Break the Stress Spiral with Dr. Scott Sherr

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We're supposed to have stress. We're supposed to be in sympathetic some of the time, but we're not supposed to be in it all the time. Over time, we're not even going to realize that we're in it because of these, like, small little things that continue to give us that stress response without us realizing it. You have a lot of things that are happening to you on a regular basis that are causing sympathetic activation. Is it your job? Is it your kids? Is it your spouse? Do you have a snoring spouse that's keeping you up all night and you're not getting any sleep? Toxins in our environment, medications that we're taking, infections that we're getting. I remember I was working with a couple people where— actually, elite athletes that had the worst-looking foundational biomarkers, but they were at the top of their game. Wow. This is not uncommon because the body can compensate for a long time until it can't.

How many women are like, God, I'm feeling like crap, my metabolism's tanking, I feel like I'm aging faster?

I think it's a much bigger issue than we realize.

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Dr. Scott, so there is a lot of women listening that feel like they're doing everything right, right? They're eating right, they're exercising, they're trying to manage stress, but they are wired, they're exhausted, their metabolism seems to have ground to a halt. They possibly wake up at 2 or 3 in the morning, like every night, and they just can't seem to stop their mind from racing. I think you call this the sympathetic spiral of doom. Is that what this is?

I do.

Yeah. All right. Tell me, tell me about that.

Sure. The idea here is that we are overstressed and we're under so much physical, emotional, cognitive stress that not only is having an effect on our nervous system, but it's also having an effect on our capacity to make energy at the same time. And so the sympathetic spiral of doom is this combination of having sympathetic nervous system that's on all the time. So your sympathetic nervous system is the one that's supposed to be on when you're getting chased by something or something's very serious and you need to like get outta the way, or the proverbial saber-tooth tiger is running after you kind of deal. But modern society doesn't really have those things anymore. All it has now is these small but very sympathetically active things that we're doing all the time, scrolling on our phone, going to meetings, doing the things that we're just going, going, going, going, going. So that sympathetic nervous system is, is active all the time. And we have the mitochondria, the part of our cells that make energy. That part of the cell is very, very important. We have a huge amount of energy requirements on a day-to-day basis. We make about 150 pounds of the energy currency in our body called ATP. And if we are not meeting our energy demands, the system starts going, oh no, I need to make more energy. You need to give me more capacity. And so the mitochondria, when they're trying to make more energy but can't, start putting out signals and say, hey, we can't make enough energy. You need to rev up even more than you already are. And then you get to this place where you're revving up more, but you don't have enough capacity anymore. Your, your reserve is so low because you're already at this high stress level, right? And you know, society rewards this stuff. It rewards women and men that go, go, go. I mean, when I was in medical school, my friends and I had shirts that said sleep is for quitters, right?

I grew up in New York.

The hustle, right? It's all something that people want because that's what's acknowledged and rewarded in our society. Then as a female, when you're getting toward midlife and your hormones are changing and all of a sudden you can't meet those kinds of demands anymore because your estrogen levels are lower, your mitochondrial function is now lower because of that, your progesterone levels are lower, and all of a sudden you can't sleep as well. And so you're like, why is everything kind of falling off when I was feeling okay a couple years ago? And so this sympathetic spiral of doom is this chronic sympathetic activation with chronic mitochondrial dysfunction that is happening without us knowing it. And then all of a sudden we feel like the wheels have fallen off and we don't know what to do.

I don't really know how a, especially a woman, now I must speak from a women's point of view because guess what?

That makes sense.

Yes. I know us well, but you look at it and not only are we, I always say, I always joke that we have, you know, two jobs or two careers cuz we have our career and then we come home and we have our career.

Right.

And then we have our kids and then we have our parents and, you know, there's very few husbands. I'm gonna make a blanket statement, but I think most of the case this is correct, that are thinking about their kids' dental appointments or birthday parties or what they're gonna wear to school. It just doesn't happen.

I'm guilty of this too. I have 4 kids and yes, my wife works full-time and yes.

Yeah, but yet, you know, I was like working full-time, primary breadwinner and putting on the birthday parties and like, and, and, and, and, you know, and I woke up at one point, I went, I didn't sleep. I don't wanna be, 'cause for a while you feel really good about it, just like you said. You're like, look at all the things I can do. And I go, I don't wanna do all these things. And I just wonder how many women are like, God, you know, I'm feeling like crap. My metabolism's tanking. I feel like I'm aging faster. And it's because, and they're looking outside of all the things, getting their labs done, et cetera. And a lot of this stuff, I don't know how you'd even see it on a lab test.

A lot of it's gonna look like it's normal, yeah.

So, I mean, how big of an issue do you think this is?

I think it's a much bigger issue than we realize. And I think, you know, just to kind of reflect back what you said about women and responsibilities, I remember when I was in California and I saw a billboard and it had a father and a son, and all it said on the, on the, on the billboard was, Dad, just show up. Like, that's all that dads are expected to do, kind of, right? Like, all they need to do is be there and then women do everything else.

Yeah, it's like, Mom, pack my lunch, get my clothes.

