Control Pain & Heal Faster with Your Brain

00:00:00.000 | - Welcome to the Huberman Lab Podcast,

00:00:02.280 | where we discuss science and science-based tools

00:00:04.900 | for everyday life.

00:00:05.900 | I'm Andrew Huberman,

00:00:10.320 | and I'm a professor of neurobiology and ophthalmology

00:00:13.660 | at Stanford School of Medicine.

00:00:15.800 | This podcast is separate

00:00:17.000 | from my teaching and research roles at Stanford.

00:00:19.480 | It is, however, part of my desire and effort

00:00:21.620 | to bring zero cost to consumer information

00:00:23.800 | about science and science-related tools

00:00:25.920 | to the general public.

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00:04:58.580 | Let's continue our discussion about neuroplasticity,

00:05:02.500 | this incredible feature of our nervous system

00:05:04.420 | that allows it to change itself

00:05:06.280 | in response to experience and even in ways

00:05:09.260 | that we consciously and deliberately decide to change it.

00:05:13.160 | That's an incredible feature.

00:05:14.660 | No other organ in our body has that capability.

00:05:17.700 | Our nervous system, which governs everything

00:05:19.800 | about who we are, how we feel, and what we do,

00:05:22.420 | does have that capability.

00:05:24.380 | The issue is most people don't know

00:05:26.040 | how to access neuroplasticity.

00:05:28.400 | Children readily access neuroplasticity

00:05:30.740 | and they don't even realize that they're doing it.

00:05:32.960 | Adults want neuroplasticity,

00:05:35.080 | and so that's what this entire month

00:05:37.040 | of the Huberman Lab podcast has been about.

00:05:39.200 | We've explored neuroplasticity

00:05:41.220 | from a variety of different perspectives.

00:05:43.920 | We talked about representational plasticity.

00:05:45.920 | We talked about the importance of focus and reward.

00:05:48.640 | We talked about this amazing and somewhat surprising aspect

00:05:52.000 | of the vestibular system,

00:05:53.600 | how altering our relationship to gravity,

00:05:57.380 | and in addition to that, making errors as we try and learn,

00:06:01.100 | can open up windows to plasticity.

00:06:03.320 | But we have not really talked so much

00:06:06.280 | about directing the plasticity toward particular outcomes.

00:06:09.440 | And thus far, we really haven't talked yet

00:06:13.680 | about how to undo things that we don't want.

00:06:18.000 | I've talked about learning, and I say learn a language,

00:06:20.280 | learn free throws, learn a particular motor skill, et cetera.

00:06:24.320 | But what about what we would call unlearning

00:06:26.240 | or about removing some aspect of our experience

00:06:29.960 | that we don't want?

00:06:31.000 | And so today, we are going to explore

00:06:33.440 | that aspect of neuroplasticity,

00:06:35.600 | and we are going to do that in the context

00:06:38.480 | of a very important and somewhat sensitive topic,

00:06:41.960 | which is pain regeneration,

00:06:45.320 | and in some cases, injury to the nervous system.

00:06:48.480 | Now, for those of you that are fortunate enough

00:06:50.760 | to not have or had a concussion,

00:06:54.320 | or not have or know someone

00:06:56.920 | who's experiencing chronic or acute pain,

00:06:59.720 | I encourage you to stay in here with us

00:07:01.360 | because a lot of the information that we are going to cover

00:07:04.740 | has direct relevance to neuroplasticity for other purposes.

00:07:10.140 | We, as always here on this podcast,

00:07:13.120 | are going to discuss some of the science

00:07:14.920 | we get into mechanism,

00:07:16.600 | but we also really get at principles.

00:07:20.740 | Principles are far more important than any one experiment

00:07:24.500 | or one description of mechanism,

00:07:26.100 | and certainly far more important than any one protocol

00:07:29.180 | because principles allow you

00:07:30.620 | to think about your nervous system

00:07:32.400 | and work with it in ways that best serve you.

00:07:35.020 | They are very flexible batches of information.

00:07:38.620 | So we are going to talk about the principles

00:07:41.180 | of neuroplasticity for removing pain

00:07:44.240 | and wound healing and injury.

00:07:45.960 | We're going to talk about acupuncture of all things.

00:07:49.360 | We are going to talk about modern medicine's attempt

00:07:52.660 | to try and restore youth to the aging

00:07:55.840 | or injured or demented brain.

00:07:59.440 | And we are going to definitely talk about tools.

00:08:02.940 | Got a lot of tools.

00:08:03.960 | I consulted a number of fantastic colleagues at Stanford,

00:08:08.280 | at Harvard Medical School,

00:08:09.580 | and in the greater community of tissue rehabilitation,

00:08:13.360 | injury and pain management in preparation for this podcast.

00:08:16.480 | I do want to be very clear and just remind you

00:08:20.480 | that I'm not a medical doctor.

00:08:22.260 | I'm a professor, so I don't prescribe anything.

00:08:24.680 | I profess things.

00:08:25.960 | I have my beliefs,

00:08:26.980 | but the podcast is for information purposes.

00:08:29.500 | I do hope that the tools that we discuss

00:08:32.580 | will be of benefit to you.

00:08:33.600 | But as always, you should talk to your doctor

00:08:37.460 | or healthcare provider about any tools

00:08:39.760 | that you plan to add or are looking to explore,

00:08:42.640 | as well as anything that you might look to remove

00:08:45.280 | from your daily protocols.

00:08:46.560 | In other words, don't change anything

00:08:47.840 | without consulting an expert first.

00:08:49.920 | You're responsible for your health, not me.

00:08:52.200 | And I say this not just to protect me,

00:08:54.480 | but also to protect you.

00:08:56.800 | So please keep that in mind as we move forward.

00:08:59.440 | And I'm very excited to share with you this information

00:09:02.700 | because I do feel that it can be of great benefit

00:09:05.100 | to a number of people.

00:09:06.360 | So let's start our discussion about pain and sensation

00:09:10.860 | and regeneration and wound healing

00:09:13.140 | with a discussion about a very important system

00:09:16.060 | in the nervous system,

00:09:16.900 | which is the somatosensory system.

00:09:19.280 | The somatosensory system is, as the name implies,

00:09:22.860 | involved in understanding touch,

00:09:26.120 | physical feeling on our body.

00:09:28.620 | And the simplest way to think about

00:09:30.200 | the somatosensory system is that we have little sensors

00:09:33.940 | and those sensors come in the form of neurons,

00:09:36.180 | nerve cells, that reside in our skin

00:09:38.640 | and in the deeper layers below the skin.

00:09:40.700 | And indeed we do.

00:09:41.880 | We have some that correspond to,

00:09:45.360 | and we should say respond to mechanical touch.

00:09:48.980 | So, you know, pressure on the top of my hand

00:09:51.880 | or a pinpoint or other sensors, for instance,

00:09:55.700 | respond to heat, to cold.

00:09:57.980 | Some respond to vibration.

00:10:00.900 | We have a huge number of different receptors in our skin

00:10:04.600 | and they take that information

00:10:07.220 | and send it down these wires that we call axons

00:10:10.420 | in the form of electrical signals to our spinal cord

00:10:12.960 | and then up to the brain.

00:10:14.380 | And within the spinal cord and brain,

00:10:16.900 | we have centers that interpret that information,

00:10:19.780 | that actually makes sense of those electrical signals.

00:10:21.920 | And this is amazing because none of those sensors

00:10:25.780 | has a different unique form of information that it uses.

00:10:29.100 | It just sends electrical potentials into the nervous system.

00:10:31.820 | So the nervous system, you somehow decode

00:10:35.600 | what a given stimulus on your skin is.

00:10:38.300 | So maybe it's the wind blowing gently

00:10:41.240 | and deflecting some of the hairs on your arm,

00:10:44.100 | or maybe it's a sharp pinprick or a hot stove

00:10:48.500 | or the warmth of a glowing fire.

00:10:51.120 | That all arrives in your nervous system

00:10:53.440 | in the form of these electrical things

00:10:55.680 | we call action potentials, which is just amazing.

00:10:57.820 | And then the brain computes them and makes sense of them.

00:11:01.280 | So we have peripheral sensors

00:11:03.700 | and we've got stations up in our brain

00:11:05.880 | and within our spinal cord

00:11:07.080 | that makes sense of all the stuff coming in.

00:11:10.060 | Pain and the sensation of pain is, believe it or not,

00:11:14.960 | a controversial word in the neuroscience field.

00:11:17.980 | People prefer to use the word nociception.

00:11:20.740 | Nociceptors are the sensors in the skin

00:11:24.080 | that detect particular types of stimuli.

00:11:27.620 | It actually comes from the Latin word nocera,

00:11:29.580 | which means to harm.

00:11:30.900 | And why would neuroscientists not want to talk about pain?

00:11:33.440 | Well, it's very subjective.

00:11:35.220 | It has a mental component and a physical component.

00:11:38.780 | We cannot say that pain is simply an attempt

00:11:42.880 | to avoid physical harm to the body.

00:11:45.640 | And here's why.

00:11:47.100 | They actually can be dissociated from one another.

00:11:50.080 | A good example would be if, God forbid,

00:11:53.460 | you were exposed to high levels of radiation,

00:11:55.940 | such as working with some sort of material

00:11:59.440 | that was radioactive or, you know,

00:12:02.020 | you were near a former radioactive plant

00:12:04.040 | or some radiation, excessive x-rays, et cetera,

00:12:07.580 | you wouldn't feel any pain during the x-rays.

00:12:09.980 | In fact, you don't.

00:12:10.820 | If you've ever had x-rays, as I have,

00:12:12.900 | you don't feel anything.

00:12:14.380 | They put you under that lead blanket,

00:12:15.900 | they run behind a wall, and then they, in my case,

00:12:17.740 | they take these pictures of your teeth

00:12:19.260 | and it's really scary because you go,

00:12:21.580 | something really terrible must be happening here,

00:12:23.220 | but you don't feel anything.

00:12:25.040 | But there can be a lot of tissue damage.

00:12:27.740 | There can be mutations introduced to cells, et cetera.

00:12:31.020 | I've had x-rays.

00:12:31.860 | I'm not saying people shouldn't have x-rays,

00:12:33.200 | but excessive x-rays certainly are not good

00:12:35.040 | for human beings.

00:12:36.520 | Likewise, with excessive exposure to any radiation.

00:12:39.240 | So there can be tissue damage

00:12:40.940 | without the physical perception

00:12:43.700 | or mental perception of pain at all.

00:12:46.840 | As well, there can be the belief of pain

00:12:50.140 | or the feeling of pain without there being tissue damage.

00:12:52.800 | And there's a famous case that was published

00:12:55.460 | in the British Journal of Medicine

00:12:57.540 | where a construction worker,

00:13:00.140 | I think he fell, is how the story went,

00:13:03.420 | and a 14-inch nail went through his boot

00:13:08.420 | and up through the boot.

00:13:09.980 | And he was in excruciating pain,

00:13:12.980 | just beyond anything he'd experienced.

00:13:15.220 | He reported that he couldn't even move in any dimension,

00:13:18.560 | even a tiny bit, without feeling excruciating pain.

00:13:21.500 | They brought him into the clinic, into the hospital.

00:13:24.540 | They were able to cut away the boot

00:13:26.260 | and they realized that the nail had gone between two toes

00:13:29.940 | and it had actually not impaled the skin at all.

00:13:33.180 | His visual image of the nail going through his boot

00:13:37.340 | gave him the feeling, the legitimate feeling,

00:13:41.260 | that he was experiencing the pain of a nail

00:13:43.780 | going through his foot, which is incredible

00:13:45.980 | because it speaks to the power of the mind

00:13:48.540 | in this pain scenario.

00:13:50.420 | And it also speaks to the power of the specificity.

00:13:54.020 | It's not like he thought that his foot was on fire.

00:13:56.220 | He thought because he saw a nail going through his foot,

00:13:59.220 | what, it was going through his boot,

00:14:01.060 | but he thought it was going through his foot,

00:14:02.900 | that it was sharp pain of the sort that a nail would produce.

00:14:07.460 | And there are thousands of these kinds

00:14:09.740 | of case reports out there.

00:14:11.640 | Now, that is not to say that all pain that we experience

00:14:14.220 | is in our head, but it really speaks

00:14:16.620 | to the incredible capacity that these top-down,

00:14:19.940 | these higher-level cognitive functions have

00:14:22.880 | in interpreting what we're experiencing out in the periphery,

00:14:26.060 | even just on the basis of what we see.

00:14:28.580 | And the example of radiation speaks to the fact

00:14:31.740 | that pain and tissue damage are dissociable

00:14:34.600 | from one another, okay?

00:14:36.340 | So why are we talking about pain

00:14:38.340 | during a month on neuroplasticity?

00:14:41.460 | Well, it turns out that the pain system offers us

00:14:44.260 | a number of different principles that we can leverage

00:14:47.160 | to A, ensure that if we are ever injured,

00:14:51.040 | we are able to understand the difference

00:14:52.660 | between injury and pain, because there is a difference,

00:14:55.880 | that if we're ever in pain,

00:14:57.100 | that we can understand the difference

00:14:58.340 | between injury and pain,

00:15:00.740 | that we will be able to interpret our pain.

00:15:02.900 | And during the course of today's podcast,

00:15:04.880 | I'm going to cover protocols that help eliminate pain

00:15:08.880 | from both ends of the spectrum,

00:15:11.000 | from the periphery at the level of the injury,

00:15:14.300 | and through these top-down mental mechanisms.

00:15:17.860 | A lot of times on this podcast, in fact,

00:15:19.580 | mostly I tend to center on the physiology,

00:15:22.460 | on the really objective things that you can describe

00:15:26.180 | and talk about diaphragmatic movement or sunlight

00:15:28.300 | of a particular number of photons, et cetera.

00:15:30.260 | But today's a really exciting opportunity

00:15:33.180 | for us to discuss some of the more subjective things.

00:15:35.340 | Believe it or not, we're going to talk about love.

00:15:37.780 | A colleague of mine at Stanford,

00:15:39.920 | who runs a major pain clinic,

00:15:42.060 | is working on and has published quality peer-reviewed data

00:15:47.820 | on the role of love in modulating the pain response.

00:15:52.360 | Only there's a twist to it,

00:15:54.260 | and I'm not going to reveal it just yet,

00:15:55.620 | but it turns out that the specific type of connection

00:15:59.780 | one has to a romantic partner actually dictates

00:16:03.700 | whether or not their love for them

00:16:05.640 | will alleviate physical pain.

00:16:07.420 | And the effects are really robust.

00:16:09.320 | It's an amazing literature.

00:16:10.780 | And so what we're talking about today

00:16:12.180 | is plasticity of perception,

00:16:14.620 | which has direct bearing on emotional pain

00:16:18.900 | and has direct bearing on trauma

00:16:20.860 | and other things that we've discussed in previous episodes

00:16:23.020 | a little bit, but that we're going to explore even more

00:16:25.820 | in an entire month about those topics.

