Your Brain Is Creating Real, Severe Pain ; A Doctor Explains Why and How to Stop It with Dr. Rebecca Kennedy

[00:00:00] What we're working with is the survival brain and the survival brain works by getting safety
[00:00:06] in numbers, safety from our tribe. And so if we're in this tribe or in this system
[00:00:12] and then there's this one person saying something different, just even how we feel in our body,
[00:00:19] like it just doesn't align with how we feel. Like maybe even logically it might make sense to
[00:00:24] ask questions and lean into it and try and figure out. But what we feel is really what we believe
[00:00:30] as humans and what we feel comes from our unconscious brain, which is not a rational
[00:00:36] thinking logical brain. And so it's just so hard to get people to change logically. We really
[00:00:42] need to change how we feel, which again really aligns with the core of tenants of doing
[00:00:47] this work and getting better as well. Hey there and welcome to Heal with Grace. I'm your host Grace
[00:00:54] Secker and I'm a holistic licensed therapist and nervous system coach who believes that the chronic
[00:00:59] and often unseen symptoms you're living with are a sign of something deeper going on. A sign that
[00:01:04] your nervous system needs attention. In each episode I'll share the science behind the most
[00:01:09] common chronic health disorders plus holistic health tips using mental, physical and spiritual
[00:01:14] practices. You'll hear what I've learned in my journey and the true stories from our trusted guests
[00:01:20] so you can feel less alone in your experience and give yourself grace no matter what you're
[00:01:24] going through. So without further ado, settle in and get cozy. It's time to heal with Grace.
[00:01:32] Hi Becca, thank you so so much for coming on the podcast today. Really appreciate it and I
[00:01:36] know that this conversation is going to be helpful. Yeah, my pleasure. Great to be here with you.
[00:01:41] Let's go ahead and jump right in and why don't you share with us a little bit about who you are
[00:01:47] and how you got into this work professionally? Yeah, so I'm a family medicine physician. I'm in
[00:01:53] Portland, Oregon. I've been a family medicine physician for over 20 years, 25 years and I
[00:01:59] worked at large health systems. I was at Kaiser Permanente for 15 years, kind of a little bit
[00:02:04] into my career. And as a primary care physician, you see everybody that doesn't get better
[00:02:11] from everything else. So over the years, and especially working with such a huge volume of
[00:02:16] patients at Kaiser, as well as really seeing the whole full picture of everyone kind of in our
[00:02:23] integrated system there, just patterns emerged that were quite clear. I mean, to me as well
[00:02:28] as most other doctors, I would say. But just so many symptoms that didn't really make sense
[00:02:35] physiologically, we couldn't help. We didn't really know what was going on. People had ongoing
[00:02:39] chronic symptoms. There is a lot of symptoms that would sort of move around in the same person,
[00:02:46] but the same kind of symptoms over and over. Also the pattern that emerged that often people
[00:02:51] also had mental health diagnoses that sort of travel together, but weren't exactly the
[00:02:56] cause or the result. Sending someone to mental health often didn't help. And so it just became
[00:03:02] this big curiosity to me. It was like this, I couldn't scratch and I just looked for years and
[00:03:07] years and years to search for better answers, not finding them for a very, very long time.
[00:03:12] And then I was very fortunate enough to come upon this mind body approach. My friend from
[00:03:17] medical school, who was a family medicine doctor would send her patients to Howard
[00:03:22] Schubertner. So I dove into it. And when I was at Kaiser, I had a little bit of time in the
[00:03:29] integrative clinic. So I started working with patients with this approach. And it was during
[00:03:34] the pandemic. And so I started seeing a lot of people with long COVID. And even right away,
[00:03:39] having thought about these connections for years, I mean, it already made sense to me
[00:03:45] that this is what was going on for long COVID. I was part of the long COVID clinic at Kaiser.
[00:03:50] I became a clinician for the long COVID clinic. And so again, being in that huge health system,
[00:03:58] there's like 600,000 members. And then Kaiser Permanente Northwest, all the people with any
[00:04:05] concern for long COVID funneled through our long COVID clinic. And there's only like four of us.
[00:04:10] So I had a huge volume of long COVID patients that I assess. And the worst of the worst,
[00:04:18] I mean, like the most severe patients, I was the one of the long COVID clinic that they would
[00:04:24] send those patients to me. So I really saw the very, very, very severe patients.
[00:04:30] And I was able to help them with this approach. And then I tried really hard to communicate
[00:04:37] what this was to the leaders, you know, get this integrated even more. But, you know, it's
[00:04:43] it's a hard ask. It's such a different way of thinking about things. And it's really hard to
[00:04:49] fit a square peg in a round hole in the medical system that's already really established. And so
[00:04:56] I decided to leave Kaiser a couple of years ago and just start my own practice. And so this is
[00:05:01] the work that I do completely. This is all I focus on now. And sort of with all that,
[00:05:07] you know, the other part, I think that's important to know also is that
[00:05:10] I came to this approach because of looking for answers for my patients. And then after I learned
[00:05:16] about the approach, I developed my own neuroplastic symptoms of quite severe pain and fatigue,
[00:05:24] which is, you know, so brain is really so hilarious in that way. But because really,
[00:05:32] it's about being trapped in our life. And I was trapped in that health system,
[00:05:37] there's a big stressor with a friend in my life and just a lot of those different things.
