Dhru Purohit Show - The Dangers of a Sedentary Lifestyle and How Movement Can Treat Chronic Pain and Prevent Disease with Dr. Andrea Furlan

Episode Date: September 11, 2024

This episode is brought to you by Birch Living, LMNT, and Thesis. One in five people is impacted by chronic pain. Many believe that chronic pain is simply a byproduct of aging, with little that can be done beyond managing it. Today’s guest offers a unique approach to chronic pain, sharing her mind-body practice for effectively addressing and alleviating it. Today on The Dhru Purohit Show, Dhru sits down with Dr. Andrea Furlan to explore chronic pain, its top drivers, and common myths about treatment. Dr. Furlan discusses the dangers of a sedentary lifestyle in exacerbating chronic pain and reveals her unique approach to treating it. She also covers how diet, sleep, and alcohol can impact chronic pain and shares the most successful interventions for addressing it. Dr. Andrea Furlan is a scientist at the Institute for Work & Health (IWH) and physician and senior scientist at the KITE Research Institute, Toronto Rehab, University Health Network(UHN). She is a Physical Medicine & Rehabilitation professor at the University of Toronto. She is chair of ECHO Ontario Chronic Pain and Opioid Stewardship at UHN and co-chair of ECHO Occupational and Environmental Medicine and ECHO for Return to Work of Public Safety Personnel at IWH. She is a physician in the pain clinic at Toronto Rehab and the author of the book 8 STEPS to Conquer Chronic Pain. A Doctor's Guide to Lifelong Relief.   In this episode, Dhru and Dr. Furlan dive into (audio version / Apple Subscriber version): Chronic vs. Acute Pain (00:00:30 / 00:00:30) Top Drivers of Chronic Pain (04:07 / 04:07) Myths About Treating Chronic Pain (08:22 / 11:35) The Dangers of a Sedentary Lifestyle (11:20 / 14:30) How to Address Chronic Lower Back Pain (21:00 / 26:17) 8 Food Rules (27:40 / 32:57) Alcohol Use and Environmental Factors (39:18 / 44:35) Supplements to Support Chronic Pain (43:30 / 48:47) Fear of Chronic Pain (53:11 / 58:28) The Most Successful Interventions (57:15 / 1:02:32) Avoiding a Sedentary Life by Activating Joy (1:00:45 / 1:06:02) Mindset Matters (1:04:30 / 1:09:47) Also mentioned in this episode: 8 Steps to Conquer Chronic Pain: A Doctor’s Guide to Lifelong Relief  To learn more about Dr. Furlan, follow her on Instagram, YouTube, Facebook, X/Twitter, or her website.  This episode is brought to you by Birch Living, LMNT, and Thesis. To get 25% off your Birch Living mattress plus two free eco-rest pillows, head over to birchliving.com/dhru today. Right now, LMNT is offering my listeners a free sample pack with any purchase. Head over to DrinkLMNT.com/dhru today. Right now, Thesis is offering my community $60 off your first subscription. Just head to takethesis.com/dhru and use the code DHRU to enhance your cognitive health today.  Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Andrea Furlin, welcome to the podcast. Chronic pain, as you know, better than anybody else, affects about 1.5 plus billion people globally. That's one in every five people that's out there today. Now, you're on a mission to help people conquer chronic pain and live a full life, which is, of course, a multifaceted issue. But I'd love to start off with the basics. Help our audience understand the difference between chronic pain. and acute pain, and then we'll get into some of the practical things, including diets,

exercises, and other mind-body practices that are available to us to help us get to the root of pain. First of all, thank you so much, Drew, for inviting me to talk to your audience. It's a great pleasure. So the difference, you know, what is acute pain, what is chronic pain? A lot of people define this by time. So if you have a pain that lasts less than three months, it's acute, and then if it lasts daily after three months, it's chronic.

Well, that is what is in the books. But actually, what happens at three months that the pain lingers? And then some people will have that pain lingering for years and years, sometimes decades, of their life. So actually, there are some explanations. If you have an acute pain, let's say a fracture or an inflammation, a toothache, they, the body heals. We know that the body heals everything. and scars don't hurt.

If the pain continues after the period that you expect the tissues to heal, the fracture is done, the orthopedic surgeon looks at the x-ray side, everything is healed here, why you still have pain? It might be because now your pain has transitioned to chronic pain, which now is becoming a neurological disorder, because it's more like a sensitization of the pain system. Drew, if you allow me a few seconds, a few minutes here, maybe I like to use the analogy of the alarm system of a house.

So the pain is the alarm system of our body. So it's exactly the same thing as an alarm system of a house. You install sensors to detect if there is a danger, right? A smoke detector, a burglar detector, a braking, carbon monoxide detector. So those are the sensors that we have for pain. And when you have acute pain, you want them. the alarm to go off and make noise because you need to go to emergency and take care of that problem.

So if you have an alarm system of your house that is making noise, you call the ambulance, the fire truck, the police, and they come, they find where's the fire, where's the problem, you fix and the alarm goes down. Chronic pain is when the alarm of your body, the alarm system of the house is malfunctioning. And why it is malfunctioning? because it became sensitized. So if a person has chronic pain, they are not going to treat with the same methods

that you use for acute pain. You're not going to call the fire truck ambulance police. You need to call the alarm company. So this is when we see chronic pain transforming from acute to chronic, we need to use different methods. We need to use methods that fix the pain system. So that's what, you know,

the analogies that I use, how do we fix this pain system? Most of them are what you just mentioned. Movement, mind-body therapies, sleep is essential, good nutrition. I would not say good diet, it's nutrition. I see a lot of people who are malnourished. Those four things are so essential to fix the pain system that that's why you're not going to recommend someone who is having a fracture. You know, to say, oh, you need to meditate, you need to do exercise, movement.

