Optimizing Sleep For Health, Performance, Recovery, and Productivity with Dr. Derek Lawrenc‪e‬ - Men Made for More Podcast

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[00:00:00] Dave  Hey there mighty men. I'm your host, Dr. Dave Paczkowski founder of Men Made For More coaching, our business helps husbands level up their life. Their leadership and their legacy in marriage and in business. The purpose of this podcast is to bring together like-minded men that feel destined for big things in their life to provide you the resources and community that you need to lead yourself, your family and your business.

[00:00:30] If you've ever felt overwhelmed, frustrated, lost, or alone on your journey to a better and more purposeful life, you're in the right spot. You weren't designed to be average. So it's time to quit living that way today. I'm giving you permission to unlock your true potential and step into all that you were made for.

[00:00:48]All right guys, welcome to today's guest episode of the men made for more podcasts, uh, joined with a, uh, amazing professional and good friend of mine, Dr. Derek Lawrence, uh, Derek, excited to have you on here today. Thanks for [00:01:00] coming on for the show.

[00:01:01] Derek: [00:01:01] Absolutely. Thank you so much for having me, you know, we've been talking about it for a long while now.

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I'm glad we were able to make some time to actually, you know, put it in the schedule and make it happen.
[00:01:12] Dave:
[00:01:12] Yeah. And I can't think of how many conversations we've had, uh, just at times like, well, over an hour or two hours of conversation, or just go some good stuff. If we just had the podcast equipment and would have hit record, we could have launched some of those on their own. Yeah.
[00:01:25] Derek:
[00:01:25] Right. I mean, I was talking to my marketing director, Kelly, who you've met, um, the other day and how, how just, it's an, it's an unfortunate, wasted opportunity that we don't sometimes just get followed around with a microphone. Um, not because what we say is. Brilliant. That's really not what it's about. It's, it's about the, the conversations that when you get a couple of professionals together, um, they just get really exciting and they get interesting and you, you, um, and they're, so they
[00:02:00] tend to come contextually and that's just a really cool, um, that's a really cool way to have that, so, yeah.
[00:02:07] Yeah. You're right. I wish we would have had a mic on a lot of times, but Hey, we're here today, so let's see where it goes.
[00:02:12] Dave:
[00:02:12] Yeah, this'll be another good one. I have a, I have no doubt about that, but let's, uh, let's give listeners to say listener jumped down a elevator with you, uh, 60 seconds to kind of explain your background briefly what you're up to you and what you're excited about.
[00:02:27] Derek:
[00:02:27] Sure. Uh, so, uh, I'm a naturopathic doctor. Uh, I've been, uh, in Carlsbad since 2013. Our practice there is revived naturopathic medicine. We have an awesome team of docs there now that are working, not only in office and remote, um, and you know, our focus in naturopathic medicine. At our clinic in particular, it was really working as a team with our patients.
[00:02:49] And we're, we're getting folks who are either frustrated with the care they have been given, or maybe haven't been given, um, despite not feeling well, not being well or their
[00:03:00] conditions not getting, uh, kind of navigated or handled appropriately or, or, or they're kind of stuck in their route to getting well.
[00:03:09] Uh, and so we ended up getting a lot of these people saying, is there something else. Go or I know something else is going on, but like I'm not getting these answers or, uh, we're, we're looking to kind of come at health from a different angle than simply disease management. And so our team of docs and myself personally, we've really worked, uh, to create a system to help like hold our patient's hand and like show them what's in front of them to be able to explore how to understand their health better.
[00:03:40] And I really. Believe that, you know, a team approach and it kind of whole systems approach of not just trying to say, well, if you have a thyroid problem, let's make sure we solely focused on your thyroid. Yeah. That's a piece of it, but it's so much, it expands so much more into the totality of your health that these
[00:04:00] factors need to be taken into consideration.
[00:04:01] Right. Um, How do you build the toolbox to help yourself? That's what this podcast is, right? It's like helping people build a toolbox of the right questions to ask, you know, um, the, one of the most, uh, I think poignant things that I say in a lot of my visits is I may not have all the answers, but what we're trying to do is ask the right question.
[00:04:21] Dave:
[00:04:21] Yeah, and so good. And, uh, you know, for those listening, I, I highly highly trust Eric and his practice and the docs there. We've, uh, With our physical therapy businesses work closely with them in the same way that we try and get to the root cause of why is your back pain going on? And we traced that upper body, lower body core w check movements, see how posture is, check how all those things are relating to it.
[00:04:43] And sometimes it's related to the back. Sometimes it's something. Completely separate. And, and yours is the same way from the medical side of things and deeper into the health. And what we realized even with back pain is we could address the movement side of things, but then working with people that are also seeing you, then there's,
[00:05:00] we're getting into the stress and the sleep and the other inflammation, all those other things that we can, we can get someone moving perfectly.
[00:05:08] But if all those things are left on a dress, then we're only, we're only getting so much, so much progress on that.
[00:05:14] Derek:
[00:05:14] Right. And you know, I've told you this, I've told Lindsay this, uh, a good physical therapist. Like yourself, like they are the naturopathic doctors of the body, of the physical kind of structural body, um, in the way of, it's not just about, Oh, it hurts here. Okay. Well, I'm going to touch here. Yeah. There's there's like, you have to do that.
[00:05:35] You got to understand that area, but, um, how often, if not all the time, do you find these interconnected pieces in whether it's. Other muscle groups, ligamentous damage, uh, tissue inflammation, structural postural genetic components as to why someone is structurally and physically in their physical body, uh, unwell.
[00:05:58] And you guys do an
[00:06:00] amazing job at trying to understand that and not just say like, okay, well, I'll grab here and then we'll put heat here. Or, you know, it's like, it's so much more complete and that's what. You know, initially when we met, got me very, um, just excited about how you take that approach. And then of course you keep your mind open to the fact that there are other factors that can keep someone unwell outside of, you know, their physical body.
[00:06:31] Right. So,
[00:06:32] Dave:
[00:06:32] Yeah, it's so good. And, and we, uh, speaking of our conversations, we've had, we, uh, you, you and I were to. Trying to think about like, where, where do we want to, where do we want to start with all this? Cause we talk about all the, you know, we have no shortage of ideas and things that we could talk for hours and hours on.
[00:06:48] And, uh, you and I both agreed that that sleep was a, a great starting point because whether, you know, whether people listening are trying to get in, in peak physical performance, uh, sleep is gonna play a
[00:07:00] huge role in recovery. If you're a business owner, just trying to. Make sure that you're, you're showing up with the energy and focus.
[00:07:07] You need to, it's going to be important, even if you're trying to just lose weight and get rid of some of the, uh, the weight around the midsection. W we'll talk about sleep. Can, can play a role in that as well. And I know I'm missing hundreds of other applications, but why don't we, uh, I'm gonna kick it off to you of, of kind of general overview, like, what is sleep and why, why do we sleep?
[00:07:27] Derek:
[00:07:27] Yeah. So we're going to start with the hardest and biggest and really unanswerable question as to like the what and the why, uh, you know, this is, um, uh, if you think about sleep, uh, from a like evolutionary standpoint, It doesn't, it doesn't make sense. And, um, I don't know if you're familiar with, uh, this sleep
[00:08:00] scientist, Matthew Walker. Have you ever heard of him? He wrote an incredible book. Why we sleep, uh, recently, um, any dives into some of these, these, uh, these concepts, um, And, and the, the reason why I say like, it doesn't fully make sense is because when we're sleeping, we were like incredibly vulnerable.
[00:08:21] So you take yourself out of the 20, 21, um, you know, Situation here where like, you know, we sleep in the King size beds with cooling mats and, you know, and I pillows and, and, and ordering. So we eat, we talk about all that stuff. I take, take that and, you know, live with roofs over our heads and worry about bills.
[00:08:45] Right. Um, you know, put that human being thousands of years ago and. The threats to our lives were much more significant, especially like from, uh,
[00:09:00] something could eat you standpoint. Right? And so being asleep unconscious for seven, eight hours during the night, when you can't see anything, it almost doesn't make sense.
[00:09:14] It's such a period of vulnerability that. And Matthew Walker makes this point that if it wasn't an important, it would've got weeded out. Like our tails they're gone. Right. You know, we got that little cock six left. Right. But you know, we've lost the tail. Uh, we evolved out of the need for that. How come sleep has stuck around.
[00:09:35] And it is because it has to be incredibly relevant and important for us from a physiological and mental functioning standpoint and evolutionary standpoint or else it probably would have gotten filtered out the best way to kind of understand what, what is sleep and, and why do we do has come from the, I mean, unfortunate experiments of sleep
[00:10:00] deprivation.
[00:10:00] And then what happens when that, when those things happen, right? Cause that's, that's almost how you learn, what it does for you is that you deprive yourself of it and then see the catastrophic consequences of whether it's acute sleep deprivation or chronic sleep deprivation. So. To get, you know, to get a little bit more into, um, the, the ideas of like, of, you know, what is sleep to put it simply.
[00:10:36] This is a, a period of time where it seems that from a physical standpoint, we regenerate. Okay. Um, from a mental and psychological standpoint and this arguably I think is some of the most important and, and, and exciting components of sleep as a, as a business owner. Um, it, it, and
[00:11:00] a human being on this moderately stressful planet, uh, it, there's a capacity of kind of psychological filtering.
[00:11:12] That sleep does for us. Um, as far as allowing degrees of emotional resilience or, or not, if you're not getting enough, a emotional capacity to kind of file and store things in an inappropriate place of this is important. Uh, this is not almost a what to remember and what to forget. Um, and. It seems that that there's kind of across the, across the mind body kind of connection.
[00:11:51] There, huge, crucial pieces to functioning as a stable, mental, emotional, psychological human being. And then
[00:12:00] as a physically resilient one as well.
[00:12:05] Dave:
[00:12:05] Yeah, that's so good. And, uh, I love the, the point of, uh, it looks totally different now than it did thousands of years ago. And it, the, uh, you know, speaks to the effects that it has to have. How would you know, how would someone listening? And, uh, I know people are going to come, come to the com, listening to the show with, with different starting points of, of what they know about sleep, but for someone that, uh, you know, whether you know a lot about it or a little, what, how can we tell on ourselves of if we're getting quality sleep?
[00:12:33] Cause some people will say, Oh, I can run fine on. Five hours, four hours or five hours. Like I don't need sleep, sleep for the week. And, uh, or if we're not getting the quality of sleep we need, how can we, what are some ways to, uh, to know, because some people, and I don't know the specific studies, but I know I've read that.
[00:12:50] You know, some people can have high reports of, well, I think I'm performing good, but then on the actual test, they're, they're not. So these things are almost like, like silent symptoms that are
[00:13:00] going on, where people are sleep deprived and they don't even know it. What are some things that, uh, people can look out for?
[00:13:05] Derek:
[00:13:05] Yeah, that's a really, that's a really good point. And it comes up almost daily in the clinic, not only in the realm of sleep, but, um, gut health is another one where we sometimes say like, you don't know what good feels like if you don't know what good feels like, you don't know what trash feels like, because you might just be living in a really.
[00:13:24] You know, dysfunctional reality and, and you have been for a very long time and you just think that's normal and you've adjusted to it. And so if you don't know what good feels like, it's hard to have that contrast. Right. And I think sleep is, uh, is an aspect of that has an aspect of that as well. So the things that I tend to look for, um, are.
[00:13:47] You know, and I ask almost everybody, these in our, in our intakes is one how, like I asked them when they're going to bed when they're getting up. Okay. So those absolute times, because the first thing I'm looking for
[00:14:00] in that is are they giving themselves an opportunity to get seven and a half eight hours of sleep?
[00:14:06] And I chose my words. Specifically there are you giving yourself an opportunity to get that much time? So a lot of times we get the, Oh, you know, I go to bed at 11 and I will wake up at six. Okay. So like your ability, if you slept literally every second of that, you would get the bare minimum seven hours of sleep.
[00:14:29] I assure you because I've done enough sleep studies on people. You're not sleeping that whole time. You might think you are, but you're not. Uh, and you know, some of the sleep trackers can give you relatively rudimentary understanding of that as well. Um, but it's not uncommon for people to be UN uh, not consciously awake, but awake, uh, for any worse from 15 to an hour of that chunk of 50 minutes to an hour
[00:15:00] of that chunk of time that they think they're sleeping.
[00:15:02] Right. So the first thing is like, are you giving yourself an opportunity to succeed? Because if you aren't, that's the first step. Right. Um, and, and then yes, we get the, well, I do, I, I functioned just perfectly fine with this. I go like, Okay. I don't believe you, but I believe you think that, um, and, and getting, getting to your point again, again, I don't, I don't recall the specific study, um, but you were commenting on this adaptation to, um, dysfunction as basically sleep deprivation can compromise performance mentally and physically.
[00:15:47] And we, we, I mean, it can be measured objectively, but subjectively subjectively, from our perspective, we're doing just as well, which is the
[00:16:00] scary spot, right. Because we think we're performing just as well as we were. When not sleep deprived, but we're actually 15, 20, 25% loss of performance mentally and physically.
[00:16:13] Um, and then of course, when someone else is going to bring that to your attention, Hey, you're not quite as blank as you blank. Right. And you're like, or as you used to be. You're like, what are you talking about? Of course. I mean, all defense of it, et cetera, but like the numbers literally wouldn't lie. And so, um, that, that goes back to this line that I, that I love.
[00:16:32] Like, I believe you, I believe you think that. Right. And, uh, and so with that, like absolute, absolute kind of time sleeping frame is important to know. And then I go, well, how many times do you wake up? Right. You waking up at night. Um, how many times are you waking up? And then of course the, the, why do you wake up feeling good?
[00:16:56] You wake up feeling like still tired. Like you want 30
[00:17:00] more minutes. Do you wake up like earlier than you want to be waking up and you're just like wired. Do you have a hard time initially? Yeah. Do you have a hard time initiating sleep? Um, all of these, all of these are questions to, to dive into the. Um, the specifics of it, because so many people don't, they just kind of think of sleep as this time to be unconscious and well, sleep is, sleep is not being unconscious.
[00:17:29] Sleep is actually a very active process. Um, it's just that we're not consciously a part of it. So looking at the hard criteria of just like, do you give yourself an opportunity to succeed, um, in and within though within that framework? Are there signs of dysfunction of difficulty initiating sleep, frequent wakings.
[00:17:51] Are you waking feeling, you know, um, tired. Um, do you snore, does your partner tell you you
[00:18:00] snore? Um, those are, those are keys for me, um, from a deeper medical standpoint. And now it seems like a good a time as any that to dive into that, um, high blood pressure is something that I'm. Frequently diving into sleep if that is, uh, on the table.
[00:18:21] Okay. Um, It will sleep, uh, high blood pressure, especially as it pertains to sleep apnea. And this is probably something we should spend a little bit of time talking about. Um, and sleep apnea is a condition in which you actually stop breathing during the night, or there's a condition called hypoxia, uh, which is in which you start to breathe very shallowly.
[00:18:46] You're still breathing, but it's very shallowly. And what happens is your. Uh, blood oxygen saturation, which, um, people are getting a little bit more familiar with this there, the little pulse oximetry you can put in your finger and they measured the capillary, uh,
[00:19:00] the management of the blood flow to the capillaries.
[00:19:01] They can give you insight into how saturated your, your red blood cells are with oxygen in a condition, sleep apnea, or even sleep hypopnea. Your blood oxygen saturation can drop. And pretty significantly at room temperature, both you and I. I don't have one sitting around me right now are probably above, well, hold on, take a deep breath.
[00:19:30] 97 98, right. Um, And, and, and it really should be around there, uh, in a condition of sleep apnea, hypopnea, uh, blood oxygen saturation can drop into the eighties and severely high seventies. And that, that matters because if you think about what your red blood cells. Do they're designed to carry oxygen and oxygen is literally fuel.
[00:19:57] They're like the spark plug for us being able to
[00:20:00] produce energy. Okay. Um, in these instances, uh, one of the common Adam patients, because your brain then gets a sense that there's not enough oxygen or your blood pressure will increase to move more blood faster. So it's getting a sense that, Hey, we need more oxygen.
[00:20:19] Well, One way to get more oxygen. If we can't absorb it as much, because we're not breathing stuff is to increase the pressure, to move the blood faster and harder, to get more oxygen to those tissues. And so it's not uncommon to see, um, sleep, play a role in high blood pressure. And that's, we kind of talked about it through the apnea lens, but I think their cortisol dysfunction there's, uh, there's a, a reason to look at it as well.
[00:20:46] And. You know, we're already starting to dabble into, um, the challenge of even like talking about a subject like this, because, and this is, this is the blessing. And the curse
[00:21:00] is because it just permeates so many different pieces and to truly like, get it, you actually need like an anatomy physiology kind of lesson to, to, to put it on.
[00:21:11] I think the pedestal that it deserves. Right. And so, um, you know, we'll have to, we'll have to make sure to give a little bit of an intro bio lesson along the way as some of this stuff happens. So, um, but to circle back on the big key things here, we're looking at what's their sleep window. Is there any noticeable, uh, that they perceive as sleep dysfunction, difficulty getting to sleep, waking up, feeling like trash in the morning.
[00:21:37] Okay. Um, and then snoring. You know, or themselves literally waking up gasping for air or their partner telling them they're snoring. These are really obvious signs there. So if your partner, if you're listening to this and your partner snores, um, whether or not they're caring about their sleep, you probably should dage them in the direction
[00:22:00] to say like, Hey hun, something's up.
[00:22:03] Dave:
[00:22:03] Hmm. Is there a, and I'm guessing some of these, these things are definitely gonna operate on a spectrum too, where someone's like, well, I'm not waking up gasping for air and, and maybe their blood pressure's okay. Maybe they likely don't know what their blood pressure is or maybe it's maybe it's okay. But, uh, then what are those other symptoms too?
[00:22:21] Cause I keep getting stuck on if we're getting a 15 to 25% or whatever you said, loss of performance. That's, uh, that's not necessarily visible. And I guess how to, like, how does someone identify this? Do you think everyone should just should get a thorough assessment? Or are there some self ways to kind of be like, could this be, cause these for me to be like, Oh yeah, I would definitely don't have that.
[00:22:45] But then it's like, well maybe I do at a low level to some degree.
[00:22:49] Derek:
[00:22:49] Yeah. So, you know, a couple of the more like intangible ways that I've seen this present, um, clinically.
[00:23:00] Okay. Is feeling stuck from a kind of motivation standpoint. Um, I call them like the blinders. Like I can do the things I need to do that are in front of me. And usually that's like my job and my family. And that's about it, right. But the, the creativity, the capacity to solve and see how to navigate some of the bigger problems is, is really narrowed. So if you're finding yourself overwhelmed, um, with what feels like an infinite amount of things on your plate, and it's overwhelming, you. Sleep would be a way something that I would be discussing because one of the things that I have found almost across the board with, and I see this a lot in my entrepreneur client, a patient base.
[00:23:59] There's
[00:24:00] always fires to put out it always problems to solve, but arguably the most important role of that person is to be the creative lead of that company. And I know I've mentioned this to you personally, is that things feel like they're going the best from a business standpoint when I'm creative. And when I'm solving problems and, and tackling my kind of creative ideas, literally sitting down and accomplishing this podcast is great. You know, that's one of them. Right. But, but to, to have the capacity to wrap your head around that when there's, when you're getting pulled in a hundred different directions, which is running a business, Um, can be hard.
[00:24:51] And one of those rate limiters, one of those blinders of being able to figure that out is definitely sleep. Um, it will support
[00:25:00] your creativity. It will support your problem solving. And this is measured. Like there's been tests, there's been studies on this. That is, is an objective truth. Um, Those matter less than the feeling of like, I can't just, I don't know.
[00:25:15] I'm just, I'm just busy. I can't seem to get to it. Um, and, and sleep plays a big role in that. The next thing would be like truly drive. Uh, and this is, uh, this starts to cross into like drive libido, uh, you know, um, Desire for intimacy. Um, but like all of those things that they're, they're, they're not, we're not talking just about, you know, sex though that matters.
[00:25:48] Um, but also like motivation to, to show up, to be your best to maybe from your perspective, like from your client to get to the gym,
[00:26:00] to not just lift, but keep. Striving towards that, you know, what do you guys call it?
[00:26:07] Dave:
[00:26:07] you got it. Speaking that you're speaking to
[00:26:10] Derek:
[00:26:10] yeah, right. I pay I've been around long enough. I've been around you enough. Um, so if that's on the table, I'm, I'm asking about sleep because not only will it truly play a role in some of the neuro-transmitter component of what drives that, but also things like testosterone. Right. Um, there is there's, there's a statistic out there that like chronic sleep deprivation will compromise testosterone levels of five, 10, 15%, uh, or, or even, you know, what they put it as in a, uh, in a more tangible way that sleep deprivation will give you the testosterone level of someone 10 years, your senior.
[00:26:54] Great. So, you know, and this, um, this I've seen in clinic
[00:27:00] in 20 year olds, right. Um, driving hustling, um, video games feel like way too, like just, just going, um, sleeping, you know, Four or five hours. And you know, of course alcohol use is rampant, which is just trashes your sleep on top of that. We can talk more about that later, but they're showing up and they're just like, I can't, I can't perform, I'm performing poorly.
[00:27:33] Uh, I'm concerned. And you're like, well, yeah, like your test testosterone is legitimately low and you're 27. Okay. What's wrong because that's not the kind of person you're about to slap testosterone cream on, right? If that's the type of person, um, that you have to say, like what is getting in the way here.
[00:27:54] And as we know, testosterones are important hormone in men and women, uh,
[00:28:00] for sex drive or libido for lean body mass, you know, um, putting on muscle, uh, and drive and motivation. So those would be, these are more like intangible things that are like, Hey, like, Still might be up here,
[00:28:17] Dave:
[00:28:17] That's that's really good too. Yeah. Cause I, I know from, from myself and we've talked about with, with running, running the business of there's the there's the in the business type stuff of, yeah. You got to see the appointments, coach, the clients do the things that need to get done, but then there's
[00:28:31] Derek:
[00:28:31] the stuff you were trained to do.
[00:28:32] Dave:
[00:28:32] then there's the, on the business stuff of, how do we actually grow this? How do we lead a team? How do we scale? How do we, you know, how do we more effectively market? How do we market our services? There's all these other things that, that come into it. And I've noticed that the times where I have been sleep deprived, those things are much harder to do because they aren't necessarily, the urgent things are the things that we need to grow the business, but you can get by days, weeks, months, unfortunately as a business owner,
[00:29:00] without.
[00:29:00] Really doing that stuff. And if you're established your, your businesses is still gonna gonna run. But you know, the other thing I noticed too is with a, and maybe this relates to some listeners too, if you're listening to a podcast like this and you're like, Oh, that's, that's really interesting, but I like having trouble processing it or having in someone's going to be over your head.
[00:29:21] Or, you know, if you're, if you're not familiar with this, but at the same time, I've listened to, I think at times when I've been low on sleep and it's like, something can. It, it just doesn't interest me the same way. I can't process it. Normally I'm like trying to take notes during it or go in. And if I just there's times I don't have the motivation to it.
[00:29:35] I'm kind of just like putting it on the background just to do it, to kind of keep myself awake. Like those are, those are other things that I was, I was thinking about as you were, as you were
[00:29:44] Derek:
[00:29:44] Yeah. It's like that processing, you know, because we've all been, we've all been in a plate place where. Things are firing on all cylinders. We'll hopefully, hopefully you've experienced that. Like, especially like mentally
[00:30:00] I, and then we've also all, most of us have been in places where it's like, I can't. I just, I don't have the, we call it like, I call it bandwidth.
[00:30:08] I don't have the bank and with, to deal with that right now. And like, I mean, that even happens during the day. Right. And that, like, that, that, as it pertains to our cortisol levels, our degree of caffeination and brainwaves, and we call a Denison and the brain. And we can talk about that a little bit too, because I think that's a really interesting piece.
[00:30:30] I think we should dive into some of that. Hormones that regulate sleep. Um, the we've all been in those places of like we're firing or we're not. And when that's, when you're not, and you need to be, and when you're not, and you need to be constantly like, it's it, it's, it then becomes an additional stressor on your psychology, right on your psyche, that compounds.
