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

Posted on March 12, 2023March 3, 2024 by Andrew David Shiller, MD

This is part 1 of a two-part video.

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

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

Posted on March 8, 2023March 3, 2024 by Andrew David Shiller, MD

This is Part 2 of a two-part video

Watch Part 1 HERE

Summary:

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

Full Transcript:

So thanks again. Take care.

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Where Do You Start, If You Have Chronic Pain, Anxiety, and IBS?

Posted on January 13, 2021March 3, 2024 by Andrew David Shiller, MD

Summary:

One of my readers asked a great question: “Doc, what are your thoughts about EBV and Herpes as causes of fibromyalgia? And what about bio-film and leaky gut? I have bad IBS, and always feel so tired. Oh, and I also have bipolar, PTSD, and panic attacks due to trauma and abuse”.

How does someone start to heal if there is so much going on?

It’s important to remember that many chronic pain and illness syndromes share underlying biological imbalances. If you can start to identify those issues, you can understand what is driving your symptoms. And that can help clarify your path to healing. At the core of almost every chronic pain and illness syndrome is the intimate relationship among the gut, the immune system, and the brain. Gut-brain-immune interactions are showing up in chronic illnesses including autoimmune disease, fibromyalgia, dementia, neuro-degeneration, arthritis, neuropathy, and more. It might be decades before the research is organized into treatment that the average family doctor will offer. In the meantime, many people benefit from safe lifestyle approaches that address the underlying causes of chronic pain and illness. And that often helps people heal, feel better, and live better. It’s helpful to think through the history of early life experiences, illness, triggers, and what issues are most prominent in life now. And to start to understand how these things interact. The reader who shared this question was asking about everything BUT her ongoing anxiety and panic, related to her history of emotional and physical abuse. It’s a shame, because those issues can heal. And then the person can heal. And the person usually doesn’t heal the physical illness if they don’t heal the toxic shame, self-blame, anxiety, and hypervigilance that often develops after such tragic events. So many folks with anxiety and chronic illness have been stigmatized with ‘it’s all in your head”, when really they have significant biological issues. The sad thing is many docs don’t seem to “get it”, even though the research shows the issues quite clearly. And unfortunately, that’s triple-bad for patients. They don’t get their needs met. They get blamed and shamed for their illness, which often makes them worse. And the stigma often creates an obstacle to recognizing the mind-body relationships that are driving the physical illness. The patients continue to suffer because they are unwilling to do the crucial mind-body healing work, which is a foundation of healing and recovery. Chronic pain and illness mean that your actual physiology is in “protective mode”. If you have anxiety, panic, depression, history of trauma, then that protective mode is amplified intensely. It’s incredibly important to develop the power of your mind and heart to shift the patterns that create disease. And to create a sense of safety, acceptance and compassion, and to get it “into your bones”. Once you learn these tools and make them real in your life, amazing things can happen. Scroll down for full transcript

Did You Know:

Dr Shiller gives regular free mind-body training sessions on zoom. You can get the schedule and register at www.mindbodygroove.com

You can learn more about Dr Shiller’s practice and schedule a telemedicine or in-person consultation at www.drshiller.com

Join the email-community to receive reliable, MD-reviewed information, inspiration, and guidance to help you Reclaim Your Life From Unresolved Pain and Chronic Illness http://bit.ly/3aOrrsQ

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.

Full Transcript:

Presentation Slides Hey everybody, Dr. Shiller here, and I want to talk today in response to a question that a reader sent in, because it is so relevant to many people when it comes to the whole idea of healing chronic pain and chronic illness. I want to talk a bit about some of the chronic syndrome that have common underlying issues, why we look at them slightly differently in the functional approach compared to the way a lot of us learned in medical school, and in particular to talk about really the relationship of some of the core physiological imbalances, some of the biology underlying chronic pain and chronic illness, no matter what the issue is, there is this underlying biology, and how does someone like me think about it. So, you can kind of look at your situation and try to get some insight, and so it is a great question she sent in, because it evokes a piece of confusion a lot of people share, and so I want you to hear this and take it in so that you do not get confused by it. So, here is her question. Doc, what are your thoughts about the article that I have read that said that mononucleosis which is Epstein-Barr virus and herpes virus can be the cause of fibromyalgia. Look, she has fibromyalgia and chronic pain. What is going on here is very generalizable though. I am going to tell you why. So, what do you think about these viruses that can cause viral, and what about the effect of the hysterectomy I had due to bad endometriosis? So, if this is an individualized thing, how do I narrow down my own personal cause? And she goes on to say, “Oh, by the way, I have bipolar disease and PTSD and panic attacks due to physical and emotional abuse,” like wow, wow, like a heart- breaking complex situation, that is not this person’s fault, she has a real physiologic illness, and she has a lot of like social and emotional trauma going on. She goes on to ask more questions; doc, what are your thoughts about leaky gut and biofilms? Do I need to diagnose that and treat that? I have irritable bowel syndrome pretty badly, I am always feeling so drained and lethargic and exhausted, and you know it has been really hard, because I do not really trust my doctors anymore. A lot of them have treated me like I am a drug seeker, and you know not only do I have fibromyalgia, but I got really bad osteoarthritis. I am only 45. I have already had a hip replacement. I am going to have another joint surgery coming up. I hurt so bad every day that I feel like living like this is just not like living life. And so the reason this is relevant to a lot of people, not just with her sort of diagnoses is because it is a complex picture and her head is spinning around with all the different possibilities of, like what do I do next? And I hear that all the time, it is so confusing. You read all the stuff on the internet, and she is talking about biofilms and leaky gut and like what comes first? What should a person start doing? What I want to say is that the thing screaming at me from her case is the PTSD and the panic attacks, and the fact that she has got like an ongoing, really intense kind of psychiatric illness, and the issues with that are not just relevant to people with psychiatric illness. If you are someone who has had early life trauma or you have had traumatic experiences or if it is less severe than that. Suppose you are just like a normal person who does not consider yourself mentally ill, but you actually like noted, yeah, like I had that really tough experience when I was in high school or college when there was that breakup of that really close relationship where I lost the person I loved and cared about or I was in college and I was abused by my professor or whatever it was and right around then my symptoms started happening, or maybe it was that car accident that did not seem so bad or I had that surgery and then suddenly things started unwinding. Well, this is for you too, okay, because the thing that is so important is that people frequently overlook the incredible power of the mind-body connection, and I want to flesh this out for you a little bit, okay. –Next Slide– So, let us start off by looking at some of these slides just to understand, like how do these syndromes develop? And you will notice what I have written here, that many chronic debilitating problems share biological imbalances, whether it is chronic pain, fibromyalgia, abdominal pain, and leaky or irritable bowel like she had, fatigue, depression, anxiety, but also things like migraine, dementia, neurodegenerative disorders, neuropathy, autoimmune disease, chronic fatigue. There are underlying imbalances that drive these diseases and they show up differently in different people, and part of the problem and challenge of conventional medicine is that they are looking at the disease as the sort of here, the disease will tell us what the problem is. If they are not looking at the kind of person who has a disease and how this disease probably developed based on the more detailed history, and that is what we do in functional medicine. So, let us keep going on this here. –Next Slide– So, we try to identify and treat the underlying biological imbalances that give rise to all these different diseases as opposed to saying, hey for this disease, we use this drug, because that is the approach that often does not work for people, and if you have a chronic illness, you may have experienced that yourself. –Next Slide– So, identifying the underlying biological imbalance, how do we do that? We think about three things. We think about antecedents, the foundational issues in the person’s life or history that set the stage. We think about triggers, transient events that shift the system and create like a different reality, and then mediators, things that keep you sick, persistent underlying physiological imbalances, and so the antecedents and the triggers give us an idea of what the mediators that might be most important are in a given patient, and that is when we start thinking about treatment. –Next Slide– So, let us keep going and unpack this some more. So, antecedents are things like genetics, adverse childhood events or early life trauma, which can actually turn on the genes of stress in an overactive hypervigilant, mental/emotional system that is intimately connected with your immune system, your gut, and everything in your body. Illnesses or exposure, lifestyle, these are early life of things that set the stage of who you are biologically, so that when the trigger comes along and it could be a stressor, an infection, a trauma or a toxic exposure or a drug exposure, it could be a serious illness, and that creates a shift, and that shift sets up some kind of mediator. It could be a change in the immune system and a kind of onset all the time. Sensitization of the nerves or the brain, what we call central sensitization or peripheral sensitization, dysfunction in the mitochondria that produce biochemical energy, imbalance in the autonomic nervous system which is that stress relaxation balance that you are meant to have, but sometimes because of various antecedents and triggers, it gets locked into a locked-on position. Issues with the gastrointestinal tract and dysbiosis, hyperpermeability, malabsorption, classic things that go on with irritable bowel syndrome, and as you can imagine, all of these mediators can feed into each other, and so it is kind of like a snowball that is going down the hill or a river that is flowing downstream. It kind of gathers energy overtime, and that is why you may have had the experience of like, “Oh, yeah, that thing happened. I was not feeling too well, it did not really get better, or I got something that got better, but then something else happened, and then like it has just gotten worse and worse over years,” and I hear that everyday over and over from almost everybody who shows up with chronic illness and chronic pain. There was some antecedent, there was a trigger, then there are these mediators that perpetuate and roll downhill like a snowball or flow downstream like a river. –Next Slide– Regardless what your diagnosis is, whether it is any of these things. Frequently, there are antecedents, triggers, and mediators, and these diagnoses are like the outcome, they are like what happens when the actual end organ gets sick and that is when people tend to have symptoms and go to the doctor, but we know that when a person has a chronic syndrome, it frequently starts a long time before that. There is actually data showing with rheumatologic disease, like osteo or like rheumatoid arthritis or lupus that there is symptom onset, then there is positive lab tests and then there is when you get a diagnosis and that can be months or years before you get a diagnosis, and that process is typically going on for a while before the person even has symptoms. So, these are processes. They are not discrete events in time. A discrete event in time can trigger the process. That is part of what is important about understanding it and part of thinking through in your life, okay, like, what was I like as a kid? Do I have a family history of illnesses or diseases like this? Like what are my antecedents? What are the triggering events that seem to bring things on and make them worse? and start trying to understand, well what might the key thing be? –Next Slide– Okay, let us keep going. All right, the gut-brain immune axis. This is just key. You could broaden this, you can add the endocrine system, you can add other aspects of your systems, because all of the systems in your body are one system, but this is a place where the money is frequently. This is the place where the money is in terms of you understanding what the issues are for you and why you stay sick? So, we had had a growing development of lots and lots of data over the years showing us these incredible connections between your brain, your gastrointestinal system, and your immune system, and at this point, like every specialty has journal articles and research findings coming out all the time, talking about these relationships, whether it is psychiatry journals, rheumatology journals, cardiology journals, and general internal medicine. It is all about this. These are the underlying physiologic things going on, and conventional medicine has not had enough time to do enough research, to really put all of this stuff together in a way that satisfies, you know, sort of the mainstream advisory boards and collectives that get together and make clinical guidelines, because it is still fuzzy, but there is a lot of underlying science that gives us directions about what to do, and those of us who practice functional medicine are early adopters. We are looking at patients who are otherwise getting sicker and sicker, because conventional medicine is not helping them, and we are saying, okay, we do not have complete data yet, we never will. Not everything that counts can be counted. We do have pictures and patterns that are showing up, and when we do relatively safe lifestyle interventions, the risk-benefit ratio of treatment is pretty good. So, let us keep moving through, and let us think a bit more about this issue that people get mixed up on, right, because this patient in particular was asking me, well, what about what is going on in my gut or did I have a viral infection that stimulated my immune system? And the answer is, yeah, those things might be really important, but you have got PTSD, you have got chronic anxiety, you have got panic attacks, that means your stress response is on all the time, saying danger, danger, danger, and that is going to re-stimulate your gut, and it is going to re-stimulate your immune system. –Next Slide– Let us unpack this a bit. This is just a progress in neuro-pharmacology and biological psychiatry, right? This is a graphic of your brain and here is your gut and here is a blow-up of your intestinal tract, showing like the inside. We call this the lumen, and in the lumen here, all the bacteria that make up your biome, you got trillions of bacteria in your gut, and they are not just hanging out there living the life. They are helping you metabolize food. They are producing metabolic products that are circulated into your system and affect all of the tissues, especially your brain. They are modulating and moderating the immune system that is living in the walls of your gut and that is in turn affecting your entire system. Chronic stress has all these neurologic pathways, by which it affects the gut, and it affects the biome and changes the biome. It is when the biome changes, for instance, certain shifts in the biome can create toxic