EP 159 WTH?!? Mysteries of the Mind: Anxiety, Benzodiazepines, and Beyond with Dr. Nicole Cain

Foreign.

Hey, welcome back everybody. This is what the health and I am Dr. Greg Eckel. Today's topic is the double edged sword of benzos. That's benzodiazepines. And this is my esteemed colleague and guest that I've been I pursued on the interwebs to get on the show, Dr. Nicole Kane, who goes by Dr. Nicole. She's got a degree in clinical psychology and is a licensed naturopathic physician in the state of Arizona. She's been interviewed as a mental health expert in Forbes, published in well and good and in journals such as ndnr, which is our naturopathic journal and has been a national speaker on Pesi Circle P E S I. Her mission is to introduce a new paradigm for understanding and treating our mental health, including anxiety, depression, bipolar disorder and even benzodiazepine tapering. As an anxiety warrior herself, she has special interest in sharing her experiences with anxiety. So in her free time, Dr. Nicole loves treasure hunting at consignment shops for Moroccan and Asian antiques. Welcome aboard, Dr. Nicole.

Thank you. And I was just going to rotate so you could see some of my treasures if. Oh yes, Video, Moroccan, India and Excell Indonesian treasures.

Oh, I love it. That's a great, that's a great pastime and it's good to. We'll remember that. So I am, I am so excited to get this conversation going. And out there there is an epidemic of anxiety and all too often I'm seeing patients that have been prescribed benzodiazepines and because they're a highly addictive substance, they're very hard to get off of. So let's talk, talk about anxiety in general. Right. As you as an anxiety warrior and you've got like, what are the eight types of anxiety? Because that doesn't really, that's the. Actually the first time I heard of the eight varieties of anxiety.

Yeah. It's so helpful to know what type of anxiety that you have so that you can leverage solutions that are going to work the best. And so if you look at the research on all of the different types of symptoms that someone who's in a state of anxiety has, we want to look at similarities between what happens in the body, what happens in the mind and the nervous system. And it appears that there's about eight types. And what I think is something I want to emphasize before jumping into what those eight types are is that if we look at our symptoms from a trauma informed model, we will understand them a little bit differently. Where the dominant medical model will look at symptoms and Say, oh, you have this diagnosis, you have this disease. We are going to give you these treatments to make it go away or to at least relieve your suffering by suppressing your symptoms. And what I want to do is just hit the ground running and set the stage at the beginning of this conversation that trauma informed research like Bessel van der Kolk and Bruce Perry and all of these amazing thought leaders are. We're finding that the naturopaths had it right to begin with and that our symptoms are information, data points about the ways that we have adapted to what did happen to us or what did not happen to us. So they're adaptive mechanisms. And the eight types of anxiety can really help us zero in on the adaptive mechanisms that your body is using primarily so that we can then go deeper and helping create restoration. So I kind of wanted to come out the gate just talking about a new framework first.

I love that. Yeah, so that is, yeah, you mentioned some greats right there. And that is a good naturopathic framework. Right. We're talking about these are an adaptation by our innate intelligence in an attempt to heal. Now sometimes though, that attempt to heal is causing some great suffering. So, you know, maybe with your, your path, like, how did you get into this specialty?