No, they need immobilization. They need surgery. They need to fix the fracture. So you see why the treatments are different. Absolutely. If you had to rank, on average, the top drivers of chronic pain, the things that are confusing are alarm system, even though everybody's unique situation is different, how would you rank some of those things in order of most important as it relates to driving some of this

pain to then kind of leased and so on and so forth? Yeah, and we know there's a lot of scientific evidence to say, because we are trying, the scientists are trying to find out what are the drivers, how acute pain transforms into chronic. And we know a lot of things now that we did not know many, many years ago, thanks to a lot of science, especially science looking inside of the brain with function MRI and things that look at where is the system malfunctioning. So one of them drew that is very much important is the danger perception, so stress. We know because in the brain, the pain is a signal of something broken, something damaged, something injured. You have a disease. You have something. So they activate the areas of the brain

that signal, danger, danger, danger. So what happens is after that initial injury, lesion disease is healed, let's talk about a fracture, for example. The alarm system doesn't turn off. The danger signal keeps activated and informing the person that they are in danger. So this is so important that some of the therapies, some of the mind-body therapies, they act exactly on that. They say, if you reduce the danger signals in the brain, the pain will go away, and that's true. And the other things that have, and where does this danger come from? It could be from childhood, early childhood adversities. So people who had adversities when they were growing up, they're more prone to transform acute pain into chronic pain.

but also current stress, fears that the person have and that trauma that is maybe not a big trauma, but a small trauma with small teeth like bullying and things that they suffer every day or stress in life. So that's one thing that we know. The second thing that we know that transforms acute pain into chronic pain is bad lifestyle choices. And that will include putting in. your body in a situation that it's low resilience. Like the body doesn't have resilience to fight that acute pain and therefore it will sensitize the pain system.

So things like drinking alcohol, smoking, nicotine or any kind of smoke, even cannabis because of the smoke, not sleeping well, not moving the body well, not eating well, working too much or being sedentary, overweight. So lifestyle puts the body at a high threshold, like a higher chance of developing chronic pain. And then, of course, there are things that we know related to the pain itself. If a person has an acute pain that is not well treated, is not well managed, like they are left to suffering pain. people don't give them the proper painkillers. Let's say a surgery.

We also know that that stress of the acute pain can also predispose the person to have more chronic pain. So there's a big push for surgeons and esthetists to treat acute pain, especially post-operatively, post-surgical, really well, because we know that that predispose people to have chronic pain. With this comes a whole different mindset at looking at pain. When you look out there today, which are hundreds of thousands of subscribers that are all just looking to find some way to live more fulfilled and less painful life, what are still some of the top myths that you see that are out there when it comes to treating chronic pain? A big one is that it's normal to feel pain with aging. So a lot of people think that aging, getting older, is like a synonym of getting more pain. And people make jokes about this.

They say, you know, arthritis comes with age. Everybody has arthritis and arthritis just gets worse. That is not true. That is not true. Okay. So learn something. It's not because you're old that you must have pain or you are going to suffer more pain. A lot of people, a lot of people, they have arthritis.

You can see their bones. They may look horrible. They don't have any pain. So we all know this. Even in MRI, you see people, this has been researched done over and over and over. They MRI people with, you know, who don't have any pain, like walking around and doing everything they want. And they have heart, even disc crination, disc extrusion, disc prolapses. they have bad arthritis.

An example is my grandmother. She was 92 and she had an x-ray of her neck because she had another thing in her head. And I looked at her x-ray. I've never seen the most horrible x-ray in my whole life. Her teeth is everywhere. She did not have any disc between the vertebra? And then I asked her, grandma, did you ever have neck pain? No, never had.

So it's not a synonym, okay? is not a synonym that you have. So that's the first big myth. The second one, Drew, is that because pain is invisible, when people, a lot of people say, I am suffering pain, I am in pain, my pain is terrible. And then the doctors look at them, the friends, the family, the co-workers, the managers, oh, you're fine, you can move everything. I don't see anything.

The doctor said that nothing is broken your bones. You're telling me that you're in pain, that you can't work? can get out of bed. That is another myth. Because pain is invisible. If the person tells you they are in pain, they are really in pain. So we do need, because again, that pain that centralizes, that I just explained to you and it transforms to chronic pain, it's called nociplastic pain because involves plasticity of the pain system. We cannot see in x-rays or normal MRIs. we can see in laboratory with some specific tests and some specific physical exam. But another myth is that these people are faking, these people are lazy or they're just depressed and they need to exercise.

And why don't you exercise more? Why don't you? It's so simple. It's not that simple. That's another myth. You know, one of the things that we've seen globally is we are increasingly, as populations get wealthier and have more resources, they tend to. to live a more sedentary lifestyle. And for many people, there's not really this understanding of how damaging a sedentary life

is to our health and how proactively it can encourage chronic pain. Can you talk to us about the dangers of being sedentary? I will start with one sentence that I tell all of my patients. Motion is lotion. We were meant to move. And if we don't move our joints or muscles or bones or, you know, nerves, and if you don't use them, you are sending messages to the brain that something is wrong. So the brain, you know, again, it all comes back to the brain.

Because the brain is where the chronic pain is interpreted, is where those dangerous signals happen. And there are a lot of problems with being sedentary. So again, you are putting your brain in a sense. situation say, okay, this person is not moving. What's wrong? Is it some danger? Why, why not? And then the other thing is that if the person needs to reach something and we all need, you know, you're moving boxes or you are, you know, carrying something, and then you suddenly need to use that muscle. You need to use that joint. It's not going to be strong. It's not going to be there flexible for you to do that movement. And then you're going to have one, you know, maybe a muscle string.

maybe a muscle at tendonitis, and then your body will get into that spiral. What's wrong? What's happening? And it's not, if you're not actively moving, your body will not know what you do. So you do need to be prepared. You need to be in good shape even to get sick. We know that people who are, they have what we call sarcopenia. I have a video on my channel about this. Sucupinia is when you start losing muscles and the area of the muscle starts getting replaced by fat,

we can see this when we do imagines of the muscles. Before you had a lot of meat and now you have all fat. People who have Sarkopinia and Sucopinia starts at age 45, 50s when we start losing these muscles, they need to work a lot to maintain their muscles. Because if they get sick, like a flu, a cold or an inflammation or God forbid some cancer, cancers and cardiovascular heart attack, and they are hospitalized, their recovery is much worse. We know that people who don't have sarco opinion, they are in good shape, they are actively with an active lifestyle.

If they are hospitalized, for any reason, they are discharged, they get better much sooner, post-surgery, post-hospital, and if they get even infections, because movement also activates the immune system. So when you move your muscles, you are producing, increasing your immunity. You are also releasing substances that are neurotransmitters that promote nerve growth. So even if you want to reduce your chances of getting dementia, Alzheimer's, cognitive impairment, memory problems at old age, move your muscles. Because muscles will then release nerve growth factor that activate the growth of nerves. So there are so many benefits.

