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

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

This is part 1 of a two-part video.

Summary:

One of my readers wrote in: “Hey Doc, I’ve been doing all the things they taught me in rehab to recover after my accident and surgery. Pacing myself. Doing the exercises. I’ve progressed, but I’m stuck. I still have significant pain and my regular doctor has nothing to offer except drugs that mess up my head. And I haven’t been able to increase my exercise tolerance enough so I’m still limited in function. Why is that happening?” It’s a great question and I’ve heard variations of it over the years. Many people just get “stuck” with persistent pain or fatigue or weakness. And the conventional approaches often don’t have a solution. Based on a few decades of integrating natural healing methods into medical and rehabilitative care, I have often been able to help people who “tried everything”. Because they didn’t really try everything. They just did the conventional stuff. The key to success has been to look for and address the six things that I talk about in this video. So please check it out and let me know what you think. Thanks Andrew David Shiller, MD

Did You Know:

Movement Toward Health is a training program that teaches you skills for transforming your health, reducing pain, improving mood and energy. It opens periodically for new members. You can get more information and join the waitlist here: www.MTHTribe.com.
Dr Shiller is available for telemedicine consultation worldwide regarding chronic pain, fibromyalgia, autoimmune disease, fatigue, and stress-related illness. Learn more here https://www.drshiller.com/consult
Dr Shiller gives regular free mind-body training sessions on zoom. Learn practical tools for transforming suffering, reducing stress and inflammation. You can get the schedule and register at www.mindbodygroove.com

Full Transcript:

Hey, it’s Dr. Shiller we’re talking today about the six things that can worsen pain and lead to disability and um, and slow the healing and recovery process. And it’s really important to check this out cuz this is not typical stuff you’re going to hear from conventional medicine. It’s not typically treatable with drugs and procedures, but it is treatable and fixable and healable through things that you can learn to do for yourself.

So these are game changing principles that have completely shifted things for so many of the people who have come to me with the, with that situation of I’m still suffering and I tried everything. Well, like, no, you didn’t try every, everything. These are things you didn’t try. Let’s do that. And in many, many, many cases, profound difference.

So let’s open this up. Let’s talk about it. . And so I first want to talk about, well, how does that process happen? What worsens it? Why is it that things tend to snowball after injury or illness and get worse and worse? And that leads to the clarity about like, okay, so what do we do about this to help you get better?

And so a little background of what I bring to this conversation. I trained in physical medicine, which is also called physiatry, pain management, internal medicine at some of the top places in the United States, and have worked in integrative rehabilitation medicine and pain management for over 20 years.

And so I’ve seen literally thousands, maybe tens of thousands of people who’ve had persistent challenging problems. alongside with my formal training, I did decades of training and clinical practice and teaching in what you might call complimentary or natural healing. So I developed this broader perspective than what they taught me at at Duke University in Harvard Medical School, and that’s, let me see, the things that conventional medicine over often overlooks.

which are really important to the recovery process and in my experience, that has been what has enabled me to frequently help people who are kind of stuck in that I’ve tried everything and I can’t get better place. And so my experience is mirrored in that of many of my colleagues who I’ve spoken with and who I’ve trained with, where when we bring these new perspectives, then there’s frequently dramatic results.

Frequently the patients who are stuck and not getting better are suddenly getting a whole lot better in feeling better. So it’s extraordinarily like a privilege and gratifying to be like, wow, this is actually. and helping means that person who was stuck in suffering with pain, inability to do stuff, brain fog, various kinds of symptoms, is now feeling better and able to function better.

And I want to be clear that this is not alternative, and this is not antagonistic to conventional medicine. It’s broadening the model. It’s understanding things more fundamentally, more systemically, more holistically, but not in the flaky. Like a grounded scientific way of understanding, well, what is your biology?

What is your mind body system? How does it function? How does it get out of function? So we’re gonna share six things that. Worsen pain and disability and prevent and block the healing process. We’re gonna share an overview of that and then in other videos I’m gonna drill down into those so you can get the detail and understand them more comprehensively.

But I really want you to have the big picture. This is probably gonna be two videos so that it’s more easily digestible. And so I really want you to plug into this whole learning series if this is a topic that seems important to you. So I want to tell you how to get access to it because I’ve set up a program that’s called Movement Towards Health, and it’s really about a training program.

It gives you skills for transforming the biology of pain and suffering and disability to the biology and the psychology of wellbeing and recovery. Um, and. , there’s a wait list for that program. It opens up periodically. My suggestion is get on that wait list because what will happen is you’ll get notifications about as these videos come out, so you can watch them.

There’s also a place in there where you can binge watch them all at once, once they’re all in place. Um, and you’ll also get notification about the program and more information about it. You might find it interesting and you might want to join. If you don’t, it’s fine. Just enjoy and learn and be inspired.

to understand what it is that is perpetuating, creating the suffering that you’re having so that you can make conscious choices about what to do about it. Because most doctors are not gonna do that because they’re not aware about it. And of course, it doesn’t mean that they’re bad people or bad doctors.