[00:31:00] Sleep and stress and all the other kind of, uh, uh, that dysfunctional that dysfunctional cycle because, um, well, it does.
[00:31:10] Dave:
[00:31:10] and what are, uh, you know, when it, when it comes to the, you know, say, say you're sleep deprived where I wouldn't go through the seasons where. You're you're busy. There's seasons where you have a lot going on and maybe it's a little harder to come from from sleep. I'm sure new parents can relate to that.
[00:31:26] I'm sure. Uh, you know, business owners can definitely relate to seasons of that, but what are the considerations around? What should people keep in mind when they know a season like that's coming up or maybe they're in the middle of it? What considerations come from a training standpoint from a. Uh, exercise standpoint from a creativity standpoint, how do you have any thoughts on how people can structure their schedule?
[00:31:47] Because we're, I really crashed last, uh, last spring, uh, coming into COVID no idea what was going on. We, my wife just came on, Lindsay just came on, full-time into our business. I'm just like, go and go and
[00:32:00] go and being like, okay, I don't know what the future holds. I need to keep our family afloat and to keep our business afloat.
[00:32:05] And I'm trying to work out really hard and my sleeps less. And in hindsight, those things were definitely not good to compound on top of each other. But what can you speak on that in terms of those considerations of when you're in that sleep deprivation of how, where do you need to modify? Cause you can't.
[00:32:21] We like to do it all. And I know a lot of people that like to, you know, okay, we're running on low sleep, but we're still going to do all those things that I was doing before at the same intensity or even higher, because I'm so wired up on cortisol. Can you speak at all of that?
[00:32:33] Derek:
[00:32:33] Yeah. And yes I can. And I can tell you it that's complicated because you start to marry in this mixture of the physiology. You start to marry in this mixture of the human being. And what it, and then the environment that, that human being is in. Right. So there's the macro environment of,
[00:33:00] of, well, like for a great example.
[00:33:04] COVID and what it's done to the world over the last 18 months now, or almost right. Um, there's the internal physiological environment, which, uh, Which responds to that and responds to our perception of stress, but then also inherently will kind of create its own cycles that then if you want to change well, you're also fighting against something that has you kind of built this, you built this rhythm and now you're looking to change it.
[00:33:38] And so you're also fighting your, what you've already put in place. So you programmed at some respect your physiology to do. And then there's the human piece of this that, that, you know, we, we sometimes don't, um, we're sometimes our own worst enemy. Right. Um, and where we may
[00:34:00] need rest, we choose the opposite.
[00:34:05] Um, so gosh, um, So to, to, to, to understand that, right? You want to know what someone's kind of external stressors are like what's on their plate from a stress standpoint. Um, that just helps you get to know this. Uh, you know, this human as a person and to connect with them, um, to empathize, to sympathize, or to maybe give them a little bit, uh, you know, the, the, the tough love of like, come on really, you know, and, you know, when you work with people, you know, you know which avenues, you know, you've learned which avenues you can kind of push on, which one do you can't.
[00:34:48] But, you know, I think one of the things that I think a lot of my patients appreciate about me is just. You know, we're, uh, we're just real. We're gonna, we're just gonna call it. Like we see it. We're not going to blow any smoke up
[00:35:00] your ass. And it's just, I like to challenge ideas. Some people like that, some people need it.
[00:35:06] Um, so getting to understand what's up, what's taking up space on the plate and I think where my specialty lies is also then saying, okay, well, what, what have we created from a, um, a physiological, maybe monster thus far? And so. I'm going to take a small little tangent here the forces at play in sleep.
[00:35:34] All right. Cause I think that this is a good place to interject those and I'll, I'll hit on maybe three things. One being stressful. Right? And this is cortisol or, well, we have a few stress hormones. Cortisol is a major one made by the adrenal glands, which sit on top of your kidneys. Okay. Um, they are, uh, cortisol secreted in a diurnal rhythm.
[00:35:58] Diurnal meaning,
[00:36:00] uh, different amounts at different times during the day. So it's actually supposed to be nice and high in the morning and then taper off in the early afternoon. It'd be nice and low in the evening. If you think about what stress hormone is designed to do, it is designed to help us rise to the occasion.
[00:36:16] Okay. Um, and so we want that in the morning and we don't want that when it's dark out and we're trying to initiate sleep to rejuvenate regenerate, et cetera, and cortisol also. So it has this, this diurnal rhythm, but it also responds to our own stressors. Um, so those can be perceived psychological stressors.
[00:36:41] Those can also be kind of physiological stressors. So, this is where, when someone is stressed out, you know, from all the things they need to do, it's not uncommon that they are actually secreting higher levels of cortisol. It's still happening generally in this diurnal rhythm, though, I
[00:37:00] have seen flat-lined rhythms before I've seen totally flipped rhythms where there.
[00:37:06] Very low in the morning and very elevated. And in the evening that person almost always has sleep problems. And you could measure this. There, there saliva tests, urine tests. We look at it commonly because when anyone has a sleep issue, it's certainly something that's on the table to say like, is this participating because it helps us tailor their treatments better.
[00:37:27] So. Cortisol is, is an important, um, important hormone as it pertains to being able to wind down and initiate sleep. It has attains in literally everything else, uh, from metabolism to stress too. I mean, if you think of what cortisol does, it's, it's almost like the antithesis to testosterone. Testosterone is there to burn fat and build lean body mass cortisol is there to multiply your fat cells.
[00:37:56] Right. And, uh, and actually
[00:38:00] destroy your lean body mass. Okay. So it's catabolic in nature versus testosterone, which is animal like anabolic building, catabolic, breaking down. Um, we need some of this, right? All of living is, is a balance between all this stuff. But when cortisol, secretion becomes out of balance is a big problem there.
[00:38:21] Right? So. Evaluating this, understanding it and then maybe doing it, something about it. Because in fact, there are tools not only in a behavioral toolbox, but also even like a supplemental toolbox that can be useful at helping to understand that. And you know, a little plug for blood sugar regulation, it plays a large role in that, but we cannot talk about that today, cause that that's another seven hour conversation.
[00:38:46] So. You know, w what's your, you know, what, what's your kind of knowledge on, on the cortisol front and like, do you, do you, do you, um, you know, is that a conversation you're having with any of your, um,
[00:39:00] any of your clients that you're working with or what's your kind of knowledge of it?
[00:39:04] Dave:
[00:39:04] Yeah. And I, I think, you know, similar to blood sugar being a separate conversation, I know we we've talked about circling back on a full, full cortisol and stress conversation for sure. Uh, I, I like to, you know, I definitely bring awareness to it with anyone that has any degree of. Of stress, which is most, most everyone, but especially the, you know, the, the busy entrepreneurs that the people that are in that like, Grind phase.
[00:39:28] And you can tell they're very upregulated, we'll have the conversation, but it a little more, I guess, the lifestyle from, from my side of things versus actually diving into maybe the physiology behind it things, the, the basics of, of. Breathing of, of schedule management of making sure that you're structuring your day in a way with boundaries and cutoff times.
[00:39:49] And when you're checking your phone, when you're doing work. So some of those things are the, you know, the basics for that, like getting out in sunshine, taking, uh, taking a walk and being able to do those things are the,
[00:40:00] you know, the, the low hanging fruit, if you will of, Hey, let's try this. See if that helps.
[00:40:04] But once, uh, you know, beyond that, the, the. I guess the more physi physiological stuff behind it, uh, is, is more not,
[00:40:12] Derek:
[00:40:12] you, you mentioned something really interesting though. You can't get a bad email at nine o'clock at night. If you don't look at your email, right? Yeah. Like you, you, you can't ruin your C with a bad email at nine 30, if you're not looking at it. And like, that might be, that might sound like kind of glib, but it's also like, It can wait most, most of the time it can wait. Emergencies, usually show up ringing emails could wait till the next morning.
[00:40:45] We're guests. What your hormone capacity to actually like navigate that because you slept well. And now it's nine, eight 30 and your cortisol is nice and high. You're actually there showing up hormonally like, Oh, that's like not
[00:41:00] as big of a fire at nine in the morning as it is at nine at night. And, and that's something too that, that I don't think is a really appreciated as much as that your capacity to show up is different at different times during the day as it pertains to hormones.
[00:41:19] So it would behoove us to try to keep those as ideal and stable as possible. So we'll, we'll, we'll shelf cortisol as a hormone that will dictate and can dictate. Sleep amongst a whole host of other things, but it plays a role in their cortisol is too high. You're going to be pretty fired up. And in fact it can be very challenging to get to sleep.
[00:41:41] And it's not uncommon that I see elevated levels of cortisol at night, participating why people were waking up. And I know that because we can help it lower it, and then they sleep
[00:41:52] Dave:
[00:41:52] Yeah, I want to get in some of the other hormones here in a minute, but the only other thing to that too, is I know cortisol is supposed to spike in the morning, but have a,
[00:42:00] you have a client specifically, I'm thinking of who getting it a side hustle business off the ground while working his nine to five.
[00:42:05] And he'd say he'd roll out of bed. Grab his phone, check his email at like four 30 in the morning. And, uh, be like, Oh, I had to start sending out all these emails to put a fire out. And I think it's the same thing. Maybe, maybe not to the same degree, but you know, is that a concern in the morning too?
[00:42:20] Because he was, he found himself really stressed out and be like, I have to do this. And it's like, well, is that fire really gonna matter? If you wait another hour, if you give yourself some time to just like wake, do five minutes of movement and breathe and exercise and get into the day that how's, that gonna affect cortisol with the first thing in the morning, part of it and how that affects maybe the rhythm throughout the day.
[00:42:39] Derek:
[00:42:39] yeah, we'll digest this statistic that most heart attacks happen on a Monday morning on the way to work. Do you like, do you need to see, do you need to like, say anything more? It's about this abrupt stressor. Right. And that's like a lot of times what these things end up doing to
[00:43:00] us early in the morning.
[00:43:01] It's you go from zero to 60 instantly or the potential is there when at four? Yeah. Like he's probably not as hormonally there as he needs to be from a cortisol standpoint and then probably testosterone standpoint. But also if he's getting a bit four, if this guy didn't go to bed at eight o'clock. He's sleep deprived, chronically not only in the short term and then chronically overall, meaning that, like that resiliency, that problem solved.
[00:43:34] It's just not there. And this is like, I have, I've had like lots of conversations with like some, uh, you know, business coaches and, and, uh, and other entrepreneurs with like, we gotta hustle. I gotta hustle and say, Yeah. Like I, I get that. I really, really do. Um, and I know how hard
[00:44:00] it is to kind of balance and navigate hustling because I still have to do that.
[00:44:05] Right. Um, and being in it for the long haul, which is sustainability, you know, I just wrote it again, small tangent, one of our newsletters for the clinic. That, um, that I wrote, I write them all personally. It w it was, it was, um, inspired by one of my patients. Who's the CEO. And I, you know, I, I, I, in our visit, I was saying like, have you ever thought about, like, looking at your health and your lifestyle as a reflection of your business?
[00:44:45] I think I might've mentioned this to you too. Um, And how, like who's going to buy that. Like if it's anxiety, riddled, you know, medication list, sleep deprived,
[00:45:00] you know, overweight, not happy. Who's buying that. Like what, what, what kind of valuation can you put on that? If that is what this business. I don't want to say requires, but has done or requires to kind of existed.
[00:45:16] That's not appealing to me, you know, to look at that as an asset or a liability in your business valuation. Right. And so I just thought that was a, I had never heard this before. I don't know where it came from. It just one of those things that, you know, you pop it pops into your head. Um, but it really, it, it, it hit.
[00:45:35] And it hit him. And, um, I just thought I would share that. So I shared in the news. I just think it's an interesting way to look at, uh, look at that. Like who's going to buy your life, you know, that stressed out, strung out CEO, business owner, you know, w is that what it takes to run this business? Cause I don't know.
[00:45:57] Dave:
[00:45:57] And expand that even more into what are your relationships
[00:46:00] look like? What, uh, what are some of those other areas real life too? It's like, if those are a mess, it's like, well, what am I selling my soul for the, for the dream of being a CEO of a successful successful company. And I love what you said about the.
[00:46:12] You know, the, the balance of hustle and grind and, and rest, I think too many people look at it from a, a micro scale of how much work can I get done this week? Same thing we see with people, how much workout can I get in this week? I'm hitting, two-a-days, I'm doing this. I'm trying to get fit, but it's like, okay, well, if your body crashes, if you can hit a hard for three months, you crash for three months.
[00:46:29] It's like, versus the person who's six months consistent, same thing in business. And being able to have those boundaries is one of the biggest changes I made myself as like a, during these, during this. Work day when I'm working, I'm going to work like super focused on focusing on when I can, can continue to get sleep in line.
[00:46:45] Like I show up better versus just like having work stretch out throughout the, throughout the course of the day and probably getting less done on the overall scheme of it.
[00:46:55] Derek:
[00:46:55] Yeah. And you know, I on this topic,
[00:47:00] I, I, I'm not sure if there's a generational piece to that where like our, our kind of generation of pho, we just kind of value some things differently or have seen other kinds of generations do this work to the bone. And, and that's not to sound appealing to me. And, and so, so, because I think that I see, I think I see the kind of mentor of, of, of balance in two groups, uh, or, or the ideal, uh, of like people can see as relevant and that's in.
[00:47:47] Uh, in our kind of age group, which I don't know whether or not you want to put that out into the ether, but it's not crazy old. It's not crazy young. We're in our mid thirties. Yeah, the sweet spot.
[00:48:00] Yeah. Um, and that like my, like 78 and older patients where I think they've just like, they've been, they, they like, they did it and they're like, no, like.
[00:48:11] Yeah, got it. I think they kind of figured it out. They're like, no, like you gotta, you gotta balance. And part of that is because I think they can't physically do what they used to and they've been having to be forced to, to kind of reconcile this, this balance of expanding and saving and conserving energy.
[00:48:30] Right. Um, and they tend to be big advocates of that and that's um, that's, uh, And I mean, maybe something comes with, you know, all of that experience. Hopefully I'll get there to know, um, that, that lens, this different perspective of, Oh, if I knew that then you know, then I would have done some of these years a little bit differently.
[00:48:55] I dunno. I mean, that was just kind of spit balling it there, but I see that
[00:49:00] strongly in those two kind of age categories and, um, yeah, resonates with me right now.
[00:49:07] Dave:
[00:49:07] Yeah. And I talk all the time about, you know, I've moved from, I used to do time management of how do I squeeze more into my day? How do I maximize the minutes of my day? You're very scheduled, focused to now, um, Yeah, for myself, for clients, it's like, let's talk energy management. How do you get the most quality out of those hours?
[00:49:27] Because I found I can work for, you know, if I get four hours of quality work, can Trump eight hours of distracted work and, and, uh, not showing up as much too. So that's, that's been a major shift for me is okay. Let's worry less about, you know, optimizing every second, every minute, trying to squeeze everything into how's your energy, how are you showing up?
[00:49:46] How. How much can you get out of those hours? And this applies to work. This applies to relationships with your spouse, your kids. You're like, how are you showing up in those times, if it's not enough to spend four hours with your kids, if you're a zombie, but you know, a
[00:50:00] short shot of, of really quality time, I'm sure they're going to remember and value more.
[00:50:06] Derek:
[00:50:06] the, um, the battle for attention is, is the war we are fighting right now. It's attention. It's what Google is paying and Instagram and Facebook are paying millions of dollars to take from us. Right. Is it an Amazon? They're, they're they're bad link for our attention, not energy, not money, attention. And unfortunately, like in some respects they're winning. Um, and, and it comes at a cost of the only thing we cannot get back. That's time. Right. You can make more money. You can chop more wood, you can grow more plants, you can work more hours or whatever. Right. But you can't get
[00:51:00] time back. And that's a very important thing to keep in mind. And then you go like, well, why should I be sleeping eight hours of it?
[00:51:15] Right. And the, the answer to that is because. The time in which you are not, has a greater capacity to be spent efficiently. And, uh, and that allows you to be more discerning with what and who you're giving your time and attention to versus pissing it away.
[00:51:44] Dave:
[00:51:44] Yeah. And I, I love to, you know, that, that strikes a chord with me of moving to like results. Like what are the results you're getting in your life, in your business? It's, uh, you know, not at the expense of your health, but like when you look at all the, all the pillars,
[00:52:00] if you will, of, of health and finances and business and relationships, like.
[00:52:04] What is that? What is the fruit you're getting from that? What are the results you're getting from that? Because people were too many people were well, I'm working. 60 hours a week. And I'm, you know, I'm putting all this, like, it's so much about like how much time you're putting in, but it's like, well, what if you could put in 40 and get the same result?
[00:52:21] Like what if you could put in 20 and, and what's going out with your relationships, like, what's the what's going on with your health and not, uh, I worked out. 20 hours this week, but like, how was your actual health, how are the markers of your health? How is your, how do you feel like all those things are much more important than wearing the badge of honor of like, well, look at how much I'm doing.
[00:52:40] This is where I'm going to get my worth from showing everyone how much I'm doing verse is it, is it showing? And that's a tough, honest reflection too. I think
[00:52:47] Derek:
[00:52:47] 100% like that. The, I think the, this little part of the conversation doesn't come from the soap box, it comes from the trenches. It comes from the
[00:53:00] trenches. Right. Um, in, in, you know, sitting here as a man trying to say, what does it mean to be. And what do I want out of all of this? What is the end game? Um, and there's no right or wrong answer to that. It's just like, what is it for you? What fills your cup? Um, and sometimes you got to figure that out. And so like, that's what this whole, that's what this whole journey is kind of about, you know? And, and, and so, For anyone listening to this, ask yourself like, is your physical therapist, is your doctor like things like having this mentality when they're working with you? I mean, wouldn't that be great? Uh, we, we do, we do. And I think that that's what, uh, that's, uh,
[00:54:00] that's an intangible piece of, of, um, really what, what our services kind of offer that you can't, it's hard to put that on a. You can't put that on a fee schedule. You know, it's hard to even put that, that on a, in, in words, on an, on the internet, cause they don't read the same way as they feel.
[00:54:23] And um, but luckily if people get to meet you, right, it's very obvious that there's more to, um, the type of care than, than, you know, like here's some, here's a hot pack.
[00:54:39] Dave:
[00:54:39] Yeah. And I figured we get into, like, whenever we talk sleep, there's, there's just, as you can see so many, so many layers that come come off of it of, and it's, uh, you know, that's what I love, what you guys do and why I'm coming to see you to get help is because like, I can't piece all those things together in my head.
[00:54:58] On my own. I can.
[00:55:00] I, I tried for awhile. I'd. I, I wouldn't say I failed, but I learned, I learned a lot of what I know what I didn't know, but you're, you're going to eventually run into a wall if you don't have someone, like, I love how you mentioned like your, your team with your, with your patients. It's a, you know, it's very much a collaborative.
[00:55:17] Process of, Hey, we're gonna, we're gonna work through this. It's not, you're gonna come see me once. And it's going to all be, uh, you know, I'll be, I'll be cured because there is so many layers that have to peel back. It's like, let's start with, let's start with this. This is what I think is a big part of it.
[00:55:31] And
[00:55:33] Derek:
[00:55:33] Yeah. Yeah. It's like the how to eat an elephant. Right? You take, you take one bite at a time. Uh, what I can help is to point to the tastiest part of the elephant to take a jump on a first, right. Or the most relevant one. And, you know, I just, I just did that with, I mean, that was my day yesterday. It seemed like my afternoon was just staffed with there's a lot in front of you right now. Like here's where I'm going to exact my value. And that is
[00:56:00] to help you understand how to work through these things, because like, this was an educated person. Like, I, I know these things are going on. I think these things are going, what do I do with all of them? Right. Um, I mean, and that's what I, that's what I do when I come and see you.
[00:56:16] It's like, I don't know, man. It just like. Yeah, it just hurts. And I don't, I don't want it to hurt anymore, but like, and like, I know plenty about the physical body, but what it, what, what you do for me is to say, Hey man, like I know, you know, stuff, I got it. Like, like, let me help you. And like, it's just like, thank you and I, and whether or not I walk out of there.
[00:56:43] You know, in zero out of 10 pain coming in at eight, or whether I walk in there at a seven inspired, both of those are successes for you because that inspiration ha ha ha. You've given me things to also do with that. Right. And
[00:57:00] it's, it's frustrating to me how. Right. You are every single time I leave and I go, like, I should just do the things that they told me to do.
[00:57:11] I do, and then they get better. And I go, like, why have I been like, irritated for the last like two weeks? Because I always
[00:57:19] Dave:
[00:57:19] Yeah, there's a side story. I'll a very good tangent. Were there anything you wanted to hit on from the other hormones that affects the cause? I know, I think we only got to cortisol.
[00:57:28] Derek:
[00:57:28] Yeah, we did. We got the cortisol and then we took this hot air balloon into, into, uh, uh, a good place. But so the other two are melatonin. Okay. Melatonin, most people are aware of this one, mostly because you can get it in a bottle. Um, but it is a hormone that is secreted by the pineal gland in our brain. Okay. And to think of what it does, a lot of people just think, Oh, it makes you go to sleep well. Yes, but that's not really what it does. It
[00:58:00] is a signal to your body to, uh, get into a space, to wind down, to sleep. So if you think of when it actually is secreted heavily, it is when it's dark out, it's almost a hormone to, to trigger, uh, or to, to tell your body that it is dark out.
[00:58:19] And in fact it is, um, It is influenced by light and dark in our environment. All right. And so when we get a nice, robust secretion of melatonin, when you know, our, our environment is darker, our brain is now marinating in this kind of message of ah, time to wind down. Time to initiate sleep. It's so happened that melatonin is also a really powerful antioxidant.
[00:58:47] Um, has some anti-inflammatory capacities has some anti viral capacities has some anti cancer property. Like it, it's an incredibly valuable hormone for us, you know, a host of different
[00:59:00] mechanisms. And that's not to say. One should just guzzle 40 milligrams of it down at night because that actually can get you into another problem.
[00:59:08] So I'm not recommending that. What we are saying is the value that it kind of carries in our body. And from a behavioral standpoint, if you extrapolate this idea that, um, this is a hormone that is responsive to, to light and to dark, well, what are a lot of us doing? As we are falling asleep or right before we're going to bed.
[00:59:35] We're on. Yeah, we're right. We're on, we're on the phone or on the computer. We're in front of the TV. We're lights on blasting. I mean, we, this, this is the piece where, um, from an evolutionary standpoint, like, Human beings. Now we're in a very different reality than they were thousands of years ago, where we have artificial
[01:00:00] light.
[01:00:00] Anytime we want. Not only do we have artificial light whenever we want now are. Cities are literally littered with light pollution, 24 hours a day. And now we carry it like four inches or six inches in front of our face, um, with a very aggressive blue wavelength of light, which seems to be what seems to impact, uh, or has the potential to impact, um, our.
[01:00:26] Overall production of melatonin. And of course all the stuff that tends to come up on these things is also very stimulating, right? So there's that aspect of it as well. Um, so melatonin is an important one to take into consideration because it can be influenced behaviorally and it can be influenced supplementally.
[01:00:48] Um, melatonin. Secretion is also one that can be very thrown off with time change. So this is a hormone that, um,
[01:01:00] is dysfunctional and like in jet lag. And then in fact, you can actually kind of influence to try to minimize jet lag if supplemented with appropriately, but it's like probably a topic for an individual case, more than a, um, broad recommendation.
[01:01:15] Um, but it's got as time in place. Um, so that's a valuable one and a valuable one that goes that, that has some. Baseline foundational, you know, we'll call it a sleep hygiene pieces to it. Um, and, and so that's kind of like, uh, like entry level, like, Hey, like don't do this, you know, or try to cut these things back.
[01:01:40] And our, you know, my kind of rule of thumb is to try to get away from devices an hour before you're trying to go to bed. That means you got to bust out the board game, the paper book, some stretching, some deep breathing, you know, a pen and paper, write your ideas down.
[01:02:00] Um, some different have even like an audio book to help, you know, listen to, or wind down, um, are all reasonable strategies.
[01:02:07] Um, but getting away from trying to, you know, scrolling that Instagram feed before you go to bed, don't do any, any. Uh, we're not doing any favors and I'm undoing any favors from a hormonal standpoint as well.
