Huberman Lab - Control Pain & Heal Faster with Your Brain
Episode Date: March 1, 2021In this episode, I describe the science of how and why pain arises in the body and brain, and how we can actively control our experience of pain. I discuss inflammation, stress, acupuncture, limb dama...ge and Traumatic Brain Injury (TBI). I review protocols that leverage the lymphatic and nervous system to accelerate pain relief and healing in a variety of situations. Other topics discussed include how heat versus cold impacts neurons and wounds, red-light, sunlight, stem cells and more. For the full show notes, visit hubermanlab.com. Thank you to our sponsors AG1 (Athletic Greens): https://athleticgreens.com/huberman LMNT: https://drinklmnt.com/huberman Supplements from Momentous https://www.livemomentous.com/huberman Timestamps (00:00:00) Introduction/Avenues for Support (00:00:31) Sponsors: AG1, LMNT (00:04:58) Deliberate Unlearning (00:06:43) Pain, Injury and Regeneration (00:09:17) A System of Touch (Somatosensation) (00:11:42) Pain and Injury are Dissociable (00:15:19) Objective versus Subjective Control of Experience (00:16:15) Plasticity of Perception (00:16:41) Lack of Pain Is Self-Destructive; So Is Excessive Pain (00:18:42) Homoculous, Ratonculous, Dogunculus (00:19:05) “Sensitivity” explained (00:21:30) Inflammation (00:22:24) Phantom Limb Pain (00:24:00) Top-down Relief of Pain by Vision (00:26:41) From Deaf to Hearing Sounds (00:28:10) Pain Is In The Mind & Body (00:29:44) Recovering Movement Faster After Injury (00:35:00) Don’t Over Compensate (00:37:34) Concussion, TBI & Brain Ageing (00:40:49) The Brain’s Sewage Treatment System: Glymphatic Clearance (00:43:05) Body Position & Angle During Sleep (00:44:30) Types of Exercise For Restoring & Maintaining Brain Health (00:47:33) Ambulance Cells in The Brain (00:49:20) True Pain Control by Belief and Context (00:51:45) Romantic Love and Pain (00:55:05) Dopaminergic Control of Pain (00:57:15) Acupuncture: Rigorous Scientific Assessment (01:07:32) Vagus Activation and Autonomic Control of Pain (01:08:30) Inflammation, Turmeric, Lead and DHT (01:11:40) Adrenalin: Wim Hof, Tummo, “Super-Oxygenation” Breathing (01:14:53) Protocols For Accelerating Tissue Repair & Managing Pain (01:17:55) Ice Is Not Always Nice (For Pain and Injury): Sludging, Fascia, Etc. (01:22:02) Chronic and/or Whole Body Pain; Red-Light Therapy, Sunlight (01:26:10) Glymphatics and Sleep (01:26:29) Stem Cells, Platelet Rich Plasma (PRP: Shams, Shoulds and Should Nots (01:31:38) Young Blood: Actual Science (01:35:44) Synthesis, Support & Resources Title Card Photo Credit: Mike Blabac Disclaimer
Transcript
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Welcome to the Huberman Lab podcast where we discuss science and science-based tools for everyday life.
I'm Andrew Huberman and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine.
This podcast is separate from my teaching and research roles at Stanford.
It is, however, part of my desire and effort to bring zero-cost to information about science and science related tools to the general public.
In keeping with that theme, I'd like to thank the sponsors of today's podcast.
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Let's continue our discussion about neuroplasticity.
This incredible feature of our nervous system that allows it to change itself in response
to experience and even in ways that we consciously and deliberately decide to change it.
That's an incredible feature.
No other organ in our body has that capability, our nervous system, which governs everything
about who we are, how we feel, and what we do, does have that capability, our nervous system, which governs everything about who we are, how we feel,
and what we do, does have that capability. The issue is, most people don't know how to access
neuroplasticity. Children readily access neuroplasticity, and they don't even realize that they're doing it.
Adults want neuroplasticity, and so that's what this entire month of the Hubertman Lab podcast has
been about. We've explored neuroplasticity
from a variety of different perspectives. We talked about representational plasticity. We talked
about the importance of focus and reward. We talked about this amazing and somewhat surprising
aspect of the vestibular system, how altering our relationship to gravity and in addition to that,
making errors as we try and learn
can open up windows to plasticity.
But we have not really talked so much
about directing the plasticity toward particular outcomes.
And thus far, we really haven't talked yet
about how to undo things that we don't want.
I've talked about learning, and I say learn a language,
learn free throws, learn a particular motor skill, et cetera.
But what about what we would call unlearning
or about removing some aspect of our experience
that we don't want?
And so today, we are going to explore
that aspect of neuroplasticity,
and we are going to do that in the context
of a very important and somewhat sensitive topic, which is pain,
regeneration, and in some cases, injury to the nervous system.
Now for those of you that are fortunate enough to not have or had a concussion or not have
or know someone who's experiencing chronic or acute pain, I encourage you to stay in here
with us because a lot of the information that we are going to cover
has direct relevance to neuroplasticity for other purposes.
We, as always here on this podcast, are going to discuss some of the science we get into mechanism,
but we also really get at principles. Principles are far more important than any one experiment or one description of mechanism
and certainly far more important than any one protocol because principles allow you to
think about your nervous system and work with it in ways that best serve you.
They are very flexible batches of information.
So we are going to talk about the principles of neuroplasticity for
removing pain and wound healing and injury where we're going to talk about acupuncture of all things.
We are going to talk about modern medicines attempt to try and restore youth to the aging or
injured or demented brain. And we are going to definitely talk about tools. I've got a lot of tools.
I consulted a number of fantastic colleagues at Stanford at Harvard Medical School and in the
greater community of tissue rehabilitation, injury, and pain management in preparation for this
podcast. I do want to be very clear and just remind you that I'm not a medical doctor.
I'm a professor so I don't prescribe anything. I profess things. I have my beliefs.
But the podcast is for information purposes. I do hope that the tools that we discuss
will be of benefit to you. But as always, you should talk to your doctor or health care provider
about any tools that you plan to add or are looking to explore as well as anything that you might look to remove from your daily protocols.
In other words, don't change anything without consulting an expert first.
You're responsible for your health, not me, and I say this not just to protect me, but also to protect you. So please keep that in mind as we move forward. And I'm very excited to share with you
this information because I do feel that it can be of great benefit to a number of people. So let's
start our discussion about pain and sensation and regeneration and wound healing with a discussion
about a very important system in the nervous system, which is the somatocensary system. The somatocensary system is, as the name implies,
involved in understanding touch, physical feeling on our body.
And the simplest way to think about the somatocensary system
is that we have little sensors, and those sensors come
in the form of neurons, nerve cells, that reside in our skin
and in the deeper layers below the skin.
And indeed, we do. We have some that correspond to, and we should say, respond to mechanical
touch. So, you know, pressure on the top of my hand or a pinpoint or other sensors,
for instance, respond to heat, to cold, some respond to vibration,
with a huge number of different receptors in our skin,
and they take that information and send it
down those wires that we call axons
in the form of electrical signals
to our spinal cord and then up to the brain.
And within the spinal cord in brain,
we have centers that interpret that information
that actually makes sense of those electrical
signals.
And this is amazing because none of those sensors has a different unique form of information
that it uses.
It just sends electrical potentials into the nervous system.
So the nervous system, you somehow decode what a given stimulus on your skin is.
So maybe it's the wind blowing gently and deflecting
some of the hairs on your arm, or maybe it's a sharp pin prick or a hot stove or the
warmth of a glowing fire.
That all arrives in your nervous system in the form of these electrical things we call
action potentials, which is just amazing.
And then the brain computes them and makes sense of them.
So we have peripheral sensors, and we've got stations up in our brain and within our spinal
cord that makes sense of all the stuff coming in. Pain and the sensation of pain is, believe it
or not, a controversial word in the neuroscience field. People prefer to use the word no seception. No seceptors are the sensors in the skin that detect
particular types of stimuli. It actually comes from the Latin word no
Sarah, which means to harm. And why would neuroscientists not want to talk
about pain? Well, it's very subjective. It has a mental component and a
physical component. We cannot say that pain is simply an attempt to avoid physical harm to the body.
And here's why.
They actually can be dissociated from one another.
A good example would be if God forbid you were exposed to high levels of radiation, such
as working with some sort of material that was radioactive or you know you wear
near a former radioactive plant or some radiation, excessive x-rays, etc.
You wouldn't feel any pain during the x-rays.
In fact, you don't, if you've ever had x-rays, as I have, you don't feel anything.
They put you under that lead blanket, they run behind a wall and in my case, they take
these pictures of your teeth and it's really scary because you go,
well, something really terrible must be happening here,
but you don't feel anything.
But there can be a lot of tissue damage
that can be mutations introduced to cells, et cetera.
I've had X-rays, I'm not saying people shouldn't have X-rays,
but excessive X-rays certainly are not good for human beings,
likewise with excessive exposure to any radiation.
So there can be tissue damage
without the physical perception
or mental perception of pain at all.
As well, there can be the belief of pain
or the feeling of pain without there being tissue damage.
And there's a famous case that was published
in the British Journal of Medicine
where a construction worker, I think he fell is how the story went.
