What Your Doc Doesn’t Know about Osteoarthritis Can Hurt you

SUMMARY

Osteoarthritis is a degenerative process that causes pain, stiffness, and loss of joint function.

In recent years, there has been a revolution in understanding osteoarthritis.

  • 20th Century science thought that osteoarthritis is caused by wear and tear on the joints due to excess weight.
  • 21st Century science shows a more accurate picture.
  • The driver of osteoarthritic degeneration and pain is a complex holistic process involving immune, metabolic, brain, gut, and hormonal interactions.
  • Excess body fat is inflammatory and drives the disease process.
  • Mechanical stress on the joints is important, but there is also biochemical and metabolic stress involved.
  • Cut dysbiosis and leaky gut are major drivers of the process.
  • Chronic stress and vagus nerve impairment can feed the vicious cycles.

The conventional approach to treating osteoarthritis is built on the old, 20th century science. It has major problems, and doesn’t change the disease process.

  • Medications like Tylenol and NSAIDs can have toxicities and may worsen joint inflammation.
  • Injections such as steroids provide short-term benefits but do not change the disease process. Some evidence suggests they can make it worse.
  • Physical treatments like exercise and acupuncture are also used.
  • Topical NSAIDs are better tolerated and can be used as an alternative to oral NSAIDs.

Want to know more about the 21st century approach to reducing pain AND the disease process? Watch part two of this video

DID YOU KNOW:

  • Movement Toward Health is a training program that teaches you skills for transforming your health, reducing pain, improving mood and energy. It opens periodically for new members. You can get more information and join the waitlist here: www.MTHTribe.com
  • Dr Shiller is available for telemedicine consultation worldwide regarding chronic pain, fibromyalgia, autoimmune disease, fatigue, and stress-related illness.  Learn more here https://www.drshiller.com/consult
  • Dr Shiller gives regular free mind-body training sessions on zoom. Learn practical tools for transforming suffering, reducing stress and inflammation.  You can get the schedule and register at www.mindbodygroove.com

Related Posts

Full Transcript

So there we go; what is arthritis? What’s the 21st-century science? The notion that osteoarthritis is not inflammatory is changing. It is a new paradigm, and we’re gonna talk a little bit of a kind of overview of how do we treat pain, how do we treat and help function improve, and how do we get the actual disease process of osteoarthritis, and so those are the main points we will get at so you know arthritis is basically pain, or that doesn’t go away or comes back in a joint warmth redness, swelling this is probably pretty basic stuff I know some of you who are out there, and I know you are dealing with this on a regular basis so you don’t need me to tell you about warmth and swelling and stiffness and pain that doesn’t go away. 

Then, sometimes, trouble moving joints is the general definition of arthritis, and arthritis can affect many different joints. When we talk about osteoarthritis, is main knee and, hip, and hands are the main ones, but arthritis can affect the spine, the hands, the elbows, the ankles,  every joint in the body; the temporal mandibular joint can have can have arthritis in it, so you know here is from the Cleveland Clinic and here they give that definition of osteoarthritis which is wear and tear, but we’re gonna focus on that right we’re gonna focus on osteoarthritis you may have heard of rheumatoid arthritis which is more of an autoimmune disease against the joint tissues gout which is where the body creates these kind of crystals that precipitate into the joint and create inflammation  ankylosing spondylitis and psoriatic arthritis which mainly affect the spine but can affect the other joints too.

 And then there’s juvenile rheumatoid arthritis, so we’re gonna focus on osteoarthritis in this conversation today, and so you know the classic signs of inflammation. This is an important distinction because, you know, until 20 years ago, you asked the average doctor, or maybe you still say, but what’s inflammation? They will say redness, pain, swelling, and heat are the four cardinal signs of inflammation. Rubore, calor, dolore, and tergore are the latin things we learned in medical school, and that is what we used to understand was inflammation. Sometimes there’s an elevated white blood count, or these clinical markers like an esr or a crp, and in rheumatoid arthritis, you can get a rapid breakdown of the joint, and then osteoarthritis was understood to be, well, there’s no inflammation there; it is just wear, and tear and but we what we know now is there is low-grade inflammation it is a subtle process where you don’t get this necessarily red hot thing going on but what you do get is this biochemical inflammation that is in the background that drives processes that create degenerative changes in the joint and those same processes like we’ll talk about in a bit affect potentially all of the chronic diseases that people deal with which is part of why people with osteoarthritis get chronic illness.

So it is  really important to understand these things occasionally someone with osteoarthritis has a warm swollen joint cause you can get what’s called an effusion where fluid flows into it and sometimes the clinical biomarkers go up but usually they don’t on the other hand there are research markers that they measure in labs that are elevated and changed in osteoarthritis and so what’s really going on is like this is a view of a healthy joint on the left side and  so that is  what’s happening in in a healthy joint that the cartilage is smooth you got these menisci and you get that nice rolling joint where the joint works just fine and it is  sliding and grooving that is  all great you got a nice wide joint space there and what happens in osteoarthritis is that that joint breaks down the cartilage breaks down over time the cartilage can completely go away and you can get this bone on bone thing right you get bone spurs which can be a source of pain cause they are like pokey things in the joint and you get narrowing of the joint which can cause these changes in the biomechanics and on a biomechanical level it can be like a vicious cycle where you lose cartilage and that nice smooth surface is no longer there and you get these bony things and pointy things that are creating more pressure which creates more breakdown and

So it is  a degenerative process that happens over the course of a long time it is  typically not a quick process like rheumatoid arthritis but like many of you might know  okay my knee started hurting a little bit a few years ago and then it got worse and then it got worse and then it got worse and they said I have osteoarthritis well that is the way it goes sometimes for sure so in any event this degenerative process happens with a joint breaks down and it hurts that is  the worst thing most people describe but some people get loss of joint function hard to bend stiffness the stiffness is frequently worse in the morning or when you’ve been immobile for a while there’s this process in osteoarthritis called gelling it is  one of those classic things when the person says yeah you know I’m really stiff and uncomfortable when I first get up but then once I walk around for a while it gets better it is  sort of a classic osteoarthritis thing as opposed to a like hot inflammatory arthritis like rheumatoid arthritis or gout flare up or something like that the really important thing to know is that okay yeah there’s so there’s this loss of function of the joints being stiff there’s frequently kind of a behavioral response to it which is like it hurts so I don’t want to move.

We will talk more about that later and the real key thing to hear right now so really listen to this  is that there are a number of different other chronic illnesses that go along with osteoarthritis you see more frequently with people who have osteoarthritis and part of it is is the new understanding of what causes osteoarthritis cause we got these underlying biological imbalances that cause these other diseases too so that is  why I really want you to understand this stuff so cardiovascular disease depression, anxiety diabetes, stroke, dementia chronic pain syndrome fibromyalgia really tough difficult things going on so osteoarthritis is growing these are estimates from you know 2015 I think it was where they had this initial data with it growing like this is just in the united states from like 46 million people to 54 million people over the course of about a little bit less than that and this is their projection for it is  gonna go up into 2040 like maybe 80 million people with osteoarthritis in America and worldwide even huger numbers than that because it is  a big world we live in 

So it is  incredibly important that we find solutions to potentially change the course of osteoarthritis cause old school is really about just treating the pain and hoping you don’t have to get a joint replacement and so we’re starting to understand things about what causes it and seeing things that we can do that we will talk about that actually can slow that process so that is  what’s so exciting about thinking about this now in 2023 where we have got like a few decades of research that are showing us like wow it is  not what we thought at all there’s things we can do that are lifestyle things to intervene and make this problem better so let’s unpack what that is obesity and osteoarthritis it is  been known forever this is what I learned people who are obese are overweight and because it is  overweight then it is  too much wear and tear in the joints and that is  what doctors would say to the patient Mr jones  overweight people are more likely  to have osteoarthritis because if you are overweight you are heavy and that means increase wear and tear on your joints so you should lose some weight like that was the old understanding but that is  not the new understanding what we’re understanding now is that extra fat tissue actually is inflammatory and it drives a whole set of biochemical changes that drives osteoarthritis so being overweight and having extra fat it is  not just that you are heavier than your joints want you to be it is  that you have a systemic metabolic thing going on that is  inflammatory and drives the disease process of osteoarthritis as well as a disease process of other stuff that is  no fun to have 

So let’s keep moving forward here so yeah 21st century thinking is much different than 20th century thinking it is  not like that with Mr Jones and somehow it is  still in the mainstream sites right I went to Hopkins medicine, John Hopkins hospital and here’s what they say on their website about osteoarthritis osteoarthritis is caused by wear and tear of the joint over time because of overuse they are missing 20 years of research they are not talking about it this isn’t so surprising it is  actually well known that medical research doesn’t get into the clinic for a long time like 20 or 30 years and you know objectively scientifically there are reasons for that because our new understanding of osteoarthritis is new and science is still working at the details about what do we want to  do about this how do we turn this into treatments what do we recommend for people how do we know what’s safe and not safe it is  a really complex question so giving credit to the conservative nature of medicine because you know one of the things that they always taught me in medical school is first do no harm and they don’t want to promote uncertainty they want certainty first but as we know we’re living in a world that is  more and more uncertain there’s lots of complex influences that are affecting what information gets given to the public and what treatments are given to the public. 

I know a lot of your faces out there you are very tuned into this kind of thing it is it is  not the benevolent thing like we thought it was there’s a lot of financial interests and political interests and all sorts of things going on but there is also reasonably a scientific interest in whoa, hold the horses let’s make sure that these things are really true and we know what to do with it before you put it on this John Hopkins website but it could be that because you are here you are interested in a more progressive understanding my view is that especially with issues where lifestyle changes can make a difference we’re talking about safe things not drugs with horrible side effects we’re talking about things that are generally safe there’s much more latitude  to be progressive to get at the cutting edge of what we know in science and actually come up with intervention that can make a difference for people at low risk to them so let’s keep moving alright yes no that is  not the answer anymore cross it out so what is the answer the answer is that osteoarthritis is caused by a complex holistic process it is systems biology where all your systems are interacting with each other your immune system your joints your brain your gastrointestinal system your hormones your brilliantly complex system of little molecules that are communicating among all of your cells it is  astonishing what goes into it we’re gonna touch on that hopefully in a way that won’t explode your brain like it explodes mine.

There’s so much to know about this. It is outrageous, but basically, we still know that mechanical stress is important, right? It puts physical stress on the cartilage, but we know that there’s biochemical and metabolic stress, and we know that excess body fat is an inflammatory organ that produces all sorts of chemistry that drives that metabolic stress on the joint. We know that mental and emotional stress can affect inflammation and that there are immune changes that there are brain signaling changes. 