metabolites that go to your brain and create anxiety, bipolar disease, panic, depression, and perpetuate that. There are also biochemical pathways, like the hypothalamic-pituitary-adrenal axis. Cortisol also influencing the thyroid axis that feeds into the gut biome situation, and from there, what is going on in the gut biome and what is going on with the integrity of the wall of your gut feeds into the overactivity of the immune cells that are living around there, and that gets systemic, and they produce pro-inflammatory cytokines, inflammatory chemicals that go to your brain and feed the issues. So, this is a loop of interaction between your brain, your gastrointestinal function, your biome, your gut barrier, and the immune function of your entire body. So, that is why people are thinking about dysbiosis and leaky gut and biofilms, that is why people are thinking about viral infections as issues or triggers that cause these chronic disease processes, because they set off this system, but that is why you also need to be thinking about your mind-body connection and the balance of your autonomic nervous system. –Next Slide– Here is a cartoon that just looks at this, like barrier dysfunction, leaky gut, intestinal permeability thing. These are all kind of different words for the same phenomenon depending on who you are talking to, but here is your normal gut. You got these junctions between the cells of your gut that keep the bad stuff inside and absorb the good stuff, so that you absorb nutrients, but you keep the bacteria in your gut, and you remove the waste products. So, along comes stressors, toxic exposures, infections, various kinds of things and create change in that biome and create leaky gut or intestinal permeability, and you have got stuff leaking through, and your immune system that surrounds the gut and your vasculature, your blood vessels that surround the gut, are exposed to all sorts of stuff, that can be incompletely digested food, that can be bacterial components that generate a big immune response systemically, and that is part of what drives the chronic inflammation that drives chronic illness and chronic pain. I hope you are starting to see the picture. –Next Slide– So, let us keep going here. The last element of these changes that happens is so relevant to this particular person who had irritable bowel and fibromyalgia, which often go together and there is a reason why, and this is it, right? Because that cycle of overactive stress response that affects gut function and dysbiosis and leaky gut and overactivity of the immune response creates peripheral and central sensitization, that means the nerves are overactive, that means everything hurts in your brain. It can also mean brain fog, it can mean more anxiety. It is a neurological overactivity, because the brain has too many excitatory chemicals. In the gut what happens is the actual nerve endings get sensitive and the actual function of the motor system that makes your gut very carefully move the food along gets either overactive or underactive. You get constipation/diarrhea or diarrhea/constipation, depending on the kind of irritable bowel that you have got going on, but that is part of the problem, stuff is moving through too fast, you are not absorbing nutrients. –Next Slide– So, what do we do about all this? Well, I have talked about this before, and this is the way I think. I think about these three domains. I call them the three Ms; mind, movement, metabolism. Mind is your mind-body relationship. It is the fact that between your ears, you have a capacity for free choice, you have a capacity for mobilizing your mindset, your thoughts, for transforming emotions, for actually shifting your physiology, and this is real science, it is not kumbaya, goofy, goofy, floofy, floofy. It is real physiology of how mind-body training and how mind-body techniques and the right kind of therapeutic tools shift your physiology. Your movement system is your musculoskeletal, neuromuscular nerves, the way that you move in space, your body was made for movement, and that shifts everything too. Exercise is the best medicine going. You got to just know how to do the right stuff for you, and then your metabolism like we are talking about, what is going on with the gut, the immune system, the hormone system, the neurotransmitters, all that biochemistry, and there is ways to think about all of these things and treat them with lifestyle. –Next Slide– So, like, all right, these are important things, right? Metabolic/biochemical, that is this part, metabolism, right? These are some of the things we work with, your diet, you know working with food sensitivities, the right nutrients, low antigen, high polyphenol diet. This is a whole lecture obviously just to talk about this, supporting the adrenal system. There is an off-label medication that I use a lot called low-dose naltrexone, because it gently shifts the immune system and enhances certain biochemicals that enhance well-being and block pain and then there is healing the gut. There is ways to treat dysbiosis and leaky gut. There is ways to treat biofilms, which can perpetuate dysbiosis. –Next Slide– And then the movement or mechanical system. Movement is medicine, it can be healing. If you are sedentary because of pain, because of joint injury, because of obesity, because every time you do exercise, you get wiped out because you have got chronic fatigue or fibromyalgia, you need to find a way to exercise that works for you, and I guarantee there is a way. I have worked with so many people who have felt like, I cannot move, I cannot do anything, but then you teach them in the right way, how they can learn to move, start where they are. Accept the current limitations and build and build and open your envelopes that you get stronger, more flexible. Build your endurance while you are doing these other aspects of healing, and obviously, there is aerobic exercise, stretching, strengthening. But most importantly potentially, especially if you are chronically ill, is mindful movement arts, whether it is yoga or tai chi or chi-gung or Feldenkrais. These are approaches that are really about helping you bring your awareness into your body. So, you are actually directly aware, you can bring compassion to yourself, you can learn to move from the inside out, as opposed to some kind of no pain, no gain thing, which just flares you up and makes you worse. –Next Slide– Okay, but here is the whole point of this talk. The real thing I want you to take home that is so important is, yeah, we have got all these different issues that give rise to these illnesses, but autonomic imbalance is huge and people do not like to recognize it. We do not want to think there is something wrong, right? And part of it I think is because so many people have been stigmatized, accused, humiliated, and otherwise dismissed; oh, you are just anxious, blah, blah, blah. I am not talking about that. I am talking about the fact that your state of calm versus anxiety. Your state of autonomic balance or imbalance is fully integrated with the underlying biological processes that give rise and perpetuate your chronic illness and your chronic pain, and if you do not address that, it is just like you are not addressing your gut imbalances or your hormonal imbalances. The fact that you are sedentary or the fact that whatever it is, it is one complete system and you really need to address the autonomic imbalance.The good thing is, there are ways to do that, there are so many techniques and tools and technologies. –Next Slide– Let us talk more about that, and I just want to like another little diagram here, right? You have a state of mind and consciousness, it is your mind-body state, and it is the way you are in relation to yourself, and that influences everything. It influences your pain pathways, it influences your brain function, your immune function, your cellular energy production, your relationships and roles with people around you, which influences your happiness, which feeds into the whole system. Your motivation and self-care, like are you doing things that nourish you and heal you or you are doing things that feel good in the moment but actually make you sicker, like eating the wrong food or using substances that create transient feeling good, but in the long run, feed into your illness process, and then of course like your whole gut barrier biome motility. Your gut-brain axis is so powerful, and if you are not doing this, you are missing the boat, but on the other hand, when you start to open your mind and start to learn tools, then you are pulling all this stuff together and you can start creating a more healing state. –Next Slide– I just want to emphasize this a bit more than chronic illness and chronic pain, your body believes you are in danger. There are biochemical, physiologic, biological, mental emotional signals that perpetuate that message. Whether it is life stress pain, trauma, immune dysfunction, toxin, drugs, acute illness, surgery, or the pandemic crisis that is going on, and all of the social difficult stuff going on, it all creates a sense of, you know, and it creates a vigilance, right? And that vigilance that you might experience mentally and emotionally is so to speak being experienced by yourselves, and that is part of what recent science is showing us, that our biology has a danger detector, our immune system has danger detectors, our mitochondria are danger detectors, and there is a cellular protective response, that is kind of like circling the wagons. The cells stop producing so much energy, they stop producing as much DNA and protein synthesis which they need to survive and thrive. There is activation of the immune system, hypervigilance, and decreased cellular communication, and that feeds into the danger response, and it gets stuck there, and the question is, how did you shift that? We treat all the physiology, we get you moving, sleeping, doing all those healthy behaviors that are so important, but there is activating the biochemistry and neurology of safety, and that is your mind-body connection. –Next Slide– And one little other thing just to keep in the back of your mind is that your brain has got three sort of functional aspects. These are not anatomically separate, but they are kind of anatomically different, right? There is your neocortex which is like your thinking psychological brain, and then there is your limbic system which is your emotional brain, and then there is your brain stem which is like your physiologic cellular influencing brain, and they are so integrated, but there are distinct things that you do to address those different aspects, and so, talk therapy like CBT is great, it helps you think better, but it does not necessarily get at your limbic system unless your therapist happens to be super talented and also work in things to connect with you on that level, and that does not necessarily get into your body unless someone is teaching you some kind of body awareness, body calming, mindfulness, somatic experiencing, EMDR. There are various techniques. Internal family system. There are different tools that you can learn, that you can do by yourself, or if you need the help, you get help from someone who helps you work through it and learn how to do it and learn how to hold you in that space, so that you can hold your own being in that space of safety, and that sends that cellular signal, and bit by bit, that is how you heal. –Next Slide– In my eyes, there are six steps to mind-body healing: relaxation, mindfulness, body awareness, insight, like developing your inner maps, you understand what is going on in your inner and outer world. There is activating the power of your heart and soul to heal you, but to generate positivity and love and compassion and caring and to actually connect to the higher aspects of your own being, which are there to heal you and that is part of what transforms you. So, this is a huge topic. I will be talking more about it. If you have not subscribed to the YouTube channel, do it, and you can also sign up to get on the email list, so that you are part of my email community. Get notified when new posts come out, and you know, I am constantly putting stuff out there in terms of mind-body healing as well as these other aspects of healing. Some of it is free, in terms of free sessions we do online. Some of it is more in-depth and more developed and really helps you build skills overtime, and so you are invited to keep tuning in. Send your feedback, I would love to hear it, and I am wishing you all the best for speedy healing. Take care.