Yeah, yeah, we were not meant to be sitting all day and doing nothing. Our body is meant to move. A lot of people get that advice from their physician, from their primary care provider. And they often hear the advice, hey, lose weight or exercise more and lose weight. And for a lot of people, it's a pretty broad spectrum. In fact, when I go to most people and I talk to them about their health, they're like, yeah, I move a lot, you know. And there's no way that they know how to quantify it of are they actually headed in the right direction. As a pain doctor, as a researcher who specializes in this, are there objective measures?

Are there things that people should be shooting for, targets, body composition, something that they can know that, hey, I am moving in the right direction. Yes, we know all movement is good and it's better to be active than it is sedentary. but what should people be shooting for to ward off pain from entering into their lives in the future? That's such a big topic, and I love talking about this. So let me first explain if a person already, because there are two things, right? If a person already developed chronic pain, we do need to take a lot of care and be careful how we start exercise. is different from if a person is healthy and they want to prevent chronic pain. Because if they are healthy, let's start with that.

If they are healthy, they don't have any problem. Health-wise, they are okay, they don't have chronic pain, but they want to improve their body to become resilient. If in the future they have any problems, they will recover better and they will prevent chronic pain. So for this person, you know, they can go to a personal trainer, a kinesiologist, or start doing what they enjoy. Do a mix of exercise, types of exercise. Mix some aerobics, which is good for the heart and lungs. But also add strengthening resistance exercise to gain muscles. Add flexibility

exercises. So then your pendants and muscles are flexible and stretched. Add also some relaxation exercise. People forget relaxation. You need to relax. And for this, you need to do exercises. Also add some balance exercise. This is really important for people who have a tendency for osteoporosis because they may have a tendency for falls and if they fall, they break their bones. So balance, endurance exercises, how much you can endure and sustain exercise. So those are all excellent exercise if you're healthy and you want to prevent chronic pain. Now, did you know, Drew, that exercise in a normal person that doesn't have this sensitization, produces endorphins and a lot of the few good hormones.

But if the person has chronic pain and they have the type of chronic pain that is this nociplastic pain because it's the alarm system of the body that is malfunctioning, they don't respond the same to exercise. For example, one of the problems of this neuroplasticity that happens in people who have chronic pain is that they don't release enough endorphins. That's one of the deficiencies that happened. You know, this, I told you the alarm system is malfunctioning. That's one of the things that happen.

They are unable to activate the endogenous or internal pharmacy. We have an internal pharmacy in a brain. It's actually in the brain stem. Here's the brain stem and here's the brain. So people, when they develop, think about fibromyalgia. I probably heard about pharmacology, which is a type of chronic pain. Over and over, people do research and they say, these people with parmialgia, they have a very difficult time to activate, open this inner pharmacy.

What happens is when they exercise, they don't release those endorphins, dynorphins, which is our potent internal analgesics, because endorphine is 100 times more potent than morphine. It's an opioid. They feel more pain. And we hear this all the time. You ask the people, you know, I ask my patients with chronic pain to exercise. if they go like crazy and they say, okay, I will, I'll do. They have terrible flare-ups.

They will be in bed with the most terrible pain for days. And that science explains that. So we do need to retrain them. They need to start doing exercise, but slowly we call this pacing. So pacing, how much you exercise, the types of exercise. We teach them to use exercise snacks. instead of having one big meal a day, eat your snacks. So again, instead of doing a lot of exercises in one day,

let's divide and do a little bit of aerobics. And sometimes for these people, going from their house to the corner and back, that's equivalent of you and me running a marathon. Well, for me, would be. That's how much tired they get and that's how much exertion they have. So it's different for people with chronic pain. We do need to give them prescriptions and they need to see like a professional, maybe a physiotherapist, an occupational therapist,

that would know how to start moving their joints. So they don't have those flare-ups. Because if they have those flare-ups, they get so discouraged. They don't want to start again. And then they become that spiral. They become more sedentary, less active because it's comfortable for them. If they, you know, maybe if I don't move, I don't have pain. So they high tell them, you need to get a little bit worse before you get better because exercise

for them is one of the methods that we can retrain that pain system. Let's talk about one of the most common types of chronic pain, lower back pain. I think it's repeatedly mentioned as the number one thing that people are going through. If someone was going to put together some exercises, exercise snacks, some corrective things, and even maybe some lifestyle issues that they might want to pay attention to. You know, you're not diagnosing anybody. This isn't it medical advice. But just to help people understand what's possible and available to them, how would you approach lower back pain?

A few months ago, December 2023, the World Health Organization released guidelines exactly for that, for chronic primary low back pain. When we say primary low back pain, it means it's this nociplastic pain. is when the pain already transformed from acute to chronic, because we know 90% of chronic low back pain is primary chronic pain. So secondary chronic low back pain would be if the person has a tumor in the spine, like a cancer, a fracture, or they have an inflammation, there are some inflammatory diseases like ankylosing spondylitis that affect the spine, or they have a neurological impairment.

But when you exclude those secondary causes of low back pain, 90% of chronic low back pain is primary, which means it's just a problem of the pain system that is having the sensitization, the muscles are tense, they are aggravated by mental stress, physical stress, sedentary life, all of those. So how do you combat this chronic back pain? It's lifestyle. Medications will not do the trick. Opioids, anti-inflammatories, analgesics, they are good if you have an acute low back pain

for a short period of time or if you have a secondary back pain that is secondary to one of those things, okay? But if it is noceplastic pain, like this primary chronic pain, medications, only if the person has some other, like a depressed, they are very depressed, so we need to give them antidepressants, or if they have another inflammatory disease that is affecting other joints we can give antiflamatories. But anyway, so don't think medication. Medication is not going to be the first line of treatment

for chronic low-backing. The first thing that they need to think is about movement. Again, motion is lotion. And what kind of movement? When I say movement, anything is movement. Dancing is movement. If they like dancing, go dancing. Start dancing a little bit.

Because dance is good. It's good. cardio exercises, flexibility. If they like swimming, go all swimming, do anything. You know, the best exercise is the one that the person does. It's not the one that I like, is what they like. Start with what you like if you like yoga, Tai Chi, Pilates, if you like stretches, whatever. Start with something. At least you get moving. If you want to go for walks, jogging, biking, start. if they have specific kinds of symptoms, like if they have more pain when they bend forward, for example, then we would recommend them, you know, maybe do more exercise that you are doing the opposite of what would aggravate your pain.

A lot of back pain is related to muscle tension here in the muscles. It's called the quadratus lumbar. So one of the exercise that I recommend my patient is always to do is stretching like this. You can make it harder by doing this. Let me see if I go back here. Yeah, like this. Yeah. And to the other side.