Well, where I feel like a lot of us are wounded healers. And so I grew up in a fairly tumultuous family environment and my natural inclination was to try to figure out what was wrong and what to do about it. And a lot of my skill set was around exploring someone's emotional experience. And so there's a lot of mood instability in my family, a lot of a history of addiction. And so I was very curious about that and studied psychobiology in undergrad, which looks at the connectivity of the brain and the body. And then I studied clinical psychology and my master's degree to really try to understand what we can do in terms of a top down approach to changing the way that we think and understand ourselves in the world, to try to change the way that we exist in our thoughts and our bodies. And then there were limitations to that. And so I wanted to study medicine. And through that study of medicine, those adaptations started to become a lot more clear. And what I think is really an important nuance that you're, you're presenting really wisely is that sometimes adaptations become maladaptive and it's context dependent. So let's say that we have somebody who was in Iraq war. Dr. Bessel van der Kolk studied veterans quite a lot in the beginning of his career. And so in war, when you hear a loud, high pitched, short sound, it becomes adaptive for your brain to associate that with gunshots or danger. And those who were able to do that were able to act quickly and effectively to survive that and then come back and be in society. But the, the problem arises when the nervous system then doesn't continue to adapt to civilian lifestyle. So this individual may be at fireworks, and the nervous system detects those similar sounds or those cues, and then it goes into that fight, flight, freeze, just like they're back in Iraq and they're not. And so what may have been beneficial when you were in the past, getting stuck in the nervous system can be problematic now. And so a lot of the work that we do is almost healing like an onion, where we work through each of those layers of adaptations on a biological, psychological, social, environmental, even spiritual level to help the body reorient in its present time and place. And sometimes those biological adaptations can cause stress. So, for example, inflammation, it can be very important, it can be very protective, and it can help us heal from infectious diseases. But chronic inflammation, we know, can cause all sorts of damage to the brain and body. And your zone of genius, doc, is brain health and brain regeneration. And so we know that this thing that was designed to help us heal can also become a problem if it's not kept within the context of your current reality.

Indeed. And so why do you think that anxiety is on the rise?

I think anxiety is. Well, one of the interesting, the biggest myths about anxiety that I hear is that people aren't anxious. And so they say, I'm not anxious, I'm stressed, or I'm not anxious, I'm frustrated. But those are more labels that are interesting for our ability to talk about it, whereas really it's autonomic arousal. And so we have the catecholamines, like dopamine and adrenaline, and we have cortisol, stress hormone. And all of those catecholamines and hormones are similar. When you're really excited on a roller coaster the day before you get married or the day that you find yourself in a really scary situation, hormonally, chemically, it feels the same, but the context that we give it is different. And so I think the answer to the question of why anxiety is on the rise is, is we want to look at environmental mechanisms. So what environmentally is causing our autonomic nervous system to go into this arousal? And so we know that circumstances can do that, but even beyond that, we know that environmental toxicity can do that. And we live in a world where agriculturalization has resulted in changes in the biochemistry of the soil, of what we're breathing in the air. So we can look at our circumstances in the environment, but then we want to look at biologically, what are we being exposed to from the environment. And then let's just have a conversation about how the world is so much more complicated with the advent of the Internet, where in the days of the Andy Griffith show, we had the newspaper, it came on Sunday, and that was everything that we were going to get in terms of news besides what old Joe down at the gas. Gas station told you. And now we're being inundated with so many data points from so many places that is changing our brain and our nervous system and could have a whole conversation about this aliens network in the brain and how its job is to be like a filter or a colander, where it's trying to filter out what is relevant and we need to be aware of and send it to your amygdala, your feeling part of the brain. And what is, what is kind of irrelevant that we can ignore and not pay attention to. And we're seeing that the environmental stimuli being upped more and more and more, that is putting a greater tax on that filter in the brain. And people are getting overwhelmed and anxious and adhd, et cetera.

Yeah, well put. All right. So circling back then into kind of differentiating because that autonomic arousal is. There's some subtypes that have been or patterns that have been put together. So anxiety just isn't anxiety. There are some differentiating factors here.

Yeah. So when I get anxious, I have noticed there's a theme to what my body does when it's anxious. And so I notice the first thing is that my heart rate picks up. So there's a little bit of intensity and speed and the heart rate. And so then when we look at physiologically what's going on, what are the causes of a faster heart rate? That's data. And so for me, it starts in the chest. It's called chest anxiety, where it may cause heart palpitations, it can cause air hunger, where you try to get a breath, but you feel like you're not getting enough oxygen. It can cause hyperventilation where I'm breathing harder and faster, or it can cause you to feel like an elephant is sitting on your chest. And so then we look at that part of the body and we're like, okay, what physiologically is going on that we can then reverse engineer to try to find that root cause of why the adaptation is happening here. And, and we can leverage holistic strategies that work really well for chest anxiety. So as an example, chamomile works super well for the gut. It works pretty well for chest anxiety. But theanine is like a unicorn for chest anxiety. It's particularly good for anxiety that shows up with palpitations and racing in the heart. So by understanding the where, the where in the body that it lives can help you zero in on what it could be caused by, how to test it, and then what to do to treat it. So the first type of anxiety is chest anxiety.