[01:02:18] Dave:
[01:02:18] Right. Well, it's a double whammy, like you said to of it's the, you know, we don't, our phones have the blue light, which we know has an effect. I don't know how much of an effect, but definitely an effect, but then there's also how much stress we carry on our phones because of texts and email and with all the things being on there and how, I don't know how many times we unlock our phones a day, I've seen the stats on it.
[01:02:40] It's just. Ridiculous. How many times we touch our phone is like in the thousands for some people. But like whenever we're open it, there's always a, there's always an intention. There's something we're seeking. We're getting, you know, the, our social media feeds are designed to keep us on the app longer.
[01:02:55] There's like, or we see that, that person, that for whatever reason, we don't know,
[01:03:00] but we're still following that or accessed a little bit. And it's like, all these things I hear from people it's like, well, just, you know, Solve that by, by creating some boundaries, like set some firm boundaries in place, you can do that during the day when you need to, but not, not right before bed.
[01:03:15] Derek:
[01:03:15] Yeah. Yeah. Um, so to, to we'll put melatonin to bed and the last one is a Denison and this is one that a lot of people don't. No anything about, and it's not uncommon that people are like, I've never heard of that before. Uh, and a dentist is really neat because it's one of these, um, bread, basically brain chemicals that builds up in your brain.
[01:03:40] And it is a major driver of like sleep pressure or tiredness, sleepiness. So in the morning, uh, It's low and it builds up throughout the day, the higher the dentist and level on our brain. Right. The more tired we become
[01:04:00] and then sleep, flushes it all down the toilet. And we start again at a baseline and low baseline and build it up.
[01:04:09] And so. One, if you're not getting good sleep enough sleep, you get an incomplete flush. I mean, I'll save some graphic toilet references, but like you don't, so you you're actually starting your next day at a higher degree of sleepiness than you maybe would like to because you had got it, incomplete flushing and recycling and elimination of that adenosine in your brain.
[01:04:36] And so you wake up the next morning after a bad sleep and we've all been there and you're like, okay. I am exponentially more tired today because you have exponentially more Denison still in your brain, you can flush it. And so that's a, that's a piece of how, um, poor sleep can then of course compound, right?
[01:04:59] Because
[01:05:00] then when you wake up tired, what do we try to do? We try to turn to the things that make us less tired. Right. Stimulants and caffeine being a major one. So this is a cool thing about caffeine. This is a component as to why it makes you feel alert. Is it blocks the Denison in your brain from sitting on its receptor.
[01:05:26] So the way neurochemicals work as they are released, and then there's a kind of sign apps. There's a ups, a space. And then there's the receptor on the kind of end molecule or on the end and neuron. And then it says, I'm going to sit here and then it activates what it's doing. So caffeine will block that.
[01:05:45] So the identity doesn't get to sleep receptor and tell you you're sleeping. So it blocks all these receptors. Then all of a sudden, our kind of perception of RJ. So level is much lower because it's not able to sit on this receptor. We get this.
[01:06:00] Oh, I feel great. Like, I, I I'm alert. I'm ready to rock. It's great.
[01:06:05] And you know what? Caffeine is not bad. It is, it exists. It's bad for some people. Uh, and of course our caffeine metabolism or caffeine metabolism, uh, is, is regulated by some genetics, which in fact, you can look at, uh, so you can understand, am I a rapid or a slow Cappy and metabolism metabolizer though, most people can have a couple cups of coffee and tell me the same thing.
[01:06:31] Uh, I personally happened to be a fast metabolizer Robert and thank you. Um, because I'm a fan. Um, but what happens is that caffeine will block those receptors. You'll get that alertness. You'll get that wakefulness. And then, well, guess what, you've metabolized that caffeine. And then all of a sudden, all that Denis and that was already there, cause it hasn't been stopped being made.
[01:06:55] It's all there. And then boom floods, all these
[01:07:00] receptors and then you're. Just, and you're like, Oh my gosh, like I'm crashing. I need some coffee. You know, that's the, that's the like, you know, 11 o'clock cup. That's the one o'clock cup though. Two, three o'clock cop, if people like, and that's how that's, how and why blood sugar aside.
[01:07:20] Cause we'll talk about that later, but like that's a major component that drives that caffeine desire. Well, the challenge there is that. Caffeine, like has a, has a half-life of like I'm in the ballpark of, I think it's like seven or eight hours. And what half-life means for any anybody listening, who doesn't know what that means.
[01:07:38] It means that amount of time to eliminate half of the amount of that substance is it's half-life. So if you have a hundred milligrams of caffeine, eight hours later, you have 50 milligrams coursing through your veins. So, and then eventually, like that will be kind of eliminated over time. So you can imagine if you're having another
[01:08:00] a hundred mil of 50 milligrams, a hundred milligrams of caffeine at two, you have 50 milligrams still at 10 o'clock at night.
[01:08:07] And that can be a real disruptor for being able to wind down because there's still enough blocking of that sleepiness, that tiredness. And so you cannot feel that. And, uh, and it will keep you awake longer into the night and. It disrupts that kind of normal sleep pattern, right? So this is where caffeine has is, is a it's a double-edged sword.
[01:08:34] Um, the seem to have some like brainwave stimulating properties as well, but, uh, there's some benefits to it. There's an enormous amount of research on caffeine and its impact on our physiology. That is in fact actually positive, um, reducing overall more mortality and disease rates. So it's not. It's not an awful molecule, but in some people, uh, especially when
[01:09:00] stress and sleep are, uh, maybe a liver detoxification, you know, are, are, are challenging pieces.
[01:09:07] You have to be discerning of when it might be actually detrimental.
[01:09:14] Dave:
[01:09:14] yeah. Summarize from a practical standpoint for those that are like, so caffeine kind of good, but kind of bad. It's all going to be in context of, would you say one, how you metabolize it and two would be. Looking at all those other factors of probably if you have a lot of stress, if you have a lot of those things, would you say probably keep it early in the day, if you're going to have it
[01:09:35] Derek:
[01:09:35] Yeah, that's usually how I'll, I'll recommend it as a, try to keep your caffeine consumption before noon, if at all possible. Here's the thing that I challenged for. Almost anyone in, in cocky stop, stop for four weeks. So you feel, I can't login. That's probably a
[01:10:00] problem. I don't want to, that's another story, right? I can't, you know, is a, is a, is a, is a bigger issue, right? Um, So I was like, I always like to do that because I've found a lot of people who like, they're there, they're here, they're there, they're smart.
[01:10:20] They're smart folks. And they're like, yeah, I know what it does for me. I know that if I, I got, I keep it regulated and it's great. And I think that it, you know, it helps me stay alert and pay attention and get work done, et cetera. But then I still challenged them to say like, stop and they find, they actually feel.
[01:10:36] Better and more sustainably, better away from it. They might miss it. They may like want it. Um, but. It's they, they actually feel better and more resilient, not drinking it then, and are actually more kind of productive in the grander scheme of things, but they just don't have that like, hi, hi there, you
[01:11:00] know, operating at 75% for a longer time than at like 135 for that 45 minutes after, you know, they've just jolted their self with caffeine.
[01:11:09] I also fall into that category, um, where, where. I mean, I've done. I, I experiment with removal of things all the time. And caffeine is definitely one where I have a, I have a complicated relationship with it. And every, every once in a while, um, we need a break from each other and that break is a little tumultuous at the beginning.
[01:11:31] I miss, I miss it. I miss, uh, you know, it's company. Uh, but eventually, you know, life goes on and, and in fact there's a, it's quite beautiful on the other side of it as well. It's just tasty too. So, uh, you know, I'm a human being. You're not sitting on that soapbox. I'm just a, another, another, uh, another person in the trenches of the caffeine battle.
[01:11:52] Um, so that's one thing I always encourage people. It's like, we'll stop and just see what life is like.
[01:11:57] Dave:
[01:11:57] yeah.
[01:11:58] Derek:
[01:11:58] alcohol is the same one too. It's
[01:12:00] like, just stop. Like I can't. Okay.
[01:12:07] Dave:
[01:12:07] That says something. Yeah, because there's something else there too. And if it, if veteran needs testimony on the, and I love coffee, I'm a, I roast my own coffee. I love like I love good quality coffee. And I had taken out to, uh, you know, taken out for four weeks, six weeks, whatever it was. And I had the harsh realization.
[01:12:27] You've got to face yourself in the mirror then too, where it's like, I'm more productive. My energy is better. My mood is better. Um, more sustained energy. My is better. It's like, man, this is tough to face. And I'm like, well, you know, maybe it was, maybe it was, yeah. So you try and it back in and then all those things take a negative D like I get the,
[01:12:46] Derek:
[01:12:46] and slippery slope too.
[01:12:48] Dave:
[01:12:48] Yeah. I get a little more alertness, but then it's like, everything else. I'm like, okay. That's, that's clear to me in an extreme case. And you know, I, I drink decaf 90. 5% of the time now, because I do enjoy the taste
[01:13:00] of it, but it's, uh, it's, it's definitely helped helped me, but as someone who I never thought I would stop drinking coffee because I wasn't drinking a lot of it either.
[01:13:07] It was one cup in the morning, but that was still enough to, to affect me. So I think, you know, trying, it is definitely, uh, a real, a great starting point of, and if you can't mentally do that, that's a, that's some of the other things you're talking about. If you, if you feel like you can't do it. Um,
[01:13:21] Derek:
[01:13:21] Yeah. Yeah. We'll put that out to the people who are listening, have them ping you and be like, Hey, I want to stop coffee, but I don't want to do it alone. Uh, you know, you might be a good ally, you know? Um, love that ball back over to me. I'll tell you if I'm in a place to do it too.
[01:13:38] Dave:
[01:13:38] it's gotta be, it's gotta be the right time. I wanna, I wanna expand on, uh, and just because something you brought up was I actually had a note down for this that I want to talk about and you kind of touched on it, but the, you know, as it relates to these hormones, so we have. The Denison, the melatonin and the cortisol.
[01:13:52] I want to talk about the, you know, the, the acute versus chronic that the compounding effects, because you kind of mentioned on that. And that was a note I wanted to
[01:14:00] circle back to because there's, I'm guessing there's a difference between. You know, a week of sleep deprivation versus the, like, what happens when this starts to compound?
[01:14:09] What effect does this have on hormones? Long-term what effect does this have on your, on your sleep long term? Is it, uh, you know, is it a, I'm giving you a couple of routes to go with this? Is it more important to get an average over the court? Like if you. Sleep six hours during the week. And then you just like crash course on the weekends.
[01:14:28] Is that enough? Is that, is that mess you up? Um, I know I'm throwing a lot at you, but giving you some, some options of where to, where to take this one.
[01:14:35] Derek:
[01:14:35] Yeah. So the, your, your bot, what I have found and what it seems to pan out in the literature is that your body always kind of tries to make up. Or some lost sleep. And in fact it will do that. Not only in the macro of hours slept, um, but even type of sleep you are getting. And we didn't even talk about things
[01:15:00] like sleep cycles and, and maybe we, and maybe we don't necessarily need to go into that, um, in depth, but there's. Um, the way sleep tends to be kind of pattern from a sleep cycle standpoint. And when we're talking about sleep cycles, it, they relate to certain brainwave patterns in our brain. So they are measured via, um, electroencephalogram or EEG during a sleep study. Um, You can see different brainwave patterns and brainwaves are basically electrical, conductivity of energy, electricity in your brain at different hurts.
[01:15:42] Right? So, um, And, uh, I'll, I'll save diving into all of that stuff, but, um, this is kind of how we determined stages of sleep is it's based on electrical conductivity in the brain. There does seem to be some
[01:16:00] physiological downstream effects that you can pick up on. And that's where some of the sleep trackers.
[01:16:06] Are designed to do that, uh, and give you an estimate of your deep sleep and your REM sleep and your light sleep around being rapid eye movement. Um, so on the deprivation front, um, your, your body tends to be quite intelligent at trying to pick up. What it needs the most. And in fact, if, uh, when, when you look at an overall night of sleep, uh, let's call it a good night of sleep.
[01:16:37] Um, you spend more time in the beginning hours in deeper sleep. You spend more time in the later part of your sleep, uh, uh, eight hours of sleep, we'll call it in rapid eye movement or REM sleep. If you, you kind of stay up too late and you truncate that deep sleep later down the road, when you have an opportunity to make
[01:17:00] up you'll you can actually find that.
[01:17:02] You spend far more time in deep sleep than you did in REM sleep, even though the sleep was kind of normal because your body's trying to make up for a piece that it lost earlier. And on the flip side of that same thing, if you end up like, Oh, I got to wake up early and hit the road or whatever it may be, you were up at three 30, four o'clock and you normally sleep until it.
[01:17:20] Seven 30 or eight. So you've truncated your mornings really cut that rev sleep by a lot. You'll find, you'll make that up later where you could like monitor your she'd be like, I barely got any deep sleep this night, but my room was huge and it was cause it's making up for it. I think the body keeps score.
[01:17:37] There's a beautiful book about trauma. Uh, and PTSD is as a body keeps score. It's about Bessel, Vander, cock, and it's just a great title, but like, this is a great example of it does, right. I mean, it's tracking all this stuff, like you're not smarter than it. Um, so on, on the acute, in the chronic. So it kind of
[01:18:00] depends on severity, right?
[01:18:01] Severe. And by like that mean like no sleeping, like not sleeping, you will significantly be compensate within days. But, and in fact, it's, it's, it's very, uh, like when people have truly have not slept for, I mean, I, I can't remember the exact kind of timeframe, but like we're talking like medical emergency type situation within days because you decompensate so dramatically from that, most of us are not in those scenarios.
[01:18:37] Most people that we see are in the, I sleep five and a half hours, six hours a night for 20 years. That's chronic sleep deprivation. That's where you get the insight. That's where like at 40 and like 45. They're just like, I can't get it up. I'm
[01:19:00] tired. Like I'm fat. Uh, my cholesterol stria high blood pressure.
[01:19:04] I'm this, I'm that? And I'm like, how did I get here? I don't eat that bad. You know, I get to the gym a couple of times or whatever, but like the, the problem is, is because they've built up a chronic, chronic sleep deprivation. And the fact is, is that it's just insidiously built up. Over the years. And when you just move the needle a little bit every week, a little bit, every month, a little bit a year, they're harder changes to note.
[01:19:35] And then all of a sudden, like a kid's these thresholds where it's like, something is wrong, something is wrong. Um, and of course you can't just in an instant. Make up that 20 years of sleep loss, but you can change it, right. You can, you can say I'm going to make a concerted effort to be different, to be better on that front.
[01:19:58] So I'm not sure if that answers your
[01:20:00] question.
[01:20:00] Dave:
[01:20:00] I think so. Essentially. It's. In the acute stay in the acute sleep deprivation. It's a little easy to, I guess, for lack of a better term catch up on sleep and the chronic cases there's changes you can make to improve your sleep, but it's going to be hard to maybe catch up on the years of, of poor sleep and hormonal
[01:20:20] Derek:
[01:20:20] because it's created, it's created usually a metabolic and a hormonal monster at that point. Right. And I say that like all that I call, like, because they do a lot of blood sugars to call it a metabolic monster. And it's because the previous, the way in which you were living. Has created a cycle and a sensitivity and an, a functionality in your body that's broken, but it's, but you made it and now you have to remake it.
[01:20:50] Right. And that doesn't just happen. Like, Oh, well I started eating well, or I started exercising. . Well, okay. That's a
[01:21:00] start. You have to do that. You got to start somewhere, but there's a monster now or trying to battle. And what I have found on a sleep standpoint is that this needs to be broken in a lot of different way, like in a lot of different parts of the chain, right?
[01:21:17] So this is where sleep hygiene. Uh, dark room, cool room, um, you know, uh, devices off, um, you know, don't drink too much water before you go to bed. So you don't wake up to pee, right? Like th th that kind of baseline stuff is like, non-negotiable okay. Then there's the next layer of, okay. Well, how do we. Maybe supplement to break it.
[01:21:50] Some of these levels and help reduce cortisol, help stimulate melatonin, uh, you know, help turn down nervous system activation,
[01:22:00] uh, increased Gabba, increased calm in the brain, especially if sleep initiation is a problem. How do we, and this is where performance. And then what you do comes into play. How do we live our day to be successful for our night, which is being active.
[01:22:18] How do we limit substances that are going to interfere with that, that you actually have to break it on so many levels because it's ingrained over decades and a little thing here or all little thing. There is usually not sufficient where, where, you know, we try to provide value is a framework for all of that.
[01:22:39] Um, understanding that that's a lot to bite off and how to work into that because you also just can't go from going to bed at midnight to go into bed at night. You'll just be like, this is a waste of my time. I'm not tired. So like, how do you structure something to support that person? Right. Um, and then how do you, you know, make, get them active during the
[01:23:00] day, get them literally physically tired.
[01:23:03] So they, they have no choice, but to go to sleep. Right. And so, you know, minimizing alcohol, you know, and of course, you know, alcohol, we could talk all day about this, but most of the time, this is a self-medication. It's not just like, Oh, I just want alcohol. It's like, I need a drink. Why don't you drink? I just need one because like, it makes this thing turn down. Okay. Well, that's a big conversational, what's why so turned up. Can we do something about that differently? Can we make it harder to turn that up? Can we turn it down a different way? Um, how do we, you know, understand our stress management and the ending of that will be the next talk. Right. But, um, so that we don't become so reliant on a substance, um, whether that's alcohol self-medicating with that, or whether it's pharmaceutical medications to wind down.
[01:23:58] Xanax and
[01:24:00] Ambiens and benzos, like they all they're out there right now. Trazadone um, and if we need something, is there like a harm reduction, you know, piece of, uh, best practice, if we do need something, um, something with maybe more side benefits than side effects. So, um, those are some things to, you know, take into consideration there.
[01:24:24] Yeah.
[01:24:24] Dave:
[01:24:24] Yeah, no, that's good. And I'll tell you what I want to do here, Derek with, uh, you know, and as people can start to see of why our conversations go on, go on so long. I still have a list of a bunch of bunch of questions I have coming up that I think other people might be interested in. And, uh, I want to get your permission on this, but if we do kind of like a, a quick hitter, practical thing of maybe an like, I, I fire off some questions and answers within maybe aim for like 90 seconds or so at the, at the most.
[01:24:51] And.
[01:24:52] Derek:
[01:24:52] For 30
[01:24:52] Dave:
[01:24:52] Aim for 30 and we'll hit 90. And the, I guess, claim I would put out for you for this. I'm sure. Like, as you guys can
[01:25:00] see, there's so much that goes into this, that these are going to be kind of like blanket general recommendations, everything. There's so many systems at play here. There's so many different factors at play that, uh, none of these are going to be straightforward answers, but they're just common questions that I know.
[01:25:16] No, uh, no will
[01:25:17] Derek:
[01:25:17] And you know, like the whole dot medical advice seek the advice of your, you know, of your, of your position before, you know, doing anything on these fronts. But I am happy to, I'm happy to, um, shoot a couple answers at you. So what you got.
[01:25:30] Dave:
[01:25:30] Uh, what do, what effect do you naps have on sleep? Is that, uh, uh, is that something that you have
[01:25:36] Derek:
[01:25:36] 90 seconds, Dave, 90 seconds.
[01:25:39] Dave:
[01:25:39] go for it?
[01:25:40] Derek:
[01:25:40] Um, I'm not against naps. Uh, if they are truly needed, I try to keep them short under. 30 minutes, ideally, and not too late in the afternoon or evening, or they're going to disrupt night's sleep. Um, they seem to have some benefit in the literature as a
[01:26:00] component of the totality of sleep in a day, but they can be detrimental for some people's, uh, overall sleep.
[01:26:07] If they're done, um, out. Kind of we'll say incorrectly or at a dysfunctional time. However, I'll put this caveat as functional medicine. If you're finding yourself tired enough in the middle of the day that you need a nap, um, that's something that I would be working up differently. Um, iron deficiency, anemia, chronic infections, folks who have Epstein-Barr virus, thyroid dysfunction.
[01:26:33] Um, I don't just go like this. That's fine. Um, uh, that raises a couple of flags for me.
[01:26:38] Dave:
[01:26:38] Gotcha. What about a circadian rhythm of our people? You know, the night owls versus the early birds, should people fight that? Should they play into that of, uh, you know, of the different rhythms we have.
[01:26:50] Derek:
[01:26:50] Yeah. Um, I try and I try not to force a round peg into a square hole, um, within reason, right?
[01:27:00] The night owls. Seem to think that they can kind of get the best of both worlds in the way of, Oh, I can stay up till two, but still wake up at eight or seven. He was like, no, you can't. So it has to come somewhere.
[01:27:15] Right. And, you know, I find more commonly the early people who get up you're one of them, um, tend to go to bed early, but it's like the night folks. Try to get their cake and eat it too. And there tend to be the ones that, uh, I mean, I am one of them. I'm not a morning person. I'm I don't like to be awake earlier than seven 30 in the morning.
[01:27:38] I just don't care for it. I never have. Uh, and I don't know if I ever will. I'm sure circumstances in my life will force out upon me at times and we'll have to compensate because of that. But, um, But my life has become much more harmonious, not trying to be something I am not from a just chronological, you know, uh,
[01:28:00] standpoint.
[01:28:00] So I try to understand that, especially the way to ebbs and flows in people's lives. Um, but it still doesn't make them super human. Okay.
[01:28:10] Dave:
[01:28:10] What about, uh, so wearables, uh, uh, what, what your thoughts are on them and which ones you tend to recommend if you do recommend them?
[01:28:18] Derek:
[01:28:18] My favorite is the ordering. Um, and I think it's my favorite because I don't like, I don't like wearing things. I don't wear a watch. Um, I've I, I, this is, uh, this has been a struggle, but the dad, I love so it's so it's worth it. So, uh, the, I think the word sticky, it's a very sticky tool for me. Um, it's easy.
[01:28:40] I, I barely notice it. Uh, it's. Pretty resilient. I mean, I've done all sorts of yard work in it and, and, and activities in it. Um, I love the data that it can provide in the field. I've looked at a lot of these different, um, a lot of these different devices. It, it
[01:29:00] is, it is in the top of, um, of kind of quality of data that you can get from it.
[01:29:06] And, um, and for me, it's. It is the important component of that is, is that I wear it and I use it because if you don't use it, it's not going to work. Um, whoops, good. Um, iPhone watch people like, uh, I can get a lot of value out of some of the sleep stuff there. Um, so from a wearable standpoint, though, those tend to be the three that I see the most commonly Fitbit too.
[01:29:33] Um, and. They all give you similar metrics? Uh, I think aura, as you know, got a couple of pieces that, that some of the other ones don't particularly like body temperature and they've had a unique, interesting piece of, of having a broad study with trying to actually predict COVID infections with raise in body temperature.
[01:29:53] So I think it's, that's an interesting metric on it as well. Um, you know, that that's
[01:30:00] a, or it is, um, Probably my favorite over the, over the, uh, past few years, once they got there, um, uh, when they're kind of new version of their ring came out, it's been something I've recommended, but we do, you know, we do have an affiliate component to that where we've been able to give our patients a pretty good discount on orderings because of it.
[01:30:21] I just find it valuable information. Um, but for me, it's the stickiness that I can wear it doesn't intrude in my life. Um, and I'm not a watch where cause uh, I don't want to sleep with that.
[01:30:32] Dave:
[01:30:32] Yeah, that's good. Speaking of body temperature. What about, uh, uh, cold plunge, heat therapy, things like that to aid in sleep.
[01:30:39]Derek:
[01:30:39] Sure. So what we know about an aspect of sleep initiation is there is a drop in body temperature and that drop a body temperature is another one of these signals to the brain, to the body, to that, that we are about to initiate sleep or that's time to initiate sleep. Um, you know, just like a Denison is a buildup of
[01:31:00] sleepiness and drop in body.
[01:31:01] Temperature is one that, um, that triggers that message to our body. So I think. Kind of a lot of forms of hydrotherapy can be useful here. The caveat to that is they can also be, um, potentially harmful, have over done or done a little bit, uh, incorrectly. So, you know, talk, well, we'll talk about one that like is accessible to everybody, which is usually a hot, a hot bath or a shower.
[01:31:29] Right. Um, And so that actually can be very useful to initiate and to get people to calm their brains, to calm down their body's ready for sleep, because you can actually get the body hot in a nice warm shower, a nice warm bathtub. And then what happens when you get out is your body kind of triggers it, it triggers the coolest self-doubt.
[01:31:50] And so that relative drop in body temperature is actually that signal for sleepiness. Um, there, the crux there is you don't want to
[01:32:00] necessarily go into bed underneath the blankets, you know, bundled up. Rip roar and hot cause you'll actually, you can, you get us get warmer and that can actually make it challenging to, to actually fall asleep, but having a hot bath before you go to bed, you know, drying off completely, you know, giving yourself, you know, 20, 30 minutes and then going into bed.
[01:32:22] Um, that relative drop is actually nice from a kind of sleepiness standpoint. Um, saunas will work in the similar way, uh, in the way in which. Uh, B having a kind of elevated internal body temperature. You're going to want to probably give yourself a little bit more time to cool off, uh, after a sauna, particularly an infrared sauna as well, just to, uh, begin to dissipate that heat before you go into your bed underneath the blankets.