I was with my wife in the car. She was so pissed when she saw that sign. Yeah. You know, and I have 4 kids and so there's a lot that I do to help the kids, but you're right. Birthday parties, dental appointments, the dermatologist, all that stuff is happening because my wife makes the appointments and I just don't think about it. I always tell her it's like doing laundry. It's like, I think about doing laundry, but I thought about it 2 weeks from now when you thought about it today. Mm-hmm. Right. And so it's like, you know, women's minds are, have amazing capacity overall. But what is happening, I think, is that. The capacity is, is at a, a certain level that they don't realize it's such a— reserve is so low as a result. And then as a result of different changes that happen in midlife, all of a sudden that capacity goes down and then the signs become obvious in the sense that you can't recover anymore. You're gaining weight, your energy is just all over the place. Your mood is all over the place.

But that's like, it's sort of the blood sugar versus insulin thing where everyone's focused on fasting blood sugar. Why aren't we looking at fasting insulin? We'll fix this. Figure it out way early. Yeah. Yeah, I see the same challenge here. We don't have these early warning signs as far as I can tell. There's not a lab you're taking for it, so—

Right.

So doctors would miss it. They're not getting trained on it, likely. Are you getting trained on nervous system regulation in med school? No, no, no, no. Like, was it considered a woo thing? Like, or just—

I think we only learned pathophysiology. That's all I remember. Like, in medical school, you learn anatomy and physiology for a semester, like your first semester. So you're in the cadaver lab You're, you know, looking at all the organs and all the things, all the tissues. You learn physiology, not normal physiology, maybe for a semester. Then the rest is just disease, right? They're not focused on keeping people healthy because the medical system is basically saying, you know what? We can't do anything about people getting sick. We are just gonna treat, treat them when they're sick and then hopefully help them a little bit.

Right. So what would these signs be then for someone since this is such a major problem that's overlooked, right? What could be some of the early signs or symptoms that things are not going well, that you— because, because again, like you said, it's a badge of honor to be stressed out and overworked, right?

Yeah. So you can look at it from an objective perspective and you look at it more from a subjective perspective. Objectively, what I typically do with patients is I work on a whole battery of things that— of laboratory testing that you wouldn't get if you went to your normal doctor. You know this very well. It's sort of like the functional integrative world. Mm-hmm. The framework is called Health Optimization Medicine, and it's a framework that was developed by a colleague and mentor named Dr. Ted. Who said like, let's see if we can keep people healthy so that we can optimize them over the long term and prevent a lot of these things from happening. That's in the ideal case, of course, right? If you look at foundational biomarkers like vitamins, minerals, nutrients, and cofactors and gut health and neurotransmitters and hormones, you can get signs of things falling off the wheels or falling off, you know, your wheels falling off the, the truck or whatever way before it actually, you actually see it. And I remember I was working with a couple people where actually elite athletes that had the worst looking foundational biomarkers. But they were at the top of their game. Wow. This is not uncommon because the body can compensate for a long time until it can't. Yeah. And, and that's what it comes down to is like we have these amazing machines that compensate as long as they can until the wheels fall off. And then I keep using that analogy for some reason. And we are like, well, what just happened? How, how could I feel so poorly all of a sudden? And, and I think what it comes down to, JJ, is that when you're thinking about sympathetic activation and mitochondrial dysfunction, this loop, the way I kind of approach it with my patients, I, it's like, look, think about it from a top-down and a bottom-up approach where top-down means that you have a lot of things that are happening to you on a regular basis that, that are causing sympathetic activation. Is it your job? Is it your kids? Is it your spouse? Do you have a snoring spouse that's keeping you up all night and you're not getting any sleep? Is it, you know, a bad relationship or something that happened in your past that you haven't addressed yet? So that's all the things that are coming from the outside, right? Mm-hmm. And then, and then you have all the things that are happening inside as well, like toxins in our environment, medications that we're taking, infections that we're getting, insulin resistance. You talk about high blood sugars, right? These are all affecting our mitochondrial function. And 94% of US adults have metabolic and mitochondrial dysfunction. Only 6% of US adults are metabolically healthy. So you get this stress that's coming directly at the mitochondria. You have this, then that's the sort of the bottom-up side of things that I call it. And then the top-down is the stuff that's coming outside. And then you, you, you talk to somebody and you're like, you have So many different things that are happening here, both outside and inside, that we need to address, right? And so the key is to understand that it's happening, and then from there being able to see, well, where can we start bringing in more support so you can start feeling better? Where I always start with this is not so much on the stress side, actually, because if you just decrease somebody's stress but their mitochondria and their cells and their immune system, their hormones are already tanking, they're not gonna feel very good. And that's because they don't have any reserve and you just, They've been elevated and trying to go and go, go to keep up with what they need to do. But as soon as you take off the, the gas pedal, put on the brakes, they're like, their system starts crashing, right? Yeah.

And, and it's like you always get sick after exams.

Exactly. Right. It's like that stress, stress, stress, you see people crash, right? And it's the same thing if you don't have enough mitochondrial support. So I'm always appreciating—

how do you know if you have enough mitochondria?

Like, yeah.

Where's the mitochondria test? I know MeScreen's trying to do it, but it's like people doing it. Yeah. Where is that? Tests that can tell us this? It would be so amazing besides a biopsy. Like, how do you know?