Got it. All right, so let's. Let's rattle them off.

Yeah. So the second one I hinted at is gut anxiety. And so this has got. This is anxiety that shows up in your gastrointestinal tract. It could be upper. Where some people, when they have autonomic arousal, the cortisol hormone causes that lower esophageal sphincter that. That blocks your esophagus from your stomach. It causes that to not close properly. And so some people, when they're anxious, they get reflux, they get heartburn. Right. And so then we can reverse engineer what's happening with that. Okay, so there may be something going on with cortisol stress hormone. Let's take a peek. And it could cause lower gastrointestinal disease. It could cause gas or bloating, diarrhea. So anxiety can cause us to. People always ask me, why do I get diarrhea when I'm anxious? So that's gut anxiety. So that's the second one. And then we have nervous system anxiety. And so this is the second symptom that I get when I'm anxious is like numbness and tingling. So if you get heat, numbness, tingling, muscle spasms, muscle cramps, headaches, anything that your nervous system is particularly responsible for, that can be really, really good for that. And that's when we look at things like magnesium, we look at things like electrolyte imbalances. We look at subluxations in the spine. That's when our spine is out of alignment. And so it can be tons of really good data. Nervous system. So that's number three. And then, let's see, number four is thought anxiety. So some people, their thoughts can make them anxious. And then other people, they're anxious and then they get thoughts. And so they could be, I have a blank mind. I can't think at all. Which happens with benzodiazepines. Right. We. We get that just shut down. Or we see it with dissociation. Where we can't quite dial in with our mind or our body. We feel a little bit floaty, or we can get racing thoughts or even obsessive compulsive OCD thoughts. So thought anxiety is a subtype. And then we have endocrine anxiety, where your body really shifts the way that the endocrine system is working. And if this could be thyroid, it could be adrenals, it could be progesterone, testosterone, estrogen, your other sex hormones. So endocrine anxiety, if the main thing is endocrine system, which we see with environmental toxicity, especially metals that can interfere with the endocrine system. And then we have anger, anxiety. And this is really interesting when we think of ayurvedic medicine, which, as you know, as a naturopathic healer is. It's a form of medicine out of India, and it's been around for over 2,000 years. And they talk about how our bodies, our minds, and our nervous systems can go out of balance in such ways that it produces a specific set of symptoms that we then can identify and heal. And anger anxiety is when we're more in that fight. A fight, flight, freeze.

Yeah.

So we have, like, anger and irritability and frustration, and we have heat. And maybe you get, like, flushes of. Some people get rosacea or they get that burning. It's more heat symptoms with anger. Let's see how many we talked about. We talked about.

We got six.

Six.

And so we got the chest, gut, nervous system, thought, endocrine, and anger so far.

And then we have depressive anxiety. And this can be. When we look at fight, flight, freeze, we also have flop, fawn, and fracture.

Okay.

And what's really interesting about this is that depressive anxiety has an element of the flop. And the autonomic nervous system responds differently when we're in flop versus when we're in fight or freeze. When we're in fight or flight or freeze, we typically see the blood pressure go up. We see the pulse speed up, the respiratory rate speeds up. But in flop, we see the opposite. Blood pressure will go down, body temperature will go down. We'll see. The heart may not be as strong. That ejection fraction may be less strong. We see this in sheep. Have you ever heard of, like, if a sheep gets stuck on a fence, it's like, well, that's it for me.

Stuck.

It goes into flop. And so the shepherd has to detach the sheep from the fence and force it to walk around.

Yeah.