00:16:28.680 | So let's get started in thinking about

00:16:31.360 | what happens with pain.

00:16:34.040 | And I will describe some examples

00:16:36.940 | of some kind of extreme cases.

00:16:39.080 | For instance, I will tell you just now

00:16:41.440 | that there is a mutation, a genetic mutation,

00:16:43.680 | in a particular sodium channel.

00:16:45.120 | A sodium channel is one of these little holes in neurons

00:16:48.360 | that allows them to fire action potentials.

00:16:50.300 | It's important to the function of the neuron.

00:16:51.680 | It's also important for the development of certain neurons.

00:16:54.500 | And there's a particular mutation.

00:16:56.300 | There are kids that are born without this sodium channel 1.7

00:16:59.900 | if you want to look it up.

00:17:01.220 | Those kids experience no pain, no pain whatsoever.

00:17:04.740 | And it is a terrible situation.

00:17:07.120 | They burn themselves.

00:17:08.980 | They tend to rest on their limbs too long.

00:17:11.520 | They don't make the micro adjustments.

00:17:13.520 | You might see me swiveling around in my chair,

00:17:14.900 | moving around a lot.

00:17:15.740 | Those micro adjustments are actually normal,

00:17:18.140 | healthy micro adjustments that prevent us

00:17:20.440 | from going into pain.

00:17:21.280 | They don't make those adjustments.

00:17:22.380 | They don't get the feedback

00:17:23.920 | that they're in a particular position.

00:17:25.360 | And so they never make those adjustments

00:17:26.860 | and their joints get destroyed essentially.

00:17:30.940 | They don't tend to live very long due to accidents.

00:17:33.180 | It's a really terrible and unfortunate circumstance.

00:17:35.860 | Some people have a mutation in the same channel

00:17:39.060 | where they make too much of this channel

00:17:40.600 | so they feel too much pain.

00:17:41.720 | In fact, it's reasonable to speculate

00:17:45.220 | that one of the reasons, not all,

00:17:46.620 | but one of the reasons why people might differ

00:17:48.820 | in their sensitivity to pain is by way of genetic variation

00:17:52.540 | in how many of these sorts of receptors that they express.

00:17:56.760 | People who make too much of this receptor

00:17:59.420 | experience extreme pain from even subtle stimuli.

00:18:02.980 | Now, the good news is there are good drug treatments

00:18:06.220 | that can block specifically this sodium channel 1.7.

00:18:10.620 | And so those people get a lot of relief

00:18:12.820 | from taking such drugs.

00:18:14.560 | So pain and how much pain we are sensitive to

00:18:18.740 | or insensitive to probably has some genetic basis.

00:18:21.740 | And then of course, there are things that we can do

00:18:24.340 | to make sure that we experience less pain,

00:18:26.920 | although pain has this adaptive role.

00:18:29.300 | So let's talk about some of the features

00:18:31.720 | of how we're built physically and how that relates to pain

00:18:35.740 | and how we can recover from injury.

00:18:38.020 | So first of all, we have maps of our body surface

00:18:43.260 | in our brain, it's called a homunculus.

00:18:45.900 | In a rat, believe it or not, I'm not making this up,

00:18:48.920 | it's called a ratonculus.

00:18:50.420 | In Costello, my dog is snoring behind me,

00:18:52.960 | it's a dogunculus.

00:18:54.600 | I could get into the nomenclature and why it's called this,

00:18:57.920 | but it's basically a representation of the body surface.

00:19:00.620 | That representation is scaled in a way

00:19:04.800 | that matches sensitivity.

00:19:06.700 | So the areas of your body that are most sensitive

00:19:09.700 | have a lot more brain real estate devoted to them.

00:19:12.700 | Your back is an enormous piece of tissue

00:19:15.220 | compared to your fingertip,

00:19:16.880 | but your back has fewer receptors devoted to it

00:19:19.640 | and the representation of your back in your brain

00:19:21.640 | is actually pretty small,

00:19:23.540 | whereas the representation of your finger is enormous.

00:19:26.660 | So how big a brain area is devoted to a given body part

00:19:31.660 | is directly related to the density of receptors

00:19:35.980 | in that body part, not the size of the body part.

00:19:38.120 | And that's why if we were to draw your homunculus

00:19:40.680 | or Costello's dogunculus,

00:19:42.840 | what we would find is that certain areas like the lips,

00:19:45.880 | like the fingertips, like the genitalia,

00:19:48.260 | like the eyes and the area around the face

00:19:51.080 | would have a huge representation.

00:19:53.260 | Whereas the back, the torso and areas of the body

00:19:55.800 | that are less sensitive

00:19:57.580 | are going to have smaller representation.

00:19:59.920 | So it'd be a very distorted map.

00:20:01.940 | You can actually know how sensitive a given body part is

00:20:06.940 | and how much brain area is devoted to it

00:20:10.580 | through what's called two-point discrimination.

00:20:12.720 | You can do this experiment if you want.

00:20:13.940 | I think I've described this once or twice before,

00:20:15.620 | but basically if you have someone put,

00:20:18.940 | maybe take two pens and put them maybe six inches apart

00:20:23.420 | on your back and touch while you're facing away

00:20:26.580 | and they'll ask you how many points they're touching you

00:20:29.840 | and you say two,

00:20:31.860 | but if they move those closer together, say three inches,

00:20:34.300 | you're likely to experience it as one point of contact.

00:20:37.680 | Whereas on your finger, you could play that game all day

00:20:41.320 | and as long as there's a millimeter or so spacing,

00:20:44.480 | you will know that it's two points as opposed to one.

00:20:46.760 | And that's because there's more pixels,

00:20:48.200 | more density of receptors.

00:20:50.560 | This has direct bearing to pain

00:20:52.360 | because it says that areas of the body

00:20:54.280 | that have denser receptors

00:20:55.360 | are going to be more sensitive to pain than to others.

00:20:58.640 | And where we have more receptors,

00:21:01.500 | we tend to have more blood vessels and glia,

00:21:05.480 | which are these support cells,

00:21:07.000 | and other cells that lend to the inflammation response.

00:21:10.360 | And that's really important.

00:21:12.000 | So just as a rule of thumb,

00:21:14.280 | areas of your body that are injured,

00:21:16.240 | that are large areas that have low sensitivity before injury

00:21:19.840 | likely are going to experience less pain

00:21:23.120 | and the literature shows will heal more slowly

00:21:28.120 | because they don't have as many cells around

00:21:31.040 | to produce inflammation.

00:21:32.520 | And you might say, wait, I thought inflammation is bad.

00:21:35.160 | Well, one of the things I really want to get across today

00:21:37.220 | is that inflammation is not bad.

00:21:40.100 | Inflammation out of control is bad,

00:21:41.960 | but inflammation is wonderful.

00:21:43.860 | Inflammation is the tissue repair response.

00:21:46.680 | And we are going to talk about subjective and objective ways

00:21:49.920 | to modulate inflammation after tissue injury,

00:21:53.260 | even after just exercise that's been too intense.

00:21:56.660 | Okay, so you have this map of your body surface,

00:21:59.520 | it's sensitive in different ways, now you know why.

00:22:01.740 | So you've got your neurobiology of somatic sensation 101

00:22:05.800 | under your belt now.

00:22:07.300 | We didn't cover everything,

00:22:08.420 | but we'll touch on some of the other details

00:22:10.620 | as we go forward.

00:22:12.080 | I thought it might be a nice time to just think about

00:22:14.820 | the relationship between the periphery and the central maps

00:22:17.160 | in a way that many of you have probably heard about before,

00:22:19.220 | which will frame the discussion a little bit better,

00:22:22.500 | which is phantom limb pain.

00:22:24.780 | Now, some of you are probably familiar with this,

00:22:26.300 | but for people that have an arm or a leg or a finger,

00:22:31.740 | or some other portion of their body amputated,

00:22:35.080 | it's not uncommon for those people to feel

00:22:38.000 | as if they still have that limb or appendage

00:22:40.520 | or piece of their body intact.

00:22:42.640 | And typically, unfortunately, the sensation of that limb

00:22:47.120 | is not one of the limb being nice and relaxed

00:22:49.780 | and just there.

00:22:52.360 | The sensation is that the limb is experiencing pain

00:22:56.600 | or is contorted in the specific orientation

00:22:59.480 | that it was around the time of the injury.

00:23:01.420 | So if someone has a blunt force to the hand

00:23:04.460 | and they end up having their hand amputated,

00:23:06.320 | typically they will continue to feel pain

00:23:08.740 | in their phantom hand, which is pretty wild.

00:23:11.800 | And that's because the representation of that hand

00:23:14.820 | is still intact in the cortex, in the brain,

00:23:18.180 | and it's trying to balance its levels of activity.

00:23:21.220 | Normally, it's getting what's called

00:23:22.620 | proprioceptive feedback.

00:23:24.180 | Proprioception is just our knowledge

00:23:26.100 | of where our limbs are in space.

00:23:27.580 | It's an extremely important aspect

00:23:29.460 | of our somatosensory system.

00:23:31.640 | And there's no proprioceptive feedback,

00:23:34.600 | and so a lot of the circuits start to ramp up

00:23:36.620 | their levels of activity, and they become very conscious

00:23:39.520 | of the phantom limb.

00:23:41.220 | Now, before my lab was at Stanford, I was at UC San Diego,

00:23:44.540 | and one of my colleagues was a guy,

00:23:46.620 | everyone just calls him by his last name, Ramachandran,

00:23:49.540 | who is famous for understanding this phantom limb phenomenon

00:23:52.860 | and developing a very simple but very powerful solution

00:23:55.700 | to it that speaks to the incredible capacity

00:23:59.940 | of top-down modulation.

00:24:01.620 | And top-down modulation, the ability to use one's brain,

00:24:04.640 | cognition, and senses to control pain in the body

00:24:07.960 | is something that everyone, not just people missing limbs

00:24:11.300 | or in chronic pain, can learn to benefit from

00:24:13.180 | because it is a way to tap into our ability

00:24:16.540 | to use our mind to control perceptions

00:24:20.140 | of what's happening in our body.

00:24:22.300 | And this is not a mystical statement.

00:24:23.760 | This is not about mind, I guess, as much as his brain

00:24:27.440 | to control our perceptions of our body.

00:24:29.120 | So what did Ramachandran do?

00:24:32.080 | Ramachandran had people who were missing a limb

00:24:37.080 | put their intact limb into a box that had mirrors in it

00:24:42.540 | such that when they looked in the box

00:24:44.420 | and they moved their intact limb, the opposite limb,

00:24:49.140 | which was a reflection of the intact limb

00:24:51.260 | 'cause they're missing the opposite limb,

00:24:52.960 | they would see it as if it was intact.

00:24:55.940 | And as they would move their intact limb,

00:24:58.020 | they would visualize with their eyes

00:25:00.680 | the limb that's in the place of the absent limb,

00:25:05.340 | so this is all by mirrors, moving around

00:25:07.660 | and they would feel immediate relief from the phantom pain.

00:25:12.660 | And he would tell them and they would direct their hand

00:25:16.060 | toward a orientation that felt comfortable to them.

00:25:20.360 | Then they would exit the mirror box.

00:25:22.100 | They would take their hand out and they would feel

00:25:26.400 | as if the hand was now in its relaxed normal position.

00:25:29.380 | So you could get real time in moments,

00:25:32.160 | remapping of the representation of the hand.

00:25:35.020 | Now that's amazing.

00:25:36.140 | This is the kind of thing that all of us

00:25:37.460 | would like to be able to do if we are in pain.

00:25:39.860 | If you stub your toe, if you break your ankle,

00:25:41.780 | if you take a hard fall on your bike

00:25:43.620 | or if you're in chronic pain,

00:25:45.420 | wouldn't it be amazing to be able to use a mind trick,

00:25:50.420 | but it's not a trick, right?

00:25:51.900 | Because it's real visual imagery

00:25:54.100 | to remap your representation of your body surface

00:25:57.820 | and where your body is.

00:25:59.220 | That is something that we could all benefit from

00:26:02.500 | because if you do anything for long enough, including live,

00:26:05.960 | you're going to experience pain of some sort.

00:26:08.140 | And this, again, I just want to remind you

00:26:09.980 | isn't just about physical injuries and pain.

00:26:12.540 | This has direct relevance to emotional pain as well,

00:26:16.120 | which we, of course, we'll talk about.

00:26:18.580 | So the Ramachandran studies were really profound

00:26:21.300 | because they said a couple of things.

00:26:22.540 | One, plasticity can be very fast,

00:26:25.220 | that it can be driven by the experience of something,

00:26:28.880 | just the visual experience.

00:26:29.940 | He had people do this mirror box thing,

00:26:32.460 | but not look into the mirror box

00:26:34.120 | and they didn't get the remapping.

00:26:35.420 | So it required visual imagery coming in.

00:26:37.900 | We also know, for instance,

00:26:41.100 | that in cases like where people are congenitally deaf,

00:26:45.680 | the cochlear implant, which is simply a way of putting,

00:26:50.380 | it's not simple, but it's a way of putting in a device

00:26:53.220 | that replaces the cochlea,

00:26:54.640 | the device that we're normally born with in the ear

00:26:59.380 | that has these little, what are called hair cells

00:27:01.380 | that deflect according to sound waves and allow us to hear

00:27:04.280 | by replacing the normal hearing apparatus

00:27:07.420 | that's deficient in deaf people with this cochlear implant,

00:27:12.060 | the brain can make sense of this artificial ear, basically.

00:27:15.740 | It's not the outside ear, not the pinna, but the inner ear.

00:27:18.780 | And they can start to hear sounds.

00:27:21.620 | Now, some people really like the artificial cochlea.

00:27:26.620 | They really benefit from it.

00:27:28.580 | It restores their ability to hear and they like it.

00:27:31.920 | Other people don't.

00:27:32.960 | Some deaf people would prefer not to hear anything,

00:27:35.420 | can be very disruptive to them.

00:27:36.980 | And some of that might have to do with the need

00:27:39.100 | for further, better engineering of these artificial cochleas.

00:27:42.420 | But all this really speaks to the fact

00:27:44.680 | that the brain is an adaptive device.

00:27:47.820 | It will respond to what you give it.

00:27:50.140 | It is not a device that is fixed.

00:27:52.020 | In fact, the essence of the brain,

00:27:53.640 | especially the human brain, is to take sensory inputs

00:27:56.900 | and to make sense of those, meaning cognitive sense,

00:28:01.000 | and then to interpret those signals.

00:28:02.700 | And so this may come as a shock to some of you,

00:28:05.180 | and by no means am I trying to be insensitive,

00:28:07.100 | but pain is a perceptual thing

00:28:09.980 | as much as it's a physical thing.

00:28:11.900 | It's a belief system about what you're experiencing

00:28:14.780 | in your body, and that has important relevance

00:28:17.220 | for healing different types of injury

00:28:19.100 | and the pain associated with that injury.