[01:32:50] Um, Cause being too hot. I think we've all know this is a real big problem in, uh, in getting to sleep and then staying asleep. Okay. So the,
[01:33:00] the, those ones, you gotta be a little bit, um, just cognizant of the timeframe, but the mechanism of being warmer and then having that relative cooldown, uh, can be useful.
[01:33:10] I've also found having a cool, uh, shower, or if you have access to, and I know you do, whether it's through a friend or a colleague, uh, and I do as well, a cold plunge can also be helpful. Uh, again, double edge sword here where if you truly do go into a cold plunge, it's either too cold or for too long. Um, You can really shift your, um, your body into a little bit more of a kind of fight or flight sympathetic dominant, uh, almost like survival mode, uh, where it triggers your nervous system too much.
[01:33:50] And you can, you can get too cold and then you'll be up trying to warm up. Um, While you're trying to actually, um, go to sleep. I've done it
[01:34:00] multiple times by accident. You know, you're just trying to say, I want to push it a little bit farther, a little bit farther. And then all of a sudden I'm like, Oh, laying in bed, just literally like shaking, trying to warm up.
[01:34:12] That's not what we're going for here. Right. But if done, right. Um, especially if. Uh, and I, and I find I fall in this category and I was like hot at night. I'm really warm. I'm hopping into my cold plunge, which I personally keep around 50 degrees. Um, sometimes a little bit cooler, um, depending on the season, but for winter time, 15 is nice.
[01:34:37] Uh, and staying in there depending on how practiced I am. Um, Long enough, but not too long is a, is a really nice way to kind of initiate for me. Just kind of calming down of that brain, like getting the monkey brain turned off, um, just getting back into the body and in a nice opportunity to go into bed.
[01:34:58] Nice and cool.
[01:35:00] Um, and that also drops your body temperature, right? So, uh, less reflectively and more. Uh, intent, uh, more, um, purposefully. Sure. So, um, again, they're, I think they're valued all of them. I think there's a double-edged sword to, to, um, to all of them as well, if you use kind of either too intensely or the wrong time.
[01:35:23] So my understanding of that, that follow up to that, uh, don't overdo it and experiment maybe cold works better for you, maybe how it works better for you. Yeah. I mean, I can't say that I have found that. One more reliable than the other, um, outside of access, right? Not, everybody's got a sauna now.
[01:35:42] Everybody's got a cold plunge that they made at home. Um, but a shower or a bathtub, um, can always be a pretty good go-to it almost. And quite honestly, I be like, Warm it's a little bit more comfortable and accessible than cool. So it's
[01:36:00] a, it's an easier thing to do. And it has some, it has some positive effects.
[01:36:05] Um, colder is more direct and I feel also has some other, um, kind of getting you out of your head effects, um, then than hot does from it's just, um, Uh, kind of what it does to your nervous system. Um, so there can be some side benefits outside of how, how it engages with you just from a temperature standpoint, cold earlier.
[01:36:30] If it's done early in the day, can that impact your sleep at all? Or is that, is it have to be right before bed? Uh, you know, I can't necessarily comment on that as it pertains to, if I've. Personally noticed or my, any of my patients who were doing this routinely, notice it like, Oh, if I do this routinely in the morning, I'm sleeping more reliably one way or the other.
[01:36:52] So, um, that, uh, I'd have to hard pass. Okay. Uh, ideal sleeping environment in terms of considerations for
[01:37:00] the room itself, a little personalized, but the data would suggest we sleep better. Slightly cooler. I think that like cool dark cave type idea. Um, you know, I know my partner does not love going into a cold bed.
[01:37:18] Uh, I, on the other hand, absolutely love it. Right. And so we have a, we have an Uhler, uh, which is like, uh, a temperature controlled mattress pad, um, and, uh, one that we can actually program to be at different temperatures at different times. Um, and so. For me, it's cranked as low as it possibly can go all the time.
[01:37:39] And I just want to get into that nice, cool bed. And, you know, for other people who like to have again to almost take advantage of that temperature change, you can kind of set it in to be a little warm, nice and warm to get into, especially in the winter time. And then you can, uh, Turn the temperature of that mat
[01:38:00] down to take advantage of one sleeping more cool in the middle of the night, but also having that drop, um, of, uh, you know, body temperature.
[01:38:09] Dave:
[01:38:09] Mm. I like that. Yeah. Uh, and then, so like dark darkness, too general. So cool. Dark are the main consider. What about eye mask versus like blackout curtains?
[01:38:20]Derek:
[01:38:20] I think that kind of is a personal preference there, whatever, however you feel most comfortable it with it getting dark. Some people don't like something over their eyes.
[01:38:30] It doesn't seem to phase me too much. Um, And we already sleep in a pretty dark room. Uh, but the eye mask I find is nice because inevitably it kind of slips up in the evening time at times, but then like, you know, if you wake up with that first time is morning. You're like, ah, well, pull it down. Like, I'm going to get a couple more.
[01:38:49] Uh, I got a few more minutes here. So, um, I can't say I've found one to be more, more powerful than the other, but that's only personal, um, um, personal
[01:39:00] preference. Okay. Noise earplugs sound machine. Some of that might depend on your partner. If you're sleeping with somebody, uh, or your environment that you are sleeping in.
[01:39:11] Um, while I don't have a purposeful noise machine, we have a noise machine in the, in our bedroom, which is an IQ air air filter. So it has a very low kind of. Hum to it. Um, or moving movement of air they'll fan. So there is a degree of similar kind of white static noise in there. Um, I don't have the, I don't have the data on, uh, whether or not that objectively changes or shifts people's sleep reliably.
[01:39:42] I think it's situationally valuable. And if you are easily. Awoken, you know, if you are asleep next to a partner who makes a lot of noise, um, and that some white noise can be
[01:40:00] valuable at drowning. Some of that out, I think there's a place for that. Um, you know, we could dive down the rabbit hole of, is it great to be sleeping with Bluetooth, something or others in your here, if that's the case, um, We'll see, we'll shelf that for another day.
[01:40:20] Um, cause I still don't know the answer to it, but uh, yeah, that's my thoughts on that. Okay. Uh, any general supplements you that tend to be good for people? I know again, very individualized, but like any natural supplements that people can consider. I mean, there's so many tools in this toolbox and there they are.
[01:40:39] They're pretty specific to what we are trying to do for that particular person. But, um, But there's definitely a place to speak about that. So, um, if we are looking at cortisol elevations, phosphatidyl searing can be very useful. Um, supplemented helps reduce cortisol levels and it works pretty
[01:41:00] well. Um, dosing matters a lot, you know, within that, um, 300, 600 milligram doses are where I tend to find, um, the most degree of effect.
[01:41:14] Um, and I worked for some people and then those people, they probably have a degree of cortisol elevation in the evening time. That's disrupting it. And for the people that doesn't work, but that's probably not their issue. In fact that usually is how it pans out. If I've clinically suggested it, they do it, we test them and they come back and they're like, eh, it didn't really do very much.
[01:41:34] And then we look at their hormone tests and you're like, yeah, that makes sense. It probably won't because you don't have a problem, um, that one's valuable. Um, Magnolia bark, um, is another one. And it's found in a lot of different like sleep combo supplementation as well. Um, Has some effect on Gabba. Gabba is a calming neurotransmitter in the brain.
[01:41:58] Generally speaking.
[01:42:00] Um, one of my go tos more recently has been Tori and taurine is an amino acid and taurine also can have precursor to GABA, but has a host of other side awesomeness to it on, um, liver gallbladder health that just have health, um, on. Um, lipids of cholesterol, blood sugar. So there's a lot of like side benefits that can come with that.
[01:42:26] And it's very, pretty safe as well. That's one we'll come in and use, you know, we talked about melatonin and the use of it, and they get to be pretty discerning with this because, um, it's easy to get into a habit of using it. Um, almost any supplemental dose is gobs more than our physiological production.
[01:42:46] And so you gotta be cognizant of that. Um, And there is some literature out there to suggest that like really high doses of it can influence your own natural production. And so like, you want to be
[01:43:00] discerning when you're choosing to use any of these nutritional supplements. Um, and then from a, uh, kind of nervous system calming, there's a host of herbs that are very kind of calming for the nervous system.
[01:43:12] And we'll turn to those. In particular, depending on what we are trying to accomplish, um, lemon balm is calming. You can get that in a tea, right. Um, kava is a more heavy hitter or, um, Valerian is in an, again, a calm, calm and kind of sleep combination. Urban valerian tastes gross, but it works. Uh, so does COVID it tastes fantastic, but, but, but they're both very kind of calming to the nervous system to have some effects on the, on the muscle and muscle relaxation.
[01:43:46] Neither of them really should be just kind of used Willy nilly they're there. They should be. It should be kind of put into a plan as to what are we trying to accomplish. And that's where sometimes objective testing can be useful. Uh, and
[01:44:00] that having a structured while therapeutic plan, I was like, well, we're what we're trying to accomplish.
[01:44:05] Is this, we're going to put these things in here. Did they accomplish the goal? And if they did wonderful, then now what? And if they didn't we'll hop com. And now what? Yeah, that's good. Uh, so I think it sounds like alcohol across the board, not good for sleep. What about something like marijuana that's complicated.
[01:44:26] Um, and from, from what I know about some of the literature out there, um, pros and cons, um, and, and the, the realm of what it can do. Or, or how it affects her. So it has to go back to doing what those sleep cycles and the seep signatures of the electromagnetic energy in the brain and what they're doing for that.
[01:44:52] So anytime we're looking at any sort of sleep agent, we want to know like, Does it, does it like knock you
[01:45:00] unconscious or does it promote sleep? And those are two different things, you know, sleep. Isn't the absence of consciousness. I think Matthew Walker says. And so some of these, you know, sleep medicines do truly that like you are not conscious, but the way your brain is kind of acting is not, is not in an ideal sleep signature.
[01:45:21] And so I've. Read some preliminary research that seems to be that THC can influence, um, sleep signatures negatively, uh, that CBD does not seem to have the same impact on, um, but that's a small kind of sample size of, uh, of what I know on the literature. And it's, uh, a little bit of a, um, A blind spot in a sleep therapeutic for me in particular, um, for a host of reasons, one simply being federally legal agent, right.
[01:46:00]
[01:45:59] Um, despite being legalized in, uh, in California for recreational use, um, one of the challenges with any of these substances that have been federally illegal, you said you're just not studying it doesn't mean that they're not. Useful. It's just that we just don't fully understand how to utilize this tool.
[01:46:22] And then of course, in the way in which the substance is now like provided there, it's like, Here you go. Here's, here's weed in a whole bunch of different kinds of forms and dosages and strains and, and, and, and, and, uh, ratios. And we have no objective understanding from, uh, from, uh, uh, we have minimal objective understanding from a kind of research standpoint of like, When would one turn to this versus this.
[01:46:52] And in fact, some of the people who literally just have boots on the ground experience of using marijuana or
[01:47:00] gain some respects have been, are, are the most valuable folks because they've been in it since 1960 something. Right. And, um, And that's a, that's a challenging place to be, um, giving medical advice.
[01:47:18] We like to have, we'd like to be able to sit back on some kind of pharmacodynamics of what we're trying to do here, even in herbal medicine. Um, and, uh, and we're gaining that. So it's going to be an interesting tool in the toolbox moving forward, um, amongst a few other things that are, Hmm, that's good.
[01:47:43] Dave:
[01:47:43] Last one. I that's, when I had a good one, I think to wrap it up on would be general, you know, we mentioned a couple of these already, but general routine recommendations for a, you know, a nighttime routine things that people can consider to help with that wind down process.
[01:48:00] Yeah. Some exercise, you know, I think that, and whether or not that happens, I mean, I wouldn't necessarily suggest it too late in the evening.
[01:48:10] Derek:
[01:48:10] Uh, I know that, I mean, when I play hockey late at night, uh, and which is when they put the really bad hockey players, which is me, uh, Our games start at like 10, which like is okay for me as this night out was after it's still not. Okay. It's not, it's not good. Uh, it's tolerable once in awhile, but like, I can't sleep until one 30 easily just to fire it up, um, from the kind of high intensity of, uh, recreational hockey camp.
[01:48:44] Uh, so. So that's, uh, that's one suggestion is to make sure exercise happens, but not too late at night and not too intensely if it's happening later in the evening time, get it in in the day. Um, I
[01:49:00] think one of the most valuable pieces of being able to get sleep is to tire your body out. So it wants to go to bed.
[01:49:08] So many of us sit in front of computers on our butts in offices for an inhumane amount of time. Spending very little physical energy and all of that, just gears turning in the brain. Right. So I think that's an important piece. Get that exercise in, um, keep caffeine, you know, we talked about this kind of before noon, if you can.
[01:49:36] Okay. Um, uh, I would say try not to eat too close to your bedtime. So try to give yourself to. Three hours between like finishing your dinner and going to bed. That might mean moving your dinner earlier. Ideally not moving your bedtime later. Right? Um, I think that that's about a very
[01:50:00] valuable piece, um, for a host of reasons.
[01:50:03] Uh, cause gut health is another conversation. I know. And I'll pause that one. So, um, the, the other things to consider are again, uh, tech removals, right? So you know, our 90 minutes before you go into bed, get away from the screens. Right. And for you, that, that usually means you got to cut your screen up at like what four o'clock.
[01:50:22] Cause you're going to bed at six. And if for the listeners. I always give Dave a hard time, uh, because by the time I'm up for the day, he's already had half of his day. And by the time I'm sitting down to have dinner, uh, he's pretty much put his PJ's on and go to bed. So, yeah. Well, that's why, if you texts me though at like seven o'clock, you don't get a response till the next morning.
[01:50:45] It's because of the priority priority phone away. I actually look at it until probably 10 or 11. Um, yeah, so it's a really tough communication conflict for us. Um, so getting the tech and the bright lights
[01:51:00] down. Right. So, uh, and that, again, I try to put a 90 minute window that's ideal, um, to, to get away from some of those things, your, if you're going to have your hot shower, it's kind of a good timeframe to be doing that in, you know, within the hour before you're trying to go to bed.
[01:51:19] Um, and that's not something that I'm pulling from. Anything other than, um, some patient experience and personal experience, it's not pulling from a research paper. Okay. Um, those would be the main ones and then setting up your room for success, which is a dark. Cool. Uh, get your TV. If you have a TV in your bedroom out.
[01:51:44] No, like don't watch TV in your bedroom. Don't do work at your bedroom. Sleep. And sex. I mean, you, you can have sex at other places too. That's fine. Um, but those are the two things that you're really
[01:52:00] limited to what you do in the bedroom, right. Maybe debt changed from day. Um, but don't associate that space with anything, but.
[01:52:11] Really those two, those two things, um, you'll want it associated with work. You don't want it associated with being awake. You don't want it associated with, with eating or having a movie. Like, just try to do, try to separate that and make it a little bit of a sanctuary that is, um, that is yours and designed for a purpose.
[01:52:34] Um, so I'm not a big like TV in the bedroom fan. It's too tempting. And, um, to just sit and let's watch it. Let's watch one more. Let's watch one more. Let's watch one more. Um, no, perhaps some time. I mean, whether you're, whether you're single or partnered up, you know, it's like you use it, you use the bedroom for what it is.
[01:52:55] You have a kitchen table for a reason. You get it. And you know, you
[01:53:00] got a family room for a reason. If you do watch your stuff at that, have put a desk up, do your work there, compartmentalize that piece so that when you can operate in the other places, they don't have all these triggers. Right. And mean you can go and we can talk about psychological triggers is a whole nother kind of conversation piece, but trying to set yourself up for it.
[01:53:22] Yeah. And it sounds like the city. Now, uh, I think those are, yeah, those are the big things. I think that's probably a crucial one go outside. This is, I think, even more relevant now with all this like work from home. Some people are literally missing. They're like for they're they're 40 seconds from the walk, from the parking lot into their, you know, into their building.
[01:53:44] And then the, you know, maybe 20 minute walk, they take around lunch, making a phone call or whatever, because now we're just like in. In the house sitting in, you know, in our, in our space, not necessarily going outside, um, go outside. You need sunlight.
[01:54:00] You need bright light in fact, and it's probably pretty valuable to have your one cup of coffee outside so you can get a little bit of that morning sunshine.
[01:54:10] We're lucky to have it in California. Let's take advantage of it. Yeah. I think the only other thing that you had you had mentioned earlier would be things like, you know, journaling, uh, reading something, not too stimulating confined to that. Meditation would be a few other things to get the, get the mind off the, all the, to do's of the day would probably be the only other thing to highlight.
[01:54:29] Yeah, absolutely. And, and, you know, from a, like a meditation practice, I'm not particularly dogmatic about when. Because if it's happening, if it's happening routinely, the concepts permeate the day. Right? And so if you're getting your meditation in the morning, you shouldn't have stage for how your day is going to unfold.
[01:54:52] Um, the realization of, of what you're trying to accomplish and the focus of that, like is not lost
[01:55:00] throughout the day. Right. And so it ends up being a piece of the puzzle that, that. That will, that you'll kind of, uh, have lasting benefits. However, if you find that this is a great time for you to. Take that, uh, excitation of the day and to kind of bring it down grounded and centered, nighttime is a very useful time.
[01:55:22] It might be the time in which you have the most free time to do that. You know, if you have kids, kids are asleep and you can spend a little bit of, you know, mom or dad, time to themselves.
[01:55:32] Dave:
[01:55:32] Yeah. That's good, man. Derek, this has been amazing. One of the. One of my, one of my favorite podcasts we've recorded.
[01:55:40] There's just so much value in this. And I know we left, we left so much out and I don't know how many times you mentioned we can go on a separate side conversation. I have a whole other topic on this between gut health and hormones and all the other blood sugar out of the other things we talked about.
[01:55:54] But I, uh, I really appreciate the, the knowledge and the time, you know,
[01:56:00] how much I respect what you do. Uh, where can. Where can we find you? Where can people either local to Southern California? I don't know if you're doing any remote virtual stuff, any, any places people can, uh, get in contact with, with you and your biz?
[01:56:15] I would love to love to hear that.
[01:56:17] Derek:
[01:56:17] Yeah. So, you know, we are, uh, are practices based in Carlsbad, Carlsbad, California, there, um, and. And so we have a revived naturopathic medicine. So our, you know, our social tags are at revive, not bad Nat med, and you can find us there. You can find us at doc Derrick as well as kind of my personal, um, uh, my personal social tag.
[01:56:39] Uh, we've got a lot of wonderful information on our website, uh, particularly designed to help people find, um, the right doc for that. At our clinic, we will do something and it'll kind of take our angles a little bit differently. So we want, we really want to find those, those right fits. So we've structured our, some of
[01:57:00] our information and content to drive that I am also the, the natural medical director at Vera via, which is an all inclusive fitness and wellness retreat.
[01:57:09] Uh, that's based out of the park Hyatt here in RVR, uh, luxury, all inclusive kind of wellness. Vacation, uh, where we have any worse from three-day stays upwards of three months. In fact, um, where people come and they'd live it day in, day out with some help. You know, we have personal trainers, nutritionists, psychologists, naturopathic doctors, running the show, and a lot had a big team of support there.
[01:57:34] So, you know, those are the places in which you can find me we're on Instagram or on Facebook at revive, not med and, uh, what we're also hoping to do. Is, uh, you know, um, continue a couple more of these conversations. Cause like you said, uh, when, when you're talking about health, it's impossible to begin to separate these topics.
[01:57:59] And
[01:58:00] this is the blessing and the curse of being able to like hit on these things is they leave a lot of, uh, unended thoughts because the totality of this w it would never end. Right. So, uh, if the, if your listeners out there, you know, are left with any, uh, any incomplete, uh, incomplete answers, right. Make sure they ping you.
[01:58:23] Right. And it's something that we can circle back and make sure we get answered to. But yeah. Thank you for taking the time and having me on and, um, I'm really, uh, you know, I'm, I'm looking forward to hearing this conversation again and going like, Oh my gosh, how come we didn't talk about this? Right. So I think what will come of, this is our little checklist of what else we got to do.
[01:58:44] Yeah. We'll be back for sure. But, uh, yeah, last, last plug on that I've been working with Derek personally, I've, uh, you know, through our physical therapy business that we have here in Carlsbad, we've worked together on many. Mutual patients. And, uh, the results I've seen personally with, with
[01:59:00] those patients have been amazing with, uh, Derek and their team there.
[01:59:03] Dave:
[01:59:03] So if you have access to him, couldn't recommend it more. But, uh, I think just generally speaking, finding someone like that in your area can be extremely valuable and don't wait for, don't wait for the. No symptoms to get to a point where you're crashing and you're responding to reacting to, to a health crisis.
[01:59:24] If you will, uh, take, take the action proactively, uh, just get some, get some more knowledge of, of some information with, with blood work, with, uh, you know, some of those have those conversations that, uh, can help, help save you a lot of time, money, frustration down the road. That's just the, the last plug on that.
[01:59:41] Derek:
[01:59:41] Yeah. And, you know, for some of the people who are, who are out of state, we, we do have the capacity to, to kind of help facilitate, um, some of their care from a consultation standpoint, because they're out of state there's, um, you know, there there's things we can't do and things we can't do, uh, as far as the, as far as the relationship we're able to build, but,
[02:00:00] um, the brain doesn't change.
[02:00:02] Right. You know, the, the information, the capacity to navigate that stuff doesn't change. And so we can help those folks. But if anyone's like, Listening to this podcast, they have a, they have a head that's screwed on their shoulders in a really deep, kind of good direction. So. Uh, no, that like you're you're, if this has intrigued you, your heading in the right direction, like follow that instinct.
[02:00:27] Um, that's what I tell a lot of people, anyone who calls the clinic, whether we're a great match for them or not. It's like, you are, you are in the right arena. You're looking for the right things. You are, you're grabbing for it. So, um, you have to reward that and say like, keep it up right now. Not every, you know, there's not one person that fits everybody, but if your head is in this sphere, Yeah, you're in a, you're in a good place.
[02:00:49] Yeah. Yeah. If you're, if you're just looking for it, if you're searching for the answers, whether you stumbled upon this, just searching for more sleep answers specifically, or if you're just regular listening and make it to the hour and a
[02:01:00] half, I don't know. However long where we're at at this point and still listening that's that perhaps to you and the, uh, Know that proactive nature that you're taking, but remember to take action, I've put off sleep stuff for so long.
[02:01:11] Dave:
[02:01:11] And that was something that I've, uh, I've seen the negative benefits of. Cause it was always something like, I know the importance of it, but I'm kind of doing what I can, but kind of not. And it's like had to, had to look myself in the mirror and be like, okay, there's definitely more, I need to be doing, I need more help with this.
[02:01:24] I need specific help someone, uh, much, much smarter than the need. Definitely. Definitely. Different we'll call it differently. Smart itself. Def just make sure you guys take an action on it. Even if it's just applying one or two things from the, uh, Huge amount of information that we poured out in this podcast.
[02:01:43] Uh, just make sure you're taking something in and doing that to, to move, continue to move, moving the right direction and make sure to take advantage of us. You know, I love hearing from you guys. Um, and I know Derek's the same with people that, uh, that reach out to him. So make sure to take advantage of that and, uh, Derek man, thanks for the thanks for the time.
[02:02:00]
[02:01:59] And I am a, I'm very, very confident that you're going to be. Back again soon. Perfect. Well, and true intrude zoom meeting form. We'll end it on this because you can't go as zoom meeting without seeing someone.
[02:02:16] I thought you were employed. They're going to pull a chicken out or something. No, they're outside right now. Thank you. So we'll just leave it with Lloyd. Thanks a lot, Dan. It was a absolute pleasure. Thanks for listening today, guys. Unbelievable that even if you apply one thing from today's show, you're taking one step closer to living as the man you were made to be.
[02:02:37] Meaningful change doesn't happen overnight. So keep showing up and keep consistent every single day until good things start to happen. If you haven't already taken 60 seconds to write a review on whatever platform you're listening on, it goes a long way in growing this podcast and reaching other men just like you, that are hungry for more in their life.
[02:02:55] If you have any questions on today's show feedback or content, you want to see more
[02:03:00] of shoot me a text. Yep. Text me (760) 477-4361 at (760) 477-4361. Let me know that you're listening to it. And so I can personally thank you for your support of myself and the show. That's it for today, guys, it's time to raise your standard for yourself.
[02:03:19] Stop settling for just getting by, go all in on your passions in the life you were made for. I love you guys and talk to you soon.

