’re like they don’t they want it and so until they’re ready just staying with that particular pattern until there’s there will be a click someday and they’ll just be like I’m sick of this I’m sick of this and then okay great well how do I want to respond to it and so I have a coach and she always says she always says your first reaction is free. So if your first reaction was to reach for that Diet Coke or whatever, every time you felt a little bit of tiredness and it’s 2 p.m., that’s fine. You might even reach for it. You might even open it up. But then when you’re like, oh, well, I really just want to drink water, then you get to then respond in a way as to how you are becoming. And so it’s like your first reaction is free. How you respond is who you’re becoming. And so just remembering that sense of grace for yourself is really helpful.

Dr. Sarah Stombaugh:
Well, and I think, thank you for taking the time to clarify reaction versus response, because those sounds synonymous. And especially with your explanation, it’s very clear that there’s that pattern. And it is this deeply ingrained pattern many times that we’ve practiced for years, for decades. We have these patterns that we’ve gone down many times in the past, yet we still have the opportunity to choose to respond. And it’s rarely a light switch. Like the light switch moment often does come after the a while after a long stinking time. And I think there’s often this point of discomfort where you see the pattern and you’re aware of the pattern and yet it’s too early or too soon to be able to change that pattern. And so that, I think sometimes it gets worse before it gets better because you recognize I’m making choices that are not in line with my goals. And there’s a frustration and discomfort that in some ways I think is good that if we can stay with recognizing there’s a pain in me going down this path over and over again, that can be part of what then derives that ultimate click. But I think it gets better sometimes before it gets, or it gets worse before it gets better.

Dr. Rashmi Schramm:
I think that’s probably the most common thing that happens. And in fact, right before I hopped on here, I had just finished up a client coaching call and she said, you know, I don’t think I’ve ever told you this before. And I’m like, oh, and she said, you know, for a while there, after I went to your retreat, I had, you know, this big pattern about this particular relationship she was in just became so apparent. And she was really mad that it became really apparent for about a month or two. And then she was able to extricate herself from the toxicity of it. But she talked about how much worse it got before she made a choice for it to get better. And so there are certain patterns when we discover them that we do just to just get to live with them. It is not common for us humans to immediately change as soon as we notice a pattern, but it is common for us to significantly have a higher rate of change once we notice a pattern. So it’s really worthwhile to notice patterns and reactivities.

Dr. Sarah Stombaugh:
Well, and I think that discomfort or the grief, you know, when we think about a toxic relationship, for example, there’s you know, there’s a lot of challenges and grief that may be coming up. And where you think about the frustration of, oh my gosh, why am I making this food choice, for example, over and over and over again. And I think that you know, in some ways having that experience and again, staying in that place of curiosity, which becomes, I think again, even more challenging, but stay in that place of curiosity of, Hey, this thing is happening to me. I made this choice. It happened again. Why am I doing that? And then next time, do I get to intervene maybe a little sooner in the pathway, for example, or ultimately make the decision to step, step away from whatever that is. That’s such a great, that’s such a great example. And yeah, So tell me, I mean, when we think about this metabolic health, we think about weight loss plateaus, there’s so many things that contribute to our weight, whether it’s the food choices that we make, our movement, our sleep, our stress, our other health conditions, the role of stress, it’s going to be, I don’t think it’s ever solved. And I think that’s one of maybe the myths is that I’ll have this like I’ll fix my stress and then I’ll have that thing in line. Talk to me a little bit about just the ongoing nature of that and maybe any reevaluation practices of what that can look like to support yourself in a long-term way.

Dr. Rashmi Schramm:
Yeah, great question. And actually, I love to define stress. So stress, the way I think of it is the perception of a threat. So it could be physical, mental or emotional. So it’s the perception of a threat. So you can line up 10 people in the same circumstance, and their stress levels will be different because their perceptions will be different. And so just kind of having established that. So if we are in a toxic work environment, for example, that will never change, right? We have to consist And so then those kinds of circumstances may be the only time where we have to really figure out how to extricate a circumstance versus how do we shift within ourselves. And so just to delineate those kinds of things, same thing for like a toxic relationship. If there is mental, emotional, physical abuse in any relationship, there is nothing that you can do within your mind-body system that’s going to give you enough safety to actually land you in a regulated state. So those kind of establishing those normative practices first, and then looking at how do we deal with ongoing long term stress, because if we are interacting, if we are living a deep, well led life, there’s just always going to be stressors that are coming our way. And so so much of the practices that I work with folks with, isn’t that we have to change our circumstance, except for those couple of, you know, very specific circumstances that that we do need to look at. than if it is the kind of chronic daily stress of work, overwork, overwhelm, sort of the responsibilities of caregiving, all of the things that we’re going through. then we get to choose how we respond to those stressors. And we really do get to choose how we respond to those stressors. And we begin with this idea of shifting our relationship with the thoughts, our relationship with those emotions. And when we can create even a moment of spaciousness, it then gives us that choice for how do I want to respond instead of react in the same way. And so maybe we give ourselves the capacity to slow down, for example. Maybe we give ourselves the capacity to not make a decision when we’re feeling really stressed out about that decision. Maybe we can take a couple of breaths. Maybe we can figure out how to just seriously be in the moment for even 10 minutes. And it doesn’t require us, again, to be in any kind of anointed space. We can really just be like, I practice mindfulness sometimes just chopping vegetables. It’s kind of cool. If you’re just chopping vegetables, you’re not trying to think about anything else. Just listening to the sounds, you’re just chopping vegetables. It’s actually a really calming thing, and it can bring our stress levels down pretty quickly. We can even do that with dishes. We can do that with laundry. We can do that with so many things. We can do that with driving. We can be humming when we’re driving, and we can work on our stress levels. And so really, I think the beginning, middle, and end of this is awareness. And that’s why I talk so much about meditation and mindfulness practices, because they accelerate our capacity to be aware of what is happening. inside of ourselves.