So there are a number of tests out there that have come out. The MiScreen's one of them, some other mitochondrial tests. The way I think about this is that if you can take a good clinical history as a practitioner, you should pretty much have an idea. I mean, it could be anything from something overt, like if you have diabetes, high blood pressure, metabolic syndrome, you have metabolic dysfunction, you have mitochondrial dysfunction.

So if you have metabolic dysfunction, you have mitochondrial dysfunction.

Yes. And defining that is sometimes helpful for people because metabolic dysfunction Sometimes it's like, what does that mean? So I try, I try to make it super simple. I say, look, can you make energy effectively? And then after you make energy, can you address the stress that happens when we make energy? Because our cells are like gasoline-powered cars. We make ATP, our energy currency. We make a lot of it, 150 pounds every single day, a huge amount. But we also make water, carbon dioxide, which, you know, goes to the plants. They make oxygen, the beautiful cycle of life. And we also make reactive oxygen species. These are small reactive molecules. That come off because of oxygen, and these are signaling molecules. But if you have too many of them, or if they're around for too long and you don't have enough antioxidants to be able to neutralize them, then you get into this place where you get a lot of stress on the system. So metabolic health really is, can you make energy effectively and can you detox from the energy that you make? Do you have enough antioxidant capacity? And if you don't have either one, one or the other, you don't have metabolic health. And that's why it's so important when you address metabolic health. You have to address it both on the energy production side and also on the detoxification side, and not just one or the other. So if you give somebody glutathione, for example, to help them with detox, but they can't make any energy, right? They're still gonna feel like crap, right? If you give them something that's gonna give them more energy, but they don't give anything on the detox side of things, they're still gonna feel like crap, right? So that's why it's so important to think about this, you know, holistically.

The woman who's feeling exhausted and feels like her metabolism's broken, how does she know Is it hormones? Is it diet? Or is it nervous system? Or is it just all of the above? Do we have— just have to consider that nervous system's always this foundational piece that always needs to be addressed?

I think the nervous system is always a big foundational piece. The question is just the sequence that's best optimized for that particular individual. Because as I mentioned, if you just say like, you know what, you need to calm down.

Oh boy, does that make us mad too.

That makes you really mad. You don't wanna tell a woman that she looks tired. You don't wanna let her tell her looks stressed that she didn't sleep or something. So you don't wanna say, hey, why don't you just calm down? Right? That, that doesn't work out, right? Uh, no, not even just that. You don't wanna work just on working on calming down the nervous system. I was talking to, uh, somebody a couple weeks ago with Lyme and mold and, and what happened was a lot of stress associated with everything else too. And she was given something by her practitioner to calm her down and she just crashed, right? And that's because she didn't have enough of that mitochondrial support to really do it. And so the way I think about this, JJ, is like, you wanna help somebody now? Right? You wanna help them feel better now. And sequencing usually is mitochondrial support first. And then from there, looking at the, the, the nervous system and, and understanding how to best downregulate that in a safe and intentional way. Over the long term, you wanna optimize their gut, you wanna optimize their hormones, optimize their neurotransmitters, but that may not be enough, you know? And, and that might not be enough right away. Like if I tell a patient that comes in to see me by my practice, hey, you know what? It's gonna take 6 months or a year, but you're gonna feel great. Right. They're gonna be like, next doctor, next doctor. I don't want to feel—

where's the pill?

Same with body composition shifts.

Yeah, it's like, it'll be a year, right? And when I tell my patients that, they're like, well, what are you going to do now, right? I'm like, well, it took you 40 or 50 years to get where you are.

At least I had a great mentor early on who was like, let's just take how long it took you to get here.

Exactly.

Yeah.

And then we can take, I don't know, we'll take like 10% of that and we'll get you better. It's like, that's fair, you know?

Yeah. And that's That's the road that we are all on, the path to health optimization, but it's challenging, right? So this is where Methylene Blue comes in very interestingly.

Yes, I wanna talk about Methylene Blue. I keep getting this hit of all I'm hearing, and it reminds me, I've been through some stupid stressful times, like, you know, a son nearly dying who got run down by a car. I mean, crazy stressful things. And what really struck me is that it's not about not having stress, it's about how resilient you are, you know? And that when you build great resilience, like if you look at people who are able to do big things, like, you know, presidents of companies or countries or whatever, they just are very good stress resilience. They have really good stress tolerance.

They tend to, yeah. Or they get very, very gray hair after their 40s.

Well, they all just seem to get that too. You know, like, crap. But, you know, the reality is if you want to really be able to do cool stuff in life, it strikes me that building that resilience.

Yes, and this is what I call sympathetic reserve.

Break down the parasympathetic and sympathetic. I don't think I've had anyone do that well on the show. It'd be good to do because we throw these around all the time.

Yeah, well, that's, that's an important piece. We have two branches of the autonomic nervous system. We have our sympathetic nervous system and our parasympathetic nervous system. Our sympathetic nervous system is known as our fight and flight, runaway or freeze nervous system, depending on the animal, depending on the person and the time. This is what's supposed to get elevated when we're under significant stress. It used to be the proverbial saber-tooth tiger that was chasing you. Now it's the likes and dislikes that you get on Facebook or whatever else, right? We're supposed to have stress. We're supposed to be in sympathetic some of the time, but we're not supposed to be in it all the time. And unfortunately, many of us are because of this, these like small little things that continue to give us that stress response without us realizing it, because over time we're not even gonna realize that we're in it. And I can tell you, I mean, there's a good proportion of people that I work with over the years that have no idea that they're always in stress.