It just means that the conventional medical model sees things a certain way and there’s a broader way of seeing things. and what I’m doing is sharing that broader way so that you can make conscious choices and do the stuff that you need to do so that you can feel better and live better. Okay, so we’re jumping in.

Problem one that worsens pain and illness and prevents healing is what we call autonomic imbalance. Okay? That’s a big scary word, but really what it means is like this, you probably know that you have a stressed. And a relaxation response. It’s built into your entire brain, spinal cord, and your whole nervous system.

It touches every cell in your body. One aspect of it is fight, flight, freeze. That’s your stress response, and the other is your. Rest, digest, and heal or relaxation response. And they’re meant to be in balance with each other. But what happens is that chronic pain, chronic illness shift the, the scale towards an overactivity of that stress fight, flight, freeze response, and a bunch of other things can shift the scale towards that, which feeds into chronic pain and chronic illness, and the underlying biology that drives chronic pain and chronic illness.

So it could be. The trauma, the injury, the illness. It could be earlier things that happened, your life that were traumatic. It could be stress, it could be lack of sleep. It could be chemical exposure or toxic exposure. It could be early life stress or adverse events, which are more and more proven to be associated with chronic pain and honest chronic illness.

And the issue is autonomic imbalance, where the system is shifted to an overactive fight flight, freeze. There are simple things that you can learn to do to bring balance to that fight, flight, freeze response. Some of them are things that you can learn on your own for free, and they are life changing for many people and they’re also life skills, and they empower you to deal with the difficulty in life no matter what it is.

So there are things you can learn on your own. There’s things you can learn together one-on-one with a therapist or in groups or various contexts that support you to retrain your system from being in this fight, flight, freeze response to being in a more relaxed, anti-inflammatory, healing oriented response.

And that’s also part of what we do in movement towards health. So moving on to number two is mood instability or mood imbalance. And the most common things you might think about are like depression and anxiety. There’s other things that go along with its symptoms of O C D. It’s a complex picture. The thing I want you to understand is that the biology of.

Depression and anxiety isn’t what we’ve always thought, which is, oh well, it’s about serotonin problems. Well, yeah, there can be issues with neurotransmitters and, and that’s how some of the pharmaceutical companies have made tons and tons of money, and they push that point of view because that’s how they make their money.

But there’s an aspect of it that has to do with inflammation. There’s an aspect of it has to do with. Your balance of your stress and react and, and relaxation response, that autonomic balance and it’s lifestyle. These are conditions that are affecting your thoughts, your emotions, and your core bodily functions.

Your brain, your brain chemistry, your immune system, your gastrointestinal system, your physical activity, your thoughts. All this stuff is deeply integrated and those things that you can do on those three levels of thought. Reframing and and mindset training of training your mind with various tools to shift your biology, of diet, of nutrients, of physical activity, lifestyle, stuff that can have a huge impact.

And the reason this is so important is because we know that depression and anxiety are part of what’s in that vicious cycle with chronic pain, with disability, with the disability cycle. And so we’ll talk more about that in a bit, but you really gotta get the mood stuff under. Number three is your overall biochemical, metabolic state of your body.

And so check out this slide, which shows some of these relationships, but like I mentioned, your. Brain and brain chemistry and your autonomic system function, your thoughts and your emotions, your gastrointestinal functions. So the biome, the barrier function of the gut, the immune system, the hormonal system of the body.

Um, these are profoundly integrated and they have a huge impact on how your body function. They have a huge impact on how you think, how you feel, how much energy you have, how much strength you have. They have an impact on sensitization of your pain pathways. So this is complex biochemistry and anatomy and metabolic stuff, and there’s things again that you can do.

That’s the big part of the gift of the functional medicine model, is how to look at all that in a scientifically based way where we can think ration. about how to address these different aspects of dysfunction, like it shows in the slide and, and that involves, again, lifestyle stuff. It’s diet and it’s nutrients, it’s mind body therapies, it’s physical exercise, physical treatments.

And these things have made a profound impact for so many of my patients who are dealing with these difficult pain and related syndromes. So the point of all of this is to sensitize. that there are these dysfunctions that can be part of what’s perpetuating the challenges you’re having, and these are things that are within your control to work on.

They’re things that typically aren’t fixed by drugs, although sometimes medications can support the process. They’re things that are fixed and changed by the things you do for yourself sometimes in conjunction or in cooperation with appropriate care caregivers or therapists or practitioners. Okay, so that’s an overview of the first.

Of the six things that can worsen pain and disability and prevent recovery. And and that’s especially true if you’ve sort of done all the right conventional things and you’ve tried everything and you haven’t gotten better, you need to [00:11:00] think about these things. And so in summary, these are dysfunctions.

These are shifts in the functioning of your whole mind body unified system. And they’re not really taught in medical school, though they are supported by medical research. I suspect that in 20 or 30 years, they will be much more widely taught in medical school. Um, but there are, there is hope and there’s help.

There’s things you can learn to do. There’s practitioners who can help you, and the first step is understanding them so you can start to actually address. , in my experience and in the experience of many, many practitioners with whom I’ve worked or trained or, or, or taught, um, that the effects can be dramatic when you actually start to shift the underlying biology that makes these things worse.