And even more, we will dive into the complex holistic process systems biology backed by ongoing scientific understanding of the gut brain immune interactions brain gut. Immune this is showing up in every field of specialty, whether it is arthritis, medicine, diabetes, neurodegenerative disease, cardiovascular disease, or psychiatry. All of the journals are starting to look at gut-brain immune interactions as being drivers of the chronic illnesses that conventional medicine doesn’t know what to do with, and osteoarthritis is no different, right so it is  interactions among these things that’ll unpack a little bit that create joint degeneration as we talked about before 

So one of the things that is  going on in the gut is this process called leaky gut you may have heard that language it also gets called intestinal permeability or intestinal hyperpermeability if you look on the left side of this slide you see these cells right this is the inside of your gut and this is the blood vessels running along it right and so here’s where your food moves through here’s where your biome lives all of the trillions of bacteria and viruses and fungi that are normal inhabitants of your gastrointestinal tract and on the left side we’ve got these healthy cells that have something called tight junctions I’m not sure if you can see it that holds the cells together and what it does is makes it so that their intestines are like an incredible filter and all they do is bring fluids and digested food across to the blood vessels where they feed the body where you absorb fluids you absorb nutrients but a variety of different things create this situation called leaky gut or intestinal hyperpermeability where those tight junctions break down and you get little particles from bacteria and partially digested food crossing over that cellular boundary and getting to the blood vessels so besides the blood vessels what have you got wrapped around your gut.

You’ve got a massive immune organ called your gut associated lymphoid tissue or galt doesn’t matter what the name is the point is that you know your gut is like an interface it is  like the border of a country and there’s soldiers on the border making sure that the bad guys don’t come across and so that is your immune system surveying your gut and when you get leaky gut you get all this stuff moving across the barrier and creating a systemic inflammatory response the other thing that happens is that you know bacteria in the gut produce this thing called lps or lipopolysaccharide and when that gets into the body well bad stuff happens if you’ve ever heard of someone who got a bloodstream infection where they got really sick that is  endotoxemia that is  lipopolysaccharide that can cause a massive massive systemic inflammation  and kill a person god forbid if it is  a really big time you know inoculation of that but when it is  just a drip over the course of time it doesn’t make a person super sick like that but what it does do is cause systemic inflammation.

And that is one of the things that leaky gut does, and that is how it contributes to so many different kinds of chronic illness, and so here’s another view of that and what this is doing it is the same thing here’s the inside of your gut here are those nice little cells protecting it as a barrier and here’s that brain-gut connection and this is the vagas nerve has anyone heard of the vagas nerve? It is  your big sort of gut affecting relaxation nerve but the vagus nerve can do all sorts of different stuff and when we’ll get into some more detail but basically the body’s responding to perceive danger whether it is  biochemical danger environmental danger there’s a war there’s a fire there’s a boss who’s a mean person there’s an ex husband who’s nasty who knows whatever the stressor is but you get changes in the way the brain and the chemicals from the brain work that that can break down and cause leaky gut that can change the ecology of the gut flora just having a chronic stress response and then there’s other things like you know antibiotics and medications and all of that that break down this barrier and it is  not just brain gut but there’s other systems that get involved like your hormones nerve function this process called oxidative stress which is like biochemical stress cellular energy the structure of your body detox systems it is  super complex biology it is  astonishing and it is  beautiful and it is  awesome when it works and I’m really into helping it work better for people so that is  what we’re talking about  

Alright, this is a lot of information; I hope it is not overwhelming. Are people having fun? Some people are nodding it is  good okay so here’s that whole gut brain immune joint degeneration thing and I’m just sort of spelling out that all this other stuff is involved too we talked already about hormones inflammation oxidative stress but mood  behavior diet you know when someone’s under stress and feels crummy and they have pain they tend to eat comfort foods which feed into other problems maybe they are drinking too much alcohol or smoking which create a toxic load on the body maybe they are doing less physical activity and physical activity is so incredibly healthy and important social isolation because of feeling sick of feeling pain not being able to get out and about the stress of social isolation you know if we were to put all of these things in a relationship and they be in a circle and there be like a million arrows and we would lose our minds looking at it but like everything here is everything connected with everything else and that is  the brilliance and beauty and complexity of systems biology because we’re learning about all these interconnections with things we’re learning about all these different variables that are influencing our  health and our disease processes and that we can mobilize them to lead us towards health as well so, just touching on that here is another key point the gut brain immune interactions that cause osteoarthritis through these other variables like we just talked about are what drives so many different  chronic illnesses like chronic pain fibromyalgia abdominal pain fatigue depression anxiety  migraine neurodegenerative problems like  Alzheimer’s or Parkinson’s disease, Neuropathy, Dementia, Autoimmune disease, Chronic fatigue syndrome, Hashimoto’s, Thyroiditis, other autoimmune diseases and these are drivers of that and that is  what we’re seeing throughout the medical literature so this is part of why it is  so incredibly important if you have a significant amount of osteoarthritis to also be thinking about okay I need to work on these underlying drivers I need to get my gut healthy, my stress level healthy, my immune system healthy.

The other thing I wanted to add is this piece about autonomic imbalance. We will talk about it more in a second, but basically, that stress response leans towards oh my gosh! There’s danger whether it is perceived or real; the body thinks it is real, and that is one of the drivers that is one of the wheels that put juice behind this whole thing because it creates a danger signal, and that danger signal primes and shifts all of these other systems and it is part of what creates the illness and response that is why I do so much stuff with mind-body stuff because it is all about how do you create safety for your body and safety for yourselves okay so that is a ton of information you weren’t supposed to see this little yellow box just the sunflowers, but here it is just to sum up that there are all these processes of inflammation oxidative stress dysbiosis  leaky gut autoimmune imbalance autonomic imbalance and obesity-related inflammation and just to give you a quick understanding I’m gonna run through this a bit but like this is not just my idea okay? For example, if you do a medical on PubMed and you look up arthritis and the microbiome, and this is just 2016 to 2024, first of all, you see how those citations are going up. 

This is exploding research. I mean, research is exploding everywhere, but especially in microbiome relationships with so many diseases. It is a thousand papers about arthritis & the microbiome if you look at only osteoarthritis, which, as we talked about, I think got a slower uptake right because people understood well microbiome & inflammation and everyone was thinking, well, osteoarthritis is not inflammatory, right? So it took a while for that to catch up there’s a lot more research in things like psoriatic arthritis in the microbiome or rheumatoid arthritis in the microbiome but there’s a significant body that is  growing I found like 120 papers in the past three years on the microbiome and osteoarthritis this is another view of those relationships it is  another way to think about it this is from this this tremendous research group at rockefeller university doctor mcewen is a huge like mind body researcher he’s like been a really mover and shaker and these are these different accesses you’ll see in the middle there’s this chronic low grade inflammation and over here it is  like the joint brain connection and the inflammatory thing in the middle and he talks about the fatty tissue adipose tissue brain connection the way all those stress chemicals and fatty tissues inflammatory molecules relate to each other and then there’s the gut brain axis like we talked about and then the whole central nervous system you know there’s more and more research about how osteoarthritis is connected to our body clock some of the like the higher centers that like organize the body the daily rhythm the circadian rhythm something called the suprachiasmatic nucleus our sleep cycles all these things are interconnected with these low grade inflammatory processes adiposity and you know whether the body storing fat or mobilizing energy the way the gut works the brain all that kind of stuff so this is big stuff and really big people are looking at it and coming up with awesome science and again in my my view of it is that this is such a big driver of all of it what’s going on between your ears do you feel safe do you feel happy do you feel connected or do you feel disconnected and unsafe and unhappy and we live in a hard world it is  really important to pay attention and nurture yourself and care for yourself  okay so autonomic imbalance immune dysregulation boom massive amount of interaction cause it is  a danger signal right?

 The autonomic system is all about whether there is danger or not. The immune system is for defense and repair; when it perceives danger, it goes into attack mode like the autonomic nervous system danger! Danger! Danger! Means inflammation and and maybe you’ve heard about this just what is that autonomic nervous system most you probably know but we got these two branches we’ve got what we call the sympathetic branch which is your fight, flight, freeze  response your stress response your get up and go it is  what mobilizes you for action and here is the way the sympathetic branch of the actual nerves themselves innovate every organ in your body and the same thing for parasympathetic which is the relaxation response this is recovery repair and heal this is rest and digest and again through your vagus nerve but also your sacral nerves through a whole bunch of  different biochemical pathways it is innovating every bit of you so there’s this potential to have balance but for most of us living in our time and for those of us who’ve had difficult stressful experiences or illnesses or trauma that sympathetic response is overactive the fight flight freezes overactive and that is part of what drives so much of this process okay?

So I’m not really into vagal stimulation as a tech thing but just to share with you the importance of your vagus nerve and there’s importance to this autonomic balance thing there are research companies and tech companies that are putting millions and millions of dollars in creating high tech vagal stimulation devices where they implant by neurosurgery a little device in your neck and you wear a little thing like a little you know looks like a pager or cellphone on your belt and it triggers your vagus nerve to fire off and trigger a relaxation response throughout your intestines into your gut gut brain access it turns it on and the reason these companies are spending millions is because the early research of vagal stimulation is astounding what it does that people come in with horrible widespread inflammation throughout their body from rheumatoid arthritis vagal stimulation,  it stops them so you know this is a high tech technology that isn’t perfect yet has all sorts of issues but they are trying to work it out 

They are making cyborgs you know how it is? They want to do everything. The point is that there’s a pathway between your vagus nerve and certain ganglia and neurotransmitters that are all in your gut that release and block the inflammatory molecule right here with this is tnf-alpha (tumor necrosis factor). It is one of the end effectors, the chemical that drives inflammation and so many of these chronic illnesses, like we’ve been talking about, tumor necrosis factor, and when they do vagal stimulation, it just shuts that down; it turns it off; it turns off the inflammation, and so that is why I keep teaching people how to stimulate your vagus nerve through breathing through mindfulness through attention through spiritual practice because that also works to stimulate the vAgas and it is one of the most powerful things you can do and it is free, it creates a safety signal when you stimulate the vagus nerve and that changes the course of chronic illness okay so this is a crazy complex slide.

There are dozens of articles with researchers mapping out all these zillions of different biochemicals talking to each other and doing things. This is a schematic of the gut and all these things coming from the liver. I’m not going to go into the details of the bottom line: gut microbiome changes cause intestine permeability and breakdown of the barrier that changes the immune system throughout your body. There are dozens and dozens of articles with pictures which show the authors’ particular sort of biases. And a similar one from the same article, right?

It is again the same idea, but what he’s pointing out is that specific changes in the bio cause an increase in joint inflammation. At the same time, they activate immune cells, which are called macrophages, and macrophages, when they are activated, are the attack cells of the immune system, so dysbiosis is a leaky gut immune system attack. Are you hearing how important this is? You need to really get it. Because there’s so much that we can do to shift that okay this is a crazy dark drawing I don’t expect anyone to understand it but it is  just another way of organizing the same set of principles that I’ve already talked about it is  in an article that is  called an integrated view of stressors as causative agents in osteoarthritis pathogenesis from biomodical molecules in 2023 briefly it is  talking here about inflammation and cell signaling and oxidation as a core thing that is  affecting these other five domains and those five domains are mechanical stress on the joint mitochondrial stress where the mitochondria don’t work and create a sick cell basically DNA damage where the actual process of  cellular division get sick and protein stress where  proteins don’t work properly as well as metabolic stress from overweight and from too much fatty tissue so again we are reviewing osteoarthritis reviewing and just getting a big picture about the 21st century science which tells us that osteoarthritis is not a wear and tear disease osteoarthritis yeah wear matters and mechanical loading matters there’s a whole set of biochemical and metabolic and biological changes that we can influence with the choices we make about how to live they are out there developing drugs to do this too

But there are lifestyle things, and that is what we’re gonna talk about next, alright, so it is good to see the sea. It is very soothing, and so, just by way of summing all of that up, I’m not gonna read this. We’ve read it so many times, but this is just okay. That is what we talked about so far. If you just came in in the past few minutes, all we did was talk about what causes osteoarthritis, mechanical stress, dysbiosis, leaky gut, immune changes, inflammation, autonomic imbalance, oxidative stress, mitochondrial stress, and metabolic stress from blood sugar control issues and diabetes and metabolic syndrome so that is like a summary of what we’ve done so far and if you want to get the details, there will be a replay.