Like ER docs?

Well, ER docs, yeah, they're a special breed. They're a different animal. Yeah. So on the other end of the spectrum is the parasympathetic nervous system. The parasympathetic nervous system is our rest, digest, detoxify, and heal nervous system. So if you are always in sympathetic, you're not going to digest, you're not going to detoxify, you're not going to heal, you're not going to recover. And, you know, for those who care about building muscle, you're not going to build any muscle either because you don't build muscle in the gym. You build it after you get home and relax.

Now, question on the parasympathetic, because, uh, it would strike me that you need both.

You do.

And that you could also be too much of a yogi.

It's a good question.

I mean, I'm sure they're rare, right?

But it's very rare to find these people that feel like blissed out on psychedelics on some island somewhere, but it's very rare to find them. But I call it for the most part. So the sympathetic spiral of doom, the opposite of that is the parasympathetic edge. Because if we can be more in that parasympathetic state, everything else is going to get easier. It's not like you have to be a yogi all the time and, you know, living on a mountaintop and have no stress at all. The idea is that when you're in that parasympathetic mode, you have more reserve, you have more capacity, and that you are going to be able to raise your capacity. If you're going to the gym and you're already like this, and like you're trying to lift weights, you're not gonna be able to lift that much more, right? But if you're at the gym, you're like, you know, list out, you're gonna have a lot more capacity to load your muscles. Think about loading your stress on a day-to-day basis. It's the same kind of idea.

Right, your reservoir's full. But do you think though that like for so many people, they're just kind of, they're almost addicted to this. They're in that spiral of doom as you talk, but it's like they're so used to being there, that's their normal, that they don't know quite what to do if they take that away. It's like the, I remember early on I had a therapist, she goes, okay, now what?

What you're going to do every day is you're going to sit quietly.

And I'm like, I'm not going to sit quiet. Like, sit quietly for 30 minutes with yourself? Nope, I'm not going to do that.

Have you heard of these experiments where they had people sit in a room for like, I think not that long, maybe 30 minutes, doing nothing? They could either do nothing or they could shock themselves and, and give themselves a shock. And what did most people choose? To shock themselves. Why? Because they didn't want to be with their own minds. Right? They didn't want to have their thoughts just go crazy because everybody knows if you start meditating, what's— what starts happening, or even not even meditating, just be alone with your thoughts for a minute, your mind is going to give the craziest things for you to think about. Your mind is programmed from thousands or millions of years of evolution to keep you alive and help you procreate. That's it, right? Everything else, the ego, if you want to call it that, or your mind, doesn't really care about that much, right? You have to reprogram it over time, and you can do this, but In essence, so many people do not wanna be with their thoughts because thoughts are intrusive. Thoughts can be really crazy. Like, I can't believe I just thought about, like, what? And, and then one thought leads to another, another, another. I could, somebody called it like a pancake kind of effect where you start with one thought, you go down this train, and all of a sudden you're at the end of it. You're like, how the fuck did I get here?

Right?

Like, how did I, and all of us have been in this situation.

Yeah.

Right. And so I think, and we're addicted to thoughts. We're addicted to them because they are super sticky, super fun, super like, oh, I'm thinking about that vacation. Oh, I'm thinking about that new partner. Oh. I'm thinking about this date, like, or I'm thinking about the past and all the stuff that I, I did back then. Like, as a result, they're just so sticky and addictive. And that's how our minds are programmed, is to be addicted to things that are gonna keep us alive. Like, on average, we have about 70,000 or 80,000 thoughts per day. If you're anxious, stressed, depressed, you have up to 120,000 thoughts every single day. And I tell my patients that, I'm like, well, should you believe everything you think if you're believing 70,000 or Thinking 70,000 thoughts a day. Some of those thoughts might be the same thoughts over and over again. They often are. Like, nah, probably not. Like, how many should you believe? I'm like, how many? 5, you know, 10. Like, not that many, you know, because most of it is just your mind going crazy.

Well, let's talk about what is actually happening when you are in these, this sympathetic spiral of doom, the stress state. What is it actually doing?

Mm-hmm.

Yeah. To your metabolic health. What's happening there?

Yeah, that's a great question. So. When you're sympathetically dominant in this fight or flight that most of us that are in most of the day, you're releasing hormones and neurotransmitters including norepinephrine and epinephrine, which are your primary driving sympathetic nervous system. And then you're also releasing cortisol. Cortisol has been the, the ugly stepchild of the room recently.

Oh, it's ridiculous what's going on right now in the female exercise space.