We covered three of the six thing, these six things. Um, the second video will show you the rest of those. Look for the link below this video to get to that video, which is the se, the, the second set of three. Um, I want to share that [00:12:00] movement towards Health is a training program to give you skills to address these underlying issues.

And I encourage you to get on the waiting list. Movement towards Health opens periodically, and if you’re on the waiting list, you’ll hear about it, you’ll get an email and you won’t miss out. Um, and you’ll also get access to the additional training sessions that go into more depth into these aspects that go into more depth on the six things that can prevent the healing process from happening.

And I just wanna stress that. , this is about empowering you. You’ve got the capacity to learn things that shift your biology, and when you learn those, you actually are acquiring life skills. It’s about building your resilience, helping you have skills to live more effectively despite all the difficult things that are going on in life.

And we have a lot of different thing, difficult things going on in life in our generation. Okay, so obviously this is an overview video. I encourage you to go to mth tribe.com, get on that wailing list, dive deeper [00:13:00] into the materials, see how it impacts you, what you learn from it. So thanks for watching this.

Um, if you like this, I encourage you, first of all to leave a comment or shoot me an email. With one thing you learned about it, and also share the video wherever you’re finding it. Share it with people you care about, who you think might benefit from starting the OR, or deepening this learning process about this journey of self-healing.

So thanks again. Take care.

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6 Things That Most Doctors Miss, Which Worsen Pain and Prevent Healing, Part 2

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

This is Part 2 of a two-part video

Watch Part 1 HERE

Summary:

Did You Know:

Movement Toward Health is a training program that teaches you skills for transforming your health, reducing pain, improving mood and energy. It opens periodically for new members. You can get more information and join the waitlist here: www.MTHTribe.com.
Dr Shiller is available for telemedicine consultation worldwide regarding chronic pain, fibromyalgia, autoimmune disease, fatigue, and stress-related illness. Learn more here https://www.drshiller.com/consult
Dr Shiller gives regular free mind-body training sessions on zoom. Learn practical tools for transforming suffering, reducing stress and inflammation. You can get the schedule and register at www.mindbodygroove.com

Full Transcript:

So thanks again. Take care.

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How To Heal Emotional Pain From Trauma, Narcissist Abuse, and Toxic Shame: Part 1

Posted on July 28, 2022March 3, 2024 by Andrew David Shiller, MD

For more videos subscribe to our YouTube channel

Summary:

You’ve probably learned by now that your physical well-being, or lack of it, is profoundly affected by what goes on in your mind and emotions. That’s not to say that your pain and suffering are “all in your head”. It reflects the reality that your mind and body are so profoundly interconnected that it probably makes sense to have one word that includes both of them. Because we can’t really find a place where one ends and the other begins. Common sense and most cultural wisdom support that idea, which is increasingly confirmed by scientific study. One of my patients, Leah, had been suffering from pain in several parts of her body for years. She had diagnoses of osteoarthritis, tendinitis, and fibromyalgia and was really suffering. She had done lots of conventional medical pain treatment with only temporary and partial benefit.

When we met, we discussed her personal. social, and medical history, as is my custom. One of the things that jumped out at me is how much stress and emotional pain she was experiencing. She had experienced physical and mental abuse as a child. While she was very successful academically and professionally, she had this chronic moderate anxiety that had been going on for years. It’s like she was just never comfortable in her own skin.

She sincerely engaged in learning breathing exercises and meditation practices to activate her relaxation response, and shift her biology away from the inflammatory biology of stress and anxiety. It helped her quite a bit with her physical pain.

While the meditation helped her be calmer and have less pain, she started to see the underlying roots of her anxiety. She noticed a near-constant sense of guilt and shame and believed that it was part of what drove her anxiety. She knew that rationally it didn’t make any sense. She was a successful and responsible person. But still, she had these deep negative feelings about herself.

I connected her with a psychotherapist colleague and they got to work. She found that the therapy and the meditation were profoundly synergistic and helpful. Her symptoms kept getting better.

What does psychotherapy do to help physical symptoms? How does it help address trauma and anxiety?

Today’s interview with my friend and colleague Josh Goldberg dives into the psychological tools which he uses to help people with chronic anxiety, relationship stress, and physical symptoms. This is the second interview with Josh. In the first one, we spoke about some of the underlying principles. Today we talk about the actual work he does with people. It’s a fascinating discussion and I hope you like it. Please feel free to comment or give feedback on the youtube post.

We broke the conversation into two parts because there was so much to say. Click here to see the second part of this interview.

