Dr. Elissa Epel: Control Stress for Healthy Eating, Metabolism & Aging

High-Level Overview

Andrew Huberman is joined by Dr. Elissa Epel, professor and vice chair of psychiatry at UCSF, director of its Center on Aging, Metabolism and Emotions, and author of The Telomere Effect and The Stress Prescription. Epel has spent her career studying how stress gets under the skin: how it drives cravings and belly fat, how it affects mitochondria and telomeres, the protective caps on our chromosomes linked to cellular aging, and which interventions can turn it around. A core theme is that stress itself is not the enemy. What matters is how we respond to it, how long we keep it alive in our heads, and whether we can recover.

The conversation is warm, thoughtful and practical, and at times personal: Epel draws on her own experience as a caregiver and long-time meditator, and Huberman shares his habits and preferences. It moves between laboratory findings on stress eating and aging, clinical trials in pregnant women and hospital workers, and a rich set of everyday tools, from mental reframes and radical acceptance to body scans, breathing and a new study of the Wim Hof method.

The Discussion Explores:

• What stress is, the difference between acute and chronic stress, and why thoughts keep it going
• Three buckets of stress tools: top-down mindset, body-based practices and changing the scene
• Why some stress is better than none for aging, and how a challenge response differs from a threat response
• Stress eating, the reward and opioid systems, compulsive eating and sugary drinks
• Mindful eating, body scans and a mindfulness program in pregnancy with effects lasting years
• Meditation, telomeres, mitochondria and evening mood
• Radical acceptance, dropping the rope, control and uncertainty
• Narrative and purpose, and early findings on breathwork and the Wim Hof method

Deep Dive into Main Ideas

What Stress Is and Why Our Thoughts Keep It Alive

Epel defines stress technically as feeling that demands exceed our resources. There is good and bad stress, acute and chronic stress, and a crucial distinction between stressors, the things that happen, and our response to them. Mounting a stress response and recovering is healthy and is how we survived as a species. The modern problem is that we keep the response alive long after the event. In her words, Our thoughts are the most common form of stress.

She notes that 46 percent of adults reported feeling overwhelmed by stress in the past year, with young adults, women and people of color especially burdened. Young adults report roughly four times the stress of adults over 65, who tend to have gained perspective. Many people are so used to daily stress that they no longer notice it, holding tension in clenched fists and shoulders, as her taxi driver told her on the way to the studio. Checking in to notice where you hold stress in your body is step one to releasing it. The stress response is also energetically expensive, drawing on ATP made by mitochondria, which helps explain why chronic vigilance leaves people exhausted.

Three Buckets of Stress Tools

For overthinking and rumination, Epel sorts tools into three bins. Top-down strategies use awareness, beliefs and mindsets to release stress. Body-based strategies, Huberman's favorites, work stress out through exercise, breathing and movement; the body changes the mind, shifting activity away from the amygdala toward sensory, experiential states. The third bin is changing the scene: getting away from stress triggers and building an environment with safety signals, even just a corner of the home with comforting pets, pictures, smells or music. Huberman adds that physical photographs can be powerful cues for positive memories.

Breathing, they agree, is the most direct and fastest path to reducing stress in the body. Huberman cites Stanford's David Spiegel, who describes breathing as a bridge between conscious and unconscious control.

Why Some Stress Is Good: Optimal Aging and the Challenge Response

Epel's research distinguishes optimal, typical and accelerated aging. Toxic, chronic stress accelerates aging, but too little stress is not ideal either, because having no stress often means not engaging with life. She describes a program that brought older adults into schools to tutor at-risk students. They took on real stress but gained purpose, relationships and meaning, and brain scans showed growth of the hippocampus, particularly in the men. Colleague David Almeida found that the small share of people reporting no daily stressors had lower cognitive health. Huberman adds Rusty Gage's work showing new neurons still forming in the hippocampus of older, terminally ill people.

Short, manageable stressors, like interval training for the body, can build stress resilience. Epel explains two psychological responses to the same stressor. In a threat response, people feel their survival or social standing is at risk; blood vessels constrict, cortisol rises, recovery is slow and inflammation follows. In a challenge response, people think they can handle it; the heart pumps more blood, the brain gets more oxygen, problem solving improves, inflammation is lower afterward and telomeres tend to be longer. Research by Wendy Mendes and others shows people can be nudged toward the challenge response.

