Total Health: Dr Sandra Indacochea Sobel On How We Can Optimize Our Mental, Physical, Emotional, & Spiritual Wellbeing

An Interview With Candice Georgiadis

Laughter — with so much turmoil and uncertainty, it may seem selfish or hopeless to seek out joyous outlets. But there is nothing selfish about this and allowing for opportunities to experience a good belly laugh, which leads to endorphin and other neurotransmitter release optimizes emotional wellness!

Often when we refer to wellness, we assume that we are talking about physical wellbeing. But one can be physically very healthy but still be unwell, emotionally or mentally. What are the steps we can take to cultivate optimal wellness in all areas of our life; to develop Mental, Physical, Emotional, & Spiritual Wellbeing?

As a part of our series about “How We Can Cultivate Our Mental, Physical, Emotional, & Spiritual Wellbeing”, I had the pleasure of interviewing Dr. Sandra Sobel.

Dr. Sandra Indacochea Sobel is a board-certified Endocrinologist who also holds additional board certifications in Lifestyle Medicine and Obesity Medicine and practices in Pittsburgh, PA. In 2021, after functioning as the Clinical Chief of Endocrinology in an academic center for seven years, she founded Summon Health, the first direct care endocrine clinic in Pittsburgh where the mission is to deliver evidence-based, personalized, and comprehensive medical attention by addressing nutrition, exercise, and stress, in addition to continuing to use medicine therapies to help each person summon their best metabolic health. At Summon Health she supplements the medical visits by applying culinary medicine through use of her teaching kitchen and meditation instruction via her meditation room.

Thank you so much for joining us in this interview series! Before we dive into the main focus of our interview, our readers would love to “get to know you” a bit better. Can you tell us a bit about your childhood backstory?

Thank you so much for the interview!

Absolutely! I am a first-generation U.S. born Latina and the eldest of 3 children. My parents immigrated here in the 1970s from Peru, so that my father could obtain his doctoral degree in metallurgical engineering. They ultimately planted roots in the suburbs of Chicago where my brothers and I grew up. My parents raised us bilingual and keeping our heritage present was important. They would host these marvelous get-togethers, where friends and family would bring their favorite foods and instruments and we would clear out the furniture of the living room so that there was ample room for the make-shift band and people to dance. A get-together wasn’t complete without the night ending in the adults telling stories of their childhood, or sharing jokes that had everyone’s eyes streaming with tears from laughter.

When I was 13 years-old, my father took a sabbatical year in Germany, purposely moving the family to a country where we didn’t know the language, so that we could have the chance to learn a third language. I went to a German school, and on weekends, my parents made it a point to around Europe. I kept up with my German studies even upon my return to the United States and it was even one of my majors in college and by the time of my college graduation, I was arguably more fluent in German than in Spanish!

What or who inspired you to pursue your career? We’d love to hear the story.

There were no physicians or other medical professionals for that matter, in my family. But there were hustlers and story-tellers and these two truths inspired me to pursue medicine.

My father was one of nine children and he was the first in his family to go to college. At the age of 18yo, he had earned a scholarship to study in the United States and left Peru for the first time at that age to move to a country where he did not speak the language. He told me he would spend endless nights with an English dictionary on the desk with him while he did his homework, trying to understand his assignments. Not only did he complete his undergraduate degree, but he went on to get a doctorate degree in engineering. As a young college professor, I remember him preparing his lesson plans and talks for national conferences. He would practice these talks with the slide projector and use my brothers and me as his audience. We had no clue what he was saying, but I was inspired to one day be able to get to gain enough confidence and share my knowledge with colleagues.

Having grown up in a family of story-tellers also inspired me to pursue my career. Whenever we got together with extended family, the adults would gather around the table and start telling stories and some of the children would sit with them at the table, to eagerly listen. I was one of those children at the table, completely entranced by these stories. I always wanted to hear more — the stories of struggle, joy, defeat, and triumph. I cherished each detail of the stories shared and I approach my privilege of being a physician in the same way. Ultimately, my patients are sharing their stories with me, and I listen intently to the details they entrust to me. I genuinely am fascinated by the health stories or experiences individuals share with me and I try to provide clarity to these symptoms or conditions.