Did You Know:

Dr. Shiller gives regular free mind-body training sessions on zoom. Learn practical tools for transforming suffering, and reducing stress and inflammation. You can get the schedule and register at www.mindbodygroove.com
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

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

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

See the other parts of this lecture series here:

Part 1

Part 2

Part 3

Summary:

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

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

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

Did You Know:

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

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

Full Transcript:

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

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

Posted on December 17, 2020March 3, 2024 by Andrew David Shiller, MD

Check Out Part 2 HERE

Summary:

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

There is Hope

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

Video Questions

The video discusses the following questions, among other things:

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

This is a complex topic. These initial two videos give an overview and some of the scientific underpinnings of the functional approach to complex illness. Subsequent videos will answer the questions of:

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

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Did You Know:

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

Full Transcript:

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

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Life-Changing Stuff Doctors Don’t Tell You About Chronic Pain, Fibromyalgia, and Chronic Illness

Posted on December 1, 2020March 3, 2024 by Andrew David Shiller, MD

Summary:

You can heal from chronic pain and illness, but most conventional doctors won’t help you. Science has shown us a great deal about why people develop chronic pain, fibromyalgia, and chronic illness, and what makes those debilitating conditions get worse. A major part of what worsens chronic pain and illness is lifestyle issues: unbalanced stress, unhealed trauma, inadequate nutrition, sleep, and physical activity feed the disease process in a vicious cycle. Science continues to clarify the pathways by which it happens. Unfortunately, conventional medicine focuses on acute illness and trauma. Most conventional doctors don’t learn about stress and lifestyle and how they can make you sicker. They’re busy dealing with acute problems which have simpler solutions. So the patients often remain in the dark, and get progressively worse. It doesn’t have to be that way. When you understand your own stress response and what triggers it, then you open up possibilities for healing from Chronic Pain, Chronic Illness, Anxiety, and Fibromyalgia. Understanding your stress response is a key part of healing from chronic pain, chronic illness, and fibromyalgia. Your Body-Mind System has a brain within your brain. It’s called your autonomic nervous system, and it touches every organ, every cell, and influences your entire body and mind. There are two branches to the autonomic nervous system. The stress response is responsible for “fight, flight, freeze”. It makes you ready for action. It’s your “get up and go”. The relaxation response is responsible for “rest and digest”. It helps you be nourished, restores your energy, and enables you to heal from illness or injury. When there is an imbalance between the two, it can be a problem. In our society, many of us are walking around with an overactive stress response. In a susceptible person, that can worsen pain, worsen chronic illness, and create a whole host of unpleasant symptoms. This video talks more about the stress and relaxation systems. How they can make you miserable. And how you can take charge and start to heal. This is video part 1 in the Understanding Stress series.

Did You Know:

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

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

Inner Healing Essentials is an intensive six-week course taught by Dr Shiller, which teaches you the Six Steps To Inner Healing. It empowers you to transform stress into vitality, and begin to take back your life from chronic pain and illness. A new class begins quarterly. To get more info and be notified of the next start date: https://andrew-david-shiller.mykajabi.com/inner-healing-essentials-waitlist.

Full Transcript:

(this talk was given as a scientific presentation and includes slides to illustrate the point. If you prefer to read the transcript, you can also download the slides) Stress Reactivity Talk Slides Hey, it is Dr. Shiller. We are going to talk today about stress reactivity, and if you have got a chronic illness or chronic pain, you should really listen carefully and pay attention. It is vitally important information. If you can get your head around and understand what I am talking about, you are opening up a door to improving your quality of life and maybe even healing your illness. I am saying this based on my own experience and with hundreds and hundreds of people as well as the latest and decades of scientific research, which are really showing us that your mind-body connection is extremely powerful. It has the power to make you sick, it has the power to help you heal, and you get to choose. Pretty much everybody knows at this point that chronic stress is not good, that it is part of what contributes to anxiety and depression and can make pain and headaches worse. It can affect job performance and relationships, and what we are understanding now is that it actually contributes to inflammation and can drive chronic illness. Let us talk about a particular case, because it is illustrative. A woman who came to see me, who I call Rebecca, who was suffering with fibromyalgia, and that means she has pain all over her body. She could not sleep. She had digestive problems. She had been a really successful, accomplished, go-getter business person, who was doing a lot of good things in life, and around age 43, she had a car accident. It was not that severe. She had a little pain in her neck and felt a little shocked afterwards, but then the pain got worse, it spread to her arm, to her other arm, to her leg. Pretty soon, her whole body was painful, and she started having other classic symptoms of fibromyalgia, and she felt like her life was spinning out of control. She was not able to be the person she used to be. She talked about how she would come home after a day of work. She worked as a marketing professional. She would come out after a day of work and be irritable and angry with her kids for just being kids. They were doing normal kid’s stuff, and it was breaking her heart that she was not able to be the mommy she wanted to be. The key thing here is fibromyalgia, like a lot of chronic illnesses and chronic pain states, has a huge aspect of it that has to do with a person’s stress response, and the functioning of all of the kind of chemical and neurologic aspects of stress in the body, and she kind of had a classic case in that way, and the classic case of somebody with fibro is kind of a high achiever, go-getter, like really active, go, go, go, go, go person, doing really well in life, and then some stressor or shock, maybe it is an operation or a car accident or other trauma and boom, their system just tanks and turns upside down, and they sort of descend into this spiral that develops the symptoms. I have described Rebecca’s case as a classic case of fibromyalgia because of its kind of chronic ongoing stressor and then a big jolt and then kind of a tipping over, that is not to say that everyone develops fibromyalgia that way, there is a lot of different patterns, a lot of different triggers, it is very individual. One of the things we hear over and over from a lot of patients is this picture of chronic stressor, big stressor, and then kind of a dysfunctional stress response associated with a lot of the other changes. There are other aspects for sure that contribute to fibromyalgia. This is not to say that fibromyalgia is just stress or just anxiety or only caused by stress. There are some people who develop fibromyalgia when they are kids. There is a lot of different factors that are going into it, but there is an aspect of dysfunctional stress response, and in some patients, that seems to be what is most prominent. What did she do and how did that help her and how does it relate to stress response? So, part of what we did together was she learned a lot about stress reactivity. She learned to see the patterns in her own life. She learned the aspects of what is going on inside of her that leads to an overactive stress response, and she learned how to deal with that. She learned techniques for bringing on relaxation. She learned techniques for developing awareness of what were her own triggers, and by doing so, she actually turned that boat around, and she did other things that had to do with nutrients and the other aspects of healing from fibromyalgia, but a key part of it, one of the things that helped her really grab hold of the whole situation was working on that stress picture and developing her mind-body skills. Let us talk a little bit more about what that is. So, let us talk a little bit more about what that means and why and how is it that stress has these effects on the body. So, we are going to do the basics of that physiology. This is a very big topic. This is part one in a number of talks about stress reactivity and the stress relaxation system in the body. First question, what is stress? Because the definition of something, it is kind of like once you know the enemy, you can do something about it. So, there is really two ways people think about stress, kind of like two definitions, one is, it is the stimulus or the event that brings on the stress, that there is something that happens to me and that is a stressor, and then the other is that it is the response of the organism to external demand or pressure. What is stress, is it the stimulus or is it the response to the stimulus? It is actually a really important question, because especially in our culture, in my eyes, we have got it kind of jumbled up. So, you could hear people saying, “hey that was very stressful or you could hear someone saying, “I feel so stressed and anxious.” Those are two very different things. If I say that was stressful, kind of implicitly assuming that the stress is the stimulus, it is happening outside of me, it is happening to me, and if I say I feel so stressed and anxious, I am acknowledging that stress is my response, and when I acknowledge that it is my response, then I can actually do something about it. I can learn about my responses. I can learn to generate different responses. I can learn to work with my own experience of stress so that I am not a victim of it. That is such a key piece of healing from chronic illness, especially chronic pain, especially fibromyalgia is putting you in the driver’s seat, so that you can understand what is going on and make conscious choices to help yourself heal. Okay, so what determines the impact of stress? Well, first we talked about this notion of perception and that our mind-body organism as a whole can either perceive a stimulus as stressful or not, that is the key first thing. Second aspect is the magnitude of that response to stress. Some people have a more intense response than others. The third thing is whether that stress response shuts off or persists. We all know somebody who goes through some really difficult thing and 10 minutes after it is over, he is like okay what is for dinner and on to the next thing. He is not even thinking about it, and then there is somebody else who has a really difficult experience, and for like hours, they are shaken by it, and it is still with them, because their body is full of stress hormones and stress biochemistry, and it stays with them for a while, and finally how does a person respond to recurrent stimuli? So, do I have something over and over and over again, does my body react more and more to it, do I become more and more activated, does my stress response really start to fire off? So, these things are obviously complex and very individualized. There are aspects that