Yeah, I haven't seen it in the female space, but Yeah. Okay. You can, you can elucidate a little bit that for, for the, your, your audience. But for me, what I think about here is that cortisol is your stress hormone. It gets released naturally in the morning when we wake up, and then it's supposed to be your highest when you wake up. And then as you, the day goes on, it's supposed to get less and less and less and less. We need cortisol. Without cortisol, we'd all be dead. Okay. But the problem is that cortisol, when it's high for long periods of time, makes those other stress hormones not work as well. So, or the stress neurotransmitters. So you have all this cortisol pumping out. But then your norepinephrine and epinephrine stop working over time. So you're pumping out more norepinephrine, epinephrine. It's not working because you have cortisol around all the time. Cortisol also, if it's pumped up for long periods of time, it depresses your immune system, causes cardiac immune issues, uh, both breaks down muscle, breaks down muscle. Um, and it also stores fat in unfortunate places. Yeah. Like, like around your organs, which is called visceral fat. Visceral fat itself has more, uh, density of cortisol receptors. And so if you have cortisol out for a long period of time, the organs themselves are gonna pick up more and create more fat because they think that you're under like stress mode, starvation, something where you're not gonna see food for a long time. You're not gonna digest your food when you have high cortisol levels, right? And so as a result of this cortisol being elevated, you actually get a lot more visceral fat too. So you see the, the skinny fat people, right? They, they look, they look okay, but they have a huge amount of visceral fat around their organs. And this is classic for somebody that's in fight or flight. All the time. And then that cortisol, that norepinephrine and epinephrine are stimulating your mitochondria. They're like, the mitochondria, the part of your cell, like, oh wow, we need to make so much energy here because you're telling us that there's a lot of energy needs. But then the mitochondria over time can't keep up and they start building up with those reactive oxygen species. And then what happens is they, they go, oh no, we can't do this anymore. We're gonna flip over and stop making energy entirely. We're trying to protect ourselves. And that's called the cell danger response, CDR. And that the cell danger response is when your mitochondria stop making energy from oxygen very effectively and just make a little bit of energy just to try to keep themselves alive. This is the classic where I'm stressed and I start putting on weight.

Mm-hmm.

Putting on more weight, right? Because the body's trying to compensate for this, but it, it can't. And so it tries to put you in hibernation mode, but you're not in hibernation mode. You're trying to do your thing. The mitochondria and the parts of the cell that are like, well, we need more energy, start spewing out more signals to get more sympathetic activation to try to get you to get more energy, but it's not happening, right? And that's where this loop really, really starts spiraling out of control.

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That's when I tended to see the most people, back when I was working with people one-on-one. Yeah. In the initial stages, you didn't see them. They're like, this is great. Yeah, yeah, yeah. It's like, I feel great, I've got energy all the time, I need more stimulants, more stimulants. Yeah, more, more, more coffee. And then all of a sudden they crash and then they come crawling in. They do. I did this to myself and I remember one of my friends was like, you must take an adrenal test. I go, I don't need, you know, anyway, took it and I was in the crash place and then I would get myself back up, you know, good again. And then I'd overdo it. Then I'd crash. I finally was like, just stop doing this. Yes. Just stop it.

A lot of my patients that are in this spiral, they're like, doc, I just need more stimulants. I just need something else that's gonna get me more focus. And I'm like, what if I told you that if we calm down your nervous system, everything would get better? They're like, no, I can't calm down. I can't calm down.

I'm like— But that seems weird though. You gotta admit, like, I actually wrote down a note and I remember this from, I've been to 7 or 8 Dr. Joe Dispenza events now. And it was like, I remember the first time he goes, now you need to meditate an hour a day. I go, I don't have time for this. Like, gimme a 5-minute one, doc. But that discovery that when you quiet things down, you're actually way more productive and get more done. Doesn't make sense. It doesn't make sense on the outset.

Yeah. The way I like to describe it with my patients is like, look, you imagine you have a big speech to give. You're in front of all the people to give it and you forget all your lines. Why? Because your brain was so sympathetically dominant. So in that fight or flight that you actually didn't get enough blood flow to the front of your brain to remember what you were gonna say, right? That's what you're doing on a day-to-day basis by just sympathetically dominating yourself all and all the time. Mm-hmm. You may not realize this. You probably don't because you're compensating until you don't, right? But if we can just drop you down just a little bit, you're going to see the benefit because you're gonna see your capacity go up. But you have to trust the process. And that's hard for people because they think, because of society, that they need to keep going, going, going, going. And this is a classic, like, I can't recover. I'm tired all the time. My mood's all over the place. I just can't do the things I used to do. I need more stimulants. I'm like, no, you don't. Let's, and I say it Nicely. I'm like, look, okay, look, more caffeine's not gonna do it, right? More stimulants are probably not gonna help you. Now, do we need to support you and get your mitochondria working better? Can we do that? Absolutely. That's gonna help you dramatically. It's gonna get you out of that cell danger response. Things are gonna get better on its own just by doing that. Oftentimes, like I had a, a, a colleague of mine a couple weeks ago, he's like, doc, I started taking methylene blue, for example, which is great on the mitochondria. And he is like, my anxiety went away. And I was like, Hmm, tell me more about that. And he is like, well, I've had anxiety all my life and I've tried, you know, tried SSRIs, tried all these things. Nothing ever works. And I, I hadn't really tried something specifically for the mitochondria. And then when you give the mitochondria what it needs to help support it, then all of a sudden it, it can start actually making energy more effectively again. And the whole system starts calming down. You start breaking that spiral. And I've seen this time and time again where I give somebody, somebody with mitochondrial support in the morning, in the evening they would sleep better. Their HRV would go up and they're like, I didn't take anything for sleep. And I was like, well, you didn't need to because your system wasn't overloaded all day trying to make more energy when it couldn't. It had more support now. And so by the time you get to the evening, you're not wired anymore. Your cortisol levels aren't as high anymore and you can actually get to bed. And so it's kind of a weird conversation to have with patients because it's like, yeah, let's get your energy better so you sleep better. They're like, huh? Okay. Um, and, and this may not solve all of the issues for sure if there's a lot of that top down. If there's a lot of stress, you have a snoring partner, you know, you haven't got a sleep divorce yet, you know, you, you have relationships that are tough or whatever, or even things in, you know, that you said that you had some traumatic kinds of things, right? Like if you haven't addressed some of those traumatic kinds of things in your, in your child— in your childhood, adulthood, whatever, like that's still the elephant in the room and needs to be addressed. But you can give people like an inclination, okay, that there's another way to do this. And it's not that you're gonna crash and you're not gonna have enough energy, it's just that we're gonna regulate you better so you get more of that what I call that parasympathetic edge.

