Pain and Suffering. How To Get Off The Mindbody Rollercoaster

Posted on June 8, 2022March 3, 2024 by Andrew David Shiller, MD

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Summary:

Did you ever practice meditation that brought you to a really calm comfortable space, and then before you know it, you’re back in the distress and suffering? What is that about? This video unpacks the inner dynamics of the rollercoaster of mind-body practice. Why can it seem like all the. benefits just disappear like smoke. What is it a see-saw of feeling good then feeling crummy. We can understand it by looking at the inner mental/emotional/physical processes. We also get insight from the sages of Torah and Kabbala who talk about the very tangible existence of our “animal soul” and “divine soul” and how to get them to play nicely together. Please watch the video and share your comments or questions.

Did You Know:

You can receive updates about new content and learning opportunities for transforming pain and suffering, by joining Dr Shiller’s email community here: drshillerupdates.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
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

How to unlearn the mind-body patterns that create chronic pain and illness.

Full Transcript:

Hi, it is Dr. Shiller here. Today I want to speak in response to a comment that I recently got from one of the people in one of my classes, and I hear this comment quite a bit. It is very relevant for a lot of people, and this is someone who was doing some meditation training, some mind body skills development. Someone who is dealing with chronic pain and some other medical challenges and social challenges. Some really hard stuff going on for her, and her comment was like this: “Hey, Doc. During the meditation, I get to this really quiet sweet space, especially the things we do that are about opening up our hearts and like giving, and I really get to a great place and my pain is gone. And it can be gone for hours, it can be gone until the next day. It is amazing. I really appreciate this. But, and here is the kicker, right? But you know, I go back out into life, whether it is the same day or the next day, and something happens. And then suddenly, it is like, I never even did the meditation, I am in this place of distress in my mind and my emotions, my pain comes back. You know, I am starting to feel like I am just kind of a phony. Like, I am imagining it, like what is really going on here? I can relate so much to the question, personally, when I was in medical school and in residency, and I was first starting to work with contemplative practice. I could very much relate to what this person is talking about, that the experience, the practice itself was deep and beautiful, and seems so transformative. Like, “Oh, my gosh, the world is going to be completely different now”. Then, you know, whatever amount of time later, it is like, boom! Getting sucked back in the same old stuff, the tension, the anxiety, I was having. Like neck pain and back pain and things like that. And so, it was really this sense of like, okay, was that real? Is this just a bunch of phoniness, like, what is really going on? And what I want to say is that it is real. The experience of dropping into quiet in your mind, your emotions, in your body, generates biology, that is healing. It generates mental emotional patterns that are healing, and very pleasant. It is real, it is reality. The issue is that you also have other aspects of your being, and your history, and your habits. There can very much be a dance between those two, I am going to call that dance and not tension, because to my eyes at this point, 20 years later, the dance is where the real artistry and the real healing and creativity of life comes in. The first principle I want to share is that wherever your mind goes, there you are. And this is something that has been said by a lot of wise people over the years, including the Baal Shem Tov and Rabbi Nachman and in some of the sages of the Torah tradition. That wherever you put your consciousness, your conscious intention, or your unconscious intention, where your mind is, that is, what is generating your, a lot of your physiology. That is what is feeding into the thoughts, you are having, the emotions that are coming up. Yes, the bodily responses you are having, together with those thoughts and emotions. So, the art and the work is really a question of starting to become aware of that. A lot of my students who are progressing further along, are starting to be aware of that, right? They start with the meditation that brings them the quiet to go, wow, this is amazing. Then they start to notice, oh, I keep thinking about that guy. Or I keep thinking about this experience or whenever I see this person, it brings on a sort of negative mind, emotion state. So, what do you do about that? Well, you start to work with it. It is an aspect of self-learning, it is reflective learning, to start to see those patterns. When you start to see those patterns, you start to become more mindful. You start to actually develop a kind of awareness that is not judgmental. You see that maybe, okay, I am self-judging, or self-doubting, or there is self-blame or even self-hatred. Then you start to actually say, wait, no, I do not want to live from that place. It is a little bit of an active will, just to decide that. Then it is an act of awareness and something transformative that happens when you just start letting your heart receive it, and be aware of it. If you were to see a little kid who is misbehaving, and they are a little kid, they are doing what little kids do. And if you are not too close to the issue, you kind of recognize and you are like, Yeah, and you can like, give that kid some support. Like, “Hey, come on over here. Listen, you know, I care about you. I love you. I see you doing that thing that is making a mess. You start to do that with yourself, and it can be transformative, because what happens is you develop the skill of dropping into a quiet place that just feels good and brings on the biochemistry and neurobiology of healing. Then you also develop this presence of mind, this mindfulness, this compassionate, discerning awareness. That lets you see your habits of going to the negative places, and lets you start to make more conscious choices. Rather than just going with the habit. Because habits, most of them we developed from back then, when we were not so conscious. A lot of your worst habits, I can guarantee you came from a place of you actually taking care of yourself. When you start to actually notice, wow, the reason I am reacting with anger is because back when this happened, I was scared, I was scared, I did not want it to happen again. So, I am angry, because I am trying to protect myself, and you start to see that kind of stuff. And that is the process. That is the work of inner healing. I want to bring another aspect to this from the Torah tradition. And you know, the inner tradition of Torah brings this notion that every human being has got what we call an animal soul and a divine soul. Your animal soul is really responsible for self-protection, self-preservation, reproduction, pleasure; it is your physical embodied self with all of the urges, and aversions that you have. A lot of that is very conditioned, a lot of it is instinctual, a lot of it is cultural, it is stuff that we just are. Then we have got this godly soul, it is a divine soul. It is the part of us that as we grow and mature, we start to naturally have a sense of desire or urge, to be generous, to be giving, to include other people in our world, to care, to actually want to make a positive difference. Those are aspects of our godly soul. Those are aspects of your elevated divine soul. In that tradition, the work of growth, the work of healing, the work of returning to our highest potential, is to come in contact with that elevated divine soul. To understand it, taste it, know it, become familiar with it, start to identify with it, and bring it with compassion, with intelligence to that animal soul. The metaphor that often gets broad is like, if you are a person who rides horses, you know that the horse needs care, the horse needs to be brushed and cleaned, the feet need to be protected, the horse needs good food, shelter and protection from bad weather. If you want to be a good horse person, you need to take care of the horse. But you also need to ride the horse, and you need to direct the horse where you want to go. That is what horsemanship or horsewomanship is really about. It is actually having the awareness and compassion for the animal, and actually having a clear connection to your own higher aspiration, your own higher purpose, your potential of who you are. I invite you to really reflect on that metaphor, reflect on the different aspects of your own experience, that you might consider your animal bodily, embodied soul. Rather than judging them as bad, just realizing that they are part of who you are, and part of what you can direct and learn to develop mastery over in your path of self-healing, of self-actualization, of being your most beautiful, powerful self in the world. You are not a phony, you are someone who is learning to pay attention. You are someone who is learning that when you give your mind to matters of the divine soul, of purpose, of potential, of possibility of expansiveness, of connection, there is a certain physiology that is supported by that, and that comes out of that. When you give your mind to the potentially more protective, negative, challenged aspects of the animal soul, you may experience negativity. But gradually over time, you learned to let your divine soul be the rider of the horse. In summary, what most people say who stick with the practice and stay true to it over time is that as you get familiar with it, as you develop a sense of greater self-acceptance, and you work through some of the challenges of relating to those more difficult parts of self, then the difference is less glaring, the extremes are less extreme and you develop a somewhat smoother pathway. We all have times of elevation and times when we fall. And what happens over time is the decline, the fall becomes for the sake of rising, and according to the Hasidic tradition, every time you have a fall, every time you slip into a negative pattern, every time you meet those difficult parts of self that are such troublemakers, it is really happening for the sake of them being elevated by your own divine soul and awareness. There is really a path here of transformation that is available to you if you are sincere and dedicated and willing to develop awareness, develop the skill of self-regulation and quieting, develop mindfulness and compassion that the bumps are less strong, you spend more time in a place of relative, Hey, it is okay. I am with it, I have got this, things are going to be alright. And you spend less time cycling into the really heavy negative patterns. It takes time, it takes effort. This is real work, but it is also incredibly fruitful and valuable, because it not only influences the process of bodily healing, it leads you to excel, a sense of self and self-expression that is ever more beautiful and evermore connected to doing good things in the world and being the kind of person you want to be. I hope this has been useful. Feel free to leave any comments or send me comments or questions by email if you want. And tune in again. Look forward to being in touch.