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Don’t Miss These 3 Things That Can Prevent Healing from IBS, Fatigue, and Chronic Pain: Part 3b

Posted on December 23, 2020March 3, 2024 by Andrew David Shiller, MD

See the other parts of this lecture series here:

Part 1

Part 2

Part 3

Summary:

Your Mind-Body connection is almost certainly part of what drives your IBS, chronic pain, fatigue, or chronic illness. You can mobilize your mind-body connection to help yourself heal. One of the most common mistakes that I see people make is to do all the dietary, nutritional, and exercise stuff, while they don’t adequately take charge of the power of their mind-body connection. This lesson answers crucial questions that you should understand, if you want to heal:

How does the Brain-Immune-Gut-Hormonal integration create and perpetuate chronic illness and chronic pain?
What is the influence of the vagus nerve on all this?
How can you stimulate the vagus nerve to start reversing the disease process?
Why should you care that your brain and stress-response has cognitive, emotional, and physiologic aspects to it’s function?
What is the cell danger response, and why is it important in your healing process?
What are the six steps of mind-body healing?

In the near future, we will talk about the healing power of movement. Even if you feel too tired, weak, or have too much pain to move, there are things you can do to build your freedom and capacity for movement. And movement is one of the best medicines we know! Please comment or reply and share your thoughts, questions, and comments. I look forward to hearing from you. Scroll down for full transcript SLIDE PDF so you can take notes if you want.