And a 14 inch nail went through his boot and up through the boot.
And he was in excruciating pain, just beyond anything he had experienced.
He reported that he couldn't even move in any dimension, even a tiny bit without feeling
excruciating pain.
They brought him into the clinic, into the hospital.
They were able to cut away the boot and they realized that the nail had gone
between two toes and it had actually not impaled the skin at all.
His visual image of the nail going through his boot gave him the feeling,
the legitimate feeling that he was experiencing
the pain of a nail going through his foot, which is incredible because it speaks to the
power of the mind in this pain scenario.
And it also speaks to the power of the specificity.
It's not like he thought that his foot was on fire.
He thought because he saw a nail going through his foot, what he thought was going through his foot,
that it was sharp pain of the sort that a nail would produce. And there are thousands of these
kinds of case reports out there. Now that is not to say that all pain that we experience is in our
head, but it really speaks to the incredible capacity that these top down, these higher level cognitive
functions have in interpreting what we're experiencing out in the periphery, even just
on the basis of what we see.
And the example radiation speaks to the fact that pain and tissue damage are dissociable
from one another.
So why are we talking about pain during a month on neuroplasticity?
Well, it turns out that the pain system offers us a number of different principles that we
can leverage to a, ensure that if we are ever injured, we are able to understand the difference
between injury and pain because there is a difference, that if we're ever in pain, that
we can understand the difference between injury and pain, that we will be able to interpret our pain.
And during the course of today's podcast,
I'm going to cover protocols that help eliminate pain
from both ends of the spectrum,
from the periphery at the level of the injury
and through these top down mental mechanisms.
A lot of times on this podcast, in fact,
mostly I tend to center on the physiology, on the really objective things that you can
describe and talk about diaphragmatic movement or sunlight of a particular
number of photons, etc. But today's a really exciting opportunity for us to
discuss some of the more subjective things. Believe it or not, we're going to
talk about love. A colleague of mine at Stanford who runs a major pain clinic
is working on and has published quality peer review data on the role of love in modulating the
pain response. Only there's a twist to it and I'm not going to reveal it just yet, but it turns out
that the specific type of connection one has to a romantic partner actually dictates
whether or not their love for them will alleviate physical pain.
And the effects are really robust.
It's an amazing literature.
And so what we're talking about today is plasticity of perception, which has direct bearing
on emotional pain and has direct bearing on trauma. and other things that we've discussed in previous episodes
a little bit, but that we are going to explore even more in an entire month about those topics.
So let's get started in thinking about what happens with pain and I will
describe some examples of some kind of extreme cases. For instance, I will tell you just now that there is a mutation,
a genetic mutation in a particular sodium channel.
A sodium channel is one of these little holes in neurons
that allows them to fire action potentials.
It's important to the function of the neuron.
It's also important for the development of certain neurons.
And there's a particular mutation.
There are kids that are born without this sodium channel 1.7.
If you want to look it up, those kids experience no pain, no pain whatsoever.
And it is a terrible situation.
They burn themselves, they tend to rest on their limbs too long.
They don't make the micro adjustments.
You might see me swiveling around on my chair moving around a lot.
Those micro adjustments are actually normal, healthy micro adjustments that prevent us from
going into pain. They don't make those adjustments. They don't get the adjustments that prevent us from going into pain.
They don't make those adjustments.
They don't get the feedback that they're in a particular position.
So they never make those adjustments and their joints get destroyed essentially.
They don't tend to live very long due to accidents.
It's a really terrible and unfortunate circumstance.
Some people have a mutation in the same channel where they make too much of this channel, so they feel too much pain.
In fact, it's reasonable to speculate
that one of the reasons, not all,
but one of the reasons why people might differ
in their sensitivity to pain
is by way of genetic variation
in how many of these sorts of receptors that they express.
People who make too much of this receptor
experience extreme pain from even
subtle stimuli. Now the good news is there are good drug treatments that can
block specifically this sodium channel 1.7 and so those people get a lot of
relief from taking such drugs. So pain and how much pain we are sensitive to
or insensitive to probably has some genetic basis and then of pain we are sensitive to or insensitive to, probably has some genetic basis.
And then, of course, there are things that we can do
to make sure that we experience less pain,
although pain has this adaptive role.
So let's talk about some of the features of
how we're built physically and how that relates to pain
and how we can recover from injury.
So, first of all,
we have maps of our body surface in our brain. It's called a homunculus. In a rat, believe it or not, I'm not making this up, it's called a rat
tonculus. In Costello, my dog is snoring behind me. It's a dog unculus. I could get into the
nomenclature and why it's called this, but it's basically a representation of the body surface.
into the nomenclature and why it's called this, but it's basically a representation of the body's surface.
That representation is scaled in a way
that matches sensitivity.
So the areas of your body that are most sensitive
have a lot more brain real estate devoted to them.
Your back is an enormous piece of tissue
compared to your fingertip,
but your back has fewer receptors devoted to it
and the representation of your back in your
brain is actually pretty small. Whereas the representation of your finger is enormous. So
how big a brain area is devoted to a given body part is directly related to the density of
receptors in that body part, not the size of the body part. And that's why if we were to draw
your homunculus or Castello's dog-unculus, what we would find
is that certain areas like the lips, like the fingertips, like the genitalia, like the
eyes and the area around the face would have a huge representation.
Whereas the back, the torso, and areas of the body that are less sensitive are going to
have smaller representations, so it would be a very distorted map.
You can actually know how sensitive a given body part is
and how much brain area is devoted to it
through what's called two point discrimination.
You can do this experiment if you want.
I think I've described this once or twice before,
but basically if you have someone put maybe take two pens
and put them maybe six inches
apart on your back and touch while you're facing away, and they'll ask you how many points
they're touching you and you say two, but if they move those closer together, say three
inches, you're likely to experience it as one point of contact.
Whereas on your finger, you could do that play that game all day, and
as long as there's a millimeter or so spacing, you will know that it's two points, as opposed
to one. And that's because there's more pixels, more density of receptors. This has direct
bearing to pain because it says that areas of the body that have denser receptors are
going to be more sensitive to pain than to others. And where we have more receptors,
we tend to have more blood vessels and glia,
which are these support cells, and other cells
that lend to the inflammation response.
And that's really important.
So just as a rule of thumb, areas of your body that are injured
that are large areas that have low sensitivity
before injury likely are going to experience
less pain and the literature shows will heal more slowly because they don't have as many
cells around to produce inflammation.
And you might say, wait, I thought inflammation is bad.
Well, one of the things I really want to get across today is that inflammation is not bad. Implamation out of control is bad, but inflammation is wonderful.
Implamation is the tissue repair response.
We are going to talk about subjective and objective ways to modulate inflammation after
tissue injury, even after just exercise that's been too intense.
You have this map of your body surface.
It's sensitive in different ways.
Now you know why.
So you've got your neurobiology of somatosensation 101
under your belt.
Now, we didn't cover everything,
but we'll touch on some of the other details
as we go forward.
I thought it might be a nice time to just think about
the relationship between the periphery and the central maps
in a way that many of you have probably heard about before,
which will frame the discussion a little bit better, which is phantom limb pain.
Now some of you are probably familiar with this, but for people that have an arm or a leg
or a finger or some other portion of their body amputated, it's not uncommon for those
people to feel as if they still have that limb or appendage or piece of their
body intact.
And typically, unfortunately, the sensation of that limb is not one of the limb being nice
and relaxed and just there.
The sensation is that the limb is experiencing pain or is contorted in the specific orientation
that it was around the time of the injury.
So if someone has a blunt force to the hand
and they end up having their hand amputated,
typically they will continue to feel pain
in their phantom hand, which is pretty wild.
And that's because the representation of that hand
is still intact in the cortex in the brain.
And it's trying to balance its levels of activity.
Normally, it's getting what's called proprioceptive feedback.
Proprioception is just our knowledge of where our limbs are in space.
It's an extremely important aspect of our sematic sensory system.
And there's no proprioceptive feedback.
And so a lot of the circuits start to ramp up their levels of activity, and they become
very conscious of the phantom limb.
Now, before my lab was at Stanford, I was at UC San Diego and one of my colleagues was a guy, everyone just calls him by his last name, Ramachandran, who is famous for understanding this phantom
limb phenomenon and developing a very simple but very powerful solution to it that speaks to
the incredible capacity of top- modulation and top down modulation,
the ability to use one's brain, cognition, and senses to control pain in the body is something
that everyone, not just people missing limbs or in chronic pain, can learn to benefit
from because it is a way to tap into our ability to use our mind to control perceptions of
what's happening in our body.
And this is not a mystical statement.
This is not about mind, I guess, as much as is brain to control our perceptions of our
body.
So what did Ramachandran do?
Ramachandran had people who were missing a limb put their intact limb into a box that had mirrors in it such that when they looked
in the box and they moved their intact limb, the opposite limb, which was a reflection
of the intact limb, because they're missing the opposite limb, they would see it as if
it was intact.
And as they would move their intact limb, they would visualize with their eyes,
the limb that's in the place of the absent limb. So this is all by mirrors, moving around
and they would feel immediate relief from the phantom pain.
And he would tell them and they would direct their hand
toward a orientation that felt comfortable to them.