Sometimes they start like this and then they go to make it harder. You are stretching this muscle. So I sit, you know, this is my office and I sit at meetings sometimes the whole day or I'm writing. And I need to get up and, you know, move. Oh, by the way, there are six moves. of the lumbar spine that I highly recommend. So there is a flexion. But again, if they feel pain when they do this one going forward, don't do it.

Just do the opposite one, which is extension. Then we call this the lateral bending from one side to another one. And the other one is rotation. Look at the wall behind you and the other one. So like the six movements, flex and extension, lateral bending to the right and left in rotation. Like if the person does this, you know, if you're sitting the whole day or if you're sedentary or even if you are, you know, on your feet, stop. How long does it take to do this?

One, two minutes and you'll be moving all the joints, you know, stretching, your muscles will get messages that they're okay. People don't pay attention to their sleep. Sleep hygiene is extremely, extremely important. I don't know how to stress this enough. Sleep is extremely important for your health, for everything, but for. people with pain is even more important. Humans are the only animals that suppress the sleep voluntarily.

Like we are able to sleep less. We are able to sleep at a disrupted times. That's not good. We do need a routine. Go to bed every day at the same time. Sleep eight hours is good. Some people seven, some people night. Around eight is good.

Don't do less than that. Try to do everything possible for you to sleep in a, healthy environment, dark, low noise, not too hot, those kind of things, right? And then, of course, we cannot talk about all of this without talking about nutrition. Nutrition is important for our body. My mother taught me this. Since I was a child, she always says, you need to eat well. If you save money on buying garbage or if you don't cook your meals, you're going to pay the price later.

You're going to pay expensive doctor bills. You're going to pay hospital bills, medications. You're going to pay the price later. And that's totally right. We do need to put the right ingredients to your body. How do you expect your body to heal to do good things for you if you don't give the nutrients to your body? And in our North American and in many other places in the world, we eat a lot of junk. That you're hungry?

and it associates you, you know, you're not hungry anymore, but it has absolutely no nutritional value. I love talking about this. Well, in fact, one of your most popular all-time videos was the power of eating a diet that's anti-inflammatory. You provided some pretty incredible food rules. It was a list of eight things to sort of avoid slash minimize and a list of also their counterparts of things to prioritize. I thought it would be a nice thing to just touch on because we're on the topic of nutrition. I'll walk you through it. And one of the first things you mentioned was

talking about the overuse of a lot of refined flowers in our diet. What's the problem with these flowers when it comes to our nutrition and when it comes to the chronic inflammatory state that so many people find themselves in? And I put them together with the refined flowers, refined sugars and white rice. So I tell my patients, avoid the white things, the white flowers, the white bread, the white rice, and the white sugar. Yeah, the refined flowers, they're bad because they remove the cover of the grain. And that's where all the vitamins are.

So you're only eating the carbohydrates. That's basically it. You're just eating the carbohydrate, which is good. I am not against carbohydrates because Hypohydrate is the main fuel of our brain. Okay, remember this. Our brain needs carbohydrates to function. And if you don't provide this to your brain,

it has to break proteins and fat, all the things, but it's going to break your proteins. But if you can give the preference to, if you're going to eat flour, a bread, I love bread, I love pasta, but then why would you remove it? all the vitamins from that flower and they are in the outer part. So that's the first thing. Refined sugar is everywhere. People have no idea how common it is. It is added to even things

that we give to our kids, cereals, chocolate. I love chocolate. It's added to ketchup. It adds, they add sugars everywhere. Although sugar is not a bad thing in itself, the amount of sugar that we eat, that's the problem. Okay. The amount of sugar that the North American diet eats, it's enormous. And what it does, it's, it gives the message to your system that you need to metabolize all of this, increases the cortisol, increases the amount of the work the deliver has to do to metabolize all of this. And it's toxic to the neurons. We know if you want to accelerate memory problems, cognitive problems, the man should give the person a lot of refined sugars. It, It's going to accelerate a lot. And of course, white rice is the same thing because you're removing the best part of the rice grain, which is the outer part that contains iron, vitamin B12, contains all the folate. And these are so essential for our body to heal.

If we lack vitamin B12, people have no idea, but it's a serious problem. It can cause damage to the nerves. The person will develop chronic pains, a neuropathic kind of pain. that is really hard to revert because after the nerves are damaged, you don't have a lot of things that you can do to revert. And people with peripheral neuropathy, either caused by lack of vitamin B12 or too much alcohol, or sometimes they have also, we don't know what is the cause, but it's terrible.

These people have tingling, burning in their hands, in their feet, doesn't go away. And it doesn't get that better with pain medication. So, yeah, people, I think they lack a lot of, they lack knowledge and awareness and the willingness to change. I find it's so hard to change because the food industry makes it easy for people to buy what is not healthy and so hard for people to buy what is healthy. Well, it seems like two rules right away that you're having people focus on is shift towards more nutrient dense foods, right? And also as a part of that, don't cut out all the fiber sources in your diet. That could be beneficial for our gut bacteria, slowing down the absorption of all the different sugars and glucose that we're exposed to.

It's not that there's any, quote, unquote, bad thing about, you know, some of these things. You'll probably maybe have them occasionally. It's just the problem becomes when you base your entire diet around them, which unfortunately, if you look around, that's what most people are doing. To continue on some of those foods that are there, I want to touch on another topic that is part of these food rules, which are avoid unhealthy fats. What are some of the unhealthy fats that you have your chronic pain patients, start to become aware of their overabundance in the diet? Yeah. So there are so many different types of fats. And I tell them, let's start with the omega-s, omega-3, six, nine, those things.

These are essential fatty acids. When we call essential, it means that your body does not fabricate itself. You need to ingest this from the diet. We need all of them, omega-3s, omega-6, omega-9, because our body needs them, especially the neurons, the brain. And if we want to fight pain, we need those. The problem is when the balance of them becomes imbalance. The North American diet is much more rich in omega-6 than omega-3s.

And omega-6 is pro-inflammatory. Omega-3 is anti-inflammatory. So you would say, why do we need an omega-6 that promotes inflammation? Of course we need inflammation in our body. We need every day when we are being invaded by virus, bacteria, our bodies producing cancer cells. We need to kill all of those. and to kill those we need inflammation. To heal, like you don't know, but sometimes you have a damage to your skin, your bones.