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Fibromyalgia and Fatigue. Four Reasons Why You Flare Up and Can’t Make Progress

Posted on May 13, 2022March 5, 2024 by Andrew David Shiller, MD

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Summary:

One of my readers writes:

“Hey Doc, I’ve been doing all the right things to improve my fitness. Pacing myself. Accepting my low threshold and working within it with lighter weights and shorter workouts. I’ve progressed, but I’m stuck and not able to increase my exercise tolerance enough. Why is that happening?”

In the video, I dive into some of the reasons why fibromyalgia and chronic pain can be so limiting in terms of activity. Sometimes there are things you can do to break through the barrier and build strength, endurance, and ability to function.

Check it out and let me know what you think.

Did You Know:

You can learn to reduce pain, improve mobility, and increase energy. Movement Toward Health is an affordable online training program that helps you heal and grow in a warm and inviting community. It opens periodically for new members. You can get more information and join the waitlist here: www.MTHTribe.com
Do you want experienced, compassionate guidance in overcoming chronic pain or illness? 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/stage-dr/consult
Have you learned to mobilize your most important self-healing superpower? If you balance your stress/relaxation response, it could change your life. Dr Shiller gives regular free mind-body training sessions on zoom. Even if you “can’t meditate”, he has a way of helping. Learn practical tools for transforming pain and suffering, reducing stress and inflammation. Sessions are free. You can register atwww.mindbodygroove.com

Full Transcript:

Hey, it is Dr. Shiller. Today, I want to talk in follow-up to a previous video in which I was discussing the suffering cycle and the disability cycle in chronic pain and chronic illness, especially fibromyalgia and related conditions, and how a person can understand that and start to break those cycles. And I got a very interesting response from one of my readers, one of the watchers, and I want to read you some of it, because you might have similar questions.

She writes, “Doc, to be honest, I have made a lot of improvements, but I never got to a place of really big improvement. I have tried gradually building my exercise. I have done behavioral modifications to pace myself. I have tried to stay within my exercise threshold. I have done things to tweak a slightly low thyroid. I do not have a positive ANA or a high inflammation marker, but I continued to get these really bad flare ups of fatigue and discomfort. My pain is much better, but the fatigue and the post exercise, just malaise and feeling horrible keep catching up with me. What do I do about that?

It is such a great question, because whether it is chronic pain, or fibromyalgia, or chronic fatigue syndrome, ME, as we call it, these are complex processes. And there are a few different things that can be going on, and I would say there are really like, four or five reasons why it can be hard to break through and actually build that activity tolerance threshold, because that is really the issue here. For someone who wants to either prevent getting more disability, disabled, or someone who wants to kind of climb out of that hole of disability and get more active, what stands in the way?

The first thing we talked about in that first video is that the threshold gets lowered, right? Like everybody has a threshold, within which we can actually be active physically without damaging ourselves. So, I can run two or three kilometers, a mile or two or three, and I can feel okay with that, but if I try to run a marathon, I would be wrecked for days, and maybe a week or longer, I might even get injured.

Everyone’s body, you included, you have a certain threshold of how much energy your cells can put out, how much metabolism your muscles can do, and above that, what happens is it overloads the system and creates a kind of state of biochemical toxicity and inflammation and acidosis. And if you are susceptible, because you have a low threshold, which is expressed in fibromyalgia, chronic fatigue, then that happens at much lower levels of exertion, and so you go over that threshold and suddenly this vicious cycle happens, which can increase inflammation, increase stress hormones, increase a whole bunch of different changes that create a flare, and so the question is, how do you work with that?

This particular person talked about, is trying to stay within threshold and doing shorter workouts with less weight, and she made a certain amount of progress, but did not really elevate her threshold, like she really wanted to. What else could be going on? One of the things is that we know that there are hormonal and immune dysregulation that happened.

We know that sometimes there are aspects of biochemical toxicity. Sometimes there are aspects of dysfunction of the mitochondria, which are your cellular energy producing organs. And all of these things are very much integrated, your degree of inflammation, your mitochondrial function, your biochemical stress, or oxidative stress, are all intertwined with each other, and when you are in a susceptible place, any one of those going up too high, can she kind of create a little vicious cycle, stuff like low grade infection feeds into that, hormonal dysfunction, whether it is your thyroid hormone, your adrenal hormones, or your sex hormones can also make you susceptible.

If you have ongoing toxicity to heavy metals or environmental pollutants, where you have got low-grade inflammation in your body from some kind of liver toxicity thing, that also makes your system more susceptible. So those things are incredibly important to address. That is a huge topic. I am trying to cover that right now. Although in future videos, I sure hope to God willing.

The last aspect that I want to bring up is really the stress response of the body. Because as we know, we already talked about it, that the stress response, the fight-flight-freeze response, which is meant to be kind of modulated by a relaxation response is intimately connected with that mitochondrial function or hormonal immune axis. They are all intimately connected, because your stress response is how your body copes, and there has been all sorts of research showing that when a person has a prolonged overactive stress response, or an acute stress response, it shifts immune function, it can shift hormonal function, it can shift mitochondrial function.

One of the ironic weird things about physical exercise is that it is a stressor, right? Like we know that to be true. You know, there is acute exercise, there is long-term exercise. But there has been tons of research that is showing that when you do exercise, your stress hormones go up, your autonomic system activates a stress response, because it is a get up and go.