Then they would exit the mirror box,
they would take their hand out, and they would feel as if the hand was now in its relaxed
normal position.
So you could get real time in moments remapping of the representation of the hand.
Now that's amazing.
This is the kind of thing that all of us would like to be able to do if we are in pain.
If you stub your toe, if you break your ankle, if you take a hard fall on your bike, or if you're in chronic pain,
wouldn't it be amazing to be able to use a mind trick, but it's not a trick, right?
Because it's real visual imagery to remap your representation of your body surface and where your body is.
That is something that we could all benefit from
because if you do anything for long enough,
including live, you're going to experience pain
of some sort.
And this, again, I just wanna remind you,
isn't just about physical injuries and pain.
This has direct relevance to emotional pain as well,
which we'll of course we'll talk about.
So the Ramachandran studies were really profound
because they said a couple of things.
One plasticity can be very fast,
that it can be driven by the experience of something,
just the visual experience.
He had people do this mirror box thing,
but not look into the mirror box,
and they didn't get the remapping.
So it required visual imagery coming in.
We also know, for instance, that in cases like where
people are congenitally deaf, the cochlear implant, which is simply a way of putting, it's
not simple, but it's a way of putting in a device that replaces the cochlea, the device
that we're normally born with, in the ear that has these little what are called hair cells that deflect according to sound waves and allow us to hear by replacing the normal hearing
apparatus that's deficient in deaf people with this cochlear implant. The brain can make sense
of this artificial ear basically. It's not the outside ear, not the pinna, but the the inner ear. And they can start to hear sounds.
Now some people really like the artificial cochlea.
They really benefit from it.
It restores their ability to hear and they like it.
Other people don't.
Some deaf people would prefer not to hear anything, can be very disruptive to them.
Some of that might have to do with the need for further better engineering of these artificial cochleas. But all this really speaks to the fact that the brain is an adaptive
device. It will respond to what you give it. It is not a device that is fixed. In fact, the essence
of the brain, especially the human brain, is to take sensory inputs and to make sense of those,
meaning cognitive sense, and then to interpret those signals.
And so this may come as a shock to some of you and binomines am I trying to be insensitive,
but pain is a perceptual thing as much as it's a physical thing.
It's a belief system about what you're experiencing in your body, and that has important relevance
for healing different types of injury and the pain associated with that injury.
In people's pursuit for neuroplasticity, a question that comes up every once in a while is
people will say, you know, if I just brush my teeth with the opposite hand for a couple
nights in a row, will I get neuroplasticity?
And the answer is probably yes.
I mean, it's a deliberate action.
You're focusing on it.
There's an end goal.
You're very likely to make errors like like you know, dropping a anterior lip
to end gums at first and then getting better at it.
And as you heard in last episode,
making errors is really important
because those errors are the signal
that plasticity needs to happen.
And then when you get the actions correct,
then those correct actions are programmed in.
I'm not sure that brushing one's teeth
with the opposite hand is the most effective use
of this incredible thing that we have, which is plasticity.
It's not going to open up plasticity for many other things.
So if that were really important to you for whatever reason, maybe you have one crowded
bathroom and it's easier to do on one side or the other than fine.
But it's kind of hard to imagine why this would be a highly adaptive behavior, unless of course you have an injured limb or you're missing a limb.
And that gets me to some really exciting and important studies that were performed mostly
in the 90s, as well as in the 2000s, and that for now there is really a solid base of
data. There's really a center of mass around a particular set of experiments that point to particular protocols for how to overcome
motor injury. And this may resonate with some of you who've ever been injured to the point where
you couldn't walk well, temporarily, I hope, or even longer. So think about a sprained ankle scenario
or a broken arm scenario. We're all familiar with the stories of people,
I mean, a cast-on and then getting the cast-off and the particular
limb that wasn't being used that was casted is much smaller in atrophied.
Most of that atrophy, you might be surprised to learn, is not because
the muscles aren't being used. It's because the nerves
sending signals to those muscles are not active
and therefore the muscles aren't contracting.
Work done by a guy named Timothy Schallert and his graduate students and postdocs, Theresa Jones and others.
In the 90s and 2000s, it showed something really wonderful that I think we can all benefit from, should we have an. And even if we simply want to balance out imbalances
in our motor activity.
And I think all of us tend to be stronger on one side
or the other side.
Usually a right-handed person will be stronger
in their left arm, not always, for compensatory reasons.
Some other time we can talk about handwriting.
The lefties likely will be stronger in their right arm. Although it kind of depends on whether or not people
are hook righties. That's when you kind of hook around them right from the top or hook
lefties. There are all sorts of theories about this that we can talk about right brain left
brain math proficiency, et cetera. Any event, what Schallert and colleague showed was that
if we have damaged our brain in the sensory motor pathways, any number
of different sensory motor pathways, or we have damaged to a limb, could be a leg, could
be an arm, could be a hand, there's great benefit to restricting the use of the opposite better performing un-injured limb or hand or other part of the
body.
They had about a dozen papers showing that if there was damage centrally in the brain
or there was damage to a limb, so unilateral damage as we say, one side, the thing to do
is not to cast up the damage side, although you need to do that to protect the
limb, of course, from further damage. So if it's a broken arm, you need to cast the arm,
or you need to brace the arm. But the key thing was to restrict movement of the
intact uninjured opposite limb. And when they did that, It forced some movement in the injured limb and remarkably through connections from the
two sides of the brain, through the corpus colosum, this huge fiber pathway that links
the two sides of the brain, they saw plasticity on both sides of the brain.
So this makes sense when you hear it.
You, let's say I injure my left ankle and I'm limping along or I'm using crutches.
You would think, well, the last thing you want to do is start, is injure your opposite
limb or not use your opposite limb.
My right ankle is perfectly fine.
But if I lean too hard on my right limb and I take all the work out of the left limb
at left ankle, that's actually setting up a situation where there's going to be run away a symmetry
in the central pathways and the nerve to muscle pathways on my left side. And so what they suggested
and what they showed in a variety of experiments was that by encouraging activity of the injured
limb provided it could be done without pain and importantly not just exercising that that limb are part of the body
but restricting the opposite healthy part of the body that the speed of
recovery was significantly faster. Now I want to repeat you don't want to go
injuring something further that's probably the worst thing you could do but in
some cases where people have damage in their brain the limbs are perfectly fine
but the motor signals aren't getting down to the limbs.
And in that case, the limb is fine, so you actually are free to use either limb as much
as you want.
And in that case, you don't want to rely on the unindured pathway too much.
In fact, you want to restrict the unindured pathway.
So I find these studies remarkable.
And they've been followed up on at the molecular level at the seller level many times
And I think the physiotherapist out there and some the rest of you who are involved in sports medicine and some of the physicians
We'll say well of course that makes perfect sense, but oftentimes this is not what happens
Oftentimes what happens is it's all about resting and limiting inflammation
et cetera of the injured limb or the limbs
corresponding to the injured part of the brain.
And these experiments and the collection of them point to the fact that the balance between
the right and left side of our body is always dynamic.
It's always being updated at the level of neural circuitry.
The Ramachandran studies with the mirror box support that too.
And that even slight imbalances in the two sides of the body can get amplified. And so when you're in a
situation where one side is injured or the brain is injured representing one
side of the body, the key thing to do is to really overwork the side that needs
the work and to restrict the activity of the side that doesn't need the work
because it's healthy. And this has great semblance to ocular dominance plasticity, which I talked about a couple
episodes ago.
I won't go into it in detail, but where the Nobel Prize-winning neurologist, Torrance
and Wiesel and David Heubel, showed that if one eye is closed early in development, that
the representation of the opposite eye in the brain is completely overtaken by the intact
eye.
So, this is important.
It means that all of our senses and our movements are competing for space in our brain.
And so, the way to think about the principle is, anytime you're injured and you're hobbling
along, you don't want to injure yourself further, but you want to try and compensate in the ways that
Respect this competition for neural real estate and what that usually means is not relying on where you're still strong
Because that's just going to create runaway plasticity that's going to make it very hard for you to recover
the motor function and in some cases the sensory function of the damaged limb. Some of you may be wondering how long and how often one should restrict the activity of the intact
or healthy limb or limbs in some cases. And the answer is you don't have to do that all day
every day. These experiments centered on doing one or two hours of dedicated work, sensory motor work, or so for instance if you had
a sprained ankle on the left you might spend part of the day where your left leg provided it's not too
painful can be exercised, again in a way that's not damaging to the injury, and the right limb can't
contribute to that exercise. So this might be pedaling unilaterally on a stationary bike. If you can do that for a different type of limb injury like an
arm injury, this might be reaching, provided the shoulder is mobile, doing
reaching, it might be even riding with the the damage side, and then
intentionally not riding with the preferred or undamaged side. This has been shown to accelerate the
central plasticity and the recovery of function, which I think is what most people want. When
people are injured, they want to get back to doing what they were doing previously, and they
want to be able to do that without pain. Now, this brings up another topic, which is definitely
related to neuroplasticity and injury, but is a more
general one that I hear about a lot, which is traumatic brain injury.
Many injuries are not just about the limb and the lack of use of the limb, but concussion
and head injury.
And I want to emphasize, I'm not a neurologist, I have many colleagues that are, at some
point, we will do a whole month on TBI, because's such a serious issue and it's such a huge
discussion.