The body needs to go there and heal. And it does this by producing inflammation. So we do need the pro-inflammatory, omega-6 and all the cascades that comes with it to promote inflammation. But when you have too much of pro-inflammatory and very little of omega-3, which is anti-inflammatory, then you don't have that balance. And what is the problem then? The problem is if then your body will always be in this pro-inflammatory state and will not be able to stop the inflammation because it's creating inflammation, but something has to go there and stop the inflammation.

And that's the omega-3. Omega-3s are found in fish, like cold water fish. People say, oh, but it's expensive. It's salmon, macaroel. Well, you can buy tuna, can tuna does the same thing. it also found in some oils, extraverting olive oil. You do need the palace. In the Asian countries, especially Japan, it's almost one-to-one because they eat a lot of fish there.

And they have less inflammation. They live longer. They live, you know, to the 90s and hundreds. Inflammation, if you have too much in your body, it may predispose to chronic pain because we now know that inside of that brain that is trying to heal the pain, there is a, there's a, a, a slow state neuroinflammation. It's different from the inflammation that we observe when you hit something here that you see red and a bum and swollen.

That neuroinflammation happens inside of the brain is different. It's just because there are some substances there that are more inflammatory. Also, we have a lot of autoimmune diseases in our society. We have a lot of inflammatory disease like rheumatoid arthritis, osteoarthritis, lupus, psoridia tritis, ankylosis, spondylitis, that everything that finishes withitis is an inflammation, colitis, elyitis, you know, a lot of things, cystitis, a lot of people have chronic pelvic pain because they have what we call chronic bladder pain, chronic cystitis. So this is related to omega-3s and 6.

Another type of unhealthy fat is the trans fats. Hopefully this is going to be eliminated from our society. We don't need trans fats. But saturated fats, they're also not the best ones. These are the meat fats. I believe that we do need those saturated fats, but not in excess. So people need to get to know a little bit about these unhealthy fats. It's interesting about the saturated fats because when you look at the literature,

most of the sources of saturated fat in North America is actually coming from baked goods. and processed, you know, sugary and sweet things. It's not coming from things like, you know, red meat and other stuff. So it's very interesting. This goes back to, again, one of your central points. We're trying to minimize and greatly diminish the percentage of processed foods that we eat overall because those things are going to be coming with all sorts of additives and junk that's just going to make it worse for our chronic pain.

We are fighting against a food industry that is so powerful. I think people need to understand the propaganda works, marketing works, what they offer in schools, what our kids are eating. That's what they're going to get used. And then they're going to become adults that grew on processed foods. And that's what they're going to eat when they become adults. You know, people like my mother, my grandmother that, you know, bought raw food in the supermarket, went to the butcher and bought real meat and cook at home are becoming more rare. I still do that. I cook a dinner every night for my whole family.

And I always cook more so then we have leftovers for lunch. But it is work. You need to learn. You need time. and in this rapid society that we leave, everybody's rushing, it's much easier just to stop at the drive-through, buy something, you feed the whole car with, you know, and then you don't have to cook.

A lot of people don't know. And that's the other thing. The generations are losing the tradition, like what grandmothers used to teach our mothers, how to cook things, and the mothers are not teaching their daughters or sons, by the way, it's not only women that cook, right? They're not teaching their children how to cook.

So where are they going to learn from? They're going to learn from YouTube, maybe, but we need a chef that cooking at home is healthy. It's the best way to do because you know exactly what you're putting in your food. You buy the best ingredients. My mother never let me buy olive oil. if it was not for the extra virgin olive oil. She said, don't buy the cheap olive oil.

Buy the most expense because that's the good one. She knew this like 40, 50 years ago. A great influence. What do you want to say about a topic that a lot of people have a lot of different thoughts on, which is alcohol, alcohol and chronic pain? Interesting. I was at the conference. I was in an International Association for the Study of Pain Conference two weeks ago in Amsterdam.

them. And I attended a lecture about alcohol and pain, and people are still trying to find, and they do studies in animals, and they look at studies in humans, and they look at the science. And there always seems to be some conflicting information in science. But you know what they said? This is what they said. This is just fresh from the conference. Too much alcohol, we know it's bad. We know. If a person drinks, every day and in high quantity that we know it's bad. So if you're drinking to socialize, to connect with people, to, because that's who you are, that's your tradition, it seems not to be so bad.

Now, if you're drinking alcohol because you want to withdraw, you are, you know, getting out of, you know, your relationships, you are, you know, fed up or you are, you are numbing some of emotions that are really bad because alcohol will do that. We'll numb some guilt, shame, anger, it will. So if you're using alcohol for the wrong reasons, it's really toxic. I never heard that before in a scientific conference. So I really, because they were trying to explain why these studies are conflicting. Like, there are some groups of people that they drink regularly alcohol, but they don't seem to have higher incidence of chronic pain.

They live longer. And they were saying maybe because the way they're drinking is to connect socially. Social connection is so important also for fighting chronic pain. We are learning more and more and more isolated people, lone people. They have much more problems of health problems, including chronic pain. It's so interesting to continue to obviously stay on top of all this stuff by having people like yourself who are going to these conferences, reading the papers. And it seems that the advice that we've generally gotten from our audience is that the idea

previously that there was some unique health benefits for alcohol has largely been debunked. And then there's the second layer. And in fact, it'll throw off your sleep. It'll make, it'll throw off your body composition. it can make chronic pain worse, et cetera. And there are societies that are out there that seem to not have maybe the entire way that they operate. Maybe they don't have the same levels of stress that we have.

Maybe they don't have the processed food culture that we have here in North America. Maybe there's just a little bit of a slower pace of life that's there where alcohol is a part of that. And we have to ask and continue to ask, can you get some of those benefits without the alcohol or is alcohol inherently a part of it? So that's the thing that everybody's looking at. But I think on average, you would feel comfortable with the recommendation that anybody that's using alcohol to sort of kind of self-medicate is a bad idea.

And generally, most people would benefit from significantly limiting or removing alcohol from their body. Yeah, the less that they can drink, the better. We know it's toxic, especially to the neurons. Drinking less is absolutely a good advice. Now, stop drinking completely, especially if you're going to use that to socialize, to it's part of your family, your tradition, where you live. Probably is not a good advice because everything else that you are doing that is right,

probably the benefit of the socialization, laughing with your family, making jokes and participating in that, it's much more, you know, protective to your brain than the, you know, tiny amount of alcohol that you're going to drink. I want to shift for a second, and I want to go into this other idea that a lot of people in our audience are always asking themselves is that in addition to a diet, are there supplements that they can use to help them with chronic pain? What does the literature show out there in terms of what's beneficial and what could be something that people could incorporate into their routine if they are suffering? from chronic pain? If a person is eating a healthy diet that includes, you know, fruits, vegetables, grains, fiber, protein, carbohydrates, healthy fats, they don't need anything. Actually, it's interesting. People who are consuming a lot of supplements are the ones who don't need supplements.