And the reality with all the trauma stuff, I find it is like peeling an onion. It's not like you're gonna go in and do one, you know, MDMA guided journey and fix it all. It's gonna take time after time after time to address all that trauma. It takes time. And there's stuff in there that you don't even remember that all of a sudden will get unpacked. Yeah. That's lying in those tissues.

Yeah, I had a friend of mine, she's an acupuncturist, and a doc in, in California. She's like, we were lamenting, like, she's like, Scott, all these people are going ayahuasca journeys and they're doing their thing and they forget that they have to work on their physiologic optimization too. It's not just about working on the trauma. Like everybody thinks, oh, work on the trauma, work on the trauma. That's all you need to do. And like you said, it takes time. There's layers for all of us, right? But there's other piece of this is that if you're not working on the physiologic side of things and optimizing there and, and addressing it, you're still gonna feel like crap at the end of dealing with your trauma. And so you might feel a little bit better for sure, but it's not gonna be the whole story. And I think that's where, when I was talking to her, her name's Ashley, I was like, Ashley, that's exactly what we're doing here is that people are just doing one or the other. Like, and for on the other side of things, if I just give somebody mitochondrial support and give them the, the best diet, the best supplementation, but I'm not addressing their nervous system, it's like the one time I agree with conventional doctors that say if you're taking supplements, you're just making yourself expensive piss because it's not gonna do anything. And we all know these people, and I've, I've worked with them, is that they've tried everything. They've been to 17 doctors and, and they, nothing seems to work with them. They're sensitive to everything. Chemicals, foods, you know, whatever, light, electromagnetic wave frequencies. That all exists. But if you're one of those people that is trying the same thing over and over again from a, like a, like a laboratory, dietary supplementation, never get better. I promise you it's your nervous system regulation that needs to address. And I won't work with people anymore that aren't also doing that piece if I really get a good sense that that's really what.

The elephant in the room is. It seems like with any— so I have a lot of friends who treat complex cases, and seems like— I don't know how you would have a complex case that doesn't have this as a piece of it.

It's almost always there. And I have a friend of mine, another friend that's in San Francisco, that's why he has ketamine therapy in the office, right? He's like, yeah, we're here to treat your Lyme and your mold, but there's also ketamine, and this is why. And when I was in San Francisco, I referred people to him all the time because it's such a big part. Because even if you don't think you have trauma—

how would someone not have trauma?

That's the thing, right? But even if you have just a chronic complex medical illness and you've had it for 5 years, there you go, right? And people don't realize that having that condition and not having energy and not having the capacity and blah, blah, blah, these are all real, but they're also in themselves traumatic. People don't realize if you had a traumatic hospitalization, if you had somebody close to you that almost died, like you, you were talking about, that's a big deal. It may not feel like that at the time, but it really does and have a significant impact on your nervous system. You may not feel safe anymore doing certain things. You may not have the capacity because your mind won't let you think certain things, or you can even forget about it entirely, right? Depending on the situation. We all have some element of trauma. It may be mild for others and significant, but if you have a chronic complex medical illness, you almost always have to address that aspect of it if you're gonna see any major healing long-term.

What's interesting about trauma too, I'm thinking about the ACE score. Yeah. I don't find that to be useful. I'm gonna say something that probably, I'm not a trauma doc, I've got friends who are trauma docs, but what strikes me from working with a lot of different clients was that I'd see someone who'd get so stressed out about something that wouldn't even register on my screen. And I think about these traumas and it's like all these different things that go, but just one of those things could have the impact that maybe 3 of them could. Like, so every single physiology is different and you might have some external stressors combined with these, you know, internally you can't just go, oh, my score on the ACE score is okay. Cuz it's that, right? Yeah. Yeah.