are genetic. There is conditioning from life experience. There is what is going on in the environment and the culture, and there is behaviour, the kind of things the person does when they are faced with stressful experiences. So, a lot of this has been sort of figured out by Dr. McEwan, he is a scientist, professor at Rockefeller University, and he has really done a lot to help our understanding of stress. This is actually a diagram or picture from Dr. McEwan about some of these similar things, and so, you know, big picture, that is what he is trying to present here. We have external things that can happen, environmental factors, major life events, trauma, abuse, bad stuff, and then there is the way the organism responds to it, perceives stress, which depends on a lot of things, like is there a perception of stress or helplessness? Is the person in those conditions already hypervigilant, their body is keyed up and ready to go, and then there is sort of individual differences that depends on genetics and history and then behavioural responses of persons like diet, smoking, drinking, exercise, things like that, that modulate the stress response, and all of that determines physiologic responses, and he describes this thing called allostatic load, and allostatic load is this pressure on the organism that makes us figure out how to adapt and deal with the circumstances. So, we are going to unpack that a little bit. Okay, so how does the body generate stress. Stress, there is this physiologic response going on, and part of it is biochemical. There are stress hormones. There is epinephrine and norepinephrine, which are the same things as adrenaline and noradrenaline, and those are our acute immediate stress hormones. When someone has a really intense thing happen, and they get that jittery feeling all over their body, that is epinephrine and norepinephrine, that creates that activation intensity. Cortisol is more like our chronic stress hormone. When stress has been going on for a while, the cortisol levels go up to help the body and mind cope with that situation, and then we have got all these chemicals called peptides that color the stress response in various different ways depending on what is going on, depending on the meaning of their stress response. You know, dancing at a wedding is stressful, but it is a joyous, fun and connected kind of stressful. Running away from a wild animal is a different kind of stressful, and it has a different biochemical environment, and it means something different and has a different impact on the body and mind. This is kind of the neurologic part of the stress system. We have a brain within our brain that is called the autonomic nervous system. You could rename that and call it an automatic nervous system. It is the part of our mind that allocates our energy, and it does that both through the chemicals we just talked about and a whole series of nerves that go from our brain all the way down to the bottom part of our spine, and there is two branches, that is what we call the sympathetic branch. You do not need to remember that word, but it is a kind of code word, the sympathetic and parasympathetic. The sympathetic branch is the stress response, that is why it also gets called fight-flight-freeze, it is responsible for “get up and go” when I need to go into action, and then the parasympathetic branch is the relaxation response. It is also relevant to recover and repair, it is like rest and digest when the body and mind are calm, when our body is able to absorb nutrients, remove waste products, we are able to connect with people, we are able to have a pleasurable experience, and these two are meant to be in balance. Let us talk about what happens when we have a stress response, that is the acute fight-or-flight freeze response. It prepares us for action, and all the things that it does to all the organs in our body are based on that. I forgot to sort of point out here, just kind of pointing out that these nerves from the sympathetic branch and the parasympathetic branch, you know, they hit the brain, the throat, the heart, the lungs, all the digestive organs, the sweat glands, the muscles, the digestive organs, the bladder, the sexual organs. So, brain, increased arousal and vigilance. Sensation, we become more sensitive. Why do people do extreme sports? One aspect of it when you jump out of a plane or bungee jump is it is a rush, it is intense, it feels good, everything becomes vivid and amazing and beautiful. You feel like you are connected to life because you are aroused, because your sensitivity is on high, because you are ready for action. The endocrine or glandular system, it mobilizes energy from our liver. We actually mobilize and increase blood sugar, so our muscles and our body can do things with it. We have stress hormones like we talked about. The heart increases blood pressure and heart rate. The lungs increase ventilation, so we get more oxygen. The digestive system does not need to work when we are running away from the tiger or running after the bus. We have decreased secretions and decreased motility of the intestines. The neuromuscular system gets ready for action, our reflexes become more active, our muscle tone and strength can increase, blood flow increases to our big muscles that we use for action and running. Stress itself is not bad. Stress is part of living. We got to do stuff in the world, and our stress response helps us do stuff. When it is in balance with our relaxation response, that is good, it is normal. You know, you see over here that here is the stress level and here is time, and like I have a stressor, and I chill, and I have more stress, but I will relax for a while, and I have more stress, and it comes down, I have something big, but then I calm down afterwards, maybe I am sleeping and this drops, maybe I am just sitting down and relaxing, maybe I am having a glass of wine with the person I love. I have a balance and my baseline stays even over time. That is not true with what we call chronic stress. It is an imbalance of stress and relaxation. Our stress response is going up and up and up and it might be coming down sometimes, but the baseline keeps going up overtime, because it is not balanced by the right degree of relaxation response, and this is where stress causes health problems. Let us think about what that looks like. The effects of chronic stress. Organ systems are interconnected. We are going to look at categories here, but they can be kind of misleading, because what affects one thing affects everything, everything is connected to everything else. They are actually not in yellow, I guess I got to correct that slide. The brain, when we have chronic stress, insomnia, irritability, anxiety, depression, impaired learning, the actual part of the brain that is responsible for new memories becomes smaller in people who have chronic stress. Brain fog, when you cannot think straight. The endocrine system, we can actually have dysregulation of our hormonal systems that can cause a lot of issues with sleep, shifts in the immune system, all kinds of things, because the body’s natural cortisol patterns overtime can get out of whack. So, they are not as consistent with help like they should be. We lose our normal, active in the daytime, relaxed and sleeping at night time, we get upside down and turned around, and that is not good for us. The heart causes hypertension, arrhythmia. Our blood clotting factors, our platelets can become more coagulable from chronic and acute stress. Digestive system, there is something that is called intestinal permeability. Intestinal permeability seems to be associated with inflammation and all the chronic diseases that we are dealing with. This is recent science in the last 10 years or so. A lot of doctors do not even know it yet, but it is going to