[00:05:42] And I have all the personality traits really that go along with with neuroplastic symptoms in
[00:05:48] general. And so I went through my own experience as well. How was that going through your own
[00:05:54] experience already knowing this work? You know, it's so funny. I think there was so much
[00:06:00] about the experience of the symptoms that didn't scare me because I understood pretty much
[00:06:05] right out of the gates what they were. And I mean, there was severe, I had like burning pain
[00:06:10] throughout my body, especially at night that when I would like moan, I couldn't I could barely even
[00:06:15] like sit up at night and really this, you know, crushing fatigue, I could work still, but I
[00:06:20] really couldn't do much else. So on one hand, they didn't scare what my conscious brain,
[00:06:27] obviously my unconscious brain had huge amounts of fear. And it's also interesting that I was
[00:06:32] helping people and people were getting better. But yet I was having these symptoms. And
[00:06:40] but I think it you know, I mean, it certainly helped me to be a better clinician and better able to
[00:06:45] help people going forward. But there was part of me that both knew I could get better. So I
[00:06:52] had that belief in that confidence that I could get better. But by the same token, I also like
[00:06:59] everyone else, I think that comes to this, also had my doubts that I could get better.
[00:07:04] That I mean, I think it's so common to see that other people have gotten better and think,
[00:07:09] yeah, yeah, yeah, well, this will work for you or you know how to do it, you can get better,
[00:07:13] but that probably won't work for me or I can't get better. And I still had that part of it,
[00:07:17] you know, part of that that doubt in my in my brain as well. As you say that,
[00:07:21] I'm also reflecting on so many people that come to this work. They've had so many
[00:07:26] experiences of something not working for them. So they've always felt like the outlier, right?
[00:07:32] And thinking, well, yeah, this isn't going to work because I've tried a million things and it hasn't
[00:07:36] worked. Yeah. That can get ingrained in just our belief system and our perception of it of this
[00:07:43] work too. Yeah. And it's such an interesting statement to say that and really think about
[00:07:48] and reflect on that, that people feel like an outlier. And the reason I chuckle is because
[00:07:54] the reality is actually that outlier is actually, in reality, the norm. And I think really feeling
[00:08:01] like an outlier is probably because lots of different clinicians, things like I used to say
[00:08:06] to my patients before I knew about this, like, Oh, well, let me give you X treatment and this
[00:08:10] should work. I've seen this work. So then it doesn't work. And then they feel like an
[00:08:14] outlier because their clinician just told them that it should work. But frankly,
[00:08:20] from my experience from the inside out, a lot of the things we do don't actually really work
[00:08:25] for a lot of people. And a lot of times that they end up working is really because of the placebo
[00:08:29] effect. And so then these messages that we're giving people as professionals that end up making
[00:08:35] them feel like the outlier is really more about an erroneous message from the clinician,
[00:08:42] I would say that's important. Yeah. I mean, not that the clinician is
[00:08:49] has any mal intent, right? They want them to get better. They're doing their best.
[00:08:54] He's the best they know. So again, what I used to do tried my best. And, you know,
[00:08:59] would see some people getting better. But I think that, you know, I think it's just so
[00:09:03] important for people to really recognize that having tried lots and lots of things
[00:09:09] that often is because of, you know, the situation of the clinician having seen it work
[00:09:14] because of the placebo effect. Yeah. Right. And so tying this a little bit back to what
[00:09:21] you said in the beginning of your experience with Kaiser and then leaving and going through
[00:09:25] your own personal experience with symptoms, because I'm just curious, what's the barrier do
[00:09:30] you think for maybe those other people in the clinic, those other clinicians to take on
[00:09:35] and understand this work? What was the difficulty there and you bringing it to them?
[00:09:42] What do you think that is? It's funny. It's such an unbelievably different way to think about
[00:09:48] things. Yeah. On one hand. And so I think it's just such a big shift. It's just really hard for
[00:09:56] a human brain, frankly, to make that big of a shift in the first place. But the other part
[00:10:02] is that because it can feel like such a tiny little fine line between what lots of people
[00:10:10] say work that ends up to be alternative medicine or what people are saying something works
[00:10:19] is really just working because of the placebo effect. And so then we've been told as clinicians
[00:10:25] so much over time, patients come in and they say, Oh, well, I got better because of X, Y and Z.
[00:10:32] But really X, Y and Z does not make sense physiologically like at all. And so they might
[00:10:38] come in and say, Oh, well, I, I took this supplement and I did this, whatever treatment and got
[00:10:45] read like therapy or this and that or manual manipulation of my, you know, whatever it
[00:10:50] is. But from our scientific standpoint, it just doesn't really make sense. And they're getting
[00:10:56] better because of the placebo effect. And so then as clinicians, I think we just discount it
[00:11:02] because well, number one, we're like, Oh, well, that's not scientific. It's woo woo. It's,
[00:11:08] you know, probably just the placebo effect, kind of stuff like that. Not to say that as
[00:11:14] clinicians, we shouldn't be more curious. Right. I mean, I think that's the main thing
[00:11:20] is that however someone got better, what we should be doing is asking them,
[00:11:24] investigating it, going towards it, which unfortunately we don't do. But I think that
[00:11:28] there's been so much of that for clinicians that, that often we just sort of discount this and say,
[00:11:34] Oh, well, this is, you know, this is woo woo or this is the next thing or whatever.
[00:11:40] And I think then also there's just sort of the problem of, you know, ego for people.
[00:11:46] I have my own ego, right? I did this. But so that gets in the way. And I think also even just
[00:11:54] when you think about this, this work, what we're working with is the survival brain.
[00:12:00] And the survival brain works by getting safety in numbers, safety from our tribe. And so
[00:12:06] if we're in this tribe or in the system, and then there's this one person saying something
[00:12:13] different, just even how we feel in our body, like it just doesn't align with how we feel,
[00:12:19] like maybe even logically, it might make sense to ask questions and lean into it and try and figure
[00:12:24] out. But what we feel is really what we believe as humans. And what we feel comes from our
[00:12:32] unconscious brain, which is not a rational thinking, logical brain. And so it's just
[00:12:38] so hard to get people to change logically, we really need to change how we feel, which again,
[00:12:45] really aligns with the core of tenants of doing this work and getting better as well.