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Less Pain And Better Outcomes For Osteoarthritis Through Functional Medicine

Check Out Part One Of This Video And Learn The Modern Understanding of Osteoarthritis

Summary

Dr. Shiller discusses the importance of healing the gut and addresses the five steps of the healing process.

  • Disease starts upstream and rolls downstream over time.
  • A comprehensive assessment is done, including functional workup and gut testing.
  • Empiric treatments can be used if gut testing is not feasible.
  • The five steps in healing the gut are removing bad stuff, replacing missing nutrients, re-inoculating the biome, repairing the gut lining, and rebalancing the brain-gut immune system.

Dr Shiller discusses the benefits of LDN, mind-body care, and the use of curcumin and boswellia for reducing pain and inflammation.

  • LDN triggers the body to produce more endorphins and enkephalins, reducing pain and inflammation.
  • Mind-body care is important for healing as stress and anxiety can drive disease.
  • Curcumin and boswellia are powerful anti-inflammatory substances that block pain and inflammatory pathways.
  • It’s important to use high-quality curcumin and boswellia and to ensure that nutritional supplements are regulated and safe.

Pain is a complex process involving various factors such as emotional response, fear avoidance, and biochemical imbalances, and it is important to address all these factors to break the cycle of chronic pain.

  • Nature-based treatments can block pain and disease processes.
  • Central sensitization can occur in conditions such as osteoarthritis, fibromyalgia, and neuropathy.
  • Emotional trauma and stress can contribute to central sensitization.
  • Pain avoidance cycle, catastrophizing, and fear avoidance can amplify pain transmission.
  • Movement, aerobic exercise, and strength training are important for managing chronic pain and osteoarthritis.
  • Mind-body healing and addressing emotional and biological responses are essential for pain management.

Did You Know

  • Movement Toward Health is a training program that teaches you skills for transforming your health, reducing pain, improving mood and energy. It opens periodically for new members. You can get more information and join the waitlist here: www.MTHTribe.com
  • Dr Shiller is available for telemedicine consultation worldwide regarding chronic pain, fibromyalgia, autoimmune disease, fatigue, and stress-related illness.  Learn more here https://www.drshiller.com/consult
  • Dr Shiller gives regular free mind-body training sessions on zoom. Learn practical tools for transforming suffering, reducing stress and inflammation.  You can get the schedule and register at www.mindbodygroove.com

Related Posts

Full Transcript

Alright, so let’s move along. Let’s think about what to do about osteoarthritis. Cause that is really what matters. This is where the metal hit is the road, or the rubber hit is the road. The pedal hit is the metal. I don’t know. The goals are to reduce pain, improve function, and slower stop the disease process. So we’re gonna do a big picture. And we’re gonna get a view of reducing pain and improving function or slowing the stopping the disease process. And my hope is to produce more content about the details so that you can understand it. So you can do the things that you can do for yourself. Cause it is so important to empower yourself with things that you can do to take care of yourself. I also, you know, a lot of us do this work one on one with people. And I’ll talk to you about that too.

So there’s the old school approach. And the new school approach. Old school is 20th-century medicine. New school is 21st-century medicine. Let’s go forward kadema. So what to do. The conventional approach. We’ve all heard about this. Probably things like analgesic medicines like Tylenol. NSAIDs nonsteroidal anti-inflammatory drugs. Advice to lose weight. And then injections like steroids and hyaluronic acid, which is kind of like joint fluid. And then there’s physical treatments, mainly exercise, but other modalities and acupuncture. These are things that are all getting lots of use in the past decades. And this is the way I train. This is what I learned to do for people with osteoarthritis. And what I’ve learned subsequently is there are serious issues with some of these things that they are not even putting out there in mainstream stuff. Because the view is like this is the best we’ve got. So we’ll touch on some of those issues in a few moments.

So the problem with conventional approaches. First of all, there’s no evidence that it actually changes the disease process. And there is evidence that it might worsen the disease process. So let’s just unpack that for a second. Okay, so medications. There’s toxicities, right? Everybody knows that Tylenol, if you take too much, can hurt your liver. And too much depends on the person. And if you have other issues that are stressing your liver, other toxication issues, less Tylenol can be toxic. And everyone is not the same. And the conventional assumption is that, well, you can take 2 to 3 grams of Tylenol a day. But I know people who have impaired liver function, I know people who have fatty liver disease, which is an inflammatory chronic low-grade inflammatory disease of the liver. They have less capacity to detoxify stuff. Some people have genetic or nutritional issues that prevent the liver from detoxifying. So sometimes Tylenol can be great but in the right measure. NSAIDs, nonsteroidal anti-inflammatory, ibuprofen, naproxen, and then all the prescription things like diclofenac and meloxicam. And you’ve probably heard of these things if you are dealing with chronic pain. And there’s the obvious things everybody knows about that they can cause gastrointestinal bleeding, that they can cause problems with the kidneys, that they can worsen cardiovascular disease and high blood pressure and even trigger heart attacks.

But there’s this other thing that not most people don’t know, which is that they can worsen joint inflammation. And you know this data. There’s a couple of things quoted at 2021 study, but there’s things going back longer than that showing that sometimes people who take NSAIDs get worse. One of the things that NSAIDs seem to do is actually drive leaky gut. They break down that gut barrier. So you don’t even have to get to the point of having a gastrointestinal bleed. NSAIDs start to break down the gut barrier. And what happens when the gut barrier breaks down? What happens when there’s lucky gut, leaky gut? What does it cause systemically? Inflammation! Right.

So it is this crazy thing. Nonsteroidal anti-inflammatory drugs cause leaky gut, which worsens inflammation. And so there’s a number of studies, and this is back from 1998, Intestinal permeability and inflammation in patients on NSAIDs. They reviewed a bunch of studies. There’s research since then for decades showing that NSAIDs contribute to leaky gut. But it is not showing up in the literature. I just recertified in my field. I had to do a bunch of CME and read all these papers and answer questions. And I read this. That year 2020, like review, one of the professional expert bodies were giving their recommendations, consensus about how to manage osteoarthritis. They talked about NSAIDs, and they didn’t even talk about leaky gut. They didn’t talk about NSAIDs causing systemic inflammation. The most kind of compelling stuff about worsening joint inflammation may have been after they stopped collecting resources for that study, for that meta-analysis. But basically, there’s a few different research studies where they gave NSAIDs to people and then looked at their joints two years later and found worse inflammation and joint space narrowing. The people who had NSAIDs were worse than the people who didn’t. So real issues there.

Okay, so we also have topical NSAIDs, and this is an important thing because there are creams and ointments and gels that are made out of NSAIDs. And we actually know that those are better tolerated. And so if you have bad osteoarthritis and you don’t know what else to do and you are worried about taking something like ibuprofen or naproxen, you can take topical NSAIDs. There’s diclofenac, there’s a bunch of different ones that are topical that don’t get absorbed as much. They don’t seem to bother the gut, and that was shown in a couple of different meta-analyses. The jury is out on whether they contribute to heart disease from what I can tell.

Okay, and then injections and steroids, right. Short term benefit is you give a person who’s got a hot, irritated, swollen osteoarthritic joint, you give them cortisone, they feel better. If they don’t have a hot swollen joint, then they often don’t feel better. And it can actually worsen the joint and it could create more joint space. We’re seeing more research showing that cortical steroid injections, cortisone injections can worsen the process of osteoarthritis. So, I tend to avoid them unless it is an emergency.

Let’s move forward. We have so much to talk about that is actually more interesting. Alright. So then there’s this functional progressive approach. We talked about old school, and then let’s talk about what I’m calling new school because I tend to think progressively. I tend to think, okay, if we’ve got some research and we are doing things that are probably safe cause they are not as invasive, then I’m more willing to take that step and share with people the reality that okay, we might not have as much research as we do with NSAIDs, but we know that NSAIDs cause all these problems and you’ve got pain, you need to walk.

So here are some of the things that research is telling us. Heal the gut, supporting detox pathways, nutrients right. Let’s just touch on this. We know that low magnesium is associated with elevated inflammatory markers. Low magnesium is associated with worse osteoarthritis outcomes. Low vitamin D is associated with worse osteoarthritis outcomes. So, the nutrient status in your body is actually really important, and these things are incredibly inexpensive and easy to take. You need a little support with them. You know B12 and B6 and B1 are so involved in so many different chemical reactions but especially pain transmission and neurotransmitter synthesis. And these are things that are really important to pain.

There’s this big category of chemicals that are called polyphenols. And polyphenols come from plants. They are colorful molecules, the things that give blueberries and raspberries and celery and spinach and other living green things. The things that nature, God, evolution, whatever you want to call it, made for us to use and eat and enjoy are profoundly disease preventing and anti-disease. They are antioxidants, and they reduce inflammation, reduce pain. We will talk about that in more detail. There’s something called LDN or low dose naltrexone which I use a lot for people who have chronic pain. And exercise is really important. Movement is medicine. There’s something called microcurrent, and I’ve been consulting with a company that created a microcurrent device. Really tiny electrocurrent electrical currents that actually reduce inflammation in a profound way. They reduce cellular stress. They enhance mitochondrial production. So this thing, this stuff is up and coming. There’s gonna be physics-based devices, what are electromagnetic, that they are gonna do amazing things to your body. If you are of the age where you ever saw Star trek and like you know Bones McCoy would come along and go you know and do this little thing on people and they would get better. Like we’re heading in that direction. I think in the decades and 100 years to come we’re gonna look back and think, oh my gosh, we used chemistry that was so dumb. Like physics is so much better. Gentle electromagnetic fields. Light. You know these things actually have physiologic effects and changes.

So keep an eye on all that. We should know that, in the eyes of conventional medicine, all this stuff is experimental. Cause we’ve got either a little bit of research or no research. But again, it is a different rationale. I don’t have a slide of this, but one of my mentors decades ago painted the picture of a lever, right? Like with a fulcrum and a lever on it, right? And if you are pressing really close to the fulcrum and you are trying to lift a load, you have to press really hard. Like if you are on a seesaw and you get really close to the hinge, you have to be really heavy to lift the other person. And that is kind of what a lot of interventional invasive things are. They are not utilizing the complexity of the biological system. So they have to hit hard, and that is where you get side effects. And on the other hand, a lot of natural approaches and products are using the complexity and the intelligence of the organism. So it is less force, it is less intensity. You are working with the system and its inherent intelligence. And that is why maybe they are more safe, and we will hear about that when it comes to polyphenols in a moment. So stay tuned.

Hope you all are doing okay. People are asking great practical questions. How much B vitamins? What form? Oh my gosh, it is wonderful. It has got to be a whole other talk, Sandy. Thank you. I appreciate you asking. It is a great question. Alright!