Because they are usually, you know, wealthy. They have access to nutrients. You know, they don't have like financial problems to acquire those health ingredients, they're the least ones who need. If you think in the world who need supplements are probably the ones who are not taking because they can't afford supplements. People who have poor access to nutrients, either because they can't afford or because it's not available where they are. That's the first thing. I recommend supplements only, only and only when there is a deficiency.

or the person has a condition that they can't absorb. Or one that is an exception is vitamin D because if they don't have, you know, exposure to sunlight or if they drink, they don't drink milk or cheese or yogurt that is enriched with vitamin D, which is rare. Like, you know, most people would be supplemented by food. If they don't, then I would say, okay, then you need vitamin D. That's the only one, because the rest, if they're eating healthy, if they eat everything, they don't need. Now, there are, of course, there are people who are deficient in vitamin B12, for example, and they don't, they can't eat, you know, sources that have vitamin B12 because of tradition or choice or because of all the problems.

Yeah, they do need vitamin B12 supplements. if a person absolutely has no access to food that contains omega-3s, yes, so then you would need supplements. But that's rare. That's rare, really. And I think there is, again, a lot of propaganda push in marketing trying to push supplements to everyone because they make millions and millions of profit out of people who buy supplements and then everything is flushed down the toilet. Well, I'd love to offer maybe a layer to that, if possible. So one of the most research areas of supplement intake is omega-3s. And we had on a gentleman name Dr. Bill. I'm blinging on his last name.

And their group is the group that looks at the omega-3 index. And a lot of observational data, you know, big trials have shown that individuals that have a higher omega-3 index tend to live longer and be. more free of chronic disease. Again, observational, you know, data that's there. I saw a lot of the data that was presented and I thought, okay, let me get my omega index tested. And obviously, there are some other blood tests that are out there that get it done. Like Boston Heart is one in America that you can get your sort of full omega spectrum. So they'll give you a breakdown. Where's your omega-3, six, nine? And they'll also in some instances tell you how much trans fats do you have inside of your, you know, body and bloodstream as well.

Even though they're banned, they often still show up in the restaurant system and processed foods at very small amounts. So even with me eating about one fish to two fish daily, I still came in and scored at about 6.8%. And I've been eating fish for a long time. And comparatively to the data, the strongest efficacy was when you're around 8%. So just by taking about a gram of fish oil a day, I have no allegiance to any product or anything that's out there.

When I retested, I was able to get back around 8.59%. So I think that on the spectrum, we probably have deficiencies, like some of the things you're talking about, like B12 deficiency, vitamin D deficiency, other deficiencies. And in some cases, there may be a question of what's optimal for us. And, you know, that's something that I think that our audience is always trying to to balance out. I mean, you did an entire video about fish oil being anti-inflammatory. So, if somebody is dealing with chronic pain, even if they're eating fish, could there be a role for something like fish oil in their diet to help them with chronic pain? When I did that video,

I remember it was during the pandemic. I revealed those studies because I found that fascinating, you know, can we measure? Can we detect deficiency? And I read the those studies, I remember, the index, how they develop the index, where they measure. But then I did not really recommend those. I was thinking, that would be cool to include in the video. I think people would like. But then there was, then I read the debate around those things and people who really disagree with that.

And they say that that's not inaccurate. So I found more evidence against measuring those things. because where you measure in the blood is not where those omega's, threes and six would be, like they would not be in the circulation. Like they would be very quickly in the circulation right after you eat, but then right after that they are internalized inside the cells. And you're not measuring them inside the cell. So we still don't have a proper measure,

but going from the studies that look at, adding a little bit of omega-3 to people who have an inflammatory disease. So that's what I found interesting is that if a person is healthy, they don't have any inflammatory disease, like the proportion eating just, you know, a little bit of fish and fish oil and the extra virgin olive oil isn't enough. You only need to start getting concerned if they have a inflammatory disease, like rheumatoid arthritis or any of the serious anticholosis spondylitis, those are arthritis provoked by pro-inflammatory disease.

For the rest, it seems to be okay. And again, those measures are still very preliminary. We're not recommending those in clinical practice because they actually do not measure what we would like to measure, which is where is this fat acting? And they are very fast. they go, they act, and then your body eliminate. So they don't stay in the circulation.

Well, let's talk about one nutrient slash, you know, you could get it in supplement form. You could get it in a lot of foods that you are a big fan of, which is magnesium. What's the role of magnesium when it comes to chronic pain specifically and just feeling overall healthy in our body? Yeah, magnesium is an ion, so it's not a vitamin. and magnesium is a this, it's like iron, magnesium, calcium. We don't consider them vitamins, but some people call them vitamins. And magnesium is important for a number of things,

especially for the function of muscles. We do need magnesium for the muscles to relax. They are also good for the bowel movement because they stay inside of the bowel and then promote, you know, a good bowel movement. There are so many different types of magnesium, magnesium sulfate, citrate, glycinate, bisglicinate. People take baths in magnesium, like apples outs. They are basically magnesium and they say that some people absorb through the skin. I'm not really sure, but it seems that they do and relax the muscles.

I think it's more the hot water that relax the muscles than the magnesium itself. But the thing is, it's really rare to be lacking magnesium because it's found in a lot of vegetables, dark green vegetables and legumes and grains. It's not that hard to find unless a person has some disease and they can't eat certain foods and they have a problem with deficiency. But what I find is, in people who have muscle pain, and a lot of my patients come with muscle pain, they have myofacial pain, they have fibromyalgia, they have difficulty sleeping. I find that adding muscle cramps, people have, you know, usually muscle cramps during when they sleep or even during the day, I find that giving them some supplements of magnesium help. I tell them that you probably don't need this for the rest of your life, but just for, you. for a couple of weeks or months, it helps them to go back to a baseline that they are sleeping better and having less pain.

Let's come back to chronic pain as a bigger picture. We talked about how lower back pain is one of the top things that people complain about regularly. I think you even said in one of your videos that 100% of people will go through some sort of lower back pain in their life, right? Especially if they live long enough. From there, what's the next biggest one that you see people looking for, answers, resources, and solutions that you are trying to provide tools for them.