be in the textbooks in another 10 or 20 years, and everyone is going to know. Constipation, irritable bowel syndrome, inflammation of the gut, all of these can be associated with chronic or intense acute stressors. Sensation, we can have increased pain transmission. We will talk more about that later. People can have more physical symptoms. The number of people who have symptoms in various parts of the body, they got funny sensations, things do not feel right, they go to the doctor or they do all these tests, they do not find anything, and then they learn to like relax, meditate, deal with their stressors or their emotions, and the symptoms just go away. Neuromuscular, tight muscles, cramping, painful muscles. Bladder, irritable bladder, having to go to the bathroom all the time, hurts to pee, things like that are related to chronic stress. Let us talk a bit about pain. Briefly, this looks complicated, but there are a few basic things. One is we have got pain receptors in our body, and those pain receptors send signals through nerves, they go to our spinal cord, and in our spinal cord, they talk to other nerves, and that goes up to our brain, to the thalamus, and the thalamus is what integrates a lot of sensory information, our emotional information, a lot of our belief systems, it is a big integrator place in the core of our brain, connected to our limbic system, and from there the signal gets transmitted out to the cortex, and the cortex is where I go auh, I have got pain in my hand, and it is really super complicated physiology. It is not like an electrical wire, where you flip the switch and the light goes on, this is like a wave of biochemical, electrochemical energy that flows up towards the brain and is color and can be turned up and turned down by a lot of different things. What are the things that can turn up pain transmission? Emotional distress, disconnection, fear, anxiety, helplessness, anger, frustration, insomnia. What are things that turn down the transmission of pain and actually block pain? Meaning, purpose, joy, things that make us feel good. Sometimes, distraction, doing things we enjoy. Another important part that I want to just point out is that, there are all these pathways going on, but there are two main pathways. There is the sensory discriminative pathway and the affective motivational pathway. The sensory discriminative pathway is the part that helps my brain know that I have got a burning sensation in my hand, but it does not give it any emotional value or any emotional impact. It is like, oh, I got burning in my hand. The affective motivational pathway is the part that goes, “ah, I got burning in my hand, I got to do something about it” that motivates us, that activates us, that is the place where stress, anxiety, depression, and other negative mind states have a huge impact on pain’s transmission. It is an integration of pain and affect or emotional aspects of ourselves. Pain modulates our emotional experience, and emotional experience modulates pain. It is a loop, it is a cycle, and that is something that comes up over and over again for people who develop chronic pain, and that was a big part of what had happened with the patient, Rebecca, that we discussed at the beginning, that when things started to get bad for her, she started to get really bent out of shape about it, she just was really stressed out about it. She was irritable. She was anxious. She was not sleeping well, and that is probably part of what helped amplify and make the pain system worse, because it feeds stress response pain, stress response pain. Let us go forward. We saw this slide before, but I want to bring out a couple of other key points, right? We learned about the individuality of whether something is stressful and how much impact it has on a person? And the key thing I want to talk about is how a person responds to recurrent stressful stimuli? Because there are three aspects. There is adaptation, habituation, and sensitization. Adaptation is what we saw before, it is the way we overall as an organism learn to deal with whatever pressure is on us, it is like our bodily, mental, emotional responses and choices. There are these two other aspects called habituation and sensitization. There is that adaptation thing. Habituation and sensitization, habituation is kind of like I get stimulated by the same thing and I learned to ignore it. Sensitization is more like I get more and more sensitive each time. I get reactive more and more. So, habituation, think about somebody who goes to train in the army, and the first time they are like next to an artillery shell, boom, like they get all startled by it, but then they hear it over and over again, it does not even bother them anymore. Frequently, there is a deeper response in the body that can be going on below the level of their conscious awareness, but they habituate because they learn to ignore it, and they just got to live their life and go forward. Think about, for instance, suppose you are in a car accident or you have some sort of traumatic experience and you have some pain and it was traumatic, and it was difficult, and you are a little flipped out by it, but you know what, you got to go to work the next day. So, you get up and you put on your work face and you do what you got to do and you have an extra cup of coffee and you go through your life, and you are just like habituated, you are dealing with it, you are not worrying about it. Meanwhile, there can be a stress response that is building underneath, and because you are not paying attention to it, but it is there. Maybe you start to have a little aching in your neck, maybe you have an extra drink or two or you smoke a little bit more. These are ways of adapting and habituating to kind of our chronic stressful response that is in your body and in your system. Sensitization is a different story, that is the person where they had that stressful event. You know, PTSD is a sensitization type of experience a lot of times, sometimes it is not, but the point is imagine someone who has that car accident, they cannot even get in a car, or you get bit by a dog when you are a kid, and you are traumatized by that. So, you are sensitized to the overall experience of what is a dog. When you hear a dog bark or a dog comes near you, get scared. Sometimes you even see a picture of a dog and you get scared, you can develop a phobia to it, that is a sensitization response. Again, this was really relevant to the case we talked about, because most people are a combination of these things. With that patient Rebecca, listening to her story, initially she sort of just tried to deal with it and be a good person and do her work and do her job, and you know take care of business and be responsible, and she habituated and she adapted, but overtime, her system became sensitized, and she was not able to anymore. She started getting more and more irritable. This is that curve of chronic stress where things build up and build up over time, and that is where the bad effects of stress come on a person. So, what do we do about stress reactivity? This is going to be brief, because really I want to just give the big picture, but the point is, the main thing is learn mind-body skills, because they are simple basic techniques anyone can learn that reduce the stress response, activate the relaxation response, and it is about working on a different part of our brain, because most of us do not learn how to do that. These days, it is a little bit different. It is getting more and more common that people are learning mind-body techniques and meditation. They stimulate your inner healing intelligence, they take away that chronic stressor, so you can get into rest and digest, and your body can get into that repair state from parasympathetic activity like we talked about earlier.