The question is, when you are doing physical exercise, are you activating too much of a stress response? So, all those other biochemical things are really important. But what is going on in the stress relaxation response, is the autonomic nervous system. Which consists of that stress response and relaxation response. Is it kind of on the edge and so out of balance, that you do a little bit of exercise, and boom, you kick into a high stress state that flips off the mitochondrial function and your hormonal and so on and so on.

It is possible, it is possible, and that is why personally, from my point of view, when people are dealing with low threshold states like fibro and chronic fatigue, it can be so useful to do what you could call mindful exercise.

Mindful exercise means exercise with awareness, and it means exercise that is deeply relaxing. So, rather than going to the gym and pumping weights, even if they are small weights, we are getting on the treadmill, or doing the stair stepper, even if it is a low volume, low intensity, those can be stressors. And so, what you really might want to consider is doing exercise, whether it is a very gentle yoga, Feldenkrais awareness through motion, movement, Tai Chi, Chi Gong, things that are really meditative, with a lot of awareness, where the physical activity is not about exertion, the physical activity is about mobilization, it is about relaxation. It is about waking up your body’s natural ability to move, to breathe, to reduce co-contraction and resistance that you might have in your neuromuscular system, and so, it is a really good place to start if mainly what you have been doing has been typical gym exercise, without awareness, without relaxation, because gym exercise without awareness and relaxation can be a stressor, mindful exercise can be done in a relaxing way.

Let us also get clear, right? A lot of people say, “Well, I tried to do yoga,” but then you find out what kind of yoga and it is more the aggressive kind. There are yoga practices that are really forceful, Ashtanga and Iyengar, you know, other things that, you know, I forgot, Vikram, that can be fairly aggressive. And that is not what I am talking about here. I am talking about gentle Hatha Yoga, where it is about awareness. It is about gradually coming into a soft pose, not pushing too hard. Lots of breath, lots of awareness, meeting the edge and just relaxing into it. So, it is a different way of moving. And it could be what will help you get started and help you start to build your mobility, your flexibility, your strength, your body awareness, and what you need to progress to higher levels of physical activity.

I hope that is interesting and helpful. I am very grateful for your comments or questions. Feel free to shoot those to me either where you are finding this video, or through an email.

Thanks for watching, and looking forward to seeing you.

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Fibromyalgia is Tough. Why is Disability Optional? Part B

Posted on April 17, 2022March 3, 2024 by Andrew David Shiller, MD

This is part B of a two part video. Please watch part A first.

Click HERE to watch part A.

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Summary:

You learned in part A of this series why the pain system gets sensitized in fibromyalgia and chronic pain, and what creates suffering, and why it can be so disabling. Click here to see part A if you missed it or want to review.. In this video (part B), you’ll learn some of the main things that you can do to reduce suffering, and break the “fear-avoidance-disability cycle” that otherwise can suck your life down the drain. This isn’t easy work. But have hope. There are things you can do to help yourself. Please let me know what you think by sending an email or commenting on this post.

Did You Know:

You can receive updates about new content and learning opportunities for transforming pain and suffering, by joining Dr Shiller’s email community here: drshillerupdates.com 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

Full Transcript:

Hi, Dr. Shiller here. We are continuing with part II of fibromyalgia and chronic pain. Why are they so disabling and what can you do about it? In part I, we looked at the whole variety of different metabolic and mind-body and sort of mechanical structural factors that can give rise to the disability and really loss of life and function that happens when people have chronic pain, especially fibromyalgia. In this part, we are going to talk about what you can do about it. I encourage you to watch part I if you have not seen it yet. So, look for that link connected to this video. I am going to bring back up the slide we ended with, let us look at that. So, just summing up, like you know that talk in 30 seconds that there are metabolic mind-body and sort of movement or motor mechanical system aspects to this whole process that the biology that gives rise to central sensitization is influenced by the mind-body variables, like your beliefs, emotions, and thoughts, and especially autonomic imbalance. Autonomic imbalance is that over-activity of the stress response that can happen with chronic pain and chronic illness. Fear avoidance is that, I do not want to do stuff because it hurts, because you are not active, and you get inactive, then your body gets weak and stiff, and you get disabled, and because you are not moving, that feeds into all of the physiologic and mind-body variables, and the place where you actually have therapeutic leverage is to actually work on these things, right? I am not going to talk about the metabolic part, those are incredibly important. I talk about those in other talks. So, have a look for that stuff. I am going to focus today on the mind-body stuff and the motor mechanical stuff, and summing up all of this, the things that we really can address with the right kind of mind-body and movement system care are really the autonomic imbalance, fear avoidance, and inactivity, and the rest that flows out of addressing those things. So, let us just talk about a few principles or interventions, and I am going to share the big picture, the top-level stuff. Every one of these big picture top-level things are things you can drill down to and learn more, and I will do that in other talks. I am really interested in your feedback, what you want to hear more about. So, feel free to respond in the comments as I am going through about what you need to hear more about or send an email or whatever it is, reach out to my office and let me know. The whole point of this content is for you, to help you, to empower you. So, let us go forward with this, okay. Other videos about metabolic and the mind-body stuff. There is a number of different steps to mind-body healing, and there is mind-body tools that you can learn to shift your physiology and especially your autonomic imbalance as well as the kind of fear avoidance thing and to heal your beliefs, emotions, and thoughts, and it is incredibly transformative because you stop and unwind these cycles that give rise to the suffering and the disability of fibromyalgia and chronic pain. Self-regulation is the foundation. Self-regulation means tools, like simple breathing and focusing techniques that actually shift your neurobiology and your biochemistry, stimulate the vagus nerve, the vagus nerve is this big nerve that comes out of your brain stem, serves your entire intestinal tract, and it is anti-inflammatory when you stimulate your vagus by going into a deep relaxation, it slows down inflammation. When you are stressed out, aggravated, when you have autonomic imbalance towards sympathetic, your vagal nerve is shut down, and it is a pro-inflammatory state, and that is why we got so much research showing that an overactive stress response is pro-inflammatory and that various mind-body techniques modulate the immune system in a positive way and help it function more effectively. There are various techniques of self-regulation, mindset and beliefs, where you put your mind is where you are going to go. It is like a person driving one of those race cars in the Monaco grand prix or wherever, where if they look at the guardrail or the tree, you are going run into the tree, and if you look for the open space, you are going to drive into the open space. Another way to think about it is that if you are focusing on negative stuff in your life, the pain, the suffering, the lack, the loss, the person who hurt you, the blame, the guilt, all of that kind of stuff, you are going to generate negativity, and it is going to cause more suffering for you, for you. You are going to suffer more because of what you think about, and again this is not blame and shame. This is just inviting you to start seeing that if you focus on the positive stuff and you start to give your mind over to the good things that you can do to help yourself, then you are going to move in that direction. It is much harder to do than it is to talk about it. So, there is a lot more to learn about this, but it is a huge piece, and I encourage you to start thinking about it. Mindfulness could also be described as compassionate present moment awareness. Most of us are used to thinking in an analytical judgmental, how can I fix this or change it mode, we are doing? How can I do it better? And we are all conditioned for that. We get especially conditioned for that when we are under stress and we are suffering, because we want a solution, we want to fix it. Mindfulness is turning that upside down, it is shifting into a place of being present and compassionate, and when you talk about it, when you read about it might make sense or not make sense, but either way, you are not doing it. Doing it is an experience, you need to practice it, you need to learn it, and what I suggest is you find a guide, whether it is, you know, on the internet with or mind space or headspace or apps, okay that is a good start, but find a teacher, find someone who can help you learn it, because it is transformative, and I can tell you from my own experience and seeing so many people who like thought about it, they read all the books. I know mindfulness, no. Because they get into the training and they start to do it, and okay if things are challenging and hard and then suddenly, “oh my gosh,” like they have a realization, they have an experience that shifts everything. I did not know that could happen. I did not know I could feel that way. I did not know I could have that much free choice about my life. You got to practice it, to get there. Everyone can do it to a certain extent, go for it, okay. Next thing, body awareness. I work with a lot of people who think good thoughts, they are prayerful, they are spiritual, they are religious, they are doing good things, thinking good thoughts, but meanwhile their body is in alarm reaction because of their trauma, because of their pain, because of their disease. It is completely different when you take the good thoughts, the positive, calm, happy mindful mind and you bring it to your bodily experience, and you start to send up a message of safety to your body, you start to bathe your cells in the biology and neurobiology and neurochemistry of safety and positivity, transformative. Cultivating positive emotion, healing emotion, healing trauma. We know that people who have had adverse childhood experiences get more illness, they get more chronic disease, it is a complex phenomenon, it does not mean it is all in your head, but what it does mean is that emotional trauma, physical trauma shift your physiology, and there are tools that you can learn to shift it back into a healthy state. These are a collection of mind-body tools that can be transformative, and all of these are things to drill down to. Every one of these mind-body tools that I have listed here are things that you can learn to actually develop skill and cultivate, and once you do that, once you start to build that skill, it is yours. It is not something you have to go back to every week to your therapist or your treatment person. You have got tools, you have got transformative tools, that can help you break a fibromyalgia flare, that can help you find your way out when something triggers you, that can help you change your physiology and reverse those vicious cycles that give rise to the suffering and the fear avoidance, inactivity, and the disability. Okay, let us get into the motor mechanical, the movement piece of this. One aspect of this is bodywork, and there is two main kinds of bodywork. There is the hands-on direct stuff, where a person is pushing and prodding and doing stuff to move, to crack and crunch and move you, that can be great for some people. In my experience, it is not so great with people with fibromyalgia, because it tends to flare you up. There is another kind of manual bodywork techniques that you could describe as indirect, they are very gentle, they are more about consciousness and finding the freedom in the tissue and your body, your fascia, your tissue unwinds and moves in response to that, and that can be profoundly transformative. You can find that from a good osteopath, from a good manually trained physical/occupational therapist, some very good massage therapists, and some chiropractors, but you want to ask if they have worked a lot with people who have chronic pain and fibromyalgia, if they know indirect gentle techniques to release tissue, to release neuromuscular imbalances and reflexes that are counterproductive. Okay, and then there is stuff you can do for yourself. There is movement arts, and my emphasis, my bias is towards what you might call meditative or mindful movement arts, because exercise can hurt. If you just go out there and treat your body like it is a peanut piece of meat and you get on the treadmill and just go, go, go for 20 minutes, you are going to go above your threshold, and you are going to make yourself worse, and you probably have had that experience with some well-intentioned physical therapist, exercise therapist, or family member who said just get up and go, go do it. But what happens when you get up and go is you activate your stress response, you activate counterproductive reflexes, you go over your threshold, and you create a crisis in your cellular physiology, and you actually feed into this cycle, and you get a fibromyalgia flare, and that is not good for anybody, and maybe you have been there, done that, and maybe you never want to move again and maybe you are thinking who is this guy telling me I should move, forget about that. I get that, I have heard that from a lot of people, but when they started to learn to do a meditative quiet kind of motion and movement that respects the limitations of your body, that respects the low threshold, that actually lets you drop your calm, happy awareness into the body, and you know where you can move. You develop your intuition of your own body’s capability, and you start to move with that intuition and you build, you open up your envelope, you gradually learn to develop more flexibility, more strength, more endurance, and over time, you are climbing out of that hole of disability, and that happens through meditative movement, and so whether it is Feldenkrais or yoga or Tai Chi Qigong, Pilates, or other things that somebody may have invented. Find someone who is really good at it, find someone who has got a lot of experience and a lot of compassion and a lot of humility, who is willing to meet you where you are at and be your guide. Let them teach you and let yourself learn, let your inner wisdom grow, so that you know how to work with your own body, and over time, you are going to heal, you are going to feel better. You may need to work on this for the rest of your life to stay healthy, but you are going to be able to start doing only stuff that is meaningful for you. You are going to be able to get back to stuff that matters. It might not be like you were when you were 24 or 36, it might be like you are now, and then you build from there. So, you restart and you restart and you grow and you heal. Okay, so summing up. Fibromyalgia, chronic pain, there is a spiral of lots of different factors that lead to disability and disuse, and there is a process for preventing and reversing that, it has to do with addressing your metabolic biochemical system, to get the underlying cause of the symptoms. It has to get to do with your mind-body system, addressing your thoughts, your beliefs, your emotions, and addressing most importantly that autonomic imbalance, it is about learning how to move again. This is a healing path, nobody can do it for you, it is your healing path and it is unique to you. I really encourage you to find your guides, find the people who can help you address those three aspects of this situation or maybe some people can address more than one for you, but you need to start walking down that road, that healing path, which is yours, you find your guides, you let them teach you, you become an expert in yourself, and with time, what is going to happen is you are going to become the hero of your own story, because no one else is your hero. They are your guides, you are the hero, you are the one who is making the journey, you are in a place where you are stuck, where you are feeling horrible or you are terrified that you are going to get worse, and what is on the other end of your journey is, I feel empowered, I feel capable, I feel stronger, I know what I need to do. I might not be perfect, I might have setbacks, but I know how to deal with the setbacks and what you are going to do is learn to be a fuller self. You are going to learn to reconnect to purpose, to do stuff that you care about, to start feeling better about life again. So, my work is dedicated to helping you learn and grow in that way. I want to hear about how you like this video, if it is good for you, let me know, leave feedback in the comments or send me an email, sign up for my email community, so you can get updates about when I produce more content, and I am here and at your service. Thanks for watching.

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Fibromyalgia is Tough. Why is Disability Optional? Part A

Posted on April 17, 2022March 3, 2024 by Andrew David Shiller, MD

This is part A of a two part video.

Click HERE to watch part B.

For more videos subscribe to our YouTube channel

Summary:

In fibromyalgia, your pain is amplified. There are known biological changes that can contribute to the increased pain. Most of those changes can be helped if you know what to do. Suffering is a more complex thing. Suffering happens where pain meets your thoughts, beliefs, and emotions. There are simple tools that you can learn to shift your experience of pain and suffering. So you can be more comfortable, happier, and live better. Disability is an even more complex process. You have choices about how to mobilize your body-mind’s healing responses.