Did You Know:

Dr Shiller is responding to the chaos and overwhelm of the corona pandemic by offering regular free stress-busting mind-body training sessions on zoom. You can get the schedule and register at www.mindbodygroove.com
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.

https://youtu.be/rCPvoRim_mw Stillness In Nature Mirrors The Stillness Within You
https://youtu.be/PGzBt2szass Stress Response Basics
https://www.drshiller.com/4-keys-to-a-mindset-that-can-transform-your-fibromyalgia/
https://www.drshiller.com/heal-pain-mindbody-wholeness/
https://www.drshiller.com/heal-fibromyalgia-pain-inflammation-fatigue-mindbody-healing/

Full Transcript:

Welcome back my friends, it is Dr. Shiller. This is part B of a long video that is talking about the complexity of chronic pain and chronic illness and really discussing an overview of the three-part healing process of addressing your mind-body system, your metabolic biochemical systems as well as your movement and structural system as three essential aspects of really taking a big picture of holistic view and that is where the therapeutic leverage is in the integrated approach, because by and large conventional medicine is looking at all these different problems as separate things as opposed to understanding the big picture and realizing that the various symptoms are flowing out of similar underlying physiologic abnormalities or imbalances and then you can address those imbalances, and so this is really, these two parts are the first part of how to really heal, and in part A of this one, we talked about kind of the scientific underpinnings of mind-body medicine and why it is so important, not only why your mind-body connection is so important in the development of chronic pain and chronic illness, and why it is so important in actually transforming and healing chronic pain and chronic illness, and what we are going to do in this video right now is get kind of an overview of the landscape of mind-body healing and understand some of the different elements and understand the rationale about why you do it, and to get a bit of insight on some of the things that people miss when they are first learning meditation or visual imagery or other sort of mind-body approaches and how to really take a big picture of view so that you not only enhance your comfort but you transform the illness process in your body, in your mind, and in the integration of mind and body. So, I hope it is informative and inspiring and interesting. –Next Slide– I want to take this question of relaxation, mindfulness, imagery, and therapy, and how it impacts your mind-body state, your state of consciousness and just review for a second the ways that it can impact your health and have a huge impact on how you are feeling, and we have talked about this about how pain pathways are altered, how brain function can be altered, how the immune function can be changed for better. We did not talk so much about this yet, but energy production by yourselves, your state of consciousness is what determines how you do in life with the people you care about, with the person at the bank, with the police officer who reports you are speeding, with all the things that we need to deal within the world in our roles and in our functioning. If I am going to place a calm and clarity where I am present to my own self, I am present to other people, then all of that stuff goes better, and I can tell you that from my own experience. I was like an anxious, weird, introverted kid when I was a kid, who did not know how to pay attention to myself or other people, and I was kind of a dork, like it just what it was. I was not a smooth person. A lot of people did not like me. I had a lot of challenges interpersonally. Not a lot of challenges in various aspects of what I was doing in life, and when I learned to get quiet and calm and actually start to live from a deeper place in my own being and start to live with more empathy for myself and more for other people, my life changed profoundly, and guess what, my relationships are not as stressful. Our relationships tend to be harmonious and positive, and I am not saying that to say I am so great. I am saying that to say that anyone can do this, and so many of the people that I have trained than other people who have trained, people who have learnt to actually find a state to calm themselves, learn how to navigate through the world to flow with the challenges when the wave comes, to ride it like a skilled surfer or dive underneath it, because of awareness, because of skill and self-management. Motivation and self-care. It starts with you, it starts in your hearts, it starts in your soul. Are you eating stuff that is actually good for you or you are eating stuff that feels good in the moment, because you have got a lot of stress and emotional anx and you are eating sugar and bakers and saturated fats which tastes so good. There is a reason they call it comfort food, but the fact is, it destroys your body, it feeds into and poisons so many of your systems, and the same thing about alcohol and other substances, and on the flip side, exercise and self-care, whether it is going for a walk, doing something pleasant that feels good, doing exercise that feels good. These are the things that actually shift your physiology for the better, and they can actually have a huge impact on your health, and that starts with where you are at, what your state of relationship with yourself in the world, and we have talked a bit about gut barriers and motility. So, all of this obviously connected, you are one unity. –Next Slide– I want to step back and think a bit more about the science again, and you basically have three functional areas of your brain, right? You have got neocortex, that is the thinking part of your brain, you have got your limbic brain is your emotional brain, your arousal brain, your stress response happens here. All of your emotions and all of your sensory step is processed here and go to your reptilian brain. Core biological functions, like blood pressure, heart rate, influences on immune function, gastrointestinal motility and function, and so when these things were first started to be evaluated, they used to think, “Oh yeah, these were strictly anatomically distinct areas and that turns out to not be true, that there is processing that goes on at these three levels, and they are different aspects of how you process reality, but their functions, they are not anatomically distant, and if you look up the triune brain, we will see this like progression of the science over the past, I think 40 or 50 years, how initially they thought it was anatomic and evolutionary and like embryonic, but the fact is there is so much interconnection. It is all one brain, but you do have these different kinds of functions and to the extent that you are aware that you got an intellectual, rational processing brain as well as an emotional, reactive brain, as well a biological and body physiological brain. You can better understand how your mind-body connection influences your health, because it influences all three levels. So, let us unpack that a little bit, because this is one of the places where people frequently fall down. I do a lot of training for people in mind-body therapies and healing. A lot of people come to me, “Dr. Schiller, I have been doing all this meditation, it is great. I go to this deep relaxed state and I feel so good. I do not have pain when I am there, but then I come back and my pain comes back or whatever the symptoms,” and you know my sense of what is going on is they are getting some degree of limbic quieting there, and they are getting some mental emotional quieting there, but they are not really getting that quiet into their body and [07:26] healing, what their body is holding on to in terms of self-protective responses, and a lot of times that person who is doing those meditations where they go up and out, they go into some sort of expanded God’s space or some sort of spiritual, energetic, expansive space, but then when they come back into their body, they are the same old person, and so they have their pain, they have their interpersonal conflicts, they get really angry with their kids or with their spouse sort of, they cannot function on their job because they hate their boss. It is because they are soft of disassociating in a certain way, and it is great to achieve that level of calm, but it is really important to bring that calm into the body and allow to start to change you and shift your instinctive, instinctual reactive patterns that come out of your heart and you are in body consciousness and memory. The way I understand it after practicing for 20 years and studying all the science is that a fundamental question that your whole body is asking all the time, whether it is your cortical or mental thinking, your emotional processing or even your physiology is are you safe or are you in danger? And that is a huge thing, because on a physiologic level, let me just unpack this, but like here are things that make us feel not safe, things that make us feel like we might be in danger or we are at risk of something bad happening, things like life stress, pain, trauma. Pain goes into every aspect of your mental, emotional, physiologic functioning; immune dysfunction and inflammation does as well. Toxins and drugs influence everything. Acute illness, surgery, or being in the midst of a pandemic influences every aspect and creates a danger signal. Your entire being is a danger detector. If our human being is not aware of danger, then you have a risk of actually getting hurt or killed. Think about primordial human who is out there in a jungle looking for mangoes, and he is looking for mangoes and he is so into mangoes, he is not even thinking about the tigers that he knows lives in the jungle, because he sees the mangoes, really there is a tiger hanging out there. If he does not see the tiger, he is going to get eaten. If he is focused on the tiger and he misses the mangoes, he can go looking for mangoes tomorrow, but he will not get eaten hopefully if he knows how to defend himself from the tiger, but the point is that we naturally have a bias towards danger and negativity, because it is protective, and we have protective responses that are built into our neuromuscular system, right? You touch a hot stove, you have a reflex that withdraws your hand, you do not have to think about it. You have reflexes throughout your body at every level of your spine in terms of your neuromuscular system, and you have got protective responses in yourselves, in your immune system. Your immune system in general is a protective response. If they would stand at the gate and say ‘friend or foe’ and to keep the bad guys out and let the good guys in, and so the danger detector is in the level of our consciousness, which I will start right correctly later, it is in our immune system, it is our structural system, and it is our biochemical system, and we have cellular protective responses. This is kind of a new thing that is showing up in biology and metabolomics, which is kind of the study of broader cells in the context of all cells, which is systems biology approach, and more and more we are seeing that they are these protective responses on a cellular level, that cell seemed to be able to shut down in response to danger, and they shut down their energy production, they can shut down communication with other cells, they can create a state of hypervigilance and immune activation, they have reduced their actual production of DNA and cellular reproduction,. So, on an actual cellular level, your body can start to shut down when you have persistent danger that it is exposed to, whether it is through your consciousness and your understanding and something dangerous in the world, whether it is immune activation, whether it is structural trauma or something that is happening physically to you, or whether it is biochemical trauma or biochemical changes that are dangerous to your body. You know, we are starting to see that the immune system has these sort of cellular and protein patterns that are called basically danger detectors or damage associative patterns. I do not want to go too much in that detail, because it will fit people out, but the point is on a cellular immune level we are wide for danger, and that protective response becomes part of what is dangerous to us, and the protective mode that develops is probably part of what maintains chronic illness, whether it is psychological protection or limbic emotional protection or physiologic cellular detection, just going to that brain diagram or there is like the stuff you are conscious of and thinking about. Then, there is a stuff that emotional you, just reacting to, whether you are aware of it or not aware of it. Then, there is stuff that your biology is reacting to, and most of us are just not aware of that at all, and so healing depends on bringing this whole system a sense of safety and a sense of calm and a sense of “Hey, it’s okay to be me,” right? –Next Slide– The protective mode is the problem, and what I encourage my patients to do and what I encourage you to do is learn to bathe your body and your mind in the biochemistry of healing, and there is a number of steps to that, and the typical mind-body interventions of relaxation and mindfulness and visual imagery and therapy are part of it, but it is a deeper more compressive thing that we have learned how to measure, but it is an experience that many people can have, and when you have it, you know it. You know what is like to be bathed in a sense of, it is okay to be mean right now. You feel it in your body, you feel it in your bones, you feel it in your heart and you know it in your mind, and the question is and the incentive is and the imperative is to learn how to cultivate that state of being and to learn how to get back into it whenever you need to, and to learn to make it part of your lifestyle if you have a chronic illness or chronic pain, so that your bathing your body in the biochemistry of healing that you are giving a signal to the protective responses in your intellect, your emotions, and your physiology to say, “It’s okay, it’s okay, we can get back to life” and that is how we get back to life, calm, safety, connection. Connection is huge, right? Connection is huge. Connections, what it is about? Positive emotion, turning off the danger response. –Next Slide– So, I have come up with what I call six steps of mind-body healing. I am not going into the details of this right now, but I want to give the overview of that, and I will talk about it again at another time if people are interested, but the six steps are relaxation, mindfulness, body awareness, and then inner insight, as well as developing heart and soul power and transformation. It is all about turning off the danger response. Let me just unpack these a little bit for a second. Relaxation is relaxation, that is the physiology that we have measured. Herbert Benson in the 70’s started measuring the relaxation response, and all this stuff is being built on his research, and it is amazing what he did. He is a cardiologist at Harvard Medical School. The relaxation response is a physiologic, low metabolic state that enables your body to start healing. Mindfulness is a state of mind. Mindfulness is a way of paying attention on purpose in a particular way to your present moment experience, to your thoughts, your emotions, your bodily sensations, and if your are inclined that way to your spiritual sense, and it is a way of learning to see what is really going on in your life. Learning to see how your own mind-body connection is operating, so you can make better choices of it. Body awareness is actually just what it says, being aware of your body. Most of us are walking around like more connected, you know, disconnected from our neck up or busy going, going, doing, doing, we think about our body when it starts to scream it is with some sort of symptoms, but body awareness by bringing your attention to your entire body and feeling it and bringing it a calm state of mind is profoundly healing and that can be done by sitting or lying down meditation. It can be done by simple movement arts like tai chi or yoga, Feldenkreis. Pilates has a lot of body awareness. There is various other approaches that can be done with tremendous body awareness and are tremendously healing. It is about inhabiting the body. It is about bringing your mind and your soul into your body with consciousness. Insight, inner map. Insight is part of what comes out of mindfulness and it comes out of body awareness. An insight comes from relating to your own being with awareness and compassion, and most of us are so full of judgment and self-doubt and self-hatred, and it happens because we get those messages at an early stage in life. It can happen because you are sick and because your body is not working like it should, your mind is not working like it should, and it is very easy to say, “I hate myself. I hate what I become. I hate the fact that I cannot do: ABCDEFG,” and what is the “I” and what is “the self”? What I want to suggest from a Torah and Kabbalistic point of view is that you have an eye, which is your higher soul. It is a deep intelligence that is not limited to your body, and when you start to reframe I hate myself and to connecting with your deeper I, your deeper self-awareness, the place of deep self-acceptance, or you actually see what is causing things and you have compassion on yourself, and it is something you develop overtime and you see the aspects of what is not right in your life, and from that place, you are so much more empowered, they actually make positive changes. Because if you are relating to all the challenging things with self-hatred and self-doubt and self-blame, then you are creating and feeding into that stress access, you are feeding into that anxiety, depression, and misery access, and when you connect to a deeper level of yourself, that is insightful and aware. What we start to do is actually see where you can intervene in an intelligent and compassionate way in your own reality to make positive choices. The next one here is heart and soul power. It is about [18:36], and that means waking up love. It means waking up compassion. It means waking up higher insight. These are really hard things to measure, but they are not hard things to feel if you feel it. Part of what we do in the meditation training I do is we awaken heart energy, and awakening heart energy is something it has been done in every spiritual tradition through all human history until ours. It is starting to happen in ours through apps and, you know, things people do in hospitals, but the point is that you can develop the energy of love in your heart, and your heart is not just a pump, your heart is a system of nerves and endocrine function as well as this is a pump that pumps your blood, but it is profoundly integrated with your brain, and your heart influences your brain and it influences your entire nervous system, and I can guarantee you that as you generate the heart energy of loving kindness and compassion, you will begin to shift your physiology, shift your emotions, and shift your thinking process about yourself and your world and for the better, and the last thing is transformation, and transformation happens when we take our body physiologic responses and our emotional reactivity, and we start to draw our higher faculties of heart and soul into those places, and that is profoundly transformative and beautiful. So, obviously all this needs to be unpacked. A lot of it is experiential and talking about it does not give it to you, but talking about it can give you a sense that it exits, and what I hope that talking about it will do is encourage you and empower you to start looking, start looking for how you can develop relaxation and mindfulness and how you can develop body awareness and compassion and insight and develop the powers of your heart and soul to heal yourself and to transform the pain and the suffering that you are living in. –Next Slide– So, I want to close with just sort of an observation that kind of sums a lot of this up. Somebody I know recently said, he was like, it is great that science has finally seen all the connections between these different things, we were talking about integrative medicine. Yeah, the connections between your heart and your mind and your gut and your immune system, science has started to see the connections, and I agree within its core. Science has seen the connections, but my sense is that reality is different than what science understands. Science is powerful. I am a scientist. I studied scientific method, I really believe in science, but we have to know that science is limited. Science is like a light that we shine on reality and we learn specific things about reality based on the scientific tools that we have for measurement and for analyzing the doubt that we get, and it does not enable us to understand all of reality, and for sure it does not enable us to understand the complexity integration of a human being, and especially human beings in relation to other human beings, the society. It is just too big and too complex and science is not there yet, and I would take this I do that science is finally finding all the connections and turned upside down and saying that science is starting to discover the fallacy of the idea that there is disconnection, because if I am starting to see connections, what I suggest to me that you know what? My heart and my gut are different things, and my heart and my immune system and my brain and my immune system are different things, and on a certain level they are, but you start as one drop of water, and you can become two, you become 4 and 8, 16 and 32, 3 trillion cells, and the fact is the amount of connectivity starts when your one cell, where everything is connected to everything else, and as you develop, everything stays connected. It is not like it is disconnected. You know, for sure, your heart has a different function than your digestive tract, but those functions are so profoundly interconnected, and one of what I suggest and invite people to move towards as there are starting to dive into and learn and practice mind-body self-healing is to experience their integration, experience their connection, experience that life has a unity to it, that you have a unity to it. If this is abstract, then it seems kind of weird too, that is okay. You do not have to believe it. My suggestion is just start, start to develop relaxation and calm, start to develop mindfulness, start to develop body awareness and compassionate awareness and insight, start to develop the power of your heart to transform your body and start to live. So, there are lots of ways to learn these things. I am going to keep talking about these things in other videos. Please feel free to share this with other people and thanks a lot for watching.