[00:12:50] Yeah, of course, I mean, it makes sense. It is a very different way. When I first got into
[00:12:55] this work, I used to say that a lot. And I think I've kind of come away from it because
[00:12:59] it's, it's my world, it's just normal to me now. And I forget that it really is like,
[00:13:06] it's a 180 of understanding yourself. Exactly. Yeah. And that's the thing. And when I first
[00:13:13] learned this, I used to walk to work at Kaiser and I would wake up in the morning and I would
[00:13:18] think, I mean, I would sort of have like this little panic where I would go, Oh my gosh,
[00:13:22] am I really saying this to people? And I would be like a little dissociated walking to work.
[00:13:27] I mean, it was like surreal to spoke with this physician the other day who just recently
[00:13:32] learned about this and she was describing sort of the same thing. But what kept me going
[00:13:36] is getting to work and enough patients, not all of them, but enough patients saying to me,
[00:13:40] Oh my gosh, this is the first thing that actually makes sense to me. And it is true because really
[00:13:46] as you put in the missing pieces, then all the information actually does make sense.
[00:13:53] Yeah. I have clients often say that too, not all, but some will say, this just makes
[00:13:58] sense now. This has to be the missing piece. It just it does. Right. Right. Right. Exactly.
[00:14:03] Yeah. And I think also what happens is that again, as a human brain, if we have a model,
[00:14:08] like a very, very stuck in place model that we've experienced, the way that our brain works is
[00:14:15] it actually just discounts pieces of information. It's like Teflon like the information comes
[00:14:21] in and it just bounces right off out of our awareness because it doesn't fit our model.
[00:14:27] And our brain then chooses the pieces of information that fit within our model.
[00:14:32] And so the information for saying to the doctors trying to tell them about this new
[00:14:38] information or patients or whoever it is learning about it is that our brain just sort of forgets
[00:14:43] about the information that doesn't make sense and takes the information where it does make
[00:14:49] sense. And we just, we just put on the periphery of our awareness, the pieces of
[00:14:54] information where it actually, there's actually absolutely no way in the world that it possibly
[00:14:59] could make sense, but we just have that outside of our awareness. Exactly. And also let's tie
[00:15:05] this into the placebo effect, or at least I want to talk about it, that even just that term
[00:15:10] can come with a dismissal, right? Oh, it's just the placebo effect. We learned about it in
[00:15:15] school when you learned about what research was and whatever grade that is, right? But
[00:15:19] we don't actually talk about what it really means and what it is. So because, and you've
[00:15:23] mentioned it a few times. So can you explain actually what it is and the power of it and why we
[00:15:28] Yeah, it's such a good point. And I think I did this as well is that, you know, we sort of
[00:15:33] what in actually this, this kind of brings a point that I think again humans work on sort
[00:15:38] of two levels of thinking. And one is like level one thinking, which is just sort of the
[00:15:42] superficial thinking. And then level two is the deeper critical thinking. But that requires
[00:15:48] a lot of energy for our brain and attention, which is not easy to have. So most of us just
[00:15:55] exist in this plane up here of level one thinking that's just, well, my mother had this. So
[00:16:01] that's why I have it. Okay, that makes sense. But we don't go to the deeper critical thinking.
[00:16:06] Well, why does that make sense? How does that make sense? So the level one thinking
[00:16:11] of placebo effect, which is kind of what I used to think about it is, oh, yeah, well,
[00:16:16] it's just that because of belief in our brain, we experience some symptoms in our body. Yeah,
[00:16:21] yeah, of course, I know that that's why we have randomized controlled trials. That's the scientific
[00:16:25] method. But really understanding in the deeper level to thinking about placebo effect
[00:16:33] is what the placebo effect is. Yeah, it's about just having the belief in our unconscious brain
[00:16:40] that creates the actual experience, like the same experience as the actual chemical effect,
[00:16:49] for instance, not a watered down experience, not a made up experience, but the actual same
[00:16:57] experience. And I think that that is the piece that we don't get. This isn't the placebo
[00:17:03] effect because my symptoms are so severe. So it couldn't be the placebo effect,
[00:17:07] because we think about it that it's a watered down version often. Or, well, it's not the placebo
[00:17:12] effect because I didn't believe it was going to work. Now, it's not about our conscious
[00:17:15] belief, actually, it's about the unconscious belief. Again, it came to this work for looking
[00:17:19] for my patients because I didn't, I mean, I did have neuroplastic symptoms in my life
[00:17:24] looking back. I mean, I think everybody does at some point. And when I was a primary care
[00:17:29] doctor at Kaiser and my kid, my two young kids were young, and I had work full time,
[00:17:34] a husband worked full time. I was having headaches every day that would start at like
[00:17:39] 3pm on weekdays. They weren't super bad. I could still live my life, you know, all this stuff.
[00:17:45] But my colleague prescribed me a medicine for an amitriptyline, this little tiny, tiny dose.
[00:17:50] It's an old, old antidepressant that we use for chronic headaches to prevent them. And
[00:17:57] when she prescribed it to me, I mean, literally my conscious brain was like,
[00:18:01] Oh, well, that's ridiculous. That's not going to work. Because I hadn't actually really seen it
[00:18:05] work in patients very well. It was such a tiny dose. So my conscious brain actually
[00:18:12] really didn't think it was going to work. But I was like, Oh, I might as well like
[00:18:16] going to do something. And the first three nights, I was headache free.
[00:18:22] And I was like, Oh, and it was like the first time I was headache free in
[00:18:25] months. And I was like, Oh, well, this is great. This is awesome. Although I think I
[00:18:29] consciously was like, Oh, well, that's a placebo effect to working.
[00:18:35] Yeah. I mean, okay, so then after that, what did you, you just said, Okay, yeah, I guess it was
[00:18:40] placebo move on, like dismissing the placebo essentially, right? Yeah, I mean, I still took it
[00:18:47] because I was hoping it would help. So I just, I still took it, but I took it, I don't know,
[00:18:51] for like a couple months or so. And then it just didn't work after that. So I just
[00:18:55] eventually stopped it. Yeah. Okay. So I want to come back to, to long COVID and
[00:19:02] get the understanding of how is long COVID the mind body placebo effect when a lot of people
[00:19:09] can be told that they have the spike proteins in their bodies or higher inflammation or
[00:19:15] extra things that are dysregulated in their body, their gut, whatever it is,
[00:19:18] like those physical explanations. So how do you explain that?