Did You Know:

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

Full Transcript:

Hey! It is Dr. Shiller, and I am going to speak with you today about fibromyalgia and disability. What I am going to say goes beyond just fibromyalgia. We are going to be talking about principles that are relevant to also chronic fatigue and chronic inflammatory illness to chronic pain problems in general, and this question that comes up over and over that eats at people is like what is this fibromyalgia thing? Is it a progressive disease that is going to eat up my body and destroy me like some kind of cancer or autoimmune thing? Like why does it have to be disabling? Am I going to get disabled? Am I going to lose all of my function and lose all of my self-respect and swirl down some sort of whirlpool into a black hole? Like what is going to happen to me? And the encouraging answer I want to give you is that it depends, that there are actually lots of places where you have an option and you have the potential power to shift the process, and what I am going to do in this talk is unpack, why does disability happen in fibromyalgia and what you can do about it? Because there is a lot of hope. So, check it out, listen, and hopefully this is useful for you. I am going to use some slides, because I am going to share a lot of information, and I want to give you visuals on it, okay? First thing we know is pain. Pain is the core thing that starts to bother so many people with fibromyalgia and one of the things that even the medical experts agree on is that there is central sensitization, and what does that mean? It means that the pain processing system is turned up, and this is a picture from Scientific America and basically you have a pain processing system that is the nerves from your say your hand, like if you have injured your hand, like in this diagram, and that signal goes up the nerves to the spinal cord and then through the brain to the parts of the brain, that says, “aah, my hand hurts.” and the part of your brain that gives you that like emotional angst a person often gets when they have pain, and the key thing that you need to know, listen up, is that your pain processing system is like an amplifier. There are several steps where the signal is transferred and processed by a lot of different factors, and that can turn things up like an amplifier, so that things that should not hurt, hurt, and if you have fibromyalgia, you probably recognize that experience where things hurt you that did not used to hurt you. Modern medicine does not really agree on a consensus about why central sensitization happens even though we know a lot of factors that cause it. We know a lot of different variables that can create hyper-extensive excitability and inflammation actually in the brain and activation of certain cellular and biological processes that turn up sensitivity of the brain, and these are some of them. We are not going to spend too much time on all of this and do not get hung up on it, but stuff that you may have already heard about it, you may have been looking into like inflammation and biochemical or oxidative stress, loss of cellular energy, hormonal changes, dysfunction in the biome or the gut motility or the gut lining, the leaky gut phenomenon in certain toxicity states, and then there is something called autonomic imbalance, and that is when that stress response is overactive compared to the relaxation response. Look into this if you have not heard of it before, but the key factor is that you have a system within your brain and spinal cord that touches every bit of your body, it is your autonomic nervous system, and it balances, it biases your energy allocation. Am I in get up and go fight flight freeze or am I in relax, rest, digest, assimilate nutrients, heal, sleep? They are two very different sets of processes and every part of you is involved in them, and one of the common things underlying a lot of pain, fatigue, and chronic illnesses is autonomic imbalance, and that is a whole other topic. Look for more information from me or other people about that. It is part of what drives the wheel of all these different changes that give rise to central sensitization and give rise to pain sensitization, and so autonomic balance is also an outcome of pain. When something hurts, like it creates that, that sense of it is not okay, that sense of loss of safety and that feeds into the process. So, just showing for the diagram, that it is a vicious cycle, where pain leads to autonomic imbalance, which leads to all of these processes moving forward and worsening of the process. Let us just think about pain for a second, because pain and suffering are profoundly interconnected, but they are not identical. Suffering and pain, the way a person experiences it are very subjective, they are very conditioned, they are very cultural. There are a lot of different things that affect how much a person suffers when they have pain, and that tends to be in the area of your beliefs and your emotional responses and your thoughts that you have about it, and so you know this is just the piece we already saw about all these sort of cellular and biochemical changes that affect pain sensitization, but then there is the interaction with the beliefs, the emotions, and thoughts, and what I am suggesting to you to start considering is that your suffering is an integration of all of these factors, it is the pain itself, and it is the way your body and mind and emotions respond to that pain, and of course as I am sure you have experienced autonomic imbalance is part of that too, because when you are suffering, when you are suffering, what you are doing, what happens is your being feels distress, it feels danger, and your stress response tends to be activated, and that feeds into all the physiologic changes like we talked about, it feeds into central sensitization, and it feeds into your beliefs and emotions and thoughts, because when we are stressed out, it changes the way we receive the world. If you are living in a reality where you are stressed out a lot of the time, that us feeding the disease process. We are going to talk more about this, but that is one of the places where you potentially have leverage. Okay, let is keep moving. I just want to point out that you could kind of separate and say, look, there is kind of metabolic process, it is just a label we are giving it for ease of understanding, that all these biological processes that we talked about that give rise to central sensitization, they are kind of on the level of metabolism and biochemistry, they are in your cells, they are in your organs, your endocrine system, and then there is your mind-body system, your beliefs, your thoughts, your emotions, right? And your autonomic balance and your central sensitization is kind of in between those two, because both of them influence it quite a bit, your metabolic biochemical state, nutrition, a lot of things like that, and your mind-body state. Let us take this to the next step, right, because there is this principle, there is a principle called fear avoidance that every good pain practitioner understands, because basically when a person is afraid of their pain, they do not want to move, and it hurts when you move. So, you do not want to move, and it is the most natural normal thing in the world, and there is no shame, and there is no blame, it is just the reality that when things hurt, you naturally do not want to move, and your reflexes know that. If I put my hand on a hot fire, I guard it, I pull it back, it is a protective reflex, and your whole system is organized around protective reflexes, and so if your autonomic system is on fire and you have autonomic imbalance, your protective avoidant reflexes are going to be even more active, but the problem is when that becomes systemic and when it hurts so you do not move, and you get, I am sorry, I am just pointing out here, sorry that autonomic imbalance thing is integrated with everything, but the main thing here to think about is that when all this stuff is happening and you respond to that natural tendency of fear avoidance by not being active, by not moving, you get inactive, your muscles and your tissues get weaker, you become stiff, and that is when disability happens. Disability is a process that happens in response to the way your body and mind are reacting and responding to pain, and it is not your fault, right? A lot of this is things that just creep up on you, and before you know it, you cannot do stuff you used to do, and the horrible thing that I have heard from so many people as they get less and less active and more and more disabled is like, well, I cannot take care of my kids, I cannot do my job, what happened to me? Who am I? This is not me, and your sense of self, your beliefs, your emotional state becomes even more out of balance, and it fits into the vicious cycles, and so it is disability cycle, and every good pain clinic knows this, which is part of why they have behavioral medicine people working together with the pain doctors, working together with the physical therapists and other therapists, because this is a holistic whole person process, and the better you understand this, the better off you will be. Let us just kind of follow this through because your movement system of your body, your muscles, your nerves. When you are physically active, you change your physiology for the better. Physical activity is one of the most helpful things you can do, it changes a lot of these metabolic processes, and so when you are inactive and becoming disabled, you are feeding into the underlying physiology that gives rise to pain sensitization. By being inactive, you are generating more inflammation and oxidative stress, potential toxic metabolites, hormonal changes, gut dysfunction, it feeds into the whole process. This is not about blame and shame, this is about opportunity, this is about understanding all these different factors and unpacking them. So, you can start to see what is relevant for you, so that you can start to make conscious choices to help yourself heal, to help unwind all of this. Every one of the changes that I put on this slide; all of these different things are biological, mental emotional, physiological processes that you have potential choice over. They all can be slowed, stopped, or even reversed depending on various lifestyle or other choices that you make, and so I am sharing all this so you can start to make those choices. The next part of this talk is really to talk about what we can do about it. I am going to pause and stop here, because we have already been at this for about 10 minutes. I am going to split this into part A and B. So, we just did as part A. Part B will be coming, look for that, and we will talk in part B about what do you really do about it. You know there is a healing process, and that healing process is addressing the metabolic, the mind-body, and the motor or mechanical parts of this. so, that is what we will do in part B. I hope you will tune in for that. I hope this has been interesting to you. My work is dedicated to helping you learn and grow in that way. I want to hear about how you like this video. If it is good for you, let me know, leave feedback in the comments or send me an email, sign up for my email community, so you can get updates about when I produce more content, and I am here and at at your service. Thanks for watching.