But I want to talk a little bit about what is known about recovery from concussion.
And this is very important because it has implications for just normal aging as well
in offset setting.
Some of the cognitive decline and physical decline that occurs with normal aging.
So we shouldn't think of TBI as just for the football players or just for the kids that had an injury or just for the person that was in the car accident. We want to learn about TBI and understand
TBI for those folks, but we're also going to talk about TBI as it relates to general degradation
of brain function because there's a certain semblance there of TBI
to general brain aging.
Typically after TBI, there are a number of different things that happen and there are
huge range of things that can create TBI.
They're all just, and the emergency room physicians are going to want to know, was the skull,
was the skull itself injured or did the brain rattle around in the skull? Was there actually a breach through the skull?
Is there a physical object in there?
How many concussions has the person had?
I mean everyone's situation with TBI is incredibly different.
But there's a constellation of symptoms that many people, if not all,
people with TBI report, which is headache,
photophobia that lights become kind of a
versive sleep disruption, trouble concentrating, sometimes mood issues.
There's a huge range and of course the severity will vary, etc.
In a previous episode, I mentioned the Kennard principle.
The Kennard principle, named after the famous neurologist named by and after the famous
neurologist, Margaret Kenn after the famous neurologist
Margaret Kennerd said that if you're going to get a brain injury better to get
it early in life than later in life and that's because the brain has a much
greater heightened capacity for repairing itself early in life than later. But of
course none of us want TBI and you can't pick when you get your TBI. You can
avoid certain activities that would give you TBI, but really when it comes to TBI,
there are a couple things that are agreed upon across the board.
The first one is, as much as possible, you want to avoid a second traumatic brain injury
or concussion.
Now, that's going to be a tough one for some of the athletes and even recreational athletes
to swallow because they want to continue in their sport.
And I'm not here to tell
you that you should or you shouldn't, but that's simply the way that it is. For folks
that are in military or that are in certain professions, construction is a place where
we see a lot of TBI. It's not always just football, a lot of construction workers are dealing
with heavy objects swinging around in space. They wear those hard hat helmets which unfortunately don't protect much against a lot of those blunt
forces and certainly not against falls and things of that sort.
So many people in order to survive and feed their families have to go back to work.
It's very clear that regardless of whether or not there was a skull break and regardless
of when the TBI happened or how many times it's happened, that the system that repairs the brain, the adult brain, is mainly centered
around this lymphatic system that we call for the brain, the glymphatic system.
Now the brain wasn't thought to have a lymphatic system.
It wasn't thought to have circulating immune cells, but about 10 years ago it was sort
of rediscovered because if you look in the literature, you realize this stuff was around
longer, that there's a glimphatic system.
It's sort of like a sewer system that clears out the debris that surrounds neurons, especially
injured neurons.
And the glimphatic system is very active during sleep.
It's been imaged in functional and magnetic resonance imaging, and the
glymphatic system is something that you want very active because it's going to clear
away the debris that sits between the neurons, and the cells that surround the connections
between the neurons, called the glia, those cells are actively involved in repairing the
connections between neurons when damaged. So the glymphatic system is so important that many people, if not all people who get TBI,
are told get adequate rest.
You need to sleep.
And that's kind of two-fold advice.
On the one hand, it's telling you to get sleep because all these good things happen
and sleep.
It's also about getting those people to not continue to engage in their activity full-time
or really try and hammer through it.
You might say, well, if you have trouble sleeping, how are you supposed to get deep sleep?
Most of the activity of the glimphatic system, this washout of the debris is occurring during
slow-wave sleep.
Slow-wave sleep, as I mentioned in a previous episode, is something that happens typically
in the early part of the evening.
So even for those of you that are falling early part of the night rather, if you're falling
asleep and then waking up three, four hours later, it's important that you continue to get
sleep, but know that the slow wave sleep is mainly packed toward the early part of the night.
So that hopefully will alleviate some of the anxiety of the 3 and 4 am wake up, although you really should follow
some of the protocols that I've suggested in your physicians,
protocols in order to try and get regular longer sleep
of seven, eight hours.
Later, we're gonna talk about the eight hour mark
as a prerequisite for repair.
The glymphatic system has been shown to be activated
further in two ways.
One is that sleeping on one side, not on back or stomach,
seems to increase the amount of wash out, or wash through,
I should say, of the glymphatic system.
There aren't a ton of data on this,
but the data that exists are pretty solid.
Again, sleeping on one side or with feet slightly elevated as well has been
shown to increase the rate of clearance of some of the debris. And that's because the
way that the glimphatic system works is it has a physical pressure fluid dynamic to it
that allow it to work more efficiently when one is sleeping on their side or with feet slightly elevated.
So this means not falling asleep in a chair while watching TV.
This means if possible, not falling asleep on one's back
or on one's stomach, sleeping on one's side.
And if you can't do that,
like I don't really like to sleep on my side,
I sleep with my feet slightly elevated,
I put out the kind of thin pillow under my ankles.
I don't have TBI, but I have had a few concussions before, but right now I feel fine, but I find
that putting the pillow under my ankles helps me sleep much more deeply and I wake up feeling
much more refreshed.
The other thing that has been shown to improve the function of the glyatic system and this is again as for sake of TBI as well as for
everyone even without brain injury is a certain form of exercise and I want to be very very
clear here. I will never and I am not suggesting that people exercise in any way that aggravates
their injury or that goes against their physician's advice.
Take your physician's advice as to whether or not you should be exercising at all and how much and into what intensity.
However, there's some interesting data and we can provide a link to the review on this.
It shows that exercise of what I guess people would nowadays call it zone two cardio, which is kind of low level cardio
That one could do while talking to somebody else. You could maintain a conversation
Although you don't have to talk to somebody else. It just gives you a sense of the intensity of the exercise that zone two cardio
for 30 to 45 minutes three times a week
seems to improve
the rates of clearance of some of the debris
seems to improve the rates of clearance of some of the debris
after injury and in general, injury or no,
to accelerate and improve the rates of flow for the glimphatic system.
I find this really interesting because I think nowadays there's such an obsession with high-intensity interval training and people trying to pack in as much as they
can into a short workout, which is great if it brings people to the table who haven't been exercising before.
But I think it's really important that we know that the data on exercise and its relationship
to brain health speak to doing 30 to 45 minutes of this kind of what we call low level cardio.
It could be fast walking, it could be jogging. If you can do that with
your injury safely, it could be cycling. This is not the kind of workout that's designed to get your
heart rate up to the point where you're improving your fitness levels at some sort of massive
rate or taking huge jumps in your VO2 max or anything like that. This is exercise. I do this
and I know a number of other people,
especially people in communities where there is a lot of TBI
are now starting to adopt this,
that the 30 to 45 minutes, three times a week or so
could be more of this zone two type cardio
can be very beneficial for wash out of debris from the brain.
And this is really interesting outside of TBI
because what we know from aging is that
aging is a nonlinear process.
It's not like with every year of life,
your brain gets a little older.
It has, sometimes it follows what's more like a step function.
And you get these big jumps in eight in markers of aging.
I guess that we could think of them as jumps down
because it's a negative thing for most everybody.
It would like to live longer and be healthier
in brain and body.
And so the types of exercise I'm referring to now
are really more about brain longevity
and about keeping the brain healthy
than they are about physical fitness.
There's no reason why you couldn't do this
and also provided again, it's safe for you,
given your brain state and injury state, etc.
There's no reason why you couldn't also combine it with weight training and other forms of cardio.
So I think this is really interesting and some of you would like to know the mechanism or at least
the hypothesized mechanism. There's a molecule called aquaporn4. It almost sounds like a like a the
fourth in a sequel of movies or something like that, but
aqua porn for is a molecule that is related to the glial system. So glial or the it means glue
and latin are these are these cells in the brain, the most numerous cells in the brain. In fact,
that in sheath synapses, but they're very dynamic cells. They're like little ambulance cells. They'll
run the micro glial will run in and will gather up debris and soak it up and then run out
after an injury.
Acropore and for is mainly expressed by the glial cell called the astrocyte.
Astro looks like a little star.
Incredibly interesting cells.
The thing to remember is that the astrocytes bridge the connection between the neurons,
the synapse, the connections between them
and the vasculature, the blood system, and the glymphatic system.
So they kind of sit at the interface and they kind of imagine somebody on an emergency
side, car crash site, who's directing everybody around as to what to do, get that person on
a stretcher, bandage them up, call their mother, et cetera, et cetera, get this out of the
road, put down some flares.
The astrocytes kind of work in that capacity, as well as doing some things more directly.
So this glimphatic system and the glial astrocyte system is a system that we want chronically
active throughout the day as much as possible, so low-level walking, zone two cardio, and
then at night during slow wave sleep is then really when this glimphatic
system kicks in.
So that should hopefully be an actionable takeaway provided that you can do that kind of cardio
safely that I believe everybody should be doing who cares about brain longevity, not just
people who are trying to get over TBI.
Now I'd like to return a little bit to some of the subjective aspects of pain modulation because I think it's so
interesting and so actionable that everyone should know about this.