[00:19:22] Yeah, I think in anything in life, and certainly in the science world, it's really important to ask,
[00:19:30] how do you know that? Why do you know that? What's the evidence? Could there be another explanation?
[00:19:40] And it's key that we ask that about everything. And so how do you know that, you know,
[00:19:48] it's spike proteins or it's a micro blood clot or cytokine or mitochondria or, you know, all of these
[00:19:53] things? Well, frankly, we don't actually really know that. There has not been randomized controlled
[00:20:00] trials that have been reproduced that show that that is actually the answer. Those are all hypotheses.
[00:20:10] None of it has been scientifically proven. So if we look at, well, what are the studies
[00:20:16] that have been done? So for instance, with the persistent viral proteins, it's a couple of studies,
[00:20:22] but one of the studies is they're relatively small. There was maybe 120 patients or something like that.
[00:20:29] But in the control group, which means the group that did not have long COVID symptoms,
[00:20:36] well, number one, in the first study, I've really looked through it and I actually couldn't
[00:20:40] find any data to show how many spike proteins there were in the control group or, you know,
[00:20:47] how much of the control group had persistent spike proteins. I couldn't actually find that data.
[00:20:51] It probably is out there someplace. But in the group with long COVID, I don't remember the
[00:20:57] exact numbers, but, you know, it's like 60% or something like that. Wasn't 100%. So there's
[00:21:04] a big chunk of people that have long COVID that don't have persistent spike proteins.
[00:21:09] Could people have long COVID for different reasons? Yeah. But generally speaking, in medicine,
[00:21:16] when we have to start explaining things in lots of different ways, generally speaking,
[00:21:23] those explanations are not correct. Really, a unifying diagnosis is really what we find in
[00:21:30] science and in medicine is more likely to be the correct diagnosis. But then the second study,
[00:21:37] I think there was like 500 patients. And there was a little bit more in the long COVID group that
[00:21:43] had persistent spike protein. I think it wasn't even 50, you know, half. So half of them didn't
[00:21:50] have persistent viral proteins. But then again, 20 or 30%, something like that. In the control
[00:21:57] group also have persistent viral proteins. So well, then how do you explain that? And
[00:22:04] again, we can keep going with all of these things. Well, maybe the one set of people is
[00:22:09] responding differently to the spike proteins than others. Or, you know, we can like kind of spin
[00:22:14] this web to do these sort of mental gymnastics to make it make sense. But if we really look at
[00:22:21] the information, well, now are we just attributing the symptoms to this finding that's maybe
[00:22:28] just a normal finding on people after they've had COVID, that isn't actually their reason.
[00:22:33] And again, it hasn't been found and studies to be the reason. And the same thing has true of
[00:22:40] like the micro blood clots. There was just a couple of small studies that were really assessed
[00:22:46] and not found that to be a very good study. And it was fibrinogen that was found,
[00:22:51] which is a precursor to a blood clot. It's not an actual blood clot. And actually people
[00:22:56] that have diabetes or other chronic health conditions can also have increased levels of
[00:23:01] fibrinogen. So, and again, has not been scientifically sound. And then there's things
[00:23:07] like maybe cytokine changes or mitochondrial changes. And is that a downstream effect,
[00:23:13] meaning if our brain is constantly sending messages to our body that we're in danger,
[00:23:20] and so it's bathing our body in cortisol and stress hormones,
[00:23:24] there are changes that happen in our body because our brain and our body are connected and in
[00:23:29] constant communication. So maybe there's some cytokine changes or mitochondrial changes,
[00:23:35] but is that actually the downstream effect because we're chronically stuck in this
[00:23:40] stress state? Or is there something about the virus damaging those cells that then is the
[00:23:47] upstream effect? And again, really, that has not been found. So, you know, there's all these pieces
[00:23:54] of information. But really, again, if you look at all of the information and you don't just allow
[00:24:00] inconvenient pieces to bounce off, that doesn't fit your biomedical model. Well, now let's look at
[00:24:08] lots and lots of times, people's symptoms go away for a little while, they get better for
[00:24:14] a month or a week or a day or six months, and then they come back. And not everybody
[00:24:21] that has long COVID does this happen with, but a lot. Well, now how does that make sense
[00:24:26] if there's persistent spike proteins or it's damaged cytokines? Why does it make sense that
[00:24:32] it got better and then got worse? It doesn't really make sense. And then the other thing,
[00:24:37] if you look at the vast majority of people who have long COVID are middle-aged women,
[00:24:42] is the highest demographic of people that have long COVID, many of whom were previously actually
[00:24:49] sitting healthy. The demographic of people that get long COVID is not elderly sick people,
[00:24:56] like elderly people that have other medical problems. So if this is biomedical damage to
[00:25:01] your body, why would that happen more in healthy middle-aged women rather than elderly
[00:25:08] frail people who had COVID? And also, why wouldn't it happen more with a really,
[00:25:14] really severe case of COVID, acute COVID? I mean, it can happen after a severe case of
[00:25:21] acute COVID, but oftentimes people had a very mild case. Sometimes so mild, they didn't even
[00:25:27] know they had a COVID case. And in fact, some people have long COVID and did not even have
[00:25:34] the COVID infection at all. And some people say, oh, well, it's just because I couldn't get tested
[00:25:43] or the antibodies later found. But when I was at Kaiser in 2021, back then, patients said to
[00:25:54] me themselves, they said, oh, I never had the COVID infection. And this was actually back when
[00:25:59] people didn't actually have COVID. And they said, oh, I just had the vaccine. I didn't
[00:26:04] have the COVID. You know, I didn't have the COVID infection. Okay, we'll talk about the vaccine in a
[00:26:09] moment. But then other patients said to me, like, looked me in the white of my eyes, like,
[00:26:14] I didn't even ask them this. They said this to me. And they said, well, I neither had COVID,
[00:26:18] acute COVID infection, nor the vaccine. And these are the same symptoms that I had prior to
[00:26:25] the pandemic even starting. And now they're worse, but they are the same symptoms of long
[00:26:31] COVID. So clinically, this is what patients were saying to me early on. And again, if we look through
[00:26:39] it through the lens, well, how does that make sense with a biomedical model that COVID and that the
[00:26:44] COVID infection and virus is causing damage in the body? Well, it doesn't doesn't make sense.