00:28:21.620 | In people's pursuit for neuroplasticity,

00:28:24.260 | a question that comes up every once in a while

00:28:26.820 | is people will say, you know, if I just brush my teeth

00:28:29.720 | with the opposite hand for a couple nights in a row,

00:28:32.040 | will I get neuroplasticity?

00:28:34.140 | And the answer is probably yes.

00:28:36.300 | I mean, it's a deliberate action.

00:28:37.580 | You're focusing on it.

00:28:38.500 | There's an end goal.

00:28:39.340 | You're very likely to make errors,

00:28:40.760 | like dropping an anterior lip and gums at first

00:28:43.500 | and then getting better at it.

00:28:44.340 | And as you heard in last episode,

00:28:46.180 | making errors is really important

00:28:48.100 | 'cause those errors are the signal

00:28:49.740 | that plasticity needs to happen.

00:28:51.340 | And then when you get the actions correct,

00:28:54.200 | then those correct actions are programmed in.

00:28:56.440 | I'm not sure that brushing one's teeth

00:29:00.220 | with the opposite hand is the most effective use

00:29:04.100 | of this incredible thing that we have, which is plasticity.

00:29:06.620 | It's not going to open up plasticity for many other things.

00:29:09.460 | So if that were really important to you for whatever reason,

00:29:13.340 | maybe you have a crowded bathroom

00:29:14.900 | and it's easier to do on one side or the other than fine.

00:29:17.140 | But it's kind of hard to imagine

00:29:18.220 | why this would be a highly adaptive behavior,

00:29:20.660 | unless of course you have an injured limb

00:29:22.180 | or you're missing a limb.

00:29:23.260 | And that gets me to some really exciting

00:29:25.460 | and important studies that were performed

00:29:28.000 | mostly in the '90s as well as in the 2000s.

00:29:31.180 | And that for now there is really a solid base of data.

00:29:34.340 | There's really a center of mass

00:29:35.980 | around a particular set of experiments

00:29:39.300 | that point to particular protocols

00:29:41.660 | for how to overcome motor injury.

00:29:44.900 | And this may resonate with some of you

00:29:46.700 | who've ever been injured to the point

00:29:48.340 | where you couldn't walk well temporarily, I hope,

00:29:52.600 | or even longer.

00:29:53.700 | So think about a sprained ankle scenario

00:29:56.220 | or a broken arm scenario.

00:29:58.020 | We're all familiar with the stories

00:30:01.240 | of people having a cast on and then getting the cast off

00:30:04.180 | and that the particular limb that wasn't being used

00:30:06.860 | that was casted is much smaller and atrophied.

00:30:10.140 | Most of that atrophy you might be surprised to learn

00:30:13.380 | is not because the muscles aren't being used,

00:30:15.980 | it's because the nerves sending signals to those muscles

00:30:19.020 | are not active and therefore the muscles aren't contracting.

00:30:22.460 | Work done by a guy named Timothy Schallert

00:30:26.860 | and his graduate students and postdocs,

00:30:30.160 | Teresa Jones and others in the '90s and 2000s

00:30:34.300 | showed something really wonderful

00:30:36.180 | that I think we can all benefit from

00:30:38.100 | should we have an injury.

00:30:39.420 | And even if we simply want to balance out imbalances

00:30:43.420 | in our motor activity.

00:30:44.880 | And I think all of us tend to be stronger on one side

00:30:48.340 | or the other side.

00:30:49.180 | Usually a right-handed person will be stronger

00:30:52.620 | in their left arm, not always for compensatory reasons.

00:30:57.620 | Some other time we can talk about handwriting.

00:30:59.260 | The lefties likely will be stronger in their right arm,

00:31:02.400 | although it kind of depends

00:31:03.380 | on whether or not people are hook righties.

00:31:05.300 | That's when you kind of hook around and right from the top

00:31:07.220 | or hook lefties.

00:31:08.540 | There are all sorts of theories about this

00:31:09.840 | that we can talk about right brain, left brain,

00:31:11.900 | math proficiency, et cetera.

00:31:13.780 | In any event, what Schallert and colleagues showed

00:31:16.420 | was that if we have damage to our brain

00:31:19.940 | in the sensory motor pathways,

00:31:23.540 | any number of different sensory motor pathways,

00:31:25.380 | or we have damage to a limb,

00:31:28.980 | could be a leg, could be an arm, could be a hand,

00:31:31.420 | there's great benefit to restricting the use

00:31:36.840 | of the opposite better performing uninjured limb

00:31:41.840 | or hand or other part of the body.

00:31:45.880 | They had about a dozen papers showing

00:31:48.420 | that if there was damage centrally in the brain

00:31:50.420 | or there was damage to a limb,

00:31:52.100 | so unilateral damage, as we say, one side,

00:31:55.220 | the thing to do is not to cast up the damaged side,

00:32:00.220 | although you need to do that to protect the limb,

00:32:02.820 | of course, from further damage.

00:32:04.100 | So if it's a broken arm, you need to cast the arm

00:32:05.940 | or you need to brace the arm,

00:32:07.560 | but that the key thing was to restrict movement

00:32:11.580 | of the intact uninjured opposite limb.

00:32:14.920 | And when they did that,

00:32:16.940 | it forced some movement in the injured limb.

00:32:21.240 | And remarkably, through connections

00:32:24.300 | from the two sides of the brain,

00:32:26.400 | through the corpus callosum, this huge fiber pathway

00:32:28.780 | that links the two sides of the brain,

00:32:30.700 | they saw plasticity on both sides of the brain.

00:32:34.060 | So this makes sense when you hear it.

00:32:36.460 | Let's say I injure my left ankle

00:32:39.620 | and I'm limping along or I'm using crutches.

00:32:42.940 | You would think, well, the last thing you want to do

00:32:44.380 | is injure your opposite limb or not use your opposite limb.

00:32:48.140 | My right ankle is perfectly fine.

00:32:49.980 | But if I lean too hard on my right limb

00:32:53.080 | and I take all the work out of the left limb,

00:32:55.860 | the left ankle, that's actually setting up a situation

00:32:59.180 | where there's going to be runaway asymmetry

00:33:01.240 | in the central pathways and the nerve to muscle pathways

00:33:05.100 | on my left side.

00:33:06.360 | And so what they suggested and what they showed

00:33:09.460 | in a variety of experiments was that by encouraging activity

00:33:13.560 | of the injured limb, provided it could be done without pain,

00:33:17.500 | and importantly, not just exercising that limb

00:33:21.420 | or part of the body, but restricting the opposite healthy

00:33:25.020 | part of the body, that the speed of recovery

00:33:29.180 | was significantly faster.

00:33:31.120 | Now, I want to repeat.

00:33:32.120 | You don't want to go injuring something further.

00:33:34.020 | That's probably the worst thing you could do.

00:33:36.140 | But in some cases where people have damage in their brain,

00:33:39.260 | the limbs are perfectly fine,

00:33:40.660 | but the motor signals aren't getting down to the limbs.

00:33:42.900 | And in that case, the limb is fine.

00:33:45.380 | So you actually are free to use either limb

00:33:48.900 | as much as you want.

00:33:49.780 | And in that case, you don't want to rely

00:33:51.700 | on the uninjured pathway too much.

00:33:53.400 | In fact, you want to restrict the uninjured pathway.

00:33:56.200 | So I find these studies remarkable.

00:33:58.420 | And they've been followed up on at the molecular level,

00:34:00.460 | at the cellular level, many times.

00:34:02.540 | And I think the physiotherapists out there

00:34:04.440 | and the rest of you who are involved in sports medicine

00:34:07.120 | and some of the physicians will say,

00:34:08.400 | "Well, of course, that makes perfect sense."

00:34:10.100 | But oftentimes this is not what happens.

00:34:12.920 | Oftentimes what happens is it's all about resting

00:34:15.440 | and limiting inflammation, et cetera, of the injured limb

00:34:19.460 | or the limbs corresponding to the injured part of the brain.

00:34:23.820 | And these experiments and the collection of them

00:34:27.560 | point to the fact that the balance between the right

00:34:30.760 | and left side of our body is always dynamic.

00:34:33.320 | It's always being updated at the level of neural circuitry.

00:34:36.100 | The Ramachandran studies with the mirror box

00:34:37.940 | support that too.

00:34:39.020 | And that even slight imbalances

00:34:41.480 | in the two sides of the body can get amplified.

00:34:43.980 | And so when you're in a situation where one side is injured

00:34:46.700 | or the brain is injured representing one side of the body,

00:34:49.240 | the key thing to do is to really overwork the side

00:34:53.140 | that needs the work and to restrict the activity

00:34:56.820 | of the side that doesn't need the work because it's healthy.

00:34:59.880 | And this has great semblance to ocular dominance plasticity,

00:35:04.400 | which I talked about a couple episodes ago.

00:35:06.360 | I won't go into it in detail,

00:35:07.760 | but where the Nobel prize-winning neurobiologists,

00:35:10.760 | Torrance Wiesel and David Hubel showed

00:35:12.240 | that if one eye is closed early in development,

00:35:15.440 | that the representation of the opposite eye in the brain

00:35:19.040 | is completely overtaken by the intact eye.

00:35:22.300 | So this is important.

00:35:24.640 | It means that all of our senses and our movements

00:35:27.500 | are competing for space in our brain.

00:35:30.340 | And so the way to think about the principle

00:35:32.640 | is anytime you're injured and you're hobbling along,

00:35:36.700 | you don't want to injure yourself further,

00:35:38.700 | but you want to try and compensate

00:35:41.460 | in the ways that respect this competition

00:35:44.800 | for neural real estate.

00:35:46.220 | And what that usually means is not relying

00:35:48.660 | on where you're still strong

00:35:50.780 | because that's just going to create runaway plasticity

00:35:53.260 | that's going to make it very hard for you

00:35:54.880 | to recover the motor function.

00:35:57.100 | And in some cases, the sensory function of the damaged limb.

00:36:00.620 | Some of you may be wondering how long

00:36:03.300 | and how often one should restrict the activity

00:36:05.840 | of the intact or healthy limb or limbs in some cases.

00:36:10.840 | And the answer is you don't have to do that

00:36:13.120 | all day every day.

00:36:14.220 | These experiments centered on doing one or two hours

00:36:17.840 | of dedicated work, sensory motor work,

00:36:21.080 | or so for instance, if you had a sprained ankle on the left,

00:36:25.120 | you might spend part of the day where your left leg,

00:36:28.220 | provided it's not too painful, can be exercised,

00:36:31.040 | again, in a way that's not damaging to the injury,

00:36:34.820 | and the right limb can't contribute to that exercise.

00:36:37.700 | So this might be pedaling unilaterally on a stationary bike.

00:36:42.180 | If you can do that for a different type of limb injury,

00:36:45.140 | like an arm injury, this might be reaching,

00:36:48.540 | provided the shoulder is mobile, doing reaching.

00:36:50.980 | It might be even writing with the damaged side,

00:36:54.860 | and then intentionally not writing

00:36:56.920 | with the preferred or undamaged side.

00:36:59.500 | This has been shown to accelerate the central plasticity

00:37:03.580 | and the recovery of function,

00:37:05.300 | which I think is what most people want.

00:37:07.400 | When people are injured, they want to get back

00:37:09.180 | to doing what they were doing previously,

00:37:10.980 | and they want to be able to do that without pain.

00:37:14.660 | Now, this brings up another topic,

00:37:16.740 | which is definitely related to neuroplasticity and injury,

00:37:20.400 | but is a more general one that I hear about a lot,

00:37:23.820 | which is traumatic brain injury.

00:37:25.260 | Many injuries are not just about the limb

00:37:27.780 | and the lack of use of the limb,

00:37:29.840 | but concussion and head injury.

00:37:31.900 | And I want to emphasize, I'm not a neurologist.

00:37:34.300 | I have many colleagues that are.

00:37:35.380 | At some point, we will do a whole month on TBI

00:37:38.740 | because it's such a serious issue,

00:37:40.500 | and it's such a huge discussion.

00:37:42.320 | But I want to talk a little bit about what is known

00:37:46.340 | about recovery from concussion.

00:37:48.060 | And this is very important because it has implications

00:37:52.820 | for just normal aging as well,

00:37:54.500 | and offset setting some of the cognitive decline

00:37:58.180 | and physical decline that occurs with normal aging.

00:38:01.520 | So we shouldn't think of TBI as just

00:38:03.580 | for the football players,

00:38:04.420 | or just for the kids that had an injury,

00:38:06.040 | or just for the person that was in the car accident.

00:38:07.740 | We want to learn about TBI and understand TBI

00:38:10.300 | for those folks, but we're also going to talk about TBI

00:38:14.180 | as it relates to general degradation of brain function,

00:38:18.460 | because there's a certain semblance there

00:38:20.980 | of TBI to general brain aging.

00:38:23.860 | Typically after TBI,

00:38:25.060 | there are a number of different things that happen,

00:38:26.560 | and there are a huge range of things that can create TBI.

00:38:30.020 | Neurologists and the emergency room physicians

00:38:33.980 | are going to want to know,

00:38:35.080 | was the skull itself injured,

00:38:38.900 | or did the brain rattle around in the skull?

00:38:42.420 | Was there actually a breach through the skull?

00:38:45.260 | Is there a physical object in there?

00:38:47.560 | How many concussions has the person had?

00:38:49.240 | I mean, everyone's situation with TBI

00:38:51.300 | is incredibly different,

00:38:52.700 | but there's a constellation of symptoms that many people,

00:38:55.420 | if not all people with TBI report,

00:38:57.100 | which is headache, photophobia,

00:39:00.100 | that lights become kind of aversive,

00:39:01.900 | sleep disruption, trouble concentrating,

00:39:04.280 | sometimes mood issues.

00:39:06.700 | There's a huge range,

00:39:07.940 | and of course the severity will vary, et cetera.

00:39:11.660 | In a previous episode, I mentioned the Kennard Principle.

00:39:15.100 | The Kennard Principle, named after the famous neurologist,

00:39:18.900 | named by and after the famous neurologist, Margaret Kennard,

00:39:22.600 | said that if you're going to get a brain injury,

00:39:24.100 | better to get it early in life than later in life,

00:39:26.180 | and that's because the brain has a much greater

00:39:28.060 | or heightened capacity for repairing itself

00:39:30.580 | early in life than later.

00:39:32.300 | But of course, none of us want TBI,

00:39:34.280 | and you can't pick when you get your TBI.

00:39:36.220 | You can avoid certain activities that would give you TBI,

00:39:39.020 | but really when it comes to TBI,

00:39:42.180 | there are a couple of things

00:39:43.060 | that are agreed upon across the board.

00:39:46.020 | The first one is as much as possible,

00:39:47.980 | you want to avoid a second traumatic brain injury

00:39:51.020 | or concussion.

00:39:52.020 | Now that's going to be a tough one for some of the athletes

00:39:54.700 | and even recreational athletes to swallow

00:39:57.440 | because they want to continue in their sport,

00:40:00.260 | and I'm not here to tell you that you should or you shouldn't

00:40:02.740 | but that's simply the way that it is.