Treating the Root Cause of Disease - Dr. Derek and Dr. Emma

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[00:00:00] Dr. Derek Lawrence: [00:00:00] Hey everyone, Dr. Derek Lawrence here. I am with Dr. Emma, and we're both at Revive Naturopathic Medicine here. Just another round table talk that Emma and I wanted to have a conversation about, because it's really, the core of naturopathic medicine, and I think a big reason as to why, or what connects patients with wanting to come and see a naturopath, particularly one that goes to our clinic. I think that we bring an important perspective to this, and that topic is  treating the cause: "Treating the Root Cause" of disease and dysfunction. And what does that actually mean? I think the, beautiful and maybe challenging thing about that phrase is it can mean different things to different people. Depends on who you're sitting in front of. Right? And then as we were saying earlier, paying lip service, or actually walking that walk and talking the talk. So I do want to start this by kind of throwing over to you, Emma, because, this was your topic idea, and, I will get carried away talking if I don't let you start. 

[00:01:21] Treating the root cause: what is that, like, what does that mean to you in general and, maybe specifics, and how has that evolved? That perspective, how has it evolved over your time being a doc and working with patients? 

[00:01:43] Dr. Emma Andre: [00:01:43] Yeah. This is a super juicy topic and, I have a number of things to say about in terms of what it means.

[00:01:50] I think about treating the root cause as a process of walking through with a patient, the journey of going back to figuring out what the first domino was that really fell. That got the person to where they are now. Which, might sound upfront like, a simple thing, but when you're sitting with somebody who has, you know, three or four decades of life before they came to sit in front of you, quite often, there's a long history of from where things actually started.

[00:02:30] And part of that is a mindset of remaining really curious about how you got to this point, so that when you go to think about treatment, you're choosing a treatment that is supporting a sustainable solution. What I mean by that is if you don't actually go back to the thing that is causing or maintaining dis-ease or imbalance in the body, then that will just continue.

[00:03:03] Even if you suppress the symptoms that are showing up, there'll be something simmering, something that remains out of balance under the surface, and will either show up in another part of the body or just won't resolve the thing that you really want to resolve. It might not get you to feel the way you're looking to feel, which is healthy and energetic and good and like yourself again.

[00:03:27] Dr. Derek Lawrence: [00:03:27] Right. You know, I think we'll probably get into our individual kind of perspectives on this, but this is a... I use an example with a lot of my patients. I love analogy. I think there's so many out there in health, but like when, especially as naturopaths we start getting deep into nitty gritty.

[00:03:49] Right. We can get into some things where it's like, it's sometimes hard to like, what do you really mean by that? But like this example, I give people all the time. It's like, if you have high blood pressure, like you go to the doc one day and they haven't had your blood pressure measured. You have high blood pressure. It's 150 over 95. And then they say, well, you have high blood pressure. Here's a blood pressure medication. Right. And then you take, start taking a blood pressure medication. Now your blood pressure is 120 over 75. Awesome. Well, if you stop taking the medication, the blood pressure goes back up again.

[00:04:22] So you, never really treated the reason why that was present. We'll put a pause there for a second. Don't get me wrong in the context of high blood pressure. Like mitigating risk is important, right? I don't want my patients stroking out and getting heart disease. Like there's a, there's a reason why we do that and you can do it pharmaceutically.

[00:04:43] You can do it naturally, but it can't stop there. That, in fact, that's just the beginning and, getting our patients to a place where it's like, Oh, I don't need that anymore. This may be a very kind of superficial example when it comes to high blood pressure. But quite honestly, like these are the boots to the ground problems that people are kind of concerned about.

[00:05:06]I think it's our job to begin to introduce those other like layers, right? It's our job to say, like, alright, we've got to mitigate risk. I want my patients alive, but what's there? And. you know, you can put any problem kind of at the top of that. And I think the more kind of complex the problem, usually the more complex the root system is underneath of it.

[00:05:30]But I liked that example. Like I think it's really tangible for people to chew on, and it's simple and everyone's heard of high blood pressure. And half the people are on a medication or borderline anyways. So, you kind of mentioned something: it sounds simple. It does sound simple. It sounds like, well, why doesn't everybody do this? 

[00:05:48] Dr. Emma Andre: [00:05:48] Well, I think every doctor does believe that they are treating the root cause. And I think that their intention would be to do so. 

[00:05:57] Dr. Derek Lawrence: [00:05:57] Yeah. 

[00:05:57] Dr. Emma Andre: [00:05:57] I really do. I think they all want genuinely to help people at the root so that they can stay healthy. That's why we get into this.

[00:06:05] That's why we go through the struggle to become a doctor. And I think the thing that you touched on that is another key, aspect in our philosophy that is so important is the way that we understand symptoms. So. High blood pressure is diagnosis, but it's also a symptom. It's a symptom of something else.

[00:06:29] Blood pressure doesn't just pop up on its own for no reason. Something else happened first, and the body responded with this symptom and to me, I see symptoms as the body's language. It's the body's form of communication. In many cases, it is the body's wisdom, and that is like a 180, I think from the dominant conventional model of what symptoms are, symptoms are seen as a problem because as you pointed out, if somebody has unchecked high blood pressure, they could stroke out.

[00:07:04] That's a problem, but that's also the body saying, Hey, Something's not right. Fix this address this. Support me, help me. It's the body's cry for help. 

[00:07:17] Dr. Derek Lawrence: [00:07:17] It's a compensation, right? It's saying like, I'm trying my best. And I mean, the neat thing about some of our diagnostic tools, like a blood pressure cuff or lab tests, which can tell us some things that you may be, or, or patients may be can't articulate or feel or otherwise is they, they kind of give us some of these insights that there are compensations happening, you know, there are symptoms or, physiology that has been augmented to try to navigate as best as it can, and that, you know, it is wild to think about how, I mean you almost framed it as like a symptom as a good thing.

[00:08:00] I mean, if we didn't have a symptom, we would probably.... right? Who knows, like we were probably just decompensate and, and die, you know, that these are actually things that we kind of care about as naturopathic doctors to say, I recognize they're here. And then I want to watch those, you know, reduce in severity and frequency and intensity as we kind of work at our resolution.

[00:08:33] I think an awesome example of these ones clinically, cause you see a ton of kids: is like skin stuff, eczema, almost anything on the skin. And I can't tell you how many moms and dads I've spoken to and, you know, the kid has eczema. Right. And I tell them I don't treat skin topically. I just haven't found it relevant.

[00:09:01] And, that totally goes exact like opposite of a lot of times of what they get from a dermatologist or their pediatrician or primary care  where they only get skin stuff, steroids, antifungals, whatever it may be. Right. and I mean, at an eczema standpoint, it's usually a steroid cream, but I. I mean, I could count on a couple of hands how many cases I've solely used something topical. And it's very few, really, if any, because it's exactly that one of those external expressions of, from my perspective, gut, immune system, balances. Right? And...

[00:09:37] Dr. Emma Andre: [00:09:37] If I could add here too, that there is when you do this, I mean, especially for kids and kids are going to express things really intensely because they tend to be more vital there. Their body shows it in a, in a more vivid expression often, which is actually a reflection of health. Believe it or not, but the, there is a problem with treating it only topically, right? I mean, especially when we're talking about eczema, there is a risk of treating it, just topically of taking this way that the body is expressing something and bubbling over and just shutting the lid on that and shoving it deeper.

[00:10:17] That is actually a problem. It's something. The body is, is working out and we are the stopping part of that process. And yes, they are uncomfortable. Yes, it's eczema can be awful. It's it can be so debilitating. And if we're really concerned with the kids' whole health, we have to be very careful about how hard we push symptoms back in, where they came from.

[00:10:43] Dr. Derek Lawrence: [00:10:43] Yeah. Like a, almost like a pressure cooker that you can't like release the steam from where you can handle a fair amount until you can't. And sometimes that has to do with amount of pressure or duration that it's lasting there and something's going to fail. And, you know, going back to the original comment, you mentioned like when did this start? Right. That I think is a really, really interesting question for almost all patients because, if you're lucky, there'll be a degree of insight into something, but like, sometimes you're, you're just, you just dig it. And you're looking for like, when did, when did you know a trigger or something like that happen? So like, how do you, how do you, cause I know how I do it, but like how do you like try to flush some of that stuff out?

[00:11:37] Or like, what are you looking to hear in a history or what are you hoping people have either reflected on before coming or, or maybe reflect on after coming to see you from that perspective. 

[00:11:53] Dr. Emma Andre: [00:11:53] I always ask the patient what first there's a number of ways to answer this question. The first one is I always ask the patient what their intuition is about how this started, because I think people have a whole lot more insight about themselves and they sometimes give themselves credit for it.

[00:12:10] I listened to that. And then from there sometimes we'll keep asking the questions, keep asking: okay. So let's say that you really started noticing that as soon as you went to college, that your digestive issues got so much worse than they were in high school. Okay. Well, what happened in high school?  When did this switch?

[00:12:31] Oh, this started at menarche. Okay. Tell me about that time. Okay. Tell me about before that. Oh, You know, tell me about even your childhood. Like some of these things are patterns that started early, early on either patterns in, our stress response, which is a really big one. How is it that we process big changes? Maybe there were... 

[00:12:54] Dr. Derek Lawrence: [00:12:54] Or taught to process big changes. Or taught how to, you know, like, right. Like we model our behavior and our environment. Right. And so it's like, if you were, if your models did something in this direction and that maybe is less than desirable. 

[00:13:15] Dr. Emma Andre: [00:13:15] Yeah. Like maybe, maybe, As a woman, maybe you had a mom who had a really poor self image. And when she was upset, she would pull out the treats and they would eat their way through their feelings. Or maybe she would stand in front of the mirror and talk about all the things that were, that are not right. these things are, I mean, these are picked up and these are habits and in some families they're totally commonplace as totally normal. Or maybe, maybe you'd watch your parents drink. That's how you dealt with a stressful day. 

[00:13:45] Dr. Derek Lawrence: [00:13:45] Right? Right. That's like socially acceptable and common of like, Oh man, I had a day. Let's have a drink or, you know, and instead of it being, you know, two fingers, it's two fingers, right. 

[00:13:58] Dr. Emma Andre: [00:13:58] I mean, especially during COVID, this has been an extremely stressful time. And that is one thing I'm hearing across the board is that people are drinking a lot more alcohol now than they have before. And I get it. It's so stressful. It's like how, if you, if you don't have other ways of knowing how to unwind to relax your mind to unplug, or if you really just don't get a break because of whatever situation you're in it's it's tough. I can see how that happens. I had a, I had a couple of cases that came to mind, that I thought might be good examples to share kind of how we trace back, as another answer to your question. I had a  mom who was in her early mid thirties who came to me with asthma and she had, she had had asthma for years and she was exhausted, which was her number one complaint, and she was overweight and she couldn't sleep. The reason she couldn't sleep was because as soon as she laid down, she would just cough and cough and cough and cough. That was how her asthma presented as a, as a chronic cough. So of course she'd gone to her PCP and they had given they had upped her steroids. They had given her cough medicine. They had given her all kinds of things to try to stop the cough. And, this had been ongoing for three years and she had a two year old also, and she's working full time. So she's stressed out. She's tired. She can't think. She's gaining more weight. She can't breathe properly. She's got all the things going on. So amongst other things, one of the things that we did was to do a food sensitivity test, because I have seen a pattern with asthma that there, we know that in that asthma triad, the allergies, the eczema and asthma, food sensitivities can be a really big portion of that.

[00:15:56] So for her, a huge trigger, we went through that whole process and we were very specific about it. And for her eggs and dairy turned out to be massive triggers for her cough. And we worked through the process of eliminating those. We did a trial and as soon as we did took about three to four weeks for that cough to really reduce and for the phlegm to go down. But she started sleeping for the first time, like I said, in three years, and she was ecstatic. And so we got her sleeping and then as soon as she was sleeping, her energy started to go back up again. Then she was able to consider exercise, which she'd been missing. So she started walking and then eventually she started running, which she hadn't done for like a decade.

[00:16:42] And so we were able to start reducing the, the other medications, which helped her overall health. Her, clarity and her presence and her ability to play with her daughter came back again and eventually we started moving towards working with the gut and the immune imbalances, which were really at the core of that.

[00:17:05] And then the other part of the thing that we went to, if we're really talking about core causes, was she had, particular, her own particular ways of dealing with stressful responses like a stressful life. And, part of that was in reaching for sugar and then part of it was in not really knowing mentally how to be calm and still. And so that was the thing that we worked on.

[00:17:33] Dr. Derek Lawrence: [00:17:33] So now I've got a couple of questions for you in that case. Cause like, I mean, I love these, these cases cause they go like, okay, well these are the things that I think about. So one, I want to know what food sensitivity tests did you do because there's, you know, there's a gamut out there. So at this particular case at this time in your career, which one did you do? 

[00:17:51] Dr. Emma Andre: [00:17:51] Us biotech. 

[00:17:52] Dr. Derek Lawrence: [00:17:52] US biotech...finger prick, IgG or blood draw?

[00:17:56] Dr. Emma Andre: [00:17:56] Finger prick IgG 

[00:17:57] Dr. Derek Lawrence: [00:17:57] Finger prick. So easy to do at home or in the office, IgG food sensitivity. I mean, probably a topic for another day, as far as like the gamut of those different ones out there.

[00:18:08] US biotech, because they actually use, very good... They use ELISA testing and they advertise it on their website. There's a lot of food testing out there and they may not tell you what methods they use. They actually test their samples twice against controls and they are much more thorough than some of the ones I've seen. That's why. 

[00:18:27] Great. Yeah. And that's, that's valuable. The, I had a comment I was going to ask again. Oh, the finger pricks. I love those for the little kiddos. you know, when it comes to like testing kids, it's like, I I'm trying to, you know, I want to play good cop usually, cause I don't want to be the bad guy. but I find the fingerprint food sensitivity tests super useful when like mom and dad are like, I think it's something he's eating, but like, I just, like, it's re like, I can't fathom like doing an elimination diet with my four year old or my five-year-old's like, cool. Like, let's try to give you a little bit of insight, so it's not, you know, it's not so drastic of an intervention. It's, it's more of like alright we found these four things let's take them out and see what your kid does. okay. I wanted to know that. So thank you. The US biotech and yeah, we have those in the clinic now, now, thanks to you. 

[00:19:17] Secondly, did you ever think about, and do you think that maybe the dairy and egg food sensitivity was behind like a silent reflux, like a, so a GERD, a gastrointestinal reflux. It just like didn't feel like heartburn, but irritated the esophagus trachea enough that that was prompting the cough. 

[00:19:41] Dr. Emma Andre: [00:19:41] Yeah, certainly it could be. And, and if that's the case, that's a really good thing. She removed them because of their risk of having ongoing reflux. That is not good. 

[00:19:53] Dr. Derek Lawrence: [00:19:53] Did she ever try, sorry for interrupting, did she ever try, like from her primary care or even you like any like acid blocking medications to like test that theory? If that was behind it?

[00:20:04] Dr. Emma Andre: [00:20:04] She did. I believe she did. I don't, I don't quite recall all the medications she tried, but it was a lot. A lot of different things. and yeah, that was it. It definitely could have been reflux. That was a part of it it's always possible. And in the end, whether or not that was the case, the treatment that we chose got her to where she wanted to go and allowed her to reduce the asthma medication. So there may have been two things going on and in the end of this, It didn't really matter because ... 

[00:20:38] Dr. Derek Lawrence: [00:20:38] Well and in end in the you... 

[00:20:39] Dr. Emma Andre: [00:20:39] It resolved. 

[00:20:40] Dr. Derek Lawrence: [00:20:40] Yeah. Well, and not only did it resolve, but I could argue that in the end you treated the cause. Meaning you treated this kind of gut immune system imbalance. These foods were salt in the wound. Right. But the sensitivity, the irritability, the volatility kind of have that immunological reaction is a more of a core problem. cause we see this all the time. Where are, well, some of them like my patients, food sensitivities aren't as intense anymore. I've had that experience personally, where are you?

[00:21:14] Just like, all right. Like I'm not going to go and eat this all the time, but like a little bit, it doesn't bother me like it historically used to, and that speaks to a degree of resiliency. Right? So regardless of if it was an exaggerated immunological response, kind of causing some tracheal, bronchial inflammation, irritation, or silent reflux, but that was probably driven from some GI inflammation, et cetera, you know, that.

[00:21:41] It's kind of neat how that core treatment, because if you look at it through that lens, Can help both of those avenues, despite from a medication standpoint, those being like two very different, kind of conventional approaches there and seemingly neither of which were particularly successful, which is neat.

[00:22:03] Dr. Emma Andre: [00:22:03] Yeah. I mean, we were treating the body. 

[00:22:05] Dr. Derek Lawrence: [00:22:05] Yeah. 

[00:22:05] Dr. Emma Andre: [00:22:05] We're not treating the condition. We're treating the body and helping them find balance, which to me is really the way that you trace back and you treat the root cause and you're bringing up a great point too. So. When I talk about food sensitivity, some people are like, Oh, are you going to take away all my favorite foods forever?

[00:22:25] It's just like this, like till I die kind of a sentence? If, if you continue to do the work of tracing back to the true, cause it's not always, like some people will remain really sensitive despite extensive treatment and things. And I would argue that if the sensitivity never goes away way, then you may just never have found that root cause.

[00:22:47] You know, and most people it has to do with gut-immune imbalances, but there can be things driving the gut and immune imbalances that can be tricky to identify. It just takes time and digging and, patient involvement to do that. But, so for some people, once you take out the foods, take out those inflammatory triggers and treat the gut, then you find that either six months to a year, two years later that they can actually enjoy intermittent small amounts of those things again, without a problem. It's like they find their threshold and they don't necessarily have to be out of your diet forever and completely kind of thing. Like if they, if they get in there either accidentally or cause you're you know, at a party and there's really nothing else to eat situation, then it's not going to be a big deal. You've built up the resilience that you can handle that you can clear that. 

[00:23:39] Dr. Derek Lawrence: [00:23:39] Yeah. You know, and the, I want to hear the other case that you have, but I want to make a comment here and, go back to that case, the, the degree at which I think we....we'll call it, like treat the root. Cause I think it's like one of these things where you need to, meet your patient where they're at too, right? Where you're going to have some people who are coming in that are kind of very foreign to things like: sleep and how it interferes with our physiology. Stress and how it interferes with our physiology. Emotional health and how it interferes with truly with our core, like blood markers, you know, and how things like our gut and our intestines move and eliminate or don't and how those things are intimately connected. I think as, you know, like even with our long patient appointments there, there's sometimes going to be just like, kind of too much education to dump all of that in at one time. And, you know, you know, and one thing I like about, you know, the way you practice and I really make sure to emphasize this, maybe even a little bit more aggressively is that I really try to get my foot in the camp that they've come from, like their primary care has looked at AB and C. Right. Cool. Like, I want to know all of that. I want to know what they did, what they didn't do. And I want to fill in some of the holes that maybe fall into that physiological realm of lab tests or imaging or, you know, something that's a little bit more familiar to them and use that as like this parlay into okay. Like. So stress exists. Not only does it exist, I can measure it. And I did. And it's terrible, you know, or, you know, or something like that. Or like, you know, from a, maybe a mood stability standpoint. And you're looking at some of like peripheral understanding of maybe their neurotransmitter levels or, or, you want to start to help them understand gut health and what that means, cause it's so beautiful and elegant, but. some numbers have an H pylori marker, you know, or a gut inflammation marker, or just like that, a food sensitivity marker helps like bridge that gap of saying, okay, this person, you know, gets where I'm, where I've come from. And I feel like confident that they can kind of like we can lead them into. Alright heres's that next deeper level.

[00:26:23] And then when you get there, you get to go even deeper and you get to go even deeper. You know, I tell some of my patients that, like, I think I'm pretty good at getting people to be weird, but they don't always start weird when they come and see me. I think they think they're normal when they start seeing me, and then there's a couple of years down the road, all of a sudden they're just like, I'm strange. And like, go like, yes, welcome. 

[00:26:45] Dr. Emma Andre: [00:26:45] Yeah, Welcome to the real you, isn't it awesome? 

[00:26:50] Dr. Derek Lawrence: [00:26:50] Yeah. It's fun to take people through that. Right. And not only is it fun to take people through that. It's fun. Yeah. It's fun to take them through it and also show them every step along the way that.

[00:27:05] Here's some literature backing exactly what we're talking about. Here's some experience that you've had, you know, proving that we're like in the right arena. And we are making this wonderful headway and like all of that just builds their confidence in, well, not only you as a teammate and helping them get well, but also themselves, because as you know, we put a lot of homework and work onto our patients and say like, I would like you to do this and if you do this, I'm expecting you to get a, B and C as a return. And then when they do, they go like, Holy smokes, I did that. And it's like, you did, I didn't, I just told you to do it. I didn't actually make you do it.

[00:27:48] I just suggested that. and, and then they gained this almost like empowerment of: oh, I can make good choices for myself. Right. and, become a little bit more in touch. And that's a really fun experience to be a part of when your patients just become better because of what they've, they've done. 

[00:28:11] Dr. Emma Andre: [00:28:11] That's where I see, and this, some people I think, Have a hard time wrapping their minds around like what you're getting at, but that's where I see dis-ease and illness as an enormous opportunity. It is an opportunity to get to know ourselves and to reconnect with our body, to start trusting it, to start learning how to listen to it and how to work in tune with it and support it. It doesn't feel that way when you feel like crap doesn't feel like any kind of opportunity, but if you really are getting to the root cause it is an opportunity to see where, like, where is that initial rub? Where are things aligned in either in how we're operating in life or in how we're treating ourselves?

[00:29:03] And when the body is imbalanced, it i. Trying to show us, it's trying to tell us, trying to communicate something we have to learn to listen really deeply. 

[00:29:13] Dr. Derek Lawrence: [00:29:13] So, so for someone who's listening to this thus far, what, what do you listen for then in a history for, you know, what kind of sets off alarm bells or triggers, you know, or we'll call like triggers of root cause or triggers of dysfunction. Like, what do you listen for? 

[00:29:37]Dr. Emma Andre: [00:29:37] There's a few things I would say. I am really curious about how people see themselves. And what they think about themselves. And I'm curious about how they see themselves in the world. Like I am, I'm often very curious about what people's world view actually is. Like what, just what they believe in terms of their place in the world, because that very much determines our mindset and our mindset is what we operate from. 

[00:30:15] Dr. Derek Lawrence: [00:30:15] Right.

[00:30:16] Dr. Emma Andre: [00:30:16] So as an example, this is kind of like out there right now. So like, as, as a concrete example, if somebody thinks... if somebody operates from a place of," I don't have anything valuable to offer. I'm worthless." or "If people really got to know me, they wouldn't like me. So I'm going to, I'm gonna just gonna keep my freaky self, like under this, this guise, and I'm just, nobody's going to really get to know me. I'm going to put up walls." That will make it hard for us to, that will make it hard for that person to ever open up. Or to share or to ever get vulnerable there's, in that kind of a presentation, there's like this sense of like a tension. Of holding in and of holding on and in different people that will show up physically in very different ways.