And in this case, we can also say that regardless of whether or not you're experiencing pain,
acute or chronic, what I'm about to tell you is as close as anything is to proof, you know,
in science we rarely talk about proof, we talk about
evidence in favor or against a hypothesis, but as close as possible to proof that our interpretation,
our subjective interpretation of a sensory event, is immensely powerful for dictating our experience
of the event. Here are a couple examples. First of all, anyone who's ever done combat sports or martial arts knows that it's incredible
how little a punch hurts during a fight and it's incredible how much it hurts after a fight.
The molecule adrenaline when it's liberated into our body truly blunts our experience of pain.
We all know the stories of people walking miles on stumped legs, people doing all sorts
of things that were incredible feats that allowed them to move through what would otherwise
be pain and afterward they do experience extreme pain.
But during the event oftentimes they are not experiencing pain. And that's because
of the pain-blunting effects of adrenaline. I'll tell you exactly how this works in a few
minutes when we talk about acupuncture. But noraprinephrine binding to particular receptors,
adrenaline binding in particular receptors actually shuts down pain pathways.
adrenaline binding in particular receptors actually shuts down pain pathways. People who anticipate an injection of morphine immediately report the feeling of loss of
pain.
Their pain starts to diminish because they know they are going to get pain relief.
And it's a powerful effect.
Now all of you are probably saying placebo effect.
Placebo effects are very real.
Placebo effects and belief effects, as they're called,
have a profound effect on our experience of noxious stimuli
like pain, and they can also have a profound effect
on positive stimuli and things that we're looking forward to.
One study that I think is particularly interesting here
is from my colleague at Stanford, Sean Mackie.
They did a neuroimaging study. They subjected people to pain. In this case, it was a heat pain.
People have very specific thresholds to heat, which they cannot tolerate any more heat.
But they explored the extent to which looking at an image of somebody, in this case, a romantic
partner that the person loved would allow them to adjust their pain response.
And it turns out it does.
If people are looking at an image or thinking about a person that they love, or even a
thing that they love, a pet that they love, studies previous to the one that Mackeen colleagues
did, showed that their experience of pain was reduced.
Their threshold for pain was higher.
They could tolerate more pain.
And they reported it as not as painful.
But there's a twist there, which is it turns out that the extent to which love will modulate
pain has everything to do with how infatuated and obsessed somebody is with the object of their love.
People that report thinking about somebody or a pet for many hours of the day,
kind of having an obsessive nature, like almost like kind of what people might call quote-unquote,
codependency for those of you that are listening and I'm just providing air quotes
because codependency is kind of a clinical thing now,
although it's thrown around a lot all the time.
It's sort of like gas lighting.
People talk about gas lighting all the time.
Now gas lighting is a real thing,
but then people talk about gas lighting
for many things outside the clinical description.
If people are very obsessed with somebody,
they have a kind of obsessive love of somebody's face.
Even if the other person doesn't know them, which is a little weird, that response, that
feeling of love internally can blunt the pain experience to a significant degree.
These are not small effects.
So, it's not just that love can protect us from pain.
It's that infatuation and obsession can protect us from pain.
And not surprisingly, how early a relationship is, how new a relationship is, directly correlates
with people's ability, they showed, to use this love, this internal representation of love
to blunt the pain response.
So for those of you that have been with your partners for many years and you love them very much
and you're obsessed with them, terrific.
You have a pre-installed,
well I suppose it's not pre-installed,
you had to do the work
because relationships are work,
but you've got a installed mechanism for blunting pain.
And again, these are not minor effects.
These are major effects.
And it's all gonna be through that top-down modulation that we talked about, not unlike the Mirabox experiments with phantom limb that relieve
phantom pain or some other top down modulation in the opposite example is the nail through
the boot, which is a visual image that made the person think it was painful when in fact
it was painful even though there was no tissue damage. it was all perceptual. So the pain system is really subject to these perceptual influences, which is remarkable
because really when we think about the somatosensory system, it has this cognitive component, it's
got this peripheral component, but there's another component, which is the way in which
our sensation, our somatosensory system is woven in with our autonomic nervous system.
And we're going to get to that next, but I want to just raise the idea
that the reason that this kind of infatuation and obsessive love
can blunt the pain response and increase one's threshold for pain
may have to do, I would say almost certainly has to do,
but it hasn't been measured yet, with dopamine release.
Because dopamine is absolutely the molecule that's liberated in our brain and body.
When there's a new kind of obsession or infatuation, it's very distinct from the kind of love chemicals,
if you will.
I don't even like calling them love chemicals.
It just feels weird.
If this were text, I would delete that line. But from the chemicals associated with warmth and connection, such as serotonin and oxytocin,
which tend to be for more stable, long-lasting relationships, dopamine is what dilates the
pupils, which gets people really excited.
They can't stop thinking about somebody.
The text messages are even exciting.
They write to them and they can't wait for the text message
to come back, the dot, dot, dot on the screen.
The text message is excruciating.
They don't respond for two minutes
and people are getting flipped out.
I'm not here to support that kind of whatever.
What I'm saying is that that obsessive type of love,
which without question is going to be associated
with the dopamine pathway, does seem to have a utility in the context of
reducing
the
unpleasantness of physical pain and probably has to a lot to do with reducing the unpleasantness of a lot of life like sitting in traffic
etc. Because when we talk about pain
Emotional pain and physical pain start to become one and the same. They are so
closely intertwined that the lines between them
normally become very blurry.
What do I mean by that?
Well, if love and infatuation can reduce pain,
presumably through the release of dopamine,
well then does dopamine release itself, blunt pain?
Should we be chasing dopamine release as a way
to treat chronic and acute pain?
And that's exactly what we're going to talk about now.
Independent of love, we're going to talk about something quite different, which is putting
needles and electricity in different parts of the body, so-called acupuncture, something
that, for many people, it's been viewed as a kind of alternative medicine, but now
there are excellent laboratories
exploring what's called electroacupuncture and acupuncture.
These are big university centers.
In fact, my source for everything I'm about to tell you next is Professor Chufu Ma at
Harvard Medical School and his papers.
I stand behind the information that I'm going to provide today, but it's extracted largely
from the Ma lab's papers, which are very rigorous,
variable isolating experiments to address just how does something like acupuncture work.
And I think what you'll be interested in and surprised to learn is that it does work,
but sometimes it can exacerbate pain, and sometimes it can relieve pain, and it all does that
through very discreet pathways for which we can really
say this neuron connects to that neuron connects to the adrenals and we can tie this all back to dopamine because in the end
It's the chemicals and neural circuits that are giving rise to these perceptions or these experiences rather of things that we call pain
Love etc. In a previous podcast episode. I mentioned my experience of visiting an acupunctureist
and getting acupuncture. The acupuncture itself didn't really do that much for me, but I wasn't
there for any specific reason. I was gifted to me by somebody and I wanted to try it. I'm not
passing judgment on acupuncture. In fact, I know a number of people that really derive tremendous benefit from acupuncture
for pain and gastrointestinal issues.
There are actually a lot of really good peer-reviewed studies supporting the use of acupuncture
for particular GI tract issues.
In recent years, there's been an emphasis on trying to understand the mechanism of things
like acupuncture and acupuncture itself, not to support acupuncture or to try to get
everybody to do acupuncture, but as a way to try and understand how these sorts of practices
might actually benefit people who are experiencing pain or for changing the nervous system or brain
body relationship in general.
And actually the National Institutes of Health in the United States
now has a entire subdivision, an institute within the National Institutes of Health, which is
complimentary health. And that institute is interested in things like acupuncture and a variety
of other practices that I think 10, 15 years ago, people probably
thought were really alternative and maybe even counter culture, at least in the States.
And it's exciting.
I think people are starting to really take a look at what's going on under the hood for
certain types of treatments that are very useful.
And I think it's very likely to lead to an expanded number of treatments for a number of
different conditions.
What I want to talk about in terms of acupuncture is the incredible way in which acupuncture illuminates
the cross-talk between the somatocensory system, our ability to feel stuff externally,
extra-oception, internally inter-oception, and how that somatocensory system
is wired in with and communicating with our autonomic nervous system that regulates our levels of alertness or calmness.
After that, I'm going to talk about how the acupuncture that's being done right now also points to relief for what's called referred pain. So this takes us all back to the homunculus. Let's start there. We have this representation of our body surface
in our brain. That representation is what we call somatotopic. And what somatotopy
is is it just means that areas of your body that are near one another, so your
thumb and your forefinger, for instance, are represented by neurons that are nearby each other in the brain. Now you might say, well duh, but actually didn't
have to be that way. The neurons that represent the tip of my forefinger and the neurons that
represent my thumb on the same hand could have been distantly located. And therefore,
the map of my body surface, the homunculus, would be really disorder, but it's not that way.
It's very ordered. It's very smooth. As, let's say, you were to image my brain, if you were to stimulate my finger, my
forefinger, and then march that stimulation across my finger, across the palm and to the nearby thumb,
you would see that neurons in the brain would also make a sort of J-shape in their pattern of
activation. So that means they're so-called somatotopy, but the connections from those brain neurons are sent into the body and they are synchronized with, meaning they crosswire with and form
synapses with some of the input from the viscera, from our guts, from our diaphragm, from our
stomach, from our spleen, from our heart.
Our internal organs are sending information up
to this map in our brain of the body surface, but it's about internal information, what we
call interoception, our ability to look inside or imagine inside and feel what we're feeling
inside.