[00:26:52] But if we look at it through the lens of, how does our survival threat physiology brain
[00:26:58] work as a human being that makes these dangerous signals that makes headaches and fatigue and
[00:27:03] insomnia and anxiety and depression and dizziness and shuts down our GI system,
[00:27:09] right? That makes sense. The other thing that happens is that when we are stuck in fight or
[00:27:14] flight mode in our nervous system, again, there are downstream effects that happen, like my body
[00:27:22] gets a lot of inflammation. Not everybody's body does when they're stuck in fight or
[00:27:26] flight, but mine does. I can see swelling in my joints when my nervous system is just regulated
[00:27:33] and stuck in the system. Rashes, like my body makes rashes. My eczema flares in my hands. It's
[00:27:40] sort of my personal beacon to know that I need to kind of take care of myself, put my tools back
[00:27:46] in place. And so these inflammatory things that happen in our body that we can see or
[00:27:52] our muscles getting shut down, we can't move our body very well, that all happens with
[00:27:58] signaling from the brain to the body because our brain is perceiving threats.
[00:28:04] I want to highlight what you just said about the physiological changes that can happen,
[00:28:09] especially inflammation. I do work with a lot of people in a lot of this audience have IC
[00:28:15] and they're told that there's a lot of inflammation in their pelvic region, pelvic
[00:28:18] area, things like that that's causing their pain. I think the same thing, I've never said it,
[00:28:26] or haven't said it out loud, but they don't ask the question, well, why is there inflammation in
[00:28:30] the first place? And you're saying that exactly as well, the autonomic system.
[00:28:36] Yeah. I think there's a couple of important points in there. Number one is, yeah, why is
[00:28:42] there inflammation in the first place? And so this is a question I get a lot. And I think
[00:28:46] that in this sort of neuroplastic mind body world is that often we can say, oh, this is 100%
[00:28:54] neuroplastic or 100% structural. And I think there's a lot of people that balk at that,
[00:29:00] which is understandable. And yes, things can be mixed. But what I would say is, number one,
[00:29:07] the vast majority of chronic symptoms are neuroplastic or mind body as the generator.
[00:29:16] And that is after being a physician for 25 years, I've seen over 70,000 patients in my career.
[00:29:24] But the thing is, it's not to say that there's not a then a downstream effect
[00:29:29] that then is coming back up and our brain is maybe now responding to that change in the body,
[00:29:36] like my knee, for instance, is where my chronic pain started. I had my ACL replaced twice 20 years ago.
[00:29:43] I got a huge amount of swelling. I mean, swelling you could see across the room that like went down
[00:29:47] my calf. So the inflammation that those cells, the inflammatory cells that my brain told my body
[00:29:55] to make. Now those inflammatory cells that message is going back up to my brain. And then
[00:30:01] my brain is now responding with warning signals to the inflammatory cells. So yes,
[00:30:08] it is responding to the structural change, but the generator of all of it is still
[00:30:15] my brain's threat response and my survival brain responding to danger in my life.
[00:30:21] That it doesn't need to be responding to through a threat response. So the root of me getting
[00:30:28] rid of all of it is still teaching my survival brain that it doesn't need to be sending these
[00:30:35] threat messages in the first place. So I would say two things back to the people who are told
[00:30:40] that they have inflammation. Number one, well, why is your brain making the inflammation in
[00:30:45] the first place? And is it making it because some sort of structural damage? So if we tear a
[00:30:50] muscle or a ligament or a bone, the inflammatory response is generated because of the structural
[00:30:58] damage to your body. But if you just get inflammation out of the blue, and there's no reason that your
[00:31:05] body was damaged otherwise, then that generally is happening because of a neuroplastic mind body
[00:31:12] signal. So number one, why is your body getting inflammation in the first place? But number
[00:31:17] two, I would also challenge people to ask, how does your clinician know that there's inflammation
[00:31:25] even in the first place? Right? Like a lot of times we're told, I've seen clinicians tell people,
[00:31:32] oh, well, the reason you're having that is because of the inflammation. But they actually have no
[00:31:38] evidence to say that. They're just saying that based on that you're describing a symptom,
[00:31:45] you as a patient are describing, oh, well, I have pain. And then the clinician says, oh, well,
[00:31:50] that's because of inflammation. But sometimes they don't actually have any objective evidence
[00:31:56] that there even is inflammation. I mean, there may be objective evidence. There's blood tests
[00:32:01] that show inflammation, or sometimes they can do a cystoscopy looking at the bladder,
[00:32:06] and they can see evidence of inflammation. So sometimes there is objective evidence.
[00:32:10] But a lot of times I see patients being told that they have inflammation when
[00:32:15] it's just the clinician saying that they're just kind of giving a reason for the symptoms.
[00:32:22] I do have quite a few people that have had the scans and have blood tests that have that. So
[00:32:26] they have this test that says, my body has inflammation. I have marker, I have right.