00:40:07.280 | For folks that are in military

00:40:08.900 | or that are in certain professions,

00:40:11.420 | construction is a place where we see a lot of TBI.

00:40:14.300 | It's not always just football.

00:40:15.620 | A lot of construction workers are dealing

00:40:17.040 | with heavy objects swinging around in space.

00:40:19.840 | They wear those hard hat helmets,

00:40:21.480 | which unfortunately don't protect much

00:40:23.340 | against a lot of those blunt forces

00:40:25.980 | and certainly not against falls and things of that sort.

00:40:28.500 | So many people, in order to survive and feed their families,

00:40:31.340 | have to go back to work.

00:40:32.540 | It's very clear that regardless of whether or not

00:40:36.140 | there was a skull break,

00:40:37.260 | and regardless of when the TBI happened

00:40:39.500 | or how many times it's happened,

00:40:41.740 | that the system that repairs the brain, the adult brain,

00:40:45.500 | is mainly centered around this lymphatic system

00:40:49.500 | that we call for the brain the glymphatic system.

00:40:53.000 | Now, the brain wasn't thought to have a lymphatic system.

00:40:55.900 | It wasn't thought to have circulating immune cells,

00:40:58.260 | but about 10 years ago, it was sort of rediscovered

00:41:01.820 | because if you look in the literature,

00:41:02.880 | you realize this stuff was around longer,

00:41:04.700 | that there's a glymphatic system.

00:41:05.980 | It's sort of like a sewer system

00:41:07.660 | that clears out the debris that surrounds neurons,

00:41:11.780 | especially injured neurons,

00:41:13.340 | and the glymphatic system is very active during sleep.

00:41:17.460 | It's been imaged

00:41:18.900 | in functional and magnetic resonance imaging,

00:41:21.900 | and the glymphatic system is something

00:41:23.580 | that you want very active

00:41:24.960 | because it's going to clear away the debris

00:41:26.760 | that sits between the neurons,

00:41:28.900 | and the cells that surround the connections

00:41:31.980 | between the neurons, called the glia,

00:41:34.440 | those cells are actively involved

00:41:36.260 | in repairing the connections between neurons when damaged.

00:41:40.140 | So the glymphatic system is so important

00:41:44.880 | that many people, if not all people who get TBI,

00:41:47.800 | are told get adequate rest, you need to sleep,

00:41:50.740 | and that's kind of twofold advice.

00:41:52.100 | On the one hand, it's telling you to get sleep

00:41:54.180 | because all these good things happen in sleep.

00:41:56.260 | It's also about getting those people

00:41:59.140 | to not continue to engage in their activity full-time

00:42:01.860 | or really try and hammer through it.

00:42:04.660 | You might say, well, if you have trouble sleeping,

00:42:07.000 | how are you supposed to get deep sleep?

00:42:09.080 | Most of the activity of the glymphatic system,

00:42:11.100 | this washout of the debris,

00:42:12.580 | is occurring during slow-wave sleep.

00:42:15.080 | Slow-wave sleep, as I mentioned in a previous episode,

00:42:18.080 | is something that happens typically

00:42:19.200 | in the early part of the evening.

00:42:21.240 | So even for those of you that are falling,

00:42:23.080 | or early part of the night, rather,

00:42:24.480 | if you're falling asleep

00:42:25.300 | and then waking up three, four hours later,

00:42:26.920 | it's important that you continue to get sleep,

00:42:30.720 | but know that the slow-wave sleep is mainly packed

00:42:33.800 | toward the early part of the night.

00:42:35.600 | So that hopefully will alleviate some of the anxiety

00:42:39.220 | of the three and 4 a.m. wake up,

00:42:41.060 | although you really should follow some of the protocols

00:42:43.620 | that I've suggested in your physician's protocols

00:42:45.620 | in order to try and get regular,

00:42:47.200 | longer sleep of seven, eight hours.

00:42:49.320 | Later, we're going to talk about the eight-hour mark

00:42:51.000 | as a prerequisite for repair.

00:42:52.900 | The glymphatic system has been shown

00:42:56.880 | to be activated further in two ways.

00:43:00.480 | One is that sleeping on one side,

00:43:03.920 | not on back or stomach,

00:43:05.560 | seems to increase the amount of washout,

00:43:09.480 | or wash through, I should say, of the glymphatic system.

00:43:12.860 | There aren't a ton of data on this,

00:43:14.200 | but the data that exist are pretty solid.

00:43:17.060 | Again, sleeping on one side,

00:43:19.160 | or with feet slightly elevated as well,

00:43:23.380 | has been shown to increase the rate of clearance

00:43:26.520 | of some of the debris,

00:43:27.800 | and that's because the way that the glymphatic system works

00:43:31.240 | is it has a physical pressure fluid dynamic to it

00:43:35.560 | that allow it to work more efficiently

00:43:38.920 | when one is sleeping on their side,

00:43:40.460 | or with feet slightly elevated.

00:43:42.100 | So this means not falling asleep in a chair

00:43:44.760 | while watching TV.

00:43:46.100 | This means, if possible, not falling asleep on one's back

00:43:49.600 | or on one's stomach, sleeping on one's side.

00:43:52.180 | And if you can't do that,

00:43:53.320 | like I don't really like to sleep on my side,

00:43:55.000 | I sleep with my feet slightly elevated,

00:43:56.480 | I put a kind of thin pillow under my ankles.

00:43:58.560 | I don't have TBI,

00:44:00.400 | but I have had a few concussions before,

00:44:03.560 | but right now I feel fine,

00:44:05.480 | but I find that putting the pillow under my ankles

00:44:08.200 | helps me sleep much more deeply,

00:44:10.000 | and I wake up feeling much more refreshed.

00:44:12.760 | The other thing that has been shown to improve the function

00:44:16.600 | of the glymphatic system,

00:44:18.020 | and this is, again, is for sake of TBI,

00:44:21.840 | as well as for everyone, even without brain injury,

00:44:25.440 | is a certain form of exercise.

00:44:27.840 | And I want to be very, very clear here.

00:44:29.760 | I will never, and I am not suggesting

00:44:32.440 | that people exercise in any way that aggravates their injury

00:44:37.440 | or that goes against their physician's advice.

00:44:41.400 | Take your physician's advice

00:44:43.000 | as to whether or not you should be exercising at all

00:44:45.920 | and how much and into what intensity.

00:44:48.240 | However, there's some interesting data,

00:44:51.280 | and we can provide a link to the review on this,

00:44:54.520 | which shows that exercise of what,

00:44:57.180 | I guess people would nowadays call it zone two cardio,

00:45:00.080 | which is kind of low level cardio

00:45:02.540 | that one could do while talking to somebody else.

00:45:04.900 | You could maintain a conversation,

00:45:06.400 | although you don't have to talk to somebody else.

00:45:08.280 | It just gives you a sense of the intensity of the exercise.

00:45:10.980 | That zone two cardio for 30 to 45 minutes,

00:45:14.240 | three times a week,

00:45:15.920 | seems to improve the rates of clearance

00:45:19.480 | of some of the debris after injury,

00:45:22.360 | and in general, injury or no,

00:45:24.640 | to accelerate and improve the rates of flow

00:45:28.760 | for the glymphatic system.

00:45:31.120 | I find this really interesting

00:45:32.540 | because I think nowadays there's such an obsession

00:45:34.540 | with like high intensity interval training

00:45:36.720 | and people trying to pack in as much as they can

00:45:39.140 | into a short workout,

00:45:40.360 | which is great if it brings people to the table

00:45:42.520 | who haven't been exercising before,

00:45:44.420 | but I think it's really important

00:45:46.360 | that we know that the data on exercise

00:45:49.160 | and its relationship to brain health

00:45:51.200 | speak to doing 30 to 45 minutes

00:45:54.540 | of this kind of what we call low level cardio.

00:45:57.920 | It could be fast walking.

00:45:59.600 | It could be jogging.

00:46:00.920 | If you can do that with your injury safely,

00:46:03.040 | it could be cycling.

00:46:04.640 | This is not the kind of workout

00:46:06.440 | that's designed to get your heart rate up

00:46:08.640 | to the point where you're improving your fitness levels

00:46:10.880 | at some sort of massive rate

00:46:14.280 | or taking huge jumps in your VO2 max or anything like that.

00:46:18.040 | This is exercise.

00:46:19.120 | I do this and I know a number of other people,

00:46:22.040 | especially people in communities where there is a lot of TBI

00:46:24.700 | are now starting to adopt this,

00:46:27.000 | that the 30 to 45 minutes, three times a week or so,

00:46:30.400 | could be more, of this zone two type cardio

00:46:34.720 | can be very beneficial for washout of debris from the brain.

00:46:37.800 | And this is really interesting outside of TBI

00:46:40.360 | because what we know from aging

00:46:42.760 | is that aging is a non-linear process.

00:46:45.400 | It's not like with every year of life,

00:46:47.240 | your brain gets a little older.

00:46:48.840 | It has sometimes it follows

00:46:50.680 | what's more like a step function.

00:46:52.200 | You get these big jumps in markers of aging.

00:46:55.720 | I guess that we could think of them as jumps down

00:46:57.440 | because it's a negative thing for most everybody

00:47:00.040 | would like to live longer and be healthier

00:47:01.800 | in brain and body.

00:47:02.720 | And so the types of exercise I'm referring to now

00:47:06.280 | are really more about brain longevity

00:47:09.080 | and about keeping the brain healthy

00:47:11.340 | than they are about physical fitness.

00:47:14.200 | There's no reason why you couldn't do this

00:47:15.640 | and also provided again, it's safe for you

00:47:19.160 | given your brain state and injury state, et cetera.

00:47:21.840 | There's no reason why you couldn't also combine it

00:47:24.820 | with weight training and other forms of cardio.

00:47:27.220 | So I think this is really interesting.

00:47:28.620 | And if some of you would like to know the mechanism

00:47:30.740 | or at least the hypothesized mechanism,

00:47:33.280 | there's a molecule called aquaporin-4.

00:47:36.880 | It almost sounds like the fourth in a sequel of movies

00:47:40.120 | or something like that.

00:47:40.960 | But aquaporin-4 is a molecule that is related

00:47:45.960 | to the glial system.

00:47:47.580 | So glia or the, it means glue in Latin

00:47:49.700 | are these cells in the brain,

00:47:51.340 | the most numerous cells in the brain, in fact,

00:47:53.320 | that in sheath synapses, but they're very dynamic cells.

00:47:56.080 | They're like little ambulance cells.

00:47:57.760 | The microglia will run in and will gather up debris

00:48:01.360 | and soak it up and then run out after an injury.

00:48:04.480 | Aquaporin-4 is mainly expressed by the glial cell

00:48:06.720 | called the astrocyte.

00:48:07.880 | Astro looks like a little star.

00:48:10.000 | Incredibly interesting cells.

00:48:11.720 | And the thing to remember is that the astrocytes

00:48:16.040 | bridge the connection between the neurons,

00:48:19.720 | the synapse, the connections between them

00:48:22.980 | and the vasculature, the blood system

00:48:25.320 | and the glymphatic system.

00:48:27.080 | So they kind of sit at the interface

00:48:28.480 | and they're going to imagine somebody on an emergency site,

00:48:30.940 | car crash site, who's directing everybody around

00:48:33.260 | as to what to do.

00:48:34.100 | Get that person on a stretcher, bandage them up,

00:48:36.880 | call their mother, et cetera, et cetera,

00:48:38.880 | get this out of the road, put down some flares.

00:48:41.200 | The astrocytes kind of work in that capacity

00:48:43.440 | as well as doing some things more directly.

00:48:45.860 | So this glymphatic system and the glial astrocyte system

00:48:49.860 | is the system that we want chronically active

00:48:52.800 | throughout the day as much as possible.

00:48:54.900 | So low level walking, zone two cardio,

00:48:57.020 | and then at night during slow wave sleep

00:48:59.320 | is then really when this glymphatic system kicks in.

00:49:02.240 | So that should hopefully be an actionable takeaway

00:49:04.740 | provided that you can do that kind of cardio safely

00:49:07.400 | that I believe everybody should be doing

00:49:09.660 | who cares about brain longevity,

00:49:11.240 | not just people who are trying to get over TBI.

00:49:13.700 | Now I'd like to return a little bit

00:49:16.440 | to some of the subjective aspects of pain modulation

00:49:20.680 | because I think it's so interesting and so actionable

00:49:24.140 | that everyone should know about this.

00:49:26.800 | And in this case, we can also say

00:49:29.800 | that regardless of whether or not you're experiencing pain,

00:49:32.200 | acute or chronic, what I'm about to tell you

00:49:35.960 | is as close as anything is to proof,

00:49:39.840 | in science we rarely talk about proof,

00:49:41.600 | we talk about evidence in favor or against a hypothesis,

00:49:44.880 | but as close as possible to proof

00:49:47.560 | that our interpretation, our subjective interpretation

00:49:51.080 | of a sensory event is immensely powerful

00:49:53.720 | for dictating our experience of the event.

00:49:56.300 | Here are a couple of examples.

00:49:59.680 | First of all, anyone who's ever done combat sports

00:50:03.360 | or martial arts knows that it's incredible

00:50:07.920 | how little a punch hurts during a fight

00:50:11.800 | and it's incredible how much it hurts after a fight.

00:50:15.120 | The molecule adrenaline, when it's liberated into our body,

00:50:18.880 | truly blunts our experience of pain.

00:50:22.980 | We all know the stories of people walking miles

00:50:28.140 | on stumped legs, people doing all sorts of things

00:50:32.200 | that were incredible feats that allowed them to move through

00:50:36.540 | what would otherwise be pain,

00:50:38.040 | and afterward they do experience extreme pain.

00:50:40.680 | But during the event, oftentimes

00:50:42.600 | they are not experiencing pain.

00:50:44.280 | And that's because of the pain-blunting effects

00:50:46.900 | of adrenaline.

00:50:48.000 | I'll tell you exactly how this works in a few minutes

00:50:50.540 | when we talk about acupuncture.

00:50:52.400 | But norepinephrine binding to particular receptors,

00:50:55.920 | adrenaline binding to particular receptors

00:50:57.840 | actually shuts down pain pathways.

00:51:00.480 | People who anticipate an injection of morphine

00:51:05.480 | immediately report the feeling of loss of pain.

00:51:11.420 | Their pain starts to diminish

00:51:12.940 | because they know they're going to get pain relief.

00:51:16.000 | And it's a powerful effect.

00:51:17.280 | Now, all of you are probably saying placebo effect.

00:51:19.440 | Placebo effects are very real.

00:51:21.240 | Placebo effects and belief effects, as they're called,

00:51:24.280 | have a profound effect on our experience

00:51:26.680 | of noxious stimuli like pain.

00:51:29.520 | And they can also have a profound effect

00:51:31.160 | on positive stimuli and things that we're looking forward to.

00:51:35.020 | One study that I think is particularly interesting here

00:51:37.880 | is from my colleague at Stanford, Sean Mackey.

00:51:39.800 | They did a neuroimaging study.

