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Tag: Fatigue

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

Posted on 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.

Related Posts:

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 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.

Related Posts:

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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Don’t Miss These 3 Things That Can Prevent Healing from IBS, Fatigue, and Chronic Pain: Pt.1

Posted on by Andrew David Shiller, MD

                                       Check Out Part 2 HERE

Summary:

If you have IBS, depression, fatigue, chronic pain, or fibromyalgia and you’re only following the conventional medical approach, you’re probably not going to get better.  There IS a path to healing from IBS, fatigue and chronic pain.  But you need to address the underlying biological issues that create the symptoms.  Learn about why these conditions develop. And learn the “can’t miss” things that you need to heal in order to get a good outcome.   Robert is 40 and is stuck and can’t move forward in life.  He’s a super intelligent and motivated person, but he has severe fatigue, abdominal pain, anxiety, and recently can’t sleep well.  He needs to be near a bathroom all morning because his bowel is so irritable that he needs to run to the toilet on a moment’s notice.  He has had workup of his debilitating digestive symptoms and the specialists said it was Irritable Bowel Syndrome.  Nobody has explained his debilitation fatigue.  And nobody has helped his need to run to the bathroom immediately and frequently.   Turns out he has abnormalities in his daily pattern of cortisol secretion.   He’s a talented, hard working ethical person and he’s deeply frustrated that he can’t do what is meaningful for him.   Conventional medicine has nothing to offer him.  Robert is not alone.  Thousands of people have similar clinical situations.  The conventional approach is to think about each of the symptoms as separate problems.  There is no integrative understanding of what underlies the whole picture.  And rarely any practical solutions.

There is Hope

But his situation is not hopeless.  Many people get better with the right understanding and treatment. If you understand the underlying issues in complex chronic pain and illness, you are more likely to find what works to help you feel better, and help in healing IBS, fatigue, and chronic pain.

Video Questions

The video discusses the following questions, among other things:
  1. How does the functional medicine approach think about complex pain and illness, and offer improvement where conventional medicine has failed?
  2. What does it mean that he has “an abnormal pattern cortisol secretion”?
  3. Is this “adrenal fatigue”?
  4. What is the connection between stress, adrenal dysfunction, IBS, fatigue, and pain?
  5. How can someone heal from fatigue, IBS, anxiety, and other related chronic illness?
This is a complex topic.  These initial two videos give an overview and some of the scientific underpinnings of the functional approach to complex illness. Subsequent videos will answer the questions of:
  1. What can a person do about the problem?
  2. What are the most commonly overlooked issues that keep people from healing? Even though they’re doing an integrative approach.
Please click the share buttons above or below the post and share it where you like.

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

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Full Transcript:

Hey, everybody, Dr. Shiller, and today I want to talk about why people get stuck with chronic pain and chronic illness?  And what you can do about it, and we are going to start in particular talking about irritable bowel syndrome, fatigue, chronic abdominal pain, which often goes along with anxiety and insomnia, and there is potentially more to it.  There are various constellations of symptoms that people get that are really disabling and conventional medicine does not really have good answers frequently for those issues. In my eyes, part of the problem according to the way I trained in conventional medicine is that we tend to think about each of those symptoms as a separate problem. We tend to not see that they are connected to each other based on underlying physiologic imbalances that are common to a lot of those symptoms, and so abdominal pain, fatigue, brain fog, chronic fatigue, neuropathy, headaches, even things like dementia, confusion, cognitive changes.   There are underlying physiologic principles and imbalance that are connected with each other.  You are one unit; all your systems are connected to each other.  So, we are going to explore that so you can understand it.  This is stuff that is not made up, it is stuff that is based on scientific evidence coming out in the past 20 or 30 years. It can take decades for that to get into common mainstream medical practice. What I see over and over again is someone who comes to me and they have had the best medical treatment, and thank God they have not had a disease that is progressive that is going to kill them, but they have ongoing symptoms. The docs either gave them meds that did not help them or gave them too many side-effects or you know what they just were not listening and understanding the whole picture. On the other side, I have seen a lot of people who have gone the more natural medicine approach, and they have gone one aspect out of that or two aspects, but they have not really holistically understood the depth of the underlying physical dysfunction. So I want you to understand that so you can understand what might be going on in your case. so that you can know what you might need to do and what you might be missing, and the whole point is that you should feel better.  So, that is where we are going.  I want to do this in the context of a case.  I want to talk about a guy who came to see me, and his name is Robert, he is in his 40s.  Basically, what is going on is he is exhausted and he cannot get moving in the morning, he cannot function.  He has got chronic pain in his belly.  He has got so much, like diarrhea every day, especially in the morning that he cannot really leave his apartment for a while.  He has got gas and bloating.  He feels anxious a lot.  Lately, he is not sleeping so well at night, and sometimes he just cannot kind of get motivated, because he feels so overwhelmed about all the different stuff going on.  So, things are kind of like over the top for him, and the physical issues started about 20 years ago, and he had a very stressful time during his higher education and stuff was going on that was maybe even on the level of like emotional abuse with some of his teachers, what they were doing to him.  It turns out that he also had some emotional and physical trauma when he was a child.  There was probably some abuse.  There was his own subjective sense of being neglected by his parents, and over the years, he tried various psychotherapeutic things.  He has always felt kind of not at ease with himself.  He has tried various psychotherapeutic approaches but never really stuck with anything, and lately he has had a lot more difficulties.  He got divorced several years ago.  He has had other challenges.  It is hard to move forward professionally.  He does not emote.  He feels like things are kind of bottled up a lot inside, and he wants to move forward.  He has got clear goals.  He is actually a great guy, but he is having a hard time doing what he knows he needs to do, and so I did an evaluation.  We did a little bit of testing and here is what it showed. –Next Slide– We did it what we call a 24-hour cortisol secretion, which means like four times over 24 hours.  We look at a saliva test and we see how much cortisol is in his saliva, which has been shown to reflect what is in the blood, and what is cortisol?  It is one of our stress hormones, and cortisol is regulated by a feedback loop. –Next Slide– So, you may have seen other videos that I have made where I talk about like this, the stress system of the body, and then we have an acute stress response which is part neurologic and part from epinephrine/norepinephrine, which are also called adrenaline and noradrenaline, and cortisol is a hormone that is also secreted in response to stress, and it helps modulate certain aspects of your physiology when you are under stress, but it also kind of has a kind of tempering effect on your acute stress response.  It is more like your chronic stress response, and cortisol is subject to all kinds of feedback.  You know, in this cartoon here, this diagram, here is your adrenal glands, that is where cortisol comes from and so do epinephrine and norepinephrine, and that controls your hypothalamus, which is in the core of your brain.  There is a normal daily rhythm of that secretion, but stress or inflammatory signals, things called cytokines stimulate the pituitary to stimulate the adrenals and that is what puts out the cortisol, and there is a feedback system to the pituitary, a feedback system to that hypothalamus, and it tends to modulate and balance things.  Now that feedback loop gets out of balance in people who have chronic stress, and it is shown to get dysregulated, and that is one of the things that is going on in chronic fatigue syndrome in lots of people with fibromyalgia and frequently other chronic illnesses.  So, let us unpack this a little bit so you can really understand it. –Next Slide– I want to go back to Robert’s actual testing, right?  So, this is a graph over 24 hours, like early in the morning, at night, and then at noon in the afternoon, and this green band is kind of like that is normal cortisol secretion, and check out where he is at, he is below normal, especially in the morning relative to the green where he is kind of closer to that in the afternoon and evening, but in the morning, he is pretty down low, and there is also something called DHEA, and that is kind of a precursor to sex hormones and it is often also modulated or downregulated in people who have a chronic cortisol response, and so that morning low cortisol is something that could be expected to really cause him to be a really fatigued and not be able to move himself in the morning, because cortisol is what parts of what gives you your bump, and so we are seeing some real physiologic data that this guy is really suffering from a dysregulation of his hormonal system, and a lot of people with fatigue are experiencing that. –Next Slide– So, let us go a little further.  