[00:32:32] And it's really stuck on that. It's hard to understand the mind body work with that. So
[00:32:39] how would you talk with someone about that? Yeah, I mean, again, it's really understanding that
[00:32:47] when our brain is stuck in the threat response or threat physiology is that it can send messages for
[00:32:52] our body to make inflammation, just like our brain gives if we're embarrassed, our brain
[00:32:58] gives a message to our cheeks to change the capillaries so that they get red. I mean,
[00:33:03] we're doing this all day long. We smell a delicious cookie. There's nothing that changes
[00:33:10] structurally in our body. It is a message to our gut and suddenly digestive juices change.
[00:33:17] We can hear it, we can feel it. Well, there was nothing actually structurally that changed.
[00:33:22] We didn't eat the cookie. It's just a signal that came into our brain. I mean,
[00:33:26] this is happening all day long. And what's interesting also, you know,
[00:33:30] way before I learned about this whole mind body approach, the reason I came here is because of
[00:33:37] my clinical experience. Again, multiple patients came to me as I was a primary care doctor and told
[00:33:44] me that their experience of autoimmune conditions was that they had abnormal blood tests showing
[00:33:52] inflammation in their body and that through their life, the blood tests would be positive
[00:33:57] when they were going through times of stress in their life and they'd have symptoms. And then when
[00:34:02] they were in times of, you know, decreased stress in their life, their symptoms would go away and
[00:34:08] their blood tests would normalize. And the first time a patient told me this, I was like, what?
[00:34:15] Like, again, I sort of was like, what are you talking about? Like, what? I mean, like,
[00:34:20] I was on the other end of things. And this wasn't even someone that like knew about
[00:34:25] really the impact of the mind body approach that we do here. They just were more a person noticing,
[00:34:31] oh, and I have stress that affects me in this way. And it didn't like, I mean, that was one of the
[00:34:36] things that I was like, well, that makes no sense. Because I thought of an autoimmune disorder as
[00:34:42] like just this, you know, illness in your body, we don't know why you have it, but it's a
[00:34:48] this structural illness in your body that just some people have, we don't know why. And I
[00:34:52] never would have imagined that stress could be a very, very specific underlying generator of it.
[00:35:01] I want to say a couple of things about it. I do think like with autoimmune disorders,
[00:35:05] I'm not necessarily saying like 100%. My body is going to, you know, the direction that
[00:35:10] everyone should go or it's going to cure everyone, anything like that, you know,
[00:35:14] needs tons of research, lots of people who have gotten better. And in something like
[00:35:18] a severe autoimmune disorder in general, I do actually recommend taking the medicine
[00:35:23] from the rheumatologist kind of early on. I think that can be an important thing to do.
[00:35:28] You're also open to the mind body work, also implementing that and kind of seeing how it
[00:35:32] goes. But I do think it can be an important piece to just really think about and reflect
[00:35:38] and just notice kind of over time. Yeah, that approach of both, right, instead of this all
[00:35:44] or nothing camp. I think especially for autoimmune, but in many different ways or conditions can be
[00:35:51] helpful. What about long COVID? How do you treat people these days that do come in?
[00:35:57] Do you do any physical intervention? No, no. I mean, that's the thing. I think again,
[00:36:01] the all, you know, it's both and, and again, the vast majority of chronic symptoms, I would say
[00:36:08] are neuroplastic and really, really viewing it that the generator of the symptoms is these
[00:36:16] psychological stressors, you know, how our unconscious brain, the survival brain is responding
[00:36:21] that it does not need to respond. And I think that it's very easy for people to go down the
[00:36:28] route of this helps structural and not structural and I'm not going to, you know, there's no
[00:36:32] reason to actually really hone it down so much. I disagree with that. I think that
[00:36:37] the more that like we really understand that the solution is in the brain and not in the body
[00:36:44] is, is the power in the tools. And if someone like 0.00001% thinks the problem is in the body,
[00:36:55] but 99.99999% it's the brain that that amount can interfere with turning down the signal.
[00:37:04] So with long COVID, again, from my perspective, there's just heaps and heaps and heaps of evidence
[00:37:10] that this is about threat physiology. And that I think it's better termed a post pandemic syndrome
[00:37:16] rather than long COVID even. And actually, even if you look at if you kind of coming back to
[00:37:22] the vaccines, again, loads of patients that have had that have a long COVID syndrome after the
[00:37:28] vaccine. And sometimes it was the symptoms started within minutes of getting the vaccine.
[00:37:35] Well, there is nothing again, so let's get to the level two critical thinking.
[00:37:41] There is nothing that a vaccine could do that's damaging our body that happens within minutes
[00:37:49] that then is going to last for years. It's just not how it works.
[00:37:53] But I also have other patients that they had a vaccine and then
[00:37:57] they did fine. And there's the long COVID symptoms started months afterwards. And now their clinician
[00:38:04] or themselves are attributing these symptoms that started months after getting the vaccine
[00:38:09] to the vaccine. Again, physiologically, if there's something that's damaging our body,
[00:38:15] that is just not how it physiologically works. The other thing is if you look
[00:38:21] actually at the vaccine trials, the group that got the placebo vaccine, so the group that got
[00:38:28] the saline injection did not get the COVID vaccine, 37% of them got side effects.