So treating the gut neutral, we already did this. The same slide, okay? So what do I do in my practice? First of all, what I want to say is sometimes the conventional approach is faster and more appropriate. I don’t like to use oral NSAIDs, but if I’m working with a young person who’s got a really hot situation, sometimes a week or 10 days of NSAIDs is okay. You take precautions, you give them stuff that helps protect the gut. It is like using antibiotics. I like not to do that, but if I have to, okay. Then let’s replace the biome and support the body’s natural health. So again, I tend towards topical instead of systemic because the topical ones have less side effects, especially towards this whole biology of gut-brain axis and all of that.

Steroid injections, you know, somebody came to me about a year ago and she had really bad arthritis for the knee. And she was having a flare-up, and her daughter was getting married in three days. And she wanted to have a good time. And, like curcumin is not gonna help your joint, and neither is LDN in three days. So I gave her a steroid injection, and her joint was better in 12 hours. And she had a great time at her daughter’s wedding. I think that is a good use of the steroid injection, and so did she. You know, on a similar note, I used to work in rehab a lot. So, somebody has a fall or an injury, whatever it is, and it is pretty common that stressor flares up their arthritis. And they are in the hospital and they come to rehab, and they are in a subacute rehab facility, and their arthritis is flared up. And if they can’t demonstrate progress in their ambulation, the insurance company is gonna cut them off and send them to a nursing home, God forbid. So, in a situation like that, knee needs to be better now or tomorrow so that this person can actually get up and walk and strengthen themselves after the stroke and go home and not get stuck in a nursing home. So you know, it is contextual, it is situational. So I try to treat the patient and not be dogmatic about it. And I encourage you to think that way too, and you know, whatever in your conversations with your doctors.

Some people do great with opioids for osteoarthritis. I’m not a big fan, but some people come to me and they say if I take one tramadol in the morning, I’m up and going and I feel great and I have been doing it for 10 years. Can you prescribe it for me? Sure, why not? It is working. In the meantime, let’s try some other things. Maybe we can get your system healthier and you won’t need it. And if they are open to that, great. But if not, I try to be a good gas station attendant. Somebody wants gas, I give them gas. If they want oil, I give them oil. I try to convince them and explain to them to use the right gas and right oil. Let’s keep going. What else is alright? This whole process of disease that we want to change? We talked about this before for the late arrivals. Welcome gut-brain immune axis joint, you know, sickness of osteoarthritis. That same process is driving a lot of other chronic illnesses and it is important to address that. A lot of people come to me cause they want that deeper underlying approach. And just so you know, I do this by telemedicine. I work through Rose Wellness which is why this whole thing is called Rose Wellness, right? It is a company in America that lets me practice in a number of different states where I’m licensed. And I also do it where I live in Israel. And so part of it can be like okay, I’ve got osteoarthritis, what do we do about pain and helping me deal with it so I can function? Great. But then there’s this underlying reality of the underlying biological imbalances that we’ve been talking about this whole time that are driving not only arthritis but potentially driving other chronic illnesses that can have horrible effects over time. So, I like to think about all of that. So I do a really comprehensive assessment. We spend like 60 to 90 minutes.

It is a functional medicine approach. It is time-intensive, right? I want to know how widespread are the joint issues. Somebody who’s got one joint that is bothered and hot might benefit from a very different approach than someone who’s got six or seven joints that are hot or back arthritis and in two knees. And it, you know, it really depends on the context and how bad things are and what’s needed in the short term to help them get going, to help them get physically active because physical activity shifts so much to this other milieu of complex systems biology. And then what’s the individual sort of a biological picture based on their history, their symptom inventory, and their conventional labs? What’s going on in the gut, mind, body, stress? Is there trauma, a lot of anxiety, immune stuff going on, oxidative stress? These things leave clues. They show up in the history, they show up in systems that, whether it is psychological cognitive symptoms versus skin symptoms versus, you know, gut stuff. Like I do a really broad look and that triangulates back and lets me know a little bit, but what’s going on here.

So my approach, what I’m aiming to do and what functional medicine is about, and this is why I work with Rose Wellness ’cause they are really into this stuff, but basically, this is another way of mapping out all the things I talked about, all these different variables: digestion, the immune system, energy production, detoxification, cardiovascular signaling molecules. But like disease is a stream rolling down stream. Things start upstream and they roll downstream over time. And what we want to do is try to start rolling the stream backward. We want to do the things that counteract and turn off the processes that create the illness experience.

Okay, so what do we do after we do that comprehensive assessment? First of all, we think about a functional workup because there are tests that we can do to really characterize what’s going on in the gut, right? There’s a test that I do, The Biome, that tells me is there a balance in the biome? Are there inflammatory nasty bacteria that tend to cause inflammation? Are there yeast that tend to cause inflammation? It gives variables about the actual immune system in the gut and something and some of the molecules that show up in the gut when there’s an overactive or out-of-balance immune system. It looks at pancreatic enzymes, and most importantly, it looks at something called zonulin in the stool. And zonulin is one of the markers that go up when someone has a leaky gut. And some people come to me, and their zonulin is pinned; it is red; it is like, whoa, big-time leaky gut.

Somebody came to me after 15 years of horrible pain, completely dysfunctional. She’s only 22 years old, miserable, unable to do almost anything. And all of the normal markers were fine, and we did this gut test. She had gluten testing by the blood, which we know isn’t sensitive. There are lots of different molecules that gluten can cross-react with and cause inflammation systemically and cause leaky gut besides the ones they test for, which were designed to look for celiac disease. And so in the testing we did in that stool, we saw this massive anti-gliadin antibody, which is one of the gluten antibodies, and massive inflammatory markers. And she’s miserable, and we just stopped gluten for three weeks, and she was like, “Oh my gosh, it is life-changing.” And that is from a stool test. But they don’t do it in conventional clinics, but they do do it. So not everybody wants to do that, not everyone can afford to do that. So sometimes we just do empiric treatments, things to address pain, inflammation, oxidative stress, gut health, nutrients, all the things we’ve been talking about. These are things that we can do to address them. So how do we heal the gut?

First of all, alright, yeah, we want to heal the gut to get out all those diseases. And I use an approach that is called 5 R’s. These are the five things we want to remove – the bad stuff, meaning foods to which a person might be sensitive, meaning toxic bacteria or fungi or viruses. We want to replace missing stuff like nutrients that might be depleted. We want to reinoculate the biome and create a healthy biome. We want to repair the gut lining. And we want to rebalance the brain-gut immune system. Those are the big picture things, and there’s lots of details, and I’m gonna give a big picture idea of what those details are. But that is the general process we try to do, and that is how we heal the gut, and that is how we turn off that fire coming from the intestines, driving systemic inflammation and a lot of these other issues.

Okay, I hope you all still with me. So, healing the gut, dealing with all of these different biological imbalances that are part of that sick intestinal and brain-gut immune system. Okay, so let’s get into this. So here we are, and we want to heal the gut, we want to address the biome, we want to address the inflammation in the gut. We all know about probiotics, and we might not all know about prebiotics and postbiotics. Cause basically, what do all those healthy bacteria in the gut eat? They eat fiber. They eat digestible and non-digestible fiber. And that is why fiber supplements are so important.

There’s something like called beta-glucan, which is a fiber-like, but it is produced by various kinds of mushrooms and fungus. Profoundly anti-inflammatory. Healthy bacteria digest it. It builds the healthy bacteria. And then they produce post products biotics. The most well-known, well-mapped things are some things called short-chain fatty acids. And there’s something called Butyrate, or butanoic acid or butyric acid, which you can actually get as a supplement. It is really cheap. And not only does it reduce intestinal inflammation, but it helps rebuild the gut barrier. And so when I’m thinking about healing the gut, yeah, these things are biome-oriented, but they are also prebiotic postbiotic, like shifting overall biochemistry and shifting the products that the bacteria in the gut are producing, which are great for the gut, healing the gut, and healing the system as a whole.

I just want to step back for a second cause I wanted just to share a thing that I’ve heard a lot from a lot of people. And maybe this applies to you or somebody you knew, but I’ve listed five things – removing the bad stuff, replacing missing stuff, re-inoculating, repairing the gut lining, rebalancing the brain-gut immune system. I can’t tell you how many people have come to me and said, “I don’t think the problem is in my gut cause I stopped gluten and I still have the problem or I stop dairy or whatever it is.” That is a good move, right? Because many people are sensitive to gluten or dairy or refined sugar. And there’s certain things that I recommend people do initially, if they are sick, to do an elimination diet for like four weeks where you stop all of that stuff and see how you feel. And if you feel better, you gradually add those things back in, and you see what’s triggering you.

So it doesn’t mean being deprived for your whole life. But what it does mean is doing due diligence and initial effort to discover things that might be poisoning your gastrointestinal tract, driving inflammation and breakdown. And if you stop those things, and you can’t kind of stop them, you know like one of my patients came back after 5 weeks. “Oh, I did the gluten-free diet. It didn’t help.” “Oh, interesting. So you didn’t have any gluten?” “Well, I had a little gluten.” “What do you mean?” “Well, I had a piece of toast in the morning, but I didn’t have all the gluten I was eating all day long.” “Like great. That is less gluten, but that is not gluten-free. If you are sitting at a campfire with your friends and you stop putting wood on the fire, and the fire is burning down, but then someone puts a piece of wood on the fire, it comes back up, and then, like, it goes down, and then they put another. You are keeping the fire going.

 And you need to let the fire go out. And typically, we recommend doing that for four or five weeks. So that is really important. But that is not enough. All that is is exploring whether there are food substances that are triggering your gut, and that is huge. But that hasn’t told you whether or not you got dysbiosis, and it hasn’t done anything to address nutrients you might be missing cause of leaky gut and a broken-down gut lining. You haven’t reinoculated the biome. You haven’t taken the stuff to help repair the gut lining. There’s a rich literature about people with celiac disease who get conventional care, which says stop this, the gluten, and they do that. But so many of them continue to be sick, and so many of them continue to have endoscopic findings of a non-healthy gut for years cause they are not doing the rest of this stuff. Cause this is 21st-century medicine, and they are in 20th-century medicine. They are just stopping the gluten.

More and more stuff is coming out about the role of this stuff. More and more we’re learning about pre- and probiotic fibers and substances. We’re learning about nutrients that heal the leaky gut. L-glutamine is a nutrient for intestinal cells. It is an amino acid. It is cheap; it is in powders, and it is in capsules.

First of all, all right, yeah. We want to heal the gut to get out all those diseases. And I use an approach that is called 5 R’s. These are the five things we want to remove: the bad stuff, meaning foods to which a person might be sensitive; toxic bacteria, fungi, or viruses. We want to replace missing stuff like nutrients that might be depleted. We want to reinoculate the biome and create a healthy biome. We want to repair the gut lining. And we want to rebalance the brain-gut immune system. Those are the big picture things. And there’s lots of details, and I’m gonna give a big picture idea of what those details are. But that is the general process we try to do, and that is how we heal the gut. And that is how we turn off that fire coming from the intestines, driving systemic inflammation and a lot of these other issues. Okay, I hope you all still with me.