What about mind-body skills?

Well, there is one aspect which is relaxation, stimulating the relaxation response. Another aspect which is working with our perception, there is something called mindfulness. Mindfulness is where we learn to pay attention in a conscious intentional way to our thoughts, emotions, bodily and sensations, and we start to learn about how we respond to reality. We start to notice the inner voice that is going on inside of us that we normally do not notice, that colors the way we perceive and colors the way we react, and we start to learn to be conscious and we start to respond rather than reacting, and that is mindfulness, and there is transformation, there are techniques for actually taking traumatic experiences or chronic negative emotions that maybe we have been storing for years or decades, that are living in our subconscious mind and affecting our body by generating stress all the time, and we can actually bring awareness and compassion and melt and dissolve and reframe those persistent negative emotions and trauma, and that can have a huge impact on our health.

How do I develop mind-body skills?

First of all, many people are listening to this and they are nodding their heads, and they are saying, “Yeah, I want mind-body skills, how do I do that?” And some people are sitting there with their arms pulled across their chest and they are thinking to themselves, “Look, I don’t meditate, I am not a mind- body guy, this is not me, I don’t relate to that,” and my suggestion if that is where you are holding is start checking out the science. If you are a rational concrete person and you are not into this, like oozy-woozy stuff, you should know it is not oozy-woozy stuff, it is scientifically proven stuff, stacks and stacks of research for decades, back as far as the 1960s and 1970s when Herbert Benson started proving what the relaxation response is and how it affects various states of body and physiologic systems. This is real stuff backed by real science, and I suggest you get over your anti-Kumbaya syndrome. I respect where you are coming from. You may have had experiences that make you think that, “Okay, I am not going to sit around in the circle and burn incense and meditate and listen to chimes and bells and all that silly stuff and enya,” but that is not what meditation is anymore. Meditation is serious mind training; it is scientifically based. If you saw the number of top athletes and top-level business executives who are using meditation practice to enhance their performance, you might think differently about it. So, the invitation is, get with modern science and modern culture and realize that these are powerful tools that can have a huge impact on your life if you are dealing with chronic illness and chronic pain. Anyone can do it. You got to take action, you got to learn the techniques and do it, and start small, five to ten minutes a day is a good start, one minute counts also. Regular consistency is the main thing. There is a lot of different techniques. We will talk about that in other talks. So, if you want more information from me on this, go to Facebook and find the group that is called “WhatHeals” and you can join that group, and that is a private Facebook group that I have, where I put out notices about all the different things that I, you know, content and information and educational type of things, so you can get notified stuff there through Facebook. There is also a community, there is a kind of a dialogue going on there, and then you can go to my website at www.drshiller.com and sign up for the newsletter, because every time I put out another post, I send it out an email to all my subscribers, so you can get that information. This is the first of a number of different talks related to this topic. There is a lot to understand. There is a lot of information that can really help you make better choices and do things that are going to have an impact on your health. I look forward to supporting you in that, and very interested in your feedback on this video if you want to leave it, whether it is on YouTube or on Facebook or wherever you see it, I love to hear your feedback. So, thanks a lot for watching and listening, and I wish you all the best.

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Why should you know about LDN for Pain and Auto-Immunity?

Posted on August 4, 2020March 3, 2024 by Andrew David Shiller, MD

Why should everyone with chronic pain or autoimmune disease know about LDN (low dose naltrexone)?

Because for many people it helps them, even if they’ve “tried everything”. That doesn’t mean it’s for everyone. What I say doesn’t mean diddly if it doesn’t help you. But LDN is something that most people don’t know about. And it’s something that helps many many people.

Some patients have told me it’s like a miracle. It’s not a miracle. But it’s often surprising when you’ve been told ‘there’s nothing else to help you’ and then something helps you. LDN for chronic nerve pain and inflammatory issues is applied physiology and common sense, and has some clinical trial support. It’s not a miracle. But it is a very safe choice that might help. If you’re facing chronic disease or chronic pain, it’s very important to be open-minded. Conventional medicine doesn’t have all the answers. Knowing that truth, is part of What Heals.

Stay open-minded, but not so open that your brain falls out.

Here’s a recent interview from the LDN radio show, that talks a bit about what is LDN and why it helps some people with chronic pain or autoimmune problems.

LDN radio show march 2018

https://vimeo.com/253572930

https://www.mixcloud.com/LDNRT/dr-andrew-david-shiller/

If you want to find out whether LDN may be helpful for you, contact the office or click here for more information.

Did you know?

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

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We broke the conversation into two parts because there was so much to say. Click here to see the second part of this interview.

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There is Hope

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Join my email community and get notified about new content and transformative self-healing skills.

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What about mind-body skills?

How do I develop mind-body skills?

Join my email community and get notified about new content and transformative self-healing skills.

Why should everyone with chronic pain or autoimmune disease know about LDN (low dose naltrexone)?

Stay open-minded, but not so open that your brain falls out.

If you want to find out whether LDN may be helpful for you, contact the office or click here for more information.

Did you know?

Join my email community and get notified about new content and transformative self-healing skills.

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