00:51:41.560 | They subjected people to pain.

00:51:43.000 | In this case, it was a heat pain.

00:51:45.240 | People have very specific thresholds to heat

00:51:47.800 | at which they cannot tolerate any more heat.

00:51:50.780 | But they explored the extent to which looking at an image

00:51:53.800 | of somebody, in this case, a romantic partner

00:51:56.300 | that the person loved would allow them

00:51:59.820 | to adjust their pain response.

00:52:02.160 | And it turns out it does.

00:52:05.100 | If people are looking at an image

00:52:07.100 | or thinking about a person that they love,

00:52:11.500 | or even a thing that they love, a pet that they love,

00:52:14.420 | studies previous to the one that Mackey and colleagues did

00:52:17.600 | showed that their experience of pain was reduced.

00:52:20.980 | Their threshold for pain was higher.

00:52:23.060 | They could tolerate more pain.

00:52:25.380 | And they reported it as not as painful.

00:52:27.520 | But there's a twist there, which is it turns out

00:52:31.260 | that the extent to which love will modulate pain

00:52:36.260 | has everything to do with how infatuated

00:52:39.700 | and obsessed somebody is with the object of their love.

00:52:44.520 | People that report thinking about somebody or a pet

00:52:49.260 | for many hours of the day,

00:52:52.540 | kind of having an obsessive nature,

00:52:54.380 | like almost like kind of what people might call

00:52:56.340 | quote unquote codependency.

00:52:57.860 | For those of you that are listening,

00:52:58.820 | I'm just providing air quotes

00:53:00.100 | 'cause codependency is kind of a clinical thing now,

00:53:02.220 | although it's thrown around a lot all the time.

00:53:04.460 | It's sort of like gaslighting.

00:53:05.540 | People talk about gaslighting all the time.

00:53:07.040 | Now, gaslighting is a real thing,

00:53:08.860 | but then people talk about gaslighting

00:53:10.540 | for many things outside the clinical description.

00:53:13.880 | If people are very obsessed with somebody,

00:53:18.340 | they have a kind of obsessive love of somebody's face,

00:53:21.380 | even if the other person doesn't know them,

00:53:22.940 | which is a little weird, that response,

00:53:27.540 | that feeling of love internally

00:53:29.580 | can blunt the pain experience to a significant degree.

00:53:34.180 | These are not small effects.

00:53:36.140 | So it's not just that love can protect us from pain.

00:53:38.820 | It's that infatuation and obsession

00:53:41.140 | can protect us from pain.

00:53:42.520 | And not surprisingly, how early a relationship is,

00:53:45.940 | how new a relationship is directly correlates

00:53:49.280 | with people's ability, they showed,

00:53:51.480 | to use this love, this internal representation of love,

00:53:55.840 | to blunt the pain response.

00:53:58.160 | So for those of you that have been with your partners

00:54:00.300 | for many years and you love them very much

00:54:02.080 | and you're obsessed with them, terrific.

00:54:04.180 | You have a pre-installed,

00:54:06.440 | well, I suppose it's not pre-installed.

00:54:07.560 | You had to do the work 'cause relationships are work,

00:54:09.460 | but you've got a installed mechanism for blunting pain.

00:54:14.060 | And again, these are not minor effects.

00:54:16.400 | These are major effects.

00:54:18.420 | And it's all going to be through that top-down modulation

00:54:20.900 | that we talked about, not unlike the mirror box experiments

00:54:23.580 | with phantom limb that relieve phantom pain

00:54:26.220 | or some other top-down modulation.

00:54:29.020 | And the opposite example is the nail through the boot,

00:54:31.280 | which is a visual image that made the person

00:54:33.260 | think it was painful when in fact it was painful,

00:54:35.780 | even though there was no tissue damage.

00:54:37.960 | It was all perceptual.

00:54:39.900 | So the pain system is really subject

00:54:41.900 | to these perceptual influences, which is remarkable

00:54:46.580 | because really when we think about

00:54:48.020 | the somatosensory system, it has this cognitive component.

00:54:50.460 | It's got this peripheral component,

00:54:52.220 | but there's another component,

00:54:54.220 | which is the way in which our sensation,

00:54:56.700 | our somatosensory system is woven in

00:54:58.380 | with our autonomic nervous system.

00:55:00.340 | And we're going to get to that next,

00:55:01.620 | but I want to just raise the idea

00:55:04.740 | that the reason that this kind of infatuation

00:55:07.340 | and obsessive love can blunt the pain response

00:55:10.560 | and increase one's threshold for pain may have to do,

00:55:15.140 | I would say almost certainly has to do,

00:55:16.740 | but it hasn't been measured yet, with dopamine release.

00:55:20.500 | Because dopamine is absolutely the molecule

00:55:23.160 | that's liberated in our brain and body

00:55:26.580 | when there's a new kind of obsession or infatuation.

00:55:30.900 | It's very distinct from the kind of love chemicals,

00:55:34.460 | if you will.

00:55:36.100 | I don't even like calling them love chemicals.

00:55:37.700 | That just feels weird.

00:55:38.620 | If this were text, I would delete that line.

00:55:40.400 | But from the chemicals associated with warmth

00:55:44.640 | and connection, such as serotonin and oxytocin,

00:55:47.560 | which tend to be for more stable, long lasting relationships.

00:55:50.900 | Dopamine is what dilates the pupils,

00:55:53.620 | which gets people really excited.

00:55:54.820 | They can't stop thinking about somebody.

00:55:56.440 | The text messages are even exciting.

00:55:58.580 | They write to them and they can't wait

00:56:00.880 | for the text message to come back.

00:56:02.360 | The dot, dot, dot on the screen.

00:56:03.760 | The text message is excruciating.

00:56:05.640 | They don't respond for two minutes

00:56:07.200 | and people are getting flipped out.

00:56:08.600 | I'm not here to support that kind of whatever.

00:56:12.320 | What I'm saying is that that obsessive type of love,

00:56:16.240 | which without question is going to be associated

00:56:18.800 | with the dopamine pathway, does seem to have a utility

00:56:22.440 | in the context of reducing the unpleasantness

00:56:27.400 | of physical pain and probably has a lot to do

00:56:29.560 | with reducing the unpleasantness of a lot of life,

00:56:31.560 | like sitting in traffic, et cetera.

00:56:32.920 | Because when we talk about pain,

00:56:34.920 | emotional pain and physical pain start

00:56:37.280 | to become one in the same.

00:56:38.520 | They are so closely intertwined that the lines

00:56:42.320 | between them neurally become very blurry.

00:56:44.700 | What do I mean by that?

00:56:45.800 | Well, if love and infatuation can reduce pain,

00:56:50.800 | presumably through the release of dopamine,

00:56:53.000 | well then does dopamine release itself, blunt pain?

00:56:56.400 | Should we be chasing dopamine release

00:56:59.360 | as a way to treat chronic and acute pain?

00:57:01.480 | And that's exactly what we're going to talk about now.

00:57:03.760 | Independent of love, we're going to talk

00:57:05.360 | about something quite different,

00:57:06.420 | which is putting needles and electricity

00:57:08.540 | in different parts of the body, so-called acupuncture,

00:57:11.020 | something that for many people,

00:57:14.180 | it's been viewed as a kind of alternative medicine,

00:57:19.240 | but now there are excellent laboratories exploring

00:57:22.560 | what's called electro-acupuncture and acupuncture.

00:57:25.080 | These are big university centers.

00:57:26.660 | In fact, my source for everything I'm about to tell you next

00:57:30.160 | is Professor Chu-Fu Ma at Harvard Medical School

00:57:33.400 | and his papers.

00:57:34.320 | I stand behind the information

00:57:35.580 | that I'm going to provide today,

00:57:36.580 | but it's extracted largely from the Ma lab's papers,

00:57:40.720 | which are very rigorous, variable isolating experiments

00:57:45.720 | to address just how does something like acupuncture work?

00:57:49.520 | And I think what you'll be interested in

00:57:51.280 | and surprised to learn is that it does work,

00:57:53.860 | but sometimes it can exacerbate pain

00:57:57.000 | and sometimes it can relieve pain.

00:57:59.200 | And it all does that through very discrete pathways

00:58:01.740 | for which we can really say,

00:58:04.000 | this neuron connects to that neuron,

00:58:05.460 | connects to the adrenals,

00:58:06.440 | and we can tie this all back to dopamine

00:58:08.800 | because in the end, it's the chemicals and neural circuits

00:58:11.360 | that are giving rise to these perceptions

00:58:13.380 | or these experiences, rather,

00:58:14.980 | of things that we call pain, love, et cetera.

00:58:17.600 | In a previous podcast episode,

00:58:19.520 | I mentioned my experience of visiting an acupuncturist

00:58:23.220 | and getting acupuncture.

00:58:25.280 | The acupuncture itself didn't really do that much for me,

00:58:30.100 | but I wasn't there for any specific reason.

00:58:32.040 | It was gifted to me by somebody

00:58:33.660 | and I wanted to try it.

00:58:35.280 | I'm not passing judgment on acupuncture.

00:58:37.740 | In fact, I know a number of people

00:58:39.140 | that really derive tremendous benefit from acupuncture

00:58:42.400 | for pain and for gastrointestinal issues.

00:58:45.640 | There are actually a lot of really good

00:58:47.360 | peer-reviewed studies supporting the use of acupuncture

00:58:50.880 | for, in particular, GI tract issues.

00:58:54.160 | In recent years, there's been an emphasis

00:58:57.660 | on trying to understand the mechanism

00:58:59.560 | of things like acupuncture and acupuncture itself,

00:59:03.160 | not to support acupuncture

00:59:05.220 | or to try to get everybody to do acupuncture,

00:59:07.080 | but as a way to try and understand

00:59:08.740 | how these sorts of practices might actually benefit people

00:59:12.880 | who are experiencing pain or for changing the nervous system

00:59:15.680 | or brain-body relationship in general.

00:59:18.260 | And actually, the National Institutes of Health

00:59:21.580 | in the United States now has a entire subdivision,

00:59:26.280 | an institute within the National Institutes of Health,

00:59:29.640 | which is complementary health.

00:59:32.160 | And that institute is interested in things like acupuncture

00:59:36.820 | and a variety of other practices

00:59:38.600 | that I think 10, 15 years ago,

00:59:41.080 | people probably thought were really alternative

00:59:43.040 | and maybe even counterculture, at least in the States.

00:59:46.360 | And it's exciting.

00:59:47.240 | I think people are starting to really take a look

00:59:49.040 | at what's going on under the hood

00:59:51.320 | for certain types of treatments that are very useful.

00:59:53.840 | And I think it's very likely to lead

00:59:55.520 | to an expanded number of treatments

00:59:57.480 | for a number of different conditions.

01:00:00.640 | What I want to talk about in terms of acupuncture

01:00:02.800 | is the incredible way in which acupuncture

01:00:05.440 | illuminates the crosstalk

01:00:08.920 | between the somatosensory system,

01:00:10.640 | our ability to feel stuff externally,

01:00:13.960 | exteroception, internally, interoception,

01:00:16.800 | and how that somatosensory system

01:00:20.480 | is wired in with and communicating

01:00:22.400 | with our autonomic nervous system

01:00:23.960 | that regulates our levels of alertness or calmness.

01:00:29.040 | After that, I'm going to talk about

01:00:30.960 | how the acupuncture that's being done right now

01:00:34.600 | also points to relief for what's called referred pain.

01:00:38.780 | So this takes us all back to the homunculus.

01:00:41.320 | Let's start there.

01:00:42.140 | We have this representation of our body surface

01:00:44.640 | in our brain.

01:00:45.860 | That representation is what we call somatotopic.

01:00:50.960 | And what somatotopy is,

01:00:53.360 | is it just means that areas of your body

01:00:55.480 | that are near one another,

01:00:56.760 | so your thumb and your forefinger for instance,

01:00:59.220 | are represented by neurons

01:01:00.760 | that are nearby each other in the brain.

01:01:03.000 | Now you might say, well, duh,

01:01:05.420 | but actually it didn't have to be that way.

01:01:06.960 | The neurons that represent the tip of my forefinger

01:01:09.080 | and the neurons that represent my thumb on the same hand

01:01:11.640 | could have been distantly located.

01:01:13.760 | And therefore the map of my body surface,

01:01:16.400 | the homunculus would be really disordered,

01:01:17.840 | but it's not that way.

01:01:18.660 | It's very ordered, it's very smooth.

01:01:20.860 | As let's say you were to image my brain,

01:01:22.800 | if you were to stimulate my finger, my forefinger,

01:01:24.920 | and then march that stimulation across my finger,

01:01:27.240 | across the palm into the nearby thumb,

01:01:29.620 | you would see that neurons in the brain

01:01:31.120 | would also make a sort of J shape

01:01:32.880 | in their pattern of activation.

01:01:34.920 | So that means they're so-called somatotopy,

01:01:37.880 | but the connections from those brain neurons

01:01:40.500 | are sent into the body and they are synchronized with,

01:01:45.340 | meaning they cross wire with and form synapses

01:01:49.720 | with some of the input from the viscera,

01:01:53.760 | from our guts, from our diaphragm, from our stomach,

01:01:56.920 | from our spleen, from our heart.

01:02:00.360 | Our internal organs are sending information

01:02:02.780 | up to this map in our brain of the body surface,

01:02:06.120 | but it's about internal information,

01:02:07.840 | what we call interoception,

01:02:09.320 | our ability to look inside or imagine inside

01:02:11.760 | and feel what we're feeling inside.

01:02:14.020 | So the way to think about this accurately

01:02:17.020 | is that our representation of ourself

01:02:19.640 | is a representation of our internal workings,

01:02:22.620 | our viscera, our guts, everything inside our skin

01:02:25.260 | and the surface of our skin

01:02:27.360 | and the external world, what we're seeing.

01:02:30.120 | Those three things are always being combined

01:02:31.920 | in a very interesting, complex, but very seamless way.

01:02:36.100 | Acupuncture involves taking needles

01:02:40.500 | and sometimes electricity and/or heat as well

01:02:43.680 | and stimulating particular locations on the body.

01:02:47.200 | And through these maps of stimulation

01:02:49.920 | that have been developed over thousands of years,

01:02:52.880 | mostly in Asia, but now this is a practice

01:02:57.620 | that's being done in many places throughout the world,

01:03:00.380 | they have these maps that speak to,

01:03:02.480 | oh, well, if you stimulate this part of the body,

01:03:04.420 | you get this response.

01:03:05.460 | And if somebody has a gastrointestinal issue,

01:03:07.320 | like their guts are moving too quick, they have diarrhea,

01:03:09.880 | you stimulate this area

01:03:10.960 | and it'll slow their gut motility down.

01:03:12.840 | Or if their gut motility is too slow, they're constipated,

01:03:15.500 | you stimulate someplace else and it accelerates it.

01:03:17.680 | And hearing about this stuff,

01:03:19.360 | it sounds kind of to a Westerner

01:03:21.240 | who's not thinking about the underlying neural circuitry,

01:03:24.280 | it could sound kind of wacky.