So, the way to think about this accurately is that our representation of our self is a representation of our internal
workings, our viscera, our guts, everything inside our skin and the surface of our skin
and the external world, what we're seeing.
Those three things are always being combined in a very interesting, complex, but very seamless
way.
Acupuncture involves taking needles and sometimes electricity and or heat as well and stimulating
particular locations on the body.
And through these maps of stimulation that have been developed over thousands of years,
mostly in Asia.
But now this is a practice that's being done many places throughout the world.
They have these maps that speak to oh
Well, if you stimulate this part of the body you get this response and if somebody has a gastrointestinal issue like their guts are moving too quick
They have diarrhea you stimulate this area and they'll slow their gut motility down or if their gut motility is too slow
They're constipated you stimulate someplace else and they accelerate it and know, hearing about this of it sounds kind of to a westerner who's not thinking
about the underlying neural circuitry, it could sound kind of wacky.
It really sounds like alternative or even kind of, you know, really out there kind of stuff.
But when you look at the neural circuitry, the neural anatomy, it really starts to make
sense.
And Chufu Ma's lab at Harvard Medical School, is an excellent laboratory, has been exploring how stimulation of different
types, intense or weak, without heat, on different parts of the body can modulate pain and
inflammation.
And what they've shown in a particularly exciting study is that stimulation of the abdomen anywhere on the midsection
weekly does nothing.
That's not very interesting, you might say.
Intense stimulation of the abdomen, however, with this electroacupuncture has a very
strong effect of increasing inflammation in the body.
This is important to understand
because it's not just that stimulating the gut does this
because you're activating the gut area.
It activates a particular nerve pathway
for the Efficiados, it's the splenic spinal sympathetic axis,
if you really wanna know,
and it's pro-inflammatory under most conditions.
However, there are other conditions where,
for instance, the person is dealing with a particular bacterial infection that can be
beneficial.
And this goes back to a much earlier discussion that we had on a previous podcast that
we'll revisit again and again, which is that the stress response was designed to combat
infection.
So it turns out that there are certain patterns of stimulation on the abdomen that can actually liberate immune cells from our immune organs, like our spleen,
and counter infection through the release of things like adrenaline. Chufu's lab also showed
that stimulation of the feet and hands can reduce inflammation.
And again, this was done mechanistically.
This was done by blocking certain pathways
with the appropriate control experiments.
This was done not in any kind of subjective way.
This was also done by measuring particular molecules,
IL-6 and cytokines and things
that are related to the inflammation response.
And what they showed is that the stimulation of the, in particular, the hind limbs at low
intensity led to increases in the activity that's vagal pathway, the vagus nerve being this
10th cranial nerve that serves the kind of rest and digest in parasympathetic, in other
words, calming response.
What this means is that we are now at the front edge of this research field that's just,
it's early days still, but it's discovering that
depending on whether or not the stimulation is intense
or mild, and depending on where the stimulation
is done on the body, you can get very different effects.
So this points to the idea that you can't say
acupuncture good or acupuncture bad.
There has to be a systematic understanding of what exactly the effect is that you're't say acupuncture good or acupuncture bad, there has to be a systematic
understanding of what exactly the effect is that you're trying to achieve.
The underlying basis for this is really relevant to the thing about adrenaline that I said
before that in a fight, it's rare that you ever feel pain when you get hit.
I've experienced that, but later it hurts a lot.
It turns out that when you stimulate these pathways that
activate in particular the adrenals, the adrenal gland liberates noraponephrine and epinephrine,
and the brain does as well, it binds to what are called the beta-noragenergic receptors.
This is really getting down into the weeds, but the beta-noragenergic receptors activate
the spleen, which liberates cells that combat infection and its anti-inflammatory.
That's the short-term quick response.
The more intense stimulation of the abdomen and other areas can be pro-inflammatory because
of the ways that they trigger certain loops that go back to the brain and trigger the sort
of anxiety pathways and that place people into a state of anxiety that
exacerbates pain. So one pathway stimulates neuropinephrine and blunts pain. The other one doesn't. What does all this mean?
How are we supposed to put all this together? Well, there's a paper that was published in Nature Medicine in 2014.
This is an excellent journal that
describes how dopamine
that describes how dopamine can activate the vagus peripherally, not dopamine in the brain peripherally, and nor up and effort can activate the vagus peripherally and reduce inflammation.
And I'm not trying to throw a ton of facts at you as I say, well, what am I supposed to do
with all this information? What this means is that there are real maps of our body surface
that when stimulated, communicate
with our autonomic nervous system, the system that controls alertness or calmness, and thereby
releases either molecules like noripinephrine and dopamine, which make us more alert as
we would be in a fight and blunt our response to pain.
And they reduce inflammation.
But there are yet other pathways that when
stimulated are pro-inflammatory. And that brings us to the question of what is all this
in inflammation stuff that people are talking about. One of the things that bothers me so
much these days, and I'm not easily irritated, but what really bothers me is when people
are talking about inflammation, like inflammation is bad, inflammation is terrific, inflammation
is the reason why cells are called to the site of injury to clear is bad. Inflammation is terrific. Inflammation is the reason why cells are called
to the site of injury to clear it out.
Inflammation is what's going to allow you to heal
from any injury.
Chronic inflammation is bad.
But acute inflammation is absolutely essential.
Remember those kids that we talked about earlier
that have mutations in these receptors
that for sensing pain, they never get inflammation.
And that's why their joints literally disintegrate.
It's really horrible because they don't actually have
the inflammation response
because it was never triggered by the pain response.
So inflammation can be very beneficial.
There's a lot of interest nowadays
in taking things and doing things to limit inflammation.
One of the ones that comes up a lot is turmeric.
I'm sure the moment anyone starts talking about inflammation, the question is, what about
turmeric? I have talked before about turmeric elsewhere. I am very skeptical of turmeric, and
I might lose a few friends, although that would be weird if my friend, that would say something
about my friendships, if I lost friends over a discussion about turmeric. But in any case, turmeric does have anti-inflammatory
properties. There's no question about that. But as we've just described, inflammation can
be a very good thing, at least in the short term. The other thing about turmeric is there
was a study published out of Stanford in collection with some work from other universities showing
that a lot of turmeric is heavily contaminated with lead.
The lead is used to get that really rich, dense, orange coloring to it that everyone wants
to see.
You have to check your sources of turmeric.
The other thing is for men in particular, turmeric can be very antagonistic to dihydrotestosterone.
Dihydrotestosterone is the more dominant form of androgen in human males.
And it's involved in things like aggression and libido
and things of that sort.
Many people that I've talked to who have taken
turmeric get a severe blunting of affect and libido.
So for some people, that might be a serious negative.
I certainly avoid turmeric.
I don't like turmeric for that reason.
I also think that the inflammation response is a healthy response.
You have to keep it in check and we're going to talk about specific practices for wound,
healing, and injury in a moment.
But this idea that just inflammation is bad and you want to reduce inflammation across
the board, nothing could be further from the truth.
We have pathways that exist in our body specifically to increase inflammation. It's the inflammation
that goes unchecked, just like stress, which is problematic for repair, for brain injury,
and that can exacerbate certain forms of dementia, et cetera. But I'd like to create a little
bit more nuance, or a lot more nuance, if possible, in the conversation around inflammation.
Because people have just taken this discussion around inflammation to be this idea that
just inflammation is bad and nothing could be further from the truth.
Before I continue, I just thought I'd answer a question that I get a lot, which is what
about Wim Hof breathing?
I get asked about this a lot.
Wim Hof, also called AK, the Iceman, has this breathing
that's similar to Tumo breathing, as it was originally called,
involves basically hyperventilating
and then doing some exhales and some breath holds.
A couple things about that, it should never be done
near water.
People who have done it near water, unfortunately, have drowned.
It's not certainly not for everybody,
and I'm not here to either promote it nor discourage
people from doing it.
But I think we should ask ourselves, what is the net effect of that?
Because a number of people have asked me about it in relation to pain management.
The effect of doing that kind of breathing, it's not a mysterious effect, it liberates a
adrenaline from the adrenals.
There is a paper published in the Proceedings in the National Academy of Sciences, which
is a very fine journal, showing that that breathing pattern can counter infection
from end to toxin. And that's because when you have adrenaline in your system and when
the spleen is very active, that response is used to counter infection and stress counters
infection. We'll talk what this more going forward,
but the idea that stress lends itself to infection
is false.
Stress counters infection by liberating killer cells
in the body.
You don't want the stress response to stay on indefinitely,
however, things like Wim Hof breathing, like ice baths,
anything that releases adrenaline will counter the infection.
But you want to regulate the duration of that adrenaline response.
This should make perfect sense.
We, as a species, had to evolve under conditions of famine and cold.
Actually, Texas right now is an extreme case of cold and power outage.
I've seen the pictures and there are a lot of people out there really suffering.
Their systems are releasing a ton of adrenaline.
They're cold.
Some of them are likely to be hungry.
They're probably stressed. They're releasing a lot of adrenaline, which is keeping them safe from infection.
After they get their heat back on and they relax and they can finally warm up again, which we would like for them very soon.