I'm 100% with you that it's really looking at the person entirely. And the scores can be helpful is they can help kind of triage a little bit, but we have a certain amount of capacity that we're born with. Some of us have a lot of capacity. Some of us have a little bit of capacity, and that's from toxin exposures, from stress, it's from trauma, all these things, right? And once you get to the top of that bucket, things start going haywire. That could be when you're 5, or it could be when you're 35 or 55, depending on the person. So I think it's so individual, but the key is that you can look at objective measures from a physiologic perspective at least, and say, okay, there's some stuff that needs to be done here. Even if there's no overt issue at the time, that you can potentially change their whole trajectory by optimizing now. Or if they're already at a place where they need a lot of help, you can still do a lot. Within that context and see a lot of reversals of things that you wouldn't imagine would be, would be reversed. You know, in our worlds of conventional medicine, you think some, some things you can't get better. That's what they'll tell you, right? You can't get better from certain things. You have fibromyalgia, here are your drugs, right? You have chronic fatigue, here are your drugs. Here, like, they just don't think that you have diabetes. Here are your drugs, right? But we know that with the right platform, the right context, the right framework, you can really see reversals of these. But you have to be acknowledging that, that, that all these aspects exist. And then the person has to be ready. Not everybody's gonna be ready for doing the major trauma work, and, and that's okay, right? Sometimes it's just, can we supplement you a little bit here to make you feel a little bit better? So you start exercising a little bit, getting a little bit of a dietary change, maybe coming down on your stress a little bit, and then we can have the conversation at some point in the future, like, okay, you ready for the next part here? Because this is only gonna go so far, but you do at least feel better along the way.

Yeah. Right. But the reality is these are things. Like, it's just an entirely different way to look at healthcare. Just like we talk about the disease care, sick care system. Well, just the way you described medical school, that's all you're learning. And it's just a different way to look at it. It's like how we would treat our car. Let's keep our car, let's keep getting it tuned up, keep it working well so we don't have to use as much gas or as oil. And it's the same thing here. It's just that people aren't trained to think this way and to then look at their body this way and to start way ahead so that they never never get to that point. You never get sick. So it sounds like a lot of this just starts with some fundamentals that would basically keep your nervous system happy.

What would those be? So fundamentally, we have to just calm down. JJ, just calm down. Shut up. Right. So I think the first thing to fundamentally understand is that you are most likely in fight or flight more than you realize.

How would someone know?

So typically it's symptoms that we were describing in the beginning. So you don't, your mood is more labile. You're kind of up and down more than you used to be. You don't recover as well. Like you exercise and just don't feel good for longer than you used to. You have like a bad night of sleep and you just, you just trashed the next day.

So that's not aging.

Yeah, that's not necessarily aging. Aging is, you know, aging is a conglomeration of many things, but mitochondrial dysfunction and nervous system dysregulation are kind of it, right? I mean, making energy is not free. That's true. So we do have. Rust that builds up in the system over time. We can, we can address that though. So for me, it's usually the looking at overt signs of it. They might be subtle, they might not be. And hopefully it's not somebody that's, you know, crashed and burned and you're talking about your cortisol being in the tank, right? Like that's sort of the end.

But just the normal person kind of going through the day, noticing they're not recovering as well, their sleep's not quite so great. Maybe they're getting a little fat around their midsection. They haven't changed anything.

Right. What did they do? Yeah. So the first step is to understand this happening. The second step is, okay, now what knowledge you have a problem. Yes, exactly. But even if you don't, like, you probably know that you probably should be more relaxed.

Yeah. Whether you, whether you think you have the problem or not, you still would want to do this. Right, exactly.

And the key is then, okay, how can you bring in more parasympathetic time during your day? And that could be very simple things. It doesn't have to be crazy hour-long meditations like Joe was asking you to do.

Oh no, he's done 4 and 5. I did a 6-hour meditation one time.

I'm sure. I'm sure. So what I tell my patients when I tell them, you know, what I do myself is like, try to break up your day so you're not constantly on, right? So have time when you're taking breaks from your computer, have time when you can get outside, have time when you can learn how to do like a little bit of breathwork if you can. It just learning how to prolong your exhales, trying to learn how to meditate. But in my experience. I could tell people this until my eyes and my ears or whatever, my mouth starts getting very dry. Oftentimes it's, let's show you what this feels like. And that's often giving you something that's gonna optimize actually the GABA system in your, in your brain. GABA is the primary brakes of your brain. It's the, it's the primary inhibitory neurotransmitter. And so if I can give something that modulates the GABA system and give them the experience of like, oh, that's what it's supposed to feel like, then they know where to get the next time they're doing it with breathwork, with meditation, with yoga, whatever. But if you don't know where there is, it's very difficult to know where there is. And so that's what I like to try to give people the experience of. But it's— how do you do that? So GABA itself, you can take, but I don't find it does— this is important, right? This is where you're going. So GABA itself is too big of a molecule to get into the brain. So if you take GABA and it works for you, you have a leaky brain. Yeah, that's a great test. It's a great test. And so I've, when I first started thinking about this and talking about it about 5 years ago, I had a number of physicians come up to me like, yep, every time if GABA works for them, they have a leaky brain. And I was like, okay, this is interesting. And then what, what's the correlation for that? Well, if you have a leaky brain, you also almost always have a leaky gut. Of course. And so if you optimize the gut, the brain barrier also gets better. And so I've had patients, yeah, doc, GABA works great for me. And then we optimize their gut and the GABA supplements stop working.. And so this is what we think about. So you don't want to take GABA supplements. If you do take them and they work for you, okay, find a good integrative doctor to work with because there's something you can do about that, which is good. Because if your blood-brain barrier is leaky, that means it's inflamed. That means you have a chronic infection, you have chronic mitochondrial stress, chronic sympathetic activation, all the things we've been talking about.

Do we have a way to test for leaky brain at this point? GABA. I mean, that's a really interesting, yeah.