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Don’t Miss These 3 Things That Can Prevent Healing from IBS, Fatigue, and Chronic Pain: Part 3a

Posted on December 22, 2020March 3, 2024 by Andrew David Shiller, MD

Click HERE to watch part 3b.

Summary:

Your Mind-Body connection drives the ongoing process of IBS, chronic pain, fatigue, or chronic illness. It can also be your greatest strength in helping heal these and other difficult chronic problems. Despite what many people say, there is hope for healing Irritable bowel syndrome, fatigue, chronic pain, and other chronic illnesses so that you can live a satisfying and meaningful life. One of the keys to healing, is to understand the complexity of these syndromes, and the underlying biological imbalances that give rise to the symptoms. The first two posts in this series talked about the systems-biology model of chronic illness. They show you how these syndromes of chronic pain and illness arise from the integration of your body-wide-brain, digestive system, immune system, hormonal system, and so-on. These are the principles that have helped me to help many people who were thought to be helpless. A word of caution: if you learn this stuff, you might know more than your regular doctor about it, so be careful. This post is going to help you understand why and how you can mobilize your mind-body connection to help yourself heal. One of the most common mistakes that I see people make, is to do all the dietary, nutritional, and exercise stuff, while they don’t adequately take charge of the power of their mind-body connection. This lesson answers crucial questions that you should understand, if you want to heal:

How does the Brain-Immune-Gut-Hormonal integration create and perpetuate chronic illness and chronic pain?
What is the influence of the vagus nerve on all this?
How can you stimulate the vagus nerve to start reversing the disease process?
Why should you care that your brain and stress-response has cognitive, emotional, and physiologic aspects to it’s function?
What is the cell danger response, and why is it important in your healing process?
What are the six steps of mind-body healing?

In the near future, we will talk about the healing power of movement. Even if you feel too tired, weak, or have too much pain to move, there are things you can do to build your freedom and capacity for movement. And movement is one of the best medicines we know! Please comment or reply and share your thoughts, questions, and comments. I look forward to hearing from you. Scroll down for full transcript SLIDE PDF so you can take notes if you want.

Did You Know:

Dr Shiller is responding to the chaos and overwhelm of the corona pandemic by offering regular free stress-busting mind-body training sessions on zoom. You can get the schedule and register at www.mindbodygroove.com
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.

https://youtu.be/rCPvoRim_mw Stillness In Nature Mirrors, The Stillness Within You
https://youtu.be/PGzBt2szass Stress Response Basics
https://www.drshiller.com/4-keys-to-a-mindset-that-can-transform-your-fibromyalgia/
https://www.drshiller.com/heal-pain-mindbody-wholeness/
https://www.drshiller.com/heal-fibromyalgia-pain-inflammation-fatigue-mindbody-healing/

Full Transcript:

Hey, my friends, welcome back. We are talking today and then continuing to talk about three things that you should not miss in healing, fatigue, irritable bowel, chronic pain, and allow the symptoms that go along with or can be associated with those things. Today, we are going to get into the nuts and bolts of like, okay, how is the person actually healed? What do you need to do and what do not you want to miss? So, listen up to this. We are going to focus today talking about your mind-body system and how foundational it is to your healing process. So, a little background, the first couple of videos really talk about the complexity of your health and the complexity of disease and the different underlying physiologic imbalances that give rise to it, and we talked about a particular case. We talked about a guy who I saw. His name is Robert. He is in his 40s. He is a great guy, intelligence, sweet, motivated, really wants to do good things with his life, but he has completely stuck and cannot function. He has got so much abdominal pain and digestive symptoms that he cannot leave the house in the morning, he is fatigued, he can barely do stuff until the afternoon. He has got increasing anxiety. Lately, he has been sleeping so well at night, and he really feels like life is getting away from him, and he is not accomplishing what he wants to accomplish in life. –Next Slide– Okay, so here is Robert’s case, like I just shared about what was going on with him, and to give an overview of what I developed in those first two videos, which I really encourage you to watch, they go into a lot of depth and it really might illuminate a lot to see those first two videos about how to understand all these things [01:36] you, but as an overview, okay. Your mind is more or less the main place that you perceive stress, danger or challenging circumstances as a profound impact on your body, and why? One of the main things is that connection of your brain and your gut. There is something called the gut-brain axis that we have known about for centuries and centuries, a lot of the early philosophers talked about, all disease starts in the gut, and science is starting to finally figure that out and pretty much every professional journal, every professional specialty is talking about gut-brain axis as it relates to diseases in rheumatology and psychiatry and orthopedics in everything, and one of the main ways is that we have got this gut-brain axis. When a person has stressful, dramatic, difficult experiences, some of the changes that we see are dysbiosis which is a change in the actual biome of what is living in your gut, something called increase intestinal permeability as well as the tendency towards more inflammation, both locally in the gut and systemically. It gets more complex than this, right? Because those changes affect the immune system and you can get dysregulation of the immune system, that can show up in a lot of different ways, and again whether it is allergy, autoimmune disease, chronic illnesses that have an immune component, chronic pain which is related to immune disturbance or a variety of other clinical issues, immune dysregulation is part of that, and we are more and more seeing that the gut is part of which drives that and that an immune dysregulation feeds back into the gut. Oxidative stress is the shift in fundamental metabolic processes or biochemical process that happen all of yourselves that is related to immune dysregulation and again it is a two-way street where they affect each other and immune dysregulation feeds back in your brain. When a person gets a virus and feels sick and tired, it is because immune chemicals are circulating from the immune system, fighting that virus or infection and they go to your brain and they make you like lie down and sleep so you can heal, but what happens when the immune system is chronically dysregulated as you get this chronic impact on the brain, which can affect things like brain fog, energy, cognitive status, and brain inflammation, which can do a lot to make you sick, and then what is going on in your brain feeds directly into your immune system. One of the biggest stimulators of your immune function is acute stress and that actually empowers immune function, and one of the biggest things that impairs your immune function is chronic stress. So, again a two-way street of relationship, and then immune dysregulation has an impact on pain transmission, and we learned about how pain is not just like an electrical wire, it is an electrochemical flow of inflammation from the place that hurts to the part of your brain where you experience it, and your volume can be turned up, and then pain in itself could actually affect immune dysregulation, and that is intimately connected, what is going on in your brain and stimulating your stress response and feeding into all of this, and your cellular function, the core level of yourselves, your cellular energy production, metabolism, and DNA synthesis is influenced by immune dysregulation, influenced by stress and mind-body issues and influenced by what is going in your pain transmission system, and so this is a web of relationships. It is a cycle of relationships that evolve to protective you but frequently is what keeps you sick, and so that is what we are going to start about, talk about unpacking. So, let us like get some more layers here so that you can understand what I am talking about. –Next Slide– So, we talked a bit about the way we think about things in functional medicine as compared to conventional medicine. We think about antecedents, these were like early life stuff that set the stage. Triggers, transient events that happen in life that can shift the system, and then mediators, persistent changes in your biology, your biochemistry, your immunity, your gut function, stuff that like perpetuate and keeps you sick. So, antecedents like genetics and early life stress or trauma; triggers like stressors, infection, drug or chemical exposure; mediators, stuff like dysregulation of hormones, not sleeping well, stress and anxiety that persists, immune dysregulation, the fundamental things that go on in irritable bowel, like pain, dysbiosis, malabsorption, inflammation. These feed into your whole system in social circumstances, and all of these changes become like a process that flows downstream overtime. Disease does not just happen. It develops over the course of months and years, and frequently there is a trigger that takes your underlying situation and shifts it, and so it starts to shift the process that perpetuates, and that is why so many people seem to have a kind of a chronic thing that develops after they have some sort of injury, illness, toxic exposure, stress or whatever it is, and then they just keep getting worse, and they go to various doctors who were treating things individually, like, oh, you got this symptom, that symptom, that symptom, but they are not looking at the underlying issues. So, we are talking about treating as much as we can going upstream, getting at the underlying issues, unwinding the cycles that make people sick and that keep you sick. –Next Slide– Okay, so like we are talking in the case of this gentleman who saw me, who has got irritable bowel, who has got chronic abdominal pain, who is not sleeping, who is got anxiety, and who is got probably some degree of chronic inflammatory stuff going on, because it is irritable bowel or association with it, and he also has hormonal dysregulation, where his normal production of cortisol is not like it should be and it is low in the morning. These are what is going on in him, but the issue that I want you to see in this slide is that those can be underlying so many different kinds of problems. So, if you have got chronic pain or fibromyalgia, abdominal pain, fatigue, depression, anxiety, migraine headaches and neurodegenerative diseases like dementia, Parkinson’s, multiple sclerosis, neuropathy where your nerves get sick, autoimmune diseases, chronic fatigue. These share common underlying physiologic imbalances, some of which we have talked about in this case. –Next Slide– So, what you are going to do about it? You probably heard me talk about the three Ms, right? And this is just what I have come up with over 20 years of practice as three handles or windows through which you can come or look at your system and you need to address off three of these, and if you miss one or two of these, you frequently are not getting at the complexity of what is going on when you have a chronic illness or chronic pain. So, obviously mind is your mind-body connection. Movement, your movement system, metabolism is all of your biochemistry, your immune system, your hormones, all of that, and these all interact with each other, that is why these circles are intersecting, and what is really happening is right in the core of it, where everything comes together, and to my perceptive, you have also got spirit, you got an aspect of your being that is beyond measure, that is beyond what science can put a finger on, and pretty much almost everybody in the world senses that in some way, and that is part of what influences everything too, because it might be part of what integrates everything. –Next Slide– So, let us go further and talk about this. I am not going to try to talk about all three Ms today. I am going to kind of run through the metabolic biochemical stuff and run through the movement, mechanical structural stuff and spend more time on the mind-body axis, and then we will talk about those other two in more depth and we will drill down into those in the later videos. So, metabolic/biochemical, what is relevant for Robert who has got the condition we talked about or first of all diet, food sensitives, nutrients that can actually reduce irritability of the gut and low antigen diet that is full of antioxidants that actually tends to irritate the gut less and can help reduce inflammation and few radicals which produce oxidative stress. We are giving some adrenal supports and botanical substances that have actually been shown in research to support mood, energy, and to have an influence on that hypothyroid pituitary adrenal axis, which is involved in our chronic stress response. There was a substance called LDN or low-dose naltrexone that I use with a lot of people with chronic illness. It is worth reading about and understanding. It an off-label use, but very common drug called naltrexone, and it gets used a lot in irritable bowel, inflammation, pain, autoimmune diseases. It seems to be pretty safe. The research that we have shows that a lot of people get benefit who have not gotten benefit from anything. So, it is very well in my experience for irritable bowel, for inflammation, and frequently for mood. In terms of dealing with stress, we talked a bit about adrenal support but there are nutrients that can help your body deal with stress, stuff like B-complex and magnesium, other substances that can be either depleted or support your system in dealing with stress, addressing dysbiosis which is that alteration in the biome that is living in the bowel, which is mainly about probiotics and prebiotics. Sometimes, we get more aggressive and actually treat it with antibacterial stuff, whether it is botanical or pharmaceutical depending on the circumstances, and then addressing leaky gut. Basically, your immune cells which get broken down from various sources, whether it is dysbiosis, toxic drugs, toxic exposure, stress. When you feed them what they need, they frequently heal, and if you do not feed them what they need, they often doubt, and again this is supported by various levels of research that certain things like L-glutamine and zinc and vitamin A and E and vitamin D and omega fatty acids help the gut heal. –Next Slide– So, let us talk about the movement/mechanical system. Movement is medicine. Your body was made to move. When you get regular exercise, and regular exercise could be aerobic, stretching strength training, or some kind of mindful movement like yoga or tai chi and various other movement arts, dance, lots of different kinds of exercise, walking. It actually stimulates hormones, reduces inflammation. It can enhance sleep, reduce pain, enhance neurotransmitter function and make you feel good, and there is a lot of depth to understand what is appropriate for you given your circumstances. Depending on your level of health, depending on how much pain you have or what kind of condition your musculoskeletal system is in. So, there is subtlety to this, and I will drill down into this some more in a later video. –Next Slide– So, let us talk about mind-body healing. When most people think of mind-body healing if you are looking up on the internet [13:05] a biomedical web search like PubMed or something, you might see things about relaxation exercises, mindfulness, visual imagery, psychotherapy, CBT, various things like that, and these are all techniques that have been used and studied to see the effect they have on the overall stress axis, to see the effect they have on various symptoms and disease complexes, and there is a lot of research over the course of 20, 30 years that show that, you know what, these things make sense. They tend to be very low risk. Once you learn it, it tends to be very low or zero cost, and the potential benefits can be very great, especially depending on how much stress, trauma, difficult stuff was going on and how overactive your stress response is, and certainly my own clinical experience of using these techniques for over 20 years in my own life and with lots of patients is seeing profound impact, and this is one of those things that people miss, because I see a lot of people who come in and they are doing all this nutritional stuff and may be they are exercising, they might have chronic pain or fibro, IBS, or chronic fatigue, or autoimmune disease or whatever, but they are not really getting at their mind-body axis, and it is complex and it is subtle. So, lot of reasons why not. Some people just are not into it. For some people, there is a stigma, like whenever they have gone to a doctor over the course of years, and I have seen this with so many people like, who will sit down and go through all the science about why mind-body medicines are really important? Why it is a therapeutic tool? Why it is not that you are crazy? It is not to do something wrong with your mind, it is just that you know what, this is a therapeutic tool that can help you, and after like, so you means it is all in my head doc? And the unfortunate thing is lot of people have been stigmatized in that way. They have had problems that their doctors could not understand because they were never perceptive and then the doctor who cannot figure it out blames the patient, and so [14:58] nuts. It is all in their head, they need to take an antidepressant. Whenever it is complex, antidepressant actually have physiological effect that are not just about dealing with anxiety and depressant, but that is part of what this all talk is about that there was so much integration of the