Stress Shields: Becoming the Lion

How do you shift from threat to challenge? Epel's chapter title captures it: be the lion instead of the gazelle. Both animals are highly aroused in a chase, but the gazelle fears death while the lion is excited about dinner. Her stress shields include listing your resources, recalling past successes with similar situations, thinking of someone who supports you, and asking whether this will matter in five or ten years. Simple statements like I've got this or I have what it takes help, as long as they fit and feel believable to you.

Another shield addresses being stressed by stress itself. Instead of reading a racing heart as harmful, remind yourself that your body is doing exactly what it should to help you cope. In reappraisal studies, people trained to see stress as positive performed better, felt more positive emotion, solved problems better and recovered faster. Epel adds that some people, through inherited tendencies or early trauma, simply have bigger threat responses; the answer is self-compassion about that first reaction and skill in what comes next.

Stress, Cravings and the Reward System

Huberman says he eats less when stressed, and Epel explains that high-sympathetic reactors like him tend to shut down digestion under stress. More people, however, overeat or binge. In these people, stress drives cravings for high-fat, high-sugar, high-salt comfort foods, often alongside higher insulin or insulin resistance, and repeated stress deposits fat in the abdominal area as a ready energy source. Stressed rodents given Oreos develop binge eating and metabolic syndrome, and similar patterns appear in people. Epel estimates that perhaps half of people with obesity have this compulsive, can't-feel-full eating style, versus fewer than 20 percent of lean people, many of whom rely on strong dietary restraint.

The endogenous opioid system is involved. Rajita Sinha at Yale found that the more insulin resistant people are, the more their reward center lights up under stress. Epel stresses that obesity is heterogeneous: not everyone with obesity is a compulsive eater, which is why her trials now screen for cravings. A combination of naltrexone and bupropion has been used to dampen compulsive eating. On the new semaglutide-type drugs, Epel hopes for safe and effective medications but argues that the toxic food environment, especially refined sugar, overrides any drug, and that better nutrition is the only public health solution. She cites UCSF colleague Robert Lustig's long-running work on sugar and processed food.

Breaking the Cycle: Mindful Eating, Surfing Urges and Removing Soda

Mindful eating alone does not produce much weight loss, but for compulsive eaters it improved insulin resistance, glucose and long-term weight loss. The skills are simple: before eating, check in, label your emotions separately from hunger, and rate your hunger from one to ten to see whether you are really hungry or bored. Another skill is to surf the urge, watching a craving rise and pass without acting on it. Short bursts of positive physical stress such as high-intensity interval training may also help metabolize stress and reduce cravings, as can push-ups, a walk or simply getting away from food.

Epel is blunt about sugary drinks: there is nothing worse for the body, and because liquid sugar reaches the brain so quickly, she compares it to crack versus cocaine. The sugar-and-caffeine high is followed by a low, a hedonic withdrawal that drives people back for more to escape feeling bad. At UCSF, she and colleagues including Lustig and a colleague who helped drive the soda tax removed sugary drinks from all hospitals and campuses. Heavy soda drinkers lost weight around the waist, but compulsive eaters did not benefit until they received motivational interviewing that tied their goals to things like time with grandchildren and avoiding diabetes. At least 100 hospitals have since stopped selling sugary drinks.

Huberman shares that his drinks are mostly black coffee, yerba mate, occasionally ketones in coffee, and a rare diet soda on a plane. They discuss how anti-smoking campaigns succeeded partly by triggering young people's rebellion against an industry profiting from their harm, and Epel notes that Eric Stice at Stanford uses a similar dissonance approach against eating disorders by revealing how food is engineered for maximum reward. In her mindful eating classes, people slowly eat a Twinkie and often find it disappointing, then savor a small piece of good chocolate to learn to enjoy small amounts.

Mindfulness in Pregnancy and the Body Scan

In a trial that took about ten years to fund and run, pregnant women with excess weight met weekly for two months in groups to learn mindful eating, nutrition and stress reduction. It did not prevent excess weight gain: about 60 percent in both groups gained more than recommended. But half as many women in the mindfulness group developed impaired glucose tolerance compared with controls. Their babies, followed by colleague Nicki Bush for nearly a decade, showed less obesity, fewer illnesses in the first year and healthier stress responses. The mothers' mental health remained better every year for eight years, which Epel calls one of the longest studies of mindfulness effects.

The practice itself was simple, prompted by reminder cards on the fridge: a mindful check-in with eyes closed and emotions labeled, slow breathing with hands on the belly, then movement such as prenatal yoga or walking. Epel also cites a study in which overweight people with strong cravings significantly reduced them with a body scan, moving attention slowly from head to toe, breathing into each area and releasing tension. Huberman speculates that cravings lock our inner state to an external object, and that the inward focus of a body scan may break that tether. Epel's advice is that we should all do some form of body scan or mind-body practice.

