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.

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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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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

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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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Pain and Suffering. How To Get Off The Mindbody Rollercoaster

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