So, healing the gut, dealing with all of these different biological imbalances that are part of that sick intestinal and brain-gut immune system. Okay, so let’s get into this. So here we are, and we want to heal the gut. We want to address the biome. We want to address the inflammation in the gut. We all know about probiotics, and we might not all know about prebiotics and postbiotics. ‘Cause basically, what do all those healthy bacteria in the gut eat? They eat fiber. They eat digestible and non-digestible fiber. And that is why fiber supplements are so important. There’s something like called beta-glucan, which is a fiber-like but is produced by various kinds of mushrooms and fungus. Profoundly anti-inflammatory. Healthy bacteria digest it. It builds the healthy bacteria, and then they produce post-products biotics. The most well-known, well-mapped things are some things called short-chain fatty acids. And there’s something called butyrate or butanoic acid or butyric acid, which you can actually get as a supplement. It is really cheap. And not only does it reduce intestinal inflammation, but it helps rebuild the gut barrier. And so when I’m thinking about healing the gut, yeah, these things are biome-oriented, but they are also prebiotic postbiotic like shifting overall biochemistry and shifting the products that the bacteria in the gut are producing, which are great for the gut, healing the gut, and healing the system as a whole.

I just want to step back for a second because I wanted just to share a thing that I’ve heard a lot from a lot of people. And maybe this applies to you or somebody you knew, but I’ve listed five things: removing the bad stuff, replacing missing stuff, re-inoculating, repairing the gut lining, rebalancing the brain-gut immune system. I can’t tell you how many people have come to me and said, “I don’t think the problem is in my gut because I stopped gluten and I still have the problem.” Or I stop dairy or whatever it is. That is a good move, right? Because many people are sensitive to gluten or dairy or refined sugar. And there’s certain things that I recommend people do initially if they are sick: to do an elimination diet for like four weeks where you stop all of that stuff and see how you feel. And if you feel better, you gradually add those things back in and you see what’s triggering you. So it doesn’t mean being deprived for your whole life, but what it does mean is doing due diligence and initial effort to discover things that might be poisoning your gastrointestinal tract, driving inflammation and breakdown. And if you stop those things and you can’t kind of stop them.

You know, like one of my patients came back after 5 weeks. “Oh, I did the gluten-free diet. It didn’t help.” “Oh, interesting. So you didn’t have any gluten?” “Well, I had a little gluten.” “What do you mean?” “Well, I had a piece of toast in the morning, but I didn’t have all the gluten I was eating all day long.” “Like great. That is less gluten, but that is not gluten-free. If you are sitting at a campfire with your friends and you stop putting wood on the fire, and the fire is burning down, but then someone puts a piece of wood on the fire, it comes back up, and then, like, it goes down, and then they put another. You are keeping the fire going. And you need to let the fire go out. And typically, we recommend doing that for four or five weeks. So that is really important. But that is not enough. All that is is exploring whether there are food substances that are triggering your gut, and that is huge. But that hasn’t told you whether or not you got dysbiosis, and it hasn’t done anything to address nutrients you might be missing cause of leaky gut and a broken-down gut lining. You haven’t reinoculated the biome. You haven’t taken the stuff to help repair the gut lining.

There’s a rich literature about people with celiac disease who get conventional care, which says stop this, the gluten, and they do that. But so many of them continue to be sick, and so many of them continue to have endoscopic findings of a non-healthy gut for years cause they are not doing the rest of this stuff. Cause this is 21st-century medicine, and they are in 20th-century medicine. They are just stopping the gluten. More and more stuff is coming out about the role of this stuff. More and more we’re learning about pre- and probiotic fibers and substances. We’re learning about nutrients that heal the leaky gut. L-glutamine is a nutrient for intestinal cells. It is an amino acid. It is cheap; it is in powders, and it is in capsules.

There are other things I give along with that frequently, like aloe or marshmallow root and a few other things that help kind of the not just the cells, the lining of the cells, but the cells that produce the mucus layer. Butyrate is the other thing; vitamin D is really important. Omega-3 fatty acids are part of that gut lining membrane and really important. They are anti-inflammatory, and like the butyrate I spoke about, postbiotic fiber, which I didn’t put in here (and it is really a mistake), is anti-inflammatory polyphenols. I’m gonna talk more about them in a minute. But examples of that are things like curcumin, berberine, and quercetin. And depending on what’s going on for the person, depending on their clinical picture, one or more of those things might be more appropriate than others. There’s a lot of polyphenols we want to think about.

Immune function, this is the place where LDN can be really incredibly powerful. LDN, in case you haven’t heard of it, is an orphan drug. The parent drug is an opioid blocker that is used for people who have substance abuse issues to block the action of the drugs they might take. When you use LDN in very low doses, like 20th or 50th of what’s used for addiction issues, what happens is it shuts down the opioid receptors for a few hours, and the body says, “Hey, I need more endorphins and enkephalins.” The body produces more of its naturally occurring pain-blocking, inflammation-blocking chemicals. So, you are triggering the body to have a more robust responsive endorphins and enkephalins. For many people, that does an incredible thing in terms of reducing digestive system symptoms, reducing pain, reducing inflammation. There’s a lot of preliminary research. LDN is one of those drugs that is never gonna get big research because it is generic, doesn’t cost anything. So there’s no company that is gonna spend $50 million to do a full set of trials and get FDA approval for LDN. It is not gonna happen anyhow. Works great for a lot of people.

Mind-body care, we talked about how danger signaling ubiquitously at the level of the cells, the level of the organism, perceived danger, stress, anxiety. You can do all this great biochemical stuff, but if you are walking around in a stress phenotype and an anxiety phenotype and a post-trauma phenotype, you are probably not gonna heal because that is probably driving your disease in a huge way, whether it is osteoarthritis or fibromyalgia or fatigue or any other number of chronic illnesses. Okay, so we want all that stuff to go away. What else?

Some practical details: we talked about the LDN a little bit. Again, this is an off-label use, a compounded drug that you get at compounded pharmacies. Very good safety profile. It has to be customized to the person so that the dose is right for the person. A lot of doctors out there just want to throw it at people and don’t titrate it properly, and that is no good. Curcumin comes from the turmeric; it is the spice of turmeric. But you really probably can’t get enough eating turmeric unless you are eating a huge amount of turmeric. But curcumin, 500mg to 1,000 mg twice daily, is a powerful anti-inflammatory. And I think I got some slides talking about it. Basically, curcumin, boswellia, some of these other polyphenols. Boswellia is also frankincense, and boswellia is another herb, another plant-based substance that comes from a root. And basically, not only does it aid in pain blocking, but it blocks a lot of those inflammatory pathways that we were talking about. They are looking at curcumin and, like, I think I’ll show it to you later in a minute.

There’s other things I’m not gonna get into dosing on this. What I should do is give a whole talk on these things and get into details because there’s particulars and details. You got ta use the right curcumin and the right boswellia ‘ because there’s a lot of junk out there. I don’t have a slide on this, but like, there have been studies for decades showing that unregulated nutritional supplements very often don’t have what’s in the bottle, don’t have what’s on the label. Actual capsules don’t have what’s on the label. There’s also evidence showing that they frequently are produced in ways that aren’t safe. So you really need to get things that have good manufacturing processes where a third party has reviewed it, and you want some evidence that what’s on the label is what’s in the capsule. So I want to talk about all that more detail on another talk because we can’t cover it all here.

But these are some of the things that I use depending on the person. A lot of people have heard about glucosamine. Glucosamine got some interesting press a bunch of years ago because of the GAIT study, which is this huge randomized control trial with lots of people. It was the biggest, supposedly best study of glucosamine. But they used a different kind of glucosamine than what had been used in all of the previous studies. They used glucosamine hydrochloride, which is not glucosamine sulfate. And it was just an assumption that, like, well, it doesn’t matter if it is sulfate or hydrochloride.

That paper that I mentioned, that review paper that I had to study and do answer all these questions to recertify recently, it actually commented in there, “We didn’t review glucosamine because the GAIT study gave such negative results. And based on a meta-analysis, we didn’t see. But you take a huge study and you put it together with a lot of smaller studies, and if the huge study is done wrong, it is gonna make all those smaller studies look like there’s nothing really happening there.” That is what happened with the initial meta-analysis after the GAIT study. More recent meta-analyses have shown, actually, no, there does seem to be some benefit, and there’s potential reasons why.

That paper that I mentioned, which is this expert panel that reviewed it, they actually said, “We can’t think of a reason why glucosamine hydrochloride wouldn’t work as well as glucosamine sulfate.” So we’re assuming that the issue is with glucosamine and not the kind of glucosamine. To hear that kind of twisted logic was very disappointing. I was very disappointed in my colleagues.

In any event, omega-3 fatty acids, fish oils, the most common source. Some people get it in green-lipped mussels, and some people get it in vegetarian sources that are grown from algae. Like, where do the fish get the omega-3s? It grows in algae. It gets eaten by little organisms, and the fish eat the organisms. That is why fish have omega-3 fatty acids. You need 1 to 2 grams a day. If you look at most fish oils, they’ll have like total omega-3s, and they’ll have EPA and DHA marked separately. What you want is 1 to 2 grams of EPA/DHA, not just the overall omega-3s because the body has to produce the ones that are really anti-inflammatory, and these are the ones that have the most data supporting their anti-inflammatory effects.

I was listening to some other research lately about how EPA and DHA help the person maintain muscle mass as they get older, and that is a really huge thing because muscle is metabolically active. There is a practice in Europe that is muscle-centric medicine. There’s a lot more research coming out about how physical exercise, using your muscles, reduces inflammation, shifts all this sort of oxidative stress stuff. It is a really huge thing. So maintaining muscle mass is incredibly important, and omega-3 is showing up as something that seems to help maintain muscle mass too.

Let’s move further, treating pain and inflammation and oxidative stress. We mentioned magnesium, vitamin D, B complex – very important things. And here is a meta-analysis and a systematic review of curcumin. They looked at 1,621 people and did better with pain control. Did as well as NSAIDs without as much side effects. The key thing is you need to use curcumin for three months, but it seems like it works as well as NSAIDs if you get a good quality curcumin, if you take enough, and you take it for 3 months. So it is a reasonable substitute for persons who’ve got osteoarthritis or are dependent on whatever NSAID. It is a reasonable thing to switch, and I do this a lot with people.

Polyphenols, like we talked about, eating the rainbow, all the colorful foods. In nature, this is a reviewed article entitled “Dietary Interventions with Polyphenols in Osteoarthritis: A Systematic Review Directed from the Practical Data and Clinical Studies and Nutrients.” And I got to get closer to this to see it, and maybe you do too, so forgive me for my face getting out of it. But basically, what they find with polyphenols, lots of different colored foods first of all – anti-inflammatory effects like we talked about, anti-pain effects, blocking pain, reducing oxidative stress, and working on signal pathways and anti-aging catabolic pathways. Kind of hard to explain that, but the point is nature’s bounty, the colorful foods that are so important to consider in quantity and build into your diet. We’ve got all this research out there looking at plant-based diets and how much better they are than meat-based diets, and everyone’s assumption is meat is bad for you, and it can be. I’m not knocking that research as a whole, but when you look at something like that, you have to realize, well, eating more plant-based foods does all sorts of amazing stuff to reduce the things that are driving chronic illness, like I spoke about in the earlier part of this talk.

There’s a whole set of biological processes – inflammation, oxidative stress, signaling DNA changes, mutations – that are drivers of osteoarthritis and chronic illness. Polyphenols, colored plant and fruit-based substances, are turning those processes down and moving them towards a healthy direction. So, polyphenols are powerhouses of nutrient for so many reasons.