There's no direct way of looking at the blood-brain barrier, only to say that certain things should not get in, right? And, and certain things should get in.

How would we know unless—

well, most people— so this is classic. Like, if you had a severe infection, or even just getting a surgery, like Long COVID, for example, if you had COVID infection and then after COVID you had reactivation of Lyme, reactivation of mold, reactivation of Epstein-Barr, that's all leaky brain. That's all just what happened there, right? Because when you get a severe trauma or severe infection, your gut gets leaky almost instantaneously. Like, A good example of this in a different context is your marathon runners. Like if you're running a marathon and you're shitting down your leg, like that's because what all just, what happened is that you were just diverting all of the fuel from your small intestine to your muscles to try to keep them alive while you were running. And that major fuel is actually glutamine. Glutamine's your primary fuel of your small intestine. And so what just happened is the gut just got massively leaky. Mm-hmm. And your brain got leaky too, by the way. Right. So, and so that's like a, like a—

another reason not to run marathons, everybody. Yeah.

Yeah. I worked with somebody recently that did the ultra mile, uh, ultra marathon in the Leadville race where I live in close to where I live in Colorado. And I got him to not have diarrhea for his entire race. Wow. Go you. Yeah, I know, right? Just glutamine for every, you know, 4 grams every 4 hours. I also give him methylglutamine and some other things. But, but anyway, so we don't have a good way of looking at the blood-brain barrier, but we do know that if the gut gets leaky, the blood-brain barrier is gonna get leaky too. And so you don't wanna take GABA is, is a short story. What you can do is modulate the GABA receptor in some different ways that are pretty interesting. The first one I would just say to not do is drink alcohol. Take benzodiazepines would be number 2. And number 3 would be take sleep drugs if you can avoid it, right? Because all of those are modulating the GABA receptor for sure, but they're depleting GABA at the same time. So they're making GABA bind strongly to the GABA receptor and depleting it very quickly. That's why you get tolerance, withdrawal, and dependence to those drugs. They feel good until they don't, until you need more and more, and then you have a hard time stopping them, right?, right? So what's interesting about the GABA receptor is that you have a place where GABA binds, and you have all these other separate sites on it called allosteric, or separate sites. And when those other separate sites are bound, you can also increase the amount of GABA to bind to. So alcohol, benzos, sleep drugs, they all bind to separate sites, and they increase the affinity for GABA to bind, is what happens. So you can use other compounds. I like a couple different ones. Kava. You've heard of kava before. Kava binds to a separate site on the GABA receptor, increasing GABA to bind. It gets through the blood-brain barrier, no problem.. But if you just use kava over time without giving a GABA source, what can happen is you can actually have an issue with kava too. And you've probably seen this in people that need more and more kava to get the same effects. You go to kava bars, you feel drunk and you need more.

And please, I just stopped using kava years ago because there was that contamination. Oh yeah. The hepatotoxicity. And so I just never used it after that.

Kava's very safe as long as you get it from the, a good source. The hepatotoxicity liver issues were very, very rare and, and giving, using the wrong parts of the plant. But what I always think about in the way we, we typically formulate is we give something that binds to a separate site and also something that's gonna bind and give you the GABA source too. So what we use is something called nicotinyl GABA, vitamin B3 attached to the GABA. Mm-hmm. The B3 has a transporter that gets it across into the brain with the GABA kind of taking a ride with it. And then you have GABA and B3 in the brain. B3 is mildly activating, which is nice, so you don't feel tired. And then the GABA's gonna give you that GABA source.

Oh, this sounds very good.

You combine it with the B3 GABA with the kava along with CBD and CBG and something called Trocom, which is great. For calming down the nervous system without causing any sedation. Hmm. So then you also can use something like another cool compound. It's called agarin, and agarin is a long-acting modulator of the GABA receptor binding to where GABA binds. Agarin's from a psychedelic mushroom called the Amanita muscaria mushroom. It's the beautiful red mushroom with white spots on it, and it's known in Christmas lore as the, maybe the reason for Christmas, not the, you know, the Christian version, but the, the, the pagan version. Um, but it doesn't give you a psychedelic experience like psilocybin. It's more like a, a twilight kind of thing. Um, but the mushroom itself is toxic. It has to be dried, um, because it has another ingredient in there called ibotenic acid, which is neurotoxic, causes the psychedelic experience. But agarin is very, very safe at low doses and it's a long-acting on the GABA receptor. So it binds directly where GABA would bind. And then we use something in a combination called, in our product called Trozee at Transcriptions, which is for sleep. Also has hanakial or hanokial from magnolia bark, and that binds to a separate site. And so the idea for me as a clinician is like, okay, you need to sleep, you need to calm down, but I can't tell you the latter because you're gonna get angry at me. You're okay if I tell you you need to sleep most of the time. So what is the lever that we need to pull here? But typically it's let's get your nervous system to calm down so you can see it, you can feel it, and then once you feel it, then we can go, okay. Now, how are we gonna get you back here? Is it breathwork for you? Is it meditation? Is it yoga? Because then you know where there is, you know, I think that's the hard thing for all of us is that I'm fine, I'm fine, I'm fine. My nervous system is fine. I'm like, no, no, no. We need to show you how to calm down.

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