[00:31:14] Dr. Derek Lawrence: [00:31:14] Let me guess they're constipated!

[00:31:16] Dr. Emma Andre: [00:31:16] It could be!

[00:31:17] Dr. Derek Lawrence: [00:31:17] Right? Like I'm just, I just got a hold on. Yeah, yeah. Or like that jaw tension, right? Where like all night, they're just like, "No!" Their teeth, they're just rubbed raw. 

[00:31:31] Dr. Emma Andre: [00:31:31] Yeah. It could be back pain. It can be knee pain. I mean that if you really want to get to the root of it, whenever we forget how incredible we truly are, how, from my perspective, how divine we truly are, whenever we forget that there is something inside of us that, knows that that's not right. And it can produce a kind of internal friction and our body will get us to listen in one way or another. 

[00:32:02] Dr. Derek Lawrence: [00:32:02] Oh, that give me chills. Yeah and so what I'm hearing when I hear you say this, I go, I'm so happy to have you here. because like when I go, when I answered that question for myself and I go like, okay, well, what am I listening for in a history? Like my brain is a little more, like a little more mechanical in the way of like, I want to know. Okay. Like, did you get sick? Was there trauma? Right. Like literally things that, that, tax, like tax the physiology on the body. Right. or, or like, you know, infectious gastroenteritis. Cause I see a lot of gut health components like w like where was, or what was that trigger? Sometimes you're going back to like, Oh, it was a little kid and I never pooped and, or it wasn't breastfed or fill in the blanks. Right. But, I love that under the roof of the clinic, we, we have like those, kind of synergistic minds because, you know, while, people can actually come and see both of us. It also just helps to know that like, like we get to have these conversations and like, then, you know, you're just like in my ear, you're like, "Derek, go deeper." you know, and you know, and it's, it keeps these things on the radar so that, you know, we just don't, we don't get lost in the mechanism, and we can entertain that and also entertain, you know, other components that are like, I wouldn't say outside of physiology, but they really aren't. They're this mindset behavior way in which it kind of sets forth our physiological responses. So, I'm grateful.

[00:33:53] Dr. Emma Andre: [00:33:53] Your body....here's something I like to remind people that your body is like, it's like an obedient puppy. It will always do what the higher levels. It will always be reflecting higher levels of your mental-emotionall wellness and your spiritual wellness.

[00:34:13] The body is kind of the last place where these truths show up. And it's usually the place where we first realize and feel like, Oh, something's off. And the more tuned in we are, the more we practice. Listening. And this is not a skill. Most people are taught. So for some people, this feels really foreign at first, and I believe every person can learn to do it if they really wish to get to the root cause.

[00:34:36] And what you brought up about trauma is so important. I mean, that is a huge thing that I like to know about and that I like to ask about because there can an inciting event, whether really big. And kind of obviously big like, physical trauma or abuse from a parent or something like that. That seems like an obvious trauma use something that seems kind of small.

[00:35:03] Like being bullied at school that can have a really profound impact or somebody saying something that as a kid, when we were really susceptible, suddenly shifted our perspective of ourselves and it never got shifted back into the right spot. And a lot of people, they've done, you know, either talk therapy to try to resolve some of these things and maybe have gotten part of it or they, they haven't, and they've put it in the past and they've shut the door on it said, like that was awful. I don't want to revisit that. And one of the biggest things that I see that trauma can do, and I see this a lot in women is that, that it will, if at some point, man or woman, somebody experienced a physical trauma. Let's say it was, a woman who was raped when she was really young, when that happened the best way for her to survive. That situation was to disconnect from her body physically disconnect and to not feel what's happening. So that disconnect, though often will mean that they never reconnect. And so I've seen women come in, who, from the collarbone down, have no idea what's going on in their body, because they're so disconnected because they did it to survive an, a horrible situation.

[00:36:27] So I'll ask them, they might have digestive stuff going on. They're like, I know there's something going on. It's like, well, where does it hurt? And they're like, I--I don't know. You know? And so in order to actually treat that, it's not like I'm going to do psychotherapy. I don't do that trauma work. That's not my specialty realm. There are people who are really trained in that, and that is something different. But in terms of learning to work with the body and learning how to actually treat the digestive piece, at some point, it is really helpful to reconnect with the body. And if we actually want to be able to listen to our intuition and know what's right for us in a way that no other person in the world can know, not even the best doctors out there, because they're not that thing in your body, you need to have, you need to slowly reenter and start feeling.

[00:37:23] Dr. Derek Lawrence: [00:37:23] Right. Yeah. Whew.

[00:37:28] Dr. Emma Andre: [00:37:28] Yeah. 

[00:37:30] Dr. Derek Lawrence: [00:37:30] That's a big visit. Yeah. 

[00:37:32] Dr. Emma Andre: [00:37:32] Yeah. Well that is not one visit. 

[00:37:36] Dr. Derek Lawrence: [00:37:36] That's the truth, but I mean, that's the value of a relationship, right? And I think that that is, something that I'm always trying to build with a patient is, is not, I don't want you to do what I tell you to do. I want you to learn from the experience that I've gained and the insights that I may have, and the, you know, the places where I chose to educate myself and helping me help you solve these problems and build context into why you are doing these things. And, I think it helps create better educated humans. I think it helps to create people who are a little more in touch with what's going on and then in touch when something's off and either know what to do or know where to go, go to, try to, you know, achieve that. So, let's, let's end with the let's end with a new, another like good case from like, again, the concrete example, cause these ones are really fun and digestible. No pun intended. If it's a GI case. 

[00:38:43] Dr. Emma Andre: [00:38:43] They so often are, aren't they? At least that's what comes through my door a lot. I see a lot of, I see a lot of GI cases. yeah, I had a young, 20 something gal who came in and her chief complaint was that she had rashes on the front of her thighs. And, 

[00:39:01] Dr. Derek Lawrence: [00:39:01] I want to stop you there.

[00:39:03] Dr. Emma Andre: [00:39:03] Yes. 

[00:39:03] Dr. Derek Lawrence: [00:39:03] Okay. So rashes on the thigh from your like conventional brain or conventional medicine approach, like what does she have? Like, what's a rash. Like what does it matter if she has a rash on her you know, on her, on her shins or whatever, it, may be. 

[00:39:21] It mattered 

[00:39:21] Dr. Emma Andre: [00:39:21] a lot to her cause she couldn't wear shorts, but I'll say from a conventional perspective that, I would have, I would think of it as like, ingrown hairs from the physical rubbing of pants after she had shaved.

[00:39:35] Dr. Derek Lawrence: [00:39:35] Hmm. Okay. 

[00:39:38] Dr. Emma Andre: [00:39:38] But she had gone to a dermatologist and they had given sort of "meh" advice. She tried it and it didn't help. So, she, She also had as a side note allergies, like seasonal allergies. Which most people would not think that the two are really connected, but it turns out they were. She had some, so she had that and they were the rashes themselves were kind of inflamed. When you looked at him, it was like the hair follicles looked inflamed. So, this wasn't the first thing we did, but just to make this a little bit shorter. One of the things we ended up doing was looking at the kind of, foods that she was eating and we ended up doing a celiac disease screen on her, which most people wouldn't think to do because, she was, her family was from India, which with that cultural descent celiac disease is not the first thing you think to test for. But we were talking about one of the things that she was going to trial was removing gluten. And, I don't like to take anyone off of gluten before take, trying to take celiac disease off the table because you can't test for it once you take it out.

[00:40:51] And there's a lot of people walking around, not knowing that they have this and it's a big deal if they do. So we tested her and h her antibodies to see to her gut celiac disease markers were off the charts. So what we do if we see that is we also get them hooked up with a gastroenterologist, because you have to confirm that diagnosis with an endoscopy, which she did and was positive. So, she had, so she, she ended up removing gluten because that's one of the things that you do as a part of the treatment. And then we went back and also, rebalanced her gut and helped her with her stress response. And in taking gluten out of her diet, the rashes completely cleared up and her allergies went away, which was a surprise to her, but not to me. And knowing what I know about that, the gut and the immune system, they're their buddies. They live in the same spot in the body and the gut and you treat one while the other is, is impacted. So, yeah, it was a really cool case. And. we did also talk about her mindset around, stress for one thing and another interesting theme of, how she would mentally attack herself, which is on a side note, is an interesting pattern that is not too uncommon in autoimmune diseases. It's almost like a mindset reflection of what's happening in the system. Not always there, but happens to be. 

[00:42:23] Dr. Derek Lawrence: [00:42:23] But it can be, yeah. So do you think, I mean, so we both know that a skin condition commonly associated with celiac disease that is dermatitis herpetiformis reflecting back  did it have that quality or was it truly more of a folliculitis type presentation?

[00:42:43] Dr. Emma Andre: [00:42:43] It was really more of a folliculitis presentation, but, yeah, that's, that's how I remember it. It was a little while ago, years ago, but that's how I remember it. Didn't, it didn't look like a classic dermatitis  herpetiformis like what you might Google and find. 

[00:42:59] Dr. Derek Lawrence: [00:42:59] Yeah. Right, right. You know, the, I love that case because it has a little bit of everything in it in the way of. Honestly, I mean, celiac diseases are really important diagnosis to know about. It can be a very significant condition if left unchecked from, I believe it increases risks with lymphoma. it certainly can participate in osteoporosis and bone mineral density, especially as you get older, because it causes significant, you know, malabsorption, But on other levels too, right?

[00:43:35] I mean, it clearly was causing a large... one, kind of inflammatory burden in her body, which causes a immune disruptive burden in her body, making her more sensitive to environmental insults. Right. Which went away, it was disrupting the kind of likely the microbiome, not only her gut, but also her skin, because our skin is really supposed to be in this kind of self regulating ecosystem. And then when stuff's on it, it's not, it's just not doing its job. Right. And you have to kind of look as to why, but, and then, you know, the autoimmune nature of celiac disease and, you know, as you commented on like some of the, self-talk that can be behind that, you know, it's, it's things we dig into and it's interesting how frequently they come up, right. that's a cool case to end on. Thanks for sharing that one. I, I liked that cause it, it, it reflects all the little, like real serious medical diagnosis, the functional restoration of health, which is above and beyond just removing gluten is actually getting things like stable again. And can't tell you how many celiac disease cases like didn't do any work after removing gluten and they just still are floundering and it's like, you have to put in some work, there was years of potential damage. We've got to help repair that a little faste. Get a little glutathione and get a little, you know, like, like let's, let's, let's fix this. Right. And then on top of that, right. I think, some, probably some pretty valuable stuff for her from, one could say like, just like life coaching standpoint of how, how do we exist on this planet in a, just a little bit happier more balanced kind of way. that's or that's a good case. Good case examples. Thanks for sharing that. 

[00:45:28] Dr. Emma Andre: [00:45:28] Yeah.

[00:45:29]Dr. Derek Lawrence: [00:45:29] Well, you know, for time's sake and for, Kellie's sanity's sake, let's wrap up this video, on our "Treat the root cause." I'm sure we could keep going on, cause it takes us all of these wonderful places. So yeah. For anyone who stuck around this long, I'm dr. Derick this is dr. Emma. We're at Revive Naturopathic Medicine. This is on YouTube, if you're not watching it there, you can subscribe to our channel for more of them. Not only with dr. Emma, but also with the other docs that Revive and, and will also be kind of posted on social media.

[00:46:01]If you've got any kind of questions or comments regarding anything that we did mention.I mean, we do monitor that and would love to kind of engage in a little conversation. If at all possible, if you want to hear something, you know, from my mouth or from Emma's mouth, let us know. We love doing these. We do it just for fun. A little  Friday fun this week, because when you get a couple of naturopaths together, they love talking about Naturopathic Medicine,

[00:46:25] So, thank you, Emma. And, we'll have another one of these shortly.

SIBO - Small Intestinal Bacterial Overgrowth: Trends, Symptoms, and Treatment

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Kellie - Marketing: [00:00:00] Welcome back everybody. This is Kelly from revive naturopathic medicine, and I am back with Dr. Derek Lawrence and Dr. Brian Myers. Today, we're going to be talking about something called SIBO, small intestinal, bacterial growth. Which is difficult for me to say, but hopefully for these doctors, they know a little bit more about this topic, so take it away. Dr. Derek and Dr. Brian. 

[00:00:32] Dr. Derek Lawrence: [00:00:32] Perfect. Thank you, Kellie. Yeah, SIBO or SIBO, "small intestinal bacterial overgrowth " is a pretty common condition, I think in both mine and Dr. Myers is practice and, and really today I want it to I really want to take an opportunity to kind of log this ball into, into Brian's court as a, and put them on the spot a little bit to tell us more about SIBO trends that he sees in it how he's going about treating it.

[00:01:02] And we actually have some results that we'll share on this video, obviously with any identifying information Hidden so that you can actually see how we diagnose a small intestinal bacterial overgrowth what the test results look like and you know how that kind of interpretation will go. I'll, I'll talk a little bit about, you know, my kind of understanding of this.

[00:01:30] Problem. And, and the cases in which I, I, I look at testing it for, and usually it's going to involve a lot of GI upset and these are so things like a lot of gas and bloating, right? These are, these are commonly symptoms of SIBO heartburn. In fact, we'll look at As well constipation can be there as well, but some of the symptoms can even trickle more into folks who you know, have other what we'll call like extra intestinal problems as well.

[00:02:01] And, and, and I know for sure, Brian, that you'll hit on some of that. So I will I'm going to kind of pass the intro over to you. And I want to hear kind of your take just on SIBO as a condition. You know, who's, who's kind of starting to raise flags or what symptoms start to raise flags for you as to, well, is this person suffering from this and and or how this condition can manifest in the real world.

[00:02:29]And then we'll maybe dive into. Some of the lab results and I'll see what you have to say about them. Right? 

[00:02:34] Dr. Brian Myers: [00:02:34] So let's establish a little bit of anatomy first. So Below our lungs in our the core of our body sits the stomach from the stomach, we have the small intestine the duodenum, jejunum and ileum.

[00:02:46]The ileum connects to the large intestine, which runs up the right side, across our lower abdomen, and then down the left side of our lower abdomen and out the backside. So. SIBO small intestine, bacterial overgrowth means that the bacteria that typically colonizes our large intestine has for.

[00:03:10] Whatever reason crept up into the small intestine and caused a bit of an overgrowth there. It's not just for whatever reason. Those reasons we'll get into a little bit later. But those bacteria aren't necessarily pathogenic bacteria. They tend to be part of the. Gut flora that we want to have in our gut, in our large intestine, but tend to cause a little bit of havoc in our small intestine.

[00:03:36]They tend to gobble up some of the nutrients that we would otherwise be better served the receiving ourselves. And then they tend to produce a fair bit of gas by way of fermenting or they tend to ferment in our small intestines, some of those nutrients. And then that manifests as either from the feeling of like a food belly or a food baby where you have this like distended abdomen and potentially some pain from the amount of gas being produced.

[00:04:02] And, you know, that ends up being flatulence or Or, or, or burping belching and that's for some people unsavory for others, still it's downright owl. And, you know is this bad or good? It's not great in the sense that you know, we're missing out on the nutrients that we would like to be providing ourselves.

[00:04:21] And for some people that can lead to more serious complications down the road. And then there's a range of severity with SIBO too, as there is with most things. So some people might have. Underlying SIBO and just not even know it. I just think I get a little gassy sometimes and that's no big deal. 

[00:04:36] Dr. Derek Lawrence: [00:04:36] Yeah. There's, you know, the way I explain to people, as they say, it's normal bugs in the wrong spot, right. It's there the generally supposed to be there, but for, you know, factors, ABC and maybe even some unknown ones you got too many in the wrong spot and You know, most of my patients are familiar with either things like kombucha or maybe some aren't or beer.

[00:05:02]But you know, when you crack that kombucha, you crack that beer, you get carbonation, right. That is a product of fermentation, right? That's what these bugs do. They ferment basically carbohydrates right from our food. And then they produce this gas And, you know, when I think a lot of us have maybe, you know, shaken up a soda, beer blows all over the place.

[00:05:30]Dr. Brian Myers: [00:05:30] That explosion's happening in your small intestine.

[00:05:33] Dr. Derek Lawrence: [00:05:33] Yeah and that's a totally like digestible way to explain it because. Everybody's had either that belch or maybe like heartburn or reflux from that gas literally causing kind of pressure dynamic issues and causing Harper. And, you know, inevitably someone's also sat on the toilet and had a degree of explosion as well.

[00:05:57]For one, you know, at one point in time in their life. But some people suffer from this and you know, I'm sure you've had these cases, Brian, like there are some people who like have to plan their day around where's the bathroom. 

[00:06:14] Dr. Brian Myers: [00:06:14] Yeah. Like we mentioned, these bugs tend to produce a fair bit of gas that gas can be hydrogen, methane or sulfide producing.

[00:06:23] And those tend to. Kind of manifest a little bit differently. Some people tend to towards having a bit of diarrhea. And again, that's where you're literally planning your day around. Like where are these bathrooms? Because I don't know when this is going to happen and that's just frankly unsavory.

[00:06:38] And then some people attend a bit towards constipation, which is unpleasant for other reasons. I mean, you know, just not having a bowel movement, you know, for, you know, a day or two or three or. Or even more, can be really uncomfortable for some in, and they're, you know, on toward long-term side effects from that too.

[00:06:57] Yeah. Eactly 

[00:06:59] Dr. Derek Lawrence: [00:06:59] on both sides of those, you can actually like they're uncomfortable symptoms, but left long enough or severe enough that they can actually be like pretty serious problems. Diarrhea can leave people chronically dehydrated. That's not uncommon. You know, I mean, you can leave, we can talk about malnourishment later, but that's an, you know, another component, but you know, chronic diarrhea can certainly do that.

[00:07:27] And on the flip side of that, chronic constipation, not only can you actually cause tissue changes in your colon, right. Where it's actually starting to expand in size and then it can lose its ability to properly kind of Create normal motility. But you can be more susceptible for things like hemorrhoids impaction, which is basically just like the stool doesn't move out.

[00:07:52] Right. We've had those cases a little bit more common in sometimes kids and elderly than general adults, but but it happens. And you know, from a more naturopathic standpoint, one of the things that we know is. There's like there's in Carol hepatic circulation, right? There's like, there's literally re-circulation of, of biochemical compounds.

[00:08:13] We'll call them that because summer. Helpful right movie, we recycled bile salts. We recycle fluid and that's important, but simultaneously all these bacteria also have endotoxin as well. And if we are recycling that or recycling estrogens at an expedited rate or other kinds of toxic stuff that we'd kind of want out of the body.

[00:08:35] We've almost secondarily now burdened the body in a whole different mechanism, which can have its whole other gamut of symptoms of, you know kind of Inbar toxicity, overwhelm, stressing, or liver detoxification pathways. So it you're you're spot on. It can be simple or not simple, but it can be less severe and it can be more is so spot on because someone might have a little Burbank.

[00:09:01] Another person. It could be the crux of a real complex health issues. You know, we talk about gas and bloating and, and I think people can identify with that. But like, let's expand that to say, Oh, well, what else? So like what other, from a symptom standpoint? Cause no, one's walking around saying. I think I'd see both acting up again, right?

[00:09:25] Dr. Brian Myers: [00:09:25] No, but they do say, I think I have a food baby after the annoying.

[00:09:29] Kellie - Marketing: [00:09:29] I wanted to ask, how do I know when to come in? Like, how do I know as a patient or someone who's listening to this know if this is something I should come in to see you guys? Or if this is just something I should wait out for a couple of days.

[00:09:46] Dr. Brian Myers: [00:09:46] I mean, if you're not having at least a bowel, not you specifically, but the whomever if you're not having at least a bowel movement today, you know, and you're having you're missing days between bowel movements, that would be an interesting. And, and noteworthy thing to mention to your practitioner.

[00:10:01]Also if you're having loose stools or not, well formed stools on a regular basis excessive gas manifesting as belching or flatulence is, is another. I mean, we've kind of like nailed that one down as, as the most hallmark sign, but I mean, people dealing with migraines, weight, loss, weight, gain.

[00:10:19]I just want to hit migraines again and also just say headaches too.  Issues with staying hydrated waking frequently at night overnight difficulty sleeping, skin pathology, skin rashes can all you know, be a derivatives of, of SIBO or small intestine, bacterial overgrowth. 

[00:10:39] Dr. Derek Lawrence: [00:10:39] Kellie, I'll share with you a couple of things that I find that I keep my radar open for. And one of them is is if someone's missing a gallbladde r. If they're missing a gallbladder--gallbladder you know, to save a long anatomy lesson, basically stores the bile that your liver produces and then is designed to dump it into the small intestine around mealtimes.

[00:11:04] And that helps us absorb our fats. And it also helps us dump other kinds of toxic compounds to be eliminated out of our gut. But one of the  functions that it also has is it, is it has this some anti-microbial capacity as well. And it keeps the the small intestine more regulated from a microbial growth. On that same front, I think low stomach acid production. Is another key component and we're rolling into "causes," but let me, let me give you the symptom that that often presents with is heartburn. So that's a real common one that I'm in this chronic heartburn cases where they've been on Pepcid prilosec. Like they they've been on something for. You know what, five plus years, the first six weeks? 

[00:11:57] Dr. Brian Myers: [00:11:57] None of those are supposed to be long-term therapies. And if you've been on those for a longterm, then please talk to your practitioner about that. They're not designed to be used in that way. And they, you know, we talked about fermentation before, and that's, you know, when you don't have enough stomach acid, guess what that means doing venting and rotting and. And that's, you know, like that can lead to all of those things that we talked about, from diarrhea to constipation. 

[00:12:27] Dr. Derek Lawrence: [00:12:27] Yeah. That heartburn is, is one of the first ones we'll, we'll look at burping reflux, all that kind of stuff. What are the other. Conditions. It's a very small sub segment of the population, but I have a couple of people who fall on the spectrum.

[00:12:44] Is that the hypermobility Ehlers Danlos syndrome folks? I don't think I have a case of that without SIBO. And then head injuries. So people who have had traumatic brain injuries concussions, mild to severe Really common environment for SIBO to overgrow. You know, my theories behind that is, is some of the most likely some of just the nervous system connection to proper gut motility has been compromised from, from literally from head trauma.

[00:13:18]Granted there's probably a multifaceted mechanism there as well, but you know, those are population basis that I think. You know, if you're, if you fall into one of those and you're kinda bloated or what we'll call like irritable bowel syndrome me, right. I mean like how annoying is that diagnosis? And because it's not, it's just saying, like, I don't know what else to call this, so we'll just call it that and hope that's satisfactory, but it's not, I think we've, we've found, and I've seen this in the literature that a large majority of, of those IBS cases are just iron 

[00:13:50] diagnosed SIBO.

[00:13:52] Right. And 

[00:13:52] just like, it's so simple, but they tend to be, and it's at least worth exploring if you've been told you have IBS. Yeah. And you said it's not so simple. I think that we'll roll us into what you were coming and going is a good next topic. Right? So What, what causes this, you know, like what do you what do you know causes it?

[00:14:13] What do you think participates in it? Like, you know, well, some of my thoughts, like the gallbladder, right? And low HCL, like a little bit more of my thoughts and clinical experiences, but like tell us a little bit more about that. 

[00:14:27] Dr. Brian Myers: [00:14:27] Yeah. I think Any sort of bowel irregularity or consistent bowel irregularity can be a contributing factor. But a lot of times it's history of antibiotic use or recent history of antibiotic use history of food poisoning. We've talked about low stomach acid and like the gut brain connection or disconnection in some cases Thyroid dysfunction on either end of that spectrum could be a contributing factor or a cause.

[00:14:56]And then since we're talking about thyroid, we might as well mention HPA access dysfunction. So HPA, meaning hypothalamus and pituitary, along with our adrenal glands and any sort of dysfunction among those important parts of our body large intestine dysbiosis that the presence of pathogens can be.