This is a huge amount of information, but this is another systematic review and meta-analysis of curcumin, basically supporting the idea about all the pharmacologic things that curcumin does – blocking molecules involved in driving inflammation inside of the cell, inhibiting oxidation by removing free radicals, promoting cartilage repair by affecting a whole bunch of different proteins living inside your joint. So, it is not just about inhibiting pain; it is about actually changing the process of disease. Like we talked at the beginning, there’s 20th-century medicine, which is all about palliation, and let’s block your pain and hope you don’t need a joint replacement. And now we’ve got these substances that we’re starting to measure in such an unbelievable way that are nature-based, available, being produced, being refined about how to deliver them, how to absorb them better. And not only do they block pain, but they block the process that drives the disease process. So that is really cool, and I’m really excited about that. And I don’t even own stock in curcumin; I just think it is great.

Okay, so blocking pain, we kind of talked about that, yeah. I’m gonna run through a few things. We’ve been at this for a little more than an hour, and I think somebody else needs to use the Zoom soon. So, I’m gonna just kind of deck, deck, deck, move through. Can you spell butyric acid? B-U-T-Y-R-I-C. Pain is not like a light switch. You’ve got an incredibly complex pain transmission pathway. It is full of these processing states in your spinal cord and your brain before it gets to the part of your brain that says “ow.” And there are amplifiers in your spine and your brain, and those amplifiers can get turned up. We call that process central sensitization, and we know that it happens in osteoarthritis, fibromyalgia, neuropathy, and a whole bunch of different things. We suspect that part of it has to do with those attack macrophages.

 We spoke about central sensitization, but it can come from stress, inflammation, and nutrient deficiencies. This is why it is really important if you have chronic pain to look at all those things carefully. That is a big part of what I do when I consult with people. It is like, let’s cover the bases. What are all the things that can cause central sensitization? Let’s see the things that we can change, check off, and shift. Let’s unpeel off the layers of things that can drive this central sensitization process. We talked about the autonomic nervous system, and just reviewing that is a big driver of central sensitization. So many people I know who have come to me miserable with chronic pain, and they dealt with their trauma, and their pain got a lot better. It is not to say that everybody who has pain is just from trauma, but if a lot of it is, and many of you may have heard of John Sarno’s work. Doctor Sarno’s approach, it is a systematic approach that a lot of docs do, and a lot of laypeople teach other people to really get at the emotional layers, writing exercises, identifying sharp, hard emotions, because that turns off that autonomic nervous system imbalance, and it also corrects a lot of brain chemistry and neuropeptides and signal molecules that may be holding an emotional response that is contributing to a pain response.

Moving forward, pain reactivity and disability. This is a huge thing for any chronic pain problem. Here is the cycle: the pain experience, for some people, creates what we call the pain avoidance cycle. Pain catastrophizing – “Oh my gosh, I’ve got pain, I can’t do anything, this is never gonna get better, it is a disaster, I’m gonna be a wreck, forget about it.” All those thought patterns that get triggered, that is part of that stress response, part of chronic anxiety. And this is not to shame or blame anybody but to recognize that that is a big driver of the cycle, and catastrophizing is one of the things that turns up the volume on pain transmission. This has been demonstrated in functional MRI scans – really important thing.

Okay, so pain-related fear, avoidance, and hypervigilance. A lot of people have pain, are guarding their joint, they don’t want to move. I see this in my practice every week with people who’ve had the injury, they’ve had the surgery, they are having pain that persists, and no one knows why. The orthopedic surgeon says everything’s fine. Part of what’s going on is they are holding their body, and it is not on purpose, it is a reflexive thing. You add some anxiety into it, it makes it worse. You add some biochemical imbalances – B12 deficiency, other different things that can make the neurologic system more irritable, magnesium deficiency – you get more of that, and that creates a secondary source of pain.

So it is really important to think about these things, including in osteoarthritis, and that process of not using the limb, not using the body part, leading to disuse, depression, disability, which feeds that whole catastrophizing pain experience. And the way out is to break through the fear, and you got to find whatever way you can find – whether it means getting psychological support, doing some Sarno work online, finding your best friend to scream at you if that works for you, getting up and moving, figuring out if it is pain that is dangerous or not. Most chronic pain is not dangerous, but the body doesn’t know that. The fear response to the body doesn’t know that, and when your fear response, your body thinks that your pain is dangerous, it feeds that vicious cycle of biology and neurochemistry and inflammation and all of that and feeds into the sickness of chronic pain. So breaking out of that, confronting it, moving forward, recovering – huge, huge thing. Sometimes you need support, sometimes you need a great physical therapist or a mental/emotional therapist.

This is just mapping it out again, we already kind of talked about it, so you know I’m not gonna talk this through because we don’t have so much time. But like that is how it works. I see this hundreds and hundreds of times where all these biochemical imbalances and metabolic balances we talked about sensitize the nervous system, create this whole distressing suffering experience, feeds it all, and feeds into fear avoidance. This is chronic pain syndrome, and getting it addressed is hugely important.

And this is what I’ve been doing for over 20 years. You need to see someone who really knows pain, who can help you out of it if you’ve fallen into this cycle. Stuff you do for yourself – strengthen coordination. I love gentle, mindful movement for chronic pain because it is gentle, and you are stimulating the relaxation response while you are strengthening the body. So tai chi, qigong, yoga, Pilates, whatever it is. There’s a lot of different approaches, there’s all sorts of great techniques for retraining the body to move freely. If you have chronic pain, osteoarthritis, I went to China many years ago when I was in medical school, and you go to any park early in the morning, you got all these elderly people moving and doing tai chi. It is like the national pastime, and part of it has to do with the effect on the joints and moving the joints to the full range of motion.

We got a bunch of people here who are in my movement towards health, tai chi, qigong-based class. You guys want to speak up and tell – no, I’m just kidding, but it is really good stuff. Aerobic exercise is good if you can do it. Strength training is really good if you can do it. The muscles of the joint need to be strong. That is the piece we haven’t really talked about, but one of the things is that in osteoarthritis, the loss of joint position sense and coordination happens before the joint breaks down. Crazy, right? That is one of the things doctors aren’t often thinking about.

So the basic idea is that the deconditioning and the loss of the neuromuscular intelligence of the joint are part of what contributes to the generative process. So it is really important to think about that movement is medicine. It generates hormones, reduces inflammation, signals molecules, helps you sleep, reduces pain, and releases neurotransmitters. Have I said this enough? So important to find a way. I’m gonna do another talk about osteoarthritis and movement training. I’m gonna do another talk about osteoarthritis and polyphenols. We’ll get into some more of the details here. I know this is a superficial overview, but I wanted to give you the big picture.

What else? Mind-body healing. So many different layers to that. Relaxation response, mindfulness. We don’t have time to really talk about this, but it is a whole area of self-healing through the mind-body system and the intelligence of your own consciousness. I’m not gonna go down this road and talk about these things in detail. I want to leave a little time for Q&A. These are some of the processes that people go through as they are healing inside, healing the deeper layers of your being. I know a lot of people who had trauma or difficult experiences and they get CBT, which is mainly about functioning, kind of behavioral therapy. But they are never working on that heart-centered or body-centered nervous system. The stress response is in the body, and you can get your thoughts in shape, and that can help you a lot. But until you meet the hyper-vigilant emotional responses and hyper-vigilant biological responses and transform them and rewire them, then they are gonna continue, and they’ll continue to drive disease. And there are safe, proven things to do that, and it is worth a whole talk. It is really worth it.

Okay, great. So, I think that is the end, folks. Thanks for staying so long. I had no idea how long this is gonna be. I hope it was fun for you.

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6 Things That Most Doctors Miss, Which Worsen Pain and Prevent Healing, Part1

This is part 1 of a two-part video.

Watch Part 2 Here

Summary:

One of my readers wrote in:   “Hey Doc, I’ve been doing all the things they taught me in rehab to recover after my accident and surgery.  Pacing myself. Doing the exercises. I’ve progressed, but I’m stuck. I still have significant pain and my regular doctor has nothing to offer except drugs that mess up my head. And I haven’t been able to increase my exercise tolerance enough so I’m still limited in function.  Why is that happening?” It’s a great question and I’ve heard variations of it over the years. Many people just get “stuck” with persistent pain or fatigue or weakness. And the conventional approaches often don’t have a solution. Based on a few decades of integrating natural healing methods into medical and rehabilitative care, I have often been able to help people who “tried everything”. Because they didn’t really try everything. They just did the conventional stuff. The key to success has been to look for and address the six things that I talk about in this video. So please check it out and let me know what you think. Thanks Andrew David Shiller, MD

Did You Know:

  • Movement Toward Health is a training program that teaches you skills for transforming your health, reducing pain, improving mood and energy. It opens periodically for new members. You can get more information and join the waitlist here: www.MTHTribe.com. 
  • Dr Shiller is available for telemedicine consultation worldwide regarding chronic pain, fibromyalgia, autoimmune disease, fatigue, and stress-related illness.  Learn more here https://www.drshiller.com/consult
  • Dr Shiller gives regular free mind-body training sessions on zoom. Learn practical tools for transforming suffering, reducing stress and inflammation.  You can get the schedule and register at www.mindbodygroove.com

Related Posts:

Full Transcript:

Hey, it’s Dr. Shiller we’re talking today about the six things that can worsen pain and lead to disability and um, and slow the healing and recovery process. And it’s really important to check this out cuz this is not typical stuff you’re going to hear from conventional medicine. It’s not typically treatable with drugs and procedures, but it is treatable and fixable and healable through things that you can learn to do for yourself.

So these are game changing principles that have completely shifted things for so many of the people who have come to me with the, with that situation of I’m still suffering and I tried everything. Well, like, no, you didn’t try every, everything. These are things you didn’t try. Let’s do that. And in many, many, many cases, profound difference.

So let’s open this up. Let’s talk about it. . And so I first want to talk about, well, how does that process happen? What worsens it? Why is it that things tend to snowball after injury or illness and get worse and worse? And that leads to the clarity about like, okay, so what do we do about this to help you get better?

And so a little background of what I bring to this conversation. I trained in physical medicine, which is also called physiatry, pain management, internal medicine at some of the top places in the United States, and have worked in integrative rehabilitation medicine and pain management for over 20 years.

And so I’ve seen literally thousands, maybe tens of thousands of people who’ve had persistent challenging problems. alongside with my formal training, I did decades of training and clinical practice and teaching in what you might call complimentary or natural healing. So I developed this broader perspective than what they taught me at at Duke University in Harvard Medical School, and that’s, let me see, the things that conventional medicine over often overlooks.

which are really important to the recovery process and in my experience, that has been what has enabled me to frequently help people who are kind of stuck in that I’ve tried everything and I can’t get better place. And so my experience is mirrored in that of many of my colleagues who I’ve spoken with and who I’ve trained with, where when we bring these new perspectives, then there’s frequently dramatic results.

Frequently the patients who are stuck and not getting better are suddenly getting a whole lot better in feeling better. So it’s extraordinarily like a privilege and gratifying to be like, wow, this is actually. and helping means that person who was stuck in suffering with pain, inability to do stuff, brain fog, various kinds of symptoms, is now feeling better and able to function better.

And I want to be clear that this is not alternative, and this is not antagonistic to conventional medicine. It’s broadening the model. It’s understanding things more fundamentally, more systemically, more holistically, but not in the flaky. Like a grounded scientific way of understanding, well, what is your biology?