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Unlearning Negative Mind Body Patterns That Create Pain and Illness: Part 2

Posted on September 26, 2021March 3, 2024 by Andrew David Shiller, MD

Watch Part 1 HERE

For more videos subscribe to our YouTube channel

Summary:

In this video series we’ve been learning about how chronic pain and associated suffering develop. The idea is to understand the chronic processes, so that you can make choices about how to reverse them and reclaim your sense of well-being and ability to function and live your life. The previous videos in this series shared how the body-mind “learns” chronic pain. You can also “unlearn” chronic pain. This video continues to explain how that process works. I spoke in previous videos about the biological processes that are involved in the development of chronic pain. Have a look at those if you haven’t seen them yet. You can see those posts HERE. We discussed how protective responses are built into the pain processing and movement control systems of your body-mind. These processes get knocked “off the rails” by certain factors. And persistent pain leads to gradual changes in those systems that can unfortunately make pain worse. It’s like vicious cycles, where the pain system gets sensitized, and the movement control system stops working as well. So movement hurts, and pain spreads. It’s richer than that, as persistent pain and the resulting stress-response lead to measurable changes in gene expression, hormonal regulation, cellular energy production, emotional regulation, immune balance, and gastrointestinal function. And these all feed back into one another and can increase pain. So there is this snowball effect, where vicious cycles of biological relationships propagate forward and create the disease of chronic pain. The good news is that many of those changes can be reversed. In my experience, your own mind/body connection is a crucial place to start the changes. One great place to start is by developing the quality of ‘mindfulness”, which starts to shift the reactivity of the protective responses. Just like your brain-body learns chronic pain, mindfulness can start the process of unlearning.

Did You Know:

Dr Shiller is available for telemedicine consultation in CT, NJ, and Florida, as well as worldwide regarding chronic pain, fibromyalgia, autoimmune disease, fatigue, and stress-related illness. His US-based consultations are offered in conjunction with Rose Wellness to enhance the quality of care and ease of your experience as a patient. Contact the office or schedule a consultation at Rose Wellness. For international consultations contact www.drshiller.com.

Movement Toward Health is an affordable and effective training program to teach you to heal and feel better and improve your functioning. It will teach you to integrate breathing techniques, mindfulness, and mindful movement techniques that are drawn from Dr Shiller’s 30+ years learning, practicing, and teaching these approaches to people suffering chronic pain and chronic illness. To get more info and be notified of the next start date CLICK HERE.
Dr Shiller gives regular free mind-body training sessions on zoom. You can get the schedule and register at www.mindbodygroove.com

Full Transcript:

As mindfulness develops, you start to notice stuff, you become more aware, because you start to develop your ability to pay attention and receive what is there. You start to notice, “Gosh, I’m spending most of my life filtering through my thoughts and beliefs about what’s going to happen instead of actually seeing what’s going to happen” and almost everybody that goes down this path is like struck by that, “Oh my gosh, I was living in fantasy and I’m starting to touch living in reality” and part of that is you start to touch the sweetness and goodness of life, you start to smell and touch and taste things that are beautiful. We will talk about that in the next part, because that is really important, but for now, we are talking about kind of inhibiting the negative patterns, because that is the other aspect of what we do, it is kind of like I said, stopping these unproductive reactive habits about your mind and your thinking, your nutritional habits, your posture, your bodily habits, what you do in the world, and it is not like you are being forced by some sort of blaming conscious and shitting yourself, like what is wrong with you, do not you know you should not do that, that is not the game, because what happens is you just start to pay attention and you just forgive everything and you just choose to be grateful and you let go and you practice letting go and being present, and what arises naturally is just a clear choice, like, “I don’t want to eat that stuff or gosh this person in my life is toxic. I want to do something different because I’m, so much negativity there or gosh look at all my own toxic thoughts, how can I be with that and let go of them” S Mindfulness practice develops this observer, that starts to notice the negativity and you naturally start to just say, “No, thank you” and you naturally become more forgiving with yourself and forgiving with other people. You naturally start to like accept your life as it is and that does not mean it is never going to change, but you are less reactive to the things that are difficult, that used to grab you and pull you into severe suffering, and it is remarkable the changes that just happen naturally that I have been privileged to witness with other people. You know it is kind of like there is concrete and then suddenly the grass grows through the crack somehow, like there is life in there that wants to come out. One example, there is a fellow that I worked with, his name is Bill, and he was a recovered alcoholic, but really struggling with cravings, a lot of difficult emotional stuff in his life, and every day was like a war to not drink, and you know we were practicing one day and Bill basically says, “I really have the urge to drink” and I said, well, okay, so what else are you experiencing? He said, well, I feel tight in my chest and I feel irritable, my back hurts. Okay, and what about the emotions? I feel irritated, I feel angry with you for asking me all these stupid questions. So, I said okay, so how about just sit with what you are experiencing, sit with the difficult emotions, just observe them and be with them, notice what they feel like, do not try to change them, just agree because that is what is happening. He sits there for like a minute and a half and then like a smile comes on his face, like why are you smiling? He’s like, well those emotions were really hard and then they just kind of went away, and I do not feel like I need to drink anymore. That was a discovery, it was something that just came to him through observing his own life, and I could give you so many examples of things like that in my own life, in the life of so many patients, where it just comes from paying attention with compassion, dropping the judgment, forgiving, being present and cultivating this part of you that actually kind of hovers above your emotional self and your bodily self and is with you all the time, and it is an expression of a deep inner intelligence, and it is your healing intelligence and that is the power of doing that kind of training to unwind these pathways of mind, emotion, and physiologic reactivity that perpetuate and develop this process of chronic pain and chronic illness, and so, as you practice and train yourself to be aware with compassion and with discernment, things start to change spontaneously, you start to just, you know, you may have lived your whole life in patterns of reactivity that are mental, emotional, and physical, and you start to notice them and they start to kind of get lighter and get less heavy and you start to have more freedom of choice, and it is from practice, it is relearning, it is rewiring, nerves that fire together wire together. When I have that experience of tasting the irritation that once created reactivity, and I choose to just be with it and let it be there and say yes, it is happening, I agree this is what is up, letting go the judgment, then I am turning off the reactivity, it is like, I am uncoupling it, you know, it is those two nerves, there is the irritated and then there is the reactive nerve, right? I am irritated, so then I get emotional, and I am basically saying, “No, I’m not believing you anymore, you are just a habit. I don’t need to get reactive when that happens” and then you start to actually uncouple your physical, emotional, mental experience from your ability to choose to have the kind of experience you want to have, and that changes your physiology, it changes your neural networks, it changes your gene expression, because you are living in a more calm, clear, connected state, where you are not as reactive. We talked about how there can be setbacks and how a person can be learning to live in a calm or clear state of mind and body but then something happens that like knocks him on the ground, knocks him back into the hole or they fall in the water, so to speak metaphorically, so what is that about, how do you deal with that? We talked a bit how just being mindful gradually that happens less and you develop the capacity to respond more effectively when it does happen, but the other thing is that there is deeper kinds of work than just sitting there and being mindful of what is going on. There is deeper work that involves getting therapeutic support, whether it is with an individual or a group or in your own inner work and intentionally going in and meeting the dark places inside, because a lot of us, most human beings, we have had experiences of profound disappointment of hurt, of trauma, of fear, times when we felt like we were disconnected and it just was not okay and, you know, there is a language for this in various psychotherapeutic and spiritual traditions, but the point is meeting those places and evoking various tools for actually doing a deeper level of work, to reclaim that part of yourself and to free up the deeply held protective responses that you might have in your heart or your body, that is profound work as well. It is a little bit beyond the context or it is a little bit beyond the scope of this video. So, I am not going to go there now, but that is something else to think about and talk about, because a lot of people with chronic pain and illness have trauma. We know that early life trauma is a huge part of what influences people to develop chronic pain and chronic illness and healing that trauma can be a profound influence on all of these physiologic processes, because what it does is sort of uncouples or discharges or disengages these deeply held patterns that said, “danger” and it is about healing those, so that your whole system can be more at ease in that rest, and there is techniques for learning that. Okay, so let us make a break now and we have talked really about the process of sort of saying no and uncoupling and unlearning negative protective responses, and we also want the process of installing and learning and actually awakening healing responses. So, we will talk about that in the next vid, hope you tune in.

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Unlearning Negative Mind Body Patterns That Create Pain and Illness: Part 1

Posted on September 22, 2021March 3, 2024 by Andrew David Shiller, MD

Watch Part 2 HERE

For more videos subscribe to our YouTube channel

Summary:

In this video series we’ve been learning about how chronic pain and associated suffering develop. The idea is to understand the chronic processes, so that you can make choices about how to reverse them and reclaim your sense of well-being and ability to function and live your life. The previous videos in this series shared how the body-mind “learns” chronic pain. You can also “unlearn” chronic pain. This video begins to explain how. I spoke in previous videos about the biological processes that are involved in the development of chronic pain. Have a look at those if you haven’t seen them yet. You can see those posts HERE. We discussed how protective responses are built into the pain processing and movement control systems of your body-mind. These processes get knocked “off the rails” by certain factors. And persistent pain leads to gradual changes in those systems that can unfortunately make pain worse. It’s like vicious cycles, where the pain system gets sensitized, and the movement control system stops working as well. So movement hurts, and pain spreads. It’s richer than that, as persistent pain and the resulting stress-response lead to measurable changes in gene expression, hormonal regulation, cellular energy production, emotional regulation, immune balance, and gastrointestinal function. And these all feed back into one another and can increase pain. So there is this snowball effect, where vicious cycles of biological relationships propagate forward and create the disease of chronic pain. The good news is that many of those changes can be reversed. In my experience, your own mind/body connection is a crucial place to start the changes. One great place to start is by developing the quality of ‘mindfulness”, which starts to shift the reactivity of the protective responses. Just like your brain-body learns chronic pain, mindfulness can start the process of unlearning.

Did You Know:

Dr Shiller is available for telemedicine consultation in CT, NJ, and Florida. worldwide regarding chronic pain, fibromyalgia, autoimmune disease, fatigue, and stress-related illness. His US-based consultations are offered in conjunction with Rose Wellness to enhance the quality of care and ease of your experience as a patient. Contact the office or schedule a consultation at Rose Wellness.

Movement Toward Health is an affordable and effective training program to teach you to heal and feel better and improve your functioning. It will teach you to integrate breathing techniques, mindfulness, and mindful movement techniques that are drawn from Dr Shiller’s 30+ years learning, practicing, and teaching these approaches to people suffering chronic pain and chronic illness. To get more info and be notified of the next start date CLICK HERE.

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

Full Transcript:

All right, so in the last video, we talked about how chronic pain and illness are processes that gradually develop over time, that genetics and life experiences and various triggers can start this process, and that your biology shifts, your system, your mind body system so to speak practices various protective and maladaptive responses and that is built into your neural networks, so practicing it over time, your system learns it and it becomes kind of set, and that is affecting your neurologic activities and emotional and mental responses, your neuromuscular functioning of your motor system, your gastrointestinal system, your hormones, your immune system. To varying degrees, those are all influenced, because it is all one system, and it is all working together, presumably to protect you from danger but effectively to generate these secondary problems of chronic pain and chronic illness. The system gets unbalanced, the neural networks change, gene expression can change, and the outcome is chronic pain and chronic illness, and just like it can be learned, it can be unlearned, and so this video is going to start talking about how do you help the healing process, how do you unlearn chronic pain, how do you relearn health? Healing is a learning process, it is about the conscious choices that you make on a daily basis, lifestyle, behavior, habits, thought patterns, mindset. You could break it into three parts, because I like to do that to make it easier and they are called three M’s, there is your mind body system, your metabolic or biochemical system, and your motor or your movement system, and all of those are ways that you can kind of grab hold of your physiology and on a regular consistent basis start to shift your physiology towards health. Obviously there is a lot to unpack there, but the point is that you really need to think about it as I am taking charge of my health. I am not expecting someone to fix me. I am not looking for an overnight miracle that suddenly I am going to be better. What I am looking for is gradual change over time that happens, because I have made conscious choices, and I have been doing stuff to help my mind body system to optimize my metabolic system, nutrition, inflammation, all of that, and to actually use the power of my movement system to help my body heal. This whole aspect of retraining and unlearning pain and illness and relearning health. There are these two parts of aspects of unlearning the bad stuff and learning the good stuff, pretty simple, right? Let us start by talking about unlearning the bad stuff and you got to start that conversation by talking about stress and almost everybody now knows that you have a stress response and you have a relaxation response, this is physiology that has been demonstrated for 50 years and interventions to evoke the relaxation response have been tested over and over and over again in so many different realms of health and showing their benefit, because they balance that system out. You are meant to go through stress in life, life is not meant to be stress-free despite what the magazines tell you, but the point is, you have stress and then you have relaxation, and the system is in balance. Most of us in our current time are stressed, there is a lot of difficult things going on in the world, and if you have got chronic pain, chronic illness, there is a protective stress response going on and you probably like overdoing it on the stress response and under-doing the relaxation response. Simple techniques, there is a bunch of different ones, can actually evoke the relaxation response, and lots of research showing us that those are beneficial in a variety of different kinds of conditions and situations, to enhance well-being, to help people cope with pain, to reduce the effects of chronic illness in various ways on various organ systems. The key is consistency. We are talking about a learning model. We are talking about the body has practiced for months or years, an unbalanced stress response and all of that influences in the whole body-wide system, and so what you are looking at doing is shifting that, and that means consistency, nerves that fire together wire together, you want to shift your neural networks, you want to bathe your whole body and mind in biochemistry that starts to shift gene expression overtime. You want to try to do it on a regular basis. Hopefully that all makes sense, but there are a couple of problems with relaxation training. I have been teaching meditation for a lot of years, and what I hear over and over again from a lot of people is, “doc, I try to relax and I get more tense.” It is a really common thing, because you know what, if I am trying to do something, I am not relaxing, effort is the opposite of relaxing, and what you could say is stress is when we are trying to put an unbalanced force on something, an absence of stress is just stopping, it is effortless, there is no effort, there is no trying to get anywhere, and so a lot of the relaxation response methods that are sort of like active, “Hey, you are going to relax,” they can trip a person up that way. If it works for you, great, do it. In my own experience, just simply bringing the awareness to the present moment, bringing awareness to the sensual experience of life, bodily sensations, breathing, sounds, textures, even the taste of food, that is all about bringing your awareness and your consciousness into the here and now, and there is not stress here and now. Mental emotional stress comes from future and past; it comes from comparing and thinking and striving and yearning and trying, and when you just bring your awareness into the here and now, the whole system starts to calm down and relax. In my experience, that is often a big change for people who are sort of stuck in the “I can’t meditate, I can’t relax.” Okay, so do not meditate, do not relax, just pay attention in a structured way, just notice what you are experiencing, notice your breathing, let your breathing be like waves coming in from the sea and rolling up on the shore and rolling out to the sea. It is an experiential process. The second big challenge with relaxation and stress management in general is what I have heard from so many people, which is, “I feel great when I am doing it, but then as soon as I get back to life, wow, everything hits me and suddenly like I am back into the vortex, and I am into the reactivity” and you know whatever it is, like the wife or the husband or the co-worker who does something unkind or the pain flare or the financial issues that trigger something, and before you know it, you have fallen back in the hole. So, what do you do about that? One of the first things you do about that is realize that it is totally normal, if you have been practicing being in a reactive stress state for months or years, then your body is used to it, that is what we are talking about here, we are trying to change physiologic habits, and it can take time, and it is totally normal that you get pulled back into the challenging stuff. There is a deeper level to this if you start really thinking about the structure of a human being and a human soul, which is that we often have areas in our deeply held experience in our heart, even in our bodily memory that are associated with painful traumatic experiences, and until we start to actually unravel that and unwind that, they are going to still pull, they are going to pull our attention, they are going to pull our physiology, they are going to have a pull on your emotional experiences. That is where it gets a bit deeper, because the idea of bringing your attention and your awareness to the present moment experience, yes, it can be very relaxing, but there is a deeper process. What happens is you develop this quality of your own mind that is able to be present, and you actually gradually condition your mind and your emotions to observe what is going on without getting sucked into the drama, without getting sucked into the judgments and the habits of self-blame, self-judgment, criticism of self or others and the emotional reactivity that they create. In my own experience and what I have witnessed with so many people, there is this process by which the awareness develops overtime, there is a part of your mind and soul that is elevated above your emotional reactivity, and you develop it, you build it, you condition it, you teach it, you learn it by practicing it, and that is why the real benefits from meditation happen from practice. By doing it on a consistent basis, by observing, by being present, by letting go of the reactivity, by falling off and getting sucked into it and then letting go again. It is a training process whereby you are essentially saying to your whole being, I am paying attention, and I am here, and I am not going to go down those pathways, I am saying no essentially to the normal reactivity, like I am sitting there and breathing, and I am paying attention, and I notice the thought that comes up that often triggers me, and I choose to just let it go. I notice an emotion that might come up, that might trigger me, maybe it is sadness or fear, and I just choose to hold it; I decide to compassionately relate to it. Okay, there is a difficult emotion, I am feeling fear, I am experiencing pain, let me just be present to that as if it was a little child who needed my loving care and attention and hold it in my heart without getting into the whole reactive, oh my gosh, how’s it going to change, I can’t live like this. The things, the habits of reactivity that naturally become part of our being when we are dealing with chronic pain and illness can be unlearned and that is really what mindfulness training is about, there is a lot of different layers to it, but the basic idea is developing awareness and consciousness that are present, discerning, and compassionate. Which means I understand why this could happen, with all the different things that have gone on in life that have happened to me, that have happened to the world, of course, this is what is happening right now. I am falling back into fear and irritation and anger. I am slipping into chronic pain. I have been rehearsing it for 10 years. Okay, I am noticing it, I am letting go, I am not getting caught in the spiral, and what happens is that there is this part of your mind or your brain or your being depending on who you want to think about it, that you develop, and it gets called mindfulness in some circles, in the teachings of Torah and Kabbalah, it is the higher soul, it is the Neshama, the part of us that is just present to our life experience and can connect our sort of lower needs and drives with our higher aspirations, and it is your biggest ally in healing. Many of the people who I serve appreciate shorter videos, because it is easy to absorb that way, and we are going to continue to learn about unlearning pain, but I am we will just to take a break here and continue in the next video, you can find that whether on the blog or on the YouTube page or elsewhere, just look for the next number in the sequence and please join me there, please share if you find this interesting, and talk to you soon.

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

Posted on December 17, 2020March 3, 2024 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:

How does the functional medicine approach think about complex pain and illness, and offer improvement where conventional medicine has failed?
What does it mean that he has “an abnormal pattern cortisol secretion”?
Is this “adrenal fatigue”?
What is the connection between stress, adrenal dysfunction, IBS, fatigue, and pain?
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:

What can a person do about the problem?
What are the most commonly overlooked issues that keep people from healing? Even though they’re doing an integrative approach.

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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.

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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Mindfulness and Cancer Pain

Posted on June 12, 2013January 18, 2019 by Andrew David Shiller, MD

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