[00:15:13] Cause even though, you know, we've kind of alluded to, that's not always the case or that these bugs aren't always bad. They can be, and you know, that just is a complicating factor then gut inflammation in general. So like our, our people that are dealing with like inflammatory bowel disease or celiac are, are certainly at risk.

[00:15:32]Yeah. Do you have other ones? There are more...

[00:15:35] Dr. Derek Lawrence: [00:15:35] Yeah, there are more, you know, I think it's a couple other ones that we should mention is, is history of food like food poisoning, right? Like, you know, acute gastroenteritis, that's you know went down, ate this taco and it just wasn't it wasn't. Right, right.

[00:15:53]And that seems to set off some immunological susceptibility for this condition to exist. I have a large female patient base and another one is intestinal adhesions. And the reason why I bring out the females on that is that you know, sometimes they've had things like hysterectomy or yeah, or C-sections these are surgical interventions that then of course, you know, need to heal.

[00:16:17]Adhesions are like scar tissue and like scar tissue connecting from these organs to your intestines and it could compromise the motility of the, and the proper kind of motility of the small intestine and the large intestine as well. But that is a system that can be set up to develop SIBO.

[00:16:38]And, and when we talk about gut motility, I'll take a little aside on here cause it's kind of in the causes kind of headline here. You know, some people think of gut motility as well. I poop every day. Right? You can poop every day and have SIBO. The motility that we tend to reference, right, when we're talking about SIBO is this intricate part of the small intestine called the migrating motor complex.

[00:17:01]And this is like, A component of like the infra muscular component of the small intestine that is designed to like sweep well, food, but also bacteria out. Right. And so when we talk about motility that is a really what we're referencing when it talks to SIBO is the health and integrity of the migrating motor complex. I think from you know, we talked about head injury component. I think that that is probably where some of the damage comes in on that front, but, but there, you don't necessarily need a head injury to have a poor migrating motor complex function. And it's also why laxatives don't solve this problem.

[00:17:43] Dr. Brian Myers: [00:17:43] And even herbal laxatives, some of those herbs that we use to have regular bowel movements you're right. I mean, constipation and, and the use of laxatives, as well as some of those other things that migrating motor complex is, is pretty essential. And like you mentioned, it's kind of like a it's, it's a coordinated effort from our muscles to just kind of squeeze everything all the way out and just kind of say like, here we go.

[00:18:05] Let's let's, let's do a quick cleanse. You know, that that tends to not occur unless we've been, you know, in a, in a foodless state for at least four hours. We tend to have one that occurs in the morning. And those are pretty essential to like keeping keeping regular healthy bowel habits. 

[00:18:25] Dr. Derek Lawrence: [00:18:25] Yeah. Well, let's let's pivot this. I'm going to lob something into your court. Brian, I got test results and I want your on the spot interpretation of them. So let me let me share my screen here so you can see these

[00:18:52] Dr. Brian Myers: [00:18:52] somebody's in trouble. 

[00:18:54] Dr. Derek Lawrence: [00:18:54] Yeah, I guess so. I wanted to avoid that. So I put my headphones in. 

[00:19:01] Kellie - Marketing: [00:19:01] That was the SIBO police.

[00:19:03] Dr. Derek Lawrence: [00:19:03] That was the SIBO police. Can both of you see this? 

[00:19:05] Dr. Brian Myers: [00:19:05] I can. 

[00:19:06] Dr. Derek Lawrence: [00:19:06] Okay, great. So you know, our, our information is hidden here, but so this is Commonwealth diagnostics. This is a SIBO test. I'll talk briefly about the test and the test collection.

[00:19:18] It's actually a breath test. So the, the mechanism that we're, we're trying to capitalize here is, is on measuring that gas production. So the test involves drinking a little sugary drink made from a lactulose there's different SIBO tests out there, but lactulose is kind of the more consensus of the better one to do . You drink the lactulose.

[00:19:39] And then every 15 minutes you breathe into a test tube. And your breath is going to contain. And then of course, you'd cap very quickly is going to contain certain levels of methane. Certain levels of hydrogen is going to condense certain levels of carbon dioxide, obviously, cause it's your breath. But we look at that and we referenced how much hydrogen, how much methane is being produced at these different time intervals.

[00:20:05] And these time intervals are meant to reflect kind of like where the transit through the small intestine and And so, you know, this is a, this is a test that you were looking for. If a person has SIBO, sometimes either high baselines and gases or spikes of hydrogen or methane, which will reflect too many bugs, hyper fermenting that sugar.

[00:20:31] Cause the thing about lactulose is we can't absorb it as, as humans. We don't absorb it but the bugs can use it. Right. And, and then we breathe in these tubes and we get a reflection of how much gas is being produced. So you know, I know Brian, you're familiar with these results. What's going on here?

[00:20:49] Dr. Brian Myers: [00:20:49] Well this looks like a positive result for SIBO, small intestinal, bacterial overgrowth. And the reason why we see that is ... The, the chart on the left is, is a pretty handy representation of those time intervals. Dr. Derek was talking about, so, you know, we can see that there was a small rise in hydrogen, early on, but we see a, a quite a bit larger rise towards the end of the of the chart there a little bit later on.

[00:21:15]And so as he said, we're trying to approximate Moving through the small intestine and then looking for peaks or changes in either of these gases which would indicate a positive SIBO test. Sometimes they come back and we may, you know, it's, it's possible that there are blooms of these bacteria that are between those time intervals.

[00:21:35] And, and that can be a little bit challenging when we're trying to interpret these results, but this test looks to be positive. As we see a combined effort from both the hydrogen and the methane a little bit later on, so. Yeah. I would definitely consider treating this patient for SIBO but also would want to take into consideration their their, their, their clinical history as well.  But that's probably what led to the decision to run this test. 

[00:21:59] Dr. Derek Lawrence: [00:21:59] So, yeah. I think if we, you know, if you get the best SIBO minds in  the room that symptoms do matter. You know, because, and they matter usually more in the cases that are a little more vague. You know where they're not overtly. Oh yeah.

[00:22:20] Like this is rip roar and high positive, like, okay. Like that's easy to interpret. Right. But they're the ones where it's like, well, there seems to be a little bit of an, a vagueness in these results and a borderline result. That's where symptoms and treating that human. Tends to matter a lot more.

[00:22:38] Well, I will I'll I will confirm with you, you like, but yes. Also commonwealths agrees with you that, that the presence of bacterial overgrowth here is supported, you know, this to me screams of, you know, hydrogen dominant SIBO. 

[00:22:54] Dr. Brian Myers: [00:22:54] Yeah, I mean, you can clearly see that towards the end, as we see that huge spike in hydrogen.

[00:22:58] Dr. Derek Lawrence: [00:22:58] Yeah. Okay. And given symptoms. And of course I didn't, there was no, there's no privy to these,  o these symptoms as well. There, you know, one of the things that we commonly look at, if we're looking at hydrogen or methane dominance is, is it's higher correlation with constipation, you know, as you mentioned that was not present in this case.

[00:23:21] So it kind of takes another kind of notch in the art. Well, we're likely looking at this, causing a problem. So yeah, I, I agree with you wholeheartedly on those results there and this this. Is arguably a patient of ours. And I'll say that because these are actually my SIBO results. 

[00:23:40] I you know, I wanted to say...

[00:23:42] Dr. Brian Myers: [00:23:42] It happens to the best of us.

[00:23:44] Dr. Derek Lawrence: [00:23:44] Yeah! I don't have, I don't have huge complaints from a GI standpoint overall, but I did notice over this last, and I don't know if this was COVID related or what I noticed.

[00:23:55] You know, I was finding myself a little more bloated feeling. I was actually having some, I was waking up just feeling like full at night and I wasn't sleeping as well. And I know that cause I wear my Oura ring. And so I could see like too many wakings at night. And I wasn't feeling as refreshed as I could.

[00:24:14] And I was gassy in the morning. It's like, that's so strange. And it...

[00:24:18] Dr. Brian Myers: [00:24:18] Were  you just waking up or you're waking because you had to like have a bowel movement because you needed to pee? 

[00:24:26] Dr. Derek Lawrence: [00:24:26] Waking up from  like, almost like GI discomfort and And so, and you know, if you know anything about me, I value my sleep.

[00:24:35]And so it was, it was disruptive to me. And I also noticed that over that kind of period of time, I got like less consistently good bowel movements. They were like looser and. That was like, I knew something was up. So I was like, well, I kind of intuitively knew. I think I probably have a little bit of this.

[00:24:54]And I can reflect back on my life and probably said, this has been a trend that I've flirted with. We could go all day about maybe why it head injuries? Ya-huh. Antibiotics? Yeah. Stress? Sure. Yeah. Right. And so this is what, like, this is what I find. Beautiful and frustrating about this. It's beautiful in the way of like, you can be like, Hey, something's wrong and we can do something about it, but it can be frustrated because it's like 95% of the world is walking around with like seven major risk factors for developing this.

[00:25:28] And then you throw a global pandemic on top of it. So I can, I can, I can confirm with you that, that these are. These are true symptoms of a SIBO, a I'll say a mild SIBO suffer. Cause 

[00:25:41] I think that I have my symptoms pale in comparison to some of my other patients. But  there's certainly there and they definitely have improved since I started doing something about this.

[00:25:50] And I want to get your take on, well, one, how would you treat this case? And I'll tell you what I did. And And then, you know, we can, can expand that to, okay, well, this was a hydrogen dominant case. Like how are you going to treat maybe something that's methane or something that's actually...

[00:26:14] Dr. Brian Myers: [00:26:14] There are a couple of different ways to approach treatment of SIBO. I commonly resort to herbal antimicrobial combination therapy. There are a couple of multi-center steam team formulations that that have been researched in the past, that can be helpful. But also just assembling a a well-rounded herbal antimicrobial combination can be really effective too.

[00:26:42] A lot of times that include herbs like berberine and or meme sometimes garlic in the form of allicin to be active. That tends to be more so for methane producing bacteria. So for some people, an herbal approach is is well suited. For others, we can use some antibiotics. This specific one that's used for SIBO is Rifaximin.

[00:27:06]The reason why we tend to use that particular antibiotic is because it is specific to the lumen of the intestines meaning that it doesn't have a very broad spectrum approach. And that can be, you know, that's just better in general, right? We don't want to kill all the bugs all over our body if we don't have to.

[00:27:24]There are some drawbacks to that too. Then a third approach for some people can be to use an elemental diet, which is basically food in elemental form over a period of two weeks. And. Kind of the approach there is to starve the bacteria. And, and that's actually interesting. If we talk about treatments that's, there's some divergent theories there.

[00:27:43] Some people think starving the bacteria while you killing them is most effective and, and still others think well, fed bacteria are easier to kill. And so You know, that there's a difference in opinion or approach there. And, and that may be a part of the nuance of like treating one person versus another always there's a nutritional component to that.

[00:28:03]We tend to try to avoid those foods that can trigger those food, babies or other unsavory symptoms. There tends to be with a, SIBO a fair bit of recurrence, and sometimes that means just changing up the. Protocol that was used from one, from one attempt to the next. But also good gut health regular well-formed consistent bowel movements, I think are a big goal and a big aim that I've been coaching my patients on of late for how to kind of resolve this on a more long-term basis.

[00:28:35] Dr. Derek Lawrence: [00:28:35] All right. So, Dr. Brian, what am I, what am I doing with these results? What are you telling me to do? 

[00:28:40] Dr. Brian Myers: [00:28:40] I would treat this person, this, "this person"...you, with let's see I would do suburban and either some neem oregano. And I would do that berberine like 1500 milligrams, three times a day. And whether you're doing Nime or oregano, you could just vary on the the dosage of that.

[00:28:59] If you're doing name, you do 600 milligrams, three times a day. If you're doing oregano a hundred milligrams three times a day I think that would be oregano. I would do maybe. Maybe that would be a little bit better indicated for you because there is a little bit of methane there. I think I might just stick to berberine and neem if it was hydrogen only.

[00:29:16]Yeah, if there was a higher amount of allicin or above of a methane, like I mentioned, then using something like allicin, and then there's even another herb that can help or another herbal blend called a Tarantino that can be really helpful for kind of like blunting or minimizing that that, that gas.

[00:29:34] Dr. Derek Lawrence: [00:29:34] Well, let me, let me share with you what I did. 

[00:29:37] Dr. Brian Myers: [00:29:37] Okay. 

[00:29:37] Dr. Derek Lawrence: [00:29:37] All right. I did none of those things and what, well, that's done highly true.  One, I use that all the time. I used these results as an opportunity to, to experiment with some new treatment ideas. You know, the. Classical berberine, oregano oil.

[00:29:55] I use it successfully almost all the time with the patients, Trental with the methane. So I totally agree with you on that. The garlic, I, I kind of go back and forth on some people tolerate it. Some people don't love, you know, the garlic burp...

[00:30:11] Dr. Brian Myers: [00:30:11] And I just want to jump in right there and say, so using garlic. Like food, garlic... Isn't always going to be as agreeable, the sulfur in that can be a little bit irritating to people who are SIBO positive. So I just want to jump in and say like, don't interpret that as like, Oh great. If I just eat garlic with my food, like I'm going to feel better because you might actually feel worse.

[00:30:31] Dr. Derek Lawrence: [00:30:31] Much worse!

[00:30:32] Dr. Brian Myers: [00:30:32] There's a specific chemical constituent from garlic called allicin. That's got some nice anti-microbial properties and that's what we're using. 

[00:30:40] Dr. Derek Lawrence: [00:30:40] Great. Yeah. Good. That was a great clarification. Pretty important there because like garlic, right? Yeah. I, I ate a whole bowl the garlic every day, and I know I got like a huge food baby.

[00:30:53]But I agree with you on all that. And those are things that I commonly will commonly will do. So from an herbal approach, I'll take that just in isolation. I'll we can take this. Screenshot from an, from an herbal approach. I actually experimented with a kind of a combination herbal tincture of a mixture of berberine. Like you mentioned, myrrh and thyme. 

[00:31:20] Dr. Brian Myers: [00:31:20] Cool. 

[00:31:20] Dr. Derek Lawrence: [00:31:20] So I made that tastes. Not good. But I took that a few teaspoons a couple of teaspoons three times a day. I also combined that with an herb called uva ursi and took that in a similar dosage and some argentyn 23 silver hydrosol to be, to be more specific, but yeah, in that, in that realm Yeah.

[00:31:46] So I decided to kind of try out a protocol and part of the reason why is I wanted to expand that treatment outside of hydrogen into a little bit of some biofilm disrupting, and that's probably a topic for another day. But also To cover a little hydrogen sulfide as well. The piece that you don't know about that is I do have some GI map results from diagnostics that had some enlightening information on some of the families there.

[00:32:16] So, you know, I'm kind of withholding information here. I know that's not fair, but that's why I chose the treatment. I did what I hope that that illuminates though, right? Is that there's like. There's like this, I don't want to say standard operating procedure, but there's these, these things that we know that work.

[00:32:32] But when you start to like understand the human who's sitting in front of you and you get maybe more data or more symptoms, you may have to stray away from that box and say, this is actually much more indicated. And of course. You pay attention to their symptoms, their improvements, and then, you know, retest them to make sure you were accomplishing...

[00:32:54] Dr. Brian Myers: [00:32:54] Like a good scientist. 

[00:32:55] Dr. Derek Lawrence: [00:32:55] Like a good  scientist, yeah. Accomplishing those goals. A couple of the other things. Not only that I like, I mean, I focus on myself, but these are things that I emphasize with my patients. Two to three meals a day, no snacks. And I say two to three, because I mean, some of my patients do a time restricted eating or, or what other people call intermittent fasting and they don't eat breakfast, so they kind of only eat twice a day.

[00:33:21] So. All right. Well, I don't, I'm not trying to force someone to eat three times if they're only eating twice. And it's something that I do relatively routinely, so I'm only usually using two, two times a day. But no snacking. And the mechanism behind that is to stop like drip feeding the small intestine with food to actually give that migrating motor complex.

[00:33:41] Like you said, that opportunity to fully pulsatile the, remove that food out of the small intestine. So reasonable aim or goal would be four hours between those meals then. Yeah. To help that migrating motor complex action. Yeah, so that, that is something I, I often recommend from a, like a food behavior standpoint, obviously the normal food hygiene of chew. You know, don't drink a ton of water while you're eating, you know, don't guzzle a big gulp while you're also trying to, you know, eat your...

[00:34:14] Dr. Brian Myers: [00:34:14] Ever.

[00:34:18] Dr. Derek Lawrence: [00:34:18] I moreso meant like a big gulp of water, but yeah, soda would be bad too. 

[00:34:26] Dr. Brian Myers: [00:34:26] There's never a good time for that. 

[00:34:28] Dr. Derek Lawrence: [00:34:28] Right. You know, that normal food, food hygiene stuff I think is important. I personally will occasionally use digestive enzymes to better facilitate breakdown. I think these are useful to use sometimes in real stressed out people to kind of cheat the system a little bit. And I don't love the idea of using them long-term we don't have to, but there's a time and a place. Right. For some of the maybe gallbladder missing people, we'll entertain using some ox bile as well to replace that.

[00:35:02]You know, and, and that's from, from like the beginnings of digestion to the food habits, to the meal timing. I think that's what we use. I emphasize a low carbohydrate diet. I know you, you're kind of in that same ballpark, as far as treating SIBO there, it's just removing the, you know, the source of fuel.

[00:35:22] Yeah. So that you talked about starving them, that, you know, I think there's a balance there of like making sure we can eat sustainably. Right that we feel good get enough energy, et cetera, but simultaneously, you know, try to minimize the bugs. And so from my case, I, you know, I generally maintain a relatively low carbohydrate diet though. I will say up until this, it was a little heavier than I normally ...

[00:35:49] Dr. Brian Myers: [00:35:49] You must've been adding some, some fuel to the fire here. 

[00:35:53] Dr. Derek Lawrence: [00:35:53] No question. I was, and I have choked that fuel out. And not only do, like, not only do I feel better, gastrointestinally I feel better full stop. End of sentence. You know, and I know I do.

[00:36:06] So it might be also Brian, why I love and Kelly, you're part of this too. Why I love fasting? Like maybe that's a component cause I always generally find it easy. I generally find it easy. I feel pretty good. And it's not unreasonable to think that a component of that is, you know, I've stopped poisoning myself on a routine basis with, you know, small intestinal, bacterial overgrowth.

[00:36:33]Dr. Brian Myers: [00:36:33] A Pathology of excess, you might say. Fascinating. And, and this may be more of a topic for another day. I think it is. But just, you mentioned that fasting tends to be easy for you and I just want it, like, what was it easy the first time you did it? 

[00:36:47] Dr. Derek Lawrence: [00:36:47] Yeah!

[00:36:48] Dr. Brian Myers: [00:36:48] Okay, cool. Yeah, that isn't always the case, so...

[00:36:51] Dr. Derek Lawrence: [00:36:51] Yeah, I mean, I've had harder ones, but I think that I think it's just that I don't know. It's something that I can just like wrap my head around really well. And and mentally I don't find it. I don't find it that, that hard. I love eating. I love cooking and I miss chewing when I'm fasting. But like, other than that, I don't think I miss. Like, I really don't miss food.

[00:37:14] I find I have valuable. And sustainable energy. Most of the time, sometimes getting into one, like day one, you know, it's a little rough, but but that picks up really quickly. Yeah. 

[00:37:28] Dr. Brian Myers: [00:37:28] Yeah. Like day two, day three. Yeah. 

[00:37:30] Dr. Derek Lawrence: [00:37:30] But that's just me. And I don't think that... Kellie, I  think you can...you moderate some parts of our fasting group there. I think that's the exception and not the rule, Hey? 

[00:37:39] Kellie - Marketing: [00:37:39] Yeah. Well, and we can also ask you that during a fast and not after. 

[00:37:43] Dr. Derek Lawrence: [00:37:43] Yeah. Right!

[00:37:44] Dr. Brian Myers: [00:37:44] You're not hungry. You're "hangry" right now, are ya?

[00:37:47] Dr. Derek Lawrence: [00:37:47] I think that maybe if we went back and watched some of my, like, literally like in the middle of fasting videos, people might be calling BS on that. I'm not entirely sure. But when I reflect on them, I can reflect on them fondly. So that must mean they're not miserable. 

[00:38:02] The outcome creates a space for gratitude, right? So that's noteworthy. 

[00:38:07] Yeah. So Brian, we hit on this a little bit with this migrating motor complex. But I want to focus on one thing in particular from a motility standpoint, because, pro motility agents are optimal gut motility in that small intestine from a migrating motor complex standpoint is arguably like crucial and like the crux behind this being a successful treatment or, or not. And there are there are medications that support this. There are herbs that support this.

[00:38:43] One could probably argue stress and stress reduction and overall improving gut health is going to play a large role in this. But you use a certain treatment called LDN or low dose naltrexone. Not only kind of through this lens, but also through a bigger picture lens. And I just want to hear again, it might be a bigger topic to talk about later, but I just want to talk about the usage in it for four SIBO and then a brief little, like what's the general population that's actually using this, this medication?

[00:39:15] Dr. Brian Myers: [00:39:15] Yeah. So like I mentioned earlier, regular consistent well-formed bowel movements is a goal. For SIBO treatment. And part of that meaning means having good motility, supporting the migrating motor complex as part of that. And there are some agents that we tend to use, particularly in our patient population that tends towards constipation, but not just limiting to the limited to those people. Low dose naltrexone is the off label use of naltrexone.  Naltrexone itself is an opioid antagonist. So it's used to help people with opioid addictions can also work for people that have in a positive way for people that are struggling with alcohol use. But those are topics for another day.

[00:39:57]When we're using the low dose form, we're using one 10th to one, 100th the strength of a standard naltrexone. And it seems to have some really positive benefits on overall gut health. The theorized method of action is that it blocks our opiod receptors for just long enough to promote an increase in our own endogenous endorphins.

[00:40:21] And and that has a positive effect. On a number of different levels. So LDN can be a nice Immune modulator for people struggling with autoimmune conditions and or cancer. And it can be a positive for people that are struggling with mood disorders as well. The range for LDN is wide, but the specific use for SIBO is as a mild motility agent.

[00:40:44] So it does function well as a mild motility agent, and that can be really helpful for people when we're aiming to get those regular. More consistent bowel movements than like once every couple of days or even, you know, once every other day it can be really effective to help have more consistent bowel movements. It's typically taken in the evening just prior to bedtime and can help again with that migrating motor complex while you're sleeping to help form a well-formed bowel movement in the morning. 

[00:41:11] Dr. Derek Lawrence: [00:41:11] Yeah. So it's a, it's like a unique medication. And most of my patients know, I don't like just jump to, you know, Hey, I suggest you take this medication, but this one is, has a, a lot of value in a lot of different realms, like through this lens of SIBO, especially because it can present itself in  more complex cases with anxiety or with depression or with autoimmune like it does just, you can have SIBO and these other things, and there are some one could call them side benefits and, you know, that's one of the things that I say about, of a lot of our therapies here is we try to use certain compounds that are going to have side benefits. Yes. They're going to help the problem that is taking up the most room on your plate.

[00:41:54] The thing that sucks, but it's also going to have, you know, a web of positive effects on your system. Ideally, you know, ones that you can feel and some that maybe are kind of behind the scenes, treating something objectively. 

[00:42:10] Dr. Brian Myers: [00:42:10] Yeah, there's some other nice benefits to it too. In addition to like all of the like wide ranging positive benefits, the buy-in is relatively low in that there's, there's, there's very little risks to no risk using this medication for even a short term or a longterm period of time. The half-life is relatively short, so it washes out of your system pretty quickly. And the biggest complaint I've experienced and that is reported is more vivid dreams. For some people that's fantastic. They love dreaming, and they like it when it's more real life-like. So for those people. Great. And then there's easy workarounds for people who are struggling with that, or, you know, some people experience a little bit of vertigo or I mean, you know, there's easy workarounds for those. And like I said, the risk is that there really isn't any unsavory side effects other than those kinds of things. So, yeah.