What is your mind body system? How does it function? How does it get out of function? So we’re gonna share six things that. Worsen pain and disability and prevent and block the healing process. We’re gonna share an overview of that and then in other videos I’m gonna drill down into those so you can get the detail and understand them more comprehensively.

But I really want you to have the big picture. This is probably gonna be two videos so that it’s more easily digestible. And so I really want you to plug into this whole learning series if this is a topic that seems important to you. So I want to tell you how to get access to it because I’ve set up a program that’s called Movement Towards Health, and it’s really about a training program.

It gives you skills for transforming the biology of pain and suffering and disability to the biology and the psychology of wellbeing and recovery. Um, and. , there’s a wait list for that program. It opens up periodically. My suggestion is get on that wait list because what will happen is you’ll get notifications about as these videos come out, so you can watch them.

There’s also a place in there where you can binge watch them all at once, once they’re all in place. Um, and you’ll also get notification about the program and more information about it. You might find it interesting and you might want to join. If you don’t, it’s fine. Just enjoy and learn and be inspired.

to understand what it is that is perpetuating, creating the suffering that you’re having so that you can make conscious choices about what to do about it. Because most doctors are not gonna do that because they’re not aware about it. And of course, it doesn’t mean that they’re bad people or bad doctors.

It just means that the conventional medical model sees things a certain way and there’s a broader way of seeing things. and what I’m doing is sharing that broader way so that you can make conscious choices and do the stuff that you need to do so that you can feel better and live better. Okay, so we’re jumping in.

Problem one that worsens pain and illness and prevents healing is what we call autonomic imbalance. Okay? That’s a big scary word, but really what it means is like this, you probably know that you have a stressed. And a relaxation response. It’s built into your entire brain, spinal cord, and your whole nervous system.

It touches every cell in your body. One aspect of it is fight, flight, freeze. That’s your stress response, and the other is your. Rest, digest, and heal or relaxation response. And they’re meant to be in balance with each other. But what happens is that chronic pain, chronic illness shift the, the scale towards an overactivity of that stress fight, flight, freeze response, and a bunch of other things can shift the scale towards that, which feeds into chronic pain and chronic illness, and the underlying biology that drives chronic pain and chronic illness.

So it could be. The trauma, the injury, the illness. It could be earlier things that happened, your life that were traumatic. It could be stress, it could be lack of sleep. It could be chemical exposure or toxic exposure. It could be early life stress or adverse events, which are more and more proven to be associated with chronic pain and honest chronic illness.

And the issue is autonomic imbalance, where the system is shifted to an overactive fight flight, freeze. There are simple things that you can learn to do to bring balance to that fight, flight, freeze response. Some of them are things that you can learn on your own for free, and they are life changing for many people and they’re also life skills, and they empower you to deal with the difficulty in life no matter what it is.

So there are things you can learn on your own. There’s things you can learn together one-on-one with a therapist or in groups or various contexts that support you to retrain your system from being in this fight, flight, freeze response to being in a more relaxed, anti-inflammatory, healing oriented response.

And that’s also part of what we do in movement towards health. So moving on to number two is mood instability or mood imbalance. And the most common things you might think about are like depression and anxiety. There’s other things that go along with its symptoms of O C D. It’s a complex picture. The thing I want you to understand is that the biology of.

Depression and anxiety isn’t what we’ve always thought, which is, oh well, it’s about serotonin problems. Well, yeah, there can be issues with neurotransmitters and, and that’s how some of the pharmaceutical companies have made tons and tons of money, and they push that point of view because that’s how they make their money.

But there’s an aspect of it that has to do with inflammation. There’s an aspect of it has to do with. Your balance of your stress and react and, and relaxation response, that autonomic balance and it’s lifestyle. These are conditions that are affecting your thoughts, your emotions, and your core bodily functions.

Your brain, your brain chemistry, your immune system, your gastrointestinal system, your physical activity, your thoughts. All this stuff is deeply integrated and those things that you can do on those three levels of thought. Reframing and and mindset training of training your mind with various tools to shift your biology, of diet, of nutrients, of physical activity, lifestyle, stuff that can have a huge impact.

And the reason this is so important is because we know that depression and anxiety are part of what’s in that vicious cycle with chronic pain, with disability, with the disability cycle. And so we’ll talk more about that in a bit, but you really gotta get the mood stuff under. Number three is your overall biochemical, metabolic state of your body.

And so check out this slide, which shows some of these relationships, but like I mentioned, your. Brain and brain chemistry and your autonomic system function, your thoughts and your emotions, your gastrointestinal functions. So the biome, the barrier function of the gut, the immune system, the hormonal system of the body.

Um, these are profoundly integrated and they have a huge impact on how your body function. They have a huge impact on how you think, how you feel, how much energy you have, how much strength you have. They have an impact on sensitization of your pain pathways. So this is complex biochemistry and anatomy and metabolic stuff, and there’s things again that you can do.

That’s the big part of the gift of the functional medicine model, is how to look at all that in a scientifically based way where we can think ration. about how to address these different aspects of dysfunction, like it shows in the slide and, and that involves, again, lifestyle stuff. It’s diet and it’s nutrients, it’s mind body therapies, it’s physical exercise, physical treatments.

And these things have made a profound impact for so many of my patients who are dealing with these difficult pain and related syndromes. So the point of all of this is to sensitize. that there are these dysfunctions that can be part of what’s perpetuating the challenges you’re having, and these are things that are within your control to work on.

They’re things that typically aren’t fixed by drugs, although sometimes medications can support the process. They’re things that are fixed and changed by the things you do for yourself sometimes in conjunction or in cooperation with appropriate care caregivers or therapists or practitioners. Okay, so that’s an overview of the first.

Of the six things that can worsen pain and disability and prevent recovery. And and that’s especially true if you’ve sort of done all the right conventional things and you’ve tried everything and you haven’t gotten better, you need to [00:11:00] think about these things. And so in summary, these are dysfunctions.

These are shifts in the functioning of your whole mind body unified system. And they’re not really taught in medical school, though they are supported by medical research. I suspect that in 20 or 30 years, they will be much more widely taught in medical school. Um, but there are, there is hope and there’s help.

There’s things you can learn to do. There’s practitioners who can help you, and the first step is understanding them so you can start to actually address. , in my experience and in the experience of many, many practitioners with whom I’ve worked or trained or, or, or taught, um, that the effects can be dramatic when you actually start to shift the underlying biology that makes these things worse.

We covered three of the six thing, these six things. Um, the second video will show you the rest of those. Look for the link below this video to get to that video, which is the se, the, the second set of three. Um, I want to share that [00:12:00] movement towards Health is a training program to give you skills to address these underlying issues.

And I encourage you to get on the waiting list. Movement towards Health opens periodically, and if you’re on the waiting list, you’ll hear about it, you’ll get an email and you won’t miss out. Um, and you’ll also get access to the additional training sessions that go into more depth into these aspects that go into more depth on the six things that can prevent the healing process from happening.

And I just wanna stress that. , this is about empowering you. You’ve got the capacity to learn things that shift your biology, and when you learn those, you actually are acquiring life skills. It’s about building your resilience, helping you have skills to live more effectively despite all the difficult things that are going on in life.

And we have a lot of different thing, difficult things going on in life in our generation. Okay, so obviously this is an overview video. I encourage you to go to mth tribe.com, get on that wailing list, dive deeper [00:13:00] into the materials, see how it impacts you, what you learn from it. So thanks for watching this.

Um, if you like this, I encourage you, first of all to leave a comment or shoot me an email. With one thing you learned about it, and also share the video wherever you’re finding it. Share it with people you care about, who you think might benefit from starting the OR, or deepening this learning process about this journey of self-healing.

So thanks again. Take care.

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6 Things That Most Doctors Miss, Which Worsen Pain and Prevent Healing, Part 2

This is Part 2 of a two-part video

 Watch Part 1 HERE

Summary:

One of my readers wrote in:   “Hey Doc, I’ve been doing all the things they taught me in rehab to recover after my accident and surgery.  Pacing myself. Doing the exercises. I’ve progressed, but I’m stuck. I still have significant pain and my regular doctor has nothing to offer except drugs that mess up my head. And I haven’t been able to increase my exercise tolerance enough so I’m still limited in function.  Why is that happening?” It’s a great question and I’ve heard variations of it over the years. Many people just get “stuck” with persistent pain or fatigue or weakness. And the conventional approaches often don’t have a solution. Based on a few decades of integrating natural healing methods into medical and rehabilitative care, I have often been able to help people who “tried everything”. Because they didn’t really try everything. They just did the conventional stuff. The key to success has been to look for and address the six things that I talk about in this video. So please check it out and let me know what you think. Thanks Andrew David Shiller, MD

Did You Know:

  • Movement Toward Health is a training program that teaches you skills for transforming your health, reducing pain, improving mood and energy. It opens periodically for new members. You can get more information and join the waitlist here: www.MTHTribe.com. 
  • Dr Shiller is available for telemedicine consultation worldwide regarding chronic pain, fibromyalgia, autoimmune disease, fatigue, and stress-related illness.  Learn more here https://www.drshiller.com/consult
  • Dr Shiller gives regular free mind-body training sessions on zoom. Learn practical tools for transforming suffering, reducing stress and inflammation.  You can get the schedule and register at www.mindbodygroove.com

Related Posts:

Full Transcript:

Hey, it’s Dr. Shiller we’re talking today about the six things that can worsen pain and lead to disability and um, and slow the healing and recovery process. And it’s really important to check this out cuz this is not typical stuff you’re going to hear from conventional medicine. It’s not typically treatable with drugs and procedures, but it is treatable and fixable and healable through things that you can learn to do for yourself.

So these are game changing principles that have completely shifted things for so many of the people who have come to me with the, with that situation of I’m still suffering and I tried everything. Well, like, no, you didn’t try every, everything. These are things you didn’t try. Let’s do that. And in many, many, many cases, profound difference.

So let’s open this up. Let’s talk about it. . And so I first want to talk about, well, how does that process happen? What worsens it? Why is it that things tend to snowball after injury or illness and get worse and worse? And that leads to the clarity about like, okay, so what do we do about this to help you get better?

And so a little background of what I bring to this conversation. I trained in physical medicine, which is also called physiatry, pain management, internal medicine at some of the top places in the United States, and have worked in integrative rehabilitation medicine and pain management for over 20 years.

And so I’ve seen literally thousands, maybe tens of thousands of people who’ve had persistent challenging problems. alongside with my formal training, I did decades of training and clinical practice and teaching in what you might call complimentary or natural healing. So I developed this broader perspective than what they taught me at at Duke University in Harvard Medical School, and that’s, let me see, the things that conventional medicine over often overlooks.

which are really important to the recovery process and in my experience, that has been what has enabled me to frequently help people who are kind of stuck in that I’ve tried everything and I can’t get better place. And so my experience is mirrored in that of many of my colleagues who I’ve spoken with and who I’ve trained with, where when we bring these new perspectives, then there’s frequently dramatic results.

Frequently the patients who are stuck and not getting better are suddenly getting a whole lot better in feeling better. So it’s extraordinarily like a privilege and gratifying to be like, wow, this is actually. and helping means that person who was stuck in suffering with pain, inability to do stuff, brain fog, various kinds of symptoms, is now feeling better and able to function better.