[00:38:37] This is what we call the no SIBO effect kind of the opposite of the placebo effect. It causes
[00:38:43] side effects, and they weren't lesser side effects. They weren't more mild. They weren't
[00:38:48] different ones than the people that got the actual COVID vaccine. Generally speaking,
[00:38:53] they were the same sort of side effects or as severe. And again, the power of our brain that
[00:39:01] creates our experiences in our brain through unconscious expectation. And then if we look
[00:39:08] at huge studies of hundreds of thousands of patients, even one study out of University of
[00:39:13] Michigan by Daniel Klaw, there was 3 million patients that he assessed, I mean patient charts,
[00:39:19] but looking at the pattern and looking at the crossover of people that had a history of other
[00:39:26] neuroplastic symptoms or chronic overlapping pain conditions, they call them, things like
[00:39:31] fibromyalgia, chronic fatigue, back pain, headaches, things like that, is that that was
[00:39:38] a better indicator of whether someone would get long COVID than actually if they had actually
[00:39:46] had the COVID virus itself. So anyway, lots of other huge studies that found that people that
[00:39:54] have a history of anxiety and depression or PTSD are more likely like far more likely to get
[00:40:01] long COVID. So again, looking through the different lens of this new science, what
[00:40:06] makes more sense. So the work that I do with people with long COVID is really 100% about
[00:40:13] that the source is in the brain. I meet them where they are, I've had patients that were
[00:40:19] bedbound for a year, eyes covered, ears covered, not talking. So I have to meet
[00:40:24] someone where they are and start with visualization and little by little kind of
[00:40:30] moving into their capability. Yeah, definitely. When you mentioned the reaction in minutes,
[00:40:37] I actually had that same thing happen with food, I would have histamine reactions and I could
[00:40:41] time myself within 10 to 12 minutes. I'd have a reaction and I knew it was something I
[00:40:49] shouldn't have eaten. And even at that time, going back to the conscious and subconscious
[00:40:54] brain, even at that time, I kind of knew that what did it make sense, but I didn't know what
[00:41:00] else to do. There was a part of me kind of like, this is weird, this can't be, but also it's
[00:41:07] happening. You know, I don't know. And if you don't have another better explanation, then you go.
[00:41:14] And then when I learned it clicked. Yeah, right. Yeah, exactly. Right. And that's,
[00:41:21] you know, an important point in all of this also is MCAS, the Mass Cell Activation Syndrome,
[00:41:26] I would say prior to it. So again, I've been a physician for 25 years working full time in Kaiser
[00:41:33] and a big health system, you know, we use evidence-based medicine. I learned from the
[00:41:37] specialists, all of these things. And I hadn't really heard of MCAS before the pandemic
[00:41:44] and how everybody and their brother is diagnosed with MCAS. Right? Often again, middle-aged,
[00:41:51] otherwise healthy people diagnosed with MCAS. And I have seen patients that have gone to,
[00:41:57] you know, MCAS now specialists that have told them, oh, well, this is genetic. You've had this,
[00:42:03] well, if it's genetic, you've had it for your life. But again, okay, level two thinking,
[00:42:08] how does that make sense? And they were told, well, this is genetic, you've had it for your
[00:42:12] life, and you're going to have it for the rest of your life. Okay, well, why didn't they have any
[00:42:17] symptoms of it for the first 25 years of their life for 35 years or however many years?
[00:42:24] Why does that work? How does that work? And again, really what, what like true MCAS is,
[00:42:29] is really huge gargantuan reaction that causes flushing and redness and swelling throughout
[00:42:35] the whole body. And a lot of people who are diagnosed with MCAS actually haven't had those
[00:42:40] symptoms. Some of them do have those symptoms. But again, that also can be the brain sending
[00:42:48] these warning signals as well. And so many, many, many, many, many, many, many patients of mine
[00:42:55] have been given the diagnosis of MCAS. But really, those symptoms completely and wholly
[00:43:00] resolve when we teach the brain that the body doesn't need protecting and it dials down
[00:43:05] those signals. Thank you. I had that on my list of something to bring up and talk about
[00:43:10] MCAS because it's a big, it's a big one. Yeah. And people are really scared of it. It becomes
[00:43:14] very intense. Yeah, I mean, if you're told that you have, I mean, any diagnosis, if you're told by
[00:43:20] a clinician, a specialist, and that you have something that we don't exactly know why you
[00:43:24] have it, or maybe it's genetic, and you're going to have it for your rest of your life.
[00:43:29] I mean, how could that not possibly just instill the fear of God in you? I mean,
[00:43:34] oh my gosh, it's gargantuan. Yeah. And then it gets worse because of that fear.
[00:43:41] Yeah, right, exactly. Okay. With everything that we've talked about, is there anything else you
[00:43:47] feel like is important to note around this that people need to hear as we start to wrap up?
[00:43:53] Well, I guess a couple of things. You know, one of the hardest, so for long COVID specifically
[00:43:58] or other kind of adjacent sort of symptoms is that one of the hardest parts that I find that gets
[00:44:05] in the way of people getting better is accepting the diagnosis for themself that this is neuroplastic,
[00:44:11] it's mind body, and it isn't something structural in their body. And people have had so many tests
[00:44:17] that they can see in black and white are abnormal. And maybe they've had a cytokine
[00:44:23] abnormal test or a mitochondria test, and they're looking at that or, you know, the blood clots or
[00:44:30] other things, chronic Lyme or mold or heavy metals or, you know, there's a whole slew of tests.
[00:44:37] And again, it's really coming back to, well, why do you know that that's true and valid?
[00:44:44] What's the science that backs that up? And I asked people this a lot. I say, well,
[00:44:48] how do you know that that's true? And many times their answer is, well, because my naturopath or
[00:44:55] my functional medicine doctor or my, you know, MD at the long COVID clinic doctor, they told me that
[00:45:01] and, you know, this is what they do. But that's not enough information and really understanding
[00:45:05] that there is a huge amount out there. And I'm not pretending that I know everything either.
[00:45:11] For sure. But, and I used to be this doctor too, that I would say these things, because that's what
[00:45:18] I had been taught. And that's what I truly believed. But really, I think it's really, really important
[00:45:23] to understand that there are a lot of blood tests out there, other sort of tests that you
[00:45:28] can see in black and white, it's abnormal, but it is not a scientifically sound test,
[00:45:34] meaning that it has not had rigorous scientific studies to show that it is accurate,
[00:45:40] meaning that whatever the abnormality is, number one, means that that's what's actually
[00:45:46] going on in your body. And number two, that that is the specific reason for any particular symptom.