Don't be afraid of it. I think the fear of the pain paralyzes more than the problem itself. We see this a lot. People have an acute episode of back pain. They get very worried. A lot of things start going on in their mind. They start spiraling. Oh, this will happen. Blah, blah, blah. And that stress, the reaction of a person to the back pain itself is worse than the problem itself. That's the first thing. There is a lot of research saying don't prescribe bad rest anymore. This is for doctors. Doctors don't prescribe bad rest if your patient has an acute back pain because if you do,

there is a lot of evidence from randomized trials done in the last 40 years showing that if a person rests, they do worse than if the person. and just try to, you know, take as normal as possible their life. I know some, I had some episodes of really bad, acute, low back pain, and I know how hard it is to move. But, and I know how frightening it is. It's really frightening because it hurts a lot. But the first thing is try not to be afraid of it.

Try to move. Try to live your life as normal as possible. You can take some analgesics in the acute phases, try not to stress too much. You can see a chiropractor, a physiotherapist, a kinesiologist, your doctor, but try to move. The other thing that people need to remember is when they have an acute back problem, seeking like a go to the doctor and demand an image, I need to see a CT scan or MRI, it's probably not the best thing to do. I am a big educator of doctors.

Most of what I do here in Canada is educating doctors how to treat chronic pain, acute pain, so they doesn't become chronic. Yes, do a good physical examination. Talk to your patient. If your patient has red flags that suggest this could be a tumor, a metastasis of a cancer, this could be a fracture, this could be an inflammatory process because my patient is having fever. Or this could be an infection in the bone because the patient uses IV drugs, they inject. drugs and now a bacteria can be growing in their vertebra. So if you're not concerned that it's one of those things, don't even order imaging.

The guidelines say if you order imaging, MRI, anything, you're going to cause more damage to the person. And that's because we all, we all have some abnormality. Right now, Drew, if I MRI your lumbar spine, I don't know how old you are, but you're probably younger than I. But I can guarantee I'll find some disc problems because research has been done. We'll find disc problems, asset problem. They're not causing you any back pain right now.

These are just incidental findings. The problem is when the patient sees that in the MRI and the doctor sees that, they all go panicking. And now they think they need to treat that thing when that thing is actually not the cause of me. It was just an incidental finding. Yeah, so it sends them on a wild rabbit chase, and they think that this disc or bold is what's driving it, and it could lead to... And it's not.

It could lead to aggressive recommendations of surgery and other things, which often makes the situation worse. No, that's great advice. You know, this goes into this other larger topic that our audience would love to hear from you on. What are the most evidence-based, adjacent, alternative, and supportive components that you have seen significantly move the needle forward when it comes to all types of chronic pain.

But in particular, lower back, shoulder, sciatica as being the top ones that people are looking for answers on. Okay. My top one right now has always been my top one. But right now I have seen a lot of success is using mind-body interventions, things that fix that pain, remember the alarm system that I mentioned in the beginning. When the alarm system is out of walk, is deregulated, that dangerous signal is going off all the time, talking to a therapist, doing some counseling, some psychotherapy helps to reduce that fear of pain,

helps to regain confidence that you can move, helps them to see stressful situations in their daily life that is aggravating, that muscle tension helps them to become more self-confident and more positive in reducing the thoughts of catastrophization. Like, oh, this is going to get worse. I'll become paralytic and I'll become in a wheelchair and this only to get worse. So talc therapy, psychotherapy, mind-body interventions are my top one right now. The other one that are holistic in the complementary field, I would say things that have help you to relax overall. So I recommend a lot of massage, acupuncture, because they will help

to downplay that stress. I didn't mention here in this interview the importance of the parasympathetic and sympathetic nervous system. The sympathetic one is the fight-flight response, the stress response. The parasympathetic is the heal, digest, the system that you cannot be relax and anxious at the same time. So if your sympathetic drive is too high, you do need to activate the parasympathetic. So those things that relax the mind and body, and that could include massage, could include manipulation, it could include music therapy, aromatherapy, do whatever it takes for you to activate your parasympathetic nerve system, because that will eventually lower the sympathetic

and the sympathetic nervous system is driven by adrenaline, not adrenaline, cortisol. So once those substances reduce, because those substances, adrenaline, cortisol, they make the pain more intense. They amplify pain. So then the person will feel better by consequence. And of course, exercise and sleep. But complementary alternative medicines, also the person needs to be, careful not to become dependent on them. I tell my patients, okay, go to acupuncture, some sessions,

but don't do a cup bunch of your life every week. You do need to stop, to not become dependent on them, and then become self-resilient, self-management, is learn things for yourself that you can do for yourself, that you don't depend on someone else. You know, earlier in your interview, you were saying that one of the challenges is we all just sit and we don't move our bodies throughout the rest of the day. What are some of your do's and don'ts and tips for when it comes to many of us that are watching even today on YouTube are sitting down? We're sitting in our jobs. We're sitting in the car. What are some things that people can be doing to be mindful of how they're sitting, have breaks or other guidelines that could follow so that we don't overabuse our body

through all this sitting? First of all, do the exercise, the movement that you enjoy. Don't try to do something that you don't like because you're not going to adhere to that. Find something that you like. It's playing volleyball. It is weightlifting, whatever it is. Find something and adhere to that. Try to do at least three times a week. So also don't do once a week. Try to do, you know, spread throughout the week. If you can't get a chunk of exercise, because you say, I don't have one hour to do exercise. Do snacks. Break down that routine. If it is stretching, aerobics, some weightlifting, resistance. an exercise, you don't need to do all of them at once, like 90 minutes doing those.

You can take snacks, break down into small chunks, so then at least you can achieve those goals. The goal is 150 minutes per week. What about posture of sitting or getting a high-quality chair? Do those things make a difference? Well, if you see my chair, it's not the most expensive chair. I cannot show you. but it's not an expensive chair, but I bought this backrest. I had bought an expensive chair, and it was horrible.

I couldn't work well. It didn't support my back. I like space to move my shoulders, and that was blocking my shoulder. But then I bought a less expensive chair, a backrest to feel that space here of my lumbar spine, and I'm fine. So what I recommend my patients with back problems is it doesn't need to be the most expensive one, but it has to be one. Sometimes it is the most expensive one. Who knows?