None of us can achieve success without some help along the way. Was there a particular person who you feel gave you the most help or encouragement to be who you are today? Can you share a story about that?

I go back to my parents being my inspiration to blaze my own path. They immigrated to the United States only having each other. Through perseverance, sacrifice, and self-belief, they were able to achieve their version of the American Dream. We had no physicians in our family and when I told them from a young age that I wanted to be a doctor, they supported me and encouraged me through my many years of schooling and gave me the confidence to blaze my own path.

Can you share the funniest or most interesting mistake that occurred to you in the course of your career? What lesson or take away did you learn from that?

I moved to Pittsburgh, PA after my internal medicine residency and prior to starting my fellowship in Endocrinology, I worked at a hybrid urgent-care/primary-care office. Pittsburgh has its own dialect and I was learning the dialect mostly from interactions with patients.

One afternoon at this urgent-care, I was seeing an older gentleman who had come in for shortness of breath and a cough. I walked in the room and spoke with him, examined him, and noticed that his blood pressure was quite elevated. I saw he was on blood pressure medicine and he confirmed to me that he was taking his medicine as prescribed. I then asked him who his primary care physician was (again, the place served as an urgent care as well). I understood his reply to be, “Yinzer”. So, I responded, “Ok sir, I will reach out to Dr. Yinzer to let him know that your blood pressure is elevated and that you should have it rechecked soon to see if you need a dose adjustment to your blood pressure medication”.

He looked at me and then, more slowly, and a little more loudly said, “Yinz are”.

I had a confused look and as I thought over his slower response, I realized that “yinz” is the Pittsburgh way of saying “You guys, or, ya’ll”. It then dawned on me that he was telling me that WE (the physicians at this hybrid office) were his primary care physicians. We both laughed about my lack of Pittsburgh-slang knowledge and I informed him that I would then be increasing the dose of his blood pressure medicine.

But this also served as an important reminder to me that prior to walking into each room with a patient, it is important to take just a couple of minutes to review the patient’s chart. Familiarize myself with who their primary physician is, what medications they are on, and what their main concern is that they would like to address at the time of the visit.

I can also say that now, after having lived 12 years in Pittsburgh, my Pittsburgh slang is on point.

Is there a particular book that made a significant impact on you? Can you share a story or explain why it resonated with you so much?

Anne Frank, The Diary of a Young Girl.

I read this book at the age of 13 years-old, while I was living in Germany.

Anne Frank was 13 years-old when she started writing that diary, while she was in hiding in fear of Nazi persecution during WWII, in the next country over to where I was living at the time, the Netherlands.

Her writings took hold of me, as the young teen experiences she was narrating were ones that I could so easily identify with. Yet at the same time, the fear of being found out and the clandestine life she wrote about, were so incomprehensible to me.

Can you share your favorite “Life Lesson Quote”? Why does that resonate with you so much?

“The journey of a thousand miles begins with one step.” -Lao Tzu

This quote is a humble reminder to myself that while the work to achieve lofty goals and intentions may feel overwhelming when taking it all into account, to not let this stall forward motion. In order to get from where I am on the journey to where I intend to go, I have to begin the journey with one step. At a time.

What are some of the most interesting or exciting projects you are working on now? How do you think that might help people?

My direct care metabolic practice! My reason for pursuing medicine as a career was my genuine interest in people’s stories, hearing their health journeys, and wanting to help investigate causes of medical conditions, but also educate and provide personalized recommendations to improve health. All of this requires mutual trust between the patient and the physician, and in order to build that trust, it also requires time to build that relationship.

I felt that this time was being taken away in traditional medical models and being outsourced, so I needed a way to protect the time I had with patients and to address all the important factors that impact a person’s metabolic health, namely: nutrition, exercise, stress, sleep, in addition to hormonal health. That is why I established a direct care metabolic health practice, where I devised a model of care where time is a priority (initial visits are 90 minutes long!) and health recommendations touch upon the previously mentioned metabolic health variables. In addition, my practice has a teaching kitchen where I apply culinary medicine principles to health, as well as a meditation room.