To convince it. And so we see that with depressive anxiety, we see more of the depressive symptoms. So we see those physiological symptoms, but then we see the emotional like despair, sadness, feelings of worthlessness, hopelessness, lack of motivation. And so then we have trauma anxiety. And really, I think that trauma anxiety is really the umbrella that would be over them. But it's all about finding the main thing. And the main thing. And so we, we all have our own adversity. But then when we go through trauma, sometimes the trauma is the main thing. So if you have flashbacks or if you have recurrent nightmares about something that happened, like being in combat or going through a divorce or being neglected your entire life, whatever it is, if the trauma is the main thing, then the treatment would be focusing on the main thing. So that's trauma anxiety.

Got it. Wow. Yeah. So that, I mean, and I'm guessing, and we have seen clinically people have clusters of these, it doesn't come out the same way every time. Those, those aspects you mentioned, the one with the benzodiazepine component with the thought or the rumination, are they, I mean, across the board, conventional land will just say, hey, here's an anxiolytic. You know, we're going to maybe use these short term, but typically we see people on them long term. If we, if we add in that conversation maybe around the benzodiazepines in particular, because that one is a sticking point for a lot of folks. And then you mentioned a couple remedies for the different subtypes. But maybe if things come to you as we're talking about the benzodiazepines, because they, they are, they, they are, they can save somebody's life and they, when prescribed effectively, they work, but it's just really should be for short term use. And what happens though is people will get chronically put on them and they're not deficient in benzodiazepines. We know that.

Exactly. Yeah. And you're pointing out, I think something that's really wise, which is smart pharmacology. And so if, if your symptoms are like a forest fire, we're not going to put out the fire with a squirt bottle of water. We want to have the intervention match the, the source of the symptoms. And so in those cases, benzos, they work. And part of my story is when I was in the worst autonomic arousal, the worst fight, flight, freeze, horrible anxiety and insomnia is benzos were really life saving for me. But as you pointed out, they're, they're very habit forming. I teach my clients that if you've taken a benzo for three consecutive days, then your body is starting to develop a tolerance to that gaba and you're going to need to taper that back down. And unfortunately, too many people end up finding me because their doctors did too rapid of a taper or they didn't even realize that they needed to do a taper. And so benzo withdrawal is a really serious problem. In fact, the New York Times just published an article that came out November 14th, so this is yesterday of 2023, and they're calling these. It's called a monster super meth and other drugs Push crisis beyond opioids. And so what the article is speaking about is that there are many substances beyond opioids that are a real crisis and becoming more of a crisis in this country, in the United States in particular, and benzos are at the top of that list.

Wow. Yeah. So it is a, it's a biggie. You know, with the stress of the last four years and life circumstances being what they are, I think the, the propaganda machine of really putting people into their limbic systems and on heightened alert, that has not helped. And so we're, we're really needing techniques to really be in tune, in touch with our vessel and our vehicle and, and in providing more of a filter versus all of this stuff coming in all of the time. I mean, the, I think there was some. And this could be totally made up by me, but the amount of information in one day's newspaper is more than, you know, what we would get as a human being on the planet in the middle ages for a lifetime. So we have definitely not kept up with the input and the Internet and just the access to everything now. And so that's where I think we see more of the, you know, forest bathing and grounding and cold plunges and breath work and adequate rest and, you know, all of these nurturing things that are, they're not sexy, but they're the foundation for health for everybody. But we kind of get lost in the. Can you just give me a pill for that?

Yeah, the pill for an ill model. Yeah, yeah. And I always try to encourage people. I love what you said because I think there's so much shame around turning towards a medication like a benzodiazepine. But I think as you emphasized that there's a time and place where these can be life saving. And if you're listening to this and you're on a benzodiazepine, is that now it gives you the opportunity to put a semicolon after that Word. And so then you can start doing the inner work and the deep work. It gives you the space. Some people, they have such severe agoraphobia or fear of leaving their homes and going out. They like forest bathing feels like such a, a monumental task. But a benzodiazepine can give you the space to be able to do that. But I really want to emphasize the importance of. Yes. And if you are using this medicine or if you want to get off of this medicine and is start to put those fundamentals in place which are going to have an accumulative benefit. And the brain and the nervous system is really plastic and malleable. It takes, they say, 90 to 120 consecutive days of reliable performance to create a new habit. But your brain can change and your nervous system can rewire. And of course, that's what thought leaders like you are out there doing. Dr. Echols is teaching people how to do that. Yeah.