Dr. Sarah Stombaugh:
Okay. So, so good. I’m trying to pick out as I think you, even back to your definitions there of what does it look like, both with a stressful situation, what are the pieces that are outside of you versus what is your, your response in that? And, you know, as I said, there are, there are certain situations that we are never going to be able to be safe in. And it’s important to recognize, are there circumstances that that need to change. And a lot of times though, it’s us who can change and can show up differently. And it may be a combination of those two, but both of those two things need to be in place that we have a safe environment and that we’ve really worked on how we’re intentionally responding in different situations. And I’ve certainly seen it play out even, you know, not that you should go quit your job or anything, but I’ve seen patients who they have been just stuck at a weight loss plateau. They’ve been doing phenomenally in a very toxic I’m thinking about one patient in particular who had a very toxic job. And as soon as she left that job, I mean, the weight just disappeared. It was wild to watch her body respond. Like her body was just… dying. I just feeling like now it’s safe for me to do, you know, to let this weight go that we’ve been holding onto. And so there may be those external pieces, but so much of our environment that we’re able to respond, how we show up, what our reaction is, and then, and then evolve that over time. So I love this idea of coming back to awareness. What, what is my body feeling? What is my body experiencing? How can I support myself in this place? Let me ask you, as you think about any other takeaways from today’s episode that you would want a listener to have, are there other things that you would want to make sure you walk away understanding and remembering this?

Dr. Rashmi Schramm:
That’s a great question. Mm-hmm. Absolutely. And I think…

Dr. Sarah Stombaugh:
As we’re having this conversation, I actually had that thought of, I’m going to listen back to this episode and think about some of this. I think one of my biggest challenges in the podcast, and as I was joking at the beginning, I think, or before we were recording, you and I, like we could talk probably all day long about this topic and maybe even many days on end about it. So we just really got a chance to brush the surface. I’m curious for my listeners, if they are interested in learning more about you, the work that you do, of course you have your wonderful podcast. Tell us a little bit about that where they can find you.

Dr. Rashmi Schramm:
Yes, Sarah. And you’re going to be featured on my podcast very soon within the next couple of weeks. So it’s going to be very exciting. Wonderful. Yes. And so Inner Peace and Power is the name of the podcast. It’s available on all platforms. There’s lots and lots of just guided meditations that are in there that are three and four minutes long. And we talk about things like self-trust. We talk about self-inquiry. We talk about self-compassion. We talk about some of the things that most modern day busy humans who are high achieving are dealing with. in a way that is very actionable, that meets folks where they are rather than it being very esoteric. And then we have amazing guests on there as well. And so if anybody wants to check that out, that’d be great. I have my website, which is just my name, RashmiShram.com. I’m on all the socials, which is my name, Dr. Rashmi Shram. On my YouTube channel, there’s lots of free meditations as well. So those can be, if somebody wants to dip their toes in and wants a science first place to dip their toes in, that’s always a great place to do it.

Dr. Sarah Stombaugh:
Yes, absolutely. And I would certainly wholeheartedly recommend you to any of my listeners, any of my patients, as we’re exploring what it looks like to be understanding this space, understanding meditation, that reconnection piece with your body. I can’t imagine a safer place to do that. So of course, we’ll have all of your information in the show notes so listeners can click down there. Rashmi, thank you so much for joining me today. This has really been a pleasure.

Dr. Rashmi Schramm:
Same. Thank you so much for having me.

Dr. Sarah Stombaugh:

And to all my listeners, thanks for joining us for this week’s episode. Make sure to check out those show notes where you can get all of the information about Rashmi and her practice, her YouTube channel, her podcast, lots of great information on there. We’ll see you all next time. Bye-bye.