And I want to be clear that this is not alternative, and this is not antagonistic to conventional medicine. It’s broadening the model. It’s understanding things more fundamentally, more systemically, more holistically, but not in the flaky. Like a grounded scientific way of understanding, well, what is your biology?

What is your mind body system? How does it function? How does it get out of function? So we’re gonna share six things that. Worsen pain and disability and prevent and block the healing process. We’re gonna share an overview of that and then in other videos I’m gonna drill down into those so you can get the detail and understand them more comprehensively.

But I really want you to have the big picture. This is probably gonna be two videos so that it’s more easily digestible. And so I really want you to plug into this whole learning series if this is a topic that seems important to you. So I want to tell you how to get access to it because I’ve set up a program that’s called Movement Towards Health, and it’s really about a training program.

It gives you skills for transforming the biology of pain and suffering and disability to the biology and the psychology of wellbeing and recovery. Um, and. , there’s a wait list for that program. It opens up periodically. My suggestion is get on that wait list because what will happen is you’ll get notifications about as these videos come out, so you can watch them.

There’s also a place in there where you can binge watch them all at once, once they’re all in place. Um, and you’ll also get notification about the program and more information about it. You might find it interesting and you might want to join. If you don’t, it’s fine. Just enjoy and learn and be inspired.

to understand what it is that is perpetuating, creating the suffering that you’re having so that you can make conscious choices about what to do about it. Because most doctors are not gonna do that because they’re not aware about it. And of course, it doesn’t mean that they’re bad people or bad doctors.

It just means that the conventional medical model sees things a certain way and there’s a broader way of seeing things. and what I’m doing is sharing that broader way so that you can make conscious choices and do the stuff that you need to do so that you can feel better and live better. Okay, so we’re jumping in.

Problem one that worsens pain and illness and prevents healing is what we call autonomic imbalance. Okay? That’s a big scary word, but really what it means is like this, you probably know that you have a stressed. And a relaxation response. It’s built into your entire brain, spinal cord, and your whole nervous system.

It touches every cell in your body. One aspect of it is fight, flight, freeze. That’s your stress response, and the other is your. Rest, digest, and heal or relaxation response. And they’re meant to be in balance with each other. But what happens is that chronic pain, chronic illness shift the, the scale towards an overactivity of that stress fight, flight, freeze response, and a bunch of other things can shift the scale towards that, which feeds into chronic pain and chronic illness, and the underlying biology that drives chronic pain and chronic illness.

So it could be. The trauma, the injury, the illness. It could be earlier things that happened, your life that were traumatic. It could be stress, it could be lack of sleep. It could be chemical exposure or toxic exposure. It could be early life stress or adverse events, which are more and more proven to be associated with chronic pain and honest chronic illness.

And the issue is autonomic imbalance, where the system is shifted to an overactive fight flight, freeze. There are simple things that you can learn to do to bring balance to that fight, flight, freeze response. Some of them are things that you can learn on your own for free, and they are life changing for many people and they’re also life skills, and they empower you to deal with the difficulty in life no matter what it is.

So there are things you can learn on your own. There’s things you can learn together one-on-one with a therapist or in groups or various contexts that support you to retrain your system from being in this fight, flight, freeze response to being in a more relaxed, anti-inflammatory, healing oriented response.

And that’s also part of what we do in movement towards health. So moving on to number two is mood instability or mood imbalance. And the most common things you might think about are like depression and anxiety. There’s other things that go along with its symptoms of O C D. It’s a complex picture. The thing I want you to understand is that the biology of.

Depression and anxiety isn’t what we’ve always thought, which is, oh well, it’s about serotonin problems. Well, yeah, there can be issues with neurotransmitters and, and that’s how some of the pharmaceutical companies have made tons and tons of money, and they push that point of view because that’s how they make their money.

But there’s an aspect of it that has to do with inflammation. There’s an aspect of it has to do with. Your balance of your stress and react and, and relaxation response, that autonomic balance and it’s lifestyle. These are conditions that are affecting your thoughts, your emotions, and your core bodily functions.

Your brain, your brain chemistry, your immune system, your gastrointestinal system, your physical activity, your thoughts. All this stuff is deeply integrated and those things that you can do on those three levels of thought. Reframing and and mindset training of training your mind with various tools to shift your biology, of diet, of nutrients, of physical activity, lifestyle, stuff that can have a huge impact.

And the reason this is so important is because we know that depression and anxiety are part of what’s in that vicious cycle with chronic pain, with disability, with the disability cycle. And so we’ll talk more about that in a bit, but you really gotta get the mood stuff under. Number three is your overall biochemical, metabolic state of your body.

And so check out this slide, which shows some of these relationships, but like I mentioned, your. Brain and brain chemistry and your autonomic system function, your thoughts and your emotions, your gastrointestinal functions. So the biome, the barrier function of the gut, the immune system, the hormonal system of the body.

Um, these are profoundly integrated and they have a huge impact on how your body function. They have a huge impact on how you think, how you feel, how much energy you have, how much strength you have. They have an impact on sensitization of your pain pathways. So this is complex biochemistry and anatomy and metabolic stuff, and there’s things again that you can do.

That’s the big part of the gift of the functional medicine model, is how to look at all that in a scientifically based way where we can think ration. about how to address these different aspects of dysfunction, like it shows in the slide and, and that involves, again, lifestyle stuff. It’s diet and it’s nutrients, it’s mind body therapies, it’s physical exercise, physical treatments.

And these things have made a profound impact for so many of my patients who are dealing with these difficult pain and related syndromes. So the point of all of this is to sensitize. that there are these dysfunctions that can be part of what’s perpetuating the challenges you’re having, and these are things that are within your control to work on.

They’re things that typically aren’t fixed by drugs, although sometimes medications can support the process. They’re things that are fixed and changed by the things you do for yourself sometimes in conjunction or in cooperation with appropriate care caregivers or therapists or practitioners. Okay, so that’s an overview of the first.

Of the six things that can worsen pain and disability and prevent recovery. And and that’s especially true if you’ve sort of done all the right conventional things and you’ve tried everything and you haven’t gotten better, you need to [00:11:00] think about these things. And so in summary, these are dysfunctions.

These are shifts in the functioning of your whole mind body unified system. And they’re not really taught in medical school, though they are supported by medical research. I suspect that in 20 or 30 years, they will be much more widely taught in medical school. Um, but there are, there is hope and there’s help.

There’s things you can learn to do. There’s practitioners who can help you, and the first step is understanding them so you can start to actually address. , in my experience and in the experience of many, many practitioners with whom I’ve worked or trained or, or, or taught, um, that the effects can be dramatic when you actually start to shift the underlying biology that makes these things worse.

We covered three of the six thing, these six things. Um, the second video will show you the rest of those. Look for the link below this video to get to that video, which is the se, the, the second set of three. Um, I want to share that [00:12:00] movement towards Health is a training program to give you skills to address these underlying issues.

And I encourage you to get on the waiting list. Movement towards Health opens periodically, and if you’re on the waiting list, you’ll hear about it, you’ll get an email and you won’t miss out. Um, and you’ll also get access to the additional training sessions that go into more depth into these aspects that go into more depth on the six things that can prevent the healing process from happening.

And I just wanna stress that. , this is about empowering you. You’ve got the capacity to learn things that shift your biology, and when you learn those, you actually are acquiring life skills. It’s about building your resilience, helping you have skills to live more effectively despite all the difficult things that are going on in life.

And we have a lot of different thing, difficult things going on in life in our generation. Okay, so obviously this is an overview video. I encourage you to go to mth tribe.com, get on that wailing list, dive deeper [00:13:00] into the materials, see how it impacts you, what you learn from it. So thanks for watching this.

Um, if you like this, I encourage you, first of all to leave a comment or shoot me an email. With one thing you learned about it, and also share the video wherever you’re finding it. Share it with people you care about, who you think might benefit from starting the OR, or deepening this learning process about this journey of self-healing.

So thanks again. Take care.

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Why should you know about LDN for Pain and Auto-Immunity?

Why should everyone with chronic pain or autoimmune disease know about LDN (low dose naltrexone)?

Because for many people it helps them, even if they’ve “tried everything”. That doesn’t mean it’s for everyone. What I say doesn’t mean diddly if it doesn’t help you. But LDN is something that most people don’t know about. And it’s something that helps many many people.
Some patients have told me it’s like a miracle.  It’s not a miracle.  But it’s often surprising when you’ve been told ‘there’s nothing else to help you’ and then something helps you.   LDN for chronic nerve pain and inflammatory issues is applied physiology and common sense, and has some clinical trial support. It’s not a miracle. But it is a very safe choice that might help. If you’re facing chronic disease or chronic pain, it’s very important to be open-minded. Conventional medicine doesn’t have all the answers. Knowing that truth, is part of What Heals.

Stay open-minded, but not so open that your brain falls out.

Here’s a recent interview from the LDN radio show, that talks a bit about what is LDN and why it helps some people with chronic pain or autoimmune problems.
LDN radio show march 2018

If you want to find out whether LDN may be helpful for you, contact the office or click here for more information.

Did you know?

Dr Shiller is available for telemedicine consultation worldwide regarding chronic pain, fibromyalgia, autoimmune disease, fatigue, and stress-related illness.  Contact the office or schedule a consultation at www.drshiller.com  Inner Healing Essentials is an intensive six-week course taught by Dr Shiller, which teaches you the Six Steps To Inner Healing.  It empowers you to transform stress into vitality, and begin to take back your life from chronic pain and illness.  A new class begins quarterly.  To get more info and be notified of the next start date: https://andrew-david-shiller.mykajabi.com/inner-healing-essentials-waitlist.
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BURSITIS–understand it, treat it, feel better

What’s Bursitis?
Bursitis means ‘inflammation of a bursa’.  A bursa is a fibrous sack that typically lubricates and cushions muscles and ligaments as they pass over bones.  When a bursa gets inflamed, it is painful.  Sometimes the bursa can fill with fluid, which makes it even more painful.  Often the body develops spasm in the muscles around the area, which are also painful.  Left untreated, those muscles and their associated nerves and soft tissues become dysfunctional.  They can generate more pain and spasm in the soft tissues related to them.  That process can radiate pain to other regions.

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How to Find Your Way Home from Debilitating Back Pain? Get a Better Map.

Sometimes the Hospital is the Worst Place to Go
Sometimes a trip to the hospital for unrelenting back pain can take a person down the road road. Ineffective and dangerous treatment is the wrong treatment. Sometimes it happens because they’re looking at the wrong map! Over the years, I’ve seen dozens of people who went to the hospital with back pain, and came out without a real solution, on heavy drugs, with bad side effects.

The Wrong Map Leads Down the Wrong Road
Sometimes back pain is caused by a fracture, an infection, a tumor, an acutely herniated disc. That’s when X-rays or MRIs get right at the problem and the right treatment happens. That’s when you want to see a neurosurgeon or orthopedic spine specialist. And I refer to docs like that every week. X-rays and MRIs give us a map of the territory. But they are not the territory. They tell us specific and limited information about the person and his or her back. And sometimes they miss the issue. The trouble is when we think the map IS the territory. ‘The X-ray shows you have arthritis’. That must be the problem, because it doesn’t show anything else. If the pain is severe and unrelenting, that’s when the provider goes down a dangerous road and starts prescribing heavy meds, which don’t get at the problem.

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