Let us take a step back and think differently about chronic disease.  When I was in medical school, they did not teach me systems biology, they taught me a fairly kind of cookbook method of thinking about very, a really simplified way of understanding things within each organ system.  If there is high blood pressure, you do this; if there is pneumonia and inflammation, you do this.  If a person has got this kind of hormonal problem, you give this drug, and systems biology is looking a little bit more complex wise, a little more complexity, and I actually got trained to think about this way when I was an engineering student at MIT.  We modelled complex systems and understood how all these different variables interacted with each other, and I was a little disappointed when I went to medical school, like really you guys are thinking so simplistically out stuff, but it actually works in acute illness, and if you have an acute illness, you want to go to the emergency room, you want the antibiotics, you want the person who is going to stop the bleeding or you know if your blood pressure is 50/ 20 and you are passing out or dying, you need that kind of acute care, which is fairly straightforward and simple.  The place where that model tends to fall down is with chronic illness.  It is getting better, but it is a slow process.  So, let us just talk for a second about what is systems biology?  First of all, we understand that all the systems are one system.  So, your cardiovascular, digestive system, your hormonal system, your immune system, are profoundly interconnected with each other.  There is complexity in relationship among all of the parts.  All of the reductionist detail that the specialists are thinking about, whether it is an endocrinologist or rheumatologist or a cardiologist, who knows so much detail about their particular organ system.  Well, we try to take that and put it in the context of your overall integrated biology, and we try to look at patterns that give rise to problems over time as opposed to just looking at one snapshot with a bunch of blood tests or you know a scan or something like that.  We want to look at, well, what was it like when you were born?  What happened during the course of your life, and how did this process that you are in unfold? –Next Slide– So, let us unpack that a little bit more, and let us look at this contrast, and you know conventional medicine really was formed by this miracle that happened when they developed antibiotics, where suddenly people who were dying of streptococcal pneumonia were living, because they discovered penicillin, and this one disease, one cause, one treatment model dominates a lot of medical thinking, and even until this day when we have got research showing how many different variables are involved, I find a lot of my colleagues really in this kind of like, well is it this or that, what is the cause? And a lot of patients come to me and say, “well what caused it? And the fact is well about five things caused it, and it happened over the course of 20 years. So, let us try to understand it that way, and it is hard to get your head out of that one disease, one cause, one treatment thing, and again each doctor has their own particular algorithm for fairly simplistically treating things.  Patients usually pass it, do what you are told, and it is mainly about acute problems, and it is not great for chronic problems, and functional medicine is different, systems biology, and the main thing, the main point of this whole slide is that we look at antecedents, triggers, and mediators.  I am going to unpack that in a second, because that is what helps us understand how that disease process develops overtime.  We want to understand the process, address underlying issues and enable the patient, which might be you to be proactive and to do things that are lifestyle-oriented, actually can help you heal. –Next Slide– So, let us talk about antecedents.  These are like foundational principles, like things that are early in life that set the stage for your whole life.  We are going to get more into detail, do not worry.  Triggers are transient events that come and go, but they shift your system in a significant way, and then mediators, these are things that are kind of persistent changes that keep you stuck in a disease pattern. –Next Slide– So, let us unpack this some more.  Antecedents, triggers, and mediators.  The thing I want you to know is this, really important, listen up.  These things are interacting over time.  It is a process.  It is like something is flowing downstream that can start when you are a little kid, that can be triggered when you are 12 or 16 or 18 or 20, that can get worse overtime as it progresses and get re-triggered when you are 40, and then suddenly you are 49 and you are sick, and the conventional approach is, well what is wrong with you now? as opposed to well how did this all develop and let us look at how that unfolded overtime because that gives us clues about what we can treat.  One way we like to talk about it is that conventional medicine tends to be downstream medicine.  The person is already sick, what are we going to do about it?  And in functional medicine, we try to go upstream, we try to find that process and get at its roots in an upstream sort of way. –Next Slide– So, antecedents like I said set the stage, what are we talking about?  Stuff like genetics, early life experience, culture. –Next Slide– These things determine physiology and triggers shift the system.  Examples of that are things like infection, trauma, surgery, an acute illness where someone is in the hospital for a while, life event, intense treatment with medications.  These things modify metabolism, they change your beliefs and emotions and behaviour. –Next Slide– They can affect gene expression and function of the genes and the physiology of every system in your body, and those become mediators, and that is what keeps you sick.  Metabolic biochemical changes, mental and emotional changes, social changes, behavioral changes, and let us unpack this a little bit, right. –Next Slide– This is going to be kind of a simplistic picture that I will go into more detail, but let us for instance just think about your brain, right, and your brain is the place where you perceive danger and your stress response happens through your brain, it is a perceptual thing.  