neurotransmitters that are involved in depression and anxiety as well as lot of other brain chemistry that are involved and actually generating and perpetuating symptoms and helping symptoms develop overtime, like that wave that flows downstream. Back to our topic, these things are techniques that get used a lot and they have been researched and let us talk more about why, just unpack this so you can see a little bit. Again, I talked about some of this in the previous talks, but I want you to see it here, because I really want to see how important this is, how real it is, how scientifically validated are these connections between your mind-body system and the rest of your systems as they relate to your level of health or illness. –Next Slide– So, these are some slides from the journal. The journal of basic and applied sciences that talk about normal stress response, chronic stress pathology, and chronic stress and cortisol resistance. So, this is the pathology and of things, right? Where person is healthy. There is a connection in physical, mental, oxidative, biochemical stress go into the brain and a signal goes out to what call the HPA or hypothalamic pituitary adrenal axis, stimulates not only epinephrine/norepinephrine with cortisol release, epinephrine/norepinephrine activate your immune system. Cortisol kind of like slows down inflammation and turns off that stress-related inflammatory response, so that you do not get sick, right? Because if you can imagine if you are out in the forest and you fall down and break your leg and you got an open wound or you get injured or something like that, your immune system needs to come in for defense and repair. So, it is a good thing that your immune system revs up with acute stress, but then when the stress is over, you want to quiet down. In some circumstances, we talked a lot about this in the previous two talks that stress does not turn down and that can happen because you got ongoing stressors, you got ongoing illness pain, injury, an environment in your life that is stressful, dangerous, whatever it is, or it could be that you got early life adverse childhood events that turned your stress response on overdrive, so that you get triggered by an illness or injury, your stress response just gets kicked for an armful and it keeps going, and you are like, hmmm, and you start to not even notice it after a while, but meanwhile, your stress response is going, going, and what happens there is you get kind of disconnect in this feedback loop and the adrenal glands are putting out cortisol, cortisol in response to this chronic stress and then that holds thing with your immune system being reactive is feeding into your brain and creating more biochemical stress from the immune overreaction, that is one of those vicious cycles, and the other thing that we have discovered over the years, because all the research you are now looking at, well, okay, chronic stress that affects health or maybe it is because of the cortisol, but wait a second, people with chronic stress do not always have the elevated cortisol, right?, that was the finding, but what they discovered is that in many cases, there was actually a loss of sensitivity to cortisol. So, it is not just that the cortisol goes high, high, high. Sometimes what happens overtime is that cortisol stops being elevated and the cells are like resistant to cortisol, the receptors downregulate. So, basically a person cannot even mount an immune response to a stressor, and that is when people start to really burnout and get that chronic fatigue, and we said this, it is probably why people start to burnout and get that chronic fatigue, immune weakness. The guy who says, “gosh, I get sick every year, anything, anybody has I get it.” I see a lot of people like that, and it is probably related to this chronic dysregulation of the HPA axis along with resistance to cortisol, so they cannot even mount a proper immune response to stress, it is of the more complicated than that, but this is part of it. –Next Slide– So, let us move forward. Let us talk about pain, whether its abdominal pain or peripheral pain in this whole feedback loop. Stress feeds this loop. We just talked about the HPA axis, and then it feeds into what we call sensitization of spinal pathways and central pathways in the brain, and central sensitization means your brain is turned up and it is like your pain processing is turned up, and peripheral sensitization means the actual nerves in your gut or your back or your knees if you have arthritis or your nerves if you have peripheral neuropathy, they become sensitized by various biochemical changes, which were all influenced by the stress response, and so this chronic stress response with all of the changes turns up sensitization in the periphery, meaning the rest of your body as well as the sensitization which is your brain and spinal cord. So, that is part of how pain gets worse. So, okay that is all the bad news. Let us talk about the good news. The good news is you have a system inside of your body that is actually there to help you cope in deal and it is probably of how mind-body therapies can help you and it is related to the something called the vagus nerve. The vagus nerve, here is a diagram that is coming from Frontiers in neuroscience and its talking about, this is not where this is coming from, forgive me. That is from another slide. Cut that. In any event, this is just a diagram that is an anatomic slide. Here is your brain, here is your spinal cord. You have got your vagus nerve pumping out here and it is connecting to all of your internal organs. Here, it says vagus right, and that is giving input to your heart, your lungs, all of your digestive organs, and then you have these other parasympathetic, which is the same branch, it is the, you know, just to review again, you have got your stress response and your relaxation response. Your relaxation response neurologically is mediated by your vagus nerve and some of the nerves in your brain as well as your pelvic splanchnic nerves that go to your pelvic organs and sexual organs and the end of your bowel, and this is all parasympathetic relaxation response. So, you can send relaxation signals to your gut and those seemed to have an impact on people with leaky gut and irritable bowel syndrome and also people with pain. –Next Slide– So, let us unpack this some more. Maybe we will see Dr. Bonas as you slide here in a moment. –Next Slide– Okay. So, vagus nerve to the rescue. What are we talking about? This looks complicated and technical and geeky and it kind of is, right? But that is the way scientists think and communicate with each other and I am part scientist, so I can hear them. Hematoencephalic barrier, that means your blood-brain barrier, right? It means your brain is protected from your nervous system, I mean from your immune system and from your blood and what it is it more or less, but the point is like this, that you have got vagus nerve fibers that are going out that actually have an influence on intestinal permeability and have an influence on inflammation in your gut. Vagal outflow has an influence actually on the bacteria in your gut. The population of bacteria in your biome that are part of what gives arise to this gut inflammation and systematic inflammation, and so vagal outflow, when the vagus nerves starts to act and gets strengthened and have increased output, it shifts a lot of the changes that give rise to complex chronic disease. This is such an important thing that, you know, most of the articles when you look in the medical literature, you look at vagus nerve and chronic illness, and you have got companies that are investing huge amounts of money in developing vagal nerve stimulators. A lot of them are invasive things where they actually like put something in your neck that stimulates your vagus nerve as it comes out, gives it like an electrical charge, and then noninvasive once they do it through the skin, and that is how really great and cool, and there is early research that shows unbelievable things, like, okay, these people have rheumatoid arthritis with really bad inflammation and deformation of joints, and they did valgus nerve stimulation and it stopped. People with chronic pain, vagus nerve stimulation, ooh, volume turns down. People with various kinds of chronic, really difficult problems, the conventional medicines often fails to deal with, and they use this invasive or noninvasive vagus nerves stimulation and you get some degree of effect. I am not here to push high tech, very expensive invasive tools that are there to stimulate your vagus nerve. I am here to push you to consider that in between your ears, with your free choice, with your mind-body connection, and your intelligence, you have the capacity to actually stimulate your vagus nerve. You have the capacity to stimulate neuro-parasympathetic nervous system and get benefits that come from vagal nerve stimulation, which seems to do a lot to turn down the volume on chronic pain, chronic illness, chronic inflammation and so on. –Next Slide– Let’s unpack this some more. Right, from Curious Immunology, Dr. Bonas has again. He loves this. He loves this. I think he is developing actual stimulation devices, but he is even talking about hypnosis and meditation and acupuncture as ways to stimulate different aspects of what we call now the vagal or cholinergic anti-inflammatory pathway that is stimulating the parasympathetic nervous system, which is the relaxation response, stimulates the anti-inflammatory pathway, and there is a bunch of biochemistry to it, right. The vago-parasympathetic reflux vagus nerve stimulates fibers that go in and elicit various kinds of neurotransmitters like acetylcholine and nicotine agonist and etc, etc. We do not want to go too much into the overwhelming detail. The point is that those things block things like tumor necrosis factor alpha. That is a cytokine, that is an inflammatory chemical that is involved in almost all of these chronic destructive illnesses like rheumatoid arthritis and chronic pain and fibromyalgia, TNF alpha, and other inflammatory cytokines like interleukin 6 are showing up as major determinates and drivers that are involved in things like diabetes and heart disease, Alzheimer’s disease, dementia, degenerative illnesses inflammatory, and vagal nerve stimulation is anti-inflammatory, and that is huge as potential game changer from other medicine. What I would predict is that in 20 or 30 years when various technologies, whether they are high-tech invasive stuff versus just knowing how to teach people to evoke the relaxation response and to get in all the aspects inside the heart and soul of a person that interrupts that relaxation response and stimulates the sympathetic or a stress response. When we really learn how to do that, we have a powerful set of tools for actually changing the course of chronic illness, and that is why we are here talking about this. –Next Slide– So, let us talk a little more. We are talking a lot about how stimulating relaxation pathways affect biochemistry, affect the way to gut, processes stuff, and the dysfunction in the gut that can be proinflammatory and create all sorts of brain toxic stuff and how we can turn that down. We looked at various ways that parasympathetic stimulation relaxation response stimulation can actually reduce inflammation systematically, but here is another aspect which is a direct effect on the pain pathways, and the fact that pain is really complex and this could be, you know, several hours long conference in itself to talk about the complexity of pain and chronic pain, but the point that I want you know is perceived pain is profoundly integrated with emotional distress and maladapted belief systems, and these are things that most of us do not really get taught how to deal with. My own experience over 20 years is teaching people how to deal with these things and seeing profound influences on not just perceived pain but the amount of distress and interruption and dysfunction in life a person has because of pain as it has processed through emotional distress and adaptive beliefs, and this is a vicious cycle, and every skilled pain management clinician, whether they are pain management, anesthesiologist or physiatrist or neurologist or the behavioral medicine people that work through the mind-body connection. This is really clear. It is really well understood. If you go to a well-equipped pain center almost anywhere in the world, they are going to be working with you on your mind-body healing. –Next Slide– Okay, so that has been kind of an overview about how chronic pain and chronic illness are really a multisystem, multifactorial problems, and how they develop overtime, and the important thing to know is that, that is part of why these things are workable and why probably you and many other people can actually have significant yield even though you have done the best of conventional medicine, but you probably have not looked at it in kind of a holistic an integrated way, and that is where the therapeutic leverage is, is addressing the different aspects that are all working together, and I talked a bit about the three-part model that I used that looks at three Ms, which are your movement or mechanical system in your body, your metabolic or biochemical system in your body, and your mind-body system, and we went into a little bit of detail about some of the scientific underpinnings of why your mind-body system is so powerfully integrated in the development of chronic pain and chronic illness, and why it is so crucial to address that in the healing process. Because you or some of the people watching this might have kind of decreased energy or attention span, because that is part of what chronic illness and chronic pain do. So, I am going to stop now and break this video into two parts. The next part is going to get more into kind of an overview really of what you should be thinking about when you are addressing mind-body healing and the different aspects of it, kind of a landscape and the overview of what mind-body healing is and some other places where people sort of fall down the pitfalls, the things that you can miss if you are not paying attention to it. So that is the second next part of this, go ahead and watch it now if you want to or you can come back to it later when you have more energy and you want to spend another, I think it is about 20 minutes or so. So, as always, feel free to share this video or this blog post wherever you are seeing it, and I am going to continue to produce information that hopefully is going to be inspiring, empowering, and transformative for you around healing from chronic pain and chronic illness. So, if you have not signed up for the newsletter, do so, and you will actually get notified when and new blog posts come out, and we will be in touch that way. On my email community, I shared various aspects and different things that inspire people. So, looking forward to seeing you next time. Thanks a lot.

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