Meditation, Telomeres and Mitochondria

Meditators tend to show slower biological aging. Short-term meditation training dampens inflammatory gene expression and boosts telomerase, the enzyme that rebuilds telomeres, while cross-sectional work by Elizabeth Hoge found longer telomeres in long-term meditators. Epel's team studied a week-long meditation retreat led by Deepak Chopra against a control group that simply vacationed at the same resort. Everyone felt great after a week, but ten months later only the meditation group still had lower depression, and people with early adversity benefited most. Epel recommends working up gradually to longer silent retreats, while emphasizing that short daily practices are what matter most for everyday stress. She adds that meditation skills can make psychedelic experiences more manageable and vice versa, and Huberman recommends the book Altered Traits.

With Martin Picard, Epel measured mitochondrial health in the blood. Mothers caring for children with autism had markedly lower mitochondrial activity than mothers of neurotypical children. Across caregivers, those with healthier mitochondria reported more positive emotion, especially in the evening, and that same-day link was stronger than links with mood on other days. Evening mood matters: people who can find some contentment, ease or joy at the end of a stressful day tend to have less depression, heart disease and early death a decade later.

Radical Acceptance, Control and Uncertainty

For chronic stressors that cannot be changed, such as caregiving, Epel teaches radical acceptance as a repeated practice, not a one-time decision. Ask yourself which unwanted situations you cannot change, and notice how much time you spend wishing things were different. When her team randomly pinged caregivers in the evening, those two questions, how much they were wishing things were different and how engaged they were in the present, predicted unhappiness and shorter telomeres. Her metaphor is pulling on a rope tied to a brick wall out of love and care: the wall never moves and your hands only get chafed. Drop the rope, she says, and your hands are free to do what you can, such as simply being loving and present.

Huberman connects this to psychiatrist Paul Conti's point that the limbic system has no sense of time, which is why old scripts get replayed. Epel explains that we crave control and certainty because they let us relax. Being comfortable with uncertainty is a beautiful but rare resilience factor, she says: during the pandemic, intolerance of uncertainty strongly predicted anxiety, PTSD symptoms, depression and distress about California's fires. It can be built like a ladder, through check-ins, reframing uncertainty as the mystery of life, and a posture exercise of leaning back and breathing slowly to let the day come to you. The two agree that we need both modes, muscling through when effort is productive and releasing when facing a brick wall, which Epel describes as skillful surfing between life's waves.

Narrative, Purpose and the Wim Hof Study

Creating a coherent narrative of stressful events is critical for finding meaning and resolution, Epel says; stress research consistently shows it is not what happens to us but how we interpret it. A sense of purpose is what lets humans rise above being, as she puts it, monkeys in clothes.

After doing the Wim Hof breathing with Wim Hof himself at a conference and feeling elated, Epel launched a study with Wendy Mendes and Aric Prather, funded by the John W. Brick Foundation. Participants practiced daily for three weeks, randomly assigned to low-arousal methods (mindfulness, slow breathing) or high-arousal positive stress (aerobic exercise or the Wim Hof method). Stress, anxiety and depression fell dramatically in every group, suggesting many paths to relief, but the Wim Hof method selectively increased daily positive emotion over time, similar to Huberman's own findings with cyclic sighing. Physiological profiles differed across interventions, and the team plans to analyze mitochondrial enzymes, telomerase and gene expression.

Conclusion

Dr. Epel's message is hopeful: stress is unavoidable, but how we respond largely determines whether it harms or strengthens us. Short, manageable challenges approached with a lion's mindset build resilience, while chronic threat, rumination and resisting what cannot change wear down our cells, our metabolism and our mood. The tools are varied and mostly free: body check-ins, reappraising stress as helpful, stress shields, breathing, exercise and short positive stressors, safety signals, mindful eating and surfing urges, body scans, daily meditation, radical acceptance, comfort with uncertainty and a purposeful narrative. For stress eating in particular, she emphasizes that environment matters, from removing sugary drinks to recognizing how food is engineered. As she and Huberman conclude, we cannot reduce stress with a drug; we have to learn to use the full range of our nervous system, from activation to deep rest.

This is a summary of "Dr. Elissa Epel: Control Stress for Healthy Eating, Metabolism & Aging" from Huberman Lab, giving you the GIST so you can decide if you want the REST. Listen to the full episode.