It can also happen through your body, because you can have a physiologic stress, but look, we will get into that later for a second.  So, we are understanding now that the brain and the gut are incredibly connected.  You know, there are journals of gut-brain axis connections.  If you look in almost every specialty journal, whether it is rheumatology or cardiology or orthopaedics, nephrology, gastroenterology, and so on, all of them are talking about the gut-brain axis, and part of what happens is like this that, there is this two-way communication, and we will go deeper into this, but some of the predominant changes that happen in your gut are dysbiosis due to changes in the bacteria, the gut, inflammation, increased permeability.  Anyhow, we are going to unpack this some more.  Those changes tend to dysregulate the immune system, and that can be making the immune system overactive or under-reactive, but the point is your immune system is meant to be imbalanced, and oxidative stress is actually a biochemical stress that is part of immune dysregulation quite frequently, and they have a cyclical relationship with each other, and going further, your mind-body connection is profoundly integrated with your immune system and your tendency towards oxidative stress.  Oxidative stress is biochemical stress that you have implied entire body and mind experience as stress.  So, stressful experiences can whack out your immune system.  Immune dysregulation and oxidative stress can affect your brain function.  I want to point out something else here, like okay, we all understand that stress and perceived danger can affect your brain, but what is with this arrow.  The fact is and this has been shown over and over again that when a person is in a stressed mind state, they are not thinking clearly, they are not relating to life with clarity.  There is a shift in brain function and brain connectivity in a stressed brain that actually leads us to perceived danger more frequently when it might not even be there.  There is something called negativity bias, where we are all kind of biased to look out for danger, but someone whose stress axis is on overdrive has an overactive vigilant tendency to look out for danger, and you may have heard of things like PTSD, where someone has an overactive stress response, and you know something happened to them in the war or whatever it was, and they have some kind of simple stressor that most people would just say, “oh that is just the car making a noise, but this guy is jumping in for cover and diving for cover.”  Let us unpack this a little bit more, right.  I took the arrows connecting the brain and gut out just so it would not be confusing.  This is a little diagram that just shows your pain pathways.   Now, I am going to unpack this later, but the fact is your experience of pain, whether it is in your body, in your hands, in your gut, wherever it is, is a sensory phenomenon, where certain nerve endings are activated, but that signal cruises up through your spinal cord where it gets conditioned and altered and goes into the core of your brain where it gets altered, and then it goes up to the part of your brain when you say “ouh” and the point is you have got amplifiers, your system of pain transmission can be turned up and it can be turned down.  Immune dysregulation has been shown to turn up your pain amplifiers.   When people have systemic immune activation, they frequently have central brain inflammation, and that is part of what creates hypersensitivity of that pain transmission system, and that is what shows up in fibromyalgia, it shows up in a lot of chronic pain states where like peripheral neuropathy and osteoarthritis, and for sure, it shows up in irritable bowel syndrome, where people get really bad pain just from eating normal stuff.  Part of it is the way their gut is reacting, part of it is that their pain pathways are amplified, the volume is turned up, and it does not mean they are faking it, it means their biology is turning up that pain processing system.   One more step here, we want to just think about cellular function.  This is like a goofy cartoon of a cell and you got these little organs in your cells called mitochondria, and mitochondria are part of what makes cellular energy, and cellular energy is what lets you have energy.  You have got millions and millions of mitochondria, they are constantly active, they are power plants, they are everywhere, especially active in your brain, in your muscles, in your heart.  If your mitochondria are not functioning, you are not functioning, and all of these changes that we are talking about, like immune dysregulation and oxidative stress, can stimulate dysregulation of your cellular function and your mitochondrial energy production, and when your mitochondria get sick, it activates your immune system and oxidative stress.  Stress itself can trigger the mitochondria to shut down and turn off, especially when it is chronic ongoing stress.   In the short-term, stress pumps you up.  In the long-term, chronic stress knocks you down, and also mitochondrial dysfunction keeps your brain from working properly, because your brain is not producing energy.  What is happening?  Brain fog, fatigue, confusion, etc.  The point is we have got vicious cycles, we have got cycles of interaction of these physiologic processes that can be triggered by all kinds of antecedents, triggers, and mediators.  What else is here?  Oh yeah, do not forget pain and mitochondrial and cellular function, because for sure, your nerves are cells, and if your nerves are not properly functioning, they are going to get sick and they are going to generate more pain.  So, look, I want to unpack this some more.  I am going to talk more detail about this with some more scientific pictures, and we are getting to about the 20-minute mark here, and so you might be like a lot of my patients where, okay the concentration and memory might be a little challenged because of the chronic illness and the things we are really talking about here.  So, we are going to cut this video right now, and part 2 will go into more depth, about really understanding more of the science behind these kinds of changes and how this constellation of underlying physiologic imbalances or changes can give a rise to a lot of different symptoms and really disabling conditions.  Keep a lookout for that and you can watch it right now or come back to it later when you have more energy.  Thanks a lot for watching, make sure to subscribe, share with your friends, and see you in the next video.
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