01:03:25.720 | It really sounds like alternative

01:03:27.160 | or even kind of really out there kind of stuff.

01:03:29.760 | But when you look at the neural circuitry, the neuroanatomy,

01:03:32.360 | it really starts to make sense.

01:03:33.560 | And Chufu Ma's lab at Harvard Medical School

01:03:36.820 | is an excellent laboratory,

01:03:39.760 | has been exploring how stimulation of different types,

01:03:43.880 | intense or weak, with heat or without heat

01:03:47.680 | on different parts of the body

01:03:50.080 | can modulate pain and inflammation.

01:03:53.640 | And what they've shown in a particularly exciting study

01:03:57.960 | is that stimulation of the abdomen

01:04:00.080 | anywhere on the midsection, weakly, does nothing.

01:04:06.000 | That's not very interesting, you might say.

01:04:08.200 | Intense stimulation of the abdomen, however,

01:04:11.080 | with this electroacupuncture has a very strong effect

01:04:15.880 | of increasing inflammation in the body.

01:04:19.640 | And this is important to understand

01:04:21.780 | because it's not just that stimulating the gut does this

01:04:25.400 | because you're activating the gut area,

01:04:28.100 | it activates a particular nerve pathway.

01:04:30.920 | For the aficionados, it's the splenic spinal sympathetic axis

01:04:34.520 | if you really want to know.

01:04:35.600 | And it's pro-inflammatory under most conditions.

01:04:40.020 | However, there are other conditions where if, for instance,

01:04:43.240 | the person is dealing with a particular bacterial infection

01:04:46.300 | that can be beneficial.

01:04:48.100 | And this goes back to a much earlier discussion

01:04:51.020 | that we had on a previous podcast

01:04:52.520 | that we'll revisit again and again,

01:04:54.380 | which is that the stress response

01:04:56.080 | was designed to combat infection.

01:04:58.000 | So it turns out that there are certain patterns

01:05:00.160 | of stimulation on the abdomen

01:05:01.560 | that can actually liberate immune cells

01:05:04.040 | from our immune organs, like our spleen,

01:05:07.080 | and counter infection

01:05:08.880 | through the release of things like adrenaline.

01:05:11.620 | Chufu's lab also showed that stimulation

01:05:15.120 | of the feet and hands can reduce inflammation.

01:05:20.120 | And again, this was done mechanistically.

01:05:23.380 | This was done by blocking certain pathways

01:05:26.260 | with the appropriate control experiments.

01:05:28.380 | This was done not in any kind of subjective way.

01:05:31.980 | This was also done by measuring particular molecules,

01:05:34.580 | IL-6 and cytokines and things that are related

01:05:37.400 | to the inflammation response.

01:05:39.080 | And what they showed is that the stimulation

01:05:41.080 | of in particular the hind limbs at low intensity

01:05:46.080 | led to increases in the activity of this vagal pathway,

01:05:51.380 | the vagus nerve being this 10th cranial nerve

01:05:53.340 | that serves the kind of rest and digest and parasympathetic,

01:05:56.260 | in other words, calming response.

01:05:58.180 | So what this means is that we are now at the front edge

01:06:00.940 | of this research field that's just,

01:06:03.840 | it's early days still,

01:06:05.100 | but it's discovering that depending on whether or not

01:06:07.400 | the stimulation is intense or mild,

01:06:10.000 | and depending on where the stimulation is done on the body,

01:06:13.260 | you can get very different effects.

01:06:14.680 | So this points to the idea

01:06:16.140 | that you can't say acupuncture good or acupuncture bad.

01:06:20.020 | There has to be a systematic understanding

01:06:22.940 | of what exactly the effect is that you're trying to achieve.

01:06:26.300 | And the underlying basis for this is really relevant

01:06:28.820 | to the thing about adrenaline that I said before,

01:06:31.500 | that in a fight, it's rare that you ever feel pain

01:06:34.700 | when you get hit.

01:06:35.540 | I've experienced that, but later it hurts a lot.

01:06:38.460 | It turns out that when you stimulate these pathways

01:06:40.960 | that activate, in particular, the adrenals,

01:06:43.940 | the adrenal gland liberates norepinephrine and epinephrine,

01:06:47.460 | and the brain does as well,

01:06:49.140 | it binds to what are called

01:06:50.180 | the beta-noreadrenergic receptors.

01:06:52.540 | Okay, so this is really getting kind of down into the weeds,

01:06:54.500 | but the beta-noreadrenergic receptors activate the spleen,

01:06:57.980 | which liberates cells that combat infection,

01:07:01.160 | and it's anti-inflammatory.

01:07:03.920 | That's the short-term quick response.

01:07:06.660 | The more intense stimulation of the abdomen and other areas

01:07:11.620 | can be pro-inflammatory because of the ways

01:07:14.900 | that they trigger certain loops that go back to the brain

01:07:18.400 | and trigger the sort of anxiety pathways

01:07:20.500 | and that place people into a state of anxiety

01:07:22.420 | that exacerbates pain.

01:07:24.180 | So one pathway stimulates norepinephrine and blunts pain.

01:07:27.300 | The other one doesn't.

01:07:28.740 | What does all this mean?

01:07:29.780 | How are we supposed to put all of this together?

01:07:31.820 | Well, there's a paper that was published

01:07:33.140 | in "Nature Medicine" in 2014.

01:07:34.980 | This is an excellent journal

01:07:36.900 | that describes how dopamine

01:07:40.460 | can activate the vagus peripherally,

01:07:43.260 | not dopamine in the brain, peripherally,

01:07:45.300 | and norepinephrine can activate the vagus peripherally

01:07:49.260 | and reduce inflammation.

01:07:50.800 | And I'm not trying to throw a ton of facts at you,

01:07:53.460 | say, "Well, what am I supposed to do

01:07:54.300 | "with all this information?"

01:07:55.260 | What this means is that there are real maps

01:07:58.340 | of our body surface that, when stimulated,

01:08:00.760 | communicate with our autonomic nervous system,

01:08:04.140 | the system that controls alertness or calmness,

01:08:06.820 | and thereby releases either molecules

01:08:09.580 | like norepinephrine and dopamine,

01:08:10.980 | which make us more alert as we would be in a fight,

01:08:14.980 | and blunt our response to pain.

01:08:17.460 | And they reduce inflammation.

01:08:20.340 | But there are yet other pathways that, when stimulated,

01:08:23.660 | are pro-inflammatory.

01:08:25.180 | And that brings us to the question of,

01:08:26.480 | what is all this inflammation stuff

01:08:28.300 | that people are talking about?

01:08:29.200 | One of the things that bothers me so much these days,

01:08:32.660 | and I'm not easily irritated,

01:08:34.140 | but what really bothers me is when people

01:08:36.420 | are talking about inflammation, like inflammation is bad.

01:08:38.600 | Inflammation is terrific.

01:08:39.880 | Inflammation is the reason why cells

01:08:41.820 | are called to the site of injury to clear it out.

01:08:44.180 | Inflammation is what's going to allow you

01:08:46.160 | to heal from any injury.

01:08:47.900 | Chronic inflammation is bad.

01:08:50.060 | But acute inflammation is absolutely essential.

01:08:52.960 | Remember those kids that we talked about earlier

01:08:54.900 | that have mutations in these receptors for sensing pain,

01:08:57.820 | they never get inflammation.

01:08:59.160 | And that's why their joints literally disintegrate.

01:09:03.240 | It's really horrible,

01:09:04.220 | because they don't actually have the inflammation response,

01:09:06.780 | because it was never triggered by the pain response.

01:09:09.840 | So inflammation can be very beneficial.

01:09:13.320 | There's a lot of interest nowadays in taking things

01:09:16.320 | and doing things to limit inflammation.

01:09:17.960 | One of the ones that comes up a lot is turmeric.

01:09:19.940 | I'm sure the moment anyone starts talking about inflammation,

01:09:22.320 | the question is, what about turmeric?

01:09:24.600 | I have talked before about turmeric elsewhere.

01:09:28.800 | I am very skeptical of turmeric.

01:09:30.660 | And I might lose a few friends,

01:09:32.480 | although that'd be weird if my friend,

01:09:34.220 | that would say something about my friendships

01:09:35.560 | if I lost friends over a discussion about turmeric.

01:09:38.340 | But in any case,

01:09:40.960 | turmeric does have anti-inflammatory properties.

01:09:44.280 | There's no question about that.

01:09:45.480 | But as we've just described,

01:09:48.000 | inflammation can be a very good thing,

01:09:49.520 | at least in the short term.

01:09:50.800 | The other thing about turmeric

01:09:52.000 | is there was a study published out of Stanford

01:09:54.540 | in collection with some work from other universities

01:09:56.560 | showing that a lot of turmeric

01:09:58.880 | is heavily contaminated with lead.

01:10:01.300 | The lead is used to get that really rich, dense,

01:10:04.920 | orange coloring to it that everyone wants to see.

01:10:08.240 | So you have to check your sources of turmeric.

01:10:10.020 | The other thing is for men in particular,

01:10:13.660 | turmeric can be very antagonistic to dihydrotestosterone.

01:10:17.800 | Dihydrotestosterone is the more dominant form of androgen

01:10:21.600 | in human males.

01:10:23.800 | And it's involved in things like aggression

01:10:26.340 | and libido and things of that sort.

01:10:28.340 | Many people that I've talked to who have taken turmeric

01:10:32.160 | get a severe blunting of affect and libido.

01:10:35.600 | So for some people, that might be a serious negative.

01:10:39.060 | I certainly avoid turmeric.

01:10:40.720 | I don't like turmeric for that reason.

01:10:43.320 | I also think that the inflammation response

01:10:45.080 | is a healthy response.

01:10:46.720 | You have to keep it in check,

01:10:48.680 | and we're going to talk about specific practices

01:10:50.400 | for wound, healing, and injury in a moment.

01:10:52.740 | But this idea that just inflammation is bad

01:10:55.920 | and you want to reduce inflammation across the board,

01:10:57.720 | nothing could be further from the truth.

01:10:59.320 | We have pathways that exist in our body

01:11:01.880 | specifically to increase inflammation.

01:11:03.920 | It's the inflammation that goes unchecked,

01:11:06.820 | just like stress, which is problematic

01:11:09.640 | for repair from brain injury,

01:11:11.380 | and that can exacerbate certain forms of dementia, et cetera.

01:11:14.580 | But I'd like to create a little bit more nuance

01:11:16.720 | or a lot more nuance if possible

01:11:18.280 | in the conversation around inflammation,

01:11:20.740 | because people have just taken this discussion

01:11:23.540 | around inflammation to be this idea

01:11:26.140 | that just inflammation is bad

01:11:27.840 | and nothing could be further from the truth.

01:11:30.440 | Before I continue, I just thought I'd answer a question

01:11:33.540 | that I get a lot, which is what about Wim Hof breathing?

01:11:37.020 | I get asked about this a lot.

01:11:38.100 | Wim Hof, also called, AKA the Iceman,

01:11:41.640 | has this breathing that's similar to Tummo breathing,

01:11:44.580 | as it was originally called,

01:11:45.700 | involves basically hyperventilating

01:11:47.460 | and then doing some exhales and some breath holds.

01:11:49.620 | A couple of things about that,

01:11:50.660 | it should never be done near water.

01:11:52.660 | People who have done it near water,

01:11:53.780 | unfortunately, have drowned.

01:11:55.180 | It's certainly not for everybody,

01:11:58.620 | and I'm not here to either promote it

01:12:01.420 | nor discourage people from doing it.

01:12:03.520 | But I think we should ask ourselves,

01:12:04.780 | what is the net effect of that?

01:12:06.180 | Because a number of people have asked me about it

01:12:08.300 | in relation to pain management.

01:12:10.860 | The effect of doing that kind of breathing,

01:12:13.100 | it's not a mysterious effect,

01:12:14.380 | it liberates adrenaline from the adrenals.

01:12:17.220 | There is a paper published in the "Prosthenes

01:12:18.820 | of the National Academy of Sciences,"

01:12:20.240 | which is a very fine journal,

01:12:21.620 | showing that that breathing pattern

01:12:23.480 | can counter infection from endotoxin.

01:12:26.460 | And that's because when you have adrenaline in your system,

01:12:29.420 | and when the spleen is very active,

01:12:32.060 | that response is used to counter infection,

01:12:36.940 | and stress counters infection.

01:12:39.800 | We'll talk about this more going forward,

01:12:41.420 | but the idea that stress lends itself to infection is false.

01:12:44.700 | Stress counters infection

01:12:46.340 | by liberating killer cells in the body.

01:12:49.200 | You don't want the stress response to stay on indefinitely,

01:12:51.900 | however.

01:12:53.520 | Things like Wim Hof breathing, like ice baths,

01:12:56.280 | anything that releases adrenaline will counter the infection.

01:13:00.300 | But you want to regulate the duration

01:13:03.440 | of that adrenaline response.

01:13:05.200 | This should make perfect sense.

01:13:06.160 | We, as a species,

01:13:07.680 | had to evolve under conditions of famine and cold.

01:13:09.760 | Actually, Texas right now is an extreme case

01:13:12.080 | of cold and power outages.

01:13:13.540 | I've seen the pictures

01:13:14.400 | and there are a lot of people out there really suffering.

01:13:17.080 | Their systems are releasing a ton of adrenaline.

01:13:19.680 | They're cold.

01:13:20.740 | Some of them are likely to be hungry.

01:13:22.800 | They're probably stressed.

01:13:24.360 | They're releasing a lot of adrenaline,

01:13:26.920 | which is keeping them safe from infection.

01:13:29.380 | After they get their heat back on and they relax

01:13:32.880 | and they can finally warm up again,

01:13:34.480 | which we would like for them very soon.

01:13:37.400 | Hopefully by the time this podcast comes out,

01:13:38.880 | that will have already happened.

01:13:40.500 | That's typically when people get sick

01:13:42.480 | because the immune response is blunted

01:13:44.520 | as the stress response starts to subside.

01:13:46.980 | So stress, inflammation, countering infection

01:13:51.420 | that comes from endotoxin,

01:13:52.680 | that comes from any number of things can be from cold.

01:13:54.920 | It can be from hyperventilation.

01:13:56.200 | It can be from a physical threat.

01:13:58.040 | It can be from the stress of an exam or an upcoming surgery.

01:14:02.680 | This adrenaline thing and the inflammation associated

01:14:05.380 | with it is adaptive.

01:14:07.160 | It's highly adaptive.

01:14:08.740 | It is a short-term plasticity that is designed

01:14:11.580 | to make us better for what we're experiencing

01:14:14.120 | and challenged with, not worse.

01:14:16.840 | And so hopefully that will add an additional layer

01:14:19.100 | to this whole idea that stress is bad,

01:14:21.120 | inflammation is bad, et cetera.

01:14:23.280 | Again, I'm not suggesting people do or don't do something

01:14:26.780 | like Wim Hof Tummo breathing.