Hopefully by the time this podcast comes out, that will have already happened. That's typically when people get sick because the immune response is blunted as the stress
response starts to subside. So stress inflammation, countering infection that comes from endotoxin,
that comes from any number of things can be from cold, it can be from hyperventilation,
it can be from a physical threat, it can be from the stress of an exam or an upcoming surgery.
The adrenaline thing and the inflammation associated with it is adaptive, highly adaptive.
It is a short-term plasticity that is designed to make us better for what we're experiencing and
challenged with, not worse.
And so hopefully that will add an additional layer to this whole idea that, you know, stress is bad, inflammation is bad, et cetera.
Again, I'm not suggesting people do or don't do something like Wim Hof Tumor breathing. I just want to point to the utility.
It's very similar to the utility from cold showers, ice baths, and other forms of anything that increase adrenaline.
Every episode I want to make sure that every listener comes away with as much knowledge as possible, but also actionable tools.
And today we've talked about a variety of tools, but I want to center in on a particular sequence of tools that hopefully you won't need, but presumably if you're a human being and you're active, you will need at some point.
It's about managing injury and recovering and healing fast, or at least
as fast as possible. It includes removing the pain. It includes getting mobility back and
getting back to a normal life, whatever that means for you. I want to emphasize that what
I'm about to talk about next was developed in close consultation with Kelly Starrett, who many of you probably have
heard of before.
Kelly can be found at the Ready State.
He's a formally trained, so degreeed and educated exercise physiologist.
He's a world expert in movement and tissue rehabilitation, etc.
They're not sponsors of the podcast.
Kelly is a friend and a colleague.
He's somebody that I personally trust and his views on tissue rehabilitation and injury.
I think I really grounded extremely well in both medicine, physiology and the real cutting
edge of what's new and what you might not get in terms of advice from the typical person.
All that said, you always, always, always should consult with your physician before adopting
any protocols or removing any protocols.
So I asked Kelly, I made it really simple.
I said, okay, let's say I were to spray my ankle or break my arm or injure my knee or
ACL tear or something like that or shoulder injury.
What are the absolute necessary things to do regardless of situation?
And what science is this grounded in?
And then I made it a point to go find the studies that either supported or refuted what he
was telling me because that's why I'm here.
So the first one is a very basic one that now you have a lot of information to act on, which
is in terms of what we know
about tissue rehabilitation, both brain and body, we know that sleep is essential. And so we both
agreed that eight hours minimum in bed per night is critical. Now what was interesting, however,
is that it doesn't have to be eight hours of sleep. We acknowledge that some of that time might
be challenging to get to sleep, especially if one is in pain or mobility is limited.
You know, we forget how often we roll over in bed or how the conditions of our sleeping
can impact those injuries, too.
So Kelli acknowledge, and I agree that eight hours of sleep would be ideal, but if not
at least eight hours in mobile.
And that speaks to the power of these non-sleep, deep-rest protocols too.
If you can't sleep doing non-sleep, deep-rest protocols, we've provided links to them before.
We're going to continue to provide links to the previous ones and new ones are coming soon.
That is extremely beneficial.
So that's a non-negotiable in terms of getting the foundation for allowing for glimphatic clearance
and tissue clearance, et cetera.
The other is, if possible, unless it's absolutely excruciating, or you just can't do it, a
10-minute walk per day, of course, you don't want to exacerbate the injury, at least a 10-minute
walk per day, and probably longer.
This is where it gets interesting.
I was taught.
I learned that when you injure yourself, you're supposed to ice something.
You're supposed to ice on it.
But I didn't realize this, but when speaking to exercise physiologists and some physicians,
they said that the ice is really more of a placebo.
It numbs the environment of the injury, which is not surprising, and will eliminate the
pain for a short while.
But it has some negative effects that perhaps offset its use.
One, it sludge is it creates sludging within the blood and other lymphatic tissues.
So it actually can create some like clotting and sludging of the tissue and fluids,
the fascial interface with muscle, and a number of the stuff that's supposed to be flowing through there can slow up
and increase inflammation in the wrong way can actually restrict movement out of the injury site,
which is bad because you want the macrophages
and the other cell types, fego cytosine,
eating up the debris and an injury
and moving it out of there so that it can repair.
So that was surprising to me,
which made me ask, well, then what about heat?
Well, it turns out, heat is actually quite beneficial.
A lot of people talk about heat shock proteins and all these genetic pathways and protein pathways that can be activated by heat.
Very little data to support the idea that heat shock proteins are part of the wound healing process.
At least in terms of the torts of conventional heat that one could use like a hot water
bottle or a hot bath or a hot compress.
The major effects seem to be explained by heat improving the viscosity of the tissues
and the clearance and the perfusion of fluid, blood, lymph and other fluids out of the
injury area.
So that's really interesting.
I didn't know this.
I thought, well, you're supposed to ice something.
I said, well, whenever I would like see a kid
get injured in soccer, never meet a course.
Now, of course, I got injured in soccer
every time I die and they give you an ice pack.
And the ice pack removes some of the pain.
I think the consensus now, which was surprising to me,
is that the ice pack is actually more of the top down
modulation.
You think you're doing something for the pain. And there's some interesting studies that actually show the placebo effect of the ice pack is actually more of the top down modulation. You think you're doing something for the pain.
And there's some interesting studies that actually show the placebo effect of the ice
pack.
So ice packs are placebo, perhaps.
That's interesting.
I'll underline, perhaps, because who knows.
Maybe there's some people out there that are going to say, this is totally crazy.
And the ice is actually very beneficial.
It seems like heat, mobility, sleep, keeping movement.
And it turns out that the movement itself can act as a bit of an analgesic.
It can actually reduce the pain.
Whereas the ice reduces the pain, but sludges the tissue and keeps the cells that need to
be removed from leaving the area.
Now what's also interesting is in neuroscience, we know that if we want to kill neurons or silence neurons,
we cool them.
This is a well-known tool in the laboratory.
Some of the early and most important studies
in neuroscience that form the basis for the textbooks
were lowering a cooling probe into a particular area
of the brain or a peripheral nerve
in order to shut down that nerve.
So the cooling will shut down the nerve.
But another very
well-known fact in neuroscience textbooks is that when the activity of the nerve pathway
or neurons comes back, there's what's called homostatic plasticity, that it rebounds
with greater pain, with a higher level of intensity, which in the pain system would equate
to greater pain. So regardless of where these neurons are on the body, if you stimulate a neuron, it's active, if you cool it, it becomes inactive, and when the neuron heats back up after
being cooled, it becomes hyperactive. And so this makes really good sense as to why heat
provided, it's not damaging levels of heat, would be more beneficial for wound healing and for
reducing pain in the short and long run, then would be cold or
ice, which I find very interesting.
Now, in terms of chronic pain, the manuscripts on this, my discussion with Kelly and with
others, point to the fact that chronic pain is basically plasticity gone wrong.
It's sort of like PTSD for the emotional system and the stress system. And chronic pain is going to involve a number of different protocols to rewire both the
brain centers and the peripheral centers associated with chronic pain.
Certain things like fibromyalgia, for instance, which is whole body pain, relate to two
little inhibition in the brain.
You have excitation and inhibition.
They come from different sources of neurons, the inhibition is mainly from GABA and glycine
and things like that.
In fibromyalgia, there's two little central
within the brain, modulation of the pain response
so that people experience whole body pain.
So in that case, the emerging therapies are really interesting.
I have a friend who works for the National Institutes of Health who unfortunately suffers
from fibromyalgia who asked me about this a lot.
And his question and what he's now actually exploring is red light therapies, something
that I've talked about on various Instagram posts.
Red light therapy typically is talked about in terms of mitochondria and the data on that
are not so terrific, at least not really published in Blue Ribbon Journals,
in most cases, except for one study that I'm aware of
from Glenn Jeffries Lab at University College London,
showing that red light stimulation to the eyes
and people 40 or older can offset some of the effects
of macular degeneration by improving the health
of the photoreceptors.
People with fibromyalgia, which is this whole body pain,
are now starting to use red light
therapies.
Now, I asked Kelly and others and some experts in pain, what are your thoughts on this red
light therapy for things like fibromyalgia and pain, especially red light local therapy?
Their idea, and I don't think this is a field that's progressed far enough now to really place any firm conclusions
on, but the idea is that red light therapy locally may have some effect, but the systemic red
light therapy, this is like wearing protection to the eyes in some cases, so not from the
treatment of macular degeneration, but wearing protection to the eyes and getting very bright
light red light therapy.
In many ways, maybe, into use Kelly's words,
approximating the effects of nature.
These are like surrogate technologies
for getting outside in the sunshine.
You know, when you're in the sun,
it might not look red,
but there are a lot of red wavelengths coming toward you.
So, the red light therapies may have some utility,
but getting into sunlight may actually have
as much or more effect.
Of course, if these wounds are on a part
of the body that you can't expose, then you could imagine why the red light therapy
might be good. Depending on the neighborhood you live in, that may or may not be a weird
thing to go outside and expose your body to sunlight. Probably a number of factors that dictate
whether or not that would be weird or not, but that's up to you, not me. And it seems that so movement, heat, not ice, light, sleep, and in some cases, the
use, and I'll talk about this in a moment, the, some cases, the use of restricting above
and below the injury to then release and then increase perfusion through the site.