I think this innovative approach to metabolic health highlights to each person that metabolic health is complex: it’s not just an abnormal lab value and, “here, take this medicine and check back with me in three months”. No! Let’s have that conversation about your nutrition patterns, your exercise patterns. Let me discuss with you what the studies have shown to be the minimum amount of time that is needed per week for exercise to reap cardiometabolic benefits. Let’s talk about non-pharmacologic ways to deal with stress and while we are at it, we can have a seat in the meditation room. When a person understands how multiple areas of our life impacts health, I have seen this increase engagement and I have seen the dramatic improvements people achieve in their health. This comprehensive approach to care has transformed many of my patients’ lives!

OK, thank you for all of that. Let’s now shift to the core focus of our interview. In this interview series we’d like to discuss cultivating wellness habits in four areas of our lives: Mental wellness, Physical wellness, Emotional wellness, & Spiritual wellness. Let’s dive deeper into these together. Based on your research or experience, can you share with our readers three good habits that can lead to optimum mental wellness? Please share a story or example for each.

1. Meditation — Everyone who is reading this has more than likely been profoundly impacted by the shift in our realities over the past 2+ years. The world shifted and this ripple effect has touched each human being. And throughout this time, we have had to find ways to pivot — multiple times. And this is incredibly stressful. If we do not have outlets to relieve stress, the internalization of these constant stressors can lead to heightened anxiety and panic. I know, because this is precisely happened to me. I was working at my computer in Fall 2020, when all of a sudden, I felt an intense pressure in my chest and a sudden feeling of doom. I read what was on my computer screen and could not see how what I was working on could elicit such a response. But the symptoms were classic of a panic attack. I realized that I had been internalizing my stress over, and over, and over again, without having established and healthy coping skills for it. That is when I decided to explore meditation. I was floored by the impact it had on me — allowing for a moment to let me mind settle and to accept that each attempt at meditation would not result in extended moments of calm. But even so, the cumulative response to consistent meditation practice resulted in significant alleviation of anxieties.
2. Proper Sleep — studies have demonstrated that individuals who do not get enough sleep have a higher prevalence of depression. Sleep impacts hormonal signaling as well, and without sufficient sleep, melatonin and cortisol cycles become disrupted as well.
3. Social Connections — one of the pillars of lifestyle medicine is relationships. Being able to foster and maintain healthy relationships with each other is essential for our mental wellness. As humans, we are not meant to experience life in isolation, and having social connections and building relationships with trusted others helps us navigate new or difficult situations and can help protect us from distress and even depression and anxiety.

Do you have a specific type of meditation practice or Yoga practice that you have found helpful? We’d love to hear about it.

Transcendental Meditation has really offered me a way to ground myself and allow capacity for the life pivots that occur without forewarning. I found guided meditation to at times increase distress, especially if the teacher was guiding the meditation through a visualization. During meditation, external thoughts creep in, this is expected and natural. However, despite this being natural, I then found I would become upset that I had missed a portion of the guided meditation — was that an important part I missed? What if that was the most important part I missed?

With transcendental meditation, I have been able to use my mantra and allow for the settling of my mind without having the same distressing reaction when thoughts creep in. And as with anything, consistency with the practice is important to reap the most benefits.

Thank you for that. Can you share three good habits that can lead to optimum physical wellness? Please share a story or example for each.

1. Hydration — staying well hydrated is so essential for physical wellness. It is important for skin turgor, mental clarity, circulation, and sleep! If one is dehydrated, this can lead to peripheral vessel constriction at night. When this occurs, it shunts blood to the core and doesn’t allow for an optimal cooling of the core during sleep, which is important for restful sleep. With proper hydration, this does not happen and individuals will experience a more restful sleep.
2. Minimize unprocessed foods — Overprocessing of food can have a litany of adverse health consequences. It frequently strips foods of important fiber and nutrients while adding sugar salt. The result of frequent consumption of these hyperpalatable low nutrient but frequently high-calorie content foods? Increase risk of high blood pressure, insulin resistance, diabetes, and obesity. Focusing on mostly consuming minimally processed to unprocessed foods and enjoying the natural flavors packed in these wholesome, nutrient dense foods will help promote physical wellness.
3. Pick up weights — and I say this as a former cardiovascular workout junkie. It wasn’t until I started incorporating resistance training did I see real transformation in my strength, toning, energy, and stamina. Alternating between cardiovascular and strength training during an exercise — an added bonus as this ‘inefficiency’ in exercise concept maximizes energy expenditure which translates to more calories burned! High five!