But it has to be one that supports your back, that you can relax, that when you're sitting, you're not thinking about your back, that you're comfortable. You know, the seat, not too hard, not too soft. And for each person is different. So they do need, go to a store and test some different ones, buy something that you can have a refund if you don't because that's what I did. I bought one very expensive, many when I renovated this office and then I had to return because I really couldn't use that one.

So buy one that you can return and get a refund if possible and try. The same thing for pillows and mattresses. There is no recipe drew for, you know, you have to buy this pillow or you have to use this mattress. Each person is different. but they need to find what it takes. And so go to a mattress store and stay there for about two hours and try one, try another one, try another one to see which one you feel better. Some people like, you know, the harder mattress.

Some people like the softer one. There is really no recipe. And we know too that really the mattress, the chair, the pillows, they're not the main drivers of chronic people. we know now because there has been some trials, they gave the best pillow to people and they compared to a less, you know, exciting one. And there was no big difference to treat people. So I would say don't spend too much money too on the most expensive thing. You may be surprised that the cheaper mattress pillow or chair might do the thing for you. These have all been great. And really, I'd like to wind down here for today's interview by coming back to the

the mindset piece of this. So many people, when they start to experience that first, second, third bout of chronic pain that's there, there's this fear that takes over where you start to feel like am I ever going to get better? Is my entire life going to look like this? And as you hinted, there's often a downward spiral that comes in, which is you become less likely to move. you want to become more sedentary and you can even become scared of daily living, which is unfortunately something that a lot of people are going through. Are there any additional things that you want to say about mindset, about something to help you get through, not just the immediate pain that's there, but to actually know that if you continue to make progress and at least work on some of these

things, maybe follow some of the videos that you've posted on your YouTube channel, that things can get better. Absolutely. I've seen so many people that, you know, they had a terrible one, two, three episodes, and many of those, I even interviewed them on my channel to show that it's possible to overcome chronic pain. They come hopeless. They come, you know, totally very disabled, because their reaction to the pain, as I said, is worse than the problem itself. So they do need some help. I'm a rehabilitation specialist. And then we need a team.

For those people who are very debilitated and they stop living their life, we need a team. We cannot do this by ourselves. We need a psychologist, a physiotherapist, a social worker. Sometimes we need a sleep therapist, a dietitian. We need the doctor to examine the, stop ordering tests, but examine the patient to see if there is really, you know, if you do a good neurological exam, examining, you know, their back, you are going to know if they have a serious problem or not. So a team is essential for this. And I would say the mindset, if a person cannot access a team, especially one that has a mind, a psychologist, someone in the mental health area, a psychologist, a social worker. even an occupational therapist, they can help a lot.

They can help the person to see their body differently. They will help the person to realize that they can do much more than what they think, that they are imposing a lot of limits on themselves because the pain is paralyzing them. The pain is putting limits. And once they see the freedom that comes when they think differently, it's life-changing. When the person loses this fear of pain and they start living their life, they say, you know what, the pain is here.

If I stay in bed or if I go see my daughter, visit my daughter, my grandchildren, the pain is the same. So I will go and visit my grandchildren. They realize how much benefits they gained from changing that mindset. And in turn, those dangerous signals in their brain will. start turning down because they are living their life and the brain says there's no reason for me to be showing that you're in danger. So mindset is so important. If they can't have access to a multidisciplinary team, if they can't get access to a psychotherapist, I highly recommend

them to join a peer group. There are healthy groups of people who live with chronic pain. In Canada, we have a lot. I believe in the United States to, in the UK, I know, a lot of groups. And those peer-led groups are people who had conquered chronic pain. They did it. And they want to now help other people who are in the same situation that they were five, 10 years ago. Join one of those groups.

Open up your mind. Open up your fears to them. They are your peers, your colleagues. They were in this situation. Find a group that is a healthy group. Usually there is a moderator. You can talk to the moderator before you join the group. most of them are free.

You don't need to pay. And here, how other people did? Because hearing from another person that walked your walk, sometimes is more potent than I'm telling you to do this. It's possible. But if you hear from someone who did it, you might believe it better than a clinician, a doctor, telling you that this works. That's powerful advice. Dr. Andrea Furlin, this has been fantastic.

You've gone through some exercises. You've talked about best sleeping practices, sitting practices. We talked about diet big picture and the foods that both promote resolution of pain, like an anti-inflammatory diet and foods that could encourage the proliferation of pain inside the body. We touched on supplements as well, too. And most importantly, we talked about mindset, which is such a big part of this whole thing. You know, you have, I believe, hundreds of videos that you've done on these topics that are out there and a very popular YouTube channel. How can people continue to follow you and the resources that you've made available to them?

Yeah, the easiest way is on my YouTube channel. It's just my name, Dr. Andrea Forland. I also have a website that people can download a lot of resources. Like almost every video that I have has a handout, a summary. and I put all of those free of charge on my website, and people can download from there. They just need to become a member, leave their email, and they will get everything.

It's my website, is Dr. Andrea Furlan.com. And I have a book that I publish. It's The Eight Steps to Conquer Chronic Pain. People can find this book in any bookstore where books are sold. Amazing. Well, we'll have the links to all those below. Please, community, subscribe to Dr. Furlin's channel. It's fantastic.

I love the exercises in particular. that you give for all different types of chronic pain, shoulder, sciatica, back, all sorts of stuff that are there. Those are great. We'll link to all them below. Thank you for being on today's podcast. And thank you for helping to make the world a place that is filled with less chronic pain and helping people conquer their own pain journey. Thank you so much for inviting me. Hi, everyone, Drew here. Two quick things. Number one, thank you so much for listening to this podcast. If you haven't already, subscribe, just hit the subscribe button on your favorite podcast app. And by the way, if you love this episode, it would mean the world to me. And it's the number one thing

that you can do to support this podcast is share it with a friend, share with a friend who would benefit from listening. Number two, before I go, I just had to tell you about something that I've been working on that I'm super excited about. It's my weekly newsletter. And it's called Try This. Every Friday, yes, every Friday, 52 weeks a year, I send down a an easy-to-digest protocol of simple steps that you or anyone you love can follow to optimize your own health. We cover everything from nutrition to mindset to metabolic health, sleep, community, longevity, and so much more. If you want to get on this email list, which is, by the way, free and get my weekly step-by-step protocols for whole-body health and optimization,

click the link in the show notes that's called Try This or just go to drew peroit.com. That's D-H-R-U-P-U-R-O-H-I-T dot com and click on the tab that says, try this.