So may actually accelerate the wound healing.
So all of this might sound just like common sense knowledge,
but to me, at least as a 45 year old,
I always just thought it's ice,
it's non-steroid anti-inflammatory drugs,
it's things that block prostaglandin.
So things like aspirin, ibuprofen, acetaminophen,
those things generally work by blocking things
like the cox prostaglandin blockers and things of that sort, things in that
pathway. Those sorts of treatments which reduce inflammation may not be so great at the
beginning when you want inflammation, they may be important for limiting pain so people
can be functional at all. But the things that I talked about today really are anchored
in three principles.
One is that the inflammation response is a good one.
This is what we're learning from Chufu Ma's lab work on acupuncture.
The immediate acute inflammation response is good.
It calls to the site of injury things that are going to clean up the injury in bad cells.
Then there are going to be things that are going to improve perfusion like the
glymphatic system, getting deep sleep, feet elevated, sleeping on one side, low-level
zone two cardio three times a week. Red light perhaps is going to be useful, although sunlight
might be just as good depending on who you talk to. And we talk about that probably more
at length in a future episode. A number
of people will ask me, I'm sure, about stem cells. And I don't want to take more of your time
by going into an hour long discussion about stem cells. Stem cells exist in all of us during
development. We were created from stem cells, which are cells that can become essentially
anything. Later cells get what's called restricted in their lineage. So a skin cell, unless you do some fancy molecular gymnastics to it, you can't actually turn
that cell into a neuron.
Yamannaka won the Nobel Prize for finding these Yamannaka factors, which you could give
a skin cell to turn into a neuron.
But that's not an approved therapy at this time, but many people ask me about plate-rich
plasma, so-called PRP.
They take blood, they enrich for platelets, and they re-inject it back into people.
Here's the deal.
This deserves an entire episode.
It has never been shown whether or not the injection itself is what's actually creating
the effect.
This is something that the acupuncture literature suffered from for a long time, that the
sham control, as it's called, sham, we don't mean it's a sham, but in science, you
say a sham control, meaning you do everything exactly the same way you would, like, so for
acupuncture, you would bring the needle right up to the skin, but you wouldn't actually
poke it into the skin, for instance, that would be a sham control.
With a drug treatment, you would inject a drug into a person
and then the control, the sham control would be
that you would bring the injection over.
You might do the injection or not do the injection
because you imagine that the injection itself
could have an effect.
It's never really been shown whether or not PRP
has effects that are separate
from injecting a volume of fluid into a tissue.
The claims that PRP actually contains stem cells
are very, very feeble.
And when you look at the literature and you talk to anyone expert in the stem cell field,
they will tell you that the number of stem cells in PRP is infinitesimally small.
In fact, so much so that these places that inject PRP for injuries are not allowed to
advertise through the use of the words stem cells.
It's actually illegal at this point.
At least as far as I know, it was through the end of last year, and I'm guessing it still is now.
Stem cells are an exciting area of technology.
However, there was a clinic down in Florida that was shut down a couple years ago
for injecting stem cells harvested from patients
into the eye from acolytogeneration.
These were people that were suffering from poor vision
and very shortly after injecting these stem cells
into the eyes, they went completely blind.
So I'm somebody who is very skeptical
of the stem cell treatment work that's out there.
It's actually very hard to get in the United States
for this reason, it's not approved.
The PRP treatments are very complicated.
The marketing around them is shaky at best.
I'm sure a number of people will say
that they had PRP and benefited from it tremendously.
And I don't doubt that.
Whether or not it was placebo,
today we talked a lot about top down control.
That's just a variant on the word placebo, belief effects.
Whether or not it was placebo or not,
I don't know, I wasn't there.
That's for you to decide.
And I'm not here to tell you that you should
or shouldn't do something,
but I do think that anything involving stem cells,
one should be very cautious of.
You should also be very cautious of anyone
that tells you that PRP is injecting a lot of stem cells. This is an evolving area that really needs a lot more work and attention. The major issue with stem cells that I think is concerning
is that stem cells are
cells that want to become lots of different things, not just the tissue that you're interested in.
So if you damage your knee and you inject stem cells into your knee,
you need to molecularly restrict those stem cells so that they don't become tumor cells.
Right?
A tumor is a collection of stem cells.
Right?
So when you get, you know, something horrible like glioblastoma in the brain, which is a terrible
thing to have, it's gliocells that returned to stem-ness, excessive stem-ness.
They've started to produce too many of themselves.
And glublastoma is often deadly, not always.
So injecting stem cells, it sounds great, and it sounds like something that one would want
to do, but one needs to approach this with extreme caution.
Even if it's your own blood or stem cells that you're re-injecting, I think those technologies
are coming, they're on the way.
If any of you are devotees of PRP, tell me your experiences with them. I'm curious. I want to see the papers. I want to know the evidence. And of course, there are always folks out there that say,
I don't care what the scientists and the physicians and the FDA say. I just want to do this. And if
that's your stance, that's your stance. I'm not here to govern that. But I do think that people should be informed. And in thinking
about tissue recovery and injury, that's what I was able to glean. Again, check
out what Kelly and his co-workers are doing at the ready state. It's
phenomenal. And they've worked with, you know, all the top people in just about
every domain of life. It seems, very high integrity folks.
Some of you are probably saying, well, I'm not injured, I'm not an athlete, I don't want
stem cell injections, I don't have, again, I think you shouldn't get stem cell injections
for now, please hold off until the field learns more about how to do that safely.
But I want to talk about an end with a really interesting and somewhat weird technology,
which is baby blood. I have a colleague
at Stanford, his name is Tony Weiss-Korey, and in 2014 his laboratory published a study
showing that the blood of young rodents, mice and rats, when transfused into old, demented rodents, mice and rats, made those old, demented rodents
recover much of their memory and seem much more vital
and energetic, better recall of different spatial learning
tasks, tissue and wound healing.
They've since shown can be improved in these older animals.
It's pretty incredible.
They went on to show several years later that blood from umbilical cords,
I'm not making this up, blood from umbilical cords, can do the same.
And this is the basis of a biotech company, actually one of my former post-oxes and now an employee there.
They've isolated the molecules from young blood
that seems to vitalize or revitalize the old brain
and body and one of those molecules
as it goes by the name Timp2TIMP2.
Where's all this going?
Well, I don't know how long it's going to be
before there are treatments based on these blood transfusions.
I doubt that blood transfusions themselves
from young people into old people
is going to be used for the treatment of dementia,
although it might, as weird as it seems,
we know that transfusions of all
sorts of stuff, for instance, fecal transplants are being used to treat obesity.
The gut microbiome of thin people is being not transfused, but is being transplanted into
the colon's and guts of obese people and leading to weight loss, which sounds really wild
and is not a topic I particularly enjoy
talking about, but nonetheless, it points to the importance of the gut microbiome in
regulating things like blood sugar and health as it relates to obesity and diabetes and
all sorts of things.
So it does appear that there are things factors in the blood of young members of a given species
that are lost over time in the older members of that species. I am not going to give you
a tool on the basis of these findings today. I am not going to tell you to consume any fluid
from any other member of your species, our species, for any reason.
But I do think that it's important to mention that the science is asking questions such as
what are the factors within the brain that allow the young brain to recover so much better
than the older brain from injury, from all sorts of things, events, et cetera.
And what are the factors in the older brain that are limiting?
And thinking about identifying which factors are going to allow people
to restore cognitive function, physical function, wound healing, and so forth.
It's a really exciting area.
I mention it not to be sensationalist, but because it's happening and
because there's a lot of excitement about it and because I think it's clear that the young brain and body and
blood are very different from the old brain body and blood and
the goal of science is to identify and isolate those factors that make that so such
that people who would otherwise get dementia or perhaps even have dementia will be allowed
to recover.
Again, not an actionable item at this point, but one to think about, perhaps not too long,
but one to think about, perhaps not too long, but one to think about. So I'm going to close there. I've talked about a lot of tools today. I've talked a lot about
some antisensation, about plasticity, about pain, about acupuncture. Some of the nuance of
acupuncture inflammation stress. We've even talked a little bit about high intensity breathing.
even talked a little bit about high intensity breathing, talked about restricting limb movement to get compensatory regrowth of pathways or I should say reactivation of pathways that
have been injured or damaged.
So as always, we take kind of a whirlwind tour through a given topic, lay down some tools
as we go.
Hopefully the principles that relate to pain and injury,
but also neuroplasticity in general,
today in the context of the sematic sensory system,
will be of use to all of you.
I don't wish injury on any of you,
but I do hope that you'll take this information
to mind and that you will think about it
if ever you find yourself in a situation
where you have to ask,
what's the difference between my perception and the actual tissue damage?
Is injury and pain is it the same?
Well, no.
Do I have some control over my experience of pain?
Absolutely.
Does all of that involve taking drugs or doing certain therapeutics?
No, not necessarily.
There's an incredible subjective component.
There also is a need sometimes to treat the injury at the level of the pain
receptors at the sight of the wound. So please take the information, do with it what you
will, and in the meantime, thank you so much for your time and attention. Before we go,
I just want to remind you to please subscribe to the YouTube channel, Apple and or Spotify.
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Once again, thanks so much for your time and attention today,
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you