01:14:28.520 | I just want to point to the utility.

01:14:29.800 | It's very similar to the utility from cold showers,

01:14:32.080 | ice baths, and other forms of anything

01:14:34.600 | that increase adrenaline.

01:14:36.480 | Every episode, I want to make sure

01:14:38.040 | that every listener comes away

01:14:39.640 | with as much knowledge as possible,

01:14:42.020 | but also actionable tools.

01:14:44.340 | And today we've talked about a variety of tools,

01:14:46.360 | but I want to center in on a particular sequence of tools

01:14:50.120 | that hopefully you won't need,

01:14:52.260 | but presumably if you're a human being and you're active,

01:14:55.560 | you will need at some point.

01:14:57.100 | It's about managing injury and recovering and healing fast,

01:15:02.100 | or at least as fast as possible.

01:15:04.320 | It includes removing the pain.

01:15:07.340 | It includes getting mobility back

01:15:10.000 | and getting back to a normal life,

01:15:12.360 | whatever that means for you.

01:15:14.140 | I want to emphasize that what I'm about to talk about next

01:15:17.340 | was developed in close consultation with Kelly Starrett,

01:15:20.960 | who many of you probably have heard of before.

01:15:24.160 | Kelly can be found at The Ready State.

01:15:25.920 | He's a formally trained,

01:15:27.360 | so degreed and educated exercise physiologist.

01:15:30.780 | He's a world expert in movement and tissue rehabilitation,

01:15:34.000 | et cetera.

01:15:34.960 | They're not sponsors of the podcast.

01:15:36.760 | Kelly is a friend and a colleague.

01:15:38.480 | He's somebody that I personally trust,

01:15:40.240 | and his views on tissue rehabilitation and injury,

01:15:44.120 | I think are really grounded extremely well

01:15:47.920 | in both medicine, physiology,

01:15:50.280 | and the real cutting edge of what's new

01:15:53.460 | and what you might not get in terms of advice

01:15:56.600 | from the typical person.

01:15:58.120 | All that said, you always, always, always should consult

01:16:00.680 | with your physician before adopting any protocols

01:16:03.440 | or removing any protocols.

01:16:05.640 | So I asked Kelly, I made it really simple.

01:16:07.600 | I said, okay, let's say I were to sprain my ankle

01:16:10.660 | or break my arm or injure my knee or ACL tear

01:16:14.080 | or something like that, or shoulder injury.

01:16:16.720 | What are the absolute necessary things to do

01:16:20.440 | regardless of situation?

01:16:21.880 | And what science is this grounded in?

01:16:25.020 | And then I made it a point to go find the studies

01:16:27.580 | that either supported or refuted what he was telling me

01:16:32.040 | because that's why I'm here.

01:16:34.480 | So the first one is a very basic one

01:16:37.400 | that now you have a lot of information to act on,

01:16:39.660 | which is in terms of what we know about tissue rehabilitation

01:16:43.920 | both brain and body, we know that sleep is essential.

01:16:46.380 | And so we both agreed that eight hours minimum

01:16:49.820 | in bed per night is critical.

01:16:51.280 | Now, what was interesting, however,

01:16:52.760 | is that it doesn't have to be eight hours of sleep.

01:16:55.940 | We acknowledge that some of that time

01:16:58.200 | might be challenging to get to sleep,

01:16:59.940 | especially if one is in pain or mobility is limited.

01:17:03.040 | We forget how often we roll over in bed

01:17:05.240 | or how the conditions of our sleeping

01:17:09.020 | can impact those injuries too.

01:17:11.060 | So Kelly acknowledged and I agree

01:17:14.720 | that eight hours of sleep would be ideal,

01:17:17.000 | but if not, at least eight hours immobile.

01:17:19.160 | And that speaks to the power

01:17:20.300 | of these non-sleep deep rest protocols too.

01:17:22.500 | If you can't sleep doing non-sleep deep rest protocols,

01:17:25.320 | we've provided links to them before.

01:17:26.880 | We're going to continue to provide links

01:17:28.240 | to the previous ones and new ones are coming soon.

01:17:31.480 | That is extremely beneficial.

01:17:32.760 | So that's a non-negotiable in terms of getting

01:17:36.320 | the foundation for allowing for glymphatic clearance

01:17:39.380 | and tissue clearance, et cetera.

01:17:41.000 | The other is, if possible,

01:17:42.800 | unless it's absolutely excruciating

01:17:45.460 | or you just can't do it, a 10 minute walk per day,

01:17:47.920 | of course, you don't want to exacerbate the injury,

01:17:50.000 | at least a 10 minute walk per day and probably longer.

01:17:53.840 | This is where it gets interesting.

01:17:55.040 | I was taught, I learned that when you injure yourself,

01:17:57.600 | you're supposed to ice something,

01:17:58.920 | you're supposed to put ice on it.

01:18:00.000 | But I didn't realize this,

01:18:01.200 | but when speaking to exercise physiologists

01:18:03.940 | and some physicians, they said that the ice

01:18:06.200 | is really more of a placebo.

01:18:08.960 | It numbs the environment of the injury,

01:18:12.080 | which is not surprising,

01:18:13.100 | and will eliminate the pain for a short while.

01:18:15.980 | But it has some negative effects

01:18:18.340 | that perhaps offset its use.

01:18:21.080 | One, it sludges, it creates sludging within the blood

01:18:24.400 | and other lymphatic tissue.

01:18:25.800 | So it actually can create some like clotting and sludging

01:18:28.400 | of the tissue and fluids, the fascial interface with muscle.

01:18:33.400 | And a number of the stuff that's supposed to be flowing

01:18:37.100 | through there can slow up and increase inflammation

01:18:39.960 | in the wrong way, can actually restrict movement

01:18:42.480 | out of the injury site, which is bad

01:18:45.720 | because you want the macrophages

01:18:47.720 | and the other cell types, phagocytosing,

01:18:50.500 | eating up the debris and injury

01:18:53.000 | and moving it out of there so that it can repair.

01:18:56.280 | So that was surprising to me,

01:18:57.520 | which made me ask, well, then what about heat?

01:18:59.680 | Well, it turns out heat is actually quite beneficial.

01:19:03.040 | A lot of people talk about heat shock proteins

01:19:04.840 | and all these genetic pathways and protein pathways

01:19:07.700 | that can be activated by heat.

01:19:09.200 | Very little data to support the idea

01:19:13.020 | that heat shock proteins are part

01:19:15.040 | of the wound healing process,

01:19:16.800 | at least in terms of the sorts of conventional heat

01:19:19.880 | that one could use like a hot water bottle

01:19:22.360 | or a hot bath or a hot compress.

01:19:25.520 | The major effects seem to be explained

01:19:27.640 | by heat improving the viscosity of the tissues

01:19:31.240 | and the clearance and the perfusion of fluid,

01:19:35.380 | blood, lymph and other fluids out of the injury area.

01:19:38.840 | So that's really interesting.

01:19:39.680 | I didn't know this.

01:19:40.520 | I thought, well, you're supposed to ice something.

01:19:41.980 | I said, well, whenever I would like see a kid get injured

01:19:44.360 | in soccer, never me, of course, no, of course,

01:19:47.320 | I got injured in soccer from time to time,

01:19:48.840 | they give you an ice pack.

01:19:49.880 | And the ice pack removes some of the pain.

01:19:52.300 | I think the consensus now, which was surprising to me,

01:19:55.500 | is that the ice pack is actually more

01:19:57.260 | of the top-down modulation.

01:19:58.780 | You think you're doing something for the pain.

01:20:01.420 | There's some interesting studies

01:20:02.780 | that actually showed the placebo effect of the ice pack.

01:20:05.000 | So ice packs are placebo, perhaps.

01:20:07.540 | That's interesting.

01:20:08.380 | I'll underline perhaps because who knows,

01:20:10.080 | maybe there's some people out there

01:20:11.240 | that are going to say this is totally crazy

01:20:13.700 | and the ice is actually very beneficial.

01:20:15.640 | But it seems like heat, mobility, sleep, keeping movement.

01:20:20.640 | And it turns out that the movement itself

01:20:22.860 | can act as a bit of an analgesic.

01:20:24.900 | It can actually reduce the pain.

01:20:26.720 | Whereas the ice reduces the pain, but sludges the tissue

01:20:29.760 | and keeps the cells that need to be removed

01:20:33.400 | from leaving the area.

01:20:35.560 | Now, what's also interesting is in neuroscience,

01:20:38.840 | we know that if we want to kill neurons or silence neurons,

01:20:42.520 | we cool them.

01:20:43.880 | This is a well-known tool in the laboratory.

01:20:46.500 | Some of the early and most important studies in neuroscience

01:20:50.380 | that form the basis for the textbooks,

01:20:52.140 | we're lowering a cooling probe

01:20:53.740 | into a particular area of the brain or a peripheral nerve

01:20:56.040 | in order to shut down that nerve.

01:20:57.700 | So the cooling will shut down the nerve.

01:21:00.040 | But another very well-known fact in neuroscience textbooks

01:21:04.760 | is that when the activity of the nerve pathway

01:21:07.300 | or neurons comes back,

01:21:08.860 | there's what's called homeostatic plasticity,

01:21:11.140 | that it rebounds with greater pain,

01:21:13.460 | with a higher level of intensity,

01:21:14.940 | which in the pain system would equate to greater pain.

01:21:17.100 | So regardless of where these neurons are in the body,

01:21:19.660 | if you stimulate a neuron, it's active.

01:21:22.020 | If you cool it, it becomes inactive.

01:21:24.000 | And when the neuron heats back up after being cooled,

01:21:27.060 | it becomes hyperactive.

01:21:28.940 | And so this makes really good sense as to why heat,

01:21:32.380 | provided it's not damaging levels of heat,

01:21:34.520 | would be more beneficial for wound healing

01:21:37.500 | and for reducing pain in the short and long run

01:21:40.460 | than would be cold or ice,

01:21:43.900 | which I find very interesting.

01:21:45.480 | Now, in terms of chronic pain,

01:21:47.220 | the manuscripts on this,

01:21:49.460 | my discussion with Kelly and with others

01:21:52.220 | point to the fact that chronic pain

01:21:53.740 | is basically plasticity gone wrong.

01:21:56.100 | It's sort of like PTSD for the emotional system

01:21:59.260 | and the stress system.

01:22:00.620 | And chronic pain is going to involve

01:22:02.900 | a number of different protocols

01:22:04.500 | to rewire both the brain centers

01:22:07.340 | and the peripheral centers associated with chronic pain.

01:22:09.620 | Certain things like fibromyalgia, for instance,

01:22:11.820 | which is whole body pain,

01:22:13.700 | relate to too little inhibition.

01:22:16.460 | In the brain, you have excitation and inhibition.

01:22:18.460 | They come from different sources of neurons.

01:22:19.860 | The inhibition is mainly from GABA and glycine

01:22:24.280 | and things like that.

01:22:25.480 | In fibromyalgia, there's too little central

01:22:29.620 | within the brain modulation of the pain responses

01:22:33.740 | so that people experience whole body pain.

01:22:36.060 | So in that case,

01:22:37.120 | the emerging therapies are really interesting.

01:22:39.060 | I have a friend who works

01:22:40.220 | for the National Institutes of Health

01:22:41.420 | who unfortunately suffers from fibromyalgia

01:22:44.100 | who asked me about this a lot.

01:22:45.300 | And his question and what he's now actually exploring

01:22:48.860 | is red light therapy,

01:22:50.260 | something that I've talked about on various Instagram posts.

01:22:53.380 | Red light therapy typically is talked about

01:22:55.060 | in terms of mitochondria.

01:22:56.960 | And the data on that are not so terrific,

01:22:59.540 | at least not really published in blue ribbon journals

01:23:02.340 | in most cases, except for one study that I'm aware of

01:23:04.920 | from Glenn Jeffrey's lab at University College London

01:23:07.540 | showing that red light stimulation

01:23:09.060 | to the eyes in people 40 or older

01:23:11.520 | can offset some of the effects of macular degeneration

01:23:13.820 | by improving the health of the photoreceptors.

01:23:16.580 | People with fibromyalgia, which is this whole body pain,

01:23:19.800 | are now starting to use red light therapies.

01:23:22.940 | And I asked Kelly and others and some experts in pain,

01:23:26.780 | what are your thoughts on this red light therapy

01:23:29.500 | for things like fibromyalgia and pain,

01:23:32.180 | especially red light local therapy?

01:23:33.940 | Their idea, and I don't think this is a field

01:23:38.480 | that's progressed far enough now

01:23:39.820 | to really place any firm conclusions on,

01:23:42.360 | but the idea is that red light therapy locally

01:23:45.780 | may have some effect, but the systemic red light therapy,

01:23:49.300 | this is like wearing protection to the eyes in some cases,

01:23:52.820 | so not from the treatment of macular degeneration,

01:23:55.100 | but wearing protection to the eyes

01:23:56.420 | and getting very bright red light therapy,

01:23:59.500 | in many ways may be, to use Kelly's words,

01:24:02.460 | approximating the effects of nature.

01:24:04.320 | These are like surrogate technologies

01:24:06.060 | for getting outside in the sunshine.

01:24:07.780 | When you're in the sun, it might not look red,

01:24:09.420 | but there are a lot of red wavelengths coming toward you.

01:24:12.060 | So the red light therapies may have some utility,

01:24:14.880 | but getting into sunlight

01:24:16.800 | may actually have as much or more effect.

01:24:19.960 | Of course, if these wounds are on a part of the body

01:24:21.840 | that you can't expose,

01:24:23.280 | then you could imagine why the red light therapy

01:24:25.280 | might be good.

01:24:26.120 | I don't know, depending on the neighborhood you live in,

01:24:27.640 | that may or may not be a weird thing to go outside

01:24:29.440 | and expose your body to sunlight.

01:24:31.100 | Probably a number of factors that dictate

01:24:33.760 | whether or not that'd be weird or not,

01:24:34.920 | but that's up to you, not me.

01:24:36.640 | And it seems that, so movement, heat, not ice,

01:24:42.280 | light, sleep, and in some cases, the use,

01:24:47.280 | and I'll talk about this in a moment,

01:24:48.940 | some cases, the use of restricting above and below the injury

01:24:52.480 | to then release and then increase profusion

01:24:54.540 | through the site.

01:24:55.380 | So may actually accelerate the wound healing.

01:24:59.560 | So all of this might sound just like common sense knowledge,

01:25:01.980 | but to me, at least as a 45-year-old,

01:25:04.680 | I always just thought it's ice,

01:25:06.140 | it's non-steroid anti-inflammatory drugs,

01:25:08.680 | it's things that block prostaglandins,

01:25:10.800 | so things like aspirin, ibuprofen, acetaminophen,

01:25:14.300 | those things generally work by blocking things

01:25:16.440 | like the, they're called cox prostaglandin blockers

01:25:21.440 | and things of that sort, things in that pathway.

01:25:24.120 | Those sorts of treatments which reduce inflammation

01:25:28.420 | may not be so great at the beginning

01:25:29.860 | when you want inflammation.