Do you have any particular thoughts about healthy eating? We all know that it’s important to eat more vegetables, eat less sugar, etc. But while we know it intellectually, it’s often difficult to put it into practice and make it a part of our daily habits. In your opinion what are the main blockages that prevent us from taking the information that we all know, and integrating it into our lives?

I love Michael Pollan’s statement, “Eat food, mostly plants, not too much”. My interpretation of this is to focus on real foods (so avoiding the ultra-processed foods), high fiber (fiber is found in plant-foods!), and moderate portion sizes.

The main blockages I know from personal life, but also in discussion with patients when we talk about nutrition is time. Everyone is incredibly busy. Having the time to meal plan, or to cook food, is a luxury. And the choices for convenience foods and fast foods abound! But the ‘convenience’ of fast foods, consumed over and over again, can eventually add up to future inconvenience of chronic disease.

Can you share three good habits that can lead to optimum emotional wellness? Please share a story or example for each.

1. Socialize with others — please see my explanation above on social connections!
2. Travel — experiencing different cultures adds to our understanding of humanity: through food, music, beliefs, and language, we can learn to appreciate the nuances that create unique interpretations of the human experience. These experiences may help transform our perceptions or our realities. And through this transformation, we also have the opportunity to reflect on shared experiences as humans. This realization of shared experiences has a profound impact on optimizing emotional wellness.
3. Laughter — with so much turmoil and uncertainty, it may seem selfish or hopeless to seek out joyous outlets. But there is nothing selfish about this and allowing for opportunities to experience a good belly laugh, which leads to endorphin and other neurotransmitter release optimizes emotional wellness!

Do you have any particular thoughts about the power of smiling to improve emotional wellness? We’d love to hear it.

Much like the effect that laughter has on emotional wellness, so does smiling! Just stop and think about what goes through your mind when you see someone smile? For me, it elicits curiosity, joy, happiness, and elation. Talk about wonderful boosts to emotional wellness!

Finally, can you share three good habits that can lead to optimum spiritual wellness? Please share a story or example for each.

Do you have any particular thoughts about how being “in nature” can help us to cultivate spiritual wellness?

When we spend intentional time outside — for example, sitting in nature, whether in meditation, doing yoga, or just absorbing its grandeur, connects us to our planet and helps provide a sense of purpose.

Ok, we are nearly done. You are a person of great influence. If you could inspire a movement that would bring the most amount of good for the greatest number of people, what would that be? You never know what your idea can trigger.

Every morning, take 5 seconds to look at yourself in the mirror, with intention, then smile.

We are very blessed that some of the biggest names in Business, VC funding, Sports, and Entertainment read this column. Is there a person in the world, or in the US, whom you would love to have a private breakfast or lunch with, and why? He or she might just see this, especially if we both tag them :-)

It would have to be Chef José Andrés. I would love to speak with him about his motivations and inspirations that go behind his genius in creating cuisines that not only enlighten and invigorate the palate, but also elicit emotional responses with the flavors he produces. I use culinary medicine in my medical practice and I have seen how it provides another opportunity to strengthen connection between humans when we discuss recipes or prepare and share in the enjoyment of eating foods together. In addition, I would love to sit down and speak with him at length about his non-profit, World Central Kitchen, where they provide meals to disaster-stricken areas of the world. He has leveraged his culinary expertise to be able to ensure that those in these disaster-stricken areas have access to one of the most basic of human needs — food.

How can our readers further follow your work online?

Follow me on social! @drsandraisobel on instagram and tiktok or Sandra Indacochea Sobel, MD on facebook!

Thank you for these really excellent insights, and we greatly appreciate the time you spent with this. We wish you continued success.

Thank you so much!