[00:45:54] And it can be really hard to let go of that information. Once you, once you see it and
[00:46:00] you've been told the information by a trusted person. And again, it's not that anyone is
[00:46:06] malintent. And people probably their lived experience as a clinician is that they've seen
[00:46:12] people get better when they've given them the supplements or treatment or whatever they do.
[00:46:17] And so it's not that they're making it up. And it's not that they're not authentic.
[00:46:22] It's just that because of the placebo and the CBO response, and that there isn't, you know,
[00:46:28] this rigorous scientific studies and all of these different areas to know,
[00:46:33] that that's the reason why that information is given to someone.
[00:46:37] Okay. Thank you for saying that.
[00:46:41] I guess the other piece, if I can just also put in is that what I've seen a lot to is that
[00:46:49] sometimes people do some mind body techniques and they don't get better. And so then they go back
[00:46:54] to, well, this must not be neuroplastic or mind body because I've tried the mind body approach
[00:47:00] and it didn't work. But that's really diagnosing in the opposite direction.
[00:47:06] We diagnose first by what makes sense, looking at the evidence, you know, going to the fit criteria,
[00:47:13] you know, do your symptoms come and go, what, touching heavy, you know, all of that.
[00:47:20] But then it's, okay, well, now I know the diagnosis and it can be a journey of figuring
[00:47:27] out for you. Like for me, I actually had symptoms for a couple of years and I knew that this was
[00:47:32] my body the whole time. But I didn't, you know, I was never, I'm a human and just willing to sort
[00:47:39] of put up with it and not actually face the deeper emotional challenges. And I think that
[00:47:44] there are things that can help calm down the symptoms a little bit, nervous system,
[00:47:49] regulation tools, can, you know, help a little bit or, you know, PRT, somatic tracking,
[00:47:55] can kind of turn off a symptom. But if we don't really walk towards that closet door and open it
[00:48:01] up and show our unconscious brain that the monsters it thinks is real, aren't really real, then our
[00:48:08] brain will keep dysregulating our nervous system. And really doing the deeper emotional work of
[00:48:14] getting out your repressed emotions, really facing the fears that your brain has deeply rooted
[00:48:20] about who you are as a person or facing difficult boundary setting or conversations. And that's not,
[00:48:27] that's not easy. For sure. Absolutely. But what I would say is I think that it's often easier
[00:48:35] than we think it is. And on the other side of it is just a whole beautiful world and life that
[00:48:43] people who get there never imagined that they would be able to get there.
[00:48:47] Yes. Yes, yes, yes, yes, yes. That is what I talk about a lot in terms of when are they stuck or
[00:48:55] why am I stuck, right? Yeah. Being a therapist, I end up getting people who've tried some things
[00:49:01] and then they're like, well, nothing's really working. I've tried it on my own or maybe a
[00:49:04] little bit, right? I mean, a little relief. But I don't understand what I'm missing or maybe
[00:49:11] this isn't my body, right? And they then think about trauma and they're like, well,
[00:49:15] what do I do with that? Anyway, so yes, that second piece is really important.
[00:49:22] Really, really important. That's your layer.
[00:49:26] Exactly. Yeah. And I think also the other pieces really often actually completely stopping
[00:49:32] anything body based can be really helpful actually. And it can feel kind of scary to do,
[00:49:38] but it can be the, it can be the sort of last bit of cutting the cord where it's
[00:49:42] really stepping into that kind of scary space. Like, look, your body is not damaged. And I didn't
[00:49:49] do many body based things. But like the few things I did like every now and then I would
[00:49:55] take an ibuprofen like literally took, I don't know, half a dozen in the two years.
[00:50:00] But when I took it, my symptoms would go away completely. Was it because it's an
[00:50:04] anti-inflammatory? Was it because of the placebo effect? I have no idea. But the
[00:50:09] thing is, is I actually had to stop taking it completely, even though I was like barely
[00:50:13] overtaking it, because when I took it and my symptoms went away, when I woke up the next
[00:50:18] day and my symptoms were gone, then what it did is it actually scared me that I wouldn't be able
[00:50:24] to get rid of them without having something external. And the same thing happened with
[00:50:29] massage. I love getting a massage. So I would, and I had all this pain in my neck,
[00:50:33] my back and stuff. And I would go to a massage therapist and I would say,
[00:50:36] please do not tell me anything about my body. Like, I don't want you to say, oh,
[00:50:41] this is really tight. Oh, this is this. Just give me a massage. I just, you know,
[00:50:44] because I wanted to just go get it and relax and enjoy it. But it only helped such a small
[00:50:50] amount of time. And again, I just sort of felt like, well, now I'm just focusing on
[00:50:55] getting rid of this muscle, trying to get rid of this muscle tension from my body. And so
[00:51:00] really what I had to do is stop doing that. And really, when I would feel this sort of tension
[00:51:05] come into my brain and think from my brain to send down a message from my brain to my body,
[00:51:12] breathe into my body and just kind of send messages for it to relax instead.
[00:51:17] I've done the exact same thing with massage. And to this day, I will not, if I do get one,
[00:51:23] I will, they'll ask, you know, what's going on. I'll never say anything. I'm just,
[00:51:27] I'm just here to enjoy. Yeah. Yeah. Exactly. Okay. Thank you so much again for coming on.
[00:51:33] This is a wonderful conversation and puts a lot of validity, a lot of validity to what I mean,
[00:51:40] what we talked about on here. And I really, I do appreciate the approach of really solidifying
[00:51:46] this is my body. Let's work with this. And the questioning is normal, totally,
[00:51:52] because this is a whole other way of thinking of it, right? But we can really solidify in this
[00:51:57] and work in this space. There is a whole other world on the other side that's beautiful.
[00:52:01] Yeah. Right. Exactly. Awesome. Well, thanks so much for having me on and for the great work
[00:52:06] that you do. I appreciate it. Yeah, for sure. Okay. And I will talk to you all next time.
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[00:52:38] Thanks for listening and I hope this brings you hope on your journey.