[00:42:58] Dr. Derek Lawrence: [00:42:58] Yeah. Perfect. Well, I mean, I'll, I'll end this you know, to make sure we respect everyone's time, but I'll end this in saying that sIBO is a pain in the butt literally and figuratively. And I think we got to some reasons as to why it can be because it's so multifactorial, it is dealing with microbes that are normal. They're supposed to be there, but just not in that amount. So it's like, you're not looking at eradicating a pathogen. And once it's gone, great. It's this gray area, this balance. And I think that I mean, I think that's why maybe us Naturopathic Doctors are the ones that tend to see this and understand this because we operate in this gray area of, it's not like black or white, it's this, this, this problem.

[00:43:45] And, and, and because of its multifactorial nature, its relationship to stress or potentially, food poisoning or potentially you know, structural abnormalities and nervous system dysfunction. Here is a degree of relapse that can happen and that's, that's frustrating. But I think that that is an important piece to bring up right at the forefront, that this is a chronic challenge that we're going to have to learn how to understand and help you figure out how to operate with.

[00:44:15] But you know, this conversation we got to have today was great. I think that we hit on some other, like real reasons why this problems kind of exists and, you know, illuminated those pillars that we gotta be paying attention to. Whether it's food or food timing or stress, or understanding our own medical history and how it can create an environment that might be susceptible to this, knowing the symptoms that we should be paying attention to. So if you're struggling from, you know, a, B and C..."maybe. I have SIBO?" And then maybe I want to sit in front of someone who knows what that is and then what to do about it, and also how to individualize it, because we already talked about today, how there's, you know, a handful almost a plethora of different treatment approaches for this to, to fix that.

[00:45:06] So I want to thank you for, for sharing that with our audience and, and Kellie from, from, from your perspective, anything else we need to kind of Wrap up with you have a better understanding of SIBO? 

[00:45:18] Kellie - Marketing: [00:45:18] Yeah, actually it definitely answered a lot of my questions. But I also just wanted to say if anybody has any further questions about SIBO or about any other of the treatments or things that have been talked about today, you can find on our website there is a request, an appointment section @revivenatmed.com. You can also find us on Instagram and Facebook. And we also have a free 15 minute consult that you can talk to any one of our doctors.

[00:45:49] Dr. Derek Lawrence: [00:45:49] Yeah. And and look forward to you know, having a couple more of these with you, Brian. And and these are, these are valuable opportunities to just bounce ideas off each other. 

[00:46:01] Dr. Brian Myers: [00:46:01] Yeah. Yeah, this was fun. I have like a list of other ones we can do. It's easy to make. 

[00:46:07] Dr. Derek Lawrence: [00:46:07] Perfect. Well, thank you both and have a good rest of your day. And for anyone who watched this long... thank you. 

[00:46:15] Dr. Brian Myers: [00:46:15] Thank you. Made it to the end! Congratulations!

[00:46:28] Dr. Derek Lawrence: [00:46:28] Made it to the end.

Biofeedback VS Neurofeedback: What's the Difference?

Biofeedback Explained

Biofeedback is a treatment that uses a device to help the body measure what it's doing and then feeds that information back to the body. Quite often it involves using some sort of electronic device with wires or leads that are placed somewhere on the body. That reading is some sort of physiological information that the body is giving off, and then feeding that information back to the body. Sometimes it's active or passive, meaning that the patient has a role to play or something that they need to do, and sometimes the device is just communicating with the body while the patient is sitting there calmly. The primary difference between neurofeedback biofeedback is that when the device is placed on the head, it is called neurofeedback, and anything that happens below the head, the rest of the body, is biofeedback. That's the most essential difference between the two.

In neurofeedback, there are a lot of different types. Some of them have all sorts of leads coming out of a cap and many different wires on the head—that's not the type we use at Revive. We use a type that involves one or two wires only, simultaneously on the head, and perhaps some ear clips at the end. There are no more than a few wires coming off of the head while it's reading brainwave activity, then feeding that information back to the brain in order to help the brain make balanced and positive changes. The essential difference there is that neurofeedback is going to have, the focus is going to be on the head, biofeedback is basically anywhere other than the head—we would put the leads somewhere on the body, such as the abdomen, the chest an arm or a leg, wherever it's indicated for the treatment.

What are the Uses of Biofeedback?

A common use for biofeedback is pain or dysfunction in the body. It's wonderful for helping to reset stuck pain patterns or chronic pain. It's wonderful to help speed up healing. It can also be used over the heart center for somebody who's experiencing anxiety or tension.

Leads can also be placed on the abdomen for digestive issues: constipation, gas, and bloating in the gut. It can also just be placed on the shoulders for general tension—anywhere that there is muscle tension, trigger points, etc… Different places where we can put the leads are on ankles, any joint really that's painful, any muscle that is painful—it's wonderful for that. Quite often, even though we might be treating pain, some patients experience a decrease in their stress and anxiety. Even if we're treating, say the knee, for example.

Passive or Active Treatments?

Here at Revive, we used systems of neurofeedback and biofeedback that are considered passive, meaning that the patient does not need to do anything while they're receiving the treatment. Traditionally, a lot of neurofeedback devices require that the patient pay attention to a screen or some sort of monitor. They are the ones looking at the feedback that they're getting from the device, and then actively helping to make changes. Whereas with the devices that we used here, there's no expected work on the part of the patient. They can just sit back and relax while we're helping the body to make those adjustments internally and on its own.

So why do we choose a passive versus an active approach to biofeedback and neurofeedback at Revive?

The short answer is that it allows the body to heal itself. Going more in-depth into that: I don't profess to know what a patient's body truly needs, and I believe in the natural healing ability that all of our bodies have. I also believe that our bodies are infinitely wiser than I can ever be and that the body really knows what it needs—sometimes it needs just a little bit of nudge or adjustment in moving in that direction.

So we have adopted a passive approach because it falls in line with our philosophy as Naturopathic Doctors: the body is wise and knows how to heal itself with just a little help and nudge in the right direction. The passive approach accomplishes just that, and it's really quite wonderful because the device isn't the thing healing the patient, it's the patient's own body that does the healing.

How Long are Treatments?

The duration of the treatment for both the biofeedback and neurofeedback treatments that we do in this clinic are quite short. Generally, they're just seconds long, perhaps to minutes, but usually less than a minute.

Thanks for reading this quick article about biofeedback and neurofeedback and their various uses at our clinic. If there are any questions that I didn't answer, please, don't hesitate to call our clinic and schedule a free phone call consult with me, and I'd be happy to answer any questions that you still have.

Introducing Dr. Brian Myers: Functional Medicine Doctor in California

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Dr. Brian Myers - Intro

Kellie - Marketing: [00:00:00] Hi everybody. This is Kellie at revive naturopathic medicine. I'm the marketing manager here and I am today with dr. Derek and dr. Brian Myers. We wanted to go ahead and introduce dr. Brian today and talk a little bit about the patients you see, what your approach is, and a little bit more about yourself.

[00:00:30] Dr. Derek Lawrence: [00:00:30] Well, let me start first because I want to give everybody a little understanding of,  why we're even talking with dr. Meyers today.  Brian and I have known each other for probably what. Almost close to 10 years now?

[00:00:46] Dr. Brian Myers: [00:00:46] I'd say so. Yeah, it sounds about right.

[00:00:49] Dr. Derek Lawrence: [00:00:49] And,  with, you know, dreams of,  you know, dreams of teaming up for a long time and,  more recently we got actually an opportunity to actually make that a reality.

[00:01:01] And that's been really fun, not only just from a colleague standpoint, but also, you know, checking a box off and saying like, Hey, we did it right. And, and for, you know, the folks at Revive,  some of you may recognize Brian's face. I mean, you may not.  Part of the reason is, is he's been kind of behind the scenes in a couple of our other projects, one,  our practice out in Bakersfield, which we happen to have the clinic of Sunrise Natural Medicine.

[00:01:31] So Brian's been out there seeing patients, and he'll tell you more about that as well as,  Most of our revive patients know that the,  naturally medical,  kind of director at Vera Aia, which is an all inclusive fitness and wellness retreat here in Carlsbad. And,  Brian also works there. So he's there one week a month right now, of course, you know, we've, we've kind of been closed due to COVID however, our,  opening date is in the near future.

[00:02:01] So I'm looking forward to that. And so Brian's also been participating, there working at the retreat and it's been even a valuable asset there. So that's why his face may look familiar may or may not look familiar, but he's been around for actually quite a while,  at Revive and in my life even longer.

[00:02:19] But,  I wanted to take this opportunity, Brian, for, you know, our patient base as a whole to really get to understand you know, how you got into medicine,  you know, how, you know, what your practice looks like, what do you love treating?  And you know, a little bit more about you. So, you know, I'll, I'll turn the mic over to you and,  maybe ping you on a couple of questions I want to know about.

[00:02:44] Dr. Brian Myers: [00:02:44] Sure. Thanks for the intro, both of you Kellie and dr. Derek.  That's right. I've been around for what seems like forever. I'm older than dirt. I've been living in California for a few years now. I was out in the Coachella Valley for awhile and, recently moved into LA and that's right between Carlsbad and Bakersfield.

[00:03:06] And so it's worked out really well to,  contribute from those areas. I also do a bit of telemedicine for some of our patients here in LA,  and that's been good too.  yeah, I got into medicine.  My family has been in medicine, so I always had that. I had good role models growing up.  I had my own  health issues,  in high school that kind of compelled me towards wanting to help others and understand more about,  our anatomy and physiology and what makes those things work.

[00:03:37] And,  then I taught for a while and all of that kind of lent itself to, you know, one of our core tenants is naturopathic doctors is to be teachers and here I am just teaching in a different capacity,  about really, really neat and interesting things that,  continue to  change.

[00:03:53] So,  that's just a little bit about how I came into this world and how I ended up here.

[00:03:59] Dr. Derek Lawrence: [00:03:59] Right. Brian, you know, what's unique and,  Kellie, I'm sure you'll catch this too.  Both, or all of us, me, you and Emma, all had parents in medicine.

[00:04:16] Dr. Brian Myers: [00:04:16] That's really interesting.

[00:04:17] Dr. Derek Lawrence: [00:04:17] And I didn't know that about Emma before we actually had, you know, our round table with her.  I know you well and I know your  dad,  who't the doc in the family. I think it's really kind of unique that  we ended up kind of coalescing here, because I know how intimately your, you know, upbringing in medicine,  has impacted how you operate today.  I was really interesting to learn how Emma's impact, how she offers it. And I know every single patient visit I come in bringing,  wisdom from my dad, who is the doc,  into those visits.

[00:05:03] And,  it's an interesting trend because I don't think like that is,  if I, if I recall back to NCNM or NUNM now, where we went to naturopathic medical school, I don't recall that being, I know, I know there are definitely people who had parents in medicine, but I don't recall that being as kind of stark of a trend, like three out of three, you know, as,  as we find it, the clinic here. And that's maybe why I think I gravitated towards, you know, when I, when I'm looking and reaching out for like who can help at the clinic there, maybe that's a little  subconscious,  trait that I have found to,  surround myself.

[00:05:44] Dr. Brian Myers: [00:05:44] Yeah. I mean, it's, you know, we had a lot of support from both the conventional and traditional medical standpoint, and I think that's really helped keep me balanced as a practitioner. I've I've  had a great luxury to be able to collaborate with my dad, you know, to bounce ideas off of him. And also my sister, who's a PA and like, you know, that's really lovely and I enjoy getting questions from them and, and like, The worlds that they practice in are similar and also very different.

[00:06:12] Yeah. And,  and, and that's just been really helpful because we have patients sometimes that like, I, I sometimes don't know what to do, and that's a great part about like the human body and learning, which never ends. And, and it's just nice to have those resources, in your family and also not in your family.

[00:06:31] Dr. Derek Lawrence: [00:06:31] Right. So I call, I call my dad sometimes my pocket radiologist. You know, we get a decent amount of, you know, diagnostic imaging. Right. But at the end of the day, I get my information from the reports and the report is only as good as the person doing the scan and the person reading the scan.

[00:06:50] And I've learned that from, you know, from, from being related to a radiologist. And so like, there are times in which I'll maybe need to get a specific type of scan done and be like, Hey, what do I actually have to put here to get the results I want to look? And the cool thing is this, like on the little message right behind the scenes.

[00:07:05] And I get exactly what I need or on the flip side of that, when you have these findings for like, Okay, well, nothing like is egregious here, but like there's a, B and C happening. And like, what does that mean? Like, how do we like connect those dots with that symptom?  Again, another little pocket dial to, you know,  the pocket radiologist and I can get some insight and, you know, that's been helpful at times for my patients, I think just a value that like we get to pass on as a luxury. I'm just kind of by default.

[00:07:42] Dr. Brian Myers: [00:07:42] Yeah. Yeah. It's been really nice. We've had good collaboration as naturopaths among naturopathic doctors, but extending that into,  some of the other disciplines.... it's just, it's an, it's a lovely luxury.

[00:07:54] Dr. Derek Lawrence: [00:07:54] Well, yeah, it has. And I think that, I mean, it's part of the reason why,  you know, I think we got on well together is that it's created a balance in the way in which we talk to our patients. Like I, I've literally been beside you talking to patients and,  it's something that I really appreciate about your, your bedside manner.

[00:08:20] The way you explain problems is it's very similar to me and, and I like that. I find personally it's a, it's a real digestible way.  so. That's you know, that's, that's a tip of the hat to you.

[00:08:36] Dr. Brian Myers: [00:08:36] Thanks.

[00:08:37] Dr. Derek Lawrence: [00:08:37] Yeah.

[00:08:38] Kellie - Marketing: [00:08:38] Brian, could you talk a little bit about,  The type of patient that you generally see, or if I'm somebody coming to the Revive website and I'm looking for a doctor who am I that's coming to you, Dr. Brian?

[00:08:53] Dr. Brian Myers: [00:08:53] Sure. Yeah. As Naturopathic Doctors,  I mean, or just as me specifically, I guess I've,  And, and maybe it's just a part about the, where I've been practicing, but I've seen a lot of people for hormone replacement therapy,  a lot of GI issues, and I think that's not location specific. I think that's more specific to everybody. I think a lot of people end up with gut health issues. Anyway, autoimmune  conditions too,  seem to be,  an area that I've had a lot of experience with. And,  Yeah, I think those are some big areas, metabolic issues,  cardio metabolic disease,  any sort of like trending towards,  MI risk or stroke or even diabetes, all of those kinds of like pathologies of excess.

[00:09:43] Dr. Derek Lawrence: [00:09:43] That's an interesting way of putting it "pathologies of excess."

[00:09:49] Dr. Brian Myers: [00:09:49] Well, I mean, It's not outside of the realm to kind of look at some at not outside of their normal possibility to look at them that way. I mean,  a lot of times it's, it's too much food, too much, too much of "the good life."

[00:10:06] Dr. Derek Lawrence: [00:10:06] Yeah. Right. That's breaking them down. Yeah, absolutely. I'm going to store that one for later. Thank you.

[00:10:14] Dr. Brian Myers: [00:10:14] Sure.

[00:10:24] Dr. Derek Lawrence: [00:10:24] Most of us Brian are putting stuff out on the internet, videos, blogs, et cetera. Right. Know you're writing content.  and yeah, we,  pop some of that up,  on our revive site here, but where else can people,  where else can people find you?

[00:10:56] Dr. Brian Myers: [00:10:56] Yeah.  I have a website (www.doctormyersnd.com) I can be found on Twitter on  Instagram at @DoctorMyersND.  So those are kind of the, the best ways to find me and then on the Revive website, of course.

[00:11:13] Dr. Derek Lawrence: [00:11:13] Perfect. Sounds good.  thanks so much for just taking the time. I know our patients are going to be, watching this to kind of learn a little bit more about you. And I look forward to having another one of these in the future.

Shockwave Therapy: Forearm Pain and Hand Pain

Shockwave Therapy by Doctor Derek Lawrence - a licensed Naturopathic Doctor. In this video Doc Derek treats an avid climber, carpenter, and woodworker. Shockwave Therapy works by transmitting energy into tissues to reduce inflammation, heal, repair, and mute pain for chronic injury. Treat carpal tunnel syndrome, climbing injury, sports injury, carpentry, woodworking, work injuries, and more naturally with this type of therapy.

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Derek: [00:00:00] Hey everyone. Dr. Derek Lawrence here at revive naturopathic medicine. And today we're doing a COVID edition. I'm going to show you guys some shockwave therapy with Randy here today. I'll give you a little insight into the case. Randy you're in construction and woodworking avid climber.

[00:00:21] Randy: [00:00:21] I am.

[00:00:21] Derek: [00:00:21] Yeah. So what we're dealing with is that it's actually a forearm kind of hand and wrist issue.

[00:00:27] Were there's some acute kind of shooting pain, especially when there's contraction and holding wood up. Correct? All right. Um, there've been some previous injuries to the hand, um, ligaments from climbing. Uh, but today we're going to take a look at this, do a brief physical exam and then do a shockwave treatment on Randy's hand, wrist and forearm.

[00:00:48] And so we can see how it's going to respond to that. Alright, so let's talk about shockwave for a second. Um, this is the probe we use. And if you can tell there's a little kind of pneumatic what we call piston at the very end of this and this piston moves in and out with some force. And that force is then transmitted into the tissue that you're treating.

[00:01:08] So in Randy's case, it's going to be his forearm to the wrist and into the hand. So why does this matter? What therapeutic benefit does this give? When you think about this, think about dropping a pebble into a pond, right? And when you do that, you see the kind of where drops in and then the ripples that move out from the side of it.

[00:01:28] So that's exactly what's happening with shockwave as well. We're actually transmitting energy into those tissues. Why that matters is because this actually has been shown to reduce inflammation, improve growth factor presence. So it helps you heal and repair faster. And it seems to actually mute pain as well.

[00:01:46] So all three of those things are going to help one: your forearm feel better and two: help it repair faster, especially if there is a chronic injury.

[00:01:55] So just so you know, Randy, uh, this treatment should last about maybe 10, 15 minutes. Um, that said we are going to treat it relatively large area here.

[00:02:04] Um, so the total treatment time, probably 10 to 15 minutes there. Most people feel benefit like right away, It'll feel looser. It'll feel a lot like there's a greater range of motion. Uh, and of course, if there is acute pain, which in your case, it's kind of intermittent, right? So you'll be able to tell probably later down the road as are using it, a lot of people, especially if there's chronic pain, they're noticing that improvement while they're walking out the door.

[00:02:30] that said, I tend to recommend to kind of weekly treatments for three to five weeks, depending on how long the problem has been there. And then just how it's progressing, moving forward.

[00:02:41] All right, Randy. So we're going to get going, first we're gonna put some ultrasound gel on and that's just to lubricate the probe.

[00:02:48] So we're going to start off by treating right up here where your forearm flexors insert into your arm here. And this is called your medial epicondyle. And I know from our physical exam, we kind of pushed on this area and it's a little tender, right?

[00:03:03] Randy: [00:03:03] It is.

[00:03:04] Derek: [00:03:04] So you can put your arm and let it rest on your leg there. And we'll put a little ultrasound gel here. So it's going to be loud because there's actually a lot of,  kind of noise being made by the machine to make that pneumatic piston move.

[00:03:19] Randy: [00:03:19] Alright.

[00:03:19] Derek: [00:03:19] And the ways is going to go is we're going to start at a relatively low intensity and as long as it's tolerated, we will move that up. What I tell people is that it maybe uncomfortable, but it shouldn't hurt.

[00:03:31] Right? We're not trying to cause a pain. So, but as you can tell, but even by palpating kind of gently, and there there's some tenderness in there, so it may be a little uncomfortable, but it shouldn't hurt or make the problem worse. We're going over bone, we're going over muscle ligament, tendon. So a variety of different tissues here.

[00:03:48] So of course we can't go very aggressive over bone it'll hurt. So we'll turn it down when we're around there. Any other regions we're gonna kind of modulate the intensity of it based on your tolerance level. Okay. So let's, let's get started.

[00:04:08] So as you can see, it's pretty low.

[00:04:10] Randy: [00:04:10] Do you want it up a little more?

[00:04:12] I can definitely do a little more. Yeah.

[00:04:27] [Music]

[00:04:27] Derek: [00:04:27] So the focus of energy is one: soft and two: not nearly as kind of targeted. And so the energy doesn't go as deep into the tissues. So it feels nice. It's just a very like superficial treatment and that it doesn't mean it's bad. It can actually be super useful and you can cover a broader area with those. If most of what you're dealing with is like muscle, tension, muscle tightness, blood flow, lymph movement.

[00:04:54] It's great. I got nothing against them, but if you're truly looking towards like tendon healing, Ligamentous healing, which are much more stubborn tissues to heal. Your theragun is not going to be this give you nearly the same therapeutic benefit. And I also can't necessarily comment on it's like peer review, like research literature, where there's a decent amount on shockwave therapy.

[00:05:16] You've heard of carpal tunnel syndrome before, right? So there's a big fiberous sheath that all of your, Forearm flexors, go on your knees right here. Sometimes that can get a little, you can get some adhesions in there, especially if there's been injury or climb or chronic overuse. Most of the time, the people who get a carpal tunnel syndrome, they get it from overuse injuries. Bad Kind of posture working at a computer all the time or repetitive motions of really something we were not designed to do, or in a kind of ergonomic and incorrect way.

[00:05:49] So we'll treat over there a little bit and then we'll get into what's called your Thenar eminence your big fat thumb muscle.

[00:05:55] Randy: [00:05:55] Yeah, okay

[00:05:57] Derek: [00:05:57] For lack of a better term.

[00:06:00] Randy: [00:06:00] What does carpal tunnel feel like?

[00:06:03] Derek: [00:06:03] A lot of times pain and numbness in your hand again, your median nerve. So a lot of times, these fingers right here.

[00:06:12] So you get numbness like all through your hand, cause the nerves aren't like...

[00:06:22] usually it spares your pinkey and sometimes your ring finger, cause that's your Ulnar nerve

[00:06:23] Randy: [00:06:23] Oh So the carpal tunnel goes to these fingers there.

[00:06:24] Derek: [00:06:24] A lot of times, yeah.

[00:06:30] Randy: [00:06:30] Yeah, right in there, that area's pretty tender.

[00:06:33] Derek: [00:06:33] Not painful, just a little uncomfortable?

[00:06:35] Randy: [00:06:35] Just uncomfortable.

[00:06:41] Derek: [00:06:41] And that's where you said the focus of some of the accute pain kind of starts.

[00:06:47] Randy: [00:06:47] Especially when I'm pinching stuff, yeah

[00:06:52] Derek: [00:06:52] Can you handle a little intensity there?

[00:06:55] Randy: [00:06:55] In there, yeah. If you start getting closer to like my wrist, it will be a little much.

[00:07:00] Derek: [00:07:00] Yeah, but right here we can? Our palms are pretty durable.

[00:07:05] Randy: [00:07:05] Yeah. It's been pretty beat up.

[00:07:22] Derek: [00:07:22] Alright, so we're done with the treatment. Now I'm going to put a little bit of like anti-inflammatory pain cream on there. non-medicated you may feel like tonight, tomorrow kind of like you got hit by a Mack truck.

[00:07:35]Randy: [00:07:35] Just in my arm?

[00:07:36] Derek: [00:07:36] Yeah, just in your arm, but keep in mind. Right. There's there's definitely, There's definitely some like some trauma to that tissue it's actually to stimulate the growth factor.

[00:07:46] So, we'll check in probably tomorrow and then a couple of days down the road, just to see how it's doing, how it's feeling. And especially after you get a little bit of use into it. So just know that the next kind of 72 hours were really going to be the timeframe in which I'm interested to see kind of how it improves.

[00:08:03] And then, like I said, we'll see you again next week.

[00:08:07] Randy: [00:08:07] Is there anything I should be doing in the next 72 hours to help it to rehab?

[00:08:11] Derek: [00:08:11] No, you don't. I mean, I would encourage you to like, not like overuse it. Yeah. You know, but just no, go about your daily, you know, your daily work and outside of that, you don't need to ice it. You don't need to take any pain medication. you know, that's what kind of, one of the benefits of it is that there's no downtime with this we want to see how it's going to perform. In your kind of normal day to day basis.

[00:08:42] Alright, there you go. So we'll see you next week.

[00:08:44] Randy: [00:08:44] Cool. Thank you very much.

Virtual Health Summit 2020

2020 Health Summit

Doctor Derek: Immune Regulation Through Gut Health

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