01:25:31.340 | They may be important for limiting pain

01:25:33.440 | so people can be functional at all.

01:25:35.380 | But the things that I talked about today

01:25:37.660 | really are anchored in three principles.

01:25:41.160 | One is that the inflammation response is a good one.

01:25:44.940 | This is what we're learning

01:25:45.820 | from Chufu Ma's lab's work on acupuncture.

01:25:48.800 | The immediate acute inflammation response is good.

01:25:51.120 | It calls to the site of injury,

01:25:53.900 | things that are going to clean up the injury in bad cells.

01:25:56.700 | Then there are going to be things

01:25:58.860 | that are going to improve profusion

01:26:00.460 | like the glymphatic system, getting deep sleep,

01:26:03.740 | feet elevated, sleeping on one side,

01:26:07.540 | low level zone two cardio three times a week.

01:26:11.060 | Red light perhaps is going to be useful

01:26:13.180 | though sunlight might be just as good

01:26:15.380 | depending on who you talk to.

01:26:16.820 | And we talk about that probably more at length

01:26:20.420 | in a future episode.

01:26:21.620 | A number of people will ask me I'm sure about stem cells

01:26:24.580 | and I don't want to take more of your time

01:26:27.500 | by going into an hour long discussion about stem cells.

01:26:29.900 | Stem cells exist in all of us during development.

01:26:31.820 | We were created from stem cells

01:26:33.820 | which are cells that can become essentially anything.

01:26:36.420 | Later cells get what's called restricted in their lineage.

01:26:39.160 | So a skin cell,

01:26:40.240 | unless you do some fancy molecular gymnastics to it,

01:26:44.200 | you can't actually turn that cell into a neuron.

01:26:46.860 | Yamanaka won the Nobel Prize

01:26:49.060 | for finding these Yamanaka factors

01:26:51.100 | which you could give a skin cell to turn into a neuron

01:26:53.060 | but that's not an approved therapy at this time.

01:26:55.540 | But many people ask me about platelet rich plasma,

01:26:59.220 | so-called PRP.

01:27:00.860 | They take blood, they enrich for platelets

01:27:04.140 | and then they re-inject it back into people.

01:27:06.340 | Here's the deal.

01:27:07.180 | This deserves an entire episode.

01:27:08.720 | It has never been shown whether or not the injection itself

01:27:13.500 | is what's actually creating the effect.

01:27:16.140 | This is something that the acupuncture literature

01:27:17.920 | suffered from for a long time,

01:27:19.420 | that the sham control as it's called,

01:27:22.040 | sham, we don't mean it's a sham,

01:27:23.340 | but in science you say a sham control,

01:27:24.980 | meaning you do everything exactly the same way you would.

01:27:28.740 | So for acupuncture,

01:27:30.140 | you would bring the needle right up to the skin

01:27:33.380 | but you wouldn't actually poke it into the skin,

01:27:35.420 | for instance, that would be a sham control.

01:27:37.960 | With a drug treatment,

01:27:38.900 | you would inject a drug into a person

01:27:41.860 | and then the control, the sham control would be

01:27:43.980 | that you would bring the injection over,

01:27:45.580 | you might do the injection or not do the injection

01:27:47.780 | 'cause you imagine that the injection itself

01:27:49.340 | could have an effect.

01:27:50.540 | It's never really been shown whether or not PRP

01:27:52.620 | has effects that are separate

01:27:53.900 | from injecting a volume of fluid into a tissue.

01:27:56.980 | The claims that PRP actually contains stem cells

01:28:00.020 | are very, very feeble.

01:28:02.940 | And when you look at the literature

01:28:05.220 | and you talk to any one expert in the stem cell field,

01:28:08.300 | they will tell you that the number of stem cells in PRP

01:28:12.500 | is infinitesimally small.

01:28:14.220 | In fact, so much so that these places that inject PRP

01:28:18.680 | for injuries are not allowed to advertise

01:28:21.580 | through the use of the words stem cells.

01:28:23.440 | It's actually illegal at this point.

01:28:24.980 | At least as far as I know,

01:28:26.100 | it was through the end of last year

01:28:28.260 | and I'm guessing it still is now.

01:28:30.580 | Stem cells are an exciting area of technology.

01:28:32.940 | However, there was a clinic down in Florida

01:28:35.940 | that was shut down a couple of years ago

01:28:37.820 | for injecting stem cells harvested from patients

01:28:41.300 | into the eye for macular degeneration.

01:28:43.100 | These were people that were suffering from poor vision

01:28:46.460 | and very shortly after injecting these stem cells

01:28:49.400 | into the eyes, they went completely blind.

01:28:51.860 | So I'm somebody who is very skeptical

01:28:56.240 | of the stem cell treatment work that's out there.

01:28:59.740 | It's actually very hard to get in the United States

01:29:01.820 | for this reason.

01:29:02.640 | It's not approved.

01:29:03.840 | The PRP treatments are very complicated.

01:29:06.320 | The marketing around them is shaky at best.

01:29:11.320 | I'm sure a number of people will say that they had PRP

01:29:14.060 | and benefited from it tremendously.

01:29:15.700 | And I don't doubt that.

01:29:17.060 | Whether or not it was placebo,

01:29:18.340 | today we talked a lot about top-down control.

01:29:20.260 | That's just a variant on the word placebo, belief effects.

01:29:24.220 | Whether or not it was placebo or not, I don't know.

01:29:26.940 | I wasn't there.

01:29:28.680 | That's for you to decide.

01:29:29.740 | And I'm not here to tell you

01:29:31.000 | that you should or shouldn't do something,

01:29:32.320 | but I do think that anything involving stem cells,

01:29:34.800 | one should be very cautious of.

01:29:36.340 | You should also be very cautious of anyone

01:29:37.780 | that tells you that PRP is injecting a lot of stem cells.

01:29:41.000 | This is an evolving area

01:29:42.480 | that really needs a lot more work and attention.

01:29:45.420 | The major issue with stem cells that I think is concerning

01:29:49.160 | is that stem cells are cells

01:29:52.200 | that want to become lots of different things,

01:29:54.240 | not just the tissue that you're interested in.

01:29:56.020 | So if you damage your knee

01:29:56.980 | and you inject stem cells into your knee,

01:30:00.060 | you need to molecularly restrict those stem cells

01:30:02.700 | so that they don't become tumor cells, right?

01:30:05.580 | A tumor is a collection of stem cells, right?

01:30:08.520 | So when you get something horrible

01:30:10.260 | like glioblastoma in the brain,

01:30:11.900 | which is a terrible thing to have,

01:30:14.240 | it's glial cells that returned to stemness,

01:30:18.080 | excessive stemness.

01:30:19.100 | They've started to produce too many of themselves.

01:30:21.580 | And glioblastoma is often deadly, not always.

01:30:25.000 | So injecting stem cells, it sounds great,

01:30:27.420 | and it sounds like something that one would want to do,

01:30:29.960 | but one needs to approach this with extreme caution,

01:30:33.120 | even if it's your own blood or stem cells

01:30:36.560 | that you're re-injecting.

01:30:37.440 | I think those technologies are coming.

01:30:39.400 | They're on the way.

01:30:40.440 | If any of you are devotees of PRP,

01:30:44.920 | tell me your experiences with them.

01:30:46.480 | I'm curious.

01:30:47.320 | I want to see the papers.

01:30:48.200 | I want to know the evidence.

01:30:49.200 | And of course, there are always folks out there that say,

01:30:51.320 | "I don't care what the scientists

01:30:52.820 | and the physicians and the FDA say.

01:30:55.520 | I just want to do this."

01:30:56.800 | And if that's your stance, that's your stance.

01:30:58.660 | I'm not here to govern that.

01:31:00.340 | But I do think that people should be informed.

01:31:02.480 | And in thinking about tissue recovery and injury,

01:31:06.680 | that's what I was able to glean.

01:31:08.280 | Again, check out what Kelly and his coworkers are doing

01:31:12.220 | at the ReadyState.

01:31:13.060 | It's phenomenal.

01:31:13.940 | And they've worked with all the top people

01:31:16.080 | in just about every domain of life, it seems.

01:31:18.640 | Very high integrity folks.

01:31:20.120 | Some of you are probably saying,

01:31:22.580 | "Well, I'm not injured.

01:31:23.520 | I'm not an athlete.

01:31:24.340 | I don't want stem cell injections.

01:31:25.600 | I don't have..."

01:31:26.640 | Again, I think you shouldn't get stem cell injections

01:31:28.640 | for now.

01:31:29.580 | Please hold off until the field learns more

01:31:31.620 | about how to do that safely.

01:31:33.180 | But I want to talk about and end with a really interesting

01:31:38.080 | and somewhat weird technology, which is baby blood.

01:31:43.080 | I have a colleague at Stanford.

01:31:44.520 | His name is Tony Weiss-Cory.

01:31:46.760 | And in 2014, his laboratory published a study

01:31:50.300 | showing that the blood of young rodents, mice and rats,

01:31:56.040 | when transfused into old demented rodents, mice and rats,

01:32:01.040 | made those old demented rodents recover much of their memory

01:32:05.960 | and seem much more vital and energetic,

01:32:10.960 | better recall of different spatial learning tasks,

01:32:16.160 | tissue and wound healing, they've since shown

01:32:19.360 | can be improved in these older animals.

01:32:22.080 | It's pretty incredible.

01:32:24.080 | They went on to show several years later

01:32:26.360 | that blood from umbilical cords, I'm not making this up,

01:32:31.360 | blood from umbilical cords can do the same.

01:32:35.280 | And this is the basis of a biotech company.

01:32:37.760 | Actually, one of my former post-docs

01:32:39.440 | is now an employee there.

01:32:41.800 | They've isolated the molecules from young blood

01:32:46.200 | that seems to vitalize or revitalize the old brain

01:32:52.240 | and body, and one of those molecules

01:32:54.160 | goes by the name Timp2, T-I-M-P, two.

01:32:56.940 | Where's all this going?

01:32:59.840 | Well, I don't know how long it's going to be

01:33:02.980 | before there are treatments

01:33:04.080 | based on these blood transfusions.

01:33:07.900 | I doubt that blood transfusions themselves

01:33:11.400 | from young people into old people

01:33:13.720 | is going to be used for the treatment of dementia,

01:33:16.720 | although it might.

01:33:18.320 | As weird as it seems, we know that transfusions

01:33:21.680 | of all sorts of stuff, for instance,

01:33:23.240 | fecal transplants are being used to treat obesity.

01:33:25.740 | The gut microbiome of thin people is being,

01:33:30.280 | not transfused, but is being transplanted

01:33:33.000 | into the colons and guts of obese people

01:33:36.100 | and leading to weight loss, which sounds really wild

01:33:39.400 | and is not a topic I particularly enjoy talking about.

01:33:42.580 | But nonetheless, it points to the importance

01:33:45.760 | of the gut microbiome in regulating things like blood sugar

01:33:49.120 | and health as it relates to obesity and diabetes

01:33:52.680 | and all sorts of things.

01:33:54.760 | So it does appear that there are things, factors,

01:33:58.120 | in the blood of young members of a given species

01:34:01.840 | that are lost over time in the older members of that species.

01:34:06.840 | I am not going to give you a tool

01:34:08.280 | on the basis of these findings today.

01:34:10.160 | I am not going to tell you to consume any fluid

01:34:14.720 | from any other member of your species, our species,

01:34:19.420 | for any reason.

01:34:21.520 | But I do think that it's important to mention

01:34:23.680 | that the science is asking questions such as

01:34:27.960 | what are the factors within the brain

01:34:31.600 | that allow the young brain to recover so much better

01:34:34.860 | than the older brain from injury,

01:34:37.000 | from all sorts of things, events, et cetera?

01:34:40.920 | And what are the factors in the older brain

01:34:43.740 | that are limiting?

01:34:45.160 | And thinking about identifying which factors

01:34:49.040 | are going to allow people to restore cognitive function,

01:34:53.560 | physical function, wound healing, and so forth.

01:34:56.320 | It's a really exciting area.

01:34:57.720 | I mention it not to be sensationalist,

01:35:00.160 | but because it's happening

01:35:02.220 | and because there's a lot of excitement about it.

01:35:05.660 | And because I think it's clear that the young brain

01:35:09.800 | and body and blood are very different

01:35:12.860 | from the old brain, body, and blood.

01:35:16.240 | And the goal of science is to identify

01:35:18.880 | and isolate those factors that make that so

01:35:21.920 | such that people who would otherwise get dementia

01:35:27.040 | or perhaps even have dementia will be allowed to recover.

01:35:29.880 | Again, not an actionable item at this point,

01:35:34.340 | but one to think about,

01:35:36.960 | perhaps not too long, but one to think about.

01:35:39.960 | So I'm going to close there.

01:35:42.200 | I've talked about a lot of tools today.

01:35:44.980 | I've talked a lot about somatosensation,

01:35:48.100 | about plasticity, about pain, about acupuncture,

01:35:51.740 | some of the nuance of acupuncture, inflammation, stress.

01:35:55.800 | We even talked a little bit about high-intensity breathing.

01:35:59.200 | Talked about restricting limb movement

01:36:01.700 | to get compensatory regrowth of pathways,

01:36:05.560 | or I should say reactivation of pathways

01:36:08.040 | that have been injured or damaged.

01:36:09.700 | So as always, we take kind of a whirlwind tour

01:36:13.800 | through a given topic, lay down some tools as we go.

01:36:18.160 | Hopefully the principles that relate to pain and injury,

01:36:22.380 | but also neuroplasticity in general today

01:36:24.900 | in the context of the somatosensory system

01:36:26.880 | will be of use to all of you.

01:36:28.260 | I don't wish injury on any of you,

01:36:31.020 | but I do hope that you'll take this information to mind

01:36:34.580 | and that you will think about it

01:36:35.780 | if ever you find yourself in a situation

01:36:38.300 | where you have to ask,

01:36:39.620 | what's the difference between my perception

01:36:41.800 | and the actual tissue damage?

01:36:43.020 | Is it injury and pain?

01:36:44.340 | Is it the same?

01:36:45.180 | Well, no.

01:36:46.020 | Do I have some control over my experience of pain?

01:36:48.660 | Absolutely.

01:36:49.880 | Does all of that involve taking drugs

01:36:51.780 | or doing certain therapeutics?

01:36:53.100 | No, not necessarily.

01:36:54.180 | There's an incredible subjective component.

01:36:56.900 | There also is a need sometimes to treat the injury

01:37:00.940 | at the level of the pain receptors at the site of the wound.

01:37:05.180 | So please take the information,

01:37:07.900 | do with it what you will.

01:37:09.400 | And in the meantime,

01:37:11.020 | thank you so much for your time and attention.

01:37:13.360 | Before we go, I just want to remind you

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01:37:47.200 | Once again, thanks so much for your time

01:37:48.840 | and attention today.

01:37:49.940 | And as always, thank you for your interest in science.

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Control Pain & Heal Faster with Your Brain

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