Thank you. Yeah. And that's why, I mean, it's the whole premise of our show here. Dr. Nicole is bringing the. The truth and real live clinicians, providers, helping a lot of people in the real world. Like this isn't just made up stuff like your heart is in this medicine and you know, you're on a mission and we'll have all of your connection criterium in the show. Notes for folks. But that's why, you know, I really did, when I came across you on the Internet, I was like, gosh, I got to get her on the show because there aren't a lot of folks in the naturopathic world with a platform to, to share it. So I love, I love this conversation and I hope that you all out there do too. What are some of the things like if you had like one actionable step for people dealing with anxiety, regardless of what type of anxiety, what would you, what would you say?

I have an exercise that I teach people to do. I call it the three minute hack. And what the purpose of the exercise is, is to start to create a, a communicative relationship with your s. Your symptoms. And so when you have a symptom come up. So let's say that you, every time you get stressed and you have to go and go to work or go to a meeting or get in your car and drive on the highway, before you do that is notice where your symptoms are. So let's say you get an attention headache. So you would close your eyes and maybe even place your hands to draw that nervous system attention to wherever the symptom is. If it's in your heart, maybe place your hands on your heart. Self touch can be really valuable to draw your grounded attention. And so then you notice that. And what we see, especially with, with the, the work of Peter Levine and the somatic work, is try to explore what that sensation looks like. If you were to imagine drawing it is how heavy is it, what is its shape, what's the temperature, what's the texture? And when you do that, you're recruiting all sorts of different synaptic connections from different associative networks in your brain. And you really look at it. And then you go to step two. And step two is you ask that part, what is it you need me to know? And then you just simply notice thoughts or feelings or sensations, whatever comes up. And then you reassure that part, that's part three. And you, you tell that part, I hear you. Thank you for sharing. And I want to reassure you that I've got you, that I have resources that you didn't have, that I can take care of you. And I want you to put your trust in me that I've got your back and that I'm listening. And then you ask that part if that part would be willing to set aside that worry or that tension or whatever it is, anger, whatever it is that's coming up, and ask it to trust you. Maybe even just for the next hour, for the next five minutes or the next day. Right. Be willing to set that aside and just do an exciting experiment and see if, if we could work together where you let me take care of you and that's the three minute hack. And when you start to create that, that's going to create what we see in the bottom up work. I kind of talked about the top down work, which is more the thoughts where you start with the logical brain, but your body keeps the score. Right. Thank you. Y and so we go into what the body is trying to tell us and we honor that. And that's the first step. No matter even really whatever symptom you have, it could be fibromyalgia and you're happy as clam, but you get pain. Do that exercise with your pain.

Oh, I love that is, that's amazing. And I love that it can be as straightforward as asking it what it needs. It is really brilliant that, that component of trusting yourself. Right. Because I think a lot of times it feels out of control. It's like, where is this coming from? Nothing really happened. Like that's the issue with anxiety is that the chemical responses just cascade for no apparent reason. And that can be, you know, again putting you into that fight or flight or flop, freeze, fracture, you know, all of those components that we want to put on there. So that really is an amazing share. Thank you. And I hope you all listening and viewing really give that a go and and write in the show notes like how that worked for you and what' what's going on because that really literally can save a life. So we are all in this together. Dr. Nicole, thank you so much for coming on what the Health. It has been so enjoyable. We'll have to do a part two. I know I probably have some loose ends out there but I love the we got the conversation going. Your thoroughness in explaining what is going on with the body. We really appreciate that. Everybody out there, if you enjoyed the show, make sure you go out, give us a five star review and write down a take home message of like what are you going to put into action? Because that's what it is. It's not just the information. You've got to act on it